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

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