OCD

• What is OCD?

  Characterised by the presence of either obsessions or compulsions (commonly both)

  Symptoms cause significant functional impairment and/or distress
• What is an obsession?

  An unwanted intrusive thought, image or urge that repeatedly enters the person's mind
• What are compulsions?

  Repetitive behaviours or mental acts that person feels driven to perform in an attempt to reduce anxiety/distress

  Can either be overt & observable by others (e.g. checking door is locked) or a covert mental act that cannot be observed (e.g. repeating a certain phrase in their head)
• What are ego-dystonic thoughts?

  Unwanted, intrusive thoughts that are out of sync with values & beliefs
• What are the RFs of OCD?

  FHx of OCD

  Age (peak onset = 10-20 years)

  Pregnancy/post-natal period

  Hx of abuse, bullying, neglect
• What are the signs & symptoms of OCD?

  Obsessions

  Compulsions

  Sensory phenomena (inc physical sensations, just-right sensations, and feelings of incompleteness)
• What are the common obsessions in OCD?

  Contamination fears - fear of becoming contaminated by germs, dirt or harmful substances

  Harm-related obsessions - fear of causing harm to oneself or others due to negligence or unintentional actions

  Unwanted sexual thoughts - intrusive & distressing sexual thoughts or images involving inappropriate behaviours

  Religious/moral obsessions - excessive concern with religious or moral issues

  Perfectionism/symmetry - intense need for orderliness, symmetry, or exactness
• What are the common compulsive behaviours in OCD?

  • Cleaning/washing: Excessive handwashing, showering, cleaning of objects, etc.
  • Checking rituals: Repeatedly checking doors, appliances, etc.
  • Counting/repeating rituals: Performing mental acts (e.g., counting) or repeating actions a specific number of times to reduce anxiety
  • Ordering/arranging behaviours: Arranging objects in a particular manner or following strict routines to achieve a sense of orderliness and control
  • Mental neutralizing strategies: Attempt to counteract intrusive thoughts with other thoughts (e.g. prayer) to alleviate distress
• What psychiatric conditions is OCD commonly associated with?

  Major depressive disorder

  Anxiety disorders

  Tics disorders

  Personality disorders
• What are the DDx of OCD?

  Obsessive-compulsive personality disorder (OCPD)

  Anxiety disorders

  Depression

  Body dysmorphic disorder

  Somatic symptom disorder

  Illness anxiety disorder (hypochondriasis)

  Delusional disorder

  Autism spectrum disorder

  Olfactory reference disorder

  Substance-induced or medication-induced OCD

  Hoarding disorder

  Trichotillomania/Excoriation disorder
• What is body dysmorphic disorder?

  Preoccupation with perceived flaws in physical appearance leading to repetitive behaviours (e.g., mirror checking)
• What is hoarding disorder?

  Accumulation of possessions due to perceived need or difficulty discarding items, without the presence of obsessions or compulsions
• What is trichotillomania?

  Repetitive hair pulling -> noticeable hair loss
• What is excoriation?

  Repetitive skin picking -> skin lesions
• What is the management of mild OCD?

  CBT including exposure and response prevention (ERP)

  Then can add in SSRI if needed
• What is the management of moderate OCD?

  Choice or either SSRI or more intensive CBT (including ERP)

  Consider clomipramine
• What is the management of severe OCD?

  Combined treatment with SSRI & CBT (inc ERP)

  Refer to secondary mental health team for assessment

  Consider clomipramine
• What are the possible complications of OCD?

  Reduced QoL

  Dermatitis (due to excessive handwashing)

  Self-harm & suicide