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As Good as It Gets

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Cara Wilkes

on 7 November 2013

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Transcript of As Good as It Gets

As Good as It Gets
Obsessive Compulsive Disorder (OCD)
• Affects Nearly 3.3 million people in the US

• First symptoms begin in childhood or adolescence

• Is thought to be a neurologically based disorder

OCD is characterized by

unwanted thoughts, impulses, or images that persist and recur so that they cannot be

dismissed from the mind.

unwanted ritualistic behaviors that an individual feels driven to perform in an attempt to

reduce anxiety.

Defenses Used in OCD
As Good as it Gets
Chief Complaint
Obsessive Compulsive Disorder
With Obsessions
Reaction formation (overcompensation)
Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion.

Excessive use of reasoning, logic, or words prevents the person from experiencing associated feelings.

With Compulsions
Compensates for an act or communication

History of Melvin's illness
In our professional opinion...
Melvin did suffer from OCD
He displayed multiple symptoms associated with an OCD diagnosis
Contamination Fears
Anxiety of stepping on sidewalk cracks
Impulsive nature to avoid social situations

Treatment Plan
Medication Treatment:
Multiple SSRI’s: Serotonin reuptake inhibitors
One Tricyclic: Clomipramine (Anafranil), also inhibits serotonin
Therapeutic Treatments:
Exposure and Response Prevention:
Starts with preventing client from performing the compulsion (such as hand washing), and gradually helping the patient limit the time between the rituals until the urge is significantly reduced or gone.
The patient learns to gradually tolerate the anxiety that occurs with not ritualistically performing these behaviors and resist the urge to perform the compulsion.
Effective ways of reducing stress
Resolve inner conflicts
Reduce anxiety
Cognitive Behavioral Therapy (CBT):
Together the client and therapist assess the problem and devise a plan towards alleviating the symptoms
There is numerous research available that has found CBT is a superior form of treatment for OCD

DSM-IV Criteria
Client has Obsessions or Compulsions
There is evidence that OCD has a strong genetic component.
There is a 7% incident of OCD in first degree relatives of patients versus 2.5% in the general population.
This supports the idea that OCD has a strong genetic factor.

We believe most of the movie accurately portrayed the most common behaviors seen in someone diagnosed with OCD.

Some of Melvin’s behaviors were likely exaggerated (such as putting the dog down the garbage chute) for comedic purposes.

Melvin does not discuss his OCD illness history in detail
“My father didn’t come out of his room for 11 years. He used to hit me
on the hands with a yardstick if I made a mistake playing the piano.”
However there have been multiple childhood emotional and behavioral
factors that have been linked to OCD later in life such as:
Sexual abuse
Physical abuse
Emotional abuse
Being bullied

Other Observations
Showed hostility towards multiple different groups of people
African Americans

1. Repetitive behaviors or mental acts that the client feels driven to perform in response to an obsession, or accordingly to rigidly applied rules

2. The behaviors or mental acts aim to prevent or reduce distress or some dreaded situation; however, they either are not realistically connected with what they are designed to neutralize or prevent or are clearly obsessive

1. Recurrent and persistent thoughts, impulses, or images that, at some time during the disturbance, are intrusive and inappropriate and cause marked distress

2. The thoughts, impulses, or images are not simply excessive worries about real problems

3. Client tries to ignore, suppress, or neutralize with some other thought or action such thoughts, impulses, or images

4. Client recognizes that the thoughts, impulses, or images are a product of his or her own mind

Expected Outcomes
Patient will:
Demonstrate techniques that can distract and distance self from thoughts that are anxiety producing
Decrease time spent in ritualistic behaviors
State they will have more control over thoughts and ritualistic behaviors
Take medications as prescribed
Willingly participate in therapeutic treatment

OCD Medications
OCD is treated using medication and therapy
Behavioral therapy is effective in treating most cases of OCD
Medication therapy includes:
Fluoxetine (Prozac)
Citalopram (Celexa)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
TCA’s (tricyclic antidepressant)
Clomipramine (Anafranil)
Full transcript