Lecture 14: Obsessive Compulsive Disorder Flashcards
Obsessions
Recurrent intrusive thoughts or urges that cause anxiety
Common domains of obsessions include (5)
- Cleanliness/contiamination-avoidance eg. Germs
- Orderliness eg. Symmetry
- Physical injury eg. Violence/accidents
- Taboo thoughts eg. Culturally forbidden sexual acts
- Scrupulously eg. Extreme adherence to moral or religious norms
Same domains of OCD occur across _______ but specific contents can ____
Cultures
Vary
Compulsions
Repetitive behaviors or mental acts performed according to strict rules
Common compulsions (7) include
- Doing tasks in a specific order/specific right number of times
- Counting or other mental rituals
- Ordering or arranging items
- Repeated checking
- Excessive cleaning or sterilizing
- Excessive hand washing
- Hoarding
Relationship between obsessions and compulsions (2)
- Obsessions cause anxiety
- To Reduce anxiety/prevent potential threats from occurring people with OCD perform compulsions
For some people with OCD compulsive behaviors are negatively reinforcing by:
Succeeding at reducing anxiety
Many compulsive behaviors often have no _____ _____ _____ on the potential threats that are intended to prevent
realistic preventative effect
OCD typically begins in _____, ______, or ____ ________
Childhood
Adolescence
Early adulthood
Who is more likely to develop OCD between Boys and girls?
Boys
Who is more likely to develop OCD between Men and Women
Women
Risk factors of OCD
- Genetic factors
- Childhood physical and sexual abuse
- Some personality characteristics eg. Negative emotionality, behavioral inhibition
- Pediatric Autoimmune neuropsychiatric Disorders associated with Streptococcla infections (PANDAS)
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
Insight
Barrier
Because obsessions cause anxiety, people with OCD have a (2)
- Overactive threat system
- Maladaptive avoidance behavior
The course of OCD is _____, with only 20% lifetime remission rates for untreated adults
CHRONIC
Comorbidities are extremely common for people with OCD (4)
- Generalized anxiety disorder/panic disorder
- Mood disorder
- Tic disorder
- Obsessive compulsive personality disorder
Suicide risk in OCD and comorbidities is ____
HIGH
Cognitive style among people with OCD (4)
- Overestimation of threats
- Overestimation of personality responsibility
- Need to control thoughts
- Intolerance of uncertainty
OCD is mediated by an overaction of the ____-_____-______ ______
Cortico-striatal-thalamic loop!
- Neurons in the ______ ____, which mediate decision making, project to and excite
- The _______, which mediates action initiation and inhibition. The over activation of the ______ decreases the inhibition of
- The ________, which mediates sensory integration and awareness, which projects back to and activates the ______ _____, closing the loop.
- Frontal cortex
- Striatum
- Thalamus
- Frontal cortex
What does the frontal cortex mediate
Decision making
What does the striatum mediate (2)
- Action initiation
- Inhibition
What does the Thalamus mediate (2)
- Sensory integration
- Awareness
In animal models using rats the stimulation of the CST loop induces OCD-like behaviors called ______ _____
Repetitive grooming
Most domains of obsessions are relevant to ______ and ______
Survival and reproduction
One way to understand OCD obsessions about cleanliness/contamination avoidance is that it’s an over-activation of what system?
Behavioral immune system
Behavioral immune system
A set of physiological mechanisms that makes us selectively attend, emotionally react (with disgust), and avoid noxious stimuli that could be harmful to health
OCD obsessions about physical injury and moral conformity is over activation of what systems?
Threat/Avoidance system just like anxiety disorders
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)
- Hoarding - of information, tools, clothing, firewood, weapons
- Checking - checking fire states, animal traps, fruit ripeness
- Washing - high pathogen environments
- Counting - count days to predict seasons, count animals to predict migration patterns, count steps for location
- Producing symmetry - beneficial for creation of tools/weapons/structures
There are 2 main treatments for OCD
- Pharmacotherapy
- Exposure and response prevention (ERP)
Pharmacotherapy for OCD (3)
- SSRI’s
- Antipsychotics
- Dopamine antagonists
All thought to help regulate the frontal cortex
Exposure and response prevention (ERP) is a type of exposure therapy in which in the person in treatment is (2)
- Exposure to a stimulus that makes them anxious
- Directed to voluntarily inhibited whatever compulsive behavior the stimulus triggers
When successful ERP can (2)
- Reduce credibility of unrealistic beliefs that “something terrible” will happen if a compulsive behavior isn’t done
- Result in extinction of the association between conditioned stimulus and conditioned response
Other OCD related disorders include: (3)
- Body dysmorphic disorder
- Hoarding disorder
3.Trichotillomania
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
- Skin
- Hair
- Nose
One variant of BDD common among men is
Muscle dysmorphia - the unrealistic belief one isn’t muscular enough
Some people with BDD have accompanying delusions of _______
Delusions of reference - believing others are observing/mocking them for their appearance
People with BDD are at elevated risk of _____
Suicide
Impairment in ______ ______ and ______ _____ are common in BDD
Social functioning and Work functioning
Common items that are hoarded include (6) but anything can be hoarded including ______
- Newspapers
- Magazines
- Old clothing
- Books
- Paperwork
Animals
Common reasons for hoarding include (2)
- Sentimental value
- Usefulness of old items
Overtime people with hoarding disorder often cannot use what?
They cannot use large parts of their home like eh kitchen or the bedrooms
Hoarding disorder usually starts in _______ and can persist into _____ ______
Adolescence and can persist into older age
Onset of hoarding disorder often follows _____ ______
Traumatic events
Hoarding is a cross cultural phenomenon observed in both ______ and ________ countries
Industrialized and developing countries
For Trichotillomania, Hair pulling may be done on any part of the body but the most common are (2)
- Scalp
- Eyebrows
Hair pulling is often accompanied by feelings of ______ or ______
Embarrassment or shame
Some people with Trichotillomania _____ their hair after pulling it out
Eat
Many people with Trichotillomania report feeling _____ before hair pulling episodes and feeling ____ after them
Tense
Relief
Does hair pulling usually occur alone or with people
Alone
Some people report symptoms of _______ when hair pulling
Dissociation
Most people with Trichotillomania also have other body related repetitive behaviors like ______ _____ or ____ ____
Skin picking or nail biting
Who is 10 times more likely to have Trichotillomania between women and men?
Women
Does lots of research exist in whether Trichotillomania occurs in developing countries?
Nope there is little research
Treatments for OCD-related disorders are similar to treatments for OCD but usually its a combo of ________ and _______ ______ ______
Pharmacotherapy and CBT
