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A Reference Guide for Diagnosing and Treating Obsessive Compulsive Disorder

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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