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century thought people were
possessed by the devil and treated by
century thought people were cleansing
century finally considered medical
century began treating with behavioral
WHAT IS OCD?
It is an anxiety disorder.
The person has recurring thoughts or
images(obsessions) and/or repetitive,
ritualistic-type behaviors that the individual is
unable to keep from doing(compulsions).
The person may try to suppress these
thoughts or behaviors but is unable to do so.
The individual knows that the thoughts or
behaviors are irrational but feels powerless to
The DSM-IV-TR describes obsessive-
compulsive disorder (OCD) as recurrent
obsessions or compulsions that are severe
enough to be time consuming or to cause
marked distress or significant impairment
It is defined as unwanted, intrusive, persistent
ideas, thoughts, impulses or images that
cause marked distress.
It denote unwanted repetitive behavior
patterns or mental acts that are
intended to reduce anxiety, not to
provide pleasure or gratification.
Affects almost 3% of world’s population
Start anytime from preschool to
Typically between 20-24
many different forms of OCD – differ
from person to person
cause of OCD is still unknown
Better when diagnosed early
OCD pts have:
weak, underdeveloped egos.
(Reasons: unsatisfactory parent-child
relationship, conditional love etc.).
Psychoanalytical Theory cont…
Regression to the pre-Oedipal anal-sadistic
phase, combined with use of specific ego
defence mechanisms (isolation, undoing,
displacement, reaction formation), produces
the clinical symptoms of obsessions and
It explains- OCD pts. as a conditioned
response to a traumatic event.
Traumatic event produces anxiety and
passive avoidance(staying away from the
active avoidance(staying with the source)
Neuroanatomy: Neuroimaging techniques
have shown abnormal metabolic rates in the
basal ganglia and orbital frontal cortex of
individuals with the disorder(Hollander &
Physiology. Electrophysiological studies,
sleep electroencephalogram studies, and
neuroendocrine studies have suggested that
there are commonalities between depressive
disorders and OCD (Sadock & Sadock,
2007). Neuroendocrine commonalities were
suggested in studies in which about one third
of OCD clients show nonsuppression on the
dexamethasone-suppression test and
decreased growth hormone secretion with
Biochemical Factors. The neurotransmitter
serotonin as influential in the etiology of
Drugs that have been used successfully in
alleviating the symptoms of OCD are
clomipramine and the selective serotonin
reuptake inhibitors (SSRIs), all of which are
believed to block the neuronal reuptake of
serotonin, thereby potentiating serotoninergic
activity in the central nervous system.
Specific criteria to be clinically diagnosed
Anxiety disorder with presence of obsessions
ego dystonic – realize thoughts and actions
are irrational or excessive
Must take up more than 1 hour a day
Must disrupt daily routine
Symptoms can’t result from effects of other
medical conditions or substances
Symptoms of Obsessions
Repeated thoughts about
contamination(e.g. may lead to
fear of shaking hands or touching
Repeated doubts(e.g. repeatedly wondering
if they locked the door or turned
off an appliance).
A need to have things in a certain order(e.g.
feels intense anxiety when things are out of
Thought of aggression (e.g. to hurt a loved
Symptoms of Compulsion
Washing and cleaning(e.g. excessive hand
washing or house cleaning).
Counting (e.g. counting number of times that
something is done).
Checking (e.g. checking something that one
has done, over and over).
Requesting or demanding assurances from
Repeating actions(e.g. going in and out of
door or up and down from a chair).
Ordering(e.g. arranging and rearranging
cloths or other items).
Note : the obsessions and compulsions seem
to be worse in the face of emotional stress.
Suggested by demonstration of ritualistic
behavior that is irrational or excessive.
MRI and CT shows enlarged basal ganglia in
PET scanning shows increased glucose
metabolism in part of basal ganglia.
PET scans indicate differences in brain activity of OCD
patients versus normal
OCD found excessive with other diseases
Common diseases: Depression, Schizophrenia…
Depression is the most common
Many people with OCD suffered from depression first
2/3 of OCD patients develop depression makes
OCD symptoms worse and more difficult to treat
People with OCD common diagnosed as
Schizophrenic hard to separate obsessions from
Only completely curable in rare cases
Most people have some symptom relief with
Treatment choices depend on the problem
and patients preferences
Most common treatments:
Cognitive: change the way they think to deal with
Behavioral: change the way they react to “anxiety-
Exposure and Response Prevention
Slowly learning to tolerate anxiety associated with
not performing ritual behavior
Talking with therapist to discover what causes the
anxiety and how to deal with symptoms
Learning cognitive strategies to deal with anxiety
then gradual exposure to feared object
Should be done when people are ready for it
Must be customized for each person’s specific form
of OCD and their needs
No side affects except increased anxiety with
exposure to fear
Often lasts about 12 weeks
Positive effects off CBT last longer than those of
If OCD returns can successfully treat again with
Best treatment approach for most is CBT combined
Anxiolytic benzodiazepine such as chloradiazepoxide or
diazepam give temporary relief from anxiety but not
really effective on obsessions and compulsions
Antidepressants because of common depression
Selective Serotonin Reuptake Inhibitors (SSRIs): alter the
levels of neurotransmitter serotonin in the brain which
helps brain cells communicate with one another
Prevents excess serotonin from being pumped back
into original neuron that released it
Then can bind to receptor sites of nearby neurons and
send chemical message that can help regulate anxiety
and obsessive compulsive thoughts
Most effective drug treatment helping about 60% of
Ex: Prozac, Zoloft, Lexapro, Paxil
Assessment should focus on the collection of
physical, psychological and social data.
The nurse should be particularly aware of the
impact of obsessions and compulsions on
physical functioning, mood, self-esteem and
normal coping ability.
Nurse should also note: the defence
mechanism used thought content or process
potential for suicide, ability to function and
social support systems.
The following criteria may be used to measure outcomes in the
care of the client with OCD.
● Is able to maintain anxiety at a manageable level without
resorting to the use of ritualistic behavior.
● Is able to perform activities of daily living independently.
● Verbalizes understanding of relationship between anxiety and
● Verbalizes specific situations that in the past have provoked
anxiety and resulted in seeking relief through rituals.
● Demonstrates more adaptive coping strategies to deal with
stress, such as thought stopping, relaxation techniques, and
● Is able to resume role-related responsibilities because of
decreased need for ritualistic behaviors.
Related to under developed ego,
Punitive superego; avoidance learning;
possible biochemical changes evidence by
ritualistic behavior and or obsessive thoughts.
Nursing management cont…
Objective : client will demonstrate ability to
cope effectively without restoring to obsessive
compulsive behaviors or increased
Nursing diagnosis 2
Ineffective role performance
Related to: need to perform rituals.
Evidence by: inability to fulfill usual pattern of
Nursing management cont…
Objective: Client will be able to resume role-
Reassessment is conducted in order to determine if the nursing
actions have been successful in achieving the objectives of
care. Evaluation of the nursing actions for the client with OCD
may be facilitated by gathering information using the following
types of questions:
● Can the client refrain from performing rituals when anxiety level
● Can the client demonstrate substitute behaviors to maintain
anxiety at a manageable level?
● Does the client recognize the relationship between
escalating anxiety and the dependence on ritualistic
behaviors for relief?
● Can the client verbalize situations that occurred in the past
during which this strategy was used?
● Can the client verbalize a plan of action for dealing with
these stressful situations in the future?
● Can the client perform self-care activities independently?
● Can the client demonstrate an ability to fulfill role related
● Can the client verbalize resources from which he or she
can seek assistance during times of extreme stress?
Definition of OCD
Sign and symptoms
OCD is a complicated issue
Most cases are incurable
Best form of treatment is CBT in combination
Most important thing that can be done to
discover more about OCD and its treatments
is to research the brain
1. Townsend Mary.C. psychyiatric mental health nursing concepts of
edition. F. a. davis company publishers. Philadelphia USA. P
2. Townsend Mary.C. psychyiatric mental health nursing concepts of
edition. F. a. davis company publishers. Philadelphia USA. P
3. R. sreevani. A guide to mental health and psychiatric nursing. 3rd
edition.jaypee brother medical publishers(p) ltd.new delhi. P179-182
4. Clinical correlates of functional impairment in children and adolescents with obsessive
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