obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy. Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over. An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.

1. OBSESSIVE COMPULSIVE
DISORDER
(OCD)
AN ANXIETY DISORDER
PRESENTED BY: Ms Mamta Bisht
Msc Nursing
(Psychiatric Nursing)
SCON

2. INTRODUCTION
• obsessive-compulsive disorder is a mental disorder whose
main symptoms include obsessions and compulsions,
driving the person to engage in unwanted, often-times
distress behaviors or thoughts. The obsessions are usually
related to a sense of harm, risk or injury. The common
Obsessions include concern about contamination, doubt,
fear of loss or letting go, fear of physically injuring
someone.It’s treatment is done through a combination of
psychiatric medications and psychotherapy.

3. DEFINITIONS
Obsessions:
Obsessions are recurrent and persistent thoughts, impulses,
or images that cause distressing emotions such as anxiety or
disgust.
These intrusive thoughts cannot be settled by logic or
reasoning.
Typical obsessions include excessive concerns about
contamination or harm, the need for symmetry or exactness,
or forbidden sexual or religious thoughts.

4. COMPULSIONS
Compulsions are repetitive behaviors or mental acts that a
person feels driven to perform in response to an obsession.
The behaviors are aimed at preventing or reducing distress
or a feared situation.
Although the compulsion may bring some relief to the
worry, the obsession returns and the cycle repeats over and
over.
Some of the common compulsions include cleaning,
repeating, checking, ordering and arranging , Mental
compulsions e.t.c

5. DEFINTION OF OCD
Obsessive-Compulsive Disorder (OCD) is a common,
chronic and long-lasting disorder in which a person has
uncontrollable, reoccurring thoughts (obsessions) and
behaviors (compulsions) that he or she feels the urge to
repeat over and over.
An obsession is defined as an idea, impulse, or image which
intrude into the conscious aware repeatedly.

6. CAUSES OF THE
DISORDER
Biological Factors:
• People with a first degree relative (parent or sibling)
with OCD have a 5 times greater risk of having the
illness.
• identical twins have more chances of developing OCD as
compared to dizygotic twins.

7. Psychoanalytical Theory:
According to the Frued’s psychoanalytical theory OCD
arises when unacceptable wishes and impulses from the id
are only partially repressed. They cause anxiety. Ego
defence mechanisms are used to reduce the anxiety. These
defence mechanisms are used unconsciously in the form of
acts, such as hand washing. These acts are thought to be
symbolically undo the unacceptable id impulses.

8. Behavior Theory:
This theory explains Obsessions as a conditioned stimulus to
anxiety. Compulsions have been described as learned behavior
that decreases the anxiety associated with the Obsessions.
This decrease in anxiety positively reinforces the compulsive
acts and they become stable learned behavior.

9. Neuroanatomical Factors:
• 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)
• Serotonin deficiency – OCD sufferers have too little
serotonin for their nerve cells to communicate
effectively

10. CLASSIFICATION OF OCD
ICD-10 classifies OCD into 3 clinical subtypes according to
the symptoms:
1. Predominantly absessive thought or rumination
2. Predominantly compulsive acts.
3. Mixed Obsessional thoughts and acts.

11. CLINICAL FEATURES OF OCD
1. Washers (obsessional rituals)
This is the most common type. Here the obsession is of
contamination with dirt,germs, body excretions and the like.
The compulsion is washing of hands or thewhole body,
repeatedly many times a day. It usually spreads onto
washing of clothes, bathroom, bedroom, door knobs and
personal articles, gradually. The person tries to avoid
contamination but unable to, so washing becomes a ritual.

12. 2. Checkers (obsessional doubt)
In this type the person has multiple doubts that the
activities may not have been completed adequately.
for example the door has not beenlocked, kitchen
gas has been left open, counting of money was not
exact and etc.the compulsion, of course, is checking
repeatedly to remove the doubt. Anyattempts to stop
the checking leads to mounting anxiety before one
doubt has been cleared, other doubts may creep in.

13. 3. Pure obsessions (intrusive thoughts)
This syndrome is characterized by repetitive intrusive
thoughts, impulses or images which are not associated
with compulsive acts.
The distress associated with these obsessions is dealt
usually by counter thought for e.g praying, undoing
actions et.c
a. Obsessional thoughts: these are words . ideas and
beliefs ghat intrude forcibly into the patients mind.
They are usually unpleasant and shocking to the
patient and may be obscene and blastophemous. E.g.
Orderliness, sexual imagery repeated doubts et.c.

14. b. Obsessional images:
These are vividly imaginary scenes often of a violent or
disgusting kind involving abnormal sexual practice
c. Obsessional impulses:
These are the urges to perform acts usually of a violenyt
or embarrassing kind, such as injuring a child, shouting in
church etc
c. Obsessional ruminations:
These involve internal debates in which arguments for
and against even the simplest everyday actions are
reviewed endlessly.

15. 4. Primary obsessive slowing(symmetry)
It is characterized by several obsessive ideas and or
extensive compulsive rituals , in the relative absence of
manifested anxiety. this leads to marked slowness in
daily activity. usually the person demand on being need
for symmetry and precise arranging so in order to
neutralize it they will continue ordering, arranging,
balancing, straightening until "just right" or perfect in
their eyes.

16. DIAGNOSIS OF OCD
• Suggested by demonstration of realistic behavior that is
irrationl or excessive.
• MRI and CT shows enlarged Basal Ganglia in some
patients.
• PET(Positron emisaion Tomography) shows incresed
glucose metabolism in part of the basal ganglia.
• ICD-10 criteria

17. TREATMENT MODALITIES
1. Psychotherapy
• Psychodynamic psychotherapy
• Cognitive Behavior therapy
• Supportive therapy
2. Phrmcologicl treatment
3. ECT
4. Self help and coping
5. Psychosurgery

18. PSYCHODYNAMIC
PSYCHOTHERAPY
This can be used for the patients who are psychologically
oriented.
The therapy is based on psychoanalysis in which the
patient is made conscious about their unconscious
thoughts and motivations thus gaining insight.

19. PSYCHODYNAMIC
PSYCHOTHERAPY
A woman comes to therapist stating that she is chronically late
and has done everything that she can to change this through a
variety of organizational tools and methods but to not avail. Her
behavior is interfering with her work and relationships.
The therapist and client discover that being early or even on time
put her at risk of waiting for the person that she was meeting.
Waiting evoked uncomfortable needful feelings, especially when she
was waiting for someone on whom she was reliant. This in part had
roots in traumatic experiences in her childhood around being
forgotten by her parents and having to wait for them: in those
situations she had felt helpless, frightened and dependent. With the
help of her therapist, she gradually grew to tolerate her needful and
dependent feelings and with that, no longer needed to eliminate these
feelings either by being late or through other problematic behaviors.

20. COGNITIVE BEHAVIOR
THERAPY
During treatment sessions, patients are exposed to the
situations that create anxiety and provoke compulsive
behavior or mental rituals. Through exposure, patients
learn to decrease and then stop the rituals that consume
their lives. They find that the anxiety arising from their
obsessions lessens without engaging in ritualistic behavior.
This technique works well for patients whose compulsions
focus on situations that can be re-created easily.

21. 2. PHARMACOLOGICAL
TREATMENT
1. Benzodiazepines
• Alprazolam(0.5-1mg/day)
• Clonazepam(0.25-0.5 mg/day)
2. Antidepressants
Clomipramine(75-300mg/day)
Fluoxetine(20-80mg/day)
Fluvoxamine(50-200mg/day)
3. Antipsychotics- these are occassionally used in low
doses in the treatment of severe anxiety
e.g. Haloperidol,Risperidine, Olanzepine.

22. 3. ELECTRO-CONVULSIVE
THERAPY
Electroconvulsive Therapy (ECT)In the presence of severe
depression with OCD, ECT may be needed. ECT is
particularly indicated when there is a risk of suicide and/or
when there is a poor response to the other modes of
treatment.

23. 4. SELF-HELP AND
COPING
Keeping a healthy lifestyle and being aware of warning
signs and what to do if they return can help in coping with
OCD and related disorders. Also, using basic relaxation
techniques, such as meditation, yoga, visualization, and
massage, can help ease the stress and anxiety caused by
OCD

24. PSYCHO SURGERY
In severe chronic incapacitating cases, where all other
treatment have failed, Streotactile site speciefic brain
surgery hs been reported to be successful. These surgery
includes:
1. Anterior cigulotomy
2. Capsulotomy
3. Limbic leucotomy
These surgery involve the separation of the frontal cortex
from deep limbic structure.

25. NURSING MANAGEMENT

26. NURSING ASSESSMENT
• Social impairment
• Obsessive thought (repetitive worries, repeating and
counting images or words)
• Compulsive behaviour (repetitive activity, like touching,
counting, doing or undoing)

27. NURSING DIAGNOSIS
1. Severe anxiety related to absessional thoughts and
impulses as evidenced by repetitive actions and
decresed social functioning.
2. Ineffective individual coping relted to under developed
ego, punitive super ego, avoidance learning, possible
biochemical changes as evidenced by realistic
behavior.
3. Altered role performance related to the need to
perform rituals, as evidenced by inability to fulfill
usual patterns of responsibility

28. 4. Chronic low self-esteem relted to the obsessiinal
thoughts and rituals s evidenced by social isolation and
low self confidence.
5. Sleep pttern disturbnces related to the obsessional
doubts and fears s mnifested by repetitive checking of
doors nd not sleeping properly.

29. 1. TO REDUCE ANXIETY
• Establish relationship through use of empathy,warmth,
and respect.
• Acknowledge behavior without focusing attention on it.
Verbalize empathy toward client’s experience rather than
disapproval or criticism.
• Assist client to learn stress management, (e.g.,thought-
stopping, relaxation exercises, imagery)
• Give positive reinforcement for noncompulsive behavior.
• Assist client to find ways to set limits on own behaviors.

30. 2. TO REDUCE OBSESSIVE
COMPULSIVE BEHAVIOR
• Work with ptient to determine the type of situations that
increase anxiety and result in such behvior.
• Meet the patient dependency needs.
• Provide positive reinforcement.
• Support patients efforts to explore the meaning and
purpose of behavior.
• Provide structured schedule activities for patient,
including adequte time for performing rituals.
• Help the ptient lern wys of interrupting absessive
thoughts.

31. 3. IMPROVE ROLE RELTED
RESPONSIBILITIES
• Determine patients previous role within the family nd the
extent to which the role is altered by the illness.
• Encourge patient to discuss conflicts evident within the
family system.
• Explore availble options for changes for djustment in the
role.
• Practice through role play.
• Provide positive reinforcement.

32. 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.

33. REFRENCES
TEXTBOOK:
1. Townsend. Mary. C; “psychiatric mental health nursing” ; jaypee brothers
medical publishers (p) ltd ; 8th edition ; pp. 537-555
2. Shreevani . R ; “textbook of mental health and psychiatric nursing ; 3rd
edition ; Jaypee publications ; pp.179-183
3. Mali.k . Santosh ; “textbook of psychiatric nursing” ; lotus publishers ; 1st
edition ; 2010 ; pp. 173-179

34. INTERNET
• https://www.psychiatry.org/patients-families/ocd/what-
is-obsessive-compulsive-disorder
• https://psychcentral.com/disorders/ocd/
• https://www.nimh.nih.gov/health/topics/obsessive-
compulsive-disorder-ocd/index.shtml

35. ASSIGNMENT
Write down the role and responsibility of a nurse in
treatment and care of patient with OCD.