Chapter 7 Flashcards
Obsessive-Compulsive Disorders
Diagnosis based on presence of obsessions or compulsions
Most people experience both
Obsessions
Intrusive and persistent thoughts, images, or impulses that are uncontrollable
Often experienced as irrational
Typically, a person spends hours immersed in obsessions
*Most common:
Contamination, responsibility for harm, sex and morality, violence, religion, and symmetry/order
Compulsions
*Repetitive, clearly excessive behaviors or mental acts to reduce anxiety
*Extremely difficult to resist the impulse
May involve elaborate behavioral rituals
Compulsive gambling, eating, etc. NOT considered compulsions, because they are pleasurable
Compulsions are motivated by desire to reduce anxiety
OCD often begins before the age of _____
OCD often begins before the age of 14
DSM-5 Criteria for Obsessions
*Obsessions are defined by
Recurrent, intrusive, persistent unwanted thoughts, urges, or images
The person tried to ignore, suppress or neutralize the thoughts, urges, or images
DSM-5 Criteria for Compulsions
Compulsions are defined by
Repetitive behaviors or thoughts that the person feels compelled to perform to prevent distress or a dreaded event
The person feels driven to perform the repetitive behaviors or thoughts in response to obsessions or according to rigid rules
The acts are excessive or unlikely to prevent the dreaded situation
The obsessions or compulsions are time consuming (e.g., at least one hour per day) or cause clinically significant distress or impairment
The obsessions or compulsions are time consuming (e.g., at least one hour per day) or cause clinically significant distress or impairment
Risk Factors Common Across Disorders
All three involve :
*OCD, BDD, and hording disorder share some genetic vulnerability
- All three involve the front-striatal circuit
- Orbitofrontal cortex
- Caudate nucleus
- Anterior cingulate
Etiology of OCD: Cognitive Behavioral Model
Previously functional responses for reducing threat become habitual
These responses are difficult to override after the threat is gone
Once people with OCD develop a conditioned response, they are slower to change their response
Exposure and Response Prevention (ERP): OCD
*Exposure to situations that elicit obsessions
-Exposes person to full force of anxiety
*Prevention from engaging in compulsive behaviors
-Promotes extinction of conditioned response
*Exposure hierarchy : Begins with tackling less threatening stimuli
Progresses to more threatening stimuli
*69-75% show significant improvement
-Among people with OCD, 1/3 unwilling to begin ERP
-Among those enrolled, 1/3 drop out of treatment
treating ocd with medication
*Antidepressant are most common
- SSRIs (serotonin reuptake inhibitors)
- Recommended as a first line treatment due to less severe side effect profile
- May require more time (up to 12 weeks) and higher doses compared to treating depression
- Most people with OCD continue to experience mild symptoms
Body Dysmorphic Disorder (BDD)
Preoccupation with one or more imagined or exaggerated defect in appearance
Perceive themselves to be ugly or “monstrous”
Women focus on: skin, hips, breasts, legs
Men focus on: height, penis size, body hair, muscularity
People with BDD find it difficult to stop thinking about their concerns
On average, 3-8 hours per day
Compelled to engage in certain behaviors to reduce distress (e.g., checking appearance in mirror)
Symptoms are extremely distressing
About 1/3 have little insight into overly harsh views
As many as 1/5 endure plastic surgery
Little evidence that surgery reduces concerns
About 1/3 endorse history of suicidal ideation
20% attempted suicide
Interferes with functioning
Symptoms and outcomes are similar across cultures
The body part of focus may differ by culture
If shape and weight concerns are the only foci, the symptoms are better explained by eating disorders
T/F BDD is found in America but not many other cultures
FALSE
DSM-5 Criteria: Body Dysmorphic Disorder
Preoccupation with one or more perceived defects in appearance
Others find the perceived defect(s) as slight or unobservable
The person has performed repetitive behaviors or mental acts (e.g., mirror checking, seeking reassurance, or excessive grooming) in response to the appearance concerns
Preoccupation is not restricted to concerns about weight or body fat
ERP: BDD
Exposure to situations that elicit obsessions
E.g., interact with people critical of their looks
Prevention from engaging in compulsive behaviors
E.g., avoid activities used to reassure themselves about their appearance
Many people continue to experience at least mild symptoms after treatment
Etiology of BDD
People with BDD are usually detail oriented, which influences how they look at features
Instead of looking at the whole, they examine one feature at a time
Consider attractiveness more important than others
Self-worth is exclusively dependent on appearance
Hoarding Disorder
The need to acquire is excessive
Extremely attached to possessions
Very resistant to efforts to get rid of them
Many are unaware of severity of problem
75% engage in excessive buying
33% engage in animal hoarding
Often begins in childhood or early adolescence
DSM-5 Criteria:Hoarding Disorder
Persistent difficulty discarding or parting with possessions, regardless of their actual value
Perceived need to save items
Distress associated with discarding
The accumulation of a large number of possessions clutters active living spaces to the extent that their intended use is compromised unless others intervene
Etiology of Hoarding Disorder
Poor organizational abilities
Difficulties with attention, categorization, and decision making
Unusual beliefs about possessions
Ability to see potential in each object
Extreme emotional attachment to objects
Avoidance behaviors
ERP: Hoarding Disorder
Exposure to situations that elicit obsessions
E.g., getting rid of possessions
Prevention from engaging in compulsive behaviors
E.g., counting or sorting possessions
Use of motivational strategies to facilitate insight into problems caused by symptoms
Provide tools and strategies to help organize and remove clutter
In-home visits for in vivo de-cluttering exercises
Deep Brain Stimulation: OCD
10% of people with OCD do not respond to multiple pharmacological treatments
Deep brain stimulation is indicated for these people
Implanting electrodes into the brain
Half attain significant relief within a couple months
Cognitive Therapy
Challenge beliefs about anticipated consequences of not engaging in compulsions
Usually also involves exposure
Treatment outcomes comparable to ERP
Posttraumatic Stress Disorder (PTSD)
Extreme response to severe stressor
-Recurrent memories of trauma
-Avoidance of stimuli associated with trauma
-Negative emotions and thoughts
-Increased arousal
Serious trauma as an event that involved actual or threatened death, serious injury, or sexual violation
55% of people report at least one lifetime serious trauma
Common traumas preceding PTSD:
Men: military trauma
Women: rape
Symptoms may develop soon after the trauma
Sometimes symptoms do not develop for years
Symptoms can be chronic
Unemployment and suicidality are common
High rates of medical illness
Prolonged exposure to trauma may lead to a broader range of symptoms
Complex PTSD
Posttraumatic Stress Disorder (PTSD) DSM
*Exposure to a serious trauma
*Duration of Symptoms last for MORE than one month.
Symptoms in the following four categories:
* Intrusion
-E.g., recurrent and intrusive memories, dreams, flashbacks
* Avoidance
-Internal and external reminders
*Negative alterations in cognitions and mood
-E.g., persistent negative beliefs and negative emotional states
*Arousal and reactivity
-E.g., aggressiveness, hypervigilance, exaggerated startle response
t/f PTSD and acute stress disorder are basically the same but have different time conditions
T
T/F when treating people, focus on one disorder onely
FALSE:
-treat the person, not just the disorder
Acute Stress Disorder
Symptoms similar to PTSD
Shorter duration of symptoms
3 days to 1 month after trauma
ASD may stigmatize reactions to serious trauma
90% of women report significant symptoms 1 month after a rape
ASD is not very predictive of who develops PTSD
Less than half develop PTSD within 2 years
Etiology of PTSD: Commonalties with Other Anxiety Disorders
Genetic risk
Greater amygdala activation
Diminished activation of regions of medial prefrontal cortex
Childhood exposure to trauma
Greater reactivity to signals of threat
Mowrer’s two-factor model of conditioning
Etiology of PTSD: Unique Factors
*Severity and type of trauma
-Directly witnessing violence (vs. indirect exposure)
-Trauma caused by human (vs. natural disasters)
Dissociation
A form of avoidance, keeping a person from confronting memories
15% of people with PTSD
Protective factors
Cognitive abilities and social support
Neurobiology: The hippocampus
Central role in autobiographical memories
Greater activation in PTSD
Treatment of PTSD
Medications (SSRIs and SNRIs)
Relapse common if medication is stopped
*Exposure treatment
-Focus on memories and reminders of trauma
-Exposure hierarchy
Direct (in vivo), Imaginal, or VIRTUAL REALITY
8 to 15 90-minute sessions
-Goals: extinguish fear response and challenge belief that the person cannot cope
- Cognitive therapy
- E.g., cognitive processing therapy
- Goal: Reduce overly negative interpretations about trauma and its meaning
Short-term treatment of ASD may prevent PTSD
Benefits lasts for years after the traumatic event
Exposure treatment appears more effective than cognitive restructuring in preventing the development of PTSD
some types of dissociations are common, example?
Some types of dissociation common (e.g., losing track of time)
“fugue” means
purposeful wandering
t/f Dementia is considered a cause of Dissociative Amnesia
-explain
false!!
Dementia - Memory fails slowly over time, Is NOT linked to stress, Accompanied by inability to learn new information
amnesia vs dissociative amnesia
Dissociative amnesia is not the same as simple amnesia, which involves a loss of information from memory, usually as the result of disease or injury to the brain. With dissociative amnesia, the memories still exist but are deeply buried within the person’s mind and cannot be recalled.
Is there a time requirement for the dissociative disorders?
I dont think so ….
iatrogenic
created within treatment
The sociocognitive model thinks that DID could be created within therapy. What is the word for this? How would this be possible? Is this considered deception?
iatrogenic : created within treatment
Reinforcement of identified alters and suggestive techniques might promote symptoms in vulnerable people
Not viewed as conscious deception
- OCD tends to be
a) more common in men than in women.
b) more common in women than in men.
c) as common in men as it is in women.
d) most common in older men.
b) more common in women than in men.
Can Somatic Symptom disorder be diagnosed even if symptoms cannot be explained medically?
yes! Somatic Symptom disorder can be diagnosed regardless of whether symptoms can be explained medically
people with dissociative amnesia will keep what type of memory?
procedural
T/F a DID diagnosis should be made alone (no other disorders)
FALSE: common other diagnosis present
= PTSD, Major Depressive Disorder, Somatic Symptom Disorders, Personality Disorders
SVT’s
- to test for Malingering
SVT’s : symptom validity test
(will actually do pretty well if even do not try- even by chance you should get a certain percent)
TOMM
TOMM :test of memory malingering
Tardive dyskinesia
a side effect of first-generation schizophrenic drugs
-making faces
