Design for OCD :
A Little More Comfort for A Delicate Group
TingTing Hu - 3474200 Danny Guo - 3492262 Yifan Yang - 3458566
Content Our Manifesto
1
End User
11
Background
2
Client
12
Concept
13
Precedents
14
Why OCD ? Diagnosis Treatment
Aims/Obejectives
6
Project Timeline
18
OCD Demongraphics
7
Bibliography
19
Prevalance Age of Onset OCD and Gender Symptoms
Manifesto As a group, we believe that the beauty of design lies in its function, and the establishment of eective communication between it and its users. Designers are problem solvers to supply what users demand.
2
We believe that designers should display a relationship between nature and their design because nature is the origin of everything, including human-beings, which can be applied to the substance of study of human nature related to the OCD project.
We believe that good design should reect a sense of feeling, such as happiness or uniqueness. In the case of the OCD project, this feeling would be a sense of release or comfort.
1
1
3
Brooks, M. (2009) OCD Comic (Excerpt)
Background It s a battle happening within your body, it involves a compulsive self struggles with an observing self. Obsessive-compulsive disorder was a rare term before 1970s, and in 1973 a researcher wrote that OCD was unquestionably one of the rarest forms of mental disorders. (Davis 2008,p209) As in before if a person who have been found with severe symptoms of OCD, he might have been treated as someone who fits between neurosis and psychosis. The area of study of OCD is huge, for years medical doctors and researchers have been dedicated their time and energy in the mental health field in order to come up with a rational solution to this disorder. On the other hand OCD can also be found in our daily life, besides mental illness it could also be a regular life pattern or a behavioral problem. Everyone must have the experience of checking our own belongings constantly during the day, in some occasions you may double check or triple check the door was really locked that stove or gas has been turned off. OCD patients feel the need of check things repeatedly, or become stuck on one issue or thoughts over and over again. These behaviors are getting in the way of our life and people suffering from it on a certain level. OCD is a disorder that has a neurological perspective, the most recognized theory of OCD is that relates to malfunctioning of the human brain chemical messengers: sterotonin. Sterotonin, known as neurotransmitters, compound that nerve cells which allows us to communicate with one another.
2
Background why ocd ? So what causes OCD after all? There are several factors on neurological perspective, physiological factors, environmental factors, genetic factors and extra dimensional factors. According to the research, OCD was once thought to be a rare mental disease is now known to be a more common issue, ďŹ ndings from a large survey suggest that 2% of the world population are aected by OCD. OCD is far more prevalent than it used to be, recently in a World Health Organization mental report it was estimated that in year 2001 OCD was among the top 20 causes of illness-related disability, worldwide with the growing of numbers still going up, more and more people start to face this problem positively. One reason OCD may have remained hidden for such a long period is that people are often secretive about their condition, out of concern that they will be considered or treated as crazy, and this is why made us take OCD as a contemporary issue to develop further on.
3
Background Diagnosis According to Fineberg and Roberts (2001), obsessions and/or compulsions are the core symptoms of OCD. Either obsessions and/or compulsions will satisfy a diagnosis. Obsessions are deďŹ ned as "unwanted ideas, images or impulses which repeatedly enter the individual's mind. Although recognized as being generated by the individual, they are egodystonic and distressing. (Fineberg and Roberts, 2001, p.2)" Compulsions are deďŹ ned as "repetitive stereotyped behavior or mental acts that are driven by rules that must be applied rigidly. They are not inherently enjoyable and do not result in the completion of any useful task. (Fineberg and Roberts, 2001, p.2)" ICD-10 (as cited in Fineberg and Roberts, 2001) requires the symptoms to be present on most days for a period of at least 2 weeks to satisfy a diagnosis. According to Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria (as cited in Abramowitz et al, 2009), to diagnose OCD, the disorder must result in great distress, and time-consuming tasks (more than 1 hour per day), or substantially interfering with normal functioning for the aected individual. And they must also recognize that the obsessions and compulsions are excessive or unreasonable.
4
egodystonic
distressing
Thoughts obsessions
2 weeks
both compulsions
behavious not enjoyable
useless
time-consuming
Background treatment The most effective treatment for OCD is cognitive behavior therapy and/or medication [1]. To be more specific, one type of the CBT called exposure and response prevention, which is the strongest evidence supporting its use in the treatment of OCD and other medications. If left untreated on its own, OCD feeds on its own and will only grow stronger. If the sufferer does not obey the compulsions the anxiety and fear multiplies and if they give in to it they become more severe in intensity. Unlike other treating method, CBT is designed to be a short-term, goal-focused therapy. It s more than just talking through the issues, instead it helps patient become the master, controlling their own thoughts, understand and change those unhelpful thinking patterns/behaviors that are maintaining their illness. But there are also challenges when treating OCD. For instance, lack of treatment education by using inappropriate method, lack of access to mental health services in certain areas and treatment resistance.
[3] In 2013, the American Psychiatric Association published the Practice Guideline for the Treatment of Patients with Obsessive Compulsive Disorder, authored by two members of the IOCDF Scientific and Clinical Advisory Board, Drs. Lorrin Koran and H. Blair Simpson. The Practice Guidelines reviewed all available research and recommends CBT and/or medication as the most effective treatments for OCD.
5
The sense of helplessness and the impairment with OCD may lead to depression and it is often seen together with other psychiatric disorders that will have a bad impact in life, such as: alcohol abuse, attention deďŹ cit disorders, drug addiction, anorexia or bulimia and other anxiety disorders. "Compared with people with other anxiety or unipolar mood disorders, those with obsessive-compulsive disorder are less likely to be married, more likely to be unemployed, and more likely to report impaired social and occupational functioning. (Abramowitz et al, 2009)"
Aims
Our aim is to come up with a conceptual campaign in searching from a graphic, object perspective that will help the patient in reducing their symptoms but ultimately changing peoples point of view that having OCD is shameful, especially in certain circumstances when one has ideas of harming others or themselves. OCD can aect your work, relationships, social life, and the quality of your life if it is not taken care of.
what
how
objectives
Through a clear understanding of the illness. Through proper diagnose method. Through putting in others shoes, get to know the patient by heart. Through interdisciplinary research from design and medical aspects. Through testing of dierent design substances such as materials, techniques and budget.
6
Brooks, M. (2009) OCD Comic (Excerpt)
OCD Demographics
Prevelance Fineberg and Roberts (2001, p.3)'s study of early 1980s studies Epidemiological Catchment Area (ECA) carried out by the National Institute of mental health showed the prevalence of OCD was higher than expected. OCD is more common than schizophrenia, and about half as common as depression. A lifetime prevalence rate is of 2-3% worldwide, with Taiwan and India below 1% as exceptions. The ECA studies was also cited in Starcevic (2005, p.242)'s ďŹ nding, "OCD was found to be the fourth most common mental disorder, with a lifetime prevalence rate of 2.5% ... The only exception was Taiwan." As the studies suggest, socioeconomic status, educational achievement, or ethnicity do not seem to inuence the prevalence.
influence ?
2-3%
< 1% worldwide taiwan ECA (1980s) by National Institute of Mental Health
socioeconomic status educatinoal achievement
7
ethnicity
OCD Demographics age of onset
females males
cut-off point 21 years
no. of probands
30
24.9
20
12.8
10
early-onset
late-onset
0 6-9
10-12
13-15
16-19
20-24
25-29
age of onset
[2] Age at onset of OCD, Epidemiology of obsessive compulsive disorder, J Clin Psychiatry (1990); 51: 10-13. Cited in Fineberg and Roberts, 2001, p.4.
Anholt et al (2014) argue that the definition of age of onset remains uncertain because some researchers have used onset of first symptoms to determine age of onset, while other researchers have used onset of distressing symptoms. According to existing research, age of onset of OCD is bimodal with a peak of incidence in childhood and mid-adulthood (Swedo et al. 1989 cited in Anholt et al. 2014, p.185). As it is shown in the diagram [2], the incidence peaks in the early teens and in the early twenties (Fineberg and Roberts, 2001, p.4). Fineberg and Roberts (2001) has also mentioned the mean age of onset of OCD is at around 20 years. A more specific categorization of the age group comes from the result of Delorme et al. (2005, cited in Anholt et al. 2014, p.186) s admixture analysis which is based on age distribution alone finds that the best cut-off point between early and late age of onset is 21 years. Result of Anholt et al (2014) s study shows the mean age of onset is 12.8 for early-onset population, and the mean age of onset is 24.9 for late-onset population. According to Starcevic (2005), 20% of patients have reported onset of OCD before age of 14, but only a small amount of children actually develop OCD.
8
OCD Demographics gender There is a female to male ratio of 1.5:1.0 which means that OCD is more common seen in women (Fineberg and Roberts, 2001). On the contrary, the female to male ratio is roughly the same as stated in the report of Stein (2002). Starcevic (2005) has also noted that OCD is insigniďŹ cantly more frequent among women than among men, but diďŹ&#x20AC;erences do exist. Similarly, surveys of referrals show the dominance of men in OCD, which might reďŹ&#x201A;ects a greater severity (Fineberg and Roberts, 2001).
first
OCD in minors (children and adolescents) is more common among males than among females, and boys encounter it earlier than girls do.
second
Onset of OCD in adults is also earlier in men than in women.
Third
Men may be more likely to have a co-occurring psychotic disorder or schizotypal personality disorder, which suggests a worse OCD prognosis that is associated with multiple disorders.
9
prevalence
age
OCD Demographics symptoms
According to Abramowitz et al (2009), certain obsessions and compulsions tend to co-occur to form five main symptom dimensions which are: Repetitive doubts / checking and reassurance-seeking Need for symmetry / ordering and counting rituals Contamination fears / washing and cleaning rituals Sexual, aggressive, religious obsessions Hoarding / collecting compulsions Comparison of symptoms of the earlyand late-onset OCD patients shows that early-onset group suffer from more ADHD (attention deficit hyperactivity disorder) symptoms, more compulsions and overall OCD symptoms (Anholt et al, 2014). Onset rates of symptoms of other mental disorders is of little difference between the two age groups. And early age of onset is associated with more severe OCD symptoms. Symptoms in the symmetry dimension have an earlier age of onset than any other symptoms (Kichuk et al, 2013).
According to Butwicka and Gmitrowicz (2009) and Flament and Cohen (2002) three most common obsessions shared by both adolescent and adult patient group are contaminations, fear of illness/fate, harm to self or loved one, and exactness/symmetry (in order from the most to the least). The three most common compulsions in adolescents are cleaning, repeating and checking, while in adults it is checking, cleaning and counting.
obsessions (adolescent, adult)
cleaning
contaminations
repeating
fear of harm
checking
symmetry
compulsions (adolescent)
compulsions (adult) checking
10
cleaning counting
end user options
In conclusion, some contributions could be made to defining the demographic group of end users by combing results from the research above. In order to design a project which is as real as possible, and concerning the possibilities of real execution, the target user group should be specifically narrowed down to a limited scope. The first group to be considered is males in adolescence aged from 12 to 14 years. This group suffers the most from symptom dimensions in contamination fears/washing and cleaning rituals, repetitive doubts/checking and need for symmetry ordering and counting rituals. The second group to be considered is all genders in adulthood aged from 21 to 25, which can be divide up into adult with early-onset and late-onset. The most common symptom dimensions for adult group are similar with those for adolescents which are mentioned in the last paragraph. In addition, early-onset adults are likely to suffer from more severe OC symptoms, especially in symmetry dimension.
end user profile The final end user group decided for this project will be adults aged from 21 to 25 who had their onset (onset of first symptoms or depressing symptoms) in childhood or adolescence, because adults with early-onset are more likely to have more severe OC symptoms than other groups with OCD. A conclusion of combined evidence we found has shown that the most common symptom dimensions of this group are contamination fears and symmetry.
age of onset In childhood or adolescence (generally before 14 years)
21-25 years
with contamination fears or symmetry dimensions
symptoms
11
age
client
http://iocdf.org/
1.international
ocd foundation
The International OCD Foundation is a donor-supported non-profit organization. Founded in 1986 by a small group of individuals with OCD. The Foundation has affiliates in 25 states and territories in the US, in addition to global partnerships with other OCD organizations and mental health non-profits around the world. The mission is to help individuals with obsessive compulsive disorder (OCD) and related disorders to live full and productive lives. Their aim is to increase access to effective treatment, end the stigma associated with mental health issues, and foster a community for those affected by OCD and the professionals who treat them. http://www.thehillsclinic.com.au/
2.the hills clinic
The Hills Clinic is a specialist practice, providing private psychiatric and psychological treatment for a wide range of mental health issues including depression, bipolar disorder and anxiety disorders. The Clinic was first opened in Castle Hill in 2004 as a response to the increasing demand for mental health services in the northwest of Sydney. The Hills Clinic was created to bring together therapists with different disciplines and to provide complimentary and comprehensive psychiatric treatment programs accessible to all ages, genders and cultures.
12
Brooks, M. (2009) OCD Comic (Excerpt)
concept You can count up all the design solutions towards an OCD patient. It s not hard to ďŹ nd out some of these designs are made to target this particular group and make fun of people with OCD. Therefore our goal and vision is to create awareness of those with OCD to people of all social status, any contribute with their own power to making a better environment for OCD patients.
13
precedent The Joyaviva exhibition at RMIT Gallery features objects, jewelry, film projection and related printed materials all under the inclusive moniker of Live Jewelry from across the Pacific. However, it is much more than a discrete thematic exhibition of contemporary wearables by 23 artists from Australia, Chile and New Zealand. It is part of a larger Joyaviva project that spans the physical realm through exhibitions, as well as various online networks and intimate dialogues between makers and wearers alike. The function of the charm was designed for residents of the coastal village of Tirua to help with their resettlement after the tsunami in February 2010.
1.
"The key to OCD is realising that despite their compulsions they have to fit in with the world, not the world change for them, if they want to be well with their condition"
2.
Chez Payne-Annetts
This project comprises five prototypes to help OCD sufferers. The objects do not attempt to facilitate the sufferers' life but rather to 'spike' their condition. The direct confrontation of their condition helps the sufferers to take control of their anxieties rather than to be dominated by them.
14
Some of the prototypes were tested during a fivedays intensive course at the OCD Centre by eight sufferers and two therapists. Their feedback helped refine the products.
precedent
3.
OCD TAP The tap is ďŹ tted with a small device to harmlessly change the colour of the water to make it look 'contaminated'. The compulsion to repeatedly cleanse hands is confronted.
4.
OCD cutlery The cutlery is 'poison tipped . The toxic pink tips clash with the notion of natural, healthy food and create a compulsion dilemma for the suďŹ&#x20AC;erer that needs to be confronted.
15
precedent
5. OCD stickers A set of transparent 'desk object' stickers to be stuck on a work desk. The stickers are arranged chaotically. 'Order' suďŹ&#x20AC;erers will be tempted to place items (eg. pen, stapler) on the matching sticker. If they do, the desk top appears chaotic; if they don't, nothing is in the 'right' place. It's a lose - lose situation and the compulsion must be confronted.
6. OCD tape This tape uses a familiar hazard graphic to communicate unfamiliar and irrational warning messages. It is used to delineate 'dangerous' territory. The messages 'spike' anxiety in the OCD suďŹ&#x20AC;erers which must be actively confronted.
16
precedent
7.
OCD books The book has perforated pages to permit the suďŹ&#x20AC;erer to tear each page out once it has been read. The desire to repeatedly turn back and reread the last section of the previous page is confronted.
17
Project timeline
18
reference Abramowitz, J.S. et al. (2009), Obsessive-compulsive disorder, The Lancet, Vol.347, Issue.9688, 491-499, Retrieved from: http://www.sciencedirect.com.wwwproxy0.library.unsw.edu.au/science/article/pii/S0140673609602403 Anholt, G.E. et al. (2014), Age of onset in obsessive-compulsive disorder: admixture analysis with a large sample, Psychological Medicine, vol.44, 185-194, retrieved from: http://journals.cambridge.org/download.php?file=%2FPSM%2FPSM44_01%2FS0033291713000470a.pdf&co de=72ae75efe986a9c8b810d4d41529542f Butwicka, A. & Gmitrowicz, A. (2009), Symptom clusters in obsessive‒compulsive disorder (OCD): Influence of age and age of onset, Eur Child Adolesc Psychiatry, 19(4), 365-370, retrieved from: http://search.proquest.com/docview/214263368?accountid=12763 Brooks, M. (2009), OCD Comic (Excerpt) [Image], Retrieved from: http://www.mollybrooks.com/gals/comics/013_ocd/ Davis, L.J. (2008), Obsession: A History, University of Chicago Press, Retrieved from: http://site.ebrary.com/lib/unsw/detail.action?docID=10290029 Flament, M.F. & Cohen, D. (2002), Obsessive compulsive disorder in children and adolescents In Fineberg, N., Marazziti, D., & J Stein, Dan. (Eds.), Obsessive Compulsive Disorder: A Practical Guide. Martin Dunitz, United Kingdom. Fineberg, N., & Roberts, A. (2001). Obsessive compulsive disorder: a twenty-first century perspective In Fineberg, N., Marazziti, D., & J Stein, Dan. (Eds.), Obsessive Compulsive Disorder: A Practical Guide. Martin Dunitz, United Kingdom. Goldsmith, T.D., Shapira, N.A., & Goodman, W.K. (2001).Assessment of OCD. In Fineberg, N., Marazziti, D., & J Stein, Dan. (Eds.), Obsessive Compulsive Disorder: A Practical Guide. Martin Dunitz, United Kingdom. Hornauer, C. Joyaviva, Retrieved from: http://www.joyaviva.net/artists/chile/carolina-hornauer/ Kichuk, S.A.et al. (2013), Symptom dimensions are associated with age of onset and clinical course of obsessive‒compulsive disorder, Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol.44, 233-239, retrieved from: http://www.sciencedirect.com/science/article/pii/S0165032702003518 Lajara, F. OCD Retrieved from: http://www.ferranlajara.com/OCD Starcevic, V. (2005), Chapter 6 Obsessive-Compulsive Disorder pp.216-275 In Anxiety Disorders in Adults: A Clinical Guide, Oxford University Press, New York. Stein, D.J. (2002), Obsessive-compulsive disorder, The Lancet,Vol.360, Issue9330, 397-405, Retrieved from: http://www.sciencedirect.com.wwwproxy0.library.unsw.edu.au/science/article/pii/S0140673602096204
19