Obsessive compulsive disorder

2. OCD
Presenter
Nandini Bhumij
M.Sc. Nursing 1st
yr.

4. History
 14th
& 15th
century thought people were
possessed by the devil and treated by
exorcism
 17th
century thought people were cleansing
their guilt
 18th
century finally considered medical
issue
 20th
century began treating with behavioral
techniques

5. WHAT IS OCD?
 It is an anxiety disorder.
 The person has recurring thoughts or
images(obsessions) and/or repetitive,
ritualistic-type behaviors that the individual is
unable to keep from doing(compulsions).
 The person may try to suppress these
thoughts or behaviors but is unable to do so.
 The individual knows that the thoughts or
behaviors are irrational but feels powerless to
stop.

6. Definition
The DSM-IV-TR describes obsessive-
compulsive disorder (OCD) as recurrent
obsessions or compulsions that are severe
enough to be time consuming or to cause
marked distress or significant impairment
(APA,2000).

7. Obsessions
 It is defined as unwanted, intrusive, persistent
ideas, thoughts, impulses or images that
cause marked distress.

8. Compulsions
 It denote unwanted repetitive behavior
patterns or mental acts that are
intended to reduce anxiety, not to
provide pleasure or gratification.

10. Obsessive-Compulsive Disorder
 Affects almost 3% of world’s population
 Start anytime from preschool to
adulthood
 Typically between 20-24
 many different forms of OCD – differ
from person to person
 cause of OCD is still unknown
 Better when diagnosed early

11. Classification ICD 9
 F42 OCD
 F42.0 Predominantly obsessive thoughts
or ruminations.
 F42.1 Predominantly compulsive acts.
 F42.2 Mixed obsessional thoughts and act.
 F42.8 Other obsessive-compulsive
disorder.
 F42.9 Obsessive compulsive disorder,
unsetisfied.

12. Etiological factors
Psychoanalytical Theory
Learning Theory
Biological Aspects
Neuroanatomy
Physiology
Biochemical Factors

13. Etiological factors
Psychoanalytical Theory
OCD pts have:
 weak, underdeveloped egos.
(Reasons: unsatisfactory parent-child
relationship, conditional love etc.).

14. Psychoanalytical Theory cont…
 Regression to the pre-Oedipal anal-sadistic
phase, combined with use of specific ego
defence mechanisms (isolation, undoing,
displacement, reaction formation), produces
the clinical symptoms of obsessions and
compulsions

15. Etiological factors
 Learning Theory
 It explains- OCD pts. as a conditioned
response to a traumatic event.
 Traumatic event produces anxiety and
discomfort.
 passive avoidance(staying away from the
source)
 active avoidance(staying with the source)

16. Etiological factors
 Biological Aspects
Neuroanatomy: Neuroimaging techniques
have shown abnormal metabolic rates in the
basal ganglia and orbital frontal cortex of
individuals with the disorder(Hollander &
Simeon, 2008).

17. Etiological factors
 Physiology. Electrophysiological studies,
sleep electroencephalogram studies, and
neuroendocrine studies have suggested that
there are commonalities between depressive
disorders and OCD (Sadock & Sadock,
2007). Neuroendocrine commonalities were
suggested in studies in which about one third
of OCD clients show nonsuppression on the
dexamethasone-suppression test and
decreased growth hormone secretion with
clonidine infusions.

18. Etiological factors
 Biochemical Factors. The neurotransmitter
serotonin as influential in the etiology of
obsessive-compulsive behaviors.
 Drugs that have been used successfully in
alleviating the symptoms of OCD are
clomipramine and the selective serotonin
reuptake inhibitors (SSRIs), all of which are
believed to block the neuronal reuptake of
serotonin, thereby potentiating serotoninergic
activity in the central nervous system.

19. Diagnostic criteria
 Specific criteria to be clinically diagnosed
 Anxiety disorder with presence of obsessions
or compulsions
 ego dystonic – realize thoughts and actions
are irrational or excessive
 Must take up more than 1 hour a day
 Must disrupt daily routine
 Symptoms can’t result from effects of other
medical conditions or substances

20. Symptoms of Obsessions
 Repeated thoughts about
contamination(e.g. may lead to
fear of shaking hands or touching
objects).
 Repeated doubts(e.g. repeatedly wondering
if they locked the door or turned
off an appliance).

21.  A need to have things in a certain order(e.g.
feels intense anxiety when things are out of
place).

22. Obsessions cont…
 Thought of aggression (e.g. to hurt a loved
one).
 Sexual imagery.

24. Symptoms of Compulsion
 Washing and cleaning(e.g. excessive hand
washing or house cleaning).
 Counting (e.g. counting number of times that
something is done).

25.  Checking (e.g. checking something that one
has done, over and over).
 Requesting or demanding assurances from
others.

26. Compulsion cont…
 Repeating actions(e.g. going in and out of
door or up and down from a chair).
 Ordering(e.g. arranging and rearranging
cloths or other items).


27.  Note : the obsessions and compulsions seem
to be worse in the face of emotional stress.

28. Clinical Features
 Obsessional thought
 Obsessional ruminations
 Obsessional doubts
 Obsessional impulses
 Obsessional rituals
 Obsessional slowness

29. Diagnosis
 Suggested by demonstration of ritualistic
behavior that is irrational or excessive.
 MRI and CT shows enlarged basal ganglia in
some patients.
 PET scanning shows increased glucose
metabolism in part of basal ganglia.

30. PET scans indicate differences in brain activity of OCD
patients versus normal

31.  OCD found excessive with other diseases
 Common diseases: Depression, Schizophrenia…
 Depression is the most common
 Many people with OCD suffered from depression first
 2/3 of OCD patients develop depression  makes
OCD symptoms worse and more difficult to treat
 People with OCD common diagnosed as
Schizophrenic  hard to separate obsessions from
delusions

32. Treatment
 Only completely curable in rare cases
 Most people have some symptom relief with
treatment
 Treatment choices depend on the problem
and patients preferences
 Most common treatments:
 Behavioral Therapy
 Cognitive Therapy
 Medication

33. Cognitive-Behavioral Therapy
 Cognitive: change the way they think to deal with
their fears
 Behavioral: change the way they react to “anxiety-
provoking” situations
 Exposure and Response Prevention
 Slowly learning to tolerate anxiety associated with
not performing ritual behavior
 Psychotherapy
 Talking with therapist to discover what causes the
anxiety and how to deal with symptoms
 Systematic Desensitization
 Learning cognitive strategies to deal with anxiety
then gradual exposure to feared object

34. Cognitive-Behavioral Therapy
 Should be done when people are ready for it
 Must be customized for each person’s specific form
of OCD and their needs
 No side affects except increased anxiety with
exposure to fear
 Often lasts about 12 weeks
 Positive effects off CBT last longer than those of
medication
 If OCD returns can successfully treat again with
same therapy
 Best treatment approach for most is CBT combined
with medication

35. Medication
 Anxiolytic benzodiazepine such as chloradiazepoxide or
diazepam  give temporary relief from anxiety but not
really effective on obsessions and compulsions
 Antidepressants because of common depression
 Selective Serotonin Reuptake Inhibitors (SSRIs): alter the
levels of neurotransmitter serotonin in the brain which
helps brain cells communicate with one another
 Prevents excess serotonin from being pumped back
into original neuron that released it
 Then can bind to receptor sites of nearby neurons and
send chemical message that can help regulate anxiety
and obsessive compulsive thoughts
 Most effective drug treatment helping about 60% of
patients
 Ex: Prozac, Zoloft, Lexapro, Paxil

37. Nursing Management

38. Nursing assessment
 Assessment should focus on the collection of
physical, psychological and social data.
 The nurse should be particularly aware of the
impact of obsessions and compulsions on
physical functioning, mood, self-esteem and
normal coping ability.

39. Nursing assessment
 Nurse should also note: the defence
mechanism used thought content or process
potential for suicide, ability to function and
social support systems.

40. The following criteria may be used to measure outcomes in the
care of the client with OCD.
The Client:
● Is able to maintain anxiety at a manageable level without
resorting to the use of ritualistic behavior.
● Is able to perform activities of daily living independently.
● Verbalizes understanding of relationship between anxiety and
ritualistic behavior.
● Verbalizes specific situations that in the past have provoked
anxiety and resulted in seeking relief through rituals.
● Demonstrates more adaptive coping strategies to deal with
stress, such as thought stopping, relaxation techniques, and
physical exercise.
● Is able to resume role-related responsibilities because of
decreased need for ritualistic behaviors.

41. Nursing diagnosis1
 Ineffective coping
 Related to under developed ego,
 Punitive superego; avoidance learning;
possible biochemical changes evidence by
ritualistic behavior and or obsessive thoughts.

42. Nursing management cont…
 Objective : client will demonstrate ability to
cope effectively without restoring to obsessive
compulsive behaviors or increased
dependency.

43. Nursing diagnosis 2
 Ineffective role performance
 Related to: need to perform rituals.
 Evidence by: inability to fulfill usual pattern of
responcibility.

44. Nursing management cont…
 Objective: Client will be able to resume role-
related responsibilities.

45. Evaluation
Reassessment is conducted in order to determine if the nursing
actions have been successful in achieving the objectives of
care. Evaluation of the nursing actions for the client with OCD
may be facilitated by gathering information using the following
types of questions:
● Can the client refrain from performing rituals when anxiety level
rises?
● Can the client demonstrate substitute behaviors to maintain
anxiety at a manageable level?

46. Cont…
● Does the client recognize the relationship between
escalating anxiety and the dependence on ritualistic
behaviors for relief?
● Can the client verbalize situations that occurred in the past
during which this strategy was used?
● Can the client verbalize a plan of action for dealing with
these stressful situations in the future?
● Can the client perform self-care activities independently?
● Can the client demonstrate an ability to fulfill role related
responsibilities?
● Can the client verbalize resources from which he or she
can seek assistance during times of extreme stress?

47. Summarization
 Definition of OCD
 Diagnostic criteria
 Etiology
 Clinical features
 Sign and symptoms
 Diagnosis
 Treatment
 Nursing management
 Evaluation

49. Conclusion
 OCD is a complicated issue
 Most cases are incurable
 Best form of treatment is CBT in combination
with medication
 Most important thing that can be done to
discover more about OCD and its treatments
is to research the brain

50. Bibliography
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edition. F. a. davis company publishers. Philadelphia USA. P
526-530.
2. Townsend Mary.C. psychyiatric mental health nursing concepts of
care. 5th
edition. F. a. davis company publishers. Philadelphia USA. P
449-454.
3. R. sreevani. A guide to mental health and psychiatric nursing. 3rd
edition.jaypee brother medical publishers(p) ltd.new delhi. P179-182
4. Clinical correlates of functional impairment in children and adolescents with obsessive
Joshua M. Nadeau | Adam B. Lewin | ...
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