OBSESSIVE-
COMPULSIVE
DISORDER
certain disorders characterized by repetitive thoughts or
behaviors such as OCD can be grouped together and
described in terms of an obsessive compulsive spectrum
the spectrum approach includes repetitive behaviors of
various types:
self-soothing behaviors such as:
Trichotillomania(pulling out of own hair), dermatillomania
(chronic skin picking)
reward seeking behaviors : hoarding, kleptomania,
pyromania(setting/starting fires)
disorder of body appearance : body dysmorphic
disorder
Obsessions are recurrent, persistent, intrusive and
unwanted thoughts, images, impulses that cause
markedly anxiety and interfere with interpersonal,
social or occupational function.
the person believes has no control over them
Compulsions are ritualistic or repetitive behaviors or
mental acts that a person carries out continuously in
an attempt to neutralize anxiety.
the theme of the ritual is associated with obsession
such as repetitive hand washing, repetitive prayers
Common compulsions include:
checking rituals (repeatedly making sure the door is
locked )
counting rituals desk in the classroom, steps taken)
washing and scrubbing the skin until raw
praying or chanting
Touching, rubbing or tapping (feeling texture of each
material)
ordering (arranging and rearranging furniture's or
items on a desk
exhibiting rigid performance (getting dressed in
unvarying patterns)
having aggressive urges ( to throw one’s child
against a wall
OCD is only diagnosed when a person is compelled
to act out behaviors to a point which they interfere
with personal social and occupational functions
Onset
it can start in childhood, especially in males
in females it begins in the 20’s
onset is typically in late adolescence
Early onset in males has more severe symptoms
more comorbid diagnoses and a greater likelihood of
family history
Related Disorders:
Excoriation – skin picking (Dermatillomania)
this is an attempt to soothe themselves (soothing
behavior}
The behavior can cause significant distress to the
patient may lead to medical complications.
alternative therapies include: yoga, acupuncture and
biofeedback
Trichotillomania ( repetitive pulling of hair) – more
common in females
BDD (body dysmorphic disorder)– preoccupation
with an imagined or slight in physical appearance
that causes significant distress for the individual and
interferes with functioning in daily life.
Tx – SSRI – antidepressants, used in the treatment
of anxiety
Hoarding – debilitating compulsive disorder
this had been a symptom of OCD
diagnosis occur between age 20 to 30 years of age
more common in females with a parent or first
degree relative that hoards
it involves excessive acquisition of animals or
useless things
treatment can be medication and cognitive
behavioral therapy, self help groups
Behavioral addictions – characterized by an
inability to resist the urge to engage in potentially
harmful actions.
Onychophagia – or chronic nail biting (self soothing
behavior)
onset is childhood with a decrease in behavior by
age 18.
May lead to psychosocial problems or cause
complications involving the nails and oral cavity
SSRI have proven to be effective
Kleptomania (compulsive stealing)- a reward seeking
behavior
the reward is not the stolen item but the thrill of
stealing and not getting caught
more common in females with comorbid of
depression and substance use.
Oniomania – or compulsive buying
the pleasure is in the acquiring the purchased
objects
spending behavior is often out of control well beyond
the persons financial means
common among females
Onset 20’s often seen in college students
it runs in the family with comorbidity for depression
Body identity integrity disorder (BIID) term given to
people who feel over complete or alienated from a
part of their body and desire amputation also known
as “amputation love”
Treatment
First line of treatment – flouvoxamine(antidepressant) and
sertraline and sertraline
Optimal treatment for OCD combine medication and
behavioral therapy
treatment resistant OCD may respond to second generation
antipsychotic such as : risperidone, Seroquel, olanzepine
behavioral therapy includes behavior and exposure
prevention:
Exposure – involves assisting the client in deliberately
confronting the situation and stimuli that he or she usually
avoid.
Response prevention – focuses on delaying or
avoiding performance of rituals.
other management: deep breathing and relaxation
Intervention
Using therapeutic communication- offering support
and encouragement
discuss the behavior (they hide their rituals) and
resulting feelings with the client- encourage the client
to talk about the feelings and ask the client to
describe them in detail if the he/she can tolerate.
Teaching relaxation and behavioral techniques –
deep breathing, progressive muscle relaxation and
guided imagery – this intervention should take place
when the clients anxiety is low so she can learn more
effectively
to manage anxiety and ritualistic behavior a baseline
of frequency and duration is necessary the client can
have a journal.
the client records the situations that trigger the
obsessions, the intensity of the anxiety, time spent
performing the ritual
Completing a daily routine
to accomplish a task the patient may need additional
time to allow for rituals
nurse and client can agree on a plan to limit the time
spent performing rituals
Providing client and family education
help the client and family talk openly about the
obsession, anxiety and rituals eliminate the clients
need to keep these things secret
family members can support emotionally
medication compliant is important
