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
What is the prevalence, onset, course and impact of BDD?
- prev: 0.7-2.4% (higher in dermatology, cosmetic surgery, adult orthodontic and oral/maxillofacial surgery patients)
- onset: 16-17yrs (treatment delay 10-15yrs)
- generally present for secondary associated disorder (eg. MDD)
- 25% attempt suicide
- course: usually chronic
- impact on functioning: range moderate (avoidance of some social sits) to extreme (completely housebound; psychiatric hospitalisation)
What is associated with on onset of BDD <18yrs?
- suicide more likely
- more comorbidity
- gradual (rather than acute) onset
What are the gender diffs in BDD?
- no diff in prev
- more similarities than differences: disliked areas, types of repetitive behaviours, severity, suicidality, course, comorbidity, cosmetic procedures
- females: comorbid ED
- males: genetic, muscle dysmorphia
What are the cognitive processes associated with BDD?
- evaluate appearance more -vely
- overvalue on physical appearance/attractiveness
- endorse assumptions about appearance “If I am ugly, I am worthless”
- more anxiety, discomfort, distress, self-focussed attention after mirror-gazing
- rumination “why am I so ugly?”
- repeated reviews of past appearance-related experiences
What is hoarding disorder?
- difficulty discarding with possessions, regardless of actual value
- perceived need to save items/distress associated with discarding
- accumulation of possessions + clutter
- distress and impairment
What is the prevalence of hoarding disorder?
- prev: 2-6% US + Europe; 1.5% South London
- more males (but more females present for treatment?)
- more common in older adults
What are the predictors of hoarding disorder?
- control over possessions (control how they are used, thus controlling their environment)
- concern about memory (lower confidence in memory)
- responsibility over possessions (responsibility for proper use and wellbeing of the object)
- emotional attachment (like human attachment, denote safety, become part of their identity)
What is trichotillomania + the consequences of it?
- recurrent hair-pulling, leading to hair loss
- repeated attempts to decrease/stop
- distress + impairment
CONSEQUENCES
- social and occupational
- musculoskeletal injury
- blepharitis
- dental damage
- swallowing hair: trichobezoars, anemia, vomit, abdo pain, bowel obstruction etc.
What is excoriation + the consequences of it?
- recurrent skin picking, leading to lesions
- repeated attempts to decrease/stop
- distress + impairment
CONSEQUENCES
- social and occupational
- tissue damage, infection, scarring
- antibiotics for infections; surgery
What is the prev and course of trichotillomania and excoriation?
1-2% (more females)
course: usually chronic
What are the psychological aspects of trichotillomania and excoriation?
- stimulate positive mood
- regulate states of high/low arousal (anxiety, boredom)
- 1/5 - 1/3 report feeling trance, depersonalisation, mesmerizes
- some have little-no awareness
- 2 types: automatic + focussed
What are the differences b/w OCD and phobia?
- anx about rituals in OCD
- anx about object in phobia
- anx more complex/diffuse in OCD
- and less complex/focussed in phobia
- anx when confronted with feared object not excessive in OCD
- anx when confronted with feared object excessive in phobia
