Obsessive Compulsive
Disorder
Dr. Pooja S. Janardan
Obsessive-Compulsive Disorder (OCD) is a
common, chronic, and long-lasting disorder in
which a person has uncontrollable, reoccurring
thoughts (obsessions) and/or behaviors
(compulsions) that he or she feels the urge to
repeat over and over.
• Obsessive compulsive disorder (OCD) is a
mental health disorder that affects people of
all ages and walks of life, and occurs when a
person gets caught in a cycle of obsessions
and compulsions.
• Obsessions are unwanted, intrusive thoughts,
images, or urges that trigger intensely
distressing feelings.
• Compulsions are behaviors an individual
engages in to attempt to get rid of the
obsessions and/or decrease his or her distress.
Signs and Symptoms
• Obsessions are repeated thoughts, urges, or
mental images that cause anxiety. Common
symptoms include:
• Fear of germs or contamination
• Unwanted forbidden or taboo thoughts
involving sex, religion, or harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order
Cont……….d
• Compulsions are repetitive behaviors that a person
with OCD feels the urge to do in response to an
obsessive thought. Common compulsions include:
• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise
way
• Repeatedly checking on things, such as repeatedly
checking to see if the door is locked or that the oven
is off
• Compulsive counting
A person with OCD generally:
• Can't control his or her thoughts or behaviors,
even when those thoughts or behaviors are
recognized as excessive
• Spends at least 1 hour a day on these thoughts
or behaviors
• Doesn’t get pleasure when performing the
behaviors or rituals, but may feel brief relief
from the anxiety the thoughts cause
• Experiences significant problems in their daily
life due to these thoughts or behaviors
TIC disorder
• May accompany OCD
• Motor tics are sudden, brief, repetitive
movements, such as eye blinking and other
eye movements, facial grimacing, shoulder
shrugging, and head or shoulder jerking.
Common vocal tics include repetitive throat-
clearing, sniffing, or grunting sounds.
Common Obsessions in OCD
Contamination
• Body fluids (examples: urine, feces)
• Germs/disease (examples: herpes, HIV)
• Environmental contaminants (examples:
asbestos, radiation)
• Household chemicals (examples: cleaners,
solvents)
• Dirt
Unwanted Sexual Thoughts
• Forbidden or perverse sexual thoughts or
images
• Forbidden or perverse sexual impulses about
others
• Obsessions about homosexuality
• Sexual obsessions that involve children or
incest
• Obsessions about aggressive sexual behavior
towards others
Losing Control
• Fear of acting on an impulse to harm oneself
• Fear of acting on an impulse to harm others
• Fear of violent or horrific images in one’s mind
• Fear of blurting out obscenities or insults
• Fear of stealing things
Religious Obsessions (Scrupulosity)
• Concern with offending God, or concern about
blasphemy
• Excessive concern with right/wrong or morality
Harm
• Fear of being responsible for something terrible
happening (examples: fire, burglary)
• Fear of harming others because of not being
careful enough (example: dropping something on
the ground that might cause someone to slip and
hurt him/herself)
Other Obsessions
• Concern with getting a physical illness or disease
(not by contamination, e.g. cancer)
• Superstitious ideas about lucky/unlucky numbers
certain colors
• Compulsions are the second part of obsessive
compulsive disorder.
• These are repetitive behaviors or thoughts that a
person uses with the intention of neutralizing,
counteracting, or making their obsessions go away.
• People with OCD realize this is only a temporary
solution but without a better way to cope they rely
on the compulsion as a temporary escape.
• Compulsions can also include avoiding situations
that trigger obsessions. Compulsions are time
consuming and get in the way of important
activities the person values
Common Compulsions in OCD
Washing and Cleaning
• Washing hands excessively or in a certain way
• Excessive showering, bathing, tooth-brushing,
grooming ,or toilet routines
• Cleaning household items or other objects
excessively
• Doing other things to prevent or remove
contact with contaminants
• Checking
• Checking that you did not/will not harm
others
• Checking that you did not/will not harm
yourself
• Checking that nothing terrible happened
• Checking that you did not make a mistake
• Checking some parts of your physical
condition or body
Repeating
• Rereading or rewriting
• Repeating routine activities (examples: going in
or out doors, getting up or down from chairs)
• Repeating body movements (example: tapping,
touching, blinking)
• Repeating activities in “multiples” (examples:
doing a task three times because three is a
“good,” “right,” “safe” number)
Mental Compulsions
• Mental review of events to prevent harm (to
oneself others, to prevent terrible consequences)
• Praying to prevent harm (to oneself others, to
prevent terrible consequences)
• Counting while performing a task to end on a
“good,” “right,” or “safe” number
• “Cancelling” or “Undoing” (example: replacing a
“bad” word with a “good” word to cancel it out)
Other Compulsions
• Putting things in order or arranging things
until it “feels right”
• Telling asking or confessing to get reassurance
• Avoiding situations that might trigger your
obsessions
Risk Factors
• Genetics
• Brain Structure and Functioning- Imaging studies
have shown differences in the frontal cortex and
subcortical structures of the brain in patients with
OCD. There appears to be a connection between
the OCD symptoms and abnormalities in certain
areas of the brain, but that connection is not clear.
Research is still underway. Understanding the
causes will help determine specific, personalized
treatments to treat OCD.
• Environment
• Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infections (PANDAS).
• Obsessions Related to Perfectionism
• Concern about evenness or exactness
• Concern with a need to know or remember
• Fear of losing or forgetting important information
when throwing something out
• Inability to decide whether to keep or to discard things
• Fear of losing
• Serotonin is involved in regulating anxiety
• Abnormality in the neurotransmitter serotonin
• In order to send chemical messages serotonin
must bind to the receptor sites located on the
neighboring nerve cells
• OCD suffers may have blocked or damaged
receptor sites preventing serotonin from
functioning to full potential
• Possible genetic mutation
Concomitant condition
• Body Dysmorphic Disorder
• Hoarding Disorder
• Trichotillomania
• Excoriation
Goals of Therapy
• Major goals of therapy for OCD include
reduction in the frequency and severity of
obsessive thoughts and time spent performing
compulsive acts.
• Reduce compulsive episodes.
• Maintain social life and increase social activity
About drugs
Drug Class MOA Side effects
Fluoxetine Selective Inhibits the serotonin Insomnia,
serotonin transporter protein. Tremors,
reuptake Also weak Dry mouth,
inhibitors norepinephrine Sweating,
reuptake inhibitor Flushing
Fluvoxamine Selective Inhibits the serotonin Asthenia,
serotonin transporter protein. diarrhea,
dizziness,
reuptake Also weak dyspepsia,
inhibitors norepinephrine insomnia,
reuptake inhibitor nervousness,
constipation,
headache,
anorexia,
Drug Class MOA Side effects
Sertaline Selective Inhibits the Dry mouth,
serotonin serotonin Sweating,
Flushing,
reuptake transporter protein. Hoarding
inhibitors Also weak disorder,
norepinephrine dizziness,
reuptake inhibitor dyspepsia,
insomnia,
nervousness,
constipation,
Escitalopram Selective Inhibits the Loss of libido
Dyspnea
serotonin serotonin Dizziness
reuptake transporter protein. Blurred vision
inhibitors Also weak Ataxia
norepinephrine
reuptake inhibitor
Paroxetine Selective Inhibits the serotonin Same as
serotonin transporter protein. Fluoxetine
reuptake Also weak
inhibitors norepinephrine
reuptake inhibitor
Citalopram Selective Inhibits the serotonin Ataxia,
serotonin transporter protein. diarrhea,
reuptake Also weak insomnia
inhibitors norepinephrine Hypnosis
reuptake inhibitor
Clomipramine TCA Increase levels of Weight gain
Dependence
norepinephrine and False vision
serotonin Dreaming
OCD IN PREGNANCY
