L3 - Obsessive Compulsive and Related Disorders Flashcards
Name some OC and related Disorders
OCD Body Dysmorphic Disorder Hoarding disorder Trichotillomania Excoriation
What is Obsessive-Compulsive Disorder?
- Obsessions and compulsions that are recurrent and persistent
- The individual recognises they are unreasonale
- O’s and C’s are distressing and time consuming (over an hour a day) and impair the person’s functioning and relationships
What is an obsession?
persistent thoughts, impulses or images that are intrusive, inappropriate or distressing.
The person must attempt to ignore or neutralise the thoughts by engaging in some mental routine/beaviour.
The person recognises the thoughts are a product of their mind and not a delusion.
What are some common obsessions?
Fears of contamination, Repeated doubts to do with safety, having things in particular order.
What are compulsions?
Repetitive behaviours/mental rituals that the person feels compelled to perform in response to an obsession or strict rules, to reduce/prevent anxiety.
- ritualised behaviour. Magical thinking.
What are some common compulsions?
Checking, cleaning, repeating.
Often there is no logical connection between compulsion and obsession, but it relieves their anxiety. - MAGICAL THINKING
Epidemiology of OCD
- no gender diff in prevalence, marital status, education or urbancity.
Usually fluctuating course, with stress levels.
Chronic course in 50% of cases.
Average age of onset - F : 25, M : 27
OCD comorbidities?
80% of people have another disorder.
most often MDD.
social phobia, specific phobia and GAD.
Neuropsychological Model of OCD?
OCD involves the orbitofrontal-subcortical circutes, caudate nucleus and thalamus.
frontal lobes and/or basal ganglia.
these are regions responsible for memory and reg of behaviour.
possible dysfunc in serotonin.
Risk Factors of OCD?
- FAMILY HISTORY: dominant and codominant mode of transmission
- EARLY CHILDHOOD EXPERIENCE & CRITICAL LEARNING INCIDENTS –> maladaptive beliefs about responsiility and threat.
- PERSONALITY FACTORS - neuroticism, psychoticism and sensitivity to punishment
What is the dominant model for explaining OCD?
The Cognitive Behavioural Model
Explain the Cognitive Behavioural Model of OCD?
- Intrusive thoughts are normal
- Some individuals place meaning on these thoughts, and thus respond with avoidance, suppression or rituals.
- These responses increase vigilance for the intrusive thought and protects the meaning of the intrusion.
VICIOUS CYCLE
TRIGGER-> OBSESSION /INTRUSION –> ANXIETY –> COMPULSIVE BEHAVIOUR / AVOIDANCE –> RELIEF…. until it happens again..
the relief reinforces the intrusive idea.
What are some ways intrusive thoughts might become obsessions? In terms of thoughts..
When the thoughts are evaluated as…
- overly important
- highly threatening
- requiring complete control
- necessitating a high degree of certainty
- associated with a state of perfection
What is BDD?
Body Dysmorphic Disorder.
A. Preoccupation with one or more perceived flaws in someone’s physical appearance that can barely be noticed by others.
B. Repetitive behaviours or mental acts - mirror checking, skin picking, comparing looks to others.
C. This causes significant stress and impacts on daily functioning
BDD Onset and course?
Mean age of onset - 16-17, but usually diagnosed 10-15 years later
25% suicide - more likely in patient with onset before 18 yrs.
usually chronic course, but improvement is likely.
Gender differences in BDD?
No difference in prevalence rates.
Males more likely to have genital preoccupations, and females more likely to have comorbid eating disorder.
Muscle Dysmporphia exclusively in males.
Explain Veales model (2004) on BDD
Cyclic model whereby the original action of fixating on an aspect of onself increases attention and awreness to the area.
Disortorted self-image is maintained, and reinforced by increased attention, heightened awareness of the impairment.
What are the cognitive processes associated with BDD?
- Appearance is evaluated negatively
- Appearance is overly valued
- Mirror gazing gives anxiety/discomfort
- Ruminative thinking
- Repeated reviews of past appearance-related experiences.
BDD and Medical Interventions?
Individuals with BDD make up a sig proportion of people seeking assistance from dermatology or plastic surgery.
BUT
they usually won’t be happy with the result and may return for treatment multiple times.
What is hoarding disorder?
A. Persistent difficulty parting with possessions even if they’re of low worth.
B. Perceived need to save items. Distress and anxiety caused from the thought of being apart from them.
C. Severe clutter of possessions in living areas, compromising their intended use.
D. Clinically sig distress or impairment on social occupational functioning as well as safe enviro for functioning of self and others
may have poor insight
Cognitive factors associated with Hoarding Behaviour?
- Want control over possessions
- Concerned about memory - keeping things bc they might need it in future.
- Feel responsibility over possessions
- Give value and human-like qualities to possessions. –> attachment
what is animal hoarding?
This is when a person has a compulsive need to collect and own animals for the sake of caring for them, resulting in accidental neglect/abuse.
why do people hoard animals?
- Animals provide conflict free relationships
- Gives hoarder a sense of purposefulness and accomplishment
- nobody wins the situation, however, as it’s not a safe place for animals.
High rates of trauma in these people –> animals are easier to negotiate with –> end up alientated –> socially isolated –> strengthens animal bonds
What is trichotillomania?
A. recurrent pulling out hair - resulting in hair loss
B. Repeated attempts to stop
C. Causes distresses and impairment of functioning
D. Not due to another med condition/subs abuse
E. Not due to another psych disorder.
- can be for hours, or less.
- can be a part of a ritualised behaviour
- can be conscious or unconscious
What are the consequences of trichotillomania?
- dental damage, bowel obstruction, vomiting, hair balls, musculoskeletal injury.
- social and occupational impairment
- sore scalp
What is excoriation?
A. Recurrent skin picking - resulting in skin lesions
B. Repeated attempts to stop
C. Causes distress and impairment of functioning across life
D. Not due to other med conditions/subs abuse
E. Not due to other psych disorder
usually doesn’t occur in presences of others. varying consciousness and amounts of time devoted
What are cognitions/psychological processes behind trichotillomania and excoriation?
- Motivated by stimulation of positive mood or feelings (eg. gratification)
- also motivated by regulation of high or low states of arousal
- some people get into a trance-like state/feeling mesmerised/depersonalised
Course of illness for excoriation?
Chronic usually.
More females affected.
Functional consequences of excoriation?
- social and occupational impairment
- tissue damage, scarring, infection
- frequently requires antibiotic treatment for infection.. sometimes even surgery
What are the two subtypes for trichotillomania and excoriation?
Automatic - occurs out of reflective awareness in sedentary situations
Focused - happens in full awareness in response to urges or negative affective states.
Psychological consequences of trichotillomania and excoriation?
Shame, distress, embarassment.
but..
the action reduces unpleasant emotions too.
Why are OCD, hoarding, BDD, trichotillomania and excoriation considered together?
Because they all exhibit intrusive thoughts, and repetitve behaviours.
They can also all be highly distressing, with severe disability and dysfunction.
