Definition

• Characterized by persistent thought and urges to perform repeated acts or rituals, usually as a means of releasing tension or anxiety.
• The frequency and intensity of the ritualistic behaviors, such as handwashing, ordering, or checking, are time consuming (taking more than one hour per day) and cause marked distress, significant impairement, or interfere with daily living.
  1. Obsession
     • The person experiences recurrent and persistent thoughts, impulses, images that are intrusive, disturbing, inappropriate, and usually triggered by anxiety.
     • The thoughts, images, and impulses are not simply excessive worries about real life problems.
     • The person recognizes the thoughts, images, and impulses are from within own mind.
  2. Compulsion
     • Repetitive behaviors or mental acts that a person feels driven to perform, which usually adhere to a rigid and specifically defined routine.
     • The behaviors and ideations are typically aimed at reducing anxiety or preventing some dreaded situation from occurring.

Specific Biological Factors

• There is some evidence that indicates OCD is linked to a deficiency in serotonin.
• Clients have also been shown to have abnormalities in frontal lobes and basal ganglia; it is un clear what the implications are for clinical care.

Signs and Symptoms

• Obsessions – recurrent, persistent ideas, thoughts or impulses, involuntarily coming to awareness.
• Ruminations – forced preoccupation with thoughts about a particular topic, associated with brooding and inconclusive speculation.
• Cognitive rituals – elaborate series of mental acts the client feels compelled to complete.
• Compulsive motor rituals – elaborate rituals of everyday functioning such as grooming, dressing, eating, washing or checking doors or appliances.
• Other symptoms – chronic anxiety, low self-esteem, difficulty expressing positive feelings and depressed mood.

Nursing Diagnoses

• Anxiety
• Powerlessness
• Ineffective verbal communication
• Self-esteem disturbance
• Impaired social interaction
• Risk for injury
• Sleep pattern disturbances
• Ineffective breathing pattern

Nursing Interventions

1. Limit, but do not interrupt, the compulsive acts.
2. Teach the client to use alternate coping methods to decrease anxiety.
3. Client’s behavior maybe frustrating to staff and family. Power struggles often result. Consistency to the approach to care is critical.
4. Assess the client’s needs carefully.
5. Provide an environment that has structure and predictability as a strategy to decrease anxiety.
6. Risk associated with the use of alcohol and drug abuse.