Obsessive

Compulsive
Disorder
Saiyad Danish
Imrose
Obsessive Compulsive
Disorder
• OCD may include:
– Washing, checking, or other
repetitive motor behavior
– Cognitive compulsions consisting of
words, phrases, prayers, or
sequences of numbers
– Obsessional slowness
– Doubts and questions that elevate
anxiety
Facts and Figures
• Prevalence
– Originally believed to be rare
• >0.1%
– Recent evidence suggests 1-3% Onset
/ Characteristics:
– Males:, high prevalence of checking
– Females:, high prevalence of washing
OCD Diagnosis (1): DSM IV
• Obsessions defined by all of the following:
– Recurrent and persistent thoughts, impulses or
images experience at some time during the
disturbance, as intrusive and inappropriate and
that cause marked anxiety or distress.
– The thoughts/impulses/images are not simply
excessive worries about real life problems.
– The person attempts to ignore or suppress such
thoughts/impulses/images, or neutralize them
with some other thought or action.
– The person recognizes that the obsessional
thoughts/impulses/images are a product of their
own mind (not imposed from without).
OCD Diagnosis (2): DSM IV
• Compulsions defined by:
– Repetitive behaviors or mental acts that the
person feels driven to perform in response to an
obsession, or according to rules which must be
applied rigidly
– The behaviors or mental acts are aimed at
preventing or reducing distress or preventing
some dreaded event or situation; however,
these behaviors or mental acts either are not
connected in a realistic way with what they are
designed to neutralize or prevent, or are clearly
excessive
• Not better accounted for by other diagnosis
Examples of Obsessions
• Doubt “Did I lock the door”
• Thought that he had cancer
• Thought / Image that he had
knocked someone down in his car
• Impulse + thought to shout
obscenities in church
• Image of corpse rotting away
• Impulse to drink from inkpot and to
strangle son
Themes in Obsessions
• Obsessions often have common themes
– Contamination, dirt, disease, illness (46%)
– Violence and aggression (29%)
– Moral and religious topics (11%)
– Symmetry and sequence (27%)
– Sex (10%)
– Other (22%)
• The themes often reflect contemporary
concerns (the devil, germs, AIDS)
Examples of Compulsions
• Scanning text for “life” having read
“death”
• Touching the ground after
swallowing saliva
• Driving back to check he hadn’t
knocked someone down in his car
• Counting 6,5,8,3,7,4 in your head
• Hand washing
Linking Obsessions and
Compulsions
OCD and “Normal” Experience
• Obsessional thoughts found in 90% of
people
– It is well replicated that 80%+ of normal people
have intrusive thoughts
– There thoughts are similar in content and form
to OCD patients
• Compulsions
– Many people have compulsions such as
stereotyped or superstitious behaviors
– 66% of normal people report some form of
checking behavior
• Is OCD qualitatively distinct?
 OCD Experiences
OCD
A man who washes his hands
100 times a day until they are
red and raw
A women who locks and relocks
her door before going to work
every day – for half an hour
A college student who must tap
on the door frame of every
classroom 14 times before
entering
A man who stores 19 years of
newspapers “just in case” – with
no system for filling or retrieving
Not OCD
A woman who unfailingly
washer her hands before
every meal
A woman who double-
checks that her apartment
door and windows are
locked each night before
she goes to bed.
A musician who practices a
difficult passage over and
over again until its perfect
A woman who dedicates all
her spare time and money
to building her record
collection
 OCD: Therapy
• Exposure and Response Prevention (ERP)
• Responsibility
– Am I a murderer or just worried about being
one?
– Normalizing / Other explanations
• Thought = action
– Can I think myself to death?
• Neutralizing
– Experiment to show how thought suppression
increases thought frequency
• Exposure: Cued Intrusions
Thanks