Lecture 17 - OCD Flashcards
OCD
- Prevalence: 2-3%
- M/F ratio almost equal. Males often earlier onset and more comorbidity
- Low spontaneous remission rates
- Most common comorbidity: MDD (67%), simple phobia (22%); social phobia (18%); eating disorder (17%).
- Egodystonic (thoughts/behaviours in conflict with needs/goals of ego or ideal self image)
- Average age of onset=20 y, 25% of the cases in adolescence (age 14)
- Onset is often gradual
Obsession; Compulsion
Obsession: Intrusive, unwanted thoughts or images
*Rare: Occurrence of obsessions without compulsions
Compulsion: Ritualized behaviors or mental acts,
generally performed to reduce anxiety related to the obsession
- Sense of pressure to act
- Attribution of the pressure to internal causes
- Source of distress
Classes of obsessions
1) Contamination: ex: my colleague used my pen, I am going to get his cold
2) Responsibility for Harm: ex: what if I put poison in my kid’s lunch?
3) Symmetry/order: ex: odd numbers are harmful/incorrect
4) Unacceptable Thoughts: ex: impulse to stab husband
Neutralization
- Strategies to control, remove, or prevent obsessions
- Not compulsions – not stereotyped or repeated; not prevent an outcome but the obsession
- Overanalyzing and rational selftalk, deliberately
- Seeking reassurance
Compulsions
- Most visible and functionally disabling features
- Motivated and intentional
- Performed to reduce stress
Categories of Compulsions
- Decontamination
- Checking
- Repeating routine activities
- Ordering/arranging
- Mental rituals
Differential Diagnoses (comorbidities)
specific phobia, obsessive compulsive personality disorder, GAD
Behavioural models of OCD - Mowrer two factors theory
- CC: intrusive thoughts associated with anxiety
- OC: compulsions are negatively reinforced because they reduce the anxiety (safety/neutralizing behaviors)
Behavioural therapy
Exposure and response prevention (exposure to fear evoking stimuli and assistance with resisting urges
to avoid or escape using compulsive behaviors)
- Effective but difficult
Salkovski’s cognitive behavioural theory of OCD
- Unwanted intrusive thoughts are normal: 90% of population experience them
- Ego-dystonic
- Individuals with OCD appraise these unwanted as
highly significant and/or threatening. - These negative appraisals increase the frequency
and intensity of intrusive thoughts. - Engage in series of overt and covert behaviors to
avoid having intrusive thoughts
Normal thoughts, images, and impulses are indications of:
- Harm to themselves or other is a serious risk
- They may be responsible for this harm or its prevention
leads to“inflated” responsibility
Leads to:
- Increased discomfort.
- Increased attention to the intrusions and external triggers of the intrusions.
- Increased accessibility to the original intrusion and other related ideas.
- Behaviors such as compulsions, and thought suppression to escape from it
Rachman’s cognitive theory
- Obsessions are caused by catastrophic misinterpretations of the significance of one’s thoughts
- Not limited to responsibility appraisals
- Interpret the intrusive thought has personal significance:
- Imply that the person is bad, mad, or dangerous
- Catastrophic interpretation elicits anxiety
Thought - Action infusion
- Belief that having an intrusive thought increases the likelihood that a specific adverse event will occur.
- Belief that having an intrusive thought is almost the moral equivalent of carrying out that particular act.
- Increase the likelihood of catastrophic interpretation of unwanted thoughts.
- OCD patients report greater TAF than controls
- But TAF seen across anxiety disorders
Purdon and Clack’s Thought control
- Faulty beliefs about the importance of controlling one’s thoughts
- Negative misinterpretations of the consequences of failure to control unwanted thoughts.
- Consequences:
- Heightened vigilance to the occurrence of intrusive thoughts
- Active resistance and attempt to suppress intrusive thoughts
Thought suppression
- Thought suppression: usually unsuccessful.
- Paradoxical thought rebound
- Increase psychological distress
- Results in escalating attempt to regain control
- This lead to increased catastrophic appraisals
Cognitive - Behavioural treatment
- Exposure & Response Prevention
- Effective, but difficult treatment.
- Behavioral experiments: a tool to test the patient (maladaptive) beliefs
- Response prevention can target the beliefs of increased responsibility
- Cognitive therapy: evaluate the appraisal of unwanted intrusive thoughts
