Obsessive Disorders Ch. 21

Week 3

Obsessive Compulsive Disorder

Involuntary and unwanted obsessions and compulsions that are distressing, consume more than 1 hr a day, and impair functioning

Common Themes: contamination, symmetry, forbidden thoughts, harm

May result in avoidant behaviors and/or habits and routines that interfere with daily functioning

Cycle of Obsessive Thoughts and Compulsive Behaviors in OCD

Obsessive thought → compulsive behavior → anxiety relieved → reinforcement of the behavior → another obsessive thought → more behaviors required to relieve anxiety

Body Dysmorphic Disorder

Preoccupation with perceived flaws or defects in one’s physical appearance that are not apparent or significant to others
o Consumes 3-8 hours per day

• Excessive, repetitive behaviors including seeking reassurance about appearance, compulsive skin picking, excessive lifting weights, using anabolic steroids, and having cosmetic surgical procedures

• Can impact social participation

Hoarding Disorder

Persistent difficulty discarding or parting with possessions regardless of value resulting in an accumulation of clutter that interferes with functionality of the environment
o Collecting = systematic and organized
o Hoarding = disorganized, excessive clutter that interferes with ability to use living spaces

Trichotillomania

Repetitive pulling out of one’s own hair

• Bald spots, thinning hair, skin issues

• GI issues if ingested

Excoriation Disorder

Recurrent skin picking

Usually associated with anxiety or boredom, causes distress and/or embarrassment

Frequently co-occurs with anxiety and/or depression

More common in women

Etiology

Genetics:

Strong familial links

Close relatives of a person with OCD have a 5x higher chance of having OCD

Neuroanatomy:

Frontal cortex involvement

Brain differences in OCD can change over time

Neurochemical:

Involves multiple neurotransmitter systems (serotonin, dopamine, and glutamate)

Cognitive and Psychological:

Self perpetuating cycel of obsessions and compulsions

Environmental: NO specific environmental causes, BUT infections and stressful or traumatic life events may increase the risk

Prevalence: Obsessive Disorders

OCD has prevalence rate of 2-3%

Average age onset: 19-20 → almost always before 35

Females more commonly affected

Cultural beliefs, religious practices, and family roles should be considered when assessing/treating

Impact on Occupational Performance: Obsessive Disorders

Cognitive: executive functioning impairments

Psychosocial: decreased social and community participation, disrupted relationships due to → time spent engaged in obsessive thinking, compulsive acts interfering w task completion, avoiding situations that may trigger symptoms

Medication and Medical Treatment: Obsessive Disorders

SSRIs

ECT most effective for people w comorbid depressions

Repetitive transcranial electromagnetic stimulation (rTMS)

Deep Brain Stimulation (DBS)

OT Intervention Approaches: Obsessive Disorders

Cognitive Adaptation

Cognitive Behavioral

Community Clutter and Hoarding Toolkit

Motivational Interviewing