Lecture 14: Obsessive Compulsive Disorder

Question 1

Obsessions

Answer 1

Recurrent intrusive thoughts or urges that cause anxiety

Question 2

Common domains of obsessions include (5)

Answer 2

1. Cleanliness/contiamination-avoidance eg. Germs
2. Orderliness eg. Symmetry
3. Physical injury eg. Violence/accidents
4. Taboo thoughts eg. Culturally forbidden sexual acts
5. Scrupulously eg. Extreme adherence to moral or religious norms

Question 3

Same domains of OCD occur across _______ but specific contents can ____

Answer 3

Cultures

Vary

Question 4

Compulsions

Answer 4

Repetitive behaviors or mental acts performed according to strict rules

Question 5

Common compulsions (7) include

Answer 5

1. Doing tasks in a specific order/specific right number of times
2. Counting or other mental rituals
3. Ordering or arranging items
4. Repeated checking
5. Excessive cleaning or sterilizing
6. Excessive hand washing
7. Hoarding

Question 6

Relationship between obsessions and compulsions (2)

Answer 6

1. Obsessions cause anxiety
2. To Reduce anxiety/prevent potential threats from occurring people with OCD perform compulsions

Question 7

For some people with OCD compulsive behaviors are negatively reinforcing by:

Answer 7

Succeeding at reducing anxiety

Question 8

Many compulsive behaviors often have no _____ _____ _____ on the potential threats that are intended to prevent

Answer 8

realistic preventative effect

Question 9

OCD typically begins in _____, ______, or ____ ________

Answer 9

Childhood

Adolescence

Early adulthood

Question 10

Who is more likely to develop OCD between Boys and girls?

Answer 10

Boys

Question 11

Who is more likely to develop OCD between Men and Women

Answer 11

Women

Question 12

Risk factors of OCD

Answer 12

1. Genetic factors
2. Childhood physical and sexual abuse
3. Some personality characteristics eg. Negative emotionality, behavioral inhibition
4. Pediatric Autoimmune neuropsychiatric Disorders associated with Streptococcla infections (PANDAS)

Question 13

People with OCD have varying levels of _____ into the maladaptive nature of their obsessive thoughts, unrealistic beliefs and maladaptive compulsions which is a _____ to treatment

Answer 13

Insight

Barrier

Question 14

Because obsessions cause anxiety, people with OCD have a (2)

Answer 14

1. Overactive threat system
2. Maladaptive avoidance behavior

Question 15

The course of OCD is _____, with only 20% lifetime remission rates for untreated adults

Answer 15

CHRONIC

Question 16

Comorbidities are extremely common for people with OCD (4)

Answer 16

1. Generalized anxiety disorder/panic disorder
2. Mood disorder
3. Tic disorder
4. Obsessive compulsive personality disorder

Question 17

Suicide risk in OCD and comorbidities is ____

Answer 17

HIGH

Question 18

Cognitive style among people with OCD (4)

Answer 18

1. Overestimation of threats
2. Overestimation of personality responsibility
3. Need to control thoughts
4. Intolerance of uncertainty

Question 19

OCD is mediated by an overaction of the ____-_____-______ ______

Answer 19

Cortico-striatal-thalamic loop!

Question 20

1. Neurons in the ______ ____, which mediate decision making, project to and excite
2. The _______, which mediates action initiation and inhibition. The over activation of the ______ decreases the inhibition of
3. The ________, which mediates sensory integration and awareness, which projects back to and activates the ______ _____, closing the loop.

Answer 20

1. Frontal cortex
2. Striatum
3. Thalamus
4. Frontal cortex

Question 21

What does the frontal cortex mediate

Answer 21

Decision making

Question 22

What does the striatum mediate (2)

Answer 22

1. Action initiation
2. Inhibition

Question 23

What does the Thalamus mediate (2)

Answer 23

1. Sensory integration
2. Awareness

Question 24

In animal models using rats the stimulation of the CST loop induces OCD-like behaviors called ______ _____

Answer 24

Repetitive grooming

Question 25

Most domains of obsessions are relevant to ______ and ______

Answer 25

Survival and reproduction

Question 26

One way to understand OCD obsessions about cleanliness/contamination avoidance is that it’s an over-activation of what system?

Answer 26

Behavioral immune system

Question 27

Behavioral immune system

Answer 27

A set of physiological mechanisms that makes us selectively attend, emotionally react (with disgust), and avoid noxious stimuli that could be harmful to health

Question 28

OCD obsessions about physical injury and moral conformity is over activation of what systems?

Answer 28

Threat/Avoidance system just like anxiety disorders

Question 29

There are multiple adaptionist hypotheses about OCD that suggest OCD compulsions can be beneficial to individuals/groups in the context of ancestral environments. Name any! (5)

Answer 29

1. Hoarding - of information, tools, clothing, firewood, weapons 2. Checking - checking fire states, animal traps, fruit ripeness 3. Washing - high pathogen environments 4. Counting - count days to predict seasons, count animals to predict migration patterns, count steps for location 5. Producing symmetry - beneficial for creation of tools/weapons/structures

Question 30

There are 2 main treatments for OCD

Answer 30

1. Pharmacotherapy 2. Exposure and response prevention (ERP)

Question 31

Pharmacotherapy for OCD (3)

Answer 31

1. SSRI’s 2. Antipsychotics 3. Dopamine antagonists All thought to help regulate the frontal cortex

Question 32

Exposure and response prevention (ERP) is a type of exposure therapy in which in the person in treatment is (2)

Answer 32

1. Exposure to a stimulus that makes them anxious 2. Directed to voluntarily inhibited whatever compulsive behavior the stimulus triggers

Question 33

When successful ERP can (2)

Answer 33

1. Reduce credibility of unrealistic beliefs that “something terrible” will happen if a compulsive behavior isn’t done 2. Result in extinction of the association between conditioned stimulus and conditioned response

Question 34

Other OCD related disorders include: (3)

Answer 34

1. Body dysmorphic disorder 2. Hoarding disorder 3.Trichotillomania

Question 35

For Body Dysmorphic disorder Common areas on the body that are sources of preoccupation include (3) but any area can be the source of preoccupation

Answer 35

1. Skin 2. Hair 3. Nose

Question 36

One variant of BDD common among men is

Answer 36

Muscle dysmorphia - the unrealistic belief one isn’t muscular enough

Question 37

Some people with BDD have accompanying delusions of _______

Answer 37

Delusions of reference - believing others are observing/mocking them for their appearance

Question 38

People with BDD are at elevated risk of _____

Answer 38

Suicide

Question 39

Impairment in ______ ______ and ______ _____ are common in BDD

Answer 39

Social functioning and Work functioning

Question 40

Common items that are hoarded include (6) but anything can be hoarded including ______

Answer 40

1. Newspapers 2. Magazines 3. Old clothing 4. Books 5. Mail 6. Paperwork Animals

Question 41

Common reasons for hoarding include (2)

Answer 41

1. Sentimental value 2. Usefulness of old items

Question 42

Overtime people with hoarding disorder often cannot use what?

Answer 42

They cannot use large parts of their home like eh kitchen or the bedrooms

Question 43

Hoarding disorder usually starts in _______ and can persist into _____ ______

Answer 43

Adolescence and can persist into older age

Question 44

Onset of hoarding disorder often follows _____ ______

Answer 44

Traumatic events

Question 45

Hoarding is a cross cultural phenomenon observed in both ______ and ________ countries

Answer 45

Industrialized and developing countries

Question 46

For Trichotillomania, Hair pulling may be done on any part of the body but the most common are (2)

Answer 46

1. Scalp 2. Eyebrows

Question 47

Hair pulling is often accompanied by feelings of ______ or ______

Answer 47

Embarrassment or shame

Question 48

Some people with Trichotillomania _____ their hair after pulling it out

Answer 48

Eat

Question 49

Many people with Trichotillomania report feeling _____ before hair pulling episodes and feeling ____ after them

Answer 49

Tense Relief

Question 50

Does hair pulling usually occur alone or with people

Answer 50

Alone

Question 51

Some people report symptoms of _______ when hair pulling

Answer 51

Dissociation

Question 52

Most people with Trichotillomania also have other body related repetitive behaviors like ______ _____ or ____ ____

Answer 52

Skin picking or nail biting

Question 53

Who is 10 times more likely to have Trichotillomania between women and men?

Answer 53

Women

Question 54

Does lots of research exist in whether Trichotillomania occurs in developing countries?

Answer 54

Nope there is little research

Question 55

Treatments for OCD-related disorders are similar to treatments for OCD but usually its a combo of ________ and _______ ______ ______

Answer 55

Pharmacotherapy and CBT