Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Obsessive-Compulsive Disorder


Related Terms

  • Obsession-compulsion Personality Disorder
  • Obsessive-compulsive Anxiety Disorder

Differential Diagnosis

Specialists

  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Duration depends upon response to medications and psychotherapy and the presence of other psychiatric disorders. Although the condition is chronic, there may be exacerbations that require hospitalization or intensive outpatient treatment. Response to treatment, type of job responsibilities, and the individual's insight into OCD could influence the length of disability.

Medical Codes

ICD-9-CM:
300.3 - Obsessive-compulsive Disorders; Anancastic Neurosis; Compulsive Neurosis; Obsessional Phobia, Any

Overview

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by persistent, intrusive, and inappropriate thoughts (obsessions) accompanied by ritualistic, repetitive behaviors (compulsions). These disturbing thoughts and behaviors occupy more than 1 hour each day and can significantly interfere with an individual's normal routine, occupational or academic functioning, social activities, or relationships.

Common obsessions are fear of contamination by germs or dirt, imagining having harmed self or others, imagining losing control of aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts, a need to have things "just so," or a need to tell, ask, or confess. Common compulsions are washing, repeating, checking, touching, counting, ordering/arranging, hoarding, or praying. Some behaviors, such as gambling, drinking, or sexual activity, are termed "compulsive"; however, in these cases, the behavior is experienced as pleasurable and is not done to defend against an obsession, so it would not be considered OCD.

Incidence and Prevalence: It is estimated that 2% to 3% of Americans have OCD (Mayo Clinic Staff). The disorder occurs equally in men and women (Greist 611).

OCD is now known to be more common than other severe mental illnesses such as bipolar disorder or schizophrenia (Mayo Clinic Staff). This disorder cost the US $8.4 billion in 1990 in social and economic losses, which was almost 6% of the total mental health bill of $148 billion ("Anxiety Disorders").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of OCD is not known but may be related to an insufficient level of a chemical in the brain called serotonin. An individual's risk of developing OCD is slightly higher if a parent or other family member has the disorder. A biological predisposition to react strongly to stress may also trigger the thoughts and rituals associated with OCD. OCD generally begins during early childhood or adolescence.

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis of OCD is based on criteria concerning obsessions and compulsions listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). Obsessions occur when an individual experiences recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate, which are not simply excessive worries about real-life problems, and which the individual attempts to suppress with another thought or action. Compulsions occur when an individual performs repetitive behaviors (e.g., hand washing, ordering, or checking) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly and that are aimed at preventing or reducing distress and are not connected in a realistic way with what they are designed to neutralize. Other criteria are that the obsessions or compulsions are usually recognized by the individual as excessive or unreasonable, cause marked distress, take more than 1 hour per day, significantly interfere with the individual's normal routine, are recognized as a product of the individual's own mind, and are not due to the effects of drug abuse, medication, or a general medical condition.

Physical exam: A physical exam might show things such as raw, chapped hands from repeated hand washing, or the individual might be observed performing ritualistic actions such as checking and rechecking the position of his or her chair. About 33% of people with OCD are depressed at the time of diagnosis, and 66% become depressed at some point (Greist 612).

Tests: There are no specific diagnostic tests for this disorder. However, positron emission tomography (PET) scans used in the research of OCD may show abnormal metabolism in certain sections of the brain.

Source: Medical Disability Advisor



Treatment

Medication therapy, combined with cognitive-behavioral therapy, is the most successful treatment. The most effective group of drugs for treating OCD is the selective serotonin reuptake inhibitor (SSRI) antidepressant group. These medications increase the level of serotonin, a neurochemical messenger, in the brain. The most effective, nondrug type of therapy is cognitive behavior therapy, which helps the individual learn to change his or her thoughts and feelings by first changing behavior through the techniques of exposure and response prevention (ERP).

The exposure technique is based on the fact that anxiety tends to decrease after repeated exposure to a feared thought or situation. Thus, an individual with obsessions about germs is told to stay in contact with "germy" objects (e.g., handling money) until anxiety disappears. In response prevention, the individual with excessive worries about germs must not only stay in contact with "germy things," but must also refrain from ritualized washing.

Family therapy might be useful, since this disorder is quite stressful to family members. It may be helpful for family members to understand the characteristics of the disorder and the way in which it is most effectively treated. The individual may meet with a psychiatrist or psychologist one or more times a week at the beginning of treatment and then gradually spread out the appointments until a maintenance level of once every 3 to 6 months is reached. Group therapy might also be a useful and cost-effective way to provide cognitive behavioral treatment.

Source: Medical Disability Advisor



Prognosis

Outcome is worse when individuals do not realize their obsessions and/or compulsions are not reality-based. Although up to 25% of patients may refuse cognitive-behavioral therapy, those who do complete it show a 50% to 80% reduction in OCD symptoms after 12 to 20 sessions ("How Is OCD Treated?").

Source: Medical Disability Advisor



Complications

Suicide could be a risk for those who develop major depression with OCD. Tics or secondary complications, such as skin problems from continuous hand washing, may occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may include modifying identifiable work situations that provoke symptoms of anxiety; decreasing workplace stimulants such as noise, cigarette smoke, or noxious chemicals; introducing the individual to stressful situations gradually under close supervision and support; providing a flexible work schedule to accommodate medical or psychiatric appointments (which normally should occur during the employee's personal time); allowing break time according to individual needs rather than a fixed schedule; and temporarily adjusting highly stressful activities.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual's behavior meet the criteria for OCD?
  • Has diagnosis been confirmed?
  • Have physiological effects of substance abuse or medication been ruled out?
  • Have underlying neurological and general medical conditions been ruled out?

Regarding treatment:

  • Has individual's treatment included behavioral therapy and drug therapy?
  • What type of medication is individual currently taking?
  • If one SSRI was not effective, would another SSRI give a better response?
  • Would individual benefit from taking an SSRI as the primary medication and another kind of medication to augment it?
  • Does individual's behavioral therapy include exposure and response prevention (ERP)?
  • Do repeated exposures to the situations or people that trigger the obsessions help individual forego the usual ritual while diminishing the anxiety and discomfort?
  • Does individual's behavioral therapy include ERP? Would this type of approach be beneficial?
  • Does individual currently attend a therapy group?
  • Are coexisting or resultant psychological conditions, such as depression, being appropriately treated?

Regarding prognosis:

  • Is a coexisting depression interfering with treatment?
  • Is therapist trained and experienced in this form of therapy?
  • Is individual highly motivated and faithful in completing homework assignments?
  • Is family cooperative?

Source: Medical Disability Advisor



References

Cited

"Anxiety Disorders: Obsessive-Compulsive Disorder." National Mental Health Association. 27 Dec. 2004 <http://www.nmha.org/>.

"How is OCD Treated?" Obsessive-Compulsive Foundation (OCF). 1998. 27 Dec. 2004 <http://www.ocfoundation.org/ocf1030a.htm>.

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Greist, John H., and James W. Jefferson. "Obsessive-Compulsive Disorder." The Merck Manual of Home Health Care. Ed. Mark H. Beers. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2003. 611-612.

Mayo Clinic Staff. "Obsessive-Compulsive Disorder." MayoClinic.com. 3 Jun. 2004. Mayo Foundation for Medical Education and Research. 27 Dec. 2004 <http://www.mayoclinic.com/invoke/cfm?id=DS00189>.

Source: Medical Disability Advisor






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