Obsessive-Compulsive and Hoarding Disorders Flashcards
Compulsivity and Impulsivity differences and similarities
Similarities
-inability to delay repetitive behaviors
Differences
- driving mechanism in compulsivity is reduction of discomfort (negative reinforcement)
- driving mechanism in impulsivity is obtaining arousal or satisfaction (positive reinforcement)
Obsessions or Compulsions causes
- distress
- time consumption> 1h/day
- interference with daily activities/relationships
OCD
characterized by compulsivity- obsessive preoccupation and repetitive behaviors
Obsession–>Anxiety–>Compulsion
- repetitive
- undesired/unwilled
- compelled
OCD Obsession
intrusive, unwelcome distressing thoughts and mental images
OCD Compulsions
the behavior the people with OCD perform in a vain attempt to relieve the fears and anxieties caused by their obsessions
OCD Types of obsessions
- contamination
- fear of harm
- symmetry/perfection
- somatic
- religious
- sexual
- hoarding
- unacceptable urges
- miscellaneous
OCD Manifestation of obsessions
- checking
- cleaning/washing
- miscellaneous
- repeating
- mental rituals
- ordering
- hoarding/collecting
- counting
OCD Course
- chronic, waxing and waning
- stress sensitivity
- considerable variability
- shifting symptoms and clusters
OCD comorbidities
- panic, phobias
- major depression
OCD DSM Diagnostic
A. Obsessions or Compulsions defined by:
- recurrent and persistent thoughts
- intrusive and inappropriate and that cause marked anxiety of distress - not simply excessive worries about real-life problems
- person attempts to ignore
- product of his or her own mind
C. marked distress, are time consuming ( more than 1 hour a day), or significantly interfere with person’s day-to-day functioning
OCD Neurobiological Substrates- Cortico-striatal-thalamic-cortical loop dysfunction
- Cortical: Orbitofrontal and anterior cingulate cortices
- Striatal: Basal Ganglia (caudate nucleus, putamen)
- Thalamic: Thalamus
OCD Neurobiological Substrates- Cortico-striatal over-activation
- These structures activated during symptom provocation
- Returns to normal with treatment
OCD Treatment- Pharmacotherapy
Medications- selective serotonin reuptake inhibitors, glutamate receptor antagonist
OCD Treatment- Psychotherapy
Cognitive Behavioral Therapy -Mindfulness Four Steps: 1. Relabel 2. Reattribute 3. Refocus 4. Revalue
Exposure and Response Prevention (ERP)
- Exposure to fear
- Refrain from ritual
OCD Treatment- Surgical interventions
- last resort
- Cut fibers btw ant. cingulate and caudate nucleus
Hoarding
-excessive collection and failure to discard objects of apparently little value, leading to clutter distress and disability
- Excessive collection
- Storing, keeping and not discarding
- Neglect of living space
Hoarding-Neurobiological Substrates
- Fronto-limbic
- Anterior Ventromedial Cortex
- Cingulate cortex
- These structures activated during symptom provocation
1. Ventromedial prefrontal cortex activated during simulated discarding
2. Anterior cingulate activated during simulated “keeping”
Hoarding- Characteristics
- difficulty discarding or letting go of possessions
- fear of losing important information, emotional attachments, or useful items
- Nature of the items
- clothes
- newspapers, mail, books
- containers
- art/craft supplies
- Severe clutter impedes use of living spaces
- appear to lack an awareness of the disorder - poor insight
Hoarding- Under regulation: Inadequate strength
- Chronic: guilt and stress can weaken resolve
- Temporary: physiological/psychological
- Externally-mediated or prompted- saving of objects in hoarders often associated with pleasure (Positive reinforcement)
- exposure / availability
Hoarding- Misregulation
- Distorted belief system with regard to possessions
- Distorted Self-Knowledge
- Poor insight: People who hoard appear to lack an awareness of the severity of the problem
Hoarding- Spiraling Distress
- Lapse
- Temporary positive mood
- Consequences
- Saving allows the hoarder to avoid the decision required to throw something away and the worry that accompanies that decision (procrastination of action)
- Subjects react with panic to discarding of items
Hoarding- Reinforcement patterns
- Compulsive behavior in OCD is negatively reinforced via avoidance conditioning (avoiding distress, feared consequences, etc.), but there is no positive reinforcement of OCD symptoms
- In hoarding, there is both avoidance conditioning (avoiding loss, etc.) and positive reinforcement
Hoarding- Under regulation: Reduced monitoring behavior
Renegade attention
Managing attention towards trigger
- Preoccupation: as if hypnotized
- One is surrounded by possessions and clutter, “possession myopia”
Hoarding- Under regulation: General
- Acquiescence
- Loss of control over attention–>transcendence failure
