Obsessive Compulsive

Disorder
Fikirte Girma (MD., Psychiatrist)
Department of Psychiatry
AAU
November 2019
Outline
• Introduction
• DSM – 5 disorders under obsessive compulsive and
related disorders
• Obsessive Compulsive Disorder

2
Introduction
• Obsessive Compulsive Disorder (OCD) is
characterized by the presence of obsessions and/or
compulsions
• Other related disorders are also characterized by
preoccupations and by repetitive behaviors or
mental acts in response to the preoccupations
• Some are primarily characterized by recurrent body-
focused repetitive behaviors (e.g., hair pulling, skin
picking) and repeated attempts to decrease or stop the
behaviors

3
Introduction cont’
• Differ from developmentally normative
preoccupations and rituals
• by being excessive or persisting beyond
developmentally appropriate periods
• The distinction between the presence of
subclinical symptoms and a clinical disorder
• Individual's level of distress and impairment in
functioning

4
Disorders under DSM – 5 obsessive
compulsive and related disorders
• Obsessive Compulsive Disorder (OCD)
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania (hair pulling disorder)
• Excoriation (skin-picking) disorder
• Substance/medication-induced obsessive compulsive and
related disorder
• Obsessive-compulsive and related disorder due to another
medical condition
• Other specified obsessive-compulsive and related disorder
• Unspecified obsessive-compulsive and related disorder
5
Obsessive Compulsive Disorder
(OCD)
• Represented by a diverse group of symptoms that
include intrusive thoughts, rituals, preoccupations,
and compulsions
• These recurrent obsessions or compulsions cause
severe distress to the person or are time consuming
and interfere significantly with the person’s normal
routine, occupational functioning, usual social
activities, or relationships
• A patient with OCD may have an obsession, a
compulsion, or both

6
OCD - Definitions
• Obsessions
• Recurrent and persistent thoughts, urges, or
images that are experienced, at some time
during the disturbance, as intrusive and
unwanted, and that in most individuals cause
marked anxiety or distress.
• The individual attempts to ignore or suppress
such thoughts, urges, or images, or to neutralize
them with some other thought or action (i.e., by
performing a compulsion).

7
OCD - Definition
• Compulsions
• Repetitive behaviors (e.g., hand washing, ordering,
checking) or mental acts (e.g., praying, counting,
repeating words silently) that the individual feels
driven to perform in response to an obsession or
according to rules that must be applied rigidly.
• The behaviors or mental acts are aimed at
preventing or reducing anxiety or distress, or
preventing some dreaded event or situation;
however, these behaviors or mental acts are not
connected in a realistic way with what they are
designed to neutralize or prevent, or are clearly
excessive.
8
OCD – Epidemiology
• Lifetime prevalence
• 2 to 3%
• 12-month prevalence
• 1.2% in US
• 1.1%-1.8% internationally
• 10% of outpatients in psychiatric clinics
• Females are affected at a slightly higher rate than
males in adulthood
• Suicide risk
• Suicidal thoughts in around 50%
• Suicide attempt in around 25% 9
OCD – Risk Factors
• Temperamental
• Internalizing symptoms, higher negative emotionality,
and behavioral inhibition
• Environmental
• Physical and sexual abuse in childhood and other
stressful or traumatic events
• Various infectious agents and post-infectious
autoimmune syndrome
• Genetics

10
OCD - Etiology
• Biological Factors
• Neurotransmitter systems
• Neuroimmunology
• Altered function in the neurocircuitry between
orbitofrontal cortex, caudate, and thalamus more
associated with corticostriatal pathways
• neurological procedures involving the cingulum are sometimes
effective in the treatment of OCD
• Genetics
• Behavioral factors
• Psychosocial factors – personality, psychodynamics
11
OCD - Clinical Presentation
• Often take their complaints to other physicians rather
than psychiatrists
• 75% have both obsessions and compulsions
• Symptoms are ego alien
• The person usually recognizes it as absurd and irrational
• Typical obsessions
• thoughts about contamination (“My hands are dirty”)
• doubts (“I forgot to turn off the stove”)
• The key characteristic of a compulsion is that it reduces
the anxiety associated with the obsession
12
13
14
OCD - Functional Consequences
• Reduced quality of life
• High levels of social and occupational impairment
• Time spent obsessing and doing compulsions
• Avoidance of situations can restrict functioning
• Specific symptoms can create specific obstacles
• Health problems
• Interference with treatment
• Few significant relationships, family dysfunction

15
OCD - Diagnosis
• DSM -5
• Presence of obsessions, compulsions, or both
• Obsessions or compulsions are time-consuming or cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
• Not attributable to the physiological effects of a
substance or another medical condition
• Not better explained by the symptoms of another
mental disorder
• Specifiers: level of insight and tic related

16
OCD – Differential Diagnosis
• Medical disorders
• Anxiety disorders
• Major depressive disorders
• Other obsessive compulsive related disorders
• Eating disorders
• Tic disorder and stereotyped movements
• Psychotic disorders
• Obsessive compulsive personality disorders

17
OCD - Comorbidity
• The lifetime prevalence for
• MDD in persons with OCD is about 67 %
• Alcohol use disorders
• Anxiety disorders
• Social phobia about 25%, Generalized anxiety disorder, Specific
phobia, Panic disorder
• Eating disorders
• Personality disorders
• The incidence of Tourette’s disorder in patients with OCD is
5 - 7%, and 20 – 30% of patients with OCD have a history of
tics
18
OCD - Development
• Mean age at onset of OCD is 19.5 years
• 25% of cases start by age 14 years
• Onset after age 35 years is unusual but does occur
• Males have an earlier age of onset than females
• nearly 25% of males have onset before age 10 years
• Onset of symptoms is typically gradual
• acute onset has also been reported

19
OCD - Course
• If OCD is untreated, the course is usually chronic,
often with waxing and waning symptoms
• Some individuals have an episodic course
• A minority have a deteriorating course
• Without treatment remission rates in adults are low
• Onset in childhood or adolescence can lead to a
lifetime of OCD
• 40% of individuals with onset of OCD in childhood or
adolescence may experience remission by early adulthood
• The course of OCD is often complicated by the co-
occurrence of other disorders
20
OCD - Treatment
• Pharmacological
• SSRI or clomipramine
• Dopamine receptor blockers…
• Psychotherapy
• Exposure and response prevention…
• Combination
• Somatic treatments

21
References
• Diagnostic and Statistical Manual of Mental
Disorders, 5th edition (DSM – 5)
• Kaplan and Sadock’s synopsis of Psychiatry, 11th
edition

22