Obsessive Compulsive Disorder(OCD)

An anxiety disorder

Obsessions

Are recurrent and persistent ideas, impulses or images that are experienced as intrusive and inappropriate and cause anxiety and distress. The patient recognises them as his/hr own thoughts, and may try to resist, but may find them impossible to remove.

In adults the most common obsessions are-

Thoughts of contaminationPathological doubt (such as, if whether

simple tasks have been properly completed)

Thoughts of having physical symptomsSymmetry, for instance, of household

objectsAggressive thoughts.

COMPULSIONS

Are recurrent and persistent behaviours or mental acts undertaken to prevent, or reduce, anxiety or distress in the belief that they will prevent a dreaded event from occurring.

They do not produce pleasure, and the tasks performed do not bring pleasure.

If they are resisted, anxiety can increase.

Common compulsions

CheckingWashingCountingNeeding to ask questions or make

confessionsCreating symmetry and orderNeeding to be precise.

Obsessions and compulsions are often linked, as the desire to resist an obsessional thought produces a compulsive act.

Linked obsessions and compulsions

Obsession Compulsion

Contamination Hand washing, avoidance of dust, germs or urine.

Doubt (eg have I switched the iron off?)

Repeated checking of the object (iron) in doubt.

Need for symmetry Compulsive slowness in maintaining symmetry.

Other obsessions

Fear of being responsible for someone’s death or illness.

Obsessive thoughts – such as an endlessly repeated chain of thought, often about a possible event in the future.

Other compulsions

Counting - such as counting up to 6 over and over again, doing everything 6 times.

Touching – the need to touch a part of the body as part of a ritual

Obsessions and compulsions have some features in common

The ideas or impulses are recurrent.They are a product of their own mindThey are accompanied by feelings of

dreadThe sufferer tries to fight them off

Although Attempts to resist them may fade over time, the patient remains aware that they are both absurd.

OCD- a subject for humour?

OCD has been used in films as a humorous device, such as by Jack Nicholson in the film “As Good as it Gets”

http://www.youtube.com/watch?v=4yOpEMqnsCQ

OCD in film

A more realistic portrayal of the illness was shown by Leonardo diCaprio in the film “The Aviator”

http://www.youtube.com/watch?v=8dR8xVqSfXc

OCD – The Reality

However, OCD is a disorder that causes great distress, as this clip shows

http://www.youtube.com/watch?v=Rn1OYlYzgm8

Criteria for diagnosis

Repetitive and unpleasant obsessions or compulsions occur on most days for at least 2 weeks.

They are acknowledged to originate from the patient’s own mind.

At least one obsession or compulsion is seen as excessive or unreasonable

Resistance is (or has been) attempted and at least one obsession or compulsion has been resisted unsuccessfully.

Although obsessions and compulsions may relieve anxiety, they are not pleasurable and impair functioning, usually by wasting time.

The difference from other anxiety disorders

Phobias – the stimulus that provokes the anxiety comes from an external object or situation.

Panic disorder or Generalised Anxiety Disorder – panic attacks are unpredictable and not linked to obsessional thoughts.

Depression

Over two thirds of patients with OCD experience major depression during their lives.

In fact, having an obsessive compulsive personality leads to depressive disorders more than to the development of OCD.

Who gets OCD?

Lifetime risk of developing the disorder -2%

Males and females are equally at riskMost common age of onset – under 25

years old.

Prognosis (progression of the disorder)

OCD can be long lasting for about a third of sufferers. They remain incapacitated in spite of treatment. This is associated with- Development of this disorder at a young ageThe need for hospitalisationSevere depression

Causes of the disorder

These may be either-Physiological orpsychological

Physical causes

We will look at possible physiological causes first

Genetic factors

Family and twin studies have shown that there is a strong family link for the disorder.

People with a first degree relative (parent or sibling) with OCD have a 5 times greater risk of having the illness.

Identical twins were more then twice as likely to develop OCD if their twin had OCD than were fraternal twins.

A variation in the COMT gene has been identified in OCD sufferers.

Biochemical factors

Serotonin deficiency – perhaps OCD sufferers have too little serotonin for their nerve cells to communicate effectively.

SSRIs (drugs to increase the movement of serotonin between cells) have been shown to reduce OCD symptoms.

PET scans show OCD sufferers have lower levels of serotonin.

After taking SSRIs, PET scans show a return to normal levels of serotonin.

Brain dysfunction

There is evidence of abnormal brain structure and activity in patients with OCD.

These abnormalities are found in the pathway linking the lobes (responsible for judgement) with the basal ganglia (which are part of the system frontal for planning behaviour)

PET scans support this and show SSRIs affect the metabolism in this area, reducing OCD symptoms.

Psychological causesPsychodynamic

Freud- OCD arises when unacceptable wishes and impulses from the id are only partially repressed so cause anxiety. Ego defence mechanisms are used to reduce the anxiety. These defence mechanisms are used unconsciously and acts, such as hand washing, are thought to be an act to symbolically undo the unacceptable id impulses.

Cognitive explanation

This can help to explain how the behaviours continue.

The thoughts like “if I don’t do this something awful will happen” cannot be controlled by the sufferer.

Such as compulsive hand washing to avoid becoming ill.

Also - the possibility that compulsive behaviour is linked to a poor memory for having carried out actions is being investigated.

Behavioural explanation

OCD develops as a way of reducing anxiety. Operant conditioning offers an explanation for this.

negative reinforcement- washing hands reduces fear, so is repeated.

Superstition hypothesis – such as footballers who have to be last on the pitch – this is associated with past success so failure to carry them out causes anxiety.

Famous people with OCD

Johnny Wilkinson, the England Rugby Union star says-“I always wear the same t-shirt under my England shirt. And I always go out to warm up, come back, put my shoulder pads on before my England shirt. I'll never warm up in my England shirt. But this is more routine rather than thinking "if I don't do this, today's going to go horribly wrong". People like to have their own routines to fight back the nerves to keep them sane.”

Bjorn Borg

Five times Wimbledon champion, never shaved during a tournament, because the first time he won, he hadn’t shaved.

John Terry

Wore the same pair of shin pads for 10 years.

Serena Williams

Claimed she lost the 2007 Paris open because "I didn't tie my laces right and I didn't bounce the ball five times and I didn't bring my shower sandals to the court with me."

Paul Ince

Had to be the last player to put on his shirt before the game.

This was fine, until another player with the same ritual joined the team!

David Beckham

Always wears long sleeved football shirts.Wears a new pair of boots for each game. David is aware he has OCD "I have to have everything in a straight

line, or everything has to be in pairs. I'll put my Pepsi cans in the fridge and if there's one too many then I'll put it in another cupboard somewhere."

Treatment

Cognitive Behavioural Therapy is the currently the most effective treatment for this disorder.

http://www.ocdaction.org.uk/ocdaction/index.asp?id=132

Message board of rituals

http://www.healthboards.com/boards/showthread.php?t=281134&page=1