NUR-3412: Mental Health Nursing - Obsessive Compulsive and Related Disorders

Obsessive Compulsive and Related Disorders

• Characterized by repetitive thoughts and repetitive behaviors
• Obsessions/Compulsions are time-consuming and cause significant distress/impairment
• Patients are fully aware of the bizarreness of the thoughts and try to resist the behaviors

Obsessive Compulsive Disorder (OCD)

• Involves recurrent intrusive ideas, images, impulses, thoughts (Obsessions) or repetitive patterns of behavior or actions (Compulsions)
• Both obsessions and compulsions are time-consuming or cause significant distress/impairment
• DSM-5 Diagnostic Criteria for OCD:
  • Presence of obsessions, compulsions, or both
  • 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
  • The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
  • The disturbance is not better explained by the symptoms of another mental disorder

Body Dysmorphic Disorder (BDD)

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
• The significance of the defect is unrealistically exaggerated
• Common complaints involve:
  • Imagined or slight flaws of the face or head, such as wrinkles or scars, shape of the nose, excessive facial hair, and facial asymmetry
• During the course of the disorder, the individual has behaviors like:
  • Mirror checking, excessive grooming, skin picking, reassurance seeking, or mental acts like comparing his or her appearance with that of others
• Causes clinically significant impairment in social and occupational functioning
• Associated with high rates of hospitalization (48%) and high rates of suicidal ideation and attempts

Hoarding Disorder

• Characterized by “persistent difficulties discarding or parting with possessions, regardless of their actual value”
• The discarding difficulties arise from fears of:
  • Losing valuable information
  • Objects of emotional significance
  • Making serious mistakes
• Often associated with distress whenever other people touch or move one’s possessions
• The symptoms result in the accumulation of a large number of possessions that:
  • Fill up and clutter the active living areas of the home, workplace, or other personal surroundings
  • Prevent normal use of the space
• Can create a public health issue by completely filling people’s homes and creating fall and fire hazards

Trichotillomania (Hair-Pulling Disorder)

• Recurrent pulling out of one's hair, resulting in hair loss
• Repeated attempts to decrease or stop hair pulling
• Most patients have bald areas on the head, lost eyelashes and eyebrows that they manage with haircuts, scarves, wigs, or makeup
• The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Excoriation (Skin-Picking) Disorder

• Recurrent skin picking that results in skin lesions
• They pick at pre-existing spots on their skin or create new lesions, often leaving more visible scabbing
• The need to pick at one’s skin creates anxiety that is alleviated when the picking has finished, but creates distress when the after-effects become visible
• Fingers and fingernails are the usual implements, biting, nail cutters, and tweezers are also used
• The most common areas of focus are:
  • Face, head, cuticles, back, arms, and legs, and hands and feet

Treatment Modalities for Obsessive Compulsive and Related Disorders

• Psychotherapy:
  • Cognitive Behavioral Therapy (CBT)
  • Exposure and response prevention
  • Thought stopping
• Medications:
  • Antidepressants (first-line treatment choice)
  • Antipsychotics (for resistant OCD)
  • Electroconvulsive Therapy (ECT)
• Lifestyle, coping, and support:
  • Psychoeducation
  • Support groups
  • Healthy outlets (e.g., hobbies, exercise, recreational activities)
  • Relaxation and stress management techniques (e.g., meditation, muscle relaxation, deep breathing, yoga, tai chi)
  • Planning, structuring time, and daily activities and focusing on life goals