Obsessive-compulsive disorder (OCD) is a mental health disorder manifested by repeated unwanted thoughts (obsessions) that lead to repetitive behaviors (compulsions). These thoughts and behaviors interfere with the patient’s daily activities and role performance.
In this article:
- Overview
- Nursing Process
- Nursing Care Plans
- Disturbed Personal Identity
- Ineffective Coping
- Risk-Prone Health Behavior
- Social Isolation
Overview
The cause of OCD is largely unknown. However, these risk factors may increase the development of OCD:
- Family history of OCD
- Structural variations in specific brain regions
- Tics (rapid muscle twitches)
- Depression
- Anxiety
- History of trauma
OCD usually begins during the teenage or young adult stage and worsens through adulthood. Stopping the cycle of obsessions and compulsions can be challenging. If the person tries to ignore the obsessions, this only increases their anxiety or fear. Compulsions result as a way to relieve distress. This cycle results in ritualistic behaviors that interfere with maintaining a normal life and relationships.
Obsessive ideas might consist of the following:
- Fear of germs or illness
- Anxiety about death or harm to loved ones
- Aggressive or intrusive thoughts
- Needing things to look a certain way
Obsessive thoughts result in compulsive behaviors like:
- Completing things in a predetermined order or number of times
- Counting objects, such as steps or bottles
- Fear of shaking hands, using public restrooms, or touching doorknobs
- Checking and rechecking locked doors, light switches, etc.
OCD is a mental health disorder found in the Diagnostic and Statistical Manual of Mental Disorders. A thorough psychological evaluation is necessary to diagnose OCD. A physical examination can rule out other causes of the patient’s symptoms.
Nursing Process
Obsessive-compulsive disorder (OCD) is usually underreported and may not be well understood by others. The management of OCD aims at controlling the symptoms to prevent them from interfering with activities of daily living. Treatment often includes psychotherapy and medications. Nursing care should focus on preventing injuries or self-harm and supporting adherence to the treatment regimen.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for OCD, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for OCD.
Anxiety
Anxiety related to obsessive-compulsive disorder can be caused by distress from repetitive, persistent, involuntary, and unwanted thoughts and behaviors.
Nursing Diagnosis: Anxiety
Related to:
- Conflicting beliefs
- Unwanted thoughts (obsessions)
- Illogical urges
- Repetitive behaviors (compulsive behaviors)
- Stressors or triggers
- Role performance conflicts
- Embarrassment
As evidenced by:
- Distressed appearance
- Verbalized feelings of insecurity
- Extreme fear
- Helplessness
- Powerlessness
- Irritable mood
- Palpitations
- Tachypnea
- Hypertension
- Focused breathing
- Hypersensitive body sensations
- Frequent blinking
Expected outcomes:
- Patient will express understanding about OCD and how it relates to their anxiety.
- Patient will demonstrate interventions to reduce stress without turning to obsessive-compulsive behaviors.
Assessment:
1. Assess the patient’s level of anxiety.
Anxiety worsens the unwanted thoughts and repetitive behaviors of a patient with OCD. Have the patient rate their anxiety on a 0-10 scale.
2. Monitor for physical symptoms.
Anxiety can cause the following:
- Palpitations
- Rapid breathing
- Hypertension
- Hand-wringing
- Restlessness
3. Observe the rituals.
Observe for indications of OCD. Patients with OCD are unlikely to seek treatment early. They may feel ashamed of their fixation and compulsions. Note unusual behaviors or rituals.
Interventions:
1. Provide safety.
Patients with OCD may have violent and intrusive thoughts of harming someone or themselves. The nurse may need to remove objects that could be used to cause injury, or the patient may need 1:1 supervision.
2. Start cognitive-behavioral therapy.
Cognitive behavioral therapy (CBT) is recommended as the first-line treatment for OCD. Talk therapy focuses on thoughts, feelings, and behaviors and can be beneficial for both OCD and anxiety or other mental health comorbidities.
3. Encourage relaxation.
Symptoms can be stressful to a patient with OCD. Stress can be relieved by activities like yoga, meditation, and massage.
4. Administer SSRIs as ordered.
Selective serotonin reuptake inhibitors are medications prescribed to manage obsessions and compulsions and reduce anxiety.
5. Consider other treatment options.
If OCD is uncontrolled by psychotherapy or medications, newer treatments may be considered. Deep Transcranial Magnetic Stimulation non-invasively stimulates nerve cells using magnetic fields to alleviate symptoms of OCD.
Disturbed Personal Identity
Patients diagnosed with obsessive-compulsive disorder (OCD) experience unwanted and intrusive thoughts, which can significantly affect their self-perception, leading to disturbed personal identity.
Nursing Diagnosis: Disturbed Personal Identity
Related to:
- Psychiatric disorder
- Low self-esteem
- Ineffective coping ability
As evidenced by:
- Confusion about goals
- Expresses feelings of emptiness
- Ineffective coping strategies
- Ineffective relationships
Expected outcomes:
- Patient will verbalize their personal strengths.
- Patient will perform appropriate self-control activities.
- Patient will engage in healthy relationships.
Assessment:
1. Assess the effect of OCD on the patient’s self-worth.
Intrusive thoughts caused by OCD can cause patients to question their values, actions, and beliefs. They may be self-critical or feel that they are unworthy or “bad” if their thoughts are negative.
2. Assess the patient’s level of anxiety or depression.
OCD can contribute to other mood disorders that may also affect the patient’s sense of self. It’s important to assess for these conditions so they can be managed effectively alongside OCD.
Interventions:
1. Use empathetic communication.
Create a nonjudgmental environment so the patient feels safe to express their fears and emotions.
2. Encourage self-reflection.
Have the patient reflect on their values and personal strengths to differentiate them from their obsessive thoughts.
3. Remind the patient that they are not their diagnosis.
OCD can become debilitating and isolating from the life and relationships the patient desires. Help the patient realize that their symptoms and behaviors do not have to define their sense of self.
4. Involve the family if applicable.
With the patient’s consent, the nurse can involve family members to assist in supporting the patient and helping them reaffirm their identity.
Ineffective Coping
Ineffective coping related to obsessive-compulsive disorder can be caused by irrational beliefs and practices resulting in maladaptive coping mechanisms.
Nursing Diagnosis: Ineffective Coping
Related to:
- Inadequate confidence in dealing with a situation
- Inadequate sense of control
- Ineffective tension release strategies
- Inadequate social support
- Stressors
- Situational crises
- Ritualistic behaviors
- Anxiety
As evidenced by:
- Altered attention
- Poor concentration
- Obsessive-compulsive behaviors
- Ritualistic behaviors
- Destructive behaviors
- Poor problem-solving abilities
- Inability to cope with stressors
Expected outcomes:
- Patient will eliminate or lessen the practice of ritualistic behaviors.
- Patient will be able to develop healthy coping strategies to manage their distress.
Assessment:
1. Assess the patient’s history.
Attempt to uncover triggers or causes of the patient’s obsessions, such as a history of trauma or abuse. Inquire about a family history of mental illness.
2. Evaluate coping mechanisms.
Evaluate if the patient uses maladaptive coping behaviors such as using alcohol or drugs to calm them or prevent ritualistic behaviors. Harmful coping methods may need further intervention.
3. Identify OCD triggers.
Certain events or thoughts often trigger ritualistic behaviors. Recognition of triggers can help reduce ritualistic behaviors.
Interventions:
1. Keep track of OCD behaviors.
An OCD diary tracks the patient’s triggers and how often they employ compulsions. It evaluates the severity of the OCD and monitors progress.
2. Exposure therapy.
Exposure Response Prevention Therapy exposes a person to a trigger causing an obsession. Controlled exposure to a triggering situation teaches the patient how to respond and cope effectively.
3. Slow down the rituals.
Advise facing the triggers and wait 10 seconds before acting on the compulsion. It increases the length of time before employing the ritual. This can potentially lessen the compulsive behavior and its interference.
4. Encourage self-help techniques.
Encourage the patient to try deep breathing, meditation, and progressive muscle relaxation to reduce tension and release fears.
5. Provide positive feedback.
Coping with OCD is challenging. Provide positive feedback and acknowledge minor successes.
Risk-Prone Health Behavior
Obsessive-compulsive behaviors may impair the patient’s ability to achieve a sense of control, ultimately affecting their health in severe cases. Some of these behaviors include pulling their hair, intentional vomiting, picking the skin until it bleeds, and excessive handwashing.
Nursing Diagnosis: Risk-Prone Health Behavior
Related to:
- Obsessive, compulsive, and ritualistic behaviors
- Anxiety
- Low self-efficacy
- Stressors
- Poor social support
As evidenced by:
- Failure to achieve an optimal sense of control
- Failure to take action that prevents health problems
- Reluctance to change compulsive behaviors
- Avoidance of medical appointments or self-care
- Substance misuse
Expected outcomes:
- Patient will remain free from injury due to ritualistic, obsessive, and compulsive behaviors.
- Patient will express willingness to participate in one therapeutic strategy to reduce compulsive behaviors.
Assessment:
1. Assess the extent and severity of the patient’s ritualistic and compulsive behaviors.
Determining the extent and severity of the patient’s ritualistic behaviors can help identify risk-prone behaviors and determine appropriate interventions to help manage the patient’s symptoms.
2. Assess the patient’s perception of current ritualistic behaviors and their effects on their health status.
The patient may have a distorted perception of ritualistic behaviors and may be unaware of the long-term effects or consequences.
Interventions:
1. Utilize motivational interviewing.
The nurse can use motivational interviewing techniques to help the patient identify harmful behaviors and create a plan to enact change.
2. Encourage mindfulness and meditation.
Practicing mindfulness allows the patient to observe their thoughts without judgment or reaction. This time may also allow them to delay ritualistic behaviors and reduce feelings of stress or anxiety.
3. Refer the patient to community support groups as appropriate.
Support groups provide empathetic and personal insight to support patients in managing obsessive thoughts and ritualistic behaviors.
4. Educate about the effects of behaviors on health.
Excessive or improper hygiene, avoidance of certain foods, and repetitive behaviors may cause issues such as skin breakdown, malnutrition, or sleep deprivation, affecting the patient’s health.
Social Isolation
Social isolation related to obsessive-compulsive disorder can be caused by withdrawal from society due to unacceptable thoughts and behaviors contradicting the norms of society.
Nursing Diagnosis: Social Isolation
Related to:
- Difficulty establishing relationships
- Obsessive-compulsive behaviors
- Unacceptable thoughts and behaviors
- Fear
- Anxiety
- Low self-esteem
- Inadequate psychosocial support system
- Lack of social support
- Ineffective social skills
As evidenced by:
- Social withdrawal
- Reduced eye contact
- Expressed feelings of withdrawal from others
- Preoccupation with own thoughts
- Reports of insecurity in public
- Loneliness
- Dissatisfaction with social support
- Lack of social activities
- Minimal interaction with others
- Depression
- Strained relationships
Expected outcomes:
- Patient will establish a relationship with others.
- Patient will participate in social activities.
- Patient will discuss their thoughts and feelings with a trusted family member.
Assessment:
1. Observe the patient’s social interactions.
Even if they are not anxious about their symptoms, patients with OCD struggle in social situations. Observe for lack of eye contact, tense posture, and a lack of verbal communication.
2. Assess the effect of OCD rituals on the patient’s relationships.
OCD often affects relationships as their personal life is disrupted by OCD routines, resulting in resentment on both sides.
3. Determine the patient’s social activities and responsibilities.
OCD symptoms consume vast amounts of time. OCD can be debilitating and prevent the patient from holding a job, managing responsibilities, and interacting with others.
4. Note for suicidal tendencies.
A major risk factor for suicidal ideation is social isolation. Patients with OCD often experience loneliness, anxiety, depression, and low self-esteem and may have thoughts of suicide.
Interventions:
1. Involve the patient’s significant others in their care.
The patient’s family and friends often want to help but may need to learn how. The patient needs time and support to deal with their condition.
2. Provide safety.
Harm OCD (HOCD) is characterized by intrusive thoughts to harm oneself or commit violence against others. The nurse should assess for these thoughts and provide safety to the patient and others.
3. Encourage family therapy.
Patients with OCD should focus on receiving treatment for their condition. Family therapy may help the provider understand the patient’s obsessions and advise on how they can help.
4. Encourage small steps.
Have the patient begin with a small action like a phone call or video chat. This can help build their confidence in communicating and interacting with others.
5. Offer support groups.
The patient may benefit from support from others who also struggle with OCD. Advise on community resources or online groups.
References
- Farrell, N. (2021, April 27). What is suicidal OCD? NOCD. Retrieved February 2023, from https://www.treatmyocd.com/blog/suicidal-ocd-2
- Fields, L. (2003, February 7). Obsessive-compulsive disorder (OCD). WebMD. Retrieved February 2023, from https://www.webmd.com/mental-health/obsessive-compulsive-disorder
- Geller, J. (2022, October). What Is Obsessive-Compulsive Disorder? Retrieved February 2023, from https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
- International OCD Foundation. (2014, April 28). What is OCD? Retrieved February 2023, from https://iocdf.org/about-ocd/
- Mayo Clinic. (2020, March 11). Obsessive-compulsive disorder (OCD) – Diagnosis and treatment – Mayo Clinic. Retrieved February 2023, from https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438
- Miller, H. A. (2017, July 10). 7 strategies to cope with OCD. Family Psychiatry & Therapy. Retrieved February 2023, from https://familypsychnj.com/2017/07/7-strategies-cope-ocd/
- National Center for Biotechnology Information. (2022, June 3). Obsessive-compulsive disorder – StatPearls – NCBI bookshelf. Retrieved February 2023, from https://www.ncbi.nlm.nih.gov/books/NBK553162/
- National Health Service UK. (2021, February 16). Overview – Obsessive compulsive disorder (OCD). nhs.uk. Retrieved February 2023, from https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/
- National Institute of Mental Health (NIMH). (n.d.). Obsessive-compulsive disorder. Retrieved February 2023, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
- Pulse TMS. (n.d.). How to recognize the social signs of obsessive compulsive disorder. Retrieved February 2023, from https://pulsetms.com/resources/ocd/social-signs/
- Townsend, M. C. (2015). Psychiatric Mental Health Nursing Concepts of Care and Evidence-Based Practice (8th ed.). FA Davis Company.
