Clinical Descriptions

• Obsessions

  • Intrusive and nonsensical

  • Thoughts, images, or urges

  • Attempts to resist or eliminate

• Compulsions

  • Thoughts or actions

  • Provide relief from obsessive thoughts

• Statistics

  • 1.6% to 2.3%(life); 1% (year)

  • Female = Male

  • Chronic

  • Onset = childhood to 30s

Diagnostic Criteria

• Presence of obsessions, compulsions, or both

• Obsessions/compulsions are time-consuming

• Disturbance is not due to substance abuse

• Disturbance not better explained by another mental health disorder

Obsessions

• 60% have multiple obsessions

  • Need for symmetry

  • Forbidden thoughts or actions

  • Cleaning and contamination

Compulsions

• Four major categories

  • Checking

  • Ordering

  • Arranging

  • Washing/cleaning

• Association with obsessions

Tic Disorder

• Involuntary movements (e.g. sudden jerking of limbs, movement of jaw, etc)

• Often co-occurs in patients with OCD

• Sometimes tics are used as compulsive behaviors –performed to relieve anxiety associated with obsessions

Causes

• Similar generalized biological vulnerability to having anxiety in general

• Specific psychological vulnerability

  • Early life experiences and learning

  • Thoughts are dangerous/unacceptable

  • Thought-action fusion

• Distraction temporarily reduces anxiety

  • Increases frequency of thought

Treatment

• Medications

  • SSRIs

    • 60% benefit

    • High relapse when discontinued

  • Psychosurgery (cingulotomy)

    • 30% benefit

• Cognitive-behavioral therapy

  • Exposure and ritual prevention (ERP)

  • Highly effective

    • One study found that 86% of patients benefit

  • No added benefit from combined treatment with drugs