8 - OCD Flashcards
Who are some celebrities with OCD?
- JK Rowling
- John Green
- Martin Luther (writer)
- St. Ignatius of Loyola
What is criterion A of OCD?
A. Presence of obsessions, compulsions, or both:
→ Obsessions are defined by (1) and (2):
1) Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2) The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
→ Compulsions are defined by (1) and (2):
1) Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
What is criterion B of OCD?
The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
If a child has an obsession stating “I am contaminated”, what would be a possible compulsion and avoidances that they would have?
-
Compulsions:
→ Washing hands (to the point of red and raw hands) and showering, gloves -
Avoidance:
→ Won’t touch light switches, door handles
→ Won’t wear “contaminated” clothes
→ Won’t use public washrooms
→ Won’t hug family members
If a child has an obsession stating “I could kill myself”, what would be a possible compulsion and avoidances that they would have?
-
Compulsions:
→ Rumination (different than depressive rumination; here it’s rather trying to answer the question all day i.e., “no i would never kill myself” and starts naming the reasons why she wouldn’t), checking of feelings (feeling sad is a danger signal), asking parents for reassurance, researching signs of suicidality on internet -
Avoidance:
→ Won’t be home alone
→ Won’t go near windows
→ Won’t use sharp knives
→ Won’t watch movies with mental health themes
What are the 15 types of OCD?
1) “Just right” OCD
- reliance on things feeling perfect according
2) False memory OCD
- intrusive thoughts exacerbate the uncertainty of a memory
3) Magical thinking OCD
- belief your thoughts influence events in physical world
4) Real events OCD
- false narrative about how event in your life happned
5) Sexual orientation OCD/SO-OCD
- Constant obsession about one’s own sexual orientation
6) Contamination OCD
- Obsessions about germs, sickness, and contagion
7) Harm OCD
- Unwanted thoughts about harming oneself or others
8) P-OCD
- Thoughts that one is sexually attracted to a child
9) Relationship OCD
- Thoughts and compulsions about a relationship
10) Somatic OCD
- Obsession with one’s own physical movements or sensations
11) Existential OCD
- Intrusive thoughts around impossible questions
12) Hoarding OCD
- Acquiring things and difficulty discarding them
13) Pure O
- Intrusive thoughts accompanied by mental rituals
14) Scrupulosity OCD (related to religion)
- Careful about one’s actions and repenting for mistakes
15) Suicidal OCD
- Unwanted thoughts and obsessions around fear of killing oneself
What are some common obsession categories and an example for each?
- Contamination: What if the public toilet has the AIDS virus on it?
- Responsibility for harm: What if i hit a pedestrian with my car by mistake?
- Sex and morality: Unwanted thoughts of incestuous relationships
- Religion: What if i don’t really believe in God?
- Violence: Thoughts of stabbing someone with the knife one is using
- Symmetry and order: The sense that odd # are bad
What are some common compulsive ritual categories and an example for each?
- Decontamination: Washing hands for 30 minutes at a time
- Checking: Checking locks, appliances, windows, driving back to check that no accidents were caused at the intersection
- Repeating routine activities: Getting up and down out of a chair until the obsessional thought has been dismissed
- Ordering/arranging: Saying the word “correct” whenever one hears the word “right” or fixing pictures on the wall until just right
- Mental rituals: Replacing a “bad” thought by thinking of a “good” thought
True or false: People can often jump between obsession categories over a period of time
True
What is the OCD cycle?
- Normal intrusive thought, doubt, image, etc.
TO - Misinterpretation as significant (obsession)
TO - Anxiety, distress, fear, worry, uncertainty
TO - Anxiety reduction strategies (compulsions/avoidances)
True or false: People without OCD don’t have the same thoughts as those with OCD.
False: If you don’t have OCD, you still have these intrusive thoughts, BUT you aren’t interpreting these thoughts as significant or doing smt to prevent it from coming back; with OCD, we linger and believe it
What are some examples of intrusive thoughts of harm?
- Impulse to jump out of high window
- Idea of jumping in front of a car
- Impulse to push someone in front of train
- Wishing a person to die
- Having the urge to kick a baby while holding them
- The thought that if I forget to say bye to someone, they might die
What are some examples of intrusive thoughts of doubts about safety, memory and so on?
- Thought that I haven’t locked the house up properly
- Idea of leaving curling iron on the carpet and forgetting to pull out the plug
- Idea that objects are not arranged perfectly
- Idea that I’ve left the car unlocked when I know I’ve locked it
What are some examples of intrusive thoughts of contamination or disease?
- Thought of catching a disease from public pools or other public places
- Thoughts I may have caught a disease from touching toilet seat
- Idea that dirt is always on my hand
What are some examples of intrusive thoughts of inappropriate or unacceptable behaviour?
- Idea of swearing or yelling at my boss
- Thought of doing something embarrassing in public, like forgetting to wear a top
- Hoping someone doesn’t succeed
- Thought of blurting smt out in church
- Thought of “unnatural” sexual acts
What is helping about confessing an impulsive thought for a person with OCD?
→ confessing the thought, not in a compulsive way, but sharing the thought where the other person can say “i’ve had thoughts like that too” which is helpful cause often people with OCD think they’re the only ones to think it
What are some common fear-based beliefs of OCD?
- Thinking about doing smt bad is the moral equivalent of doing smt bad
- I can and should be able to control unwanted thoughts
- I can and should be able to figure out if my unwanted thoughts mean smt terrible
- Having “bad thoughts” means there is smt wrong with me
- I’ll become dangerously ill from the contaminant
- The distress associated with incompleteness and the need for completeness are intolerable
What can we say about functional impairment in OCD?
- Can range from minor to severe
- Interference with school, work, relationships, family
- Can interfere with normal developmental experiences (if it’s taking up a lot of the day)
→ p.ex: participating in sports, hanging out with friends, etc.
Approximately __% of general population in a given year (in kids).
1%
What is the female to male ratio of OCD?
- Similar female to male ratio, but males start earlier (onset is early adolescence to mid-20s), and some evidence for difference in themes
→ but we can see OCD in kids of 3-4 years old all the way up to old age
→ but the fears and obsessions are related to their age
OCD can be ___ if untreated, BUT as treatable as other ___ disorders.
Chronic; anxiety
What are some comorbidity statistics of OCD?
→ 76% lifetime diagnosis of anxiety disorder (before OCD)
→ 41% lifetime diagnosis of major depressive disorder (after OCD)
→ 30% lifetime diagnosis of tic disorder
What are the NICE guidelines for OCD treatment?
-
First line: CBT with exposure and response prevention (ERP)
→ can’t be a generalized CBT, it really has to be a specialized CBT for OCD
→ the generalized CBT is actually a lot like compulsions, so we adjust the way we do the intervention to avoid that -
SSRI drug treatment can be added with increased severity
→ not enough evidence for SSRI alone in kids and adolescents or starting with SSRI for kids and adolescents
What is the logic of OCD intervention?
- Exposure to the obsession or exposing yourself to a stimulus to confront the obsession
→ p.ex; seeing a rope for someone with suicidal obsessions
→ Response prevention: DON’T do the safety behaviour
→ alter the misinterpretations; psychoeducation, show list of thoughts that people have in the general population, give confessions with people around them, record them when they come up, etc
