Obsessive Compulsive Disorder
This disorder is characterized by involuntary recurring thoughts or images that the individual is unable to ignore and by recurring impulse to perform a seemingly purposeless activity. These obsessions and compulsions serve to prevent extreme anxiety on the part of the individual.
Patients with obsessive-compulsive disorder are prone to abuse alcohol, anxiolytics, or other substances in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder. Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.
The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies have shown brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.
The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness. Common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or stool), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of his own mind and that they interfere with normal daily activities but feels powerless to stop them.
The patient's history may also reveal the presence of compulsions irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred since the last time he checked). In all cases, obsessive-compulsive behaviors and activities consume more than 1 hour of the patient's time per day. The activities are done to alleviate anxiety triggered by the patient's core fear.
During the assessment interview, determine the patient's personality type. The obsessional personality usually is rigid and conscientious and has great aspirations. He exhibits a formal, reserved manner, with precise and careful movements and posture; he takes responsibility seriously and finds decision-making difficult. He lacks creativity and the ability to find alternate solutions to his problems.Also evaluate the impact of obsessive-compulsive phenomena on the patient's normal routine. He'll typically report moderate to severe impairment of social and occupational functioning.
- Chronic low self-esteem
- Ineffective coping
- Ineffective role performance
- Impaired social interaction
- Risk for injury
- Social isolation
Nursing Key outcomes Nursing Care Plans For Obsessive–Compulsive Disorder
- The patient will express feelings of anxiety as they occur.
- The patient will develop self-esteem.
- The patient will express fears and concerns.
- The patient will demonstrate effective social interaction skills.
- The patient will cope with stress without excessive obsessive-compulsive behavior.
- The patient will reduce the amount of time spent each day on obsessing and ritualizing.
- Ritualistic behavior won't produce harmful effects.
- The patient will maintain family and peer relationships
- Client is able to maintain anxiety at level in which problemsolving can be accomplished.
- Client is able to verbalize signs and symptoms of escalating anxiety.
- Client is able to demonstrate techniques for interrupting the progression of anxiety to the panic level.
Nursing Interventions Nursing Care Plans For Obsessive–Compulsive Disorder
- Approach the patient unhurriedly.
- Provide an accepting atmosphere; don't show shock, amusement, or criticism of the ritualistic behavior.
- Allow the patient time to carry out the ritualistic behavior (unless it's dangerous) until he can be distracted into some other activity. Blocking this behavior raises anxiety to an intolerable level.
- Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin breakdown, and rituals or preoccupations may cause inadequate food and fluid intake and exhaustion. Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect.
- Let the patient know you're aware of his behavior. For example, you might say, I noticed you've made your bed three times today; that must be very tiring for you. Help the patient explore feelings associated with the behavior. For example, ask him, What do you think about while you are performing your chores?
- Make reasonable demands, and set reasonable limits; make their purpose clear. Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment.
- Explore patterns leading to the behavior or recurring problems.
- Listen attentively, offering feedback.
- Encourage the use of appropriate defense mechanisms to relieve loneliness and isolation.
- Engage the patient in activities to create positive accomplishments and raise his self-esteem and confidence.
- Encourage active diversional resources, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience.
- Assist the patient with new ways to solve problems and to develop more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day he may indulge in obsessive behavior). Gradually shorten the time allowed. Help him focus on other feelings or problems for the remainder of the time.
- Identify insight and improved behavior (reduced compulsive behavior and fewer obsessive thoughts). Evaluate behavioral changes by your own and the patient's reports.
- Identify disturbing topics of conversation that reflect underlying anxiety or terror.
- Observe when interventions don't work; reevaluate and recommend alternative strategies.
- Monitor effects of pharmacologic therapy.