OCD: Signs, Symptoms and Diagnosis Dr Suhail Undre Consultant, Crisis Resolution / Home Treatment, Dudley

• Obsessive compulsive disorder (OCD) is described as an illness where there are recurring obsessions or compulsions that are severe enough to be time consuming and cause marked distress or significant impairment • People with the disorder recognise that their reactions are irrational or disproportionate • An obsession is a recurrent and intrusive thought, feeling, idea or sensation • A compulsion is a conscious, standardised, recurring pattern of behaviour such as counting, checking or avoiding (rituals) • Obsessive compulsive disorder can manifest with just intrusive thoughts and no compulsions

Obsessions as defined by (1), (2), (3) and (4): (1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. (2) the thoughts, impulses, or images are not simply excessive worries about real-life problems. (3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralise them with some other thought or action. (4) the person recognises that the obsessional thoughts, impulses, or images are a product of his or her own mind.

Compulsions as defined by (1) and (2): (1) repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession (2) the behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation

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At some point during the course of the disorder, the person has recognised that the obsessions or compulsions are excessive or unreasonable.

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The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

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If another disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g. preoccupation with food in the presence of an eating disorder).

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The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Specify if: With Poor Insight: if, for most of the time during the current episode, the person does not recognise that the obsessions and compulsions are excessive or unreasonable.

Contamination

45%

Pathological symptoms

42%

Somatic symptoms

36%

Need for symmetry

31%

Aggressive

28%

Sexual

26%

Multiple obsessions

60%

Checking

63%

Washing

50%

Counting

36%

Need to ask or confess

31%

Symmetry or precision

28%

Hoarding

18%

• The most common emotional response is anxiety followed by depression, shame, guilt and disgust.

• Obsessive compulsive disorder affects about 2.3% of people at some point in their life. • Rates during a given year are about 1.2% and it occurs worldwide. • It is unusual for symptoms to begin after the age of thirty five and half of people develop problems before twenty. • Males and females are affected about equally. • 1.2% of the population will have OCD, which equates to 12 out of every 1000 people. • Approximately 741,504 people are living with OCD at any one time. • Fourth most common mental illness in many western countries that will affect men, women and children regardless of their race, religion, nationality or social group.

• From the 14th - 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil. Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism. • In the early 1910s, Sigmund Freud attributed obsessive compulsive behaviour to unconscious conflicts that manifest as symptoms.

• Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious“.

Pharmacotherapy • SSRI’s, Clomipramine, Combination therapies Psychotherapy • CBT • Treatments like hypnotherapy, NLP, EFT and many other alternative therapies rarely have a long term impact on successfully treating OCD. Specialist Units • Springfield University Hospital • Maudsley

• Dundee • SheffIeld • Bristol

Complex illness No specific causes (aetiology) Treated with medication and psychotherapy As good as it gets