Chapter 7: Obsessive-Compulsive Related and Trauma-Related Disorders Flashcards
What is obsessive-compulsive disorder (OCD)?
an anxiety disorder involving persistent and uncontrollable thoughts or the performance of certain acts again and again, causing significant distress and interference w/ everyday functioning
What are obsessions?
intrusive, recurring thoughts that seem irrational and uncontrollable to the person experiencing it
What are six types of foci of obsessions in OCD?
- contamination
- responsibility for harm
- sex and morality
- violence
- religion
- symmetry or order
What are compulsions?
repetitive, clearly excessive behaviors or mental acts that a person feels driven to perform to reduce the anxiety caused by obsessive thoughts
What are five common compulsive rituals for those with OCD?
- decontamination
- checking
- repeating routine activities
- ordering/arranging
- mental rituals
Are the habits of compulsive gamblers, eaters, and drinkers considered compulsions?
no - these behaviors are motivated by pleasure; compulsions are motivated by the feeling that something dire will happen if the act is not performed
What is body dysmorphic disorder (BDD)?
a disorder marked by preoccupation w/ an imagined or exaggerated defect in appearance (ex: wrinkles, body hair, nose)
How many hours per day do people w/ BDD think about their appearance?
3-8 hours
What are common compulsive behaviors for those w/ BDD?
- checking appearance in mirror
- comparing appearance to that of others
- asking others for reassurance about their appearance
- using strategies to change or camouflage their appearance
Why do many people with BDD not receive treatment?
- mental health professionals do not ask about these symptoms
- those w/ BDD often feel too ashamed to raise their concerns
Is a preoccupation with only weight or body fat considered BDD?
no - this rules out BDD (is an eating disorder)
What is hoarding disorder?
a disorder in which the person has a compulsive need to acquire objects and extreme difficulty in disposing of those objects
When does animal hoarding usually emerge?
middle age or older
What is the heritability estimate of OCD, hoarding, and BDD?
40 to 50%
What are the fronto-striatal circuits?
neural pathways that connect regions of the frontal cortex and areas of the basal ganglia; these pathways are implicated in obsessive-compulsive disorder
Which three regions of the frontal-striatal circuits are unusually active in people with OCD?
- orbitofrontal cortex
- caudate nucleus
- anterior cingulate
What is the goal of cognitive behavioral theory for OCD?
to understand why a person with OCD continues to show the behaviors or thoughts used to ward off an initial threat well after the threat is gone
What is thought-action fusion?
the tendency to believe that thinking about something is
as morally wrong as engaging in the action or can make the imagined event more likely to occur - contributes in the persistence of obsessions
What is thought suppression?
an attempt to stop a certain thought that has the paradoxical effect of inducing preoccupation w/ that thought - considered to intensify obsessions
What does the cognitive behavioral model suggest about the etiology of hoarding disorders?
people w/ hoarding disorder have poor organizational abilities, unusual beliefs about possessions, and avoidance behaviors
What is the most commonly used medication used for OCD, BDD, and hoarding disorder?
antidepressants
What is the major psychological approach for OCD, BDD, and hoarding disorder?
exposure and response prevention (ERP)
Why is some caution warranted when treating OCD with SSRIs?
SSRIs require more time and higher doses to treat OCD (compared w/ depression)
Why is caution warranted when treating hoarding disorder with antidepressant treatment?
-much research focuses on hoarding symptoms among OCD patients
What is exposure and response prevention (ERP)?
sufferer is prevented from engaging in compulsive ritual activity and instead faces the anxiety provoked by the stimulus - leads to eventual extinction of the conditioned response (anxiety)
What is the reasoning behind exposure and response prevention (ERP)?
- not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus
- the exposure promotes the extinction of the conditioned response (the anxiety)
What does the exposure element of ERP focus on for those w/ hoarding disorder?
getting rid of their objects
What is deep brain stimulation?
used for OCD patients who do not respond to medication - involves implanting electrodes into the brain (one of several regions of basal ganglia)
How do trauma-related diagnoses differ from other major DSM diagnoses?
only diagnosed when a person develops symptoms after a traumatic event
What is posttraumatic stress disorder (PTSD)?
an anxiety disorder in which a particularly stressful event, such as military combat, rape, or a natural disaster, brings in its aftermath intrusive re experiencing of the trauma, a desire to avoid reminders of the event, changes in emotions and thought patterns, and indicators of heightened arousal
Which event spurred the development of PTSD?
the Vietnam War
What is the most common type of trauma preceding PTSD for men?
military trauma
What is the most common type of trauma preceding PTSD for women?
rape
Which symptoms, in addition to trauma, are required for a PTSD diagnosis?
- intrusively re experiencing the traumatic event
- avoidance of stimuli associated w/ the event
- other signs of negative mood and thought that developed post trauma
- symptoms of increased arousal and reactivity
What is acute stress disorder (ASD)?
a short-lived anxiety reaction to a traumatic event; if it lasts more than a month, it is diagnosed as posttraumatic stress disorder
What are two major concerns about the ASD diagnosis?
- the diagnosis could stigmatize very common short-term reactions to serious traumas
- the diagnosis of ASD is not very predictive of who will develop PTSD
What proportion of people who develop ASD will develop PTSD within 2 years?
less than half
What are some benefits to an ASD diagnosis?
may encourage providers to identify people who could use more support after a trauma
What percentage of people who developed PTSD by age 26 had been diagnosed w/ another psychological disorder before age 21?
93%
What fraction of people who develop PTSD have a history of anxiety disorders?
2/3
What percentage of American fighters wounded in Vietnam developed PTSD?
20%
What percent of prisoners of war in Vietnam developed PTSD?
50%
Why might traumas caused by humans be more likely to cause PTSD than natural disasters?
they challenge ideas about humans as benevolent
Which brain region is PTSD uniquely related to?
heightened activity in hippocampus
What is dissociation?
a symptom in which a group of mental processes is split off from consciousness
What are some factors that affect how likely someone will develop/recover from PTSD?
- dissociation (higher dissociation, more likely to develop PTSD)
- social support
- intelligence (to make sense of horrifying events)
How is trauma beneficial to some people?
awakens an increased appreciation of life, renews a focus on life priorities, and provides an opportunity to understand one’s strengths in overcoming adversity
What is the primary psychological approach to treating PTSD?
exposure treatment
What is eye movement desensitization and reprocessing (EMDR)?
approach to PTSD in which client recalls a scene and visually tracks therapist’s fingers
Why do some question the efficacy of EMDR?
claims that the eye movement component isn’t necessary (just regular old exposure)
What is imaginal exposure?
treatment for anxiety disorders that involves visualizing feared scenes for extended periods of time (esp when in vivo exposure can’t be conducted)
What is cognitive processing theory?
designed to help victims of rape and childhood sexual abuse dispute tendencies toward self blame - guilt!!
What is Critical Incident Stress Debriefing (CISD)?
involves immediate treatment of trauma victims within 72 hours of traumatic event - one long group session
Why is CISD highly controversial?
- those who received CISD tended to fare worse in terms of PTSD treatment (many would not have otherwise developed PTSD)
- therapists often enforce coping strategies onto clients
