Obsessive- Compulsive Disorder

1. E Obsessive- Compulsive Disorder R E P R E S E N T A T I O N O F O C D I N P O P U L A R C U L T U R

2. Overview • Review • Diagnostic Criteria • Associated Features and Disorders • Frequency, Prevalence, and Course • Treatment • Pop Culture Analysis • Slang • Famous Cases • Movies • TV

3. Obsessions • Persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress • Ego-dystonic—individual’s sense that the content of the obsession is alien, not within his or her control, and not the kind of thought he or she would expect to have • Unlikely to be related to a real-life problem • Attempt made to ignore, suppress, or neutralize obsessive thoughts or impulses with some other thought or action

4. Obsessions Most Common Obsessions • Thoughts about contamination • Repeated doubts • A need to have things in a particular order • Aggressive or horrific impulses • Sexual imagery

5. Compulsions • Repetitive behaviors or mental acts, the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification • Drive to perform compulsions to reduce distress that accompanies an obsession or to prevent some dreaded event or situation • Rigid or stereotyped acts performed according to idiosyncratically elaborated rules without being able to indicate their purpose • Clearly excessive or are not connected in a realistic way with what they are designed to neutralize or prevent

6. Compulsions Most Common Compulsions • Washing and cleaning • Counting • Checking • Requesting or demanding assurances • Repeating actions • Ordering

7. Diagnostic Criteria • Criterion A : Recurrent obsessions or compulsions • Criterion B : At some point during the course of the disorder, the person recognizes that the obsessions or compulsions are excessive or unreasonable • This criterion does not apply to children • In adults there is a broad range of insight into the reasonableness of the obsessions or compulsions • An individual’s insight into the disorder may vary across times and situations • Specifier: With Poor Insight—for most of the time during the current episode, the individual does not recognize that the obsessions or compulsions are excessive or unreasonable

8. Diagnostic Criteria • Criterion C : Obsessions or compulsions are severe enough to be time consuming (take more than one hour per day) or cause marked distress or impairment • Significantly interfere with normal routine, occupational functioning, usual social activities, or relationships with others Criterion D : If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it Criterion E : The disturbance is not due to the direct physiological effects of a substance or general medical condition

9. Associated Features and Disorders • Excessive use of substances: alcohol or sedative, hypnotic, or anxiolytic medications • Tourette’s Disorder: incidence rate ranging from 35% to 90% • Tics:between 20% and 30% of individuals with OCD report current or past tics • Dermatological problems: caused by excessive washing with water or cleaning agents • Avoidance: attempts to avoid objects or situations that provoke obsessions or compulsions can be extensive and severely restrict general functioning • Hypochondriachal concerns: repeated visits to physicians to seek reassurance • Sleep disturbances • Guilt: pathological sense of responsiblity

10. Associated Features and Disorders • In Adults • Major Depressive Disorder • Specific Phobia • Social Phobia • Panic Disorder • Generalized Anxiety Disorder • Eating Disorders • Obsessive-Compulsive Personality Disorder • Dependent Personality Disorder • Avoidant Personality Disorder • In Children • Learning Disorders • Disruptive Behavior Disorders • Group A Beta-hemolytic Streptococcal Infection (scarlet fever and strep throat): characterized by prepubertal onset, associated neurological abnormalities, abrupt onset of symptoms, episodic course in which exacerbations are temporally related to the streptococcal infections

11. Frequency, Prevalence, and Course • Frequency and Prevalence • Adults: equally common in males and females • Life-time prevalence: 2.5% • 1-year prevalence: 0.5% - 2.1% • Children: more common in males than females • Life-time prevalence: 1% - 2.3% • 1-year prevalence: 0.7%

12. Frequency, Prevalence, and Course • Course • Modal age of onset • Males: between ages 6 and 15 • Females: between ages 20 and 29 • Onset is usually gradual, but cases of acute onset exist • Majority of individuals have waxing and waning course • 15% show progressive deterioration in occupational and social functioning • 5% have an episodic course with minimal or no symptoms between episodes

13. Treatment • Medication: SSRIs—Fluoxetine (Prozac) • TACs—Clomipramine (Anafril) • Cognitive Behavioral Therapy • Exposure Therapy • Touch or come close to a “contaminated” object • Think dreaded thoughts deliberately for a set amount of time • Resist ritualizing and accept the accompanying feelings of anxiety and discomfort

14. Treatment • Support Groups • 1. Professionally Assisted • Organized and run by a mental health professional • Group therapy; an extension of individual therapy • Held in the therapists office; group members pay a fee • 2. Mutual Support • Run by individual(s) who are recovered OCD sufferers • Discuss medication, symptoms, cognitive behavioral therapy • Informational, not therapeutic • Mental health professionals may be guest speakers • Usually held in a public facility without a fee

15. Treatment • Support Groups • 3. Twelve Step Program • Run by members of Obsessive Compulsives Anonymous (OCA) • Same format as the original 12-step program • Alcoholics Anonymous • Network of groups throughout the United States • 4. G.O.A.L. (Giving Obsessive Compulsives Another Lifestyle) Groups • Founded in 1981 by a psychologist and OCD sufferer • Prevent relapse with exposure and response prevention therapy in a group setting • Members run the group, but a professional therapist is present

16. Treatment • Support Groups • 5. Online Support • Offer free and immediate support from other OCD sufferers, information about treatment and ways to cope, advice from medical professionals • Information and advice for family members of OCD sufferers • Basic Strategy for Recovery • 1. Learn to stop using rituals • 2. Learn to face anxiety without them

17. Obsessive Compulsive Disorder in Popular Culture • Slang • Used as an adjective to describe a person’s perfectionist tendencies • Diminishes the severity of the disorder • Represents a lack of understanding of the disorder

18. Famous Cases • Marc Summers • - American TV personality, producer • - Best known for hosting Double Dare on Nickelodeon • - Currently hosts Unwrapped and Ultimate Recipe Showdown on The Food Network

19. Famous Cases • Howard Hughes • - American aviator, engineer, industrialist, film producer/director • - Set multiple air speed records • - Produced Hell’s Angels, Scarface, The Outlaw • - Owned and expanded Trans World Airlines

20. OCD in the Movies • The Aviator (2005) • Character with OCD: Howard Hughes • Signs and symptoms: • Rituals related to food • Fear of contamination • Excessive hand washing • Tics • Verbal repetition • Need to have things in a particular order • **Says he sees things that are not there and feels like he is losing his mind** • **Paranoia** Treatment: no measures taken to treat the disorder

21. OCD in the Movies • As Good As It Gets (1997) • Character with OCD: Melvin Udall • Signs and symptoms: • Fear of contamination • Checking • Repeated actions • Irrational rituals • **Homophobia** • **Racism** • **Misogyny** • Treatment: medication and counseling from a psychiatrist

22. OCD on TV MTV True Life: I Have Obsessive-Compulsive Disorder (1998) • Morgan: Performs rituals to please God and keep her mother alive • Therapy: Pretends to attend her mother’s funeral • Ryan: Fear of contamination, checking, tic (“huffing”) • Therapy: Does not seek treatment • Jessica: Counting, irrational rituals, need to have things in a particular order • Therapy: Made to resist ritualizing

23. OCD on TV Monk (2002) Character with OCD: Adrian Monk • Signs and symptoms: • Fear of contamination • Counting, ordering • Washing and cleaning • Generalized Anxiety Disorder • 38 Phobias • Avoidance • Dependent Personality Disorder • Treatment: • Weekly visits to his therapist, Dr. Kroger • Uses medication in a few episodes

24. Obsessive Compulsive Disorder in Popular Culture Consider the implications if the average person’s understanding of Obsessive-Compulsive Disorder is based solely on representations in the media. • Does the media accurately represent OCD? • Does the use of OCD in slang strengthen or weaken the stigma surrounding psychological disorders? • How do comedies and dramas about OCD sufferers influence the general public’s perception of disorder? • How are aspects of the disorder exaggerated or diminished for the sake of Hollywood or “good TV?”