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Clinical and Neuropsychology - 1 > CPch7 - Obsessive Compulsive and related Disorders > Flashcards

CPch7 - Obsessive Compulsive and related Disorders Flashcards

1
Q

What is OCD and what does it entail?

A
  • Obsessive Compulsive Disorder
    1. repetitive thoughts and urges (obsessions)
    2. irresistible need to engage in repetitive behaviors or mental acts (compulsion)
  • time consuming (>1) or distress/impairment
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2
Q

What are Obsessions?

A
  • intrusive and persistently recurring thoughts, images or impulses
  • they are uncontrollable
  • often appear irrational to the person experiencing them
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3
Q

What is unique about obsessions in a person with OCD?

A
  • they last for hours every day
  • they interfere with normal activities
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4
Q

What are obsessions most often about?

A
  1. fear of contamination frmo germs or disease
    > e.g. need to change clothes and shower after being in a room with someone who choughed
  2. sex, morality, violence, religion, symmetry/order, responsability for harm
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5
Q

What study explained how contamination could spread so drastically according to a person with OCD?

A
  • people with OCD and control group was asked what part of the building was the most contaminated
    > no difference in results (both indicated a trash can and the toilets)
  • researcher rubbed 1st pencil against toilet, then 2nd pencil against 1st (… for 12 pencils)
  • participants rated contamination level of all 12 pencils
    > participants with OCD rated 12th pencil as much contaminated as 1st
    > control group rated 6th pencil free of contamination
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6
Q

What are compulsions?

A
  • behaviors or mental acts
  • drive to perform them repetitively and excessively to reduce anxiety caused by obsessive thoughts
  • act usually repeated untill “feels right”
  • motivated by feeling that something serious will happen if act is not performed (no motivation of pleasure)
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7
Q

What are some contingencies of OCD?

A
  • experience of high stress and self-doubt
  • stress worsensd as the symptoms of OCD interfere with work and relationships
  • OCD relates to premature mortality from medical conditions and suicide
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8
Q

What is the relationship between culture and OCD?

A
  • cultural values might shape:
    > prevalence of disorder
    > the nature of obsessions and compulsions
  • e.g. culture where uncleanliness is considered sinful, washing compulsions are more common
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9
Q

Summary of definitions of Obsessions and Compulsions

A
  • Obsessions are defined by
    1. Recurrent, intrusive, persistent, unwanted thoughts, urges,
    or images
    2. The attempt to ignore, suppress, or neutralize such thoughts,
    urges, or images
  • Compulsions are defined by
    1. Repetitive behaviors or mental acts that a person feels
    driven to perform in response to an obsession or according
    to rigid rules
    2. The behaviors or acts are performed to reduce distress or
    prevent a dreaded event
    3. The behaviors or acts are excessive or unlikely to prevent the
    dreaded event
  • The thoughts or activities are time-consuming (e.g., at least 1 hour
    per day) or cause clinically significant distress or impairment
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10
Q

What are two examples of OCD stories?

A

1.1 David Adam started becoming obsessed with the fear of HIV even before the possibility of actually being infected
1.2 seeked treatment only 19 years after obsessions began, when they started interfering with his relationship with his daughter
2.1 Ian Davis had compulsions about measuring the distance between the coccyx and the seat
2.2 “noise does get very very loud and the stress wouldn’t go away”

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11
Q

What are some examples of the most common obsessions?

A
  • Contamination: ‘‘What if the public toilet I used had the coronavirus on it?’’
  • Symmetry or order: The feeling that books, dishes, or other objects must be perfectly
    arranged on a shelf
  • Sex and Morality: ‘‘What if I could not resist the impulse to touch a stranger’s breasts?’’
  • Religion: Inappropriate, disturbing sexual images of deities (gods)
  • Violence: ‘‘What if my husband was stabbed on his way to work today?’’
  • Responsability for harm: ‘‘What if I dropped my baby down the stairs by mistake?’’
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12
Q

What are some examples of the most common compulsions?

A
  • Decontamination: Showering for hours a day, wiping down all objects upon entering
    the house, or asking visitors to wash before they enter the house
  • Checking: Returning seven or eight times in a row to see that lights,
    stove burners, or faucets are turned off, windows fastened,
    and doors locked
  • Repeating routine activities: Touching a body part or repeating a word again and again
  • Ordering/arranging: Sorting all books and cereal boxes into alphabetical order
  • Mental rituals: Counting, solving a math problem, or repeating a phrase in one’s
    mind until anxiety is relieved
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13
Q

What is the lifetime prevalence of OCD?

A

1.3%

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14
Q

Genders differences in OCD

A

slightly more common in women than men

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15
Q

When does OCD typically begin?

A
  • childhood and early adolescence
  • once present, often becomes chronic
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16
Q

Etiology

A
  • set of causes for a disease or condition
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17
Q

How can the etiology of OCD be explained?

A
  • Behavioral Model (compulsions)
  • Cognitive Model of Obsessions
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18
Q

What is the goal of Behavior Theory regarding OCD?

A
  • why person with OCD continues to show compulsions even after threat is gone
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19
Q

how was the response of people with OCD compulsions post-threat researched?

A

> two-phase experiment
1. - placing electrodes on participants’ wrists (creating threat)
- participants told that they would receive shock (US) when certain shape was shown (CS)
- participants had to step on foot pedal to avoid the shock (CR)
= participants with OCD and control group learned equally well to press foot pedal to avoid shock
2. - electrode was unhooked (threat gone)
= people with OCD still pressed foot pedal (or strong urge to do so) when shape appeared
= control group did not press pedal (and no urge)

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20
Q

What does the Behavioral model of OCD argue?

A
  • people with OCD engage in compulsions even after threat is gone because response to threat became habitual
    > people with OCD are slower than others to change response to conditioned stimulus
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21
Q

What is the Cognitive Model of Obsessions?

A
  • it explains obsessions in OCD
  • people with OCD try harder to suppress obsessions and this makes them worse
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22
Q

What main beliefs do people with OCD have? What are they called?

A

People with OCD believe that:
- thinking about something is as morally wrong as engaging in that action
- thiking about an event can make it more likely to occur
* thought-action fusion
ps. - people with OCD feel especially responsible for preventing harm

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23
Q

How does thought-action fusion explain obsessions?

A
  • for people with these beliefs, initial intrusive thoughts become especially distressing
  • to get rid of these thoughts, people with OCD attempt thought suppression
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24
Q

what did the study on thought suppression show?

A
  • control group was asked to think about a white bear
  • experimental group was asked not to think about a white bear
  • both groups had to ring a bell whenever they would think about a white bear
    = people in the experimental group thought about white bears more than the control group
    + rebound effect (after trying to suppress thought for five minutes, thought more about w.b. in next five minutes than control g.)
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25
Q

When is thought suppression most likely to fail?

A
  • when working memory is limited
  • working memory is often limited if people are worried
  • (you are worried-> working memory limited-> thought suppression fails)
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26
Q

What is the problem with OCD according to the Cognitive model of obsessions?

A
  • response to the thought is the problem (not initial thought)
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27
Q

How was the thought-action fusion theory proven?

A
  • parents of one-month-old babies recruited
    -> most parents had intrusive thoughts (e.g. about dropping the baby)
    -> asked if they believed that those thoughts could make event more likely
    = if agreed, showed more OCD symptoms by the time baby was 3-4 m.o.
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28
Q

What is BDD and what does it entail?

A
  • body dysmorphic disorder
    1. spend hours a day thinking about own appearance
    2. engage in compulsive behaviors designated to address concerns about own appearance (e.g. mirror checking )
  • others find the perceived defect(s) slight or unobservable
  • preoccupation is not restricted to weight or body fat concerns
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29
Q

How many hours do people with BDD spend thinking about their appearance?

A
  • 3 to 8
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30
Q

What are the most common compulsive behaviors for people with BDD?

A
  • checking appearance in the mirror
  • comparing their appearance to that of other people
  • asking others for reassurance about their appearance
  • using stratagies to change their appearance or camouflage disliked body areas (e.g. grooming, tanning, exercising, …)
  • some avoid reminders of their appearance (e.g. mirrors, reflections or bright lights)
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31
Q

What are some symptoms? (+ statistics)

A
  • 1/3 of people with BDD are convinced that others see their flaws as grotesque (because they have little insight on it)
  • 1/5 endure plastic surgery(ies)
    • often plastic surgeries do not alleviate their concerns, and patients want to sue or hurt surgeons
  • 1/3 have wanted to commit suicide
  • 20% attempt suicide
  • 1/3 miss school or work to avoid contact with others because of the shame they feel
  • 40% reported being unable to work (some become housebound)
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32
Q

What are the cultural differences in BDD?

A
  • symptoms and outcomes are similar across cultures
  • body part that becomes a focus of concern sometimes differ by culture
    > e.g. eyelid concerns in Japan
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33
Q

Genders differences in BDD

A

slightly more common in women than men

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34
Q

What is the lifetime prevalence of BDD?

A

3%

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35
Q

What is the etiology of BDD?

A
  • some people report that their symptoms started after being teased about their appearance
  • people with BDD are detail-oriented
    > this was studied through eye-tracking studies
  • people with BDD consider attractiveness vastly more important than control group
    = many people with BDD think that their self-worth is exclusively dependent on their appearance
36
Q

When does BDD typically begin?

A
  • adolescence
  • once present, often becomes chronic
37
Q

What is Hoarding disorder and what does it entail?

A
  • spending a lot of time thinking about current and future possessions
  • engage in intensive efforts to acquire new objects (efforts similar to OCD)
  • inability to part with those objects (resistant to efforts to get rid of them)
  • perceived need to save items
38
Q

are people with Hoarding Disorder aware of it?

A
  • many people with H.D. are unaware of disorder
    > severe consequences on people around them
  • profound negative effects on self-esteem on people who are aware
39
Q

What are some consequences of H.D.?

A
  • accumulation of objects can interfere with ability to use kitchen or bathroom
    -> this leads to poor hygiene, difficulty cooking and exposure to dirt
    -> this leads to poor physical health (e.g. respiration problems)
  • many family members leave because they do not understand attachment to objects
  • many people with H.D. are unable to work and keep buying new objects -> this leads to poverty
  • threat of eviction (10%)
40
Q

What is animal hoarding?
Is it more common in women or men?

A
  • hoarding animals
  • view themselves as animal rescuers
  • not able to provide adequate care
  • animal protection agencies often involved
  • much more prevalent in women
41
Q

What is the lifetime prevalence of Hoarding disorder?

A

hard to estimate because:
- patients often lack insight
- happens in secret behind closed doors
* estimated prevalence: 1.5%

42
Q

Gender differences in hoarding disorder

A

equally common in women and men
* animal hoarding much more common in women than men

43
Q

When does hoarding disorder typically begin?

A
  • childhood and early adolescence
  • once present, often becomes chronic
  • often worsen over time (parents and lack of income can hinder shopping when young)
44
Q

What type of cognitive problems do people with H.D. have?

A
  • problems with attention
  • difficulty categorizing objects and making decisions
    • study: when asked to organize objects in categories, people with H.D. are slower, make more categories and perceive more anxiety
45
Q

How could cognitive problems explain hoarding?

A
  • difficulty in deciding: many will buy many versions of same object
  • difficulty in categorizing: difficult to determine how to clean and organize objects (hours per day trying to get rid of objects but impossible)
46
Q

What does the cognitive model of HD explain?

A
  • HD evolves also because difficulties in attention, decision-making and categorization
  • people with HD hold unusual beliefs about their possessions
47
Q

What unusual beliefs do people with HD hold?

A
  • they are able to see possible functionality in every object (e.g. pen cap as game piece)
  • extreme emotional attachment to their possessions
  • these emotional attachments make it harder to tackle the chaos-> chaos is delayed, avoidance behavior
48
Q

What are some examples of emotional attachment that people with HD have with their possessions?

A
  • comfort in seeing objects
  • fear of losing them
  • responsability for taking care of them
  • objects as core to their sense of self
  • grief when forced to part
49
Q

What is the comorbidity between OCD, BDD and Hoarding Disorder?

A
  • 1/3 of people with BDD and 1/4 of people with H.D. meet diagnostic criteria for OCD in their lifetime
  • 1/3 of people with OCD experience at least some symptoms of hoarding
  • all three syndromes tend to co-occur with depression and anxiety disorders and slightly with substance use disorder
  • 3/4 of people with OCD experience anxiety disorder in their lifetime
50
Q

What is the Hereditability of OCD, BDD and H.D.?

A
  • between 0.40 and 0.50
  • there is a moderate genetic contribution (to each disorder)
  • some overlap in genetic and neurobiological risk factors
  • study of 5000 twins: disorders appeared to have shared genetic vulnerability
51
Q

What part of the brain do OCD, BDD and H.D. involve?

A
  • fronto-striatal circuits
52
Q

What regions of the fronto-stratal circuits are unusually active in people with OCD?

A
  • orbitofrontal cortex
  • caudate nucleus
  • anterior cingulate cortex
53
Q

How were these areas studied? What were the results?

A
  • brain activity increases if shown a picture of an object that tends to provoke symptoms
  • e.g. a soiled glove for people with fear of contamination
  • successful treatment decreases activation of orbitofrontal cortex and caudate nucleus
54
Q

What happens when people with BDD are shown pictures of their own face?

A
  • hyperactivity of the orbitofrontal cortex and caudate nucleus
55
Q

What happens when people with hoarding symptoms are faced with decisions about whether to keep or get rid of a possession?

A
  • hyperactivity in orbitofrontal cortex and anterior cingulate cortex
56
Q

If there is an overlap in brain regions, why some people develop one and not the other disorder?

A
  • each disorder is tied with additional brain regions
    > e.g. BDD tied with more engagement in visual regions of the brain
  • psychological processes also might promote one disorder more than the other
57
Q

How can OCD, BDD and HD be threated?

A
  1. medications
  2. psychological treatment
58
Q

what medications are best to treat these disorders?

A

Antidepressants
- SSRI (most commonly recommended because fewer side effects)
- Anafranil
* for OCD, antidepressant work but need more time and higher dosage compared to depression (and some symtpoms still present)
* they should also work for BDD and HD
! hoarding symptoms predict poorer response to antidepressants (half as likely to respond to medication as patients with only OCD)

59
Q

What is ERP?

A
  • exposure and response prevention
  • it had to be adapted to OCD, BDD and HD (different in each disorder)
60
Q

ERP in OCD

A
  • patients are exposed to situations that elicit obsessions and related anxiety
  • they refrain from performing any compulsive ritual during exposure
61
Q

What is the explanation of ERP in OCD?

A
  • not performing the ritual exposes the patient to the full anxiety provoked by stimulus
  • exposure promotes extinction of the conditioned response (anxiety)
  • facing the feared stimulus helps patient develop new, more positive thoughts in response to stimulus
62
Q

What is the approach of ERP in OCD?

A
  • hierarchical approach (less to more threatening stimuli)
  • e.g. from being in dirty room to touching floor with hand
  • client guided to avoid compulsions
  • often ERP done at home with therapist and family members
63
Q

How often should ERP be done?

A
  • acute treatment: up to 20 sessions
  • daily, twice a week or weekly (different research supports different times)
  • often booster sessions within first 6 months after acute treatment
64
Q

is ERP powerful?

A
  • as powerful as antidepressant
  • effective for children, adolescents and adults
  • 69-75% of people receiving this treatment show significant improvement (mild symptoms often persist)
65
Q

What is the disadvantage of ERP?
+ statistics

A
  • very hard for patients
    > 1/3 not willing to start ERP
    > 1/3 drop out after starting
66
Q

What are some other psychological treatments for OCD?

A
  • relaxation techniques (not really effective)
  • other techniques to change people’s beliefs of what will happen if do not engage in compulsions
  • mixed findings
67
Q

how is ERP tailored to BDD?

A
  • exposure: interaction with people who could be critical of patient’s looks
  • response prevention: avoid activities to reassure themselves of appearance (e.g. mirror checking)
    + strategies to address cognitive features of disorder
    > e.g. excessively critical evaluations of physical features
    > belief that self-worth depends on appearance
68
Q

is ERP effective against BDD?

A
  • major decrease in BDD symptoms
  • effects are maintained in the months after treatment ends
    ! mild symptoms still experienced after treatment
  • internet-based versions of BDD can also be helpful
    > 1/2 of treated showed improvements even after 2 years
69
Q

How is ERP applied to HD?

A
  • tackling hardest part: getting rid of objects
  • halting rituals that people with HD engage in to reduce anxiety (e.g. counting or sorting possessions)
  • therapy cannot begin addressing symptoms until person has reached insight of disorder
70
Q

how can therapists help people with HD reaching insight?

A
  • motivational strategies to help consider reasons to change
  • when they decide to change, therapists help them make decisions about their objects
71
Q

what is the process of ERP for HD?

A
  • reach insight
  • make patient decide to change
  • provide the patient with tools to organize and remove clutter
  • office + at-home sessions to physically remove clutter together
  • better outcomes when clients are not rushed to get rid of objects
72
Q

is ERP for HD effective?

A
  • yes but HD difficult to treat
  • 2/3 still show some symptoms after treatment
  • individual and group versions both help
  • self-help groups also help (+ they are affordable)
73
Q

What are the consequences of HD on the family?

A
  • can seriously damage family relationships
  • relatives at first help clear the clutter, only to then become very distressed when attempts fail
  • some remove possessions when hoarder is away-> creates mistrust and animosity
  • family members should identify aspects of clutter that is most dangerous (e.g. lack of access to emergency exit)
    -> helps set priorities with HD person
    > there are also support groups for family members
74
Q

What is an alternative treatment for OCD?

A
  • 10% of OCD patients will not respond to pharmacological treatment
  • Deep transcranial magnetic stimulation (dTMS)
    > magnetic stimulation applied to the scalp
  • Deep brain stimulation (DBS)
    > electrodes implanted in basal ganglia
  • significant side effects (only considered as last resource)
  • significant relief within a couple of months of treatment
75
Q

Notes from the lecture

A
76
Q

Trichotillomania

A

compulsive hair pulling

77
Q

Excoriation disorder

A

compulsive skin picking

78
Q

what are some types of compulsions?

A
  • cleaning
  • order
  • chicking
  • protective thinking
  • (cognitive treatment: start thinking about their therapy/new strategies obsessively)
79
Q

Overt vs Covert behavior

A
  • overt behavior: behavior that can be observed
  • covert behavior: behavior that cannot be observed (e.g. counting in their head)
80
Q

What does the study by Rachman and de Silva show about OCD?

A
  • “which intrusions do you have?”
  • of the 23 intrusions by patients, 13 were considered abnormal
  • of the 58 intrusions by controls, 10 were considered false-positives (abnormal)
    = OCD intrusions cannot be identifiable
    = students did equally well in identifying intrusions as psychologists
81
Q

What is the difference between intrusions of controls and people with OCD?

A
  • having intrusions is quite normal
  • form and content are quite similar

Differences: (OCD-patients…)
- frequency (more often)
- experiences as more intense
- duration (last longer)
- more distress
- stronger urge to neutralise

82
Q

Etiology of OCD: cognitive styles

A
  • Emotional reasoning
    > inferring state of the world from emotion
    > e.g. I’m afraid, so there’s danger
    > e.g. it doesn’t feel right, it feels dirty, therefore I am dirty
  • Magical thinking
    > suspicious thoughts
    > e.g. if I step on the cracks, my mother will die
  • dichotomous thinking
    > most people: omission<commission> > in OCD: omission=commission
    e.g. for most people leaving the gas on on purpose (commission) is way worse than doing it by accident (omission); for people with OCD they have the same value
83
Q

What are the two domains of the thought-action fusion? (TAF)

A
  • TAF-Likelihood
    > thinking about it increases the chances of its occurrence
    > e.g. ‘‘don’t think about your wife having a car crash or it will happen’’
  • TAF-Moral
    > thinking about something is equivalent to acting
    > e.g. ‘‘thought of harming child: bad mother!”
  • these are scales of self-reports, and people with OCD score quite high
84
Q

Cognitive theory - Etiology

A
  • Intrusions: Ego-dystonic
    > happen to everyone (e.g. thought about pushing someone)
  • Automatic thought: Ego-syntonic
    > different between people with OCD (“it means I am a bad person”) and controls (“what a weird thought”)
    = behavior to suppress, neutralize compulsions typical of OCD
85
Q

What are some contingencies of the cognitive theory of OCD?

A
  • Thought suppression (white bear effect)
  • Excessive checking (increased memory distrust)
    > e.g. if constantly checking, you start to not trust your memory anymore
  • Operant conditioning (neurotic paradox)
    > short term relief, long term pathology
    > fear goes down temporarely, but since they have such repeated compulsions, they do not see that catastrophic event doesn’t happen if they don’t engage in compulsions and thought remains
86
Q

conclusions on etiology of OCD

A
  • intrusions are normal
  • problem arises when interpreting intrusions
  • cycle of: obsessions-> anxiety-> compulsions-> relief-> obsessions, …
  • Don’t focus only on cognitive models! Other models exist as well
87
Q

treatment for OCD

A
  • exposure with response prevention
    > hard but essential
  • cognitive therapy
    > difference in OCD patients: some have big insight (know that intrusions are not true), some have no insight (think that intrusions are actually true)
  • Medication: SSRIs
    > typically higher than for mood disorders
    > goes back when stopped
    > supportive of other therapies
  • Deep brain stimulation
    > in therapy refractory cases
    > sometimes stimulation + ERP is the best way

Clinical and Neuropsychology - 1 (21 decks)

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