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

\