Obsession
- Recurrent and persistent thoughts, urges, or images that are
experienced, at some time during the disturbance, as intru-
sive 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).
Compulsions
- Repetitive behaviors (e.g., hand washing, ordering, check-
ing) or mental acts (e.g., praying, counting, repeating words
silently) that the individual feels driven to perform in re-
sponse to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or re-
ducing 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 de-
signed to neutralize or prevent, or are clearly excessive.
DSM V
B. The obsessions or compulsions are time-consuming (e.g., take
more than 1 hour per day) or cause clinically significant distress
or impairment in social, occupational, or other important areas of functioning.
Mx
Combination of pharmacotherapy and CBT
Psychoeducation is also crucial.
Explain to the patient that talking about the obsesssions and compulsions will not make
them worse.
Pharmocotherapy:
-Clomiopramine(TCA) and the serotonin reuptake inhibitors for example fluoxetine,
citalopram, fluvoxamine, paroxetine, sertraline and escitalopram.
The response is often slower in OCD than in other disorders, so an adequate trial of
medication is 12 weeks.
Response may require significantly higher doses of medication, these doses are
associated with cardiac arrhythmias and should be given under supervision of a
specialist
Once response is observed, patients should be kept on meds for at least a year and
meds should be tapered gradually.
CBT:
Exposure with response prevention- for example having the patient with
contamination concerns put his or her hand in the toilet bowl or tough the desk or floor
and ask the patient not to wash.
