Obsessive-Compulsive Disorders
Week 7: Obsessive-Compulsive Disorders
It is getting embarrassing to go to my hair stylist. She always comments on the bald patches on my head. They keep getting bigger as I continue to pull out one strand of hair at a time. I even do it in my sleep. I can’t help myself. It all started when I was in high school when I would pull just from the back. Now I have to wear my hair a specific way so the bald patches don’t show. I don’t even color my hair anymore. I don’t want anyone to notice me.
Michelle, age 27
Although actual statistics vary, obsessive-compulsive disorder impacts approximately 1.2% of the population in the United States (APA, 2013, p. 239). It is characterized by the presence of obsessive thoughts, which are manifested as persistent thoughts, images, or even “urges.” The only way that the individual can disperse the anxiety of these persistent thoughts/images or urges is to perform a behavior (the compulsion). The compulsion could be checking things, counting, reciting a silent prayer, or repeating a number of phrases. The disorder becomes so pervasive that the person can spend a significant amount of time each day attending to the compulsion in order to relieve the anxiety caused by the obsession.
This week, you will, once again, become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans.
Learning Resources
Required Readings
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
Standard 14 “Professional Practice Evaluation” (pages 80-81)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Obsessive-Compulsive and Related Disorders”
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 21, “Obsessive-Compulsive Disorder”
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New York, NY: Cambridge University Press.
To access information on specific medications, click on The Prescriber’s Guide, 6th Ed. tab on the Stahl Online website and select the appropriate medication.
Obsessive-compulsive disorder
citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. Journal of Family Psychology, 28(3), 287–298. doi:10.1037/a0036709
Required Media
Obsessive-Compulsive Disorder. (2015). [Video file] Naples, FL: National Educational Video, Inc.
Note: The approximate length of this media piece is 20 minutes.
Optional Resources
Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment. Spirituality in Clinical Practice, 1(S), 53–70. doi:10.1037/2326-4500.1.S.53
Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: What moderates improvement? Journal of Consulting and Clinical Psychology, 83(5), 926–937. doi:10.1037/ccp0000025
Assignment: “Captain of the Ship” Project – Obsessive-Compulsive Disorders
In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.
Students will:
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders
Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders
Identify medical management needs for clients with obsessive-compulsive disorders
Identify community support resources for clients with obsessive-compulsive disorders
Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:
Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:
Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
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