Obsessive -

Compulsive
Disorder

It is a mental disorder with two components:
obsessions, which consist of thoughts, impulses,
or mental images; and compulsions, which are
repetitive behaviors that the person feels driven
to perform in response to the obsessions. In some
cases, the compulsion may represent a strict rule
that the patient must apply rigidly in every
situation (tying one's shoes a certain number of
times, for example) in order to feel "right." The
exact content of obsessions varies from person to
person, although certain themes are common.
People with OCD experience their disturbing
thoughts and images as intrusive and troublesome,
but they recognize that their thoughts are
products of their own minds. Obsessive thoughts
are different from worries about such real-life
problems as losing one's job or bad grades in
school. In addition, obsessive thoughts are not
ETIOLOGICAL
THEORIES

Psychodynamics

Freud placed origin for obsessive-compulsive
characteristics in the anal stage of
development. The child is mastering bowel
and bladder control at this developmental
stage and derives pleasure from
controlling his or her own body and
indirectly the actions of others.

Erikson’s comparable stage for this disorder
is autonomy versus shame and doubt. The
child learns that to be neat and tidy and to
handle bodily wastes properly gains
parental approval and to be messy brings
criticism and rejection.

The obsessional character develops the art of the
need to obtain approval by being excessively tidy
and controlled. Frequently the parents’ standards
are too high for the child to meet, and the child
continually is frustrated in attempts to please
parents.

The defensive mechanisms used in obsessive-
compulsive behaviors are unconscious attempts by
the client to protect the self from internal
anxiety. The greater the anxiety, the more time
and energy will be tied up in the completion of the
client’s rituals. First, the client uses regression, a
return to earlier methods of handling anxiety.
Second, the obsessive thoughts are either devoid
of feeling or are attached to anxiety. Thus,
isolation is used. Third, the client’s overt attitude
toward others is usually the opposite of the
unconscious feelings. Thus, reaction formation is
Biological

Although biological and neurophysiological
influences in the etiology of anxiety disorders
have been investigated, no relationship has yet
been established. The mind-body connection is
well accepted, but it is difficult to establish
whether the biological changes cause anxiety or
the emotional state causes physiological
manifestations. However, recent findings suggest
that neurobiological disturbances may play a role
in obsessive-compulsive disorder, with
physiological and biochemical factors also playing
significant roles.
Family Dynamics

The individual exhibiting dysfunctional behavior is
seen as the representation of family system
problems. The “identified patient” (IP) is carrying
the problems of the other members of the family,
which are seen as the result of the
interrelationships (disequilibrium) between family
members rather than as isolated individual
problems.

Multiple factors contribute to anxiety disorders.
 
PREDISPOSING

RISK FACTORS
•
– Stressful Life Events
• Pregnancy
• Psychosocial Factors:

-personality functions

-psychodynamic functions

-behavioral functions
– Step throat
• Environment
• PRECIPITATING
• RISK FACTORS:


– Biological Factors
• -Genetics (Family History)
– Tourette’s Syndrome
• Nursing Diagnosis: Anxiety related
to repetitive actions secondary to
Obsessive Compulsive Disorder
• Subjective Cues:
• “I always wash my hands every
minute” as manifested by the
patient.
• Objective Cues:
• -Repetitive Actions
• -Decreased Social and Role
Independent:


• Establish relationship through use of empathy,

warmth, and respect. Demonstrate interest in
client as a person through use of attending
behaviors.
• Acknowledge behavior without focusing attention on
it. Verbalize empathy toward client’s experience
rather than disapproval or criticism.
• Use a relaxed manner with the client; keep the
environment calm.
• Assist client to learn stress management, (e.g.,
thought-stopping, relaxation excercises, imagery)
• Identify what the client perceives as relazing (e.g.,
warm bath, music). Engage in constructive
activities such as quiet games that require
• Encourage participation in a regular exercise
program.
• Give positive reinforcement for noncompulsive
behavior. Avoid reinforcing compulsive
disorder.
• Assist client to find ways to set limits on own
behavior. At the same time allow adequate
time during the daily routine for the ritual.
• Discuss home situation, include family/ SO as
appropriate.

Collaborative:
• Administer as indicated, e.g.,: Fluvozamine
(Luvox), Clomipramine (Anafranil),
Fluoxetine (Prozac)

Nursing Diagnosis: Impaired skin integrity related to
repetitive behaviors related to cleansing, such as
washing, brushing teeth, showering secondary to
Obsessive Compulsive Disorder.

Cues:

-Disruption of skin surfaces; destruction of skin/tissues (e.g.,
mucous membranes)

Nursing Interventions:

Independent:

Assess changes in skin/tissue (e.g., alterations in skin turgor,
edema, dryness, altered circulation, and presence of
infections).

Encourage use of mild soap and hand creams, while using
methods previously described in ND.

Discuss measures client can take during/after cleaning
behaviors( e.g., use of rubber gloves and application of
antiseptic cream).


Nursing Diagnosis: Risk for altered Role Performance related to
Psychological Stress Secondary to Obsessive Compulsive
Disorder.

Cues:

No signs and symptoms.

Nursing Interventions:


Independent:


1. Determine client’s role within family and extent to which illness-

related thoughts and actions affect role relationships.
2. Discuss client’s perceptions of role, how obsessive-compulsive
behaviors affect role, and whether perceptions are realistic.
3. Identify conflicts that exist within the family system and specific
relationship that are affected. Encourage family member to
begin to discuss identified problem areas.
4. Explore options for changes or adjustments in role and practice
behaviors using role-play.
5. Encourage participation by all family members in problem-solving
process and plans for change.
6. Provide positive reinforcement for movement toward resuming role
responsibilities and decreasing ritualistic behaviors.