OCD

• Obsessive–compulsive disorder (OCD) – previously classified as an anxiety disorder due to the sometimes extreme anxiety that people experience.
• Obsessive–compulsive spectrum – certain disorders characterized by repetitive thoughts and/or behaviors, such as OCD. 
• The spectrum approach includes repetitive behaviors of various types: 

  • self-soothing behaviors
  • reward-seeking behaviors
  • disorders of body appearance or function
• • self-soothing behaviors
  • Trichotillomania,
  • Dermatillomania
  • onychophagia; 
• • reward-seeking behaviors
  • Hoarding,
  • Kleptomania
  • Pyromania
  • Oniomania
• • disorders of body appearance or function
  • body dysmorphic disorder (BDD)
• Obsessions - recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function.
• Compulsions - ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.
• Theme of the ritual is associated with that of the obsession
• • repeatedly making sure the door is locked or the coffee pot is turned off

  checking rituals
• • each step taken, ceiling tiles, concrete blocks, or desks in a classroom

  counting rituals
• • feeling the texture of each material in a clothing store; touching people, doors, walls, or oneself)

  Touching, rubbing, or tapping:
• • arranging and rearranging furniture or items on a desk or shelf into perfect order; vacuuming the rug pile in one direction

  Ordering
• • getting dressed in an unvarying pattern

  Exhibiting rigid performance
• • to throw one’s child against a wall


  Having aggressive urges
• OCD – diagnosed only when these thoughts, images, and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational functions. 
• OCD can start in childhood, especially in males. 
• OCD in females commonly begins in the 20s
• • Distribution between the sexes in OCD is equal. 
• The onset OCD is typically in late adolescence, with periods of waxing and waning symptoms over the course of a lifetime.
• Early-onset OCD (average age of 11): 

  • more likely to affect males
  • more severe symptoms
  • more comorbid diagnoses
  • greater likelihood of a family history of OCD
• Late- onset OCD (average age of 23) 
• Cognitive models of OCD by Aaron Beck’s 

  • accepted as a partial explanation for OCD since CBT is a successful treatment 
• Cognitive model describes the person’s thinking as:


  • believing one’s thoughts are overly important and therefore having a need to control those thoughts
  •  “If I think it, it will happen,”
  • perfectionism and the intolerance of uncertainty; 
  • inflated personal responsibility (from a strict moral or religious upbringing) 
  • overestimation of the threat posed by one’s thoughts.
• Cognitive model

  •  focuses on childhood and environmental experiences of growing up. 
• manifested through repetitive, meaningless, and difficult behaviors to conquer. 

  OCD
• • The person understands that these rituals are unusual and unreasonable but feels forced to perform them to alleviate anxiety or to prevent terrible thoughts.
• • source of distress and shame to the person, who may go to great lengths to keep them secret. 

  Obsessions and compulsions
• Recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance as intrusive and unwanted and that in most individuals cause marked anxiety or distress

  Obsessions
• The individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action
• Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

  Compulsions
• The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation
• These behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
• The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• • excessive worries


  generalized anxiety disorder; 
• • preoccupation with appearance

  BDD; 
• • difficulty discarding or parting with possessions: hoarding disorder; 
• • Trichotillomania: hair-pulling disorder; 
• • Excoriation (skin- picking): skin-picking disorder; 
  • Stereotypies: stereotypic movement disorder; 
  • ritualized eating behavior: eating disorders; 
• • preoccupation with substances or gambling: substance-related and addictive disorders; 
  • preoccupation with having an illness: illness-anxiety disorder; 
  • sexual urges of fantasies: paraphilic disorders; 
  • Impulses: disruptive, impulse control, and conduct disorders;