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Obsessive Compulsive Disorder (OCD) is a chronic anxiety disorder in which a person has repeated, intrusive, unwanted thoughts, mental images or impulses ( obsessions) that are relieved by repeated ,unwanted behaviours (compulsions). People with OCD are classically unable to control these thoughts and behaviours, spend a great deal of time daily in these obsessions and compulsions, develop anxiety, guilt and distress due to symptoms. These symptoms interfere with all aspects of life like school, work, and relationships.
OCD affects all age groups adults, adolescents and children.

SIGNS AND SYMPTOMS OF OCD

Common obsessions include:

  • Fear of dirt or contamination with germs, bodily fluids, secretions, pollutants etc
  • Fear of causing harm to self or others ( maybe due to something the person did or did not do)
  • Fear of making a mistake
  • Fear of being embarrassed or behaving in a socially unacceptable manner
  • Fear of blurting obscenities
  • Fear of thinking evil or sinful thoughts
  • Need for order, symmetry and exactness
  • Excessive doubts and need for constant reassurance
  • Intrusiveness violent mental images
  • Forbidden or pervert sexual or blasphemous thoughts, images or impulses
  • Lucky unlucky colors, numbers , words
  • Religious obsessions
  • Excessive concern with a body part ( dysmorphophobia)

Common Compulsions include:

  • Repeated, excessive or ritualized cleaning, washing, grooming, toilet routines
  • Refusing to shake hands, touch doorknobs etc
  • Repeatedly checking things like locks, stoves
  • Constant counting mentally or aloud
  • Constantly arranging or rearranging things
  • Being stuck in mind of words , images, or thoughts
  • Repeating specific words, phrases, prayers
  • Collecting or hoarding items with no apparent value
  • Repeating actions like re reading, erasing, re writing, in-out of door, up -down on seat
  • Need to touch, tap or rub
  • Other self damaging or self mutilating behaviors

OCD in KIDS

A CBT treatment plan is designed to improve overall wellbeing of the child not just hs or her obsessions or compulsions. The child may need treatment to improve self esteem, build social skills, improve family relationships, and academic functioning. In case of other significant issues interfering with treatment like a case of severe depression or family conflict they should be treated first followed by CBT for OC symptoms.

Treatment

A Comprehensive Clinical Assessment and treatment plan lays the essential foundation for successful treatment. After assessment treatment is started with medication and Cognitive Therapy.

Assessment and Diagnosis

The comprehensive clinical assessment helps to obtain a complete and sensitive understanding of the OCD symptom themes, baseline severity, course and impairment, family history, medical co morbidity like tics and chorea, potentially difficult areas for treatment and co morbid psychiatry disorders.

It includes Diagnostic Interviews, Clinician Rated Instruments ( Y-BOCS or CY-BOCS: Yale Brown Obsessive Compulsive Scale), other measures like Obsessive Compulsive Impact Scale and Family Accommodation Scale. Assessment helps the clinician plan CBT and Exposure Response Prevention therapy. it also helps to monitor improvement in symptoms with medication.

Medication

The most effective medications prescribed for OCD are SSRI’s Selective Serotonin Reuptake Inhibitors. These medications include Sertraline, Paroxetine, Fluvoxamine, Fluoxetine,Citalopram. Other medications include tricyclic antidepressants like Clomipramine. Atypical antipsychotics have also proven useful in low doses. Benzodiazepines are also used to relieve anxiety symptoms.

CBT

Cognitive Behavior Therapies such as Exposure Response Prevention ERP, Imaginal Exposure or Mindfulness based CBT are one of the most effective treatments for OCD with a success rate of 65% to 85%. The symptoms list generated in Clinical Assessment becomes the primary tool for all CBT therapies. These therapies are challenging and long term. Results come after taking regular sessions and performing all homework as assigned by your therapist.

15 day Intensive OCD Treatment Plan

This plan includes initial assessment done over 2 sessions to create a treatment plan followed by ten sessions of CBT done over alternate days and 3 booster sessions.


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