Unit 2 OCD

●      Obsessive Compulsive Disorder

           

Obsessive-compulsive disorder (NOT obsessive-compulsive personality disorder): 

·       Begins in late teens/early twenties.

·       biological origins.

·       obsessions and compulsions cause distress.

·       may co-occur with Tourette’s disorder. 

·       Rituals used to bind anxiety.

 

           

Body dysmorphic disorder: 

  • Preoccupation with an imagined “defective body part”

             

           

Hoarding disorder:

  • Excessive collecting of items that are essentially worthless.

 

             

           

Trichilothimania

·       Begins in childhood.

·       Recurrent twisting or pulling out of one’s hair resulting in hair loss and damage.

 

           

Excoriation disorder:

·       Begins in childhood.

·       Recurrent skin-picking, resulting in skin lesions, infection, and scarring.

Patho:

·       Caught in a “mind trap.”

·       obsessions create tremendous anxiety; individuals perform compulsions to relieve the anxiety temporarily

·       attempts to resist obsessive thought or compulsive behavior causes person to have increased anxiety

·       time consuming, cause marked distress or lead to impairment in functioning or incapacitated by symptoms

 

           

Etiology

·       biological, psychological and environmental factors.

·       early onset OCD have family history

 

S/Sx

·       We all have some ocd traits, and there is an obsessive-compulsive personality disorder where perfectionism, orderliness and obstinacy are present

·       About 10 % are disabled by this illness. 

Severity can be related to time involved: 

·       mild less than one hour a day,

·       moderate 1-3 hours a day,

·       severe 3-8 hours a day and

·       extreme nearly constant. 

·       Hyper moral and following letter of law, more resistant to treatment

·       Many conceal rituals as they fear embarrassment or stigmatization

 

Assessment

·       Persistent intrusive thoughts & repetitive behaviors performed in ritualistic manner

·       They know that thoughts are trivial, actions are inappropriate, but do it to bind anxiety

·       Males develop ages 6-15, females 20-29.

·       About 2 out of 100 people have OCD

·       The most common themes are contamination fears, checking locks, needs for symmetry, counting, touching things, intrusive thoughts

·       Major depression may accompany this disorder

 

Nurse/Patient Relationship

·       Give patient limited time to perform rituals, agree on schedule

·       Calm, non-authoritarian manner

·       Tepid water and hand cream

·       Help them verbalize stressors and feelings

·       Guide them to substitute positive anxiety reducing behaviors for obsessions and rituals

·       Provide simple tasks and activities to refocus

·       Recognize non ritualistic behaviors

·       Obsessions create tremendous anxiety – give time to perform compulsions which are necessary not pleasurable

  • Use positive feedback in group activities

 

 

Medical Treatment

SSRIs used in higher doses than for depression:

·        citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)…and others.

·       TCA:  clomipramine (Anafranil)

·       Can take weeks or months to relieve compulsions and longer to decrease obsessions

·       Reassurance and education for side effects of medications such as sedation, dizziness, headache

 

 

Therapies

·       Exposure and response prevention- weakens the link, therapists provoke the obsession, and patient does not engage in ritual or compulsion. Confront fears but discontinue escape response.

·       Example: plunge hands in basket of discarded tissues and sit there without hand washing ritual behaviors

·       Thought stopping techniques: positive imagery; thought diaries; replace the thought

·       Deep breathing

 

Exposure Therapies

            Systematic desensitization: imagine certain aspects of feared object or situations combined with relaxation; graduated exposure

            Flooding: a technique that exposes the patient to the feared situation all at once; also called implosion therapy

            Real situations are called vivo exposure

            Imagined situations are called imaginal exposure