lesson 8 (ch7) Obsessive Compulsive related disorders and trauma related disorders Flashcards
DSM- IV-TR vs DSM-5 in terms of obsessive compulsive and trauma related disorders
-in DSM-IV-TR Obsessive-Compulsive and related disorder and Trauma-related disorders were included w/ anxiety disorders
- b/c some common symptoms, risk factors, and treatments w/ anxiety disorders
- DSM-5 creates new chapters for Obsessive-Compulsive and Related Disorders, and Trauma-Related Disorders
- b/c distinct causes
Obsessive-Compulsive and Related Disorders
- Obsessive-Compulsive Disorder (OCD)
- Body Dysmorphic Disorder
- Hoarding Disorder
Obsessive-Compulsive Disorder (OCD)
obsessions: repetitive unwanted thoughts and urges
compulsions: repetitive behaviors and mental acts (counting etc), person feels compelled to perform to prevent distress/ dreaded event
those with OCD often have both
obsessions or compulsions are time consuming (atleast 1hr a day) or cause clinically significant impairment/distress
Body Dysmorphic Disorder
- Repetitive thoughts and urges about personal appearance
Hoarding Disorder
- repetitive thoughts and behaviors about possessions
Obsessions
- intrusive, persistent, uncontrollable thoughts or urges
- experienced as irrational
most common: contamination, sexual and aggressive impulses, body problems
compulsions
- impulse to repeat certain behaviors or mental acts to avoid distress (cleaning, counting, touching, checking)
- extremely difficult to resist the impulse
- may involve elaborate behavioral rituals
- compulsive gambling, eating, etc NOT considered compulsions b/c pleasurable
person feels driven to perform repetitive behaviors in response to obsessions or according to rigid rules
onset of OCD, comorbidity
Develops either before age 10 or during late adolescence/ early adulthood
1.5 times more common in women
often chronic
- only 20% complete recover
- 75% comorbid anxiety disorder
- 66% major depression
- 33% hoarding symptoms
- substance abuse common
Body Dysmorphic Disorder (BDD)
Preoccupied w/ imagined or exaggerated defect in appearance
- perceive themselves as ugly/ “monstrous”
- women focus: skin, hips, breasts, legs, Men: height, penis, body hair, muscles
- engage in compulsive behavior (check mirrors, camoflage through makeup/ plastic surgery)
- high levels of shame/ anxiety/ depression
- nearly all have another comorbid disorder
prevalence body dysmorphic disorder
2% prevalence rate, 5-7% for women seeking plastic surgery
occurs slightly more often in women
DSM-5 Criteria for BDD Body Dysmorphic Disorder
- preoccupation w/ perceived defect
- person performed repetitive behaviors or mental acts (mirror checking, seeking reassurance, excessive grooming) in response to appearance concerns
- preoccupation not restricted to concerns about weight or fat
Hoarding Disorder
Cannot part w aquired objects
- often worthless
- extremely attached, resisted to relinquishing
66% unaware of severity
33% are animal hoarders
- animals often receive inadequate care
severe consequences
- squalid living conditions
- negatively impacts relationships
usually begins in childhood/adolescence, but severe impairment doesn’t surface until later. animal hoarding often doesnt emerge until middle age or older
DSM-5 criteria of hoarding disorder
- persistent difficulty discarding possesions regardless of value
- perceived need to save items
- distress associated w discarding
- accumulation of possessions clutters active living spaces so intended use is compromised unless others intervene
Genetic Etiology of Obsessive-Compulsive and Related disorders
Heretability accounts for 40-50% of variance in whether OCD, Hoarding, or BDD develop
they share some overlap in genetic and neurobiological risk factors
Neurobiological factors- Etiology of Obsessive-Compulsive and Related disorders
Hyperactive regions of the brain (fronto-striatal circuits)
- Orbitofrontal cortex
- Caudate nucleus
- anterior cingulate
Neumonic: ocd about orbital bone, cauldalie cream, interior design
Hyperactive strattetella
Etiology of OCD: Behavioral and Cognitive factors
Operant reinforcement
- compulsions negatively reinforced by reduction of anxiety
- have a stronger conditioned response to stimulus, even after it is no longer connected to something negative
cognitive factors
- lack of satiety signal
-Yadasentience
- subjective feeling of completion (knowing you have done enough, cleaned enough etc)
- Attempts to suppress intrusive thoughts, makes matters worse
Neumonic yadda yadda yadda while eating
Etiology of Body Dysmorphic Disorder
- not actually seeing their body/ face as distorted
- detail orientated, engrossed in small flaws, see one feature at a time rather than the whole
- believe in an exaggerated immportance of appearance
etiology of hoarding disorder
evolutionary perspective:
- adaptive to stockpile vital resources
cognitive-behavioral factors
- poor organizational abilities
- unusual beliefs about possessions
- avoidance behaviors
Treatment of Obsessive-Compulsive and related disorders (3)
- Medications
- Exposure plus response prevention
- cognitive therapy
Medications: Treatment of Obsessive-Compulsive and related disorders
- SSRIs (not as effective for hoarding)
-takes more time and higher doses to treat OCD vs depression - Tricyclic antidepressants: anafranil (clomipramine)
Exposure plus response prevention (ERP)
(Treatment of Obsessive-Compulsive and related disorders
- not performing ritual exposes the person to the full force of anxiety provoked by stimulus
- exposure results in the extinction of the conditioned response (the anxiety)
while very effective, its very difficult for clients and about 1/3 drop out
Cognitive therapy: treatment of Obsessive-compulsive and related disorders
- challenge beliefs about anticipated consequences of NOT engaging in compulsions
- usually also briefly uses exposure
treatment for BDD body dysmorphic disorder
- uses principles of ERP (exposure plus response prevention)
might expose them to someone critical of there looks, then for response prevention, prevent them from using safety behaviors like checking themselves in the mirror
treatment for hoarding disorder
ERP- exposure element focuses on getting rid of objects.
response-prevention aspect focuses on stopping rituals to reduce anxiety- like counting or sorting possessions
therapists use motivational strategies to help clients see why they might want to change
also might do at-home visits to get a better sense of hoarding degree and allows for in vivo exercises on decluttering
Deep Brain Stimulation (OCD)
a treatment used for those w OCD who don’t respond to multiple pharmacological treatments
involves implanting electrodes into brain (regions in the basal ganglia
only works for half, chance of severe side effects
Trauma-related disorders (+ why different than other diagnoses in DSM)
- diagnosed when a person develops symptoms after traumatic event, triggers serious psychological symptoms
- contrast w all other major DSM diagnoses b/c they are defined by symptom profiles. Trauma-related diagnoses have emphasis on the cause
PTSD (Posttraumatic Stress Disorder)
- Extreme response to severe stressor (anxiety, avoidance of stimuli assoc. w trauma, numbing, neg emotions/ thoughts, increased arousal)
- exposure to traumatic event that involves actual/ threatened death/ injury
- trauma leads to intense fear or helplessness
- symptoms present for more than a month
- war for men, rape for women
four categories of symptoms for ptsd
- intrusively re-experiencing traumatic event (nightmares, intrusive memories, images)
- avoidance of stimuli associated w event
- mood and cognitive changes (memory loss, negative thoughts/ emotions, withdrawal, blame self or others)
- increased arousal/reactivity (irritability, hyper-vigilance, recklessness, jumpiness, difficulty concentrating
Neumonic: soldier back in war, hides in cave, bad mood, what was that
how does ptsd develop?
- tends to be chronic
- sometimes develops soon after trauma, or may develop years after initial event
- less satisfied in relationships, rates of divorce are high
- higher risk of suicide and self-injury, also illness
- usually comorbid w/ other conditions
- women 1.5 to 2 x as likely to develop ptsd
differences in DSM-IV-TR and DSM-5 (PTSD)
- experience of intense emotion at time of trauma- removed in DSM-5
- Definition of traumatic events is now narrower
- specific symptoms must begin after trauma - added in DSM-5
- DSM-5 criteria require avoidance symptoms to be present for diagnosis of PTSD
Complex PTSD
- prolonged exposure to trauma (such as repeated childhood abuse)
- may lead to broader range of symptoms than DSM criteria for PTSD (negative emotions, relationship disturbances, neg self-concept)
- DSM-5 doesn’t include diagnosis for complex ptsd
Acute Stress Disorder (ASD)
- Symptoms similar to PTSD but shorter duration (3 days to 1 month)
- DSM-5 removes dissociation as a symptom
- 90% of rape victims experience ASD
- predicts higher risk of PTSD w/in two years
two concerns about ASD diagnosis
- could stigmatize common short-term reactions to serious trauma
- not very predictive of who will develop PTSD (less than half)
however, it could help people get support after a trauma, and treatment could prevent PTSD
etiology of PTSD- similarities w anxiety
- common risk factors w other anxiety disorders
- genetic, overactive amygdala, childhood exposure to trauma, selective attention, neuroticism, and negative affectivity
- Mowrer’s two factor model of conditioning also applicable
etiology of PTSD- unique factors (not anxiety related)
unique factors
- severity and type of trauma (trauma caused by humans more likely to cause PTSD)
- neurobiological (smaller hippocampal volume)
- avoidance coping, dissociation, memory suppression
- greater intelligence, social support, and ability to grow from experience enhance ability to cope
Neumonic: small collegiate hippo at war
psychological treatment of PTSD
- exposure to memories and reminders of original trauma
- either in vivo or imaginal (VR is effective)
- more effective than medication
- can be difficult at first, may increase symptoms
- cognitive therapy
- enhance beliefs about coping abilities
- COGNITIVE PROCESSING THERAPY used to dispute self-blame, reducing guilt and dissociation
- adding CT to exposure does not improve treatment response
- treatment of ASD may prevent PTSD (benefits even 5 years after)
CISD- critical incident stress debriefing
-immediate treatment of trauma victims (w/in 72 hrs of event)
- one group session, regardless of whether they have symptoms
- may be harmful
