OCD: Implications for Counselling

Karen Boileau, Ashlee Ellerbruch, Maria Elsdon, Meagan Keashly, & Kim Long

Overview

History of OCD Defining OCD Cognitive Behavior Theory Models of OCD

Interventions for OCD

Behavioral Cognitive-Behavioral Belief and Appraisal

Implications for Counselling

Medication Cognitive Behavior Therapy Exposure Response Repetition

A Peek at OCD

Examples of Obsessions and Compulsions

A woman spends hours in the shower washing her body in a sequence that has to be the same each time. She will use a towel only if it is handed to her directly from a dryer and has not touched anything An aunt will not babysit for her nieces because she is afraid she will stab them with a knife as they sleep For five years a woman has been washing her arms up to the elbow 50 times a day until they are raw because she is worried that her germs will infect her family A man covers everything with a paper towel before touching it. If anything is touched by his clothes, he has to wash it. He can barely use his left hand because he is reluctant to let it touch anything
Examples from: Obsessive Compulsive Disorder, 1998

History of OCD
Seventeenth Century Obsessions and compulsions were often described as symptoms of religious melancholy Nineteenth Century Modern concepts of OCD begin to evolve as neurosis implied a neuropathological condition 1877:Zwangsyorstellung Westpahal (a German Psychiatrist) coined the term Zyangsyorstellung (compelled presentation or ideas) In Great Britain it was translated into 'obsession' while in the U.S. it became 'compulsions' A compromise was reached by calling it 'obsessive-compulsive disorder Twentieth Century Pierre Janet and Sigmund Freud isolated OCD from neurasthenia. They helped to define basic OCD symptoms: oanxiety, preoccupation with dirt or moral questions and fear of acting on unacceptable impulses Twenty-First Century Advances in pharmacology, neuroanatomy, neurophysiology and learning theory have allowed a more therapeutically useful conceptualization of OCD There is still no pinpoint on the cause of the disorder

What is OCD?
Basic Stats on OCD:

A Canadian survey found a lifetime prevalence of 3% The median age of onset is about 19 years old Women account for 60% of adults with OCD o In children, however, this ratio is reversed
Paris, 2006; Taylor, 2005

Defining Obsessions and Compulsions:

Obsessions are upsetting thoughts, images or urges o Examples of obsession (in order of most to least common): contamination, aggressive impulses, sexual content, somatic concerns and the need for symmetry. Compulsions are repetitive and intentional acts or thoughts o typically these actions tend to reduce distress and they are quite excessive o Example: May be performed in response to an obsession. Or are performed according to certain rules (usually having to do with a pattern or set of numbers)

Barlow & Durand, 2005; Obsessive Compulsive Disorder, 1998

Diagnosing OCD: DSM-IV-TR

A. Either Obsessions or Compulsions Obsessions o Recurrent and persistent thoughts, impulses or images that cause anxiety or distress o These thoughts, impulses or images are not just excessive worries o The person attempts to neutralize these with some other thought or action o the person recognizes that the thoughts, impulses or images are a product of their mind Compulsions o Repetitive behavior or mental acts that the person feels driven to perform o The behaviors or mental acts are meant to try and reduce distress or prevent some dreaded event or situation B. The person recognizes that the obsession/compulsions are unreasonable or excessive

C. The obsessions/compulsions are time consuming, or interfere with a daily routine

D. If the person has another Axis I diagnosis the content of the obsessions/compulsions is not restricted to it E. The obsessions/compulsions that are disturbing the person are not due to effects of a substance or general medical condition
Reference: APA, 2000