Lecture 4 - OCD Flashcards
What are obsessions?
- recurrent and persistent thoughts, urges or images
- experiences as intrusive and unwanted
- cause marked distress and anxiety
- attempts to ignore or suppress them; or neutralise with some action (compulsion)
up to 80% of general pop
What are compulsions?
- repetitive behaviours or mental acts
- feel driven to perform in response to obsession, or according to rigid rules
- aimed at preventing/reducing anxiety or distress; or prevent dreaded situation
- not connected in a realistic way or clearly excessive
up to 50% of general pop
What is OCD, according to the DSM-5? What are the specifiers?
- obsessions, compulsions or both
- time-consuming (1hr/day)
- distress or impaired functioning
SPECIFIERS
- good/fair insight
- poor insight
- absent insight/delusional beliefs
- tic-related
What is the prev, onset and course of OCD?
- prev: 1.9%
- average onset: 27M, 25F
- mode onset: 6-15M, 20-29F
- course: often fluctuates with stress levels
- chronic in 50% of cases
What are the most common features of OCD?
- contamination/illness + washing/cleaning
- obsessive doubt + repeated checking
- symmetry, orderliness, numbers
- hoarding/collecting
- obsessional slowness
What are the gender and childhood effects in OCD?
- childhood onset more common in boys
- female: cleaning, aggression
- male: obsessional slowness, symmetry, sexual, number, touching
- childhood onset: experience it differently, commonly lack insight
What are the complications associated with OCD?
- recruit others into checking/avoiding (offloads responsibility; doesn’t question validity of thoughts)
- comorbid skin/hair conditions from washing
What is the comorbidity in OCD?
80% have 1 other dx
46% have 3+ other dx
depression 55% social phobia 23% specific phobia 21% GAD 20% tic-related disorders 37-59%
OCPD:
75% OCD do not have OCPD; 80% OCPD to not have OCD
PSYCHOSIS:
23% with SZ have OCD
64% with SZ have OCD symptoms
OCD symptoms related to psychosis severity, positive and depressive sx
NOTE: excessive gambling/eating/substance use is NOT compulsive
What are the risk factors for OCD?
- family history
- early childhood + critical learning incidents: maladaptive beliefs about responsibility and threat
- personality: neurotic, psychotic, sensitivity to punishment
- temperamental: more internalising symptoms, higher negative emotionality and behavioural inhibition in childhood
What are the neuro aspects of OCD?
- brain areas: orbitofrontal (subcortical circuits, caudate nucleus, thalamus); frontal lobes; basal ganglia
- possible dysfunction in 5HT neurotransmission
- functional deficits: exec functioning, memory, organisation
What are the cognitive aspects behind obsessions and compulsions?
- obsessions = overdeveloped vigilance for threat, responsibility + need for social approval
- compulsions: emanate from belief is self-sufficient and resourceful + world is ordered and systematic
What are the cognitive factors of OCD?
- beliefs about inflated responsibility
- thought-action fusion
- perfectionism (concern about making mistakes, not setting high standards)
- doubt (uncertainty associated with own behaviour > repetitive behaviour; primary (oven on) and secondary (house fire) inferences)
What makes intrusive thoughts become obsessions?
- highly threatening
- overly important
- require complete control
- associated with state of perfectionism
- associated with a degree of certainty
What is the proposal regarding and OCD spectrum?
with Tourette’s, autism, somatoform (BDD) and impulse disorders
- phenomenological and neurobiological overlap
- but how closely related are they aetiologically?
What is Body Dysmorphic Disorder?
- preoccupation with 1+ perceived deficits or flaws in physical appearance, not observable by others/appear minor
- repetitive behaviours or mental acts in response to appearance concerns
- distress + impairment
Specifier: muscle dysmoprhia
