1. Never Just Right:
Solving the Puzzle of
Obsessive‐Compulsive
Disorder
Andrew Jacobs, Psy.D., C.Psych.
Psychologist, Anxiety Disorders Program
Jakov Shlik, MD, FRCPC
Psychiatrist and Clinical Director, Anxiety Disorders Program

2. Overview
• OCD: Impact
• What is OCD – and What Isn’t?
• OCD Treatment
• GePng Help in ORawa
• Online Resources

3. Rates of OCD
• ORawa Metro Area, 2011: 1,236,324 people
• LifeZme prevalence of OCD: 2.3%
– 28,435 people in ORawa will have diagnosable
OCD in their lifeZme
• One‐year prevalence of OCD: 1.2%
– 14,836 people in ORawa have diagnosable
OCD this year
Based on data from NaZonal Comorbidity Survey (Ruscio et al, 2010) and StaZsZcs Canada (2012)

4. OCD & Other Mental Health Concerns
• Over the course of a lifeZme, individuals with OCD
oben experience the following:
– Other anxiety disorders: 76%
– Mood disorders: 63%
– Substance use disorders: 39%
– ANY disorder: 90%
Ruscio, Stein, Chiu, & Kessler, 2010

5. What is OCD?
(and what isn’t…)

6. What are Obsessions?
• Intrusive, recurring, persistent thoughts, mental images,
or urges that cause marked anxiety or distress
• More than “excessive worry”
• A person tries very hard to get rid of the
obesssion with another thought or behaviour
• A person knows the obsession comes from his/her
own mind
Based on DSM‐IV‐TR (2000)

7. Some Common Obsessions
• Excessive, intrusive thoughts about dirt, germs,
illness, or contaminaZon
• Fears of having accidentally caused harm
• Excessive doubZng of whether tasks were complete
or accurate
• UpsePng, “nonsensical” need for specific order or
exactness
• UpsePng aggressive, sexual, or religious thoughts
that are out of character

8. What Aren’t Obsessions?
• InfatuaZon
• Fantasies
• Over‐thinking
• UpsePng memories
• Worrying
• Intrusive thoughts*

9. Intrusive Thoughts are NORMAL
• 90% of people report experiencing intrusive thoughts
(Salkovskis, 1998)
• It is not the intrusion that makes an obsession or
OCD; it is our anxiety, distress, and reacZon to it

10. So Why Not Just Stop
Thinking About It?
An Experiment

11. What are Compulsions?
• RepeZZve behaviours or mental tasks a person must
perform according to very set rules and/or in
response to an obsession
• Compulsions aim to bring down distress or prevent a
bad thing from happening, although they are either
very excessive or wouldn’t realisZcally work
Based on DSM‐IV‐TR (2000)

12. Some Common Compulsions
• Checking doors, windows, locks,
appliances many Zmes
• Washing and cleaning a great deal
• CounZng objects, words, etc
• Arranging and rearranging objects
• Following very specific “rituals”
• Looking for reassurance excessively

13. What Aren’t Compulsions?
• Tidiness / orderliness
• Habits
• Impulses
• AddicZons
• SupersZZous behaviours (usually)

14. Avoidance
• Triggers become linked with obsessions and are
avoided
– Avoid due to fear of intrusive thoughts
– Avoid to prevent need to do compulsions

15. The Cycle & Growth of OCD
• Obsessions are never saZsfied
• Compulsions are never complete
• Avoidance expands

16. What Makes it a Disorder?
• Impact
– Very upsePng
– Quality of life
– Time‐consuming

17. Treatment of OCD
Exposure & Response PrevenZon (ERP)
MedicaZons

18. Exposure & Response PrevenZon
• Behavioural change‐based therapy
• Learning through new experiences
• EssenZally a process of reversing what the OCD is
telling a person to think, feel, and do
– IdenZfy OCD cycle in acZon
– Face feared situaZons / triggers
– Carry through without compulsions
– Allow the anxiety to change and fade on its own

19. Exposure
• Targets oben on a hierarchy of difficulty
• Gradually confront avoided items, situaZons,
and thoughts
• Stay in the situaZon
– Anxiety gradually declines
• Repeat

20. Response PrevenZon
• Stop compulsive behaviour
– Very challenging
– Leads to high anxiety at first
• Declines with Zme
• Alternate: “ruin” compulsion
– Example – touch something “contaminated”
aber washing hands

21. Gains from ERP
• Learn new things
– Feared outcome doesn’t happen
– Ability to cope is beRer than expected
• Fear and anxiety gradually decrease
• Avoidance gradually decreases
• Urge to do compulsions decreases
• Thoughts become less upsePng

22. A Course of ERP
• Typically 10‐20 sessions, 60‐120 minutes
• Exposures are done both in session and on own
• Client is never forced to do anything

23. ERP: The BoRom Line
• Very challenging, but it works
– Extremely well‐researched, established, and
effecZve treatment for OCD
– ERP and similar therapies are effecZve for
approximately 2/3 to 3/4 of individuals

24. MedicaZons Used to Treat OCD
• Used to treat OCD:
– SSRIs / SNRIs – Serotonin Reuptake Inhibitors
– Tricyclic anZdepressants
• To help treatment
– Atypical anZpsychoZcs / mood stabilizers

25. GePng Help for OCD in ORawa

26. At The Royal
• Physician referral to The Royal
• Assessment by psychiatrist or psychologist
– Treatment is done both through medicaZons and
through ERP
– ERP is usually done in a group

27. In the Community
• Look for therapists with the following:
– Professionally qualified / licensed
– OCD‐specific experience
– Behavioural or cogniZve‐behavioural treatment approach
• Unless the pracZZoner is a physician, his/her services
will likely not be covered by OHIP / RAMQ; however,
private insurance may assist

28. Online Resources
• InternaZonal OCD FoundaZon
– www.ocfoundaZon.org
• Anxiety & Depression AssociaZon of America
– www.adaa.org
• Anxiety Disorders AssociaZon of Ontario
– www.anxietydisordersontario.ca
• The Royal
– www.theroyal.ca