OCD

Question 1

Obsessions

Answer 1

persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress

	- Thoughts about hurting someone
	- Did I lock the front door?
	- I am going to pick up a virus

Question 2

Compulsions

Answer 2

repetitive behaviors or mental acts of which the goal is to prevent or reduce anxiety or distress

	- hand washing
	- checking
	- counting

Question 3

Diagnosis

Answer 3

• presence of obsessions or compulsions- can be mental or behavioral
• obsessions or compulsions must take more than 1 hour/day
• some individuals do not recognize the senseless nature of their obsessions or compulsions
• related to hoarding disorder, body dysmorphic disorder (preoccupation with perceived defects or flaws), trichotillomania (hair-pulling), excoriation (skin-picking)
• common symptom dimensions: cleaning, symmetry, forbidden thoughts, and harm to self or others

Question 4

OCD Characteristics

Answer 4

• about 1% of the population over 12 months
• no large gender difference
• development is gradual
• modal onset is 13-15 for males and 20-24 for females
• comorbidity is high; 49% comorbid anxiety; 27% comorbid MDD

Question 5

Interventions

Answer 5

• exposure and response prevention
• Medications like clomipramine (CMI), or ssri’s (fluoxetine, fluvoxamine, sertaline) often used, no definitive outcome benefit
• intensive daily sessions
• Imaginal and in vivo exposure
• involve significant others?-studies have shown no real benefit, but it is helpful to have a spouse or friend and take the pressure off the therapist

Question 6

Protocol for Exposure and Response Prevention

Answer 6

• identify threat cues, avoidance, rituatls, and feared consequences
• introduce SUDS (Subjective Units of Discomfort Scale), 0-100
• rule out other disorders (SA, MDD)
• Introduce ERP (breaking two associations: 1- stimulus and anxiety, and 2- response behavior and anxiety reduction
• assign hw to monitor symptoms
• develop a suds hierarchy
• being exposure treatments (both imaginal and in vivo)
• assign exposure hw (2 hr) between sessions
• remind patients about response prevention and encourage them
• conduct home visits (4 hour exposure sessions)
• Develop a maintenance schedule