Anxiety Disorders: OCD Flashcards
What was Ignacious of loyola’s OCD?
- worried about forgetting his sins so he would go and confess over and over (scrupulosity - religiously or morally focused OCD)
DSM-5-TR criteria for OCD
A: a presence of obessions, compulsions, or both
1. obsessions: normal spontaneous thought but it is intrusive/unwanted
- the individual attempts to ignore or suppress the thoughts with another thought or action
2. compulsions: safety behaviour, thing you’re doing on purpose to prevent the feared event from happening (can be physical or mental)
- are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation but are not connected realistically to the feared thing + excessive
What cycle do people with OCD get stuck in?
Obsessions increase anxiety
Compulsions decrease anxiety
over and over and over again
Gilbert: obsession, compulsions, avoidance
Obsession:
- “I am contaminated”
- Afraid that the feeling of contamination will become too overwhelming to tolerate and will last forever
Compulsions:
- Washing hands and showering, gloves
- His hands are raw (can measure progress by seeing if hands become less raw over time)
Avoidance:
- Won’t touch light switches, door handles
- Won’t wear “contaminated” clothes
- Won’t use public washrooms
- Won’t hug family members
sometimes he doesn’t want to spread germs and other times he doesn’t want to get germs
Kelly: obsession, compulsions, avoidance
Obsession:
- “I could kill myself” [witnesses an image of killing self in various ways]
- She doesn’t want to kill herself, this would be the worst case scenario for her
- She’s not depressed and never tried to kill herself
- She’s terrified that her thought means she’s more likely to kill herself
Compulsions:
- Rumination, checking of feelings, asking parents for reassurance, researching signs of suicidality on the internet
- She treats feeling sad as a danger signal, so she checks herself a lot
Avoidance:
- Won’t be home alone
- Won’t go near windows
- Won’t use sharp knives
- Won’t watch movies with mental health themes
In anxiety disorders (OCD) rumination means:
- trying to convince yourself that the obsession is untrue
- Ex: Kelly constantly says “no I’m not going to kill myself” in her head
Repugnant obsession:
a thought that you find taboo
Marry: obsession, compulsions, avoidance
Obsession:
- [Urge to push a stranger into traffic]
- She’s not going to, she’s the least likely person in the world
Compulsions:
- Rumination, reassuring herself, picturing happy thoughts, rigid prayer
- “no I’m not going to do that”
Avoidance:
- Keep distance from strangers
- Keep hands hooked on backpack
- Avoid areas with heavy traffic
What is the diagnosis frame for OCD since the first onset of symptom (in years)
8 years
Interesting Kind: Sexual Orientation OCD
Obsessional content is all about “I really think I am straight but I am terrified that I might actually be gay and I don’t know it and it will come out 25 years from now” and they think about it all day
- Watching movies and checking what characters they are attracted to
- Interpret dreams
- Avoiding all of male friends
- Talk or walk in a different way
Interesting kind: Pedophile OCD
people become terrified that they may be sexually attracted to children - they aren’t attracted to children but they fear they are
- Not watching shows with kids in it
- Not seeing their grandchildren
- Not walking by playgrounds
Does the person know their OCD doesn’t really make sense?
The person (chariot driver) knows it doesn’t make sense, but intrusive thoughts (horses) are making them think that the thing would be so horrible that they have to prevent it
What do compulsions prevent?
they prevent a person from learning anything about the misinterpretations of their intrusive thought as significant
do normal intrusive thoughts exist? examples?
Yes! People without OCD have all sorts of thoughts, but they don’t interpret them as an emergency
Examples:
- impulse to jump out of a window
- thoughts of dropping a baby
- idea that dirt is on hands
- thought of blurting out something in class
- thought of leaving the stove on when leaving the house
- thought they forgot to lock the house
what does misinterpreting an intrusive thought as significant mean?
An example can be thought of like: “thinking that I want someone to break into my house is just as bad as telling someone to break into my house”
how much of the general population in a given year is diagnosed with OCD?
1% - 1 in 200 children
are men and women just as likely as one another to have OCD?
- Similar female to male ratio, but males start earlier (onset is early adolescence to mid-20s), and some evidence for difference in themes (contamination is girls and violence in boys)
What are some comorbidities with OCD?
- 76% lifetime diagnosis of anxiety disorder (before OCD)
- 41% lifetime diagnosis of major depressive disorder (after OCD)
- 30% lifetime diagnosis of tic disorder
NICE: first like on treatment for OCD, can SSRIs be involved?
- CBT with exposure and response prevention (.80 effect size)
- SSRI treatment can be asses with increased severity - there is no good evidence for it
What the treatment would look like:
Want to bring on the thought on purpose
- Present a stimulus to remind them of the thought, write the word out
- Cut out the compulsion and change the interpretation as significant
- Give them psychoeducation on normal thoughts that everyone has
- Make them do an audio recording of the content of the thoughts, and this can be used in the future for other patients
Analogies used in OCD treatment
“OCD is like a bully on the school yard and everyday he asks you for your lunch money and you keep giving him your money. this happens every day, and then he keeps wanting more and more and then you get trapped”
- What would you do? “need to stop giving him my money” - they know!
OCD is like a car, compulsion = fuel, we want to kill the compulsions - make the car run out of gas
Doing an exposure is a lot like swimming in cold water, what would happen if you just put your toes in? what happens if you jump in? at first its rly cold but then your body will adjust to it
Harry Potter analogy: hiding out in the woods when escaping, they have to destroy a necklace with a special sword but before he does it, it messes with him and shows him his worst fears and when he finally destroys it, the images disappear and they’re all gone
What doesn’t work to improve OCD?
- engaging with the contents of the obsession
- providing reassurance
- distraction (relaxation breathing)
- telling people to think of something else
Gilbert exposures:
- Touch light switch and delay washing
- Re-contaminate immediately after shower
- Wear clothing that has been contaminated
- Zoom calls in addition to the office, in the bedroom, to contaminate his clothes and his bed, can show us his washing ritual, go in missions to hug him family members
Kelly exposures:
- Repeat intrusive thought over and over (in song, backward) without compulsions
- Hold a knife while thinking feared thought
- Psychologist asks the client intrusive thought and client does not engage
○ “Do you think your going to kill yourself?”
