Lisa - Obsessive-compulsive and related disorders Flashcards
DSM-5:
Obsessive-compulsive and related disorders
- Obsessive-Compulsive Disorder
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (Hair-Pulling Disorder)
- Excoriation (Skin-Picking Disorder)
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder
⭐️Obsessions and compulsions are recurrent and persistent
-Individual recognises they are excessive or unreasonable
😥Obsessions/compulsions cause marked distress, are time-consuming (>1 hour/day) and significantly interfere with functioning and relationships.
⭐️Whilst large proportions of the population experience intrusive, unpleasant, unwanted thoughts and engage in ritualised behaviour, what separates them from those with OCD is that they are able to overcome and not remain so fixated on these thoughts.
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Obsessions
⭐️COGNITIVE component
Persistent ideas🙋, thoughts🙇, impulses 💳👜, or images 📷 that are experienced as intrusive and inappropriate and cause marked anxiety or distress.
Individual recognises thoughts are a product of their own mind vs delusional thinking (psychosis).
Common types:
- Fears of contamination (germs, infection)
- Repeated doubts (safety- checking power points, scruples)
- Need to have things in a particular order (eg lined up neatly)
- Sexual, horrific or blasphemous imagery
- Aggressive or inappropriate impulses
- Nonsensical thoughts or images
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Compulsions
⭐️BEHAVIOURAL component
Overt, repetitive behaviour (handwashing, checking) or covert mental acts (praying, counting, repeating words silently) the goal of which is to PREVENT or REDUCE anxiety ➡️ to a self-perpetuating cycle of anxiety;
Can include rigid/stereotyped acts according to elaborate rules without any real explanation of them (eg mantra, muscle tension practice- a women going through a muscle tension routine to ⬇️ her anxiety of believing her family were in accidents because she saw the image of it in her mind; thought this routine would prevent it from happening)=ILLOGICAL.
Common Types:
- Washing and cleaning
- Checking (most common)
- Repeating
- Ordering
- Mental rituals (counting, prayers)
- Reassurance seeking
- Hoarding
- Compulsive shopping
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Gender and Comorbidity
Manifests in females 👧🏻 as cleaning and ‘aggressive obsessions’.
Manifests in males 👦🏼 as slowness, symmetry, numbers, touching rituals, and ‘sexual’ symptoms.
Comorbidity with:
- MDD (eg someone with obsessions about germ/infection transmission may compulsively need to wash hands before hugging their children/showing affection to partner. This can be disruptive and damaging to relationships and could thus ➡️ MDD 😥)
- Social phobia
- Specific phobia
- GAD
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Neuropsychological underpinnings
OCD involves various brain regions:
- orbitofrontal-subcortical circuits, caudate nucleus, thalamus
- frontal lobes and/basal ganglia
- Possible dysfunction in serotonin neurotransmission
- Neuropsychological functioning: deficits in executive functioning as well as memory, regulating behaviour and organisational skills.
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
🚫Risk factors
Family History👨👨👧: evidence of dominant or codominant mode of transmission.
Early childhood experiences and critical learning incidents ➡️ maladaptive beliefs about responsibility and threat.
Personality factors 👦🏼👧🏻👨🏻👩🏼: neuroticism, psychoticism, and sensitive to punishment.
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Salkovskis’ Cognitive Behavioural Model of OCD
- Begins with the premise that INTRUSIVE THOUGHTS ARE NORMAL.
- However, certain individuals PLACE MEANING on these thoughts, and thus respond to them in some way (eg avoid, suppress, ritualise, etc.)
- These RESPONSES ⬆️ VIGILANCE for the intrusive thoughts and protects (REINFORCES) the MEANING OF THE INTRUSION.
♻️Self-perpetuating cycle that increases one’s chances of experiencing the obsessions again and even more strongly.😥
DSM-5:
Obsessive-Compulsive and related disorders:
Obsessive-compulsive disorder:
Cognitive Factors
Intrusive thoughts might become obsessions if they are evaluated as:
-OVERLY IMPORTANT (if I’m thinking this way, it must be important)
-HIGHLY THREATENING (if I continue to think like this, something bad will happen)
-REQUIRING COMPLETE CONTROL (I’ve got to stop thinking this way)
-NECESSITATING A HIGH DEGREE
OF CERTAINTY (I need to be certain that nothing bad will happen)
-ASSOCIATED WITH A STATE
OF PERFECTION (I can’t stop thinking about this until I do it perfectly)
DSM-5:
Obsessive-Compulsive and related disorders:
Body Dysmorphic Disorder (BDD)
⭐️Pre-occupation with1/+ perceived defects or flaws in physical appearance that are not observable or appear slight to others.
Perform repetitive behaviours:
- Mirror checking
- Excessive grooming
- Skin picking
- Reassurance seeking
Or mental acts:
-Comparing his or her appearance with that of others
For males: MUSCLE DYSMORPHIA is more common💪: preoccupied with the idea that their body is too small (genitalia) or insufficiently muscular 👦🏻 vs 👨🏻
😥Individuals with either disorder are more likely to attempt suicide, have more comorbidity (females more likely to have comorbid eating disorder😥) and have gradual (vs acute) disorder onset.
😥Major overlap between cosmetic surgery and BDD
❓To what extent could social and cultural pressures influence the prevalence of BDD?
Conforming to society or cultural standards of beauty may serve as a protective factor against BDD.
With the spotlight now on societal body images in men, can see how cultural standards of men being muscular and big are depicted in the mass media ➡️⬆️risk of muscle dysmorphia
DSM-5:
Obsessive-Compulsive and related disorders:
Body Dysmorphic Disorder:
Impact on functioning
-Can range from moderate (eg avoidance of some social situations) to extreme and incapacitating (eg being completely housebound)
😥Job, academic, or role functioning (eg as a parent or caregiver), which is often severe (eg performing poorly, missing school or work, not working)
😥Social functioning (eg social activities, relationships, intimacy)
😥Psychiatric hospitalisation
DSM-5:
Obsessive-Compulsive and related disorders:
Body Dysmorphic Disorder:
Cognitive Processes
Compared to healthy controls individuals with BDD:
😥Evaluate appearance more negatively
😥Endorse assumptions about appearance such as “if my appearance is defective then I am worthless”
😥Overvalue physical appearance and attractiveness (eg choose to be friends with more attractive people)
😥Experience more anxiety and discomfort after mirror gazing
😥Experience more distress and self-focussed attention after mirror-gazing (eg remember negative comments of others strongly)
😥Engage in ruminative thinking (why am I so ugly?)
😥Engage in repeated reviews of past-appearance related experiences
DSM-5:
Obsessive-Compulsive and related disorders:
Hoarding Disorder
⭐️Persistent difficulty discarding or parting with possessions, regardless of their actual value
⭐️This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
Can also be diagnosed even if you have poor insight.
DSM-5:
Obsessive-Compulsive and related disorders:
Hoarding Disorder:
Cognitive factors
- Control over possessions
- Concern about memory
- Responsibility over possessions
Hoarding animals 🐶🐱🐰: compulsive need to collect and own animals for the sake of caring for them that results in accidental or unintentional neglect or abuse.
- Animals may provide a conflict-free relationship with the individual, unconditional love;
- Perceptions of being a refuge for unloved animals may provide the individual with a sense of purpose, a special role, means that they are loving and caring.
😥However in many cases, everyone suffers with animal hoarding- animals are abused, humans neglect their own health and wellbeing, hoarder also often becomes socially isolated, reinforcing bond and need to take responsibility and care for animals.
DSM-5:
Obsessive-Compulsive and related disorders:
Trichotillomania (hair-pulling)
⭐️Recurrent pulling out of one’s hair, resulting in hair loss.
Functional consequences: 😥Social/occupational impairment 😥Musculoskeletal injury 😥Blepharitis 😥Dental damage 😥Trichobezoars as a result of swallowing of hair
