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Obsessive Compulsive Disorder

Getting Help and Support for Recovery

Presentation in Support of

OCD Awareness Week

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DSM-5-TR Disorders

OCD and Related Disorders

BDD

Hoarding

Trichotillomania – Hair Pulling

Excoriation – Skin Picking

Other – nail biting, lip biting

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Obsessive-Compulsive Disorder

Between 2% to 3% of U.S. population suffer from OCD in a given year
It is equally common in men and women (adults more women; children 2x more boys) and equally common in different racial and ethnic groups
Most of those with OCD seek treatment

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OCD Trickster

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Obsessive-Compulsive Disorder

Made up of two components:

Obsessions

Senseless intrusive thoughts, ideas, impulses, or images seem to invade a person’s consciousness – misinterpreted as significant and threatening

Compulsions

Repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety – these compulsive behaviors are reinforced by the reduction in distress they engender

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Obsessive-Compulsive Disorder

Diagnosis is called for when symptoms:

Feel excessive or unreasonable
Cause great distress OR
Take up much time (more than 1 hour a day)
Interfere with daily functions

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Common Types of Obsessions and Compulsions

Contamination Obsessions – Cleaning, Avoiding
Symmetry – Ordering, Arranging, Counting
Perfectionism – Checking, Repeating
Illness and Safety – Checking, Avoiding
Harming – Checking, Reassurance Seeking
Moral and Religious – Confessing, Praying
Doubting – ROCD, SOOCD
Miscellaneous -

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Cognitive Errors

Assigning too much importance to thoughts.
Overestimation danger of bad event.
Overestimating the consequesces of danger of harm.
Overestimating responsibility.
Overestimating the possibility for control, certainty or perfectionism.

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LARRY

Larry is a 20 year old student who successfully completed his first year of college.
He is engaging, friendly and extremely distressed. He reports that during the Fall semester of his sophomore year, he became suddenly very depressed and anxious.
He is plagued by thoughts about suicide. He panics when he thinks: “ I’m going to lose control and kill myself”.

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LARRY

He feels horrible, depressed, vacant, fearful, detached from himself (depersonalized).
He has panic attacks, early morning anticipatory anxiety, difficulty sleeping, difficulty eating, fatigue, relentless thoughts about killing himself, and avoidance of places and things that trigger the suicidal thoughts.
He reports going to work as do his job as a waiter but stays at home otherwise or sees his girlfriend. He has gone to the Emergency Department several times with the fear that he will kill himself.

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LARRY

He was recently hospitalized because his outpatient psychiatrist thought he was at risk because of the suicidal thoughts. The hospital modified his medication and recommended therapy several times a week.

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LARRY

Obsesses about killing himself and neutralizes the thought with reassurance about how he wants to live, and that he would never want to die. He compares himself to people he met in the hospital who were truly suicidal and says “I am afraid of dying, I do not want to die.”
He would ask his father to engage in discussion about his suicidal thoughts as a way of getting reassurance. His father and mother could not tolerate listening to his discussions and this caused family arguments. He got so upset with his father one evening that he exploded and threw furniture. His father was frightened by this behavior and wanted him in the hospital.
He would doubt himself and try to reassure himself by praying or tracing his actions and making sure he did not take too many pills. He feared the he would kill himself without knowing by taking too many pills by not paying attention.

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OCD �Intrusive Thoughts

Everyone has repetitive, unwanted, and intrusive thoughts

People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen
This is the critical misinterpretation that leads to performing compulsive acts.
For example, my thought that I could harm my cat, Eleanor – but I let the thought go down the stream of consciousness!

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'Do one thing every day that scares you’. Eleanor Roosevelt

My Cat, Eleanor Roosevelt

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Normal Intrusive Thoughts

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OCD �Intrusive Thoughts

To avoid such negative outcomes, they attempt to “neutralize” their thoughts with actions (or other thoughts)
Neutralizing thoughts/actions may include:

Seeking reassurance
Thinking “good” thoughts
Washing
Checking

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OCD�Intrusive Thoughts

When a neutralizing action reduces anxiety, it is reinforced

Individual becomes more convinced that the thoughts are dangerous
As fear of thoughts increases, the number of thoughts increases
Thought Suppression Effect

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�OCD – Cognitive Behavior Therapy �

Behavioral therapy

Exposure and response prevention (ERP)

Clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions
Therapists often model the behavior while the client watches

Homework is an important component

Between 60 and 90 percent of clients have been found to improve through ERP, with 50% to 80% symptom reduction rate, and improvements are often durable

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Cognitive Behavior Therapy for OCD

Psychoeducation – mostly based on understanding habituation –
Hierarchy Development
In vivo and Imaginal Exposure; Cognitive restructuring (challenge cognitive distortions
Relapse Prevention

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Perfectionism Hierarchy

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Scrupulosity Hierarchy

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Imaginal Exposure - Flooding

I am severely depressed, it’s so deep in my head, it’s incurable, and any thought I have is from this horrible depression. It is not from my OCD. The fact that I worry about this shows how severely depressed I am. And because I am depressed I will no doubt swallow all my pills one night and really commit suicide because that’s truly what I want to do because I don’t want to live anymore. I’m absolutely miserable and I’ve been fooling myself that it’s OCD all along. I have a form of depression that only a few people get and no matter what it is impossible to get rid of. If I stop doing compulsions I will be even more depressed. I really want to kill myself because life is not what it used to be.

I won’t be able to deal with the thoughts anymore and will end up killing myself.

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Family Accommodation –

“ways in which family members assist the individual with OCD in the performance of rituals, avoidance of anxiety provoking situations, or modification of daily routines to assist a relative with OCD.”

(Lebowitz & Block, 2012)

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Accommodation

Linked to greater severity, disruption, and worst treatment outcomes.
60% of families involved in rituals of individuals with OCD.
Treatment that addresses accommodation leads to improved treatment outcomes.

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Accommodations

Providing Reassurance

Observing Rituals

Waiting for the Individual

Stop oneself from saying or doing things

Participating in Compulsions

Facilitate Avoidance

Tolerate Unusual Behaviors/Disruption of Household Routines

Help with Everyday Tasks/Decisions

Take on Individual’s Responsibilities

Modify Routines

(Family Accommodation Scale For Obsessive-Compulsive Disorder – Pinto, Van Noppen, Calvocoressi, 2012)