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Obsessive Compulsive Disorder and Addiction Awareness
#ocdawareness #obsessivecompulsivedisorder

Cheap CEUs are available for this presentation at
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Objectives
~ Define obsessions and compulsions
~ Define obsessive compulsive personality disorder
~ Define addiction
~ Explore common obsessions and compulsions and their function
~ Explore why addiction often co-occurs with OCD
~ Identify interventions appropriate to assist people with OCD, OCPD and Addiction.
Introduction
~ “Obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on different levels, including phenomenology, co-morbidity, neurocircuitry, neurocognition, neurochemistry and family history” Obsessive-Compulsive Disorder, Impulse Control Disorders and Drug Addiction
~ Activity in the orbitofrontal cortex is associated with cocaine and alcohol craving and obsessive–compulsive disorder
~ Obsessions and compulsions are central characteristics of OCD and addiction
~ Proposed that impulse control and obsessive- compulsive disorders may acquire qualities of the other with time
Introduction
~ Compulsivity in OCD and addictions is related to impaired dopamine and serotonin release
~ Treatment of these disorders must address alterations in the underlying motivations (experiential learning) and neurobiology
Obsessions
~ Obsession
~ Disturbing recurrent and persistent thoughts (if I don’t…) or impulses (I must…) that are intrusive
~ Fears of germs, taboo thoughts, aggressive thoughts, need to do particular behaviors to prevent harm
~ Thoughts do not focus exclusively on real problems (generalized anxiety, eating disorders, addiction, PTSD, postpartum depression)
~ The person attempts to ignore or suppress the thoughts or impulses
~ The person is aware that the obsessional thoughts, impulses, or images are a product of his or her own mind
Common Obsessions
~ Relationship
~ “If I enjoy when my partner is away, maybe I don't really love them.”
~ “Sometimes I look at other people and think about cheating. Maybe I secretly want someone else.“
~ “Sometimes my partner looks at other people. Maybe they want someone else.”
~ “My partner hasn’t texted me all day. They must be cheating on me or not want me anymore.”
~ Harm OCD
~ “If I drive on a bridge I might drive off and kill everyone”
~ “If the doors aren’t locked someone will break in and kill us.”
~ If I didn’t turn off the stove…
~ If I am around other people…

Common Obsessions
~ Health
~ What if this pain is cancer?

Compulsions
~ Repetitive behaviors or thoughts that the person feels driven to perform to prevent or reduce distress or keep something bad form happening
~ The symptoms of OCD are not the result of another psychiatric disorder present or caused by a medical condition or substance abuse (i.e. cravings, diabetes, Chron’s disease).

Common Compulsions
~ Relationship
~ Comparing partner to others
~ Comparing self to others
~ Frequent breakups
~ Needing frequent reassurance
~ Harm
~ Checking
~ Washing
~ Isolating
~ Prayer
~ Health
~ Nutrition
~ Detoxification (Exercise, diet, sauna)
~ General
~ Magical thinking (rituals, mantras)

Obsessive Compulsive Personality Disorder
~ A pervasive pattern of preoccupation with orderliness, perfectionism, and control in a variety of contexts beginning by early adulthood as indicated by 4+ of the following:
~ Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
~ Shows perfectionism that interferes with task completion
~ Is excessively and unnecessarily devoted to productivity to the exclusion of recreation
~ Is overconscientious and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
~ Is unable to discard worn-out or worthless objects even when they have no sentimental value. (Hoarding)
~ Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
~ Adopts a miserly spending style
~ Shows rigidity and stubbornness

Interventions
~ Medications for addiction which modulate dopamine system through
~ Opioid (e.g. Buprenorphine and naltrexone)
~ Glutamate (e.g. Topiramate)
~ Serotonin/ 5HT3 (e.g. Ondansetron)
~ GABA (e.g. baclofen and topiramate)
~ Treatment of these disorders must account for alterations in the underlying neurobiology of the condition. For example
~ Naltrexone for people with co-morbid SUD and ICD
~ Topiramate for people with co-morbid ICD and eating disorders
Interventions–Cognitive
~ Explore when the OCD or OCPD began
~ Explore when the addiction began
~ In what ways does the OCD or OCPD
~ Address feelings of unsafeness?
~ Develop a checklist
~ Journaling and exploring probability that something bad will happen
~ Reaching out to a support person (i.e. feel overpowered by emotions or thoughts)
~ Protect from rejection or failure?
~ Explore the beliefs surrounding rejection and failure
~ Enhance hardiness
~ Improve self-esteem
~ Explore where those messages came from and their validity
Interventions–Cognitive
~ How does the addiction help the person?
~ Use chaining to explore how the addiction relates to the obsessive thoughts to trigger cravings and compulsions (using)
~ Fears of germs anxiety  cravings to rebalance neurotransmitters  use
~ Discussion: What is your thought/or the situation  what are your feelings  what are your urges and what is the function of those urges
~ Learn about distress intolerant thoughts (Draw from the hat)
~ Develop alternative self statements
~ Learn about urges and riding the wave
~ Learn about unhooking
~ Develop distress tolerance skills

Interventions
~ Identify and develop a plan to mitigate triggers or vulnerabilities for the OCD or OCPD (logs, plans)
~ Beach Ball Activity: Common triggers for OCs / OCPD behavior intensification
~ Address cognitive distortions that contribute to distress
~ Mindreading, personalization, all or nothing, catastrophizing, availability heuristic (likelihood)
~ Facts, exceptions, probability
~ Mindful awareness activities to improve self-awareness of increasing anxiety or anger levels and promote early intervention
~ Psychological flexibility
~ 4 Stations: For and against behaviors and thoughts
Interventions
~ Exposure and Response Prevention (ERP w/biofeedback)
~ Think the thought or about the situation describe how you feel in session
~ If I don’t clean the kitchen, my husband will die.
~ If I am around people I will get sick and die.
~ Practice re-regulation/distress tolerance activities when prevented from engaging in the compulsive behavior (breathing, talking to a support)

Summary
~ There is significant overlap between OCD and addictive behaviors.
~ Treatment involves
~ Identifying the underlying thoughts
~ Exploring what is contributing to fears of unsafeness (harm, rejection) and powerlessness
~ Identifying the function of the thoughts and behaviors
~ Practice Exposure and Response Prevention to decondition the compulsive behaviors
~ Potentially medicating the neurotransmitter imbalance until the brain can adapt (reroute)