Running head: OBSESSIVE-COMPULSIVE DISORDER
Obsessive-compulsive disorder (OCD)
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OBSESSIVE-COMPULSIVE DISORDER
Topics: Obsessive-compulsivedisorder (OCD)
Pretend you are teaching a group of students about your chosen topic. Create two
to three learning objectives
The following should be included
1. Definitions
2. Biopsychosocial, cultural, developmental assessment and screening tools with
validity and reliability
3. DSM-5criteria
4. Psychotherapeutic options
5. Psychopharmaceutical management with detailed pharmacological analysis
6. Current evidence (not published more than three years ago) related to topic
7. Legal/ethical considerations
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Learning Objectives
i. At the end of this presentation, students will be able to demonstrate a higher
understanding of the prevalence, etiology, and treatment options for Obsessive-
compulsive disorder (OCD).
ii. At the end of this presentation, students will be able to explain the current evidence
research and legal/ethical considerations in the care and treatment of Obsessive-
compulsive disorder (OCD) patients.
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Obsessive-compulsive disorder (OCD
Obsessive-compulsive disorder (OCD) is a type of mental disorder affecting people from all
walks of life. Essentially, OCD occurs when an individual is caught in a cycle of obsessions and
compulsions. These may include unwanted intrusive thoughts, ideas, sensations, and urges that
cause intensely distressing feelings to the affected person. Some of the common obsessions and
compulsions in OCD include contamination, loss of control, unwanted sexual thoughts, mental
compulsions, checking, repeating, and religious obsessions, among others. Noteworthy, these
obsessions and compulsions can potentially interfere with the individual's daily activities as well
as social interactions. Some of the risk factors of OCD include; having a parent or sibling with
OCD, depression and anxiety, trauma, and a history of sexual and physical abuse (Taylor &
Jang, 2017).
Biopsychosocial, cultural, developmental assessment and screening
The biopsychosocial model recognizes three major categories of the causes of OCD. These
include biological, psychological, and sociocultural causes. Regarding age, for instance, OCD
develops in late adolescence or early adulthood. Genetics, the presence of other mental disorders,
stress, pregnancy, and the postpartum period have been found to be major risk factors for OCD.
Cultural identity has a significant impact on OCD. For instance, cultural beliefs, superstition, and
religion have been found to influence OCD symptoms. Therefore, it is important for caregivers
to take into account the effect of religion and beliefs only on OCD symptoms but on patient's
attitudes towards their disorder.
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DSM-5 Criteria
i. The DSM-5 provides health professionals with official definitions as well as criteria
for diagnosing OCD and other mental disorders. Below is the DSM-5 Diagnostic
Criteria for OCDL:
ii. Presence of obsessions and compulsions- These include recurrent and persistent
sensations, urges, and impulses. The patient attempts to ignore or suppress intrusive
thoughts, feelings, ideas, and impulses.
iii. The compulsions or obsessions are time-consuming. For instance, they take more
than one hour per day. Their obsessions and compulsions are causing clinically
significant distress in the individual's social, occupational, educational, and other vital
areas of functioning (Beyond OCD.org, 2019).
iv. The OCD symptoms are not attributable to substance, drug or medication abuse, or
any other medical condition.
v. The disturbance caused by the obsessions and compulsions are not better explained
by symptoms of other different mental disorders.
Treatment Options
Other than medications, psychotherapy has become another vital treatment option for OCD. The
first psychotherapeutic option is Cognitive behavioral therapy (CBT).
Essentially, CBT employs two major scientific techniques to change the individual's behavior
and thought patterns: exposure and response prevention (ERP) and cognitive therapy. Cognitive-
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behavioral therapists take OCD patients through CBT sessions, and the number and type of
sessions depend on the severity of the condition. ERP) basically involves gradual exposure of the
patient to his or her feared objects or obsessions, such as cleaning, fluids, and then having him or
her learn healthy ways to cope with the anxiety.
The other psychotherapeutic option for OCD is imagining exposure (IE). Also known as
visualization, EI involves creating scenarios that elicit the anxieties individuals might experience
in routine situations. "As they habituate to the discomfort, with decreased anxiety over time,
they are gradually desensitized to the feared situation, making them more willing to move the
process to real life, and engage in the next step, ERP" ( Anxiety and Depression Association of
America, 2019). Another psychotherapeutic option for OCD is Habit Reversal Training.
Basically, this includes awareness training, social support, positive reinforcements as well as
relaxation techniques. The goal of Habit Reversal Training is to increase the individual's
awareness of how and when the obsession, urge, or thought develops, making it easier for him or
her intervene and make a positive change.
Psychopharmaceutical management
The first class of medications used in the treatment of OCD is selective serotonin reuptake
inhibitors (SSRIs). One of the key advantages of SSRIs is that they can ease dosing as well as
toxicity in overdose. However, these SSRIs may take up to two to four months to start working.
Some of the common SSRIs used in treating OCD include citalopram (Celexa), venlafaxine
(Effexor), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), as well
as sertraline (Zoloft). According to Medscape (2019), "Only antidepressants that potently inhibit
presynaptic reuptake of serotonin appear to be effective in treating obsessive-compulsive
disorder (OCD)." The only tricyclic antidepressant that possesses this particular quality is
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Clomipramine (Anafranil). It is important to note that these medications affect the serotine,
which is used as a messenger in the brain.
Over the years, a plethora of research studies has been conducted to provide deeper information
and understanding of OCD. A study conducted by Ferreri et al. (2019) found that Smartphone
assessment apps and the Web Screening Questionnaire possess adequate sensitivity as well as
specificity in the detection of OCD symptoms compared to full-length structured clinical
interviews. The study also revealed that "CBT supported by smartphone, internet, or computer
may not be more effective than that delivered by a qualified practitioner, but it is easy to use,
well accepted by patients, reproducible, and cost-effective."
In the field of intervention, Hezel & Simpson (2019) found that exposure and response
prevention (ERP) is an effective first-line psychotherapy for the treatment of OCD. OCD in
children and adolescents has also become another major area of concern for many researchers.
Krebs & Heyman (2020), a significant proportion of children and adolescents, responded with
full and partial remissions to CBT that was combined with SSRI.
Legal/ethical considerations
There are some legal and ethical issues involved in the care of OCD patients. Firstly, the rights
of patients with mental illness (PWMI) encompasses the fundamental rights of individuals being
treated for OCD and other mental disorders. These include the principle of respect for autonomy
principle of non-maleficence, informed consent, justice, confidentiality, and beneficence. Being
ambassadors of good mental health, it is very important for care givers to take into consideration
these legal and ethical issues in order to not only improve patient satisfaction but also to avoid
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the legal problems emanating from the breach of the above-mentioned principles. Care givers
have the professional responsibility to the human rights of PWMI.
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References
Anxiety and Depression Association of America (2019). Treatments for OCD. Retrieved from
https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/treatments-
for-ocd
Beyond OCD.org (2019). Clinical Definition of OCD. Retrieved from
https://beyondocd.org/information-for-individuals/clinical-definition-of-ocd
Ferreri, F., Bourla, A., Peretti, C. S., Segawa, T., Jaafari, N., & Mouchabac, S. (2019). How New
Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-
Compulsive Disorder (e-OCD). JMIR Mental Health, 6(12), e11643.
Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-
compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl
1), S85.
Krebs, G., & Heyman, I. (2015). Obsessive-compulsive disorder in children and adolescents.
Archives of disease in childhood, 100(5), 495-499.
McKenney, K., Simpson, A., & Stewart, S. E. (2020). OCD in Children and Adolescents: The"
OCD Is Not the Boss of Me" Manual. Guilford Press.
MedScape (2019). Obsessive-Compulsive Disorder (OCD). Retrieved from
https://www.webmd.com/mental-health/obsessive-compulsive-disorder#2
Taylor, S., & Jang, K. L. (2017). Biopsychosocial etiology of obsessions and compulsions: An
integrated behavioral–genetic and cognitive–behavioral analysis. Journal of Abnormal
Psychology, 120(1), 174.
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Initial Post
In a Word document, address the following prompts:
Elaborate on etiology, stressors, problems of addiction, dependence, and relapse in the
U.S. currently.
Discuss potential objective physical and mental examination findings when examining a
client with a substance abuse issues with rationales.
Discuss the neurobiological mechanism that underlies the addictive behavior reinforcing
properties.
What are the first-line pharmacotherapy and psychotherapy interventions with
implications for monitoring (for alcohol and for opioid abuse).
Post your completed Word document to this discussion forum.
Use APA format with reference list (two to three books and/or articles).
OBSESSIVE-COMPULSIVE DISORDER
Substance/drug addiction has increasingly become a major problem in the United States.
According to American Addiction Center (2019), "almost 21 million Americans have at least one
addiction, yet only 10% of them receive treatment." Since the year 1990, drug overdose deaths in
the U.S have more than tripled, with over 700,000 Americans dying from overdosing drugs.
Research has identified several factors that contribute to the development of substance use.
Firstly, some of the biological risk factors for addiction. According to Recovery Answers, genes
contribute approximately 40-60 percent of the risk for addiction development. Differences in
metabolic variations in gender and race have also been identified as potential risk factors for
addiction. Also, psychosocial factors such as personality traits, familial factors, peer factors
(such as substance-using peers and poor social skills), sociocultural factors (including
accessibility and affordability of substance) have contributed to the high rates of addiction in the
U.S.
While a lot of efforts are being made to prevent and treat addiction in the U.S, relapse has been
identified as a major challenge to the recovery process. American Addiction Center (2019)
reveals that "more than 85% of individuals relapse and return to drug use within the year
following treatment." Research has also revealed that more than 2/3 of people in recovery relapse
within weeks to months after the commencement of the addiction treatment. Some of the major
causes of relapse include stress, dishonesty, unrealistic, interacting with drug abusers, etc.
Successful treatment of individuals with substance abuse requires physical as well as mental
examination. Blood alcohol concentration (BAC) is one of the first important tests that should be
conducted to determine the current impairment caused by alcohol. On the other hand, urine tests
should be conducted to provide information regarding the individual's recent use of illicit drugs
OBSESSIVE-COMPULSIVE DISORDER
such as opiates, cannabis, etc. Gamma-glutamyl transferase (GGT) test used to measure damage
to the patient's liver cells caused by the use of alcohol.
Simply put, addiction results from the interaction of drugs with the individual's genetic,
psychological, emotional, behavioral as well as environmental factors causing long-lived
alterations in his or her functional and biochemical properties of neurons in the brain.
Essentially, addictive substances commandeer the circuits responsible for controlling emotions
and motivations hence impairing the individual's voluntary control of addictive behavior. In
addition, research has established that the use of chronic drugs contributes to the formation of
deeply ingrained memories that give the individual drug cravings. According to Bockstaele
(2014), "most drugs of abuse share a common mechanism involving increases in extracellular
concentrations of dopamine in the nucleus accumbens via activation of dopaminergic neurons in
the ventral tegmental area." The release of dopamine in response to an individual's substance-
related stimuli is enhanced over stimuli associated natural reinforces, resulting in atypical goal-
directed behaviors that cause addiction.
There are several first-line pharmacotherapy and psychotherapy interventions for the monitoring
of alcohol and opioid abuse. Cognitive-behavioral therapy is one of the common psychotherapy
interventions for individuals with alcohol, marijuana, and cocaine addiction. Essentially, CBT
helps the patient to recognize, understand, avoid, and cope with the circumstances in which he or
she is likely to use drugs (National Institute of Drug Abuse, 2019). On the other hand,
multidimensional family therapy is used to address a wide array of influences on the individual's
drug abuse patterns, and its primary goal is to improve overall family functioning. The other
interventions include motivational interviewing and motivational incentives.
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References
National Institute of Drug Abuse (2019). Treatment Approaches for Drug Addiction. Retrieved
from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
American Addiction Centers (2019). Alcohol and Drug Abuse Statistics. Retrieved from
https://americanaddictioncenters.org/rehab-guide/addiction-statistics
National Institute of Drug Abuse (2019). Drugs, Brains, and Behavior: The Science of
Addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-
science-addiction/treatment-recovery
Bockstaele, E. (2014). The Neurobiology of Addiction-like Behaviors. The ILAR Journal.
Retrieved from http://nas-sites.org/ilarjournal/previous-issues/neurobiology-of-addictive-
behaviors/the-neurobiology-of-addiction-like-behaviors/
Drug Abuse.org (2019). Types of Addiction Treatment Therapies. Retrieved from
https://drugabuse.com/treatment-therapy/
