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Anxiety, Obsessive-Compulsive Disorder

&

Related Disorders

Presented by: Alayna, Alyssa D, Alexis, & Miranda

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Conditions table of contents

Classic Picture

01

Impact on Occupation

02

Performance Skills

04

Performance Patterns

05

03

06

Contextual/ Environmental Concerns

Client Factors

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Classic Picture

01

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What is anxiety vs an anxiety disorder?

Anxiety: slight uneasiness -> extreme fear

Natural human feeling

Anxiety disorder: extreme feeling of fear beyond appropriate situations
DSM-5 Criteria

(Brown et al., 2019)

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15%

Prevalence & Incidence of Anxiety

Of the population will be diagnosed with anxiety disorder in their lifetime

(Brown et al., 2019)

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1.2 billion

Prevalence & Incidence of Anxiety

People have a diagnosable anxiety disorder on a global level

(Brown et al., 2019)

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40 million

Prevalence & Incidence of Anxiety

People experience difficulty with an anxiety disorder every year.

(Brown et al., 2019)

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Gender Differences

Women are 2x more likely to develop an anxiety disorder than men

(Brown et al., 2019)

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Etiology of Anxiety

Biological Factors

GABA & Serotonin completion

Genetic factors

Familial history = 20% risk increase
Phobia = 61% risk increase

Psychosocial factors

Lived experiences, upbringing, etc
Abnormal response to anxiety

(Brown et al., 2019)

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Types of anxiety

Type	Definition
Separation anxiety	Excessive fear about being apart from something ( person, object, or location, etc.)
Social anxiety	Extreme fear or distress when in social situations and strive to avoid social situations at all costs
Selective mutism	The consistent inability to speak in social situations
Panic Disorder	Repetitive panic attacks or events of extreme fear that elicit physical symptoms such as trembling and sweating

(Atchison & Dirette, 2023)

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Types of anxiety cont.

Type	Definition
Phobia	An irrational fear over one specific item or situation
Agoraphobia	Thoughts about harmful events or bad things happening on a regular basis
Generalized Anxiety Disorder (GAD)	An all-encompassing fear about daily life and circumstances an individual encounters on a day-to-day basis.

(Atchison & Dirette, 2023)

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Signs & Symptoms: Anxiety disorders

Physical

Sensory

Cognition

Fatigue
Sweating
Trembling
Nausea
SOB
Frequent urination
Hyperventilation

Elevated responses
Sensitivity to stimuli/environmental changes

Decreased attention
Emotional dysregulation
Decision making
Problem solving

(Atchison & Dirette, 2023)

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Course & Prognosis: Anxiety

Chronic nature

Untreated
Varying onset ages

Disorder-specific

Childhood onset: separation anxiety, social anxiety, phobias

Selective mutism; age 5

Later onset: agoraphobia; age 35
GAD has no definite “start” and “finish”

Predictors

Prenatal stress
Upbringing; trauma, bullying, etc
Unhealthy familial relationships

(Atchison & Dirette, 2023)

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Psychopharmacological Management: Anxiety

No medical treatments or surgeries are strongly suggested for anxiety disorders

Selective Serotonin Reuptake Inhibitors (SSRIs):

First-line treatment for anxiety disorders.
Common SSRIs: Prozac (fluoxetine), Paxil (paroxetine), Luvox (fluvoxamine), Zoloft (sertraline), Celexa (citalopram).
Initial side effects: Slight nausea or jitters

Benzodiazepines:

Short-term relief of acute anxiety or in addition to SSRIs.
Common benzodiazepines: Xanax (alprazolam), Ativan (lorazepam).
Concerns: Addictive
Withdrawal issues: Can lead to rebound anxiety, insomnia, diarrhea, light sensitivity, and balance issues among older clients

(Atchison & Dirette, 2023)

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Of the U.S. population has OCD

1-3%

Lifetime prevalence rate

2.3%

Prevalence & Incidence of OCD & related disorders

(Brown et al., 2019)

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Gender Differences

More affected during adulthood

More affected during childhood

(Brown et al., 2019)

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Prevalence & Incidence of OCD & related disorders

Predictors:

Family history
Younger onset age
Being single
Higher economic status

(Atchison & Dirette, 2023)

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Etiology: OCD & related disorders

Neurological

Environmental

Genetic

Hyperactivation of the frontal cortex
Dysregulation of neurotransmitters

GABA
Serotonin

Previous injury

Stroke, TBI, TI

Childhood environment
Upbringing; life experiences within previous, current, and future environments
Triggers: PTSD, Panic disorder

Family history

Twin studies

(Brown et al., 2019)

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Types of OCD & related disorders

Type	Definition
Body dysmorphic disorder	Engages in obsessive compulsions with oneself and repeatedly checks their physical appearance
Hoarding disorder	Obsession with retaining objects and the fear of discarding materials and personal possessions
Trichotillomania (hair pulling)	Engages in a body-focused repetitive behavior (BFRB) revolving around pulling out hair
Excoriation (skin picking)	Engaging in a BFRB of picking their own skin

(Atchison & Dirette, 2023)

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Signs & Symptoms: OCD & related disorders

Obsessions

Repetitive behavior

Compulsions

Relief from anxiety producing obsession

Disorder specific

Frequency
Duration
Intensity
Infection

(Atchison & Dirette, 2023)

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Course & Prognosis: OCD & related disorders

Chronic in nature

Untreated: waxing and waning pattern

Rare not to have diagnosis by the age of 40

Later onset: prerequisite to depression diagnosis

Difficulty with decision making

Early onset: 41% greater persistence rate

(Atchison & Dirette, 2023);(Brown et al., 2019)

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Treatment: OCD & related disorders

CBT

ECT & rTMS

EPR

DBS

Cognitive behavioral therapy: emotional regulation

Electroconvulsive therapy & repetitive transcranial electromagnetic stimulation: ease neural pathways

externally

Exposure and response prevention: control compulsive thoughts/behaviors

Deep brain stimulation: ease neural pathways internally

(Atchison & Dirette, 2023);(Brown et al., 2019)

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Associated Disorders

Depressive disorders
Substance abuse disorder
Eating disorders
Personality disorders
Schizophrenia
Common themes: depersonalization & derealization

(Atchison & Dirette, 2023);(Brown et al., 2019)

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Impact on Occupation

02

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Activities of Daily Living

Anxiety

OCD

Inconsistent showering habits
Forgetting to brush their teeth
Neglecting personal grooming
Difficulties with dressing
Occupational initiation problems
Disrupted daily routine

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Increased time for daily activities
Compulsions about clothing choices
Excessive rituals around cleanliness and hygiene
Avoidance of certain foods due to contamination fears

Anxiety

Individuals with anxiety may have inconsistent showering habits, which can include not showering at all or showering too much. They may forget to brush their teeth and neglect grooming, such as hair and nail care. Choosing appropriate clothing can also be difficult, leading to issues with getting dressed and changing into clean clothes. Additionally, anxiety can cause occupation initiation issues, making it hard to get out of bed and disrupting their routines.

OCD

According to research by Zisler and others, individuals with OCD who experience compulsions reported spending more time on 10 out of 13 daily tasks compared to those without OCD. Specifically, 66% of individuals with OCD experienced compulsions when changing clothes, and 62% had compulsions while showering. Many also have excessive rituals around cleanliness and hygiene, which can lead to showering too often and for too long. Fears of contamination may cause them to avoid certain foods which can make eating challenging.

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Instrumental Activities of Daily Living

Anxiety

OCD

Financial management challenges
Struggles with decision-making
Driving difficulties
Trouble navigating crowded places
Challenges with household tasks
Medicine management struggles

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Perfectionism preventing task completion with chores
Repeated cleaning of household items
Excessive check of locks and appliances

Anxiety:

People with anxiety may have challenges with financial management. This may be trouble budgeting and managing household expenses which may lead to insufficient funds. Additionally they may struggle with decision making such as planning meals, managing schedules, or organizing household tasks. Individuals with anxiety may find driving stressful, especially during rush hour or over long distances. Using public transportation can be difficult as well which makes going places a challenge. Going to the grocery store or any other crowded place can also become more difficult for people with anxiety. Challenges with household tasks can include difficulty cleaning up, washing dishes, and doing laundry although some people may over-clean and never feel satisfied with the results. Anxiety may cause individuals to forget to take medications or to worry excessively about potential side effects, leading to inconsistent use.

OCD:

Rituals or compulsions can take up a lot of time, making it difficult to complete tasks like grocery shopping, cleaning, or other chores. People with OCD may also repeatedly clean certain items in their house and excessively check locks and other appliances.

High percentages reported experiencing obsessions/compulsions when:

Leaving the apartment (84%)
Cleaning (70%)
Grocery shopping (66%)

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Rest & Sleep

Anxiety

OCD

Disrupted sleep patterns

Falling asleep
Staying asleep
Getting enough sleep

Fatigue affecting other areas of occupation

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Rituals delaying sleep onset
Intrusive thoughts can keep individuals awake
Challenges with sleep routines
Exhaustion from poor sleep patterns

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Education

Anxiety

OCD

Difficulty concentrating during class
Performance anxiety regarding tests, presentations, etc.
Hesitant to engage in class discussions
Attendance problems due to feeling overwhelmed

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Time consuming rituals may disrupt studying
Obsessive worries impacting focus and performance
Perfectionism may get in the way of assignment completion

Anxiety

Individuals with anxiety may excessively worry about future events during class, studying, or while doing homework which can affect their ability to get work done. Additionally, they may have performance anxiety when it comes to tests or presentations which can affect how well they perform regardless of how much time they spent preparing. They might be also hesitant to engage in class discussions due to fear of what others might think about them and they might avoid attending class because they feel overwhelmed.

OCD

Individuals with OCD may spend so much time on their rituals that they have no time left to study or complete assignments. Similarly to anxiety, they may have obsessive worries that impact their focus and performance on school work. And perfectionism may get in the way of assignment completion. Meaning they are never satisfied with their work which may affect their ability to complete tasks on time.

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Work

Anxiety

OCD

Challenges in job performance
High levels of stress from work demands and personal expectations
Physical and emotional struggles
Communication barriers
Difficulty finding a job

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Inability to finish work due to excessive revisions
Intrusive thoughts can affect productivity
Impact on attendance

Anxiety can impact work performance. Individuals may find it hard to remember details, concentrate, and take initiative on tasks. They may also experience significant increases in stress level from work demands and personal expectations. People may feel physical and emotional struggles such as low energy, pain, and fatigue, which can make work even more difficult. Chaotic and noisy work environments can increase anxiety, making it harder to focus. Additionally, individuals might avoid looking for new jobs because they feel they are not good enough. They may also struggle to communicate with coworkers or supervisors, adding to their challenges at work.

OCD

Individuals with OCD may have difficulty finishing work in a timely manner due to excessive revisions. Additionally, intrusive thoughts can disrupt concentration which can affect productivity. Compulsions may also result in missed days at work or difficulty maintaining a regular schedule.

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Leisure

Anxiety

OCD

Difficulty prioritizing leisure activities over responsibilities
Difficulty concentrating on quiet activities
Spending excessive time watching TV
Inconsistent levels of exercise
Pet care struggles

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Obsessive thoughts affect relaxation and enjoyment
Perfectionism can limit engagement in creative activities

Anxiety: Many individuals with anxiety face challenges in prioritizing leisure activities over responsibilities, often feeling overwhelmed by their daily tasks. Concentrating on quiet activities, such as reading or meditating, can also be difficult due to racing thoughts. Additionally, individuals may spend excessive time watching TV. Exercise levels can be inconsistent which can negatively impact mental health, because regular physical activity can be good for well-being. Individuals with social anxiety may find it difficult to take their pets outside of the house, worrying about encounters with other people which can affect their pets well-being as well.

OCD: Obsessive thoughts can impact relaxation and enjoyment in leisure activities. When intrusive thoughts take over, it becomes difficult to engage fully in activities meant for leisure. Perfectionism also limits participation in creative activities. Individuals may feel their work must meet unrealistically high standards, leading to avoidance of these activities.

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Play

Anxiety

OCD

Avoiding group activities due to fear
Difficulty focusing and fully engaging in play activities
Fear of judgement during team-based activities

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Fear of contamination affecting participation in team games
Obsessions about outcomes affect exploration in creative play

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Social Participation

Anxiety

OCD

Challenges meeting new people
Over-planning and avoidance
Problems maintaining contact with loved ones
Difficulty communicating
Imbalance of social and alone time

(Geller, 2022; Zisler et al., 2024; Obsessive-Compulsive Disorder, 2017; Gunnarsson et al., 2021)

Excuses to avoid social interactions in order to complete compulsions
Difficulty engaging in conversation
Challenges in maintaining relationships

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Client Factors

03

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Anxiety

Body Structures

Increase in the size of the amygdala

Values, Beliefs, Spirituality

Distorted thoughts can lead to distorted values and beliefs
May not participate in community spiritual events

Body Functions

Heightened reactions to stressful situations

Leads to the symptoms of anxiety including the physical, cognitive, social, emotional, and sensory symptoms

(Martin et al., 2013)

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OCD

Body Structures

Decreased amount of gray matter in different areas of the brain*
Decrease in the size of the amygdala

* = No relation to function

Values, Beliefs, Spirituality

Patterns of obsessing over values and beliefs
Compulsions in spirituality

Repetition in prayers
Constant organization of religious material
Repeated asking of reassurance questions

Body Functions

Changes in concentration
Interruption of thought processes
Getting “stuck” in a repetition of sequencing complex movement

(Pujol et al., 20004; Zisler et al., 2024)

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Performance Skills

04

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Performance Skills- Anxiety

Cognitive

Sensory

Motor

Anxiety causes cognitive deficits when presented with a fearful stimulus such as trouble sequencing, organizing and recalling directions for tasks due to hyperarousal.

Sensory seeking vs Sensory avoiding

Sweating, shaking, hypertension, increased heart rate, increased blood pressure and or trembling.

(Brown et al., 2019).

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Performance Skills- Anxiety Continued….

Emotional Regulation

Social Communication

Individuals diagnosed with anxiety may also experience emotional dysfunction due to increased suppression and avoidance of negative emotions.

one might avoid high populated areas that may provoke negative physical symptoms such as tremors, sweating, increased heart rate- which impact social interaction .

(Brown et al., 2019).

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Performance Skills- OCD

Cognitive

Sensory

Emotional Regulation

Social Communication

Motor

OCD also affects cognitive functions such as executive functioning when organizing tasks due to altering repetitive compulsive behavior and selective attention.

Individuals diagnosed with OCD might avoid sensory stimuli that may trigger unwanted obsessions or compulsions.

OCD also affects emotional regulation by participating in compulsions to self-soothe for coping as a result to an unwanted stimulus.

Social interaction is also negatively impacted for Individuals diagnosed with OCD. This is due to avoiding specific people if they trigger unwanted repeated compulsions

Poor fine motor and visual motor skill deficits (more common in pediatric clients).

(Grisham et al., 2009; Bloch et al., 2011; Brown et al., 2019).

Sensory: This may include public bathrooms and doctors' offices

Cog: In a 2009 cohort study exploring the premorbid impairments of individuals with OCD found that individuals among the OCD group demonstrated poor performance on tests that evaluate visuospatial and visuomotor abilities compared to control group. It is important to note that along there was observable instances of divided attention during tasks. This is due to receiving positive feedback by the individual when completing repetitive behavior.

Motor skills: The same literature from 2009 also shows that participants within a cohort study OCD were much slower at completing the grooved Pegboard test compared to control groups (Grisham et al., 2009). These results were even consistent with adjustment to hand preference. With that, in a later longitudinal study from 2011 that followed children with OCD into early adulthood found similar findings that revealed that individuals with OCD performed poorly on the purdue pegboard test with the dominant hand condition (Bloch et al., 2011).

ER: Such as washing hands when in a messy room or counting out loud when anxious

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Performance Patterns

05

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Anxiety

Habits

Routines

Rituals

Roles

Individuals may “freeze” which could take away ability to do habits
May need put more thought into their habits

How they spend their day
What they may avoid due to stress

Stress might keep them from their rituals, especially if the rituals may come with stress (example, family holidays)

May avoid stressful roles
Examples

Healthcare worker
Higher-up
Being a parent

(Wein., 2016)

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OCD

Habits

Routines

Rituals

Roles

Can get hung up on their habits
Do their habits a specific number of times

Routines may take longer
May become too obsessed with what they are doing and cannot get other things done

May become obsessed with ritual and not be able to continue their day until rituals are completed

If role has too many components, might not be able to accomplish everything they are required to do within their role

Could lose roles

(Zisler et al., 2024)

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Contextual/ Environmental Concerns

06

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Contextual/ Environmental Concerns

Environmental factors:

Upbringing
Triggering stimuli

Personal factors:

Parenting style/upbringing
Parental role
Social roles throughout the lifespan

(Brown et al., 2019).

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Client-centered Intervention: Emma

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About Emma

Diagnosed with GAD at 10 years old
Gym class triggered anxiety
Would be so anxious to go to school she would become sick
Felt like she did not have control
Was jealous of her peers by how they could live without anxiety and panic attacks

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Mindful Morning Intervention: Mindfulness Schedule for Morning Occupations

Guiding model of practice

MOHO

Focus on motivation to go to places outside of home and habituation of everyday positive self care routines

Purpose

Promote independent use of healthy mindfulness techniques to reduce symptoms of high anxiety during their daily routine

Occupation we focused on:

Eating

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Breakdown of Intervention

5

10

Completion of a mindfulness schedule and selecting mindfulness techniques to practice using a handout

Greet client, overview of session, providing / reviewing educational handouts, verbalizing instructions, reviewing client’s morning routine and when they feel the most anxious

Practice time for the mindfulness schedule (5 senses for grounding), technique will be completed while doing an occupation (eating)

Debrief and self-reflection

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Thank you!

Any questions?

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References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 74(4). https://doi.org/10.5014/ajot.2020.74s2001

Atchison, B., & Powers Dirette, D. (2023). Conditions in Occupational Therapy:

Effect on Occupational Performance, Sixth Edition (6th ed.). Wolters Kluwer.

Bloch, M. H., Sukhodolsky, D. G., Dombrowski, P. A., Panza, K. E., Craiglow, B. G., Landeros-Weisenberger, A., Leckman, J. F., Peterson, B. S., & Schultz, R. T. (2011). Poor fine-motor and visuospatial skills predict persistence of pediatric-onset obsessive-compulsive disorder into adulthood. Journal of Child Psychology and Psychiatry, 52(9), 974–983. https://doi.org/10.1111/j.1469-7610.2010.02366.x

Brown, C., Stoffel, V., & Muñoz, J. P. (2019). Occupational therapy in mental health: A vision for participation (2nd ed.). F.A. Davis Company.

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References

Brown, C., Stoffel, V., & Muñoz, J. P. (2019). Occupational therapy in mental health: A vision for participation (2nd ed.). F.A. Davis Company.

Dong, D., Wang, Y., Chang, X., Luo, C., & Yao, D. (2017). Dysfunction of Large-Scale Brain Networks in Schizophrenia: A Meta-analysis of Resting-State Functional Connectivity. Schizophrenia Bulletin, 44(1), 168–181. https://doi.org/10.1093/schbul/sbx034

Geller, J. (2022, October). What Is Obsessive-Compulsive Disorder? Psychiatry.org. https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder#:~:text=Obsessive%2Dcompulsive%20disorder%20(OCD)

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References

Grisham, J. R., Anderson, T. M., Poulton, R., Moffitt, T. E., & Andrews, G. (2009). Childhood neuropsychological deficits associated with adult obsessive–compulsive disorder. British Journal of Psychiatry, 195(02), 138–141. https://doi.org/10.1192/bjp.bp.108.056812

Gunnarsson, A. B., Hedberg, A. K., Håkansson, C., Hedin, K., & Wagman, P. (2021).Occupational performance problems in people with depression and anxiety. Scandinavian Journal of Occupational Therapy, 30(2), 148–158. https://doi.org/10.1080/11038128.2021.1882562

Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. The Psychiatric clinics of North America, 32(3), 549–575. https://doi.org/10.1016/j.psc.2009.05.004

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References

Obsessive-Compulsive Disorder (OCD) – OT Dude. (2017). Otdude.com. https://www.otdude.com/academy/nbcot-exam-prep/lesson/pediatric-psychosocial-disorders/topic/obsessive-compulsive-disorder-ocd/#Impact_on_Occupations

Pujol, J., Soriano-Mas, C., Alonso, P., Cardoner, N., Menchon, J. M., Deus, J., Vallejo, J. (2004). Mapping structural brain alterations in obsessive-compulsive disorder. Arch Gen Psychiatry, 61(7), 720-730. doi:10.1001/archpsyc.61.7.720

Wein, H. (2016). Understanding anxiety disorders. NIH News in Health. https://newsinhealth.nih.gov/2016/03/understanding-anxiety-disorders.

Zisler, E. M., Meule, A., Koch, S., Schennach, R., & Voderholzer, U. (2024). Duration of daily life activities in persons with and without obsessive–compulsive disorder. Journal of Psychiatric Research, 173, 6-13.