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