Question

Describe the diagnostic criteria for OCD and discuss the treatment approach using exposure and response-prevention. Provide a case example from the text or other scholarly source.

Answer 1

• An obsessive-ompulsive disorder diagnosis can only come from a qualified mental health professional. To receive an OCD diagnosis, you must meet certain diagnostic criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). If you receive an OCD diagnosis, it means that you have a chronic mental illness that will require lifelong management.
• To receive an OCD diagnosis, one must meet these general criteria:
• One must have obsessions and compulsions
• The obsessions and compulsions must significantly impact one's daily life
• One may or may not realize that their obsessions and compulsions are excessive or unreasonable
• One's obsessions must meet specific criteria:
• Intrusive, repetitive and persistent thoughts, urges, or images that cause distress
• The thoughts do not just excessively focus on real problems in the life
• One unsuccessfully try to suppress or ignore the disturbing thoughts, urges, or images
• One may or may not know that your mind simply generates these thoughts and that they do not pose a true threat
• One's compulsions must meet specific criteria:
• Excessive and repetitive ritualistic behavior that they feel they must perform, or something bad will happen. Examples include hand washing, counting, silent mental rituals, checking door locks, etc.
• The ritualistic compulsions take up a least one hour or more per day
• One performs these physical rituals or mental acts to reduce the severe anxiety caused by the obsessive thoughts.
• For OCD, the technique for facing fears is called exposure and response prevention (ERP).ERP is done by:
• Exposing (E) yourself to situations that bring on obsessions (triggers)
• Not engaging in the unhelpful coping strategies that include compulsions or rituals, and avoidance (Ritual Prevention- RP)
• Exposure simply means facing or confronting one's fears repeatedly until the fear subsides.Response prevention means refraining from compulsions, avoidance, or escape behaviors.
• For example, suppose a person with obsessive-compulsive disorder (OCD) has germ contamination phobia. A typical exposure exercise consists of shaking hands with someone (exposure), and not washing hands afterwards (response prevention).
• Exposure therapy may be conducted using in vivo exposure (meaning real live exposure to the feared stimulus). Alternatively, it may be conducted using imagination. Regardless of the method, individuals are encouraged to repeatedly face the anxiety-producing stimulus until habituation occurs.
• Case study-
• At the age of 11 years, 9 months, Jason began exhibiting a significant number of ritualistic and avoidance behaviors. It is not unusual for a child to develop symptoms of OCD at this age.
• Specifically, Jason experienced contamination fears, hand washing rituals, excessive use of hand sanitizer, avoidance of contaminated items (e.g., door knobs, library books, bathroom), contamination related checking behaviors (i.e., repeatedly checking food expiration dates), not sitting on chairs, not using sheets or pillows, and not touching other items (e.g., public benches) due to concerns that they were dirty.
• Jason reported significant levels of anxiety when prevented from completing his rituals. His symptoms began interfering with his academic, social, and family functioning around his twelfth birthday and beginning of the sixth grade.
• Specifically, his teachers noticed that he was not able to turn pages with his hands, touch papers that other children had touched, or sit comfortably in his chair.
• Based on his report and his parents’ observation, Jason spent several hours per day at home washing his hands or worrying about potentially contaminated items throughout the house (i.e., door knobs, bathroom items).
• Because of these OCD symptoms, Jason was referred by his family physician for evaluation and treatment.
• An example of exposures, Jason was required to touch several common items in the hospital where the therapist’s office is located (i.e., elevator buttons, door handles) and exposures were repeated until Jason habituated to the anxiety.
• Though Jason was initially hesitant to comply with exposures, he completed them with encouragement. In fact, Jason reported being “proud” of himself when exposures were completed.
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