Obsessive Compulsive Disorder
Lauren Bellafiore
Jennifer Palese
Lauren Phillips
Professor Demshock
July 27, 2004
I. DSM IV-TR Diagnostic Criteria for Obsessive Compulsive
Disorder (300.3)
A. Obsessions
1. Recurrent and persistent thoughts, impulses, or images that are
experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems
3. The
person attempts to ignore or suppress such thoughts, impulses, or images ,or to neutralize them with some other thought
of action.
4. The person recognizes that the obssessional thoughts, impulses or images are a product of his or
her own mind (not imposed from without thought assertion.
B. Compulsions
1. Repetitive behaviors (eg,
hand-washing, ordering, checking,) or mental acts (eg., praying, counting, repeating words sliently) that the person
feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
2. The
behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however
these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize
or prevent or are clearly excessive
C. At some point during the course of the disorder the person had recognized
that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children
D. The
Obsessions or Compulsions
1. Cause marked distress
2. Are time consuming (take more than 1 hour a day)
3.
Significantly interfere with the persons normal routine or occupational (or academic) functioning, or usual social activities
or relationships.
E. If another Axis I disorder is present , the content of the obsessions or compulsions
is no restricted to it (eg., preoccupation with food in the presence of an eating disorder).
F. The disturbance
is not due to the direct physiological effects of a substance or a general medical condition.
*Specify poor judgement
if the person does not realize the obsessions and compulsions are excessive or unreasonable (Note: This does not apply to
children)
II. OCD in a Classroom Setting
A. Fear of dirt, germs or contamination
1.
Rituals to avoid or undo contact with contaminated person or object
2. Repeatedly frequenting the bathroom to wash
hands
3. Avoidance of touching objects including door knobs, books, classmates
writing utensils, chalk, toys,
or any other foreign objects
4. The use of a tissue or any other objects (ex./ the child's sleeve or
mitten)
to avoid direct contact with objects
B. Symmetry and Ordering/ Arranging Obsessions
1. Arranging objects on
school desk to achieve a balance or symmetry
2. Placing objects in proper order in locker
3. Preoccupation
with symmetry of clothes or objects (ex./ shirt must
must be buttoned evenly and symmetrically at all times)
4.
Walking in an unusual pattern down a hallway or sidewalk
C. Repeating / Checking Compulsions
1. Repeatedly
checking to make sure backpack is packed properly
2. Repeatedly checking that his/her locker is locked
3.
Repeatedly checking homework assignments
4. Repeatedly walking in and out of the classroom doorway
5. Performing
compulsions in sets of numbers (ex/. Always washing washing hands five times)
6. Repeatedly asking the same
questions over and over again D. Exhibiting specific rituals including the way he or she gets up from his or her seat,
packs his or her backpack, or grooms him or herself
E. Fear of illness or harm coming to oneself or relatives
1.
Seeking reassurance that they and their family are safe
2. Frequent calls to home to make sure family is okay
F.
Need for Reassurance
1. Ask to teacher to repeat something over and over tomake sure they understand the information
correctly
2. Repeatedly questioning if something an answer on a test is correct
3. Frequent requests for reassurance
from others
G. Perfectionism
1. Working slowly and extremely carefully
2. Trying to make letters perfect
when writing
3. Making sure not to coloroutside the lines
H. Lateness to class due to obsessions, compulsions,
or rituals
III. Assessing the Severity of OCD ( Referenced from Y-BOCS):
A. Sub-Clinical
1. Some interference from obsessions and compulsions
2. Individual has minor distress from symptoms
3. Individual as complete, or much control of symptoms
B. Clinical/Mild/Moderate
1. Excessive worries
and recurring thoughts
2. Exercises compulsive behavior in response to obsessions
3. Able to functional, with
marked difficulty
C. Severe
1. Unable to control obsessions and compulsions
2. Rituals consume several
hours of patients day
3. Unable to extreme difficulty, or inability to function in almost all areas
D. Extreme
1. Person is completely controlled by the disorder
2. Unable to function, and needs constant supervision
Tests
for Adults
A. Y-BOCS (Yale Brown Obsessive Compulsive Scale)
1. Clinician rated to measure severity
2.
Scores may change/improve with treatment
B. Diagnostic Interview
1. Conducted by clinical psychologist holding
a Ph.D. to determine
extent and severity of disorder
C. OCI ( Obsessive Compulsive Inventory)
1. Developed
to more comprehensive than most tests, and allows for
A large range of severity scores.
D. BAI (Beck Anxiety
Inventory)
1. Designed to asses the severity of symptoms in adults and children
Using a 21 item self-report
Inventory.
E. MOCI (Maudsley Obsessive Compulsive Inventory)
F. CAC (Compulsive Activity Checklist)
G.
STAI (Spielberger State-Trait Inventory)
H. NIMH-GOCS (The National Institute of Mental Health Global
Obsessive
Compulsive Scale)
I. CGIS (Clinical Global Improvement Scale)
Tests For Children
A. CY-BOCS (Child
Yale-Brown Obsessive Compulsive Scale)
B. NIMH-GOCS (The National Institute of Mental Health Global
Obsessive
Compulsive Scale)
C. CGIS (Clinical Global Improvement Scale)
D. Teacher Report Form
E. Self-Report
and Parent OCD Checklist
1. List most common OCD Symptoms
2. Filled out weekly by both child and parent
F.
(MASC) Multidimensional Anxiety Scale for Children
IV. Treatment/Counseling a student with OCD
A. Educate the family and patient of treatments available for disorder
1. Psychotherapy: Cognitive Behavioral
Therapy (CBT)
a. Teaches necessary skills to resist compulsions and obsessions
b. Helps change distorted automatic
thoughts and maladaptive assumptions
Medication:
Medication with Serotonin Reuptake Inhibitor (SSRI)- This
is newer types of medication available and will help balance the chemicals in the brain.
Educate families and patients
about the benefits of learning how to cope and handle with OCD through the use of the sources listed below:
Internet
Support groups
Library
Two Stages of treatment:
1. Acute Treatment Phase: this stage is designed
to help end OCD.
2. Maintenance Treatment Phase: Prevent future incidents of OCD.
Sharing:
For people
currently in treatment: share support and encouragement for others going through OCD and talk to those who have had this problem.
For treatment graduates: Share you experience with others who have OCD, this is an attempt to help relapse prevention.
V. Recommendations/Resources for Teachers
Educate teaching personnel on neurological
disorders:
1. Teacher certification to include a minimum 3 credit hour course on disorders that can severely disrupt
a child's ability to succeed
2. Provide in-service courses to all teachers and school personnel
a. Recognize
and respond to OCD in school age children
View film entitled "Sin City" which encourages role playing in which school
personnel become special education students.
Provide a workshop to all teaching personnel who will sit on mandatory
Child Study committees:
respect the privacy of the student and family
talk with parents and advocates regarding
any changes
make realistic recommendations
C. Encourage teachers to attend conferences and seminars pertaining
to OCD.
Provide teacher-parent workshops to open channels of communication:
Offer support and understanding
to the students and their families affected by this disorder.
Provide a hotline for parents to contact school in an
emergency
Provide an emergency number(s) for school to contact parent(s)
E. Develop a library of videotapes
and reading material
Gives teaching professionals a critical link in the identification, treatment, and management
of OCD children and adolescents.
F. Provide teaching professionals with Internet access to the various resources to
obtain information on available support groups.
G. Develop a chain of command within the school and district regarding
how to handle neurological disorders.
H. Provide, if needed, training exercises for school personnel regarding home
visits for those students with a particular OCD i.e. hoarding
VI. Recommendations/Resources for Parents
and Family
Educating family on the disorder
1. Open dialogue with therapist and school personnel
to accept the illness and work towards recovery.
Learn all you can about the disorder.
workshops
therapists
Internet
Develop family coping skills
Know how others have learned to deal with similar illnesses.
Attend anger management classes to avoid placing blame
Provide better ways to communicate their feelings and
frustrations.
Attend group sessions about the benefits of behavior therapy
Encourage loved ones to participate
in and comply with treatment.
Encourage family members to participate in Child Study teams for school age children.
VII.The Student's Treatment Team
-OCM Advocates for School Age Children
-Professionals
who defend the child's rights at Child Study committee meetings and impartial hearings, if needed.
-School Based Support
Team
1. Director for Pupil Personnel Services:
Plans for school related expenditures necessary to meet agreed
up annual goals.
Plan for summer school services to meet the childs IEP.
2.School Psychologist:
Provide
counseling
Provides testing and assessment in conjunction with state guidelines
Guidance Counselor
Coordinate
school and community resources to best meet the student's goals. students classroom schedule related school services
speech resource room
Classroom and Resource Room Teachers:
Ensure that the students IEP is being followed.
Provide the additional incentives to help the student be successful.
VIII.Community Resources
for The Student
Western BOCES (Board of Cooperative Educational Services)
Eastern BOCES (Board of
Cooperative Educational Services)
Nassau BOCES (Board of Cooperative Educational Services)
Behavior Therapists
Social Workers
Obsessive Compulsive Foundation
Support Groups
Obsessive Compulsive Anonymous
www.counseling-psychotherapy.com www.ocdonline.com
IX.Medications used to treat OCD
A.
Nonselective SSRI's which affect neurotransmitters other than serotonin
1. Anafranil (Clomipramine)
B. Side
Effects of SSRI's
1. Sedation
2. Weight Gain
3. Sexual Problems
4. Dizziness
5. Dry
Mouth
6. Problems with blood pressure
7. Irregular Heartbeat
C. Selective Serotonin Reuptake Inhibitors
1. Fluoxetine (Prozac)
2. Fluvoxamine (Luvox)
3. Paroxetine (Paxil)
4. Sertraline (Zoloft)
5. Citalopram (Celexa)
6. Escitalopram (Lexapro)
D. Side Effects of SSRI’s
1. Insomnia
2. Nervousness
3. Nausea
4. Diarrhea
Works Cited
American
Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders (4th ed. TR). Washington, DC: American
Psychological Association.
Andrus, M. & Brooks, J.L. (1997). As Good As It Gets. United States: Columbia/Tristar
Studios
Butcher, J. N., Hooley, J. M.,& Mineka, S. (2004). Abnormal Psychology (12th ed). Boston: Pearson Education.
http://www.brainphysics.com/ocd/ybocs.html
http://www.swin.edu.au/victims/resources/assessment/affect/oci.html
http://www.ocfoundation.org
<http://www.childdevelopmentinfo.com/disorders/child_OCD.htm>
<http://www.aacap.org/publications/factsfam/ocd.htm>
http://serendip.brynmawr.edu/bb/neuro/neuro01/web1/index.html
<http://www.childadvocate.net/OCD_and_therapy.htm>
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2510699&dopt=Abstract
http://www.members.aol.com/overcomeocd/group.htmlx
Grade Received on this Project : A
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