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CHAPTER 15 OCD and Related Disorders

Terms in this set (26)

______ are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function. The person knows these thoughts are excessive or unreasonable but believes he or she has no control over them.
Obsessions
______ are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. Usually, the theme of the ritual is associated with that of the obsession, such as repetitive hand washing when someone is obsessed with contamination or repeated prayers or confession for someone obsessed with blasphemous thoughts.
Compulsions
_______ disorder is diagnosed only when these thoughts, images, and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational functions. Examples include a man who can no longer work because he spends most of his day aligning and realigning all items in his apartment or a woman who feels compelled to wash her hands after touching any object or person.
OCD
______ disorder can be manifested through many behaviors, all of which are repetitive, meaningless, and difficult to conquer. The person understands that these rituals are unusual and unreasonable but feels forced to perform them to alleviate anxiety or to prevent terrible thoughts.
OCD
Obsessions and compulsions are a source of distress and shame to the person, who may go to great lengths to keep them secret.

OCD can start in early childhood, more often in _____, and more commonly begins in the 20s. Periods of _____ and _____ symptoms over lifetime
females

waxing

waning
Self-soothing behaviors:

______ skin picking
______ hair-pulling
______ chronic nail-biting
Excoriation

Trichotillomania

Onychophagia
Reward-seeking behaviors:

_______ compulsive stealing
_______ compulsive buying
Kleptomania

Oniomania
______ involves excessive acquisition of animals or apparently useless things, cluttered living spaces that become uninhabitable, and significant distress or impairment for the individual.

______ can seriously compromise the person's quality of life and even become a health, safety, or public health hazard.
Hoarding

Hoarding
______ disorder is the term given to people who feel "overcomplete," or alienated from a part of their body and desire amputation.

______ disorder is not an officially APA-accepted diagnosis, and there is disagreement about the existence of the condition. People describe feelings of anguish and distress with their intact bodies and report feeling "natural, like they were intended to be" after an amputation.
Body identity integrity disorder (BIID)

Body identity integrity disorder (BIID)
______ disorder is also known as amputee identity disorder and apotemnophilia or "amputation love."

From an ethical standpoint, few surgeons will amputate a limb merely on a person's request. People resort to actions such as packing the limb in dry ice until the damage is so advanced that amputation becomes a medical necessity, or in some cases, amputation is done with a power tool by nonmedical persons, leaving a physician to save the person's life and mitigate with the damage.
Body identity integrity disorder (BIID)
Is the following statement true or false?

OCD can be manifested through many behaviors, all of which are repetitive and meaningless. The person understands that these rituals are unusual and that he and she can prevent them by avoiding the source of stress.
False

Rationale: Although it is true that OCD is manifested through many behaviors and that the person is aware that the rituals are unusual, he or she feels forced to perform them to alleviate anxiety or prevent terrible thoughts. OCD is chronic and extremely difficult to conquer. Treatment is long-term therapy plus medication.
OCD Combination of medications and therapy

Medications:
First line: SSRIs _____ and _____

Second line: SNRI _____

Treatment-resistant OCD: second-generation antipsychotics ______, _______, and ______
fluvoxamine and sertraline

venlafaxine

risperidone, quetiapine, and olanzapine
OCD Behavioral therapy

______ therapy Deliberately confronting situation and stimuli that client usually tries to avoid

______ therapy Focuses on delaying or avoiding performing the rituals, learning to tolerate the thoughts and anxiety
Exposure

Response prevention
______ scale, the nurse can use this tool along with the following detailed discussion to guide his or her assessment of the client with OCD.
Yale-Brown Obsessive-Compulsive Scale.
OCD Assessment

History: The client usually seeks treatment only when obsessions become too overwhelming or when compulsions interfere with daily life or both.

Roles and relationships: As the time spent performing rituals increases, the client's ability to fulfill life roles successfully _____. Relationships also suffer as family and friends tire of the repetitive behavior, and the client is less available to them as he or she is more consumed with anxiety and ritualistic behavior.
decreases
OCD Assessment

General appearance and motor behavior: tense, anxious; embarrassment

Mood and affect: overwhelming _____

Thought processes and content: describe obsessions as rising out of nowhere
anxiety
OCD Assessment

Judgment and insight: recognizes obsessions as irrational but unable to stop them

Self-concept: powerlessness, low self-esteem

Physiological and self-care considerations: _____ problems, _____ and _____ changes
sleeping

appetite

weight
Cognitive models of OCD arise from ______ cognitive approach to emotional disorders. This has long been accepted as a partial explanation for OCD, particularly since CBT is a successful treatment.
Aaron Beck's
______ cognitive model describes the person's thinking as

(1) believing one's thoughts are overly important, that is, "If I think it, it will happen," and therefore having a need to control those thoughts;

(2) perfectionism and the intolerance of uncertainty; and

(3) inflated personal responsibility (from a strict moral or religious upbringing) and overestimation of the threat posed by one's thoughts.
Aaron Beck's
Cognitive model based on Aaron Beck's cognitive approach to emotional disorders focuses on _____ and ______ experiences of growing up
childhood

environmental
Is the following statement true or false?

The best way to help a client with OCD is to avoid talking about the obsessive-compulsive behaviors, as the client feels ashamed of the behaviors.
False

Rationale: Although a client with OCD is typically ashamed and embarrassed by the behaviors, it is important to offer encouragement, support, and compassion; to be clear that you believe he or she can change; and to develop and follow a written schedule with specified time and activities. In order to accomplish these tasks, you will need to talk with the client about the behaviors.
Outcomes for clients with OCD include:

•The client will complete daily routine activities within a realistic time frame.
•The client will demonstrate effective use of relaxation techniques.
•The client will discuss _____ with another person.
•The client will demonstrate effective use of behavioral therapy techniques.
•The client will spend less time performing ______.
feelings

rituals
Client and Family Education for OCD

For Clients:
•Teach about ______.
•Review the importance of talking openly about obsessions, compulsions, and anxiety.
•Emphasize ______ compliance as an important part of treatment.
•Discuss necessary ______ techniques for managing anxiety and decreasing prominence of obsessions.
•Tolerating ______ is uncomfortable but not harmful to health or well-being.
OCD

medication

behavioral

anxiety
Client and Family Education for OCD

For Families:
•Avoid giving _____ such as, "Just think of something else."
•Avoid trying to _____ the problem; that never works.
•Be ______ with your family member's discomfort.
•Monitor your own _____ level, and take a break from the situation if you need to.
advice

fix

patient

anxiety
OCD Evaluation

Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities.

When obsessions occur, the client manages resulting anxiety without engaging in complicated or time-consuming _______.

He or she reports regained control over his or her life and the ability to tolerate and manage anxiety with minimal disruption.
rituals
OCD Intervention

oTherapeutic communication
oRelaxation techniques
oBehavioral techniques
oDaily _____ completion
oClient and family education
routine
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