Obsessive-Compulsive Disorder

Article excerpt

TOPIC. Identification and management of obsessive-compulsive disorder (OCD).

PURPOSE. To increase advanced practice clinicians' awareness of the prevalence, screening tools, diagnostic criteria, differential diagnosis, and therapeutic management of OCD.

SOURCES. Published literature.

CONCLUSIONS. Nurses have a pivotal role in teaching self-management techniques to people with OCD.

Search terms: Anxiety disorders, obsessive-compulsive disorder


Anxiety disorders pose significant mental health problems and impair social functioning and quality of life, despite significant progress in understanding and treating anxiety disorders, such as obsessive-compulsive disorder (OCD). Anxiety disorders are one of the two most common types of psychiatric disorders, yet scant attention has been focused on treatment of OCD, the fourth most common psychiatric disorder in the United States (Rasmussen & Eisen, 1992). The traditional example of obsessive compulsive disorders is Lady Macbeth, who obsessed about her guilt and repeatedly washed her hands and intoned, "Out, out damned spot."

OCD is a treatable and biological disease in which serotonin metabolism plays a major role. It is an anxiety disorder with persistent thoughts and repeated rituals to control those thoughts. Anxiety is a hyperalert state causing excessive autonomic arousal and diminished coping that can be crippling and can seriously interfere with a person's life, increase health concerns, and absorb costly medical services. Approximately 4 million Americans suffer from anxiety disorders such as OCD, but only one in four is accurately diagnosed and treated (Rasmussen & Eisen, 1992).

The purpose of this article is to increase advanced practice clinicians' awareness of the prevalence, screening tools, diagnostic criteria, differential diagnosis, and therapeutic management of OCD. Effective management of anxiety disorders rests on sound scientific knowledge, which can enable advanced practice nurses to reduce anxiety and prevent complications. Failure to detect and diagnose OCD among many anxious patients leads to costly urgent care visits and other consequences such as suicide risk, depression, or chemical dependency. Diagnosis can be missed when medical care focuses on the chief physical complaint without considering anxiety disorders. Detecting OCD is a challenge when patients do not automatically report anxiety and OCD symptoms.

Incidence and Prevalence

Anxiety and mood disorders are the most frequent psychiatric disorders in America. In the Economic Catchment Area Survey, the 6-month prevalence of OCD was 1.6%; lifetime prevalence was 2.5% (Greist & Jefferson, 1995, 1998). OCD interferes with the quality of life and performance of more than 5 million Americans. OCD occurs more than twice as often as panic disorder or schizophrenia. Approximately equal numbers of females (53%) and males (47%) have OCD (Greist & Jefferson). The prevalence of OCD in the United States is similar to rates in Canada, Europe, Taiwan, and Africa. According to Greist and Jefferson, most people seek treatment from a medical or primary care provider but not a psychiatrist. Onset typically occurs during childhood or teenage years for males and during the 20s for females (Greist & Jefferson).

Historically, OCD developed among people who had biological disorders such as Von Economo's disease, war-related head injuries, and Gilles de la Tourette's syndrome. About 55% to 74% of people with Tourette's syndrome have OCD symptoms, and 6 out of 10 sufferers meet the diagnostic criteria for OCD (Coffey et al., 1998; Rasmussen & Eisen, 1992; Steketee & Frost, 1998). This pattern of OCD following a neurological disorder suggests that OCD is related to neuroanatomical deviations. Family and twin studies also suggest a genetic susceptibility to OCD. …