Obsessive-Compulsive and related disorders include:

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania (Hair-Pulling Disorder)
Excoriation (Skin-Picking) Disorder
 INTRODUCTION
Obsessive-compulsive disorder is neurotic disorder whose
main symptoms include obsessions and compulsions,
driving the person to engage in unwanted, often-times
distressing behaviors or thoughts.

Its
treatment is done through a combination of psychiatric
medications and psychotherapy.
 DEFINITIONS

Obsessions:
Obsessions are recurrent and persistent thoughts, impulses, or
images that cause distressing emotions such as anxiety or
disgust.
These intrusive thoughts cannot be settled by logic or reasoning.
Typical obsessions include excessive concerns about
contamination or harm, the need for symmetry or exactness, or
forbidden sexual or religious thoughts.
 DEFINITIONS

Compulsions
Compulsions are repetitive behaviors or mental acts that a
person feels driven to perform in response to an obsession.
Although the compulsion may bring some relief to the
worry, the obsession returns and the cycle repeats over and
over.
Some of the common compulsions include cleaning,
repeating, checking, ordering and arranging, mental
compulsions, etc.
 DEFINITION OF OCD
Obsessive-Compulsive Disorder (OCD) is a chronic and
long-lasting disorder in which a person has uncontrollable,
reoccurring thoughts (obsessions) and behaviors
(compulsions) that he or she feels the urge to repeat over and
over.
These obsessions and compulsions are severe enough to
cause significant distress or impairment in the social,
occupational, and other important areas of functioning.
 ETIOLOGICAL FACTORS
1. Biological Factor:
 First-degree relatives
Identical twins

2. Neurotransmitters
Imbalance in serotonin, dopamine, and glutamate

3. Neuroanatomical Factor:
There is evidence of abnormal brain structure and
activity in patients with OCD.
4. Psychotherapy Theory:
OCD arises when unacceptable wishes and impulses from the
id are only partially repressed. They cause anxiety. Ego
defense mechanisms are used to reduce anxiety. These
defense mechanisms are used unconsciously used in the form
of acts, such as handwashing.
5. Cognitive Theory:
Dysfunctional beliefs are the route cause for OCD and the
strength with which it is held determines the risk of
developing OCD.
6. Behavior Theory:
This theory explains obsessions as a conditioned
stimulus to anxiety. Compulsions have been
described as learned behavior that decreases the
anxiety associated with the obsessions.
This decrease in anxiety positively reinforces the
compulsive acts and they become a stable
learned behavior.
7. Psychosocial Factor:
Disturbed mother-child relationship
Fear of abandonment
Recent object loss
Emotional neglect
Childhood abuse (physical, emotional,
or sexual)
 CLINICAL FEATURES OF OCD

1. Washer (obsessions rituals)

This is the most common type. Here the obsession is
contamination with dirt, germs, body excretions, and
the like. The compulsion is washing hands or the
whole body, repeated many times a day. It usually
spreads onto washing of clothes, bathroom, bedroom,
doorknobs, and personal articles, gradually. The
person tries to avoid contamination but is unable to,
so washing becomes a ritual.
2. Checkers (obsession doubt)
In this type the person has multiple doubts that the
activities may not have been completed adequately.
For example, the door has not been locked, kitchen
gas has been left open, counting of money was not
exact, etc. the compulsion, of course, is checking
repeatedly to remove the doubt.
3. Pure obsessions intrusive thoughts
This syndrome is characterized by repetitive intrusive
thoughts, impulses, or images which are not associated
with compulsive acts.

A. Obsessional thoughts: there are words, ideas, and

beliefs that intrude forcibly into the patient’s mind. They
are usually unpleasant and shocking to the patient and
maybe obscene and blasphemous. E.g., orderliness,
sexual imagery repeated doubts, etc.
B. Obsessional images:
These are vividly imaginary scenes often of a violent or disgusting kind
involving abnormal sexual practice.

C. Obsessional impulses:
These are the urges to perform acts usually of a violent or embarrassing
kind, such as injuring a child, shouting in church, etc.

D. Obsessional ruminations:
These involve internal debates in which arguments for and against even
the simplest everyday actions are reviewed endlessly.
4. Primary obsessive slowing symmetry
It is characterized by several obsessive ideas and or
extensive compulsive rituals, in the relative absence
of manifested anxiety. This leads to marked slowness
in daily activity, usually, the person demands on being
the need for symmetry and precise arranging so in
order to neutralize it they will continue ordering,
arranging, balancing, straightening until just right or
perfect in their eyes.
 DIAGNOSIS OF OCD
DSM5
Suggested by demonstration of realistic behavior that is
irrational or excessive.
MRI and CT show enlarged Basal Ganglia in some
patients.
PET or Positron Emission Tomography shows increased
glucose metabolism in part of the basal ganglia.
ICD 10 criteria
 TREATMENT MODALITIES
1. Psychotherapy
Psychodynamic therapy
Individual psychotherapy
Cognitive Behavior therapy

2. Pharmacological treatment
3. ECT
4. Self-help and coping
5. Psychosurgery
 PSYCHODYNAMIC THERAPY
This can be used for patients who are psychologically
oriented.
The therapy is based on psychoanalysis in which the
patient is made conscious about their unconscious
thoughts and motives and thus gaining insight into the
condition.
It is focused on client's self awareness and understanding
of the influence of the past or present behavior.
 INDIVIDUAL PSYCHOTHERAPY

Discuss the difficulties of the client and help them

understand their anxiety and methods to deal with
them.
Logical and rational explanations are given to
anxiety-producing situations.
Psychoeducation
 COGNITIVE BEHAVIOR THERAPY
During treatment sessions, patients are exposed to
situations that create anxiety and provoke compulsive
behavior or mental rituals.
Through exposure, patients learn to decrease and then
stop the rituals that consume their lives.
They find that the anxiety arising from their obsessions
lessens without engaging in ritualistic behavior.
 BEHAVIOR THERAPY
Thought stopping: the client is asked to yell or scream in his mind
to stop whenever unwanted thoughts arise.
Systematic desensitization and reciprocal inhibition.
1. Training relaxation technique prior to exposure to the stimulus.
2. The client is gradually step-wise step exposed to the anxiety-
producing stimulus.
Implosive flooding: the therapist describes the anxiety-producing
situation in vivid detail so that the client can imagine the situation.
The therapy is continued until a topic no longer produces anxiety.
 PHARMACOLOGICAL TREATMENT
1. Benzodiazepines
 Alprazolam – 0.5mg/day
 Clonazepam – 0.25-0.5 mg/day
2. Antidepressants
 Clomipramine – 75-300mg/day
 Fluoxetine – 20-80mg/day
 Fluvoxamine – 50-200mg/day
3. Antipsychotic –these are occasionally used in low doses in the treatment
of severe anxiety.
e.g., Haloperidol, Risperidone, Olanzapine.3
 ELECTROCONVULSIVE THERAPY

Electroconvulsive Therapy or ECT – in the presence

of severe depression with OCD, ECT may be needed.
ECT is particularly indicated when there is a risk of
suicide and/or when there is a poor response to the
other modes of treatment.
 SELP-HELP AND COPING
Keeping a healthy lifestyle and being aware of warning
signs and what to do if they return can be hep in coping
with OCD and related disorders. Also, using basic
relaxation techniques, such as meditation, yoga,
visualizations, ad massage, can help ease the stress and
anxiety caused by OCD.
NURSING MANAGEMENT
 NURSING ASSESSMENT

Social impairment
Obsessive thought ex. Repetitive
worries, repeating and counting images
or words.
Compulsive behavior ex. repetitive
activity, like touching, counting, doing
or undoing.
 NURSING DIAGNOSIS
1. Severe anxiety related to obsessional thoughts and impulses
as evidenced by repetitive actions and decreased social
functioning.
2. Ineffective individual coping related to the underdeveloped
ego; possible biochemical changes as evidenced by the
inability to fulfill usual patterns of responsibility.
3. Altered role performance is related to the need to perform
rituals, as evidenced by the inability to fulfill usual patterns
of responsibility.
4. Chronic low self-esteem related to obsessional
thoughts and rituals evidenced by social isolation and
low self-confidence.

5. Sleep pattern disturbances related to obsessional

doubts and fear manifested by repetitive checking of
doors and not sleeping properly.
 1. TO REDUCE ANXIETY

 Establish relationships using empathy warmth, and respect.

 Acknowledge behavior without focusing. Verbalize empathy
toward clients’ experiences rather than disapproval or
criticism.
 Assist client to learn stress management (e.g., thought-
stopping, relaxation exercises, imagery)
 Give positive reinforcement for non-compulsive behavior.
 Assist client to find ways to set limits on own behaviors.
 2. TO REDUCE OBSESSIVE
COMPULSIVE BEHAVIOR
 Work with patient to determine the type of situation that increases
anxiety and results in such behavior.
 Meet the patient dependency needs.
 Provide positive reinforcement.
 Support patients' efforts to explore the meaning and purpose of
behavior.
 Provide structured schedule activities, for the patient, including
adequate time for performing rituals.
 Help the patient learn ways of interrupting obsessive thoughts.
3. IMPROVE ROLE RELATED
RESPONSIBILITIES
Determine the patient's previous role within the family to the
extent to which the role is altered with the illness.
Encourage patients to discuss conflicts evident within the
family system.
Explore available options for changes for adjustment in the
role.
Practice through role play.
Provide positive reinforcement.
 BODY DYSMORPHIC DISORDER

Is characterized by preoccupation with one or more

perceived defects or flaws in physical appearance that are
not observable or appear only slight to others.
There is an excessive, exaggerated belief that the body is
deformed or defective in some specific way.
It may include imagined or slight flaws of the face or
head, shape of nose, facial asymmetry etc.
 HOARDING DISORDER

Is characterized by persistent difficulties in

discarding or parting with possessions even those
of little or no value due to the perceived need to
save them.
Individual may hoard any books, wrappers,
packing bags, food, animals, etc.
TRICHOTILLOMANIA (HAIR PULLING
DISORDER)

Is defined as a recurrent pulling out of one’s hair

resulting in hair loss.
Common sites: scalp, eyebrows, eyelids, eye lashes.
More common among females (college students)
CON.
This behavior may be proceeded or
accompanied by various emotional
states, such as anxiety, tension, or
boredom.
EXCORIATION DISORDER (SKIN PICKING
DISORDER)
Is characterized by a compulsion to repeatedly pick their
own skin, which results in skin lesions.
Individuals may pick at healthy skin, minor irregularities
(pimples), lesions, and scars.
 These behaviors may be proceeded or accompanied by
various emotional states such as anxiety, tension, or
boredom.
Thank you!