Lecture 4 OCD Flashcards
DSM-V OCD and related disorders
OCD
body dysmorphic disorder
hoarding disorder
excoriation disorder
trichotillomania
Common features of DSM-V OCD disorders
- repetitive behaviours or mental acts, difficult to decrease or stop
- highly comorbid with each other
- likely to be present in first degree relatives of probands
DSM-V criteria for OCD (4)
A) presence of obsessions, compulsions, or both
B) obsession or compulsion time-consuming (>1 hour a day)
C) symptom not attributable to physiological effects of substance or medical condition
D) disturbance not better explained by symptoms of another mental disorder
specify if:
- with good insight
- tic-related
Obsessions defined by 1) and 2)
1) recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted, that caused marked anxiety or distress
2) attempts to ignore or suppress such thoughts, urges or images, or to neutralise them with some other thought or action
Compulsions defined by 1) and 2)
1) repetitive behaviours or mental acts that individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2) behaviour or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event. not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive
4 dimensions of presenting symptoms in OCD
cleaning
-contamination obsessions and cleaning compulsions
harm
-fears of harm to oneself or others and related checking compulsions
symmetry
-symmetry obsessions and repeating, ordering, and counting compulsions
forbidden or taboo thoughts
-aggressive, sexual, and religious obsessions and related compulsions
*often symptoms in more than one dimension
Common compulsions in OCD (5)
Washing and cleaning
- washing hands excessively
- excessive showering, cleaning
Checking
- that you did not harm others or self
- that nothing terrible happened, you didn’t make a mistake
Repeating
-rereading or rewriting, repeating routine activities or body movement
Mental compulsions
-counting while performing a task, cancelling, undoing
Ordering and arranging objects
Lifetime prevalence of OCD
2-3%
Age of onset
mean 19.5, 25% start by 14
Gender difference
more common in women, men often earlier onset (before 10)
Course
chronic if untreated, 80% still diagnosed after 40 years
Comorbity
76% comorbid anxiety disorder
63% comorbid major depression or bipolar
How does operant reinforcement maintain OCD
- compulsion negatively reinforced by reduction of anxiety
- avoidance maintains anxiety
- obsession=>anxiety=>compulsion=>relief
obsession: constant thoughts about whether…
anxiety: strong, uncomfortable feelings of anxiety
compulsion: repeatedly checking to confirm
relief: relief from anxiety, obsessive response strengthened for the future
Cognitive model of OCD
- obsessions are not qualitatively different from intrusive thoughts in the general population
- response to thoughts is different
- OCD results from misinterpretation of intrusive thoughts, they think thinking = doing
- cognitive factors
-attempts to suppress intrusive thoughts:
trying makes matter worse, results in checking for thoughts thereby creating them
Cognitive factors associated with OCD (4)
intolerance of uncertainty
inflated responsibility
thought-action fusion
magical ideation
Treatment of OCD
Medication 40- 60% benefit
- tricyclic antidepressant: anafranil
- SSRI(serotonin reuptake inhibitors)
CBT
- Exposure and Response Prevention: 75% benefit
- cognitive restructuring: challenge beliefs about intrusive thoughts, consequences of not engaging in complusions
- behavioural experiments
Hoarding disorder (6)
A) Persistent difficulty discarding or parting with possessions, regardless of actual value.
B) difficulty is due to perceived need to save the items and distress associated with discarding
C) Accumulation of possessions that clutter living areas and compromises their intended use. If living areas uncluttered, it is only because of the interventions of third parties
D) causes clinically significant distress or impairment in social, occupational, or other areas of functioning
E) not attributable to another medical condition
F) not better explained by the symptoms of another mental disorder
Specify:
- excessive acquisition
- good or fair insight
prevelance: 2-6% at any point
most above age 65 but starts quite early
Body dysmorphic disorder (4)
A) Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
B) At some point during the course of the disorder, individual has performed repetitive behaviors or mental acts in response to the appearance concerns.
C) preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D) appearance preoccupation not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for eating disorder.
Specify:
- insight from good to absent/delusional
- with muscle dysmorphia
Muscle dysmorphia specifier
- preoccupied with the idea that his or her body build is too small or insufficiently muscular.
- used even if the individual is preoccupied with other body areas
Functional consequence of body dysmorphic disorder
- impaired psychosocial functioning
- avoidance of social situation, relationships, intimacy
- 20% youth drop out of school
- can be completely housebound
- elevated suicide risk
Trichotillomania (5)
A) Recurrent pulling out of one’s hair, resulting in hair loss.
B) Repeated attempts to decrease or stop
C) hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) hair pulling or hair loss is not attributable to another medical condition
E) hair pulling is not better explained by the symptoms of another mental disorder
Excoriation (5)
A) Recurrent skin picking resulting in skin lesions
B) Repeated attempts to decrease or stop
C) The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) The skin picking is not attributable to the physiological effects of a substance or another medical condition
E) The skin picking is not better explained by symptoms of another mental disorder
