3.3 - Self harm, OCD & Eating Disorders

Question 1

What is compulsion?

Answer 1

• the experience of overwhelming urges to repeat a behaviour, perhaps even in the knowledge that it is harmful
• present in numerous disorders

Question 2

How can self-harm be divided up?

Answer 2

• suicide
• non-suicidal self-injury (NSSI) - including cutting, burning, scratching, hitting, hair-pulling, poisoning, pinching, ingesting objects

Question 3

When does self-harm occur?

Answer 3

• non-suicidal self-injury typically occurs in the context of low self-worth and persistent distress
• serves various functions, mainly related to reducing this distress
• can help people feel in control of their punishment and feel safe
• the body’s response to injury includes releasing endogenous opioids which can numb the pain the person is feeling from being anxious/depressed all the time
• temporary relief from anxiety
• can rapidly become compulsive

Question 4

Why are habits formed?

Answer 4

• to help the brain become more efficient - tasks done often are assigned to different parts of the brain to free up the frontal lobe for other tasks - allows us to do more things at once
• this means you have less conscious control over that behaviour as it almost happens automatically

Question 5

What is the distress cycle?

Answer 5

• state of distress –> distress-reducing behaviour (self-harm, substance use, disordered eating, compulsive rituals) –> temporary relief –> negative reinforcement –> urge to repeat –> habit formation –> compulsion
• distress-reducing behaviour itself is damaging –> state of distress

Question 6

What is the difference between liking something and obsession?

Answer 6

• liking something and wanting to think about it all the time is voluntary but obsession is when you think about something all the time even though you don’t want to
• intrusive thoughts/images

Question 7

How is OCD characterised?

Answer 7

• obsessions - intrusive thoughts/images - distressing and involuntary (cannot control despite considerable effort)
• compulsive behaviours - serve to relieve state of anxiety/tension
• negative reinforcement, driven by the distress caused by intrusive thoughts, and cemented by habit-formation, are central to compulsion in OCD

Question 8

What is the OCD cycle like?

Answer 8

• obsession (intrusive thoughts) –> rumination –> state of distress –> distress-reducing behaviour –> temporary relief –> negative reinforcement –> urge –> repetition –> compulsion
• distress-reducing behaviours include checking, washing, counting, arranging, touching, repeating etc

Question 9

What are some symptoms of eating disorders?

Answer 9

• restriction of diet
• purging
• episodes of laxative abuse
• excessive exercise
• symptoms to do with body image and self-worth

Question 10

How can eating disorders be conceptualised?

Answer 10

• as means of reducing intense distress, particularly feelings of loss of control

Question 11

What are eating disorder cycles like?

Answer 11

• low self-worth and anxiety –> projected onto body –> diet restriction:
• feelings of failure –> binge eating –> intense distress – purge (forcing food out e.g. by laxatives) –> temporarily relief
• high calorie food –> neural reward –> temporary relief –> negative reinforcement –> compulsion
• can lead to cognitive inflexibility, brain starvation and weight loss –> safety, control, achievement –> compulsion