L9: OCD 1 Symptomatology & Treatment Flashcards
What are the DSM diagnostic criteria of OCD?
A. presence of obsessions, compulsions, or both
B. OCs are time consuming or cause clinically significant distress or impairment in social, occupational, or other areas of functioning
C. symptoms are not attributable to the physio effects of substance or another medical condition
D. disturbance not better explained by symptoms of another mental disorder
obessions: recurrent & persistent thoughts, impulses, or images experienced as intrusive & undesirable and that cause anxiety or distress
individual attempts to ignore/suppress/neutralize these w compulsions: repetitive actions or psych activities that person feels compelled to do in reaction to obsession or according to rigid rules. aimed at preventing/reducing fear or suffering, or preventing a dreaded event/situation. but have no real connection w what needs to be neturalized /prevented, or are clearly excessive
avoidance is another common strategy in response to obsessions
specifiers:
- w good or fair insight
- w fair insight
- w absent insight/delusional beliefs
- tic related
What are common OCD themes?
so 4 main dimensions:
- Contamination & cleaning (contimination obsessions & decontamination rituals)
- Reponsibility for causing or not preventing harm & checking / reassurance seeking (aggressive obsessions & checking rituals)
- Need for order and symmetry & ordering/counting (obsessions about order or exactness & arranging rituals)
- Unacceptable taboo violent, sexual, or blasphemous thoughts w mental rituals
What are common differential diagnoses in OCD?
- medical disorders: dementia etc
- medication/drugs like cocaine, amphetamines
- GAD or MDD have excessive worries as well
- body dysmorphic disorder cus preoccupation w appearance
- hoarding disorder cus difficulty discarding or parting w possession
- autism, tourettes, retardation, parkinson, schizophrenia, frontal lobe lesion cus repettitive & stereotyped behaviour
- eating disorders cus ritualized eating behaviour
- substance & addictive disorder cus preoccupation w substance or gabming
- paraphilic disorders cus sexual urges or fantasies
- psychotic disorders cus thought insertion or delusional ideas
Is behaviour in OCD ego-dystonic or ego-syntonic?
ego-dystonic: the content of obsessions is incongruent w the persons belief system
What are differences & commonalities between OCD and OCPD?
OCD:
- egodystonia since behaviours & thoughts conflict w ones self image, they want to get rid of their symptoms
- one/few domains
- 23% comorbidity w OCPD
OCPD:
- egosyntonic: patients dont find their rigid behaviours disturbing cause they align w their self image cause they want: rigidity, need for control, perfectionism
- multiple domains
Define phenomenology
study of experiences, perceptions, thoughts, feelings, memories, and fantasies.
goal is to describe reality as it appears to a person.
What is the phenomenology of obsessions in OCD?
- obsessionality w the obsession & compulsion
- aka extreme focus & intentionality
- patient feels they are PASSIVELY (obsessed) subjected to intrusive thoughts while they ACTIVELY (obsession) perform compulsions to mitigate the distress caused by obsessions
- this obsessionality -> narrowed perecption where rest of world becomes meaningless & patient becomes isolated
- patient loses ability to judge irrational nature of obsessionality
- affects patient’s sense of self (i think therefore i am), OCD becomes big part of them
- reinforcement & association processes make obsessional thoughts/behaviour more persistent
What is the phenomenology of compulsions in OCD?
- loss of control over thoughts & actions
- objective compulsivity: inevitable progression from one mental event to another (depressed mood -> gloomy thoughts)
- subjective compulsivity: feeling of being compelled: characteristic of OCD
- compulsivity in both obsessions (immediatly experienced as compulsive) & compulsions (gradually become compulsive)
- ## perceived loss of free will and control
What is the phenomenology of reflection in OCD?
active participation of patients in their OCD through their constant mental engagement w obsessions & compulsions
- subjective reflection on their thoughts, actions, feelings
- egodystonia of the thoughts & behaviours
- OCD obsessions distinct from delusions cause OCD patients reflect on & resist their obsessions
- have hard time believing truth over their OCD
- perceived effectiveness of rituals strengthens convictions
What is the phenomenology of certainty in OCD?
- common theme in OCD: need for absolute certainty & control so fear of uncertainty
- try to achieve illusion of control throught OCD
What are the 6 cognitive biases in OCD?
- intolerance of uncertainty: belief that its necessary & possible to be completely certain that negative outcomes will not occur
- thought-action fusion: 1) belief that mere presence of a thought makes the thougt imporant 2) thought has ethical or moral ramificiations 3) thinking the thought is the same as performing an act
- inflated sense of responsibility (both for one’s own thoughts & behaviour as for situations that might be risky to other): belief that one has the power to cause, and/or duty to prevent negative outcomes
- overestimation of danger/threat: belief that negative events are especially likely & would be especially awful
- perfectionism: belief that mistakes & imperfection are intolerable
- need to control thoughts: belief that complete control over one’s thoughts is both necessary and possible
What are the OCD-related disorders?
- Hoarding disorder: persistent difficulty of disposing of belongings due to strong need to save objects + suffering associated with disposing of them
- Body dysmorphic disorder: Preoccupation w 1 or more subjectively perceived defects / imperfections in one’s appearance that arent perceived by others / are considered by them to be insignificant. associated w repetitive body-oriented behavior (e.g., grooming, seeking reassurance) or psychological activity (e.g., comparing one’s own appearance with that of others).
- Trichotillomania: Repeated pulling of hair despite attempts to stop
- Skin picking disorder: repeated plucking of the skin causing skin lesions, despite attempts to stop
- O-C or related disorder due to substance/medication
- O-C or related disorder due to a somatic condition
- Otherwise specified O-C or related disorder
- unspecified O-C or related disorder
What are the evidence based treatment for OCD & in which OCD mechanism do they intervene?
- CBT: Cognitive Therapy & Exposuring and Response Prevention
- pharmacotherapy w SSRIs (serotonergic) & dopaminergic (anti psychotic) medication
- Neuromodulation (rTMS, Deep Brain Stimulation (DBS))
- Acceptance & Commitment Therapy
what is the main model of ocd?
obsessions -> anxiety/distress -> compulsions -> temporary relief (this last arrow = negative reinforcement)
How is CBT/cognitive therapy used in OCD?
- normalize intrusive thoughts (since they become obsessions when u appraise them as a real threat)
- repair dysfunctional beliefs (since these also lead to false appraisal) aka COGNITIVE RESTRUCTURING ex: make actual estimation of catastrophe, pie technique for probability of own responsibility in catastrophe,
- aim: reduce obsessional fear & the need for compulsive behaviour by heping patient correct dysfuncitonal thinking & modifying behavioural responses to obsessional stimuli
