1. Obsessive Compulsive
Disorder
(OCD)
An anxiety disorder

2. 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.

3. In adults the most common
obsessions are-
 Thoughts of contamination
 Pathological doubt (such as, if whether
simple tasks have been properly
completed)
 Thoughts of having physical symptoms
 Symmetry, for instance, of household
objects
 Aggressive thoughts.

4. 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.

5. Common compulsions
 Checking
 Washing
 Counting
 Needing to ask questions or make
confessions
 Creating symmetry and order
 Needing to be precise.

6. 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 Repeated checking of the
the iron off?) object (iron) in doubt.
Need for symmetry Compulsive slowness in
maintaining symmetry.

7. 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.

8. 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

9. Obsessions and compulsions have
some features in common
 The ideas or impulses are recurrent.
 They are a product of their own mind
 They are accompanied by feelings of
dread
 The sufferer tries to fight them off
 Although Attempts to resist them may fade
over time, the patient remains aware that
they are both absurd.

10. 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=4yOpE
MqnsCQ

11. 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=8dR8xV
qSfXc

12. OCD – The Reality
 However, OCD is a disorder that causes
great distress, as this clip shows
 http://www.youtube.com/watch?v=Rn1OYl
Yzgm8

13. 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.

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

15. 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.

16. 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.

17. Who gets OCD?
 Lifetime risk of developing the disorder -
2%
 Males and females are equally at risk
 Most common age of onset – under 25
years old.

18. 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 age
 The need for hospitalisation
 Severe depression

19. Causes of the disorder
 These may be either-
 Physiological or
 psychological

20. Physical causes
 We will look at possible physiological
causes first

21. 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.

22. 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.

23. 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.

24. Psychological causes
Psychodynamic
 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.

25. 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.

26. 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.

27. Famous people with OCD

28. 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.”

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

30. John Terry
 Wore the same pair of shin pads for 10
years.

31. 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."

32. 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!

33. 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."

34. Treatment
 Cognitive Behavioural Therapy is the
currently the most effective treatment for
this disorder.
 http://www.ocdaction.org.uk/ocdaction/ind
ex.asp?id=132

35. Message board of rituals
 http://www.healthboards.com/boards/show
thread.php?t=281134&page=1