Obsessive-Compulsive and Related Disorders

Key Points

• OCD features intrusive obsessions and compulsions that temporarily reduce anxiety but reinforce long-term cycles.
• Related disorders include body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.
• Exposure and response prevention (ERP) is a primary evidence-based treatment for OCD.
• Nursing care focuses on symptom tracking, coping support, medication monitoring, and stigma reduction.

Pathophysiology

OCD-related disorders involve dysregulated threat/salience processing, compulsive habit loops, and anxiety reinforcement. Neurobiological factors (including serotonergic pathway involvement), trauma/stress load, and learned behaviors contribute to chronicity.

Temporary relief after rituals strengthens repetition and functional impairment.

Classification

• OCD core cycle: Obsession → anxiety/distress → compulsion → temporary relief → recurrence.
• Related disorders: Body dysmorphic, hoarding, trichotillomania, and excoriation presentations.
• Treatment strata: ERP/CBT first-line, adjunctive medication, and selected advanced interventions.

Nursing Assessment

NCLEX Focus

Assess time consumed by rituals and resulting functional impairment, not just symptom presence.

• Assess obsession themes, compulsion types, and daily time burden.
• Assess trigger patterns, avoidance, and distress severity.
• Assess skin/hair/body injury risks in body-focused repetitive behaviors.
• Assess comorbid depression, anxiety, and suicidality risk.
• Assess readiness for ERP and family/support involvement.

Nursing Interventions

• Support ERP principles and reinforce response-prevention adherence.
• Teach distress-tolerance and anxiety-regulation strategies.
• Provide nonjudgmental education on disorder mechanisms and recovery trajectory.
• Monitor medication effects and side effects for OCD-targeted regimens.
• Coordinate multidisciplinary supports for home safety and functional restoration.

Ritual Accommodation Trap

Staff/family accommodation of compulsions may reduce short-term conflict but worsens long-term disorder severity.

Pharmacology

SSRIs are common first-line medications for OCD-related symptoms; adjunctive options may be used for resistant cases. Nursing monitoring includes delayed-response expectations, side effects, adherence, and interaction with psychotherapy goals.

Clinical Judgment Application

Clinical Scenario

A client spends hours daily washing, avoids touching household items, and develops skin breakdown while reporting “I know this is irrational but I cannot stop.”

Recognize Cues: Classic obsession-compulsion cycle with physical harm and functional loss. Analyze Cues: Insight present, but anxiety reinforcement maintains compulsive behavior. Prioritize Hypotheses: Priority is safety plus ERP-oriented intervention. Generate Solutions: Build graded exposure plan, response prevention supports, and skin-care management. Take Action: Implement coordinated therapy/medication plan with daily monitoring. Evaluate Outcomes: Track ritual duration, distress tolerance, and functional recovery.

Related Concepts

• anxiety-related-disorders - Differentiates generalized/panic/phobic anxiety from OCD cycles.
• trauma-induced-and-stress-related-disorders - Addresses overlap with trauma-driven symptoms.
• self-harm-and-suicide - Guides risk planning in severe distress and comorbid depression.
• stress-and-anxiety - Provides foundational autonomic and coping context.
• client-engagement - Supports sustained participation in challenging ERP-based treatment.