Tutorial 3 Anxiety Disorders – OCD
Look at the examples described in the task, what is going on?
Annelies: compulsive checking
Michiel: compulsive counting
Forcing neighbor on ground: pure obsession/aggression
Father of Rianne: compulsive cleaning
OCD according to DSM IV
The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions
(Criterion A) that are severe enough to be time consuming (they take more than 1 hour a day)
or cause marked distress or significant impairment (Criterion C). At some point during the course
of the disorder, the person has recognized that the obsessions or compulsions are excessive or
unreasonable (Criterion B).
Obsessions persistent ideas, thoughts, impulses, or images that are experienced as intrusive
and inappropriate and that cause marked anxiety or distress. The intrusive and inappropriate
quality of the obsessions has been referred to as "ego-dystonic." This refers to the individual's
sense that the content of the obsession is alien, not within his or her own control, and not the
kind of thought that he or she would expect to have. However, the individual is able to
recognize that the obsessions are the product of his or her own mind and are not imposed from
without (as in thought insertion).
Most common obsessions: repeated thoughts about contamination (e.g., becoming
contaminated by shaking hands), repeated doubts (e.g., wondering whether one has
performed some act such as having hurt someone in a traffic accident or having left a door
unlocked), a need to have things in a particular order (e.g., intense distress when objects are
disordered or asymmetrical), aggressive or horrific impulses (e.g., to hurt one's child or to shout
an obscenity in church), and sexual imagery (e.g., a recurrent pornographic image).
Based on a study of more than 1,000 patients with OCD Rasmussen and Eisen reported that fear
of contamination (50%) and pathological doubt (42%) were the most common obsessions,
whereas symmetry (32%), aggression (31%), sex (24%), and religion (10%) were less common.
The thoughts, impulses, or images are not simply excessive worries about real-life problems (e.g.,
concerns about current ongoing difficulties in life, such as financial, work, or school problems)
and are unlikely to be related to a real-life problem.
The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or
to neutralize them with some other thought or action (i.e., a compulsion). For example, an
individual plagued by doubts about having turned off the stove attempts to neutralize them by
repeatedly checking to ensure that it is off.
Compulsions repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts
(e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce
anxiety or distress, not to provide pleasure or g ratification. In most cases, the person feels driven
to perform the compulsion to reduce the distress that accompanies an obsession or to prevent
some dreaded event or situation.
Overt – openlijk
Covert – in je hoofd. Begint te zingen of te bidden in je hoofd.
For example, individuals with obsessions about being contaminated may reduce their mental
distress by washing their hands until their skin is raw; individuals distressed by obsessions about
having left a door unlocked may be driven to check the lock every few minutes; individuals
Look at the examples described in the task, what is going on?
Annelies: compulsive checking
Michiel: compulsive counting
Forcing neighbor on ground: pure obsession/aggression
Father of Rianne: compulsive cleaning
OCD according to DSM IV
The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions
(Criterion A) that are severe enough to be time consuming (they take more than 1 hour a day)
or cause marked distress or significant impairment (Criterion C). At some point during the course
of the disorder, the person has recognized that the obsessions or compulsions are excessive or
unreasonable (Criterion B).
Obsessions persistent ideas, thoughts, impulses, or images that are experienced as intrusive
and inappropriate and that cause marked anxiety or distress. The intrusive and inappropriate
quality of the obsessions has been referred to as "ego-dystonic." This refers to the individual's
sense that the content of the obsession is alien, not within his or her own control, and not the
kind of thought that he or she would expect to have. However, the individual is able to
recognize that the obsessions are the product of his or her own mind and are not imposed from
without (as in thought insertion).
Most common obsessions: repeated thoughts about contamination (e.g., becoming
contaminated by shaking hands), repeated doubts (e.g., wondering whether one has
performed some act such as having hurt someone in a traffic accident or having left a door
unlocked), a need to have things in a particular order (e.g., intense distress when objects are
disordered or asymmetrical), aggressive or horrific impulses (e.g., to hurt one's child or to shout
an obscenity in church), and sexual imagery (e.g., a recurrent pornographic image).
Based on a study of more than 1,000 patients with OCD Rasmussen and Eisen reported that fear
of contamination (50%) and pathological doubt (42%) were the most common obsessions,
whereas symmetry (32%), aggression (31%), sex (24%), and religion (10%) were less common.
The thoughts, impulses, or images are not simply excessive worries about real-life problems (e.g.,
concerns about current ongoing difficulties in life, such as financial, work, or school problems)
and are unlikely to be related to a real-life problem.
The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or
to neutralize them with some other thought or action (i.e., a compulsion). For example, an
individual plagued by doubts about having turned off the stove attempts to neutralize them by
repeatedly checking to ensure that it is off.
Compulsions repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts
(e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce
anxiety or distress, not to provide pleasure or g ratification. In most cases, the person feels driven
to perform the compulsion to reduce the distress that accompanies an obsession or to prevent
some dreaded event or situation.
Overt – openlijk
Covert – in je hoofd. Begint te zingen of te bidden in je hoofd.
For example, individuals with obsessions about being contaminated may reduce their mental
distress by washing their hands until their skin is raw; individuals distressed by obsessions about
having left a door unlocked may be driven to check the lock every few minutes; individuals
