Obsessive Compulsive

Disorder

DR. Marwa Elslamony

Definition:
An obsession is disturbance in content of thought
characterized by recurrent and intrusive thought, felling,
idea or sensation.
A compulsion is disturbance in behavior characterized by
Conscious, standardized, recurring pattern of behavior
such as counting, checking or avoiding.
N.B. Obsessions increase anxiety whereas carrying out
compulsions reduces it but when a person resist carrying
out anxiety is increased.
Etiology:

Biological Factors:
Neurotransmitters many studies prove that decrease
serotonin is involved in the symptom formation at
obsession and compulsion in the disorder.
Genetics  Available genetic data on OCD support
the hypothesis that the disorder has a significant
genetic component. Higher incidence of obsessive
compulsive disorder in close relatives of patients with
the illness.
Psycho social factors:

Personality factors: obsessive compulsive disorder

differs from obsessive compulsive personality disorder
most people with obsessive compulsive disorder don't
have premorbid compulsive symptoms and such
personality traits are neither necessary nor sufficient
for the development of OCD. Only about 15 to 35
percent of patients with OCD have had premorbid
obsessional traits
Etiology:
Psychodynamic factors: Patients may become invested in
maintaining the symptomatology because of secondary gains.
For example, a male patient, whose mother stays home to
take care of him, may unconsciously wish to hang on to his
OCD symptoms because they keep the attention of his mother.
Often, interpersonal difficulties increase the patient's anxiety
and, thus, increase the patient's symptomatology as well.
Research suggests that OCD may be precipitated by a number
of environmental stressors, especially those involving
pregnancy, childbirth, or parental care of children.
Clinical features:
People with both obsessions and compulsions constitute at
least 75 percent of affected patients.
Compulsive behaviors e.g. wash hands repeatedly.
Difficulty eating or refusal to eat.
Difficulty sleeping or insomnia.
Ambivalence.
Disturbance in normal function due to obsession as
compulsive behavior.
Self mutilation and other physical problems.
Clinical features:

Aggression toward others.

Anxiety and over emphasis.
Rigidity as extremely high standard can't tolerate
any from standard.
Guilt feelings and fears.
Low self esteem.
Difficulty or slowness in completing daily living
activities as tasks because of ritualistic behavior.
Types
Example
Types of obsessive
Obsession Compulsion
Checking, doubt Is worried about turning off lights Check several time to see if lights
or about locking door off or door is locked
Germs, dirty Believes every thing is dirt or Avoid touching surface or people
contaminated and will scrub hands if forced
to touch
Somatic obsessive such as illness, Believe that teeth, mouth insides Gargling and septic for several
death and decay are decaying and rotting hours every days
Need for order and organization Needs to have everything in its Constantly arranges and rearranges
place items
Sexual ideation Has recurrent though of touching a Avoid woman and when is present
woman breast when is of woman leaves a room
present of woman
A violence Constantly thinks about cutting off When a red heard woman enter
red headed woman head leaves a room
Complication
If untreated obsessive compulsive disorder can lead to
aggressive behavior toward self and others.
Depression
skin down.
Infection caused by skin beak down.
Increased risk of physical harm.
Treatment
Pharmacotherapy.
Selective Serotonin Reuptake Inhibitors.
Clomipramine.
Other Drugs: If treatment with clomipramine or an SSRI
is unsuccessful, many therapists augment the first drug
by the addition of valproate (Depakene), lithium
(Eskalith), or carbamazepine (Tegretol). Other drugs
that can be tried in the treatment of OCD are venlafaxine
(Effexor), pindolol (Visken), and the monoamine oxidase
inhibitors (MAOIs), especially phenelzine (Nardil).
Treatmemt
Behavior Therapy: Behavior therapy is as effective as
pharmacotherapies in OCD. Behavior therapy can be
conducted in both outpatient and inpatient settings.
Desensitization, thought stopping, flooding, and
aversive conditioning have also been used in patients
with OCD.
Psychotherapy.
Teaching guidelines

Teach the client's family:

- Obsessive compulsive is chronic anxiety disorder that respond to
different treatment strategies.
- Thought impulses and images are inventory and may worsen with
stress.
Teach the client:
Behavior and cognitive strategies to mange anxiety and reduce the
symptoms of the disorder.
Different classes of drug have different side effect profiles. Recognizing
and reporting side effect is an important part of managing client drug
therapy.
Achieving symptoms control thorough pharmacotherapy. May take
month.
Nursing Care
Assessment
Nursing history:
Health perception – management pattern
Extreme concern about diet germs and disease.
Fear of going crazy.
Inability to control feelings.
Over use of health care system to ease anxiety symptom and under
use.
Nutritional – metabolic pattern
Weight loss resulting from fear of contained food.
Weight gain result from compulsive eating.
Change in appetite.
Assessment

Elimination pattern
Constipation.
Frequent urination.
Increase sweating. Cold and Clammy skin.
Sleep pattern
Decrease sleep.
Fatigue after sleep.
Inability to relax.
Assessment
Cognitive pattern
Self destructive or aggression ideas.
Difficulty in concentrating and understand.
Role – relationship pattern
Disturbance in inter personal relationship.
Diminish ability to meet occupational functional or
parental expectation.
Concern about distressful work situation.
Assessment

Sexual reproductive pattern

Fear of intimate contact with others.
Sexual dysfunction.
High risk sexual Behavior.
Dissatisfaction with sexual relation.
Physical findings:
Cardio vascular
Palpitation. - Sweating. -Cold clammy skin.
Elevate blood pressure.
Assessment

Respiratory:
Increase respiratory rate.
Shortness of breath.
Something sensation.
Chocking sensation.
Assessment

Gastro intestinal
Dry mouth. - Nausea – Vomiting
Diarrhea.- Abdominal distress
Genitourinary
Frequent urination.
Musculoskeletal
Increase fatigue.
Muscle tension.
Neuralgic
Dilated pupil. - Dizziness faintness
Light headiness. - Restlessness
 
Nursing diagnosis

In effective individual coping related to ritualistic behavior.

Out come:
Identify signs and symptoms of increase anxiety.
Report level of anxiety being experienced function.
Nursing intervention:
Provide the client with time for compulsive behavior.
Encourage client to verbalize his feeling.
Have client to collaborate with team to develop the plan of care.
Assess the degree of interference with daily functions by determine
how much time the client spends on compulsive behavior.
 Encourage client to talk about cause of disease.
Nursing diagnosis
Impaired skin integrity related to ritualistic behaviors
involving cleaning such as hand washing.
Out come:
Demonstrate evidence of skin integrity.
Demonstrate evidence of being infection free.
Nursing intervention:
Assess client's skin integrity and mucus membrane.
Encourage the client to use only mild soap and skin
cream during ritualistic behaviors involve cleaning.
Nursing diagnosis
 Altered family process related to inability to express feeling and
develop intimate relationship.
 - Out come:
 Recognize need for support external to their family system.
 Report their understanding of the illness.
 Utilize community based resources to develop supportive network.
 Nursing intervention:
 Collaborate with family members to define and clarify their
relationship with one another.
 Help family members to identify their feelings and importance of
sharing these feeling.
 Teach the family about obsessive compulsive behavior and ways they
can assist the client relaxation and behavioral modification.