Download OCD Facts

OCD Facts
*All facts obtained through DynaMed
Database or ocdeducationstation.org
Definition
• obsessions are recurrent and persistent thoughts,
impulses or images experienced as intrusive and
inappropriate
• compulsions are feelings of being driven to perform
repetitive behaviors or mental acts in response to
obsession or according to rules that must be
applied rigidly
Common Obsessions and
Compulsions
Obsessions
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contamination
safety
fear of committing sin
need for order
sexual/aggressive
thoughts
Compulsions
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cleaning
checking
counting/repeating
arranging
touching objects
hoarding
seeking reassurance
making lists
Who is most affected?
• OCD more common in women than men in most
countries
• Onset
• onset peak age 13-15 years,
• female onset peak age 20-24 years
• Many adults diagnosed with obsessive
compulsive disorder report symptoms
began in childhood
• (Weissman, M. et al., 1994)
Prevalence
• Many research reports cite OCD as the fourth most common
mental illness after phobias, substance abuse, and major
depression.
• Lifetime prevalence of OCD in young people:
o worldwide, is approximately 1-2%
o (lifetime prevalence of OCD refers to the percentage of
individuals in a given statistical population who, at some point in
their lives, have experienced a case of OCD).
• Another figure commonly referred to in the OCD research is
that at any one given point in time, OCD affects
approximately 1 in 100 children.
• Overall, OCD has been found to be one of the most common
psychiatric illnesses affecting children and adolescents.
• http://www.nimh.nih.gov/statistics/1ocd_adult.shtml
Celebrities with OCD
• http://www.rethink-anxiety-disorders.com/famouspeople-with-ocd.html
Causes
• Direct cause uncertain
• Evidence points to genetic component to
susceptibility to OCD…particularly involving genes
that that work to tone down glutamate.
• (Arnold, et al., 2006)
• Abnormalities (as seen in fMRI studies) in the
prefrontal cortex….esp. areas that control activity
from the amygdala (emotional processor)
o See Abstract – OCD causes - Biological
Diagnosis
• Some factors:
• presence of obsessions or compulsions that
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are time-consuming (take > 1 hour/day)
cause distress or impairment
are recognized by the patient as excessive or unreasonable
not due to medication, drug abuse or medical condition
if another Axis I disorder present, the content of obsessions or compulsions
not restricted to it
• Use of Yale-Brown Obsessive Compulsive Scale (YBOCS)
• Irregularity on PET scans (esp. in prefrontal cortex)
Treatment - Counseling
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Behavior therapy most studied is exposure and response
prevention (ERP)
•
ERP appears more effective than progressive muscle relaxation
•
ERP appears more effective than clomipramine alone or pill
placebo
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clinician-guided behavior therapy more effective than computerguided behavior therapy which is more effective than relaxation
•
cognitive-behavioral therapy (CBT) appears effective compared
to no therapy, sertraline alone or pill placebo
•
cognitive therapy and behavioral therapy appear to have similar
efficacy over 4-16 weeks (level 2 [mid-level] evidence)
Behavior Therapy
• effective exposure and response prevention (also
called exposure and ritual prevention, ERP, EX/RP)
o exposure may include
• in vivo exposure - gradual, prolonged confrontation with anxiety
provoking stimuli
• imagined exposure
o continue exposure until anxiety decreases (habituation)
o response prevention - abstinence from rituals as opposed to active
blocking
o duration of therapy 1-3 months
Predictors of better outcome with
behavioral therapy
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early adherence to exposure homework
employment
living with family
no previous treatment
having fear of contamination
overt ritualistic behavior
absence of depression
Cognitive Behavioral Therapy (CBT)
• May include:
o
psychoeducation, cognitive training, mapping OCD target symptoms and exposure
and response therapy (EX/RP)
• therapy is more intense, involving individual or group sessions
with trained therapists, homework, and monitoring procedures
• Cognitive-behavioral group therapy appears highly effective
compared to no therapy
o
o
47 patients with OCD (DSM-IV criteria) randomized to 12 weekly sessions of cognitivebehavioral group therapy vs. waiting list control
70% treatment vs. 4% control patients had improvement (p < 0.001, NNT 2)
• Also works better with SSRIs
o ***See Abstract – OCD Treatment –
Group treatment and SSRIs
CBT (cont.)
• cognitive therapy and behavioral therapy appear
to have similar efficacy over 4-16 weeks on 6
randomized trials
• exposure and response prevention reported to
result in higher recovery rates (45% vs. 13%) than
cognitive behavioral therapy at 3 months after
treatment based on follow-up of 62 patients in one
of these trials
o See Abstract: OCD treatment – CBT vs. Beh therapy
Prognosis
• typically chronic course with waxing and waning of
symptoms
• patients who respond to medications may
experience significant improvement in symptoms
but are rarely cured of illness
• ***See Abstract – OCD Prognosis