Never Just Right: Solving the Puzzle of Obsessive Compulsive Disorder Andrew Jacobs, Psy.D., C.Psych. Psychologist, Anxiety Disorders Program Jakov Shlik, MD, FRCPC Psychiatrist and Clinical Director, Anxiety Disorders Program
Overview OCD: Impact What is OCD and What Isn t? OCD Treatment GePng Help in ORawa Online Resources
Rates of OCD ORawa Metro Area, 2011: 1,236,324 people LifeZme prevalence of OCD: 2.3% 28,435 people in ORawa will have diagnosable OCD in their lifezme One year prevalence of OCD: 1.2% 14,836 people in ORawa have diagnosable OCD this year Based on data from NaZonal Comorbidity Survey (Ruscio et al, 2010) and StaZsZcs Canada (2012)
OCD & Other Mental Health Concerns Over the course of a lifezme, individuals with OCD oben experience the following: Other anxiety disorders: 76% Mood disorders: 63% Substance use disorders: 39% ANY disorder: 90% Ruscio, Stein, Chiu, & Kessler, 2010
What is OCD? (and what isn t )
What are Obsessions? Intrusive, recurring, persistent thoughts, mental images, or urges that cause marked anxiety or distress More than excessive worry A person tries very hard to get rid of the obesssion with another thought or behaviour A person knows the obsession comes from his/her own mind Based on DSM IV TR (2000)
Some Common Obsessions Excessive, intrusive thoughts about dirt, germs, illness, or contaminazon Fears of having accidentally caused harm Excessive doubzng of whether tasks were complete or accurate UpsePng, nonsensical need for specific order or exactness UpsePng aggressive, sexual, or religious thoughts that are out of character
What Aren t Obsessions? InfatuaZon Fantasies Over thinking UpsePng memories Worrying Intrusive thoughts*
Intrusive Thoughts are NORMAL 90% of people report experiencing intrusive thoughts (Salkovskis, 1998) It is not the intrusion that makes an obsession or OCD; it is our anxiety, distress, and reaczon to it
So Why Not Just Stop Thinking About It? An Experiment
What are Compulsions? RepeZZve behaviours or mental tasks a person must perform according to very set rules and/or in response to an obsession Compulsions aim to bring down distress or prevent a bad thing from happening, although they are either very excessive or wouldn t realiszcally work Based on DSM IV TR (2000)
Some Common Compulsions Checking doors, windows, locks, appliances many Zmes Washing and cleaning a great deal CounZng objects, words, etc Arranging and rearranging objects Following very specific rituals Looking for reassurance excessively
What Aren t Compulsions? Tidiness / orderliness Habits Impulses AddicZons SupersZZous behaviours (usually)
Avoidance Triggers become linked with obsessions and are avoided Avoid due to fear of intrusive thoughts Avoid to prevent need to do compulsions
The Cycle & Growth of OCD Obsessions are never sazsfied Compulsions are never complete Avoidance expands
What Makes it a Disorder? Impact Very upsepng Quality of life Time consuming
Treatment of OCD Exposure & Response PrevenZon (ERP) MedicaZons
Exposure & Response PrevenZon Behavioural change based therapy Learning through new experiences EssenZally a process of reversing what the OCD is telling a person to think, feel, and do IdenZfy OCD cycle in aczon Face feared situazons / triggers Carry through without compulsions Allow the anxiety to change and fade on its own
Exposure Targets oben on a hierarchy of difficulty Gradually confront avoided items, situazons, and thoughts Stay in the situazon Anxiety gradually declines Repeat
Response PrevenZon Stop compulsive behaviour Very challenging Leads to high anxiety at first Declines with Zme Alternate: ruin compulsion Example touch something contaminated aber washing hands
Gains from ERP Learn new things Feared outcome doesn t happen Ability to cope is berer than expected Fear and anxiety gradually decrease Avoidance gradually decreases Urge to do compulsions decreases Thoughts become less upsepng
A Course of ERP Typically 10 20 sessions, 60 120 minutes Exposures are done both in session and on own Client is never forced to do anything
ERP: The BoRom Line Very challenging, but it works Extremely well researched, established, and effeczve treatment for OCD ERP and similar therapies are effeczve for approximately 2/3 to 3/4 of individuals
MedicaZons Used to Treat OCD Used to treat OCD: SSRIs / SNRIs Serotonin Reuptake Inhibitors Tricyclic anzdepressants To help treatment Atypical anzpsychozcs / mood stabilizers
GePng Help for OCD in ORawa
At The Royal Physician referral to The Royal Assessment by psychiatrist or psychologist Treatment is done both through medicazons and through ERP ERP is usually done in a group
In the Community Look for therapists with the following: Professionally qualified / licensed OCD specific experience Behavioural or cognizve behavioural treatment approach Unless the praczzoner is a physician, his/her services will likely not be covered by OHIP / RAMQ; however, private insurance may assist
Online Resources InternaZonal OCD FoundaZon www.ocfoundazon.org Anxiety & Depression AssociaZon of America www.adaa.org Anxiety Disorders AssociaZon of Ontario www.anxietydisordersontario.ca The Royal www.theroyal.ca