Chapter 9 OCD disorders

Question 1

Describe how obsessive compulsive disorder presents.

Answer 1

Plagued by obsessive thoughts that cause compulsions that cause the individual to capitulate time consuming, repetitive behavior that last more than an hour per day with an obsession on order and cleanliness.

Memory Note: Think Melvin Udall (Jack Nicholson) from As Good as it Gets. He is textbook OCD

Question 2

Describe how body dysmorphic disorder presents.

Answer 2

An otherwise normal looking person seeing and being obsessed with part of their body looking hideous. Honestly, I know this one all too well. I believed I was hideous. Thanks Lauren.

These people are emotionally distressed and will often spend 3-5 hours concerning themselves with their appearance, they will shop for beauty products obsessively and even get plastic surgery.

Question 3

True or False, People with Birth Defects and Burn Marks can have Body Dysmorphic disorder

Answer 3

False: While people with birth defects and burn marks worry about their looks. People with BDD often see physical deformities that are not there or overemphasize small flaws.

Question 4

Muscle dysmorphia

Answer 4

when a person believes their body is too small or not jacked enough. They will often engage in steroid use, have poor life quality and even have high suicide attempts.

Question 5

Describe how hoarding disorder presents.

Answer 5

A persistent over accumulation of possessions that is illogical and has paranoia about anything being lost or unkept and results in excessive cluttering and even disgusting habitation. Asking to clean out the clutter often reposts significant distress to the client.

Mental Note: Ruth. Think about Both her houses.

Question 6

Define obsessions and compulsions. Provide a list of examples of each thought/behavior.

Answer 6

Obsessions are intrusive thoughts, urges or images that invade a persons sense of being and will not quit unless a person capitulates.

Compulsions are obsessive behaviors as a result of the obsessions such as washing hands 5 times or making sure everything is orderly.

Question 7

Give examples of characteristics that would not be consistent with a body dysmorphic disorder diagnosis.

Answer 7

People with normal appearance adherence such as getting ready for a date. Burn victims and people with birthmarks

Question 8

Describe the epidemiology of OCD.

Answer 8

OCD’s onset is usually younger at 19 but can start as early as 14 with 25% of cases. Women have higher rates than men and effects 1.2% of US adults

Question 9

Describe the epidemiology of body dysmorphic disorder.

Answer 9

Effecting women more than men with a prevalence rate for 2.4% of US adults. Men are more concerned with build, dick size and baldness while women are concerned with looking fat, and small feminine features such as tis and ass.

Honestly there is a bit of Leka here

Question 10

Describe the epidemiology of hoarding disorder.

Answer 10

Females more than males and tends to be 3 times as worse in older individual like Ruth. Effecting maybe 1.5-6% of the US population but these numbers are hard to track

Ruth really fit the docket here

Question 11

Gender Differences of OCD and BDD

Answer 11

Women tend to have higher rates of both OCD and body dysmorphia. Though with OCD, boys are more often diagnosed when they are young vs girls.

Question 12

Compare the Prevalence Rate of OCD,BDD and hoarding

Answer 12

OCD is 1.2% in the US and Worldwide, Body Dysmorphia is 2.4% in the US and 1.7-2.9% worldwide, Hoarding is harder to measure but its believed 1.5-6% of US adults hoard.

Question 13

Describe the comorbidity of OCD.

Answer 13

-High comorbidity with all anxiety disorders especially panic disorders, nearly 76%.

-41% of those with OCD are comorbid with bipolar and depressive disorders, also tic disorders particularly in men.

Question 14

What mental illnesses are commonly tested for OCD since they are often linked or comorbid

Answer 14

-Schizophrenia, bipolar, eating disorders, body dysmorphic disorder and Tourette’s

Question 15

What are the most common comorbidities for OCD? Be specific.

Answer 15

Anxiety disorders such as GAD, panic disorder, social anxiety disorder, phobias and often mood disorders such as bipolar and depressive disorders

Question 16

What is the OCD triad in children? What two other disorders complete this triad?

Answer 16

OCD, tic disorder and ADHD in kids which leads there to believe there is a neurobiological fault here. Children also have a different presentation of OCD than adults due to this fact and will show the triad

Question 17

Which disorder is body dysmorphic disorder most comorbid with?

Answer 17

MDD, Social anxiety disorder, and substance abuse

Question 18

Hoarding Comorbidity

Answer 18

Highly comorbid with anxiety and some degree of MDD

Question 19

Is there a hereditary (genetic) relationship with OCD

Answer 19

twin studies show a strong link to OCD and genetics with an 80% concordance rate with identical twins and 50% with fraternal twins. First family members have a five fold increase as well.

Interesting, family relations to OCD patients have strong obsessive tendencies but not always compulsive tendencies

Question 20

Is there a genetic relationship with Body Dysmorphic disorder and hoarding?

Answer 20

With BDD and hoarding with genetics plays a role, environmental factors seems to be far more involved.

Question 21

What Neurotransmitters are involved in OCD disorders?

Answer 21

Serotonin is a contributing factor. Increasing levels of serotonin help with OCD and depressive symptoms. Antidepressants that did not address serotonin were not effective in alleviating symptoms.

Glutamate, GABA and dopamine may be involved in the maintenance of OCD but more research is needed

Question 22

Brian structures involved with OCD

Answer 22

The orbitofrontal cortex which is responsible in impulse control and mediating emotions which sends signals through the caudate nuclei then through the thalamus to decide what to do about the thought. With OCD it is believed to be an overactivation of the orbitofrontal cortex and a lack of filtering by the caudate nuclei and thus overloads the thalamus with compulsion

Mental Note: This neurocircuitry was really interesting. Usually lack of impulse control is the issue with most disorders but in this case the OBF is the problem

OBF-CNT (Orbitofrontal Cortex- Caudate Nucleus, Thalamus)

Question 23

Do all those with intrusive thoughts have OCD?

Answer 23

We all have an intrusive thought of double checking something important such as “did I leave the oven on?” But people with OCD cannot escape these thoughts and think about them repeatedly and as a detriment to their life

Mental Note: Chad and Abe believed they have OCD but they don’t

Question 24

What is the cognitive therapy understanding of OCD

Answer 24

People with OCD are more sensitive to thoughts about overestimation about the probability of harm, loss of control and uncertainty and disaster rehearse negative consequences.

They also experience deconformation bias where they seek out info that proves their failure. This leads to an inability to trust their instincts.

Capitulating to obsessions with compulsions reduces anxiety thus creating a feedback loop

Question 25

How do behaviorists describe OCD

Answer 25

Described through operant conditioning. The obsessions cause distress and the compulsions provide relief to the distress and then reinforces the behavior

Question 26

What are the biological implications regarding the etiology of OCD and related disorders? What brain structures have been linked to these disorders?

Answer 26

Has a strong genetic link with serotonin being the main neurotransmitter involved. However, the circuitry between the Orbitofrontal cortex to the caudate nuclei and overloading of the thalamus is responsible

Question 27

What is the best treatment for OCD

Answer 27

ERP (Exposure and Response Prevention) Uses relaxation techniques while in vivo or simulations exposing the client to things that trigger on their obsessions without following through with compulsions. They put the clients obsessions on a hierarchy of obsessions from lowest top highest, working on the lowest first and highest last. ERP is largely successful if clients follow through on treatment.

Question 28

Are meds good for OCD?

Answer 28

Psychopharmacology has a limited effectiveness and symptoms pick up right up when meds are done. If done at all, its usually SSRI’s

Question 29

Describe treatment options for body dysmorphic disorder.

Answer 29

Same as OCD, ERP and SSRI’s. ERP has more success but the numbers appear to be limited a bit with remission at 9% at 1 year but 76% at 8 years

Question 30

Describe treatment options for hoarding disorder.

Answer 30

Because Hoarding patients do not experience intrusive thoughts like OCD, ERP does not have a high success rate. Traditional CBT methods tend to be the best methods

Question 31

What are the different components of Exposure and Response Prevention? How do they work together to reduce OCD symptoms?

Answer 31

They train the client to manage their feelings during the obsession part of OCD usually done with some form of exposure therapy. The engage in relaxation techniques to manage their response in regard to the compulsions. Over time they learn to no cave to their obsessions and respond more normally to things that triggered them

Question 32

According to Frost and Hartl (1996) what are the main components that contribute to the maintenance of hoarding disorder?

Answer 32

Engaging in a complex decision-making process, over valuing possessions which leads to hoarding. Exposure and cognitive restructuring help manage distress and proper appraisal of items to keep and discard reasonably