CP: Chapter 7 Obsessive Compulsive Disorders Flashcards
obsessions =
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.
wat is nog een criteria van obsessions
the person attempts to ignosre or suppress the thoughts/urges/images, or tries to neutralize them with another thought or action
obsessive-compulsive disorder belangrijkste criteria
presence of obsessions, compulsions or both
compulsions =
repetitive behaviours (hand washing/checking) or mental acts (counting, praying, repeating words) that the individual feels driven to perform in response to an obsession or according to rules that must be applied
the acts are aimed at preventing/reducing anxiety, or to prevent some event/situation, but the behaviours or mental act are not connected in a realistic way or are clearly excessive.
the obsessions and compulsions must be…
time consuming or impairing in daily life
4 specifications of OCD
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
Specify if:
Tic-related: The individual has a current or past history of a tic disorder.
body dysmorphic disorder =
preoccupied with an imagined or exaggerated defect/flaws in their physical appearance, that are not observable or appear slight to others.
een criteria van BDD
at some point the individual has performed repetitive behaviours(mirror checking, reassurance seeking) or mental acts (comparing) in response to the concerns
en moet impairment hebben in daily life, en niet te maken hebben met body weight bij een eating disorder!
4 specifications of muscle dysmorphia
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
Specify if:
With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.
hoarding disorder=
persistent difficulty parting with possessions, regardless of their actual value. perceived need to save items, distress with discarding them.
clutter living areas. if living areas are uncluttered it is of interventions of third parties (family, cleaners, authorities)
is iets anders dan obsessive compulsive disorder!
specificication hoarding disorder
excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space.
voorbeelden van andere hoarding behaviours
(e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).
many people with hoarding disorder…
are unaware of the severity of their disorder.
hoeveel heritability bij obsessive-compulsive and related disorders
40-50%
welke 3 brain regions bij OCD and related
orbitofrontal cortex
caudate nucleus (basale kernen: planning the execution of movement, but also in learning, memory, reward, motivation, emotion, and romantic interaction)
anterior cingulate cortex (emotion regulation, cognitive control)
these 3 brain regions are activated when…
ppl with BDD see their own face
ppl with hoarding disorder see their objects
OCD en yedasentience
= subjective feeling of knowing you have done enough. dit is niet goed werkend in ocd
5 common compulsions of OCD
contamination
checking
repeating routine activities (touching)
ordering/arranging
mental rituals
once someone with OCD develops a conditioned response to a stimulus, the person is
slower than others to change the response to that stimulus after it is no longer rewarded
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thought-action fusion
people with OCD tend to believe that:
(1) thinkin about something is as morally wrong as engaging in the action or (2) thinking about an event
can make it more likely to occur
people with OCD tend to engage in..
thought suppression
however, this usually leads to more presence of the thought
people with BDD are…
unusually detail-oriented, and this influences how they look at facial features
A behavioral model of OCD suggests that people sustain
conditioned responses as habits long after the contingencies that conditioned the initial behavior have
shifted. Thought suppression may exacerbate tendencies toward obsessions, and thought–action fusion
may increase the likelihood of thought suppression.
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Cognitive behavioral models of hoarding disorder focus on …
poor organizational abilities (difficulties with attention, categorization, and decision making), unusual beliefs about possessions, and avoidance behaviors.
hoarding is evolutionair gezien opzich logisch!
what is the most used medication in ocd
anti-depressants
what is the most used therapy in ocd
exposure-response prevention
ERP in ocd
OCD: exposure to situations that elicit the compulsive act and then they are supposed to refrain from the compulsive ritual. challenging peoples beliefs about what will happen if they do not engage in these rituals
ERP in body dysmorphic disorder
exposure to interact with people who could be critical of their looks, response of activities they use to reassure themselves about their appearance
For the treatment of BDD, ERP is supplemented
with cognitive strategies to challenge people’s overly negative views of their appearance, their excessive focus on their appearance, and their belief that self-worth depends on their appearance.
ERP in hoarding disorder
exposure to disposal of stuff
response prevention focuses on not doing the activities to reduce their anxiety
ERP for hoarding disorder often involves motivational strategies to enhance insight and willingness to consider change.
acute stress disorder =
when symptoms occur between 3 days and 1 month after trauma
what for treatment for treatment resistant ocd
Deep transcranial magnetic stimulation (dTMS) and deep brain stimulation (DBS)
OCD, BDD, and hoarding disorder are each moderately heritable. There is some shared genetic risk across these three disorders
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welke brain region in het algemeen bij OCD
fronto-striatal circuits (rewards!)
OCD has been linked to activity in the fronto-striatal circuits, including the orbitofrontal cortex, the caudate nucleus, and the anterior cingulate cortex, during tasks that provoke symptoms.
People with BDD also show hyperactivity in regions of
the orbitofrontal cortex and the caudate nucleus when viewing photos of themselves.
Hoarding disorder involves hyperactivity in the orbitofrontal cortex and the anterior cingulate cortex during symptom-provoking tasks.
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welke region extra bij BDD
visual processing regions
behavioural model for ocd
Tendencies toward repetitive thoughts and behaviors in OCD may be related to a tendency for conditioned responses to become habitual, such that they are sustained even after the threat is removed. Obsessions may be intensified by attempts to suppress unwanted thoughts, in part because people with OCD tend to believe that thinking about something is as bad as doing it, a tendency referred to as thought–action fusion.
BDD cognitive model
The cognitive model relates BDD to a detail-oriented analytic style and an overvaluing of the importance of appearance to self-worth.
antidepressants in BDD and hoarding
little research, geen goed bewijs voor. wel voor ocd.
A criterium for acute stress disorder
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. learning about it from others
4. exposure to aversive details (via media alleen bij baan)
death injury sexual violence, directly or witnessing as it occured to others
symptoms van acute stress syndrome en hoeveel?
minimaal 9:
- memories
- dreams
- dissociation/flashbacks
- distress
- inability to feel positive emotions
- altered sense of reality
- inability to remember certain aspects
- avoid distressing memories
- avoid external reminders
- sleep
- irritable
- hypervigilance
- concentration
- startle response
post traumatic stress disorder when
als de symptomen er na 1 maand nog zijn
kritiek ASD
could stigmatize short-term, normal reactions to trauma. and most people with ptsd do not qualify for ASD within the first month
etiology of ptsd
2/3 of ppl with ptsd have history of other anxiety disorder
two-factor model of conditioning in ptsd
classical conditioning of fear response -> learn to avoid -> operant conditioning maintains the avoidance behaviour -> avoidance is reinforced via reduction of fear
which type of onset is more likely to cause trauma
trauma caused by humans vs trauma caused by nature
ptsd in brain?
greater activation of amygdala
diminished activation of medial prefrontal cortex (learning and extinguishing fear)
smaller hippocampus
meer activity locus coeruleus
meer activity norepinephrine system
what is another risk/preventative factor for ptsd
coping mechanisms (avoiding = more risk of ptsd, dus dissociation and memory suppression)
medication treatment for ptsd
antidepressants: serotonergic reuptake inhibitors (SSRI)
2 therapies for ptsd
cognitive behavioral therapy
exposture therapy, bijvoorbeeld eye movement desensitization and reprocessing (EMDR)
emdr =
person imagines a situation related to the trauma whilst tracking the therapists fingers
exposure treatment bij asd to prevent ptsd
kan effectief zijn, short term exposure treatment therapy
ptsd is diagnosed only after…
a traumatic event
4 symptoms algemeen of ptsd
re-experiencing the trauma
avoidance of reminders of the trauma
negative alterations in cognitions and mood
hyper-arousal.
Research and theory on the causes that are specific to PTSD focus on…
severity and nature of the traumatic event, as well as on hippocampal activity; functional connectivity of the salience network, the central executive network, and the default mode network; dissociation; and other factors that may enhance the ability to cope with stress, such as social support and intelligence.
soorten exposure voor ptsd treatment
direct exposure
imaginal exposure
virtual reality exposure
