A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which nursing response is most rapeutic?

Correct Answer: A. Accepting the client’s obsessive-compulsive behaviors

A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client’s attempt to feel secure is therapeutic. When a specific treatment plan is developed, other nursing responses may also be acceptable. Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function.

• Option B: In The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, which was published by the American Psychiatric Association (APA) in 2013, Obsessive-Compulsive Disorder sits under its own category of Obsessive-Compulsive and Related Disorders. Obsessions are defined as intrusive thoughts or urges that cause significant distress; the patient attempts to neutralize this distress by diverting thoughts or performing rituals. Compulsions are actions the patient feels pressured to do in response to the anxiety/distress producing obsessions or to prevent an uncomfortable situation from occurring. These compulsions may be illogical or excessive.
• Option C: The most common obsessions include fears of contamination, fears of aggression/harm, sexual fears, religious fears, and need to make things “just right.” The compensatory compulsions for these obsessions include washing and cleaning, checking, reassurance-seeking, repeating, and ordering, and arranging. As OCD has the possibility of hindering one’s social growth and development, the WHO lists OCD as one of the ten most disabling conditions by financial loss and a decrease in quality of life.
• Option D: Those who have OCD have a 7% risk of Tourette syndrome and a 20% chance of developing tics. As the treatment for OCD involves selective serotonin reuptake inhibitors (SSRIs) and possible antipsychotics, adverse effects of these medications including but not limited to weight gain, tardive dyskinesia, and dystonia, must also be monitored.