Obsessive Compulsive Disorder

definition

presence of obsessions, compulsions or both in which either or both are time consuming (>1hr per day) or cause clinically significant distress or impairment in an area of functioning

characteristics of OCD

recurring, uncontrollable thoughts (obsessions) and repetitive, anxiety driven behaviors (compulsions)

obsessions

recurrent, persistent, intrusive, and unwanted thoughts, urges, or images

• causes marked anxiety or distress

• individuals attempt to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (e.g. performing a compulsion)

compulsions

repetitive behaviors or mental acts that the individual fears driven to perform in response to an obsession

• aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation

• not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

examples of obsessions

thoughts about doing a complusion or facing terrible consequences

examples of complusions

washing hands qhour, calling parents every 30 mins, etc.

age of onset in males

before 10 years

age of onset in females

adolescence, also risk during peripartum and pp periods

chronic course

spontaneous remissions rates are low

earlier onset is

risk for longer-term courses

comorbidities in adults

mood disorders

comorbidities in children

anxiety disorders

other comorbidities OCD

• neurodevelopmental disorders

• eating disorders

functional consequences of OCD

occupational/social impairment, developmental difficulties, finances, health and nutrition

nursing assessment- biological domain

• Physical health and functioning

  • PRIORITY= skin integrity (cleaning compulsions)

    • Dermatitis, eczema 

  • Sleep length 

  • Frequent visits to PCP 

• Nutrition 

• Substance use= self-medicating or suppressing obsessions 

• Medications/treatments

priority

skin integrity (cleaning complusions)

nursing interventions- biological (meds)

SSRIs, TCAs, SNRIs, Antipsychotics

nursing interventions psychotherapies

Neuromodulation, DBS, ECT, TMS, rTMS, ERP, graduated exposure therapy, mindfulness

psychological

• exposure and response prevention (ERP)

• graduated exposure therapy

• mindfulness

nursing interventions- biological (neuromodulation)

deep brain stimulation (DBS), electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS, rTMS)

exposure and response prevention

gradually exposes patients to fear inducing triggers while prevention them from engaging in compulsive rituals, allowing anxiety to naturally subside