OCD

Prachi Bhavesh Sanghvi

I M.Sc Clinical Psychology

St. Agnes Centre for Post-Graduate Studies and Research

DSM IV TR:300.3 OCD as a part of anxiety disorders

DSM V:Obsessive-Compulsive and related disorders300.3 OCD300.7 BDD300.3 Hoarding disorder312.39 Trichotillomania698.4 Excoriation (skin-picking) disorderSubstance/medication induced obsessive-compulsive and related disorder294.8 Obsessive-compulsive and related disorder due to other medical condition300.3 Other specified obsessive-compulsive and related disorder300.3 Unspecified obsessive-compulsive and related disorder

ICD-10:F42 Obsessive - compulsive disorderF42.0 Predominantly obsessional thoughts or ruminationsF42.1 Predominantly compulsive acts [obsessional rituals]F42.2 Mixed obsessional thoughts and actsF42.8 Other obsessive - compulsive disordersF42.9 Obsessive - compulsive disorder, unspecified Prachi Sanghvi, M.Sc. Clinical Psychology

Prachi Sanghvi, M.Sc. Clinical Psychology

•Obsessions are defined by (1), (2), (3), and (4):(1) recurrent and persistent thoughts, impulses or images that are experienced at some time during the disturbance as intrusive and inappropriate and that cause marked anxiety or distress.(2) The thoughts, impulses or images are not simply excessive worries about real life problems.(3) The person attempts to ignore or suppress such thoughts, impulses or images or to neutralize them with some other thought or action.(4) The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion).

•The most common obsessions: repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, symmetry, aggressive or horrific impulses and sexual imagery.

•Compulsions are defined by (1) and (2):(1) repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.(2) The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

The most common compulsions: washing and cleaning, counting, checking, symmetry and precision, requesting or demanding assurances, repeating actions and ordering.

(American Psychiatric Association, 2000)Prachi Sanghvi, M.Sc. Clinical Psychology


EPIDEMIOLOGY

•Life time prevalence of 2.5% and a I -year prevalence of 0.5%- 2.1% in adults.•Lifetime prevalence of 1%-2.3% and a I-year prevalence of 0.7% in children and adolescents. •Prevalence rates of OCD are similar in many different cultures around the world (American Psychiatric Association, 2000).

•In India, lifetime prevalence of 0.6%. More common in unmarried males. Common in people from upper social strata and with high intelligence (Ahuja N, 2011).

Diagnostic featuresA. Either obsessions or compulsionsB. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.C. The obsessions or compulsions cause marked distress, are time consuming (more than 1 hour a day) or significantly interfere with the person's normal routine, occupational (or academic) functioning or usual social activities or relationships.D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to itE. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.Specify if: With Poor Insight


Associated features and Disorders•Features

•Content and theme•Confronting the situation that triggers obsessions and compulsions•Avoiding public situations that triggers obsessions and compulsions. Pervasive avoidance may leave an individual housebound.•Hypochondriacal concerns and sleep disturbances•Performing compulsions may become a major life activity, leading to serious marital, occupational, or social disability.

•DisordersAdults

Major depressive disorderOther anxiety disordersEating disordersPersonality disorders

ChildrenLearning disordersDisruptive behavior disorders

Tourette’s disorder•Laboratory findings

•may exhibit increased autonomic activity•Physiological reactivity decreases after the performance of compulsions.

•Physical examination findingsDermatological problems caused by excessive washing with water or caustic cleaning agents may be observed.

(American Psychiatric Association, 2000 & American Psychiatric Association, 2013)Prachi Sanghvi, M.Sc. Clinical Psychology


Differential diagnosis• Obsessive-Compulsive Personality

Disorder• Anxiety Disorder Due to a General

Medical Condition• Recurrent or intrusive thoughts, impulses,

images or behaviors• Major Depressive Episode• Generalized Anxiety Disorder • Hypochondriasis• Substance induced anxiety disorder

(American Psychiatric Association, 2000)


Comorbidity•Drug addiction•Depression•Obsessive–compulsive personality disorder•Major depressive disorder•Bipolar disorder•Generalized anxiety disorder•Anorexia nervosa & bulimia nervosa•Social anxiety disorder •Tourette’s syndrome•Asperger’s syndrome•Attention deficit hyperactivity disorder•Dermatillomania (compulsive skin picking)•Body dysmorphic disorder•Trichotillomania

(American Psychiatric Association, 2000)

Etiology• Biological factors

NeurotransmittersGeneticsBrain imaging studiesNeuroimmunology

• Psychodynamic factors• Behavioural factors• Environmental factors

(Ahuja N, 2011 and Sadock B & Sadock V, 2007)


Course•Usually begins in adolescence or early adulthood but may also begin in childhood. •Modal age at onset: between 6-15 yrs for males and between 20-29 yrs for females. •Mostly, onset is gradual but acute onset has been noted in some cases. The majority have a chronic waxing and waning course with exacerbation of symptoms that may be related to stress. •About 15% show progressive deterioration in occupational and social functioning. About 5% have an episodic course with minimal or no symptoms between episodes.


Prognosis/Outlook

Poor prognosisyielding to compulsions

childhood onsetunder-employmentpersonality disorder

lack of satisfying relationshipsgenerally poor quality of life

Need for hospitalization

Good prognosisMilder, brief duration and episodic nature of symptoms

Good functioning before full onsetgood social and occupational adjustment

(Sadock B & Sadock V, 2007)Prachi Sanghvi, M.Sc. Clinical Psychology


ManagementPharmacotherapyAntidepressants (SSRIs)BenzodiazepinesAntipsychoticsAntibiotic therapy

Behaviour and cognitive therapyBehavioural modificationThought stoppingExposure and ritual preventionSystematic desensitizationmodeling

Electroconvulsive therapy

Psychosurgery

(Ahuja N, 2011)


References•Ahuja N, A Short Textbook of Psychiatry (7th ed.), 2011, Jaypee Publishers.•American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (4th rev. ed.), 2000, American Psychiatric Publishing•American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (5th ed.), 2013, American Psychiatric Publishing•Comer R J, Abnormal Psychology (8th ed.), 2013, Worth publishers, New York•Sadock B and Sadock V, Kaplan & Sadock’s Synopsis of Psychiatry: Behavioural Sciences/Clinical Psychiatry (10th ed.), 2007, Lippincott Williams & Wilkins.•World Health Organization, The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines, 2007, Geneva.

OCD

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