TR

Obsessive Compulsive Disorder

Clinical Descriptions

  • Obsessions
    • Intrusive and nonsensical
    • Thoughts, images, or urges
    • Attempts to resist or eliminate
  • Compulsions
    • Thoughts or actions
    • Provide relief from obsessive thoughts
  • Statistics
    • 1.6% to 2.3%(life); 1% (year)
    • Female = Male
    • Chronic
    • Onset = childhood to 30s

Diagnostic Criteria

  • Presence of obsessions, compulsions, or both
  • Obsessions/compulsions are time-consuming
  • Disturbance is not due to substance abuse
  • Disturbance not better explained by another mental health disorder

Obsessions

  • 60% have multiple obsessions
    • Need for symmetry
    • Forbidden thoughts or actions
    • Cleaning and contamination

Compulsions

  • Four major categories
    • Checking
    • Ordering
    • Arranging
    • Washing/cleaning
  • Association with obsessions

Tic Disorder

  • Involuntary movements (e.g. sudden jerking of limbs, movement of jaw, etc)
  • Often co-occurs in patients with OCD
  • Sometimes tics are used as compulsive behaviors –performed to relieve anxiety associated with obsessions

Causes

  • Similar generalized biological vulnerability to having anxiety in general
  • Specific psychological vulnerability
    • Early life experiences and learning
    • Thoughts are dangerous/unacceptable
    • Thought-action fusion
  • Distraction temporarily reduces anxiety
    • Increases frequency of thought

Treatment

  • Medications
    • SSRIs
    • 60% benefit
    • High relapse when discontinued
    • Psychosurgery (cingulotomy)
    • 30% benefit
  • Cognitive-behavioral therapy
    • Exposure and ritual prevention (ERP)
    • Highly effective
    • One study found that 86% of patients benefit
    • No added benefit from combined treatment with drugs