Obsessive Compulsive Disorder (OCD)

Question 1

Definition

Answer 1

OCD is characterised by obsessions and compulsions

Question 2

Obsessions definition

Answer 2

• Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore.
• E.g an overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind.

Question 3

Compulsions definition

Answer 3

• Repetitive actions the person feels they must do, generating anxiety if they are not done. Often these compulsions are a way for the person to handle the obsessions.
• E.g, checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down. This is a normal behaviour, but in OCD the person may check every plug in the house 10 times before being able to go to sleep or leave.

Question 4

Cycle of OCD

Answer 4

• The obsessions lead to anxiety, which leads to the compulsive behaviour, which leads to a temporary improvement in the anxiety. Shortly after the temporary improvement in anxiety the obsession reappears, leading to further anxiety, further compulsive behaviour with a temporary relief.

Question 5

Associated conditions

Answer 5

OCD is strongly related to other mental health issues:
- Anxiety
- Depression
- Eating disorders
- Autistic spectrum disorder
- Phobias

Question 6

Risk factors

Answer 6

Family history
Age: 10-20 years
Pregnancy/postnatal period
History of abuse, bullying, neglect

Question 7

Diagnositic criteria

Answer 7

Y-BOCS.
- 8 - 15 = Mild OCD,
- 16 - 23 = Moderate OCD,
- 24 - 31 = Severe OCD,
- 32 - 40 = extremely severe OCD.

Question 8

Management

Answer 8

Mild: low intensity psychological treatment
- CBT
- Exposure and response prevention (ERP)
Moderate: SSRI (FL drug) or more intensive CBT
- Fluoxetine specifically for body dysmorphic disorder
- Clomipramine = alternative to FL
Severe: refer to secondary care mental health team