NRS 403 Obsessive Compulsive Disorder

NRS 403
Mental Health/Psychiatry Disorders

Udeh P.A
Dept. of Nursing Sciences
College of Health
Obsessive-Compulsive Disorder
• Obsessive-compulsive disorder (OCD), one of the anxiety
disorders, is a potentially disabling condition that can persist
throughout a person's life. The individual who suffers from
OCD becomes trapped in a pattern of repetitive thoughts
and behaviours that are senseless and distressing but
extremely difficult to overcome. Persons with OCD suffer
from a combination of obsessions and compulsions.

Cont...
• Obsessions are recurrent thoughts, images, or impulses

that are experienced as intrusive and inappropriate and
that cause marked anxiety or distress. (Eg fear of self
contamination, fear that one has forgotten to do
something important like locking a door, turn of light or a
need to have things in one’s life like chairs /shoes in a
room in a particular physical arrangement).
Compulsion
• Compulsions are repetitive behaviors or mental acts, the goal of which is to
prevent or reduce anxiety or distress. Persons who experience obsession
often find relief from it through repetitive ritualistic actions or compulsions.
For individual with obsession about being contaminated may reduce their
mental distress by washing their hands until their skin get raw. Similarly,
individual distresses by obsession about having left a door unlocked may be
driven to check the lock multiple times. Persons with this diagnosis recognise
that their thoughts and behaviors are unreasonable. Many persons with this
disorder hide their symptoms and rituals from family and friends
Causes
• The cause of obsessive-compulsive disorder isn't fully understood. Main theories
include:
• Biology. OCD may be a result of changes in body own natural chemistry or brain
functions.
• Genetics. OCD may have a genetic component, but specific genes have yet to be
identified.
• Environment. Some environmental factors such as infections are suggested as a
trigger for OCD,
• Family history. About 25% of OCD sufferers have an immediate family member
with the disorder.
• Behavioural, cognitive, and environmental factors. Learning theorists believe that
compulsions are actually learned responses that help an individual reduce or
prevent anxiety or discomfort associated with obsessions or urges.
Cont...
• Inflated responsibility: a belief that one has the ability to cause or is responsible
for preventing negative outcomes;
• Perfectionism: a belief that one cannot make mistakes and that imperfection is
unacceptable;
• Traumatic brain injuries have been associated with the onset of OCD, which
provides further evidence of a connection between brain function impairment
and OCD.
• Other mental health disorders. OCD may be related to other mental health
disorders, such as anxiety disorders, depression, substance abuse or tic disorders

Pathophysiology
• Biological causes of OCD focus on a circuit in the brain which regulates primitive aspects of
behaviour such as aggression, sexuality, and bodily excretions. This circuit relays information
from a part of the brain called the orbitofrontal cortex to another area called the thalamus.
When this circuit is activated, these impulses are brought to the person’s attention and cause
him to perform a particular behaviour that appropriately addresses the impulse.
• For example, after using the restroom, a person may begin to wash his hands to remove any
harmful germs he may have encountered. Once he has performed the appropriate behaviour—
in this case, washing of hands—the impulse from this brain circuit diminishes and he stops
washing his hands. It has been suggested that if a person has OCD, his brain has difficulty
turning off or ignoring impulses from this circuit. This, in turn, causes repetitive behaviours
called compulsions and uncontrollable thoughts called obsessions.

Signs and Symptoms
• Examples of obsession signs and symptoms include:
• Fear of being contaminated by touching objects others have touched
• Doubts that you've locked the door or turned off the stove
• Intense stress when objects aren't orderly or facing a certain way
• Images of hurting yourself or someone else that are unwanted and make
you uncomfortable
• Thoughts about shouting obscenities or acting inappropriately that are
unwanted and make you uncomfortable
• Avoidance of situations that can trigger obsessions, such as shaking
hands
• Distress about unpleasant sexual images repeating in your mind
Cont...
• Examples of compulsion signs and symptoms include:
• Hand-washing until your skin becomes raw
• Checking doors repeatedly to make sure they're locked
• Checking the stove repeatedly to make sure it's off
• Counting in certain patterns
• Silently repeating a prayer, word or phrase
• Arranging your canned goods to face the same way

Diagnoses
• Physical exam. This may be done to help rule out other mental health
problems
• Lab tests. These may include, for example, a complete blood count (CBC), to
check for alcohol and drugs use.
• Psychological evaluation. This includes discussing your thoughts, feelings,
symptoms and behavior patterns with mental health experts
• Diagnostic criteria for OCD. The doctor may use criteria in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), published by the American
Psychiatric Association.
Treatment
• Obsessive-compulsive disorder treatment may not result
in a cure, but it can help bring symptoms under control so

that they don't rule your daily life. Some people need
treatment for the rest of their lives.
• The two main treatments for OCD are psychotherapy and
medications. Often, treatment is most effective with a

combination of these.
Cont...
• 1. Cognitive behavior therapy (CBT) is the method of psychotherapy most
often used; Exposure and response prevention is a key element of CBT that
has been proven effective in the treatment of OCD. Patients are taught to
confront situations that create fear related to their obsessions, and to avoid
performing compulsive behaviors in response. The feared situations may be
confronted directly (e.g., touching objects in a public restroom), or through
imagined encounters (e.g., imagining shaking hands with another person).
Patients refrain from performing rituals until the level of anxiety dissipates.
Therapy may take place in individual, family or group sessions.

Cont...
• Psychotherapy
• Cognitive behavioral therapy (CBT), a type of psychotherapy, is
effective for many people with OCD. Exposure and response
prevention (ERP), a type of CBT therapy, involves gradually exposing
you to a feared object or obsession, such as dirt, and having you
learn healthy ways to cope with your anxiety. ERP takes effort and
practice, but you may enjoy a better quality of life once you learn to
manage your obsessions and compulsions.

Cont...
• 2. Medications
• Certain psychiatric medications can help control the obsessions and
compulsions of OCD. Most commonly, antidepressants are used e g
• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Fluvoxamine
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)
Cont...
• 3. Sometimes, medications and psychotherapy

aren't effective enough to control OCD
symptoms. Deep brain stimulation (DBS) can
be done for treating OCD that doesn't respond
to traditional treatment approaches.
Cont...
• 4. Complementary and Alternative Medicine
• There are limited trials of complementary and

alternative medicine approaches for the treatment
of OCD. Initial studies have suggested beneficial
effects for moderate-intensity aerobic exercise and
mindfulness interventions (e.g., meditative
breathing).

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NRS 403

Mental Health/Psychiatry Disorders

• Obsessive-compulsive disorder (OCD), one of the anxiety

disorders, is a potentially disabling condition that can persist

throughout a person's life. The individual who suffers from

OCD becomes trapped in a pattern of repetitive thoughts

and behaviours that are senseless and distressing but

extremely difficult to overcome. Persons with OCD suffer

from a combination of obsessions and compulsions.

• Obsessions are recurrent thoughts, images, or impulses

prevent or reduce anxiety or distress. Persons who experience obsession

often find relief from it through repetitive ritualistic actions or compulsions.

individual distresses by obsession about having left a door unlocked may be

for preventing negative outcomes;

provides further evidence of a connection between brain function impairment

disorders, such as anxiety disorders, depression, substance abuse or tic disorders

him to perform a particular behaviour that appropriately addresses the impulse.

called compulsions and uncontrollable thoughts called obsessions.

• Hand-washing until your skin becomes raw

• Checking doors repeatedly to make sure they're locked

• Checking the stove repeatedly to make sure it's off

• Counting in certain patterns

• Silently repeating a prayer, word or phrase

• Arranging your canned goods to face the same way

check for alcohol and drugs use.

• Psychological evaluation. This includes discussing your thoughts, feelings,

symptoms and behavior patterns with mental health experts

Statistical Manual of Mental Disorders (DSM-5), published by the American

in a cure, but it can help bring symptoms under control so

• The two main treatments for OCD are psychotherapy and

medications. Often, treatment is most effective with a

performing compulsive behaviors in response. The feared situations may be

confronted directly (e.g., touching objects in a public restroom), or through

imagined encounters (e.g., imagining shaking hands with another person).

Therapy may take place in individual, family or group sessions.

• Cognitive behavioral therapy (CBT), a type of psychotherapy, is

effective for many people with OCD. Exposure and response

prevention (ERP), a type of CBT therapy, involves gradually exposing

you to a feared object or obsession, such as dirt, and having you

manage your obsessions and compulsions.

• Certain psychiatric medications can help control the obsessions and

compulsions of OCD. Most commonly, antidepressants are used e g

• Paroxetine (Paxil, Pexeva)

• 3. Sometimes, medications and psychotherapy

• 4. Complementary and Alternative Medicine

• There are limited trials of complementary and

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