Obsessive Compulsive Disorder

Question 1

Intrusive thought

Answer 1

Fleeting, unwelcome thought or image, often inappropriate in content or given the situation, most people experience it at some point

Question 2

Intrusive thoughts in OCD

Answer 2

At heart, very similar thought just more intense, can’t easily dismiss or tolerate intrusive thoughts

Question 3

Obsession

Answer 3

Intrusive thought that cannot be easily dismissed

Question 4

Compulsion

Answer 4

A behavior that helps dismiss the obsession

Question 5

OCD DSM criteria

Answer 5

Presence of obsessions, compulsions, or both

Question 6

Obsession DSM definition

Answer 6

Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive or unwanted, and that in most individuals cause marked anxiety or distress
Individual attempts to ignore or suppress these or neutralize them with some other thought or action

Question 7

Four Main Themes of Obsessions

Answer 7

Contamination: center on cleanliness of self, physical environment, or objects
Symmetry: items need to be aligned or positioned in a certain way; also applies to behaviors
Forbidden thoughts: tend to have aggressive, sexual, religious, or taboo content
Harm: terrible things happening to self or loved one

Question 8

Compulsions

Answer 8

Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
Aimed at preventing or reducing anxiety or distress or preventing a dreaded event, not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (defined by time)

Question 9

Linked obsessions and compulsions

Answer 9

Often
Contamination- washing hands, stuff, avoiding germy locations
Symmetry- ordering objects, counting
Forbidden thoughts- prayer, thoughts or body movements to counteract bad thought
Harm- checking (stove is off, etc)

Question 10

Not Just Right Experience

Answer 10

Perception that something is not the way it should be, experienced as unsettling

Question 11

OCD more DSM criteria

Answer 11

Obsessions or compulsions are time consuming (more than an hour a day) or cause clinically significant distress or impairment
Not attributable to something else

Question 12

How common is OCD?

Answer 12

1-4% of the population, most cases emerge before age 18, 2/3 of kids show symptoms of OCD 14 years later

Question 13

Gender and OCD

Answer 13

Rates comparable across girls and boys
Boys have earlier onset- before puberty, girls after
In childhood more boys, girls catch up

Question 14

OCD pattern

Answer 14

Intrusive thought leads to feelings (anxiety/distress/NJRE) leads to compulsive ritual leads to moment of relief leads to intrusive thought again starting the cycle over
Compulsions are effective at relieving discomfort of intrusive thought but only short-term, obsession continues to recur
Intrusive thought could be if I don’t do ritual something bad will happen

Question 15

Neural mechanisms of OCD

Answer 15

Related to response inhibition because a compulsion is a response that is hard to inhibit- BG

Question 16

Cortico-Striato-Thalamo-Cortical Pathway

Answer 16

CSTC
Cortex, striatum, thalamus
Inhibiting responses is related to the BG (includes striatum and caudate)
BG communicate with other parts of the brain including frontal cortex, thalamus (limbic system), and ACC (anterior cingulate cortex, processing pain and emotional reactions and impulse control)
should regulate how intense of a reaction to a threatening stimuli should be

Question 17

CSTC in OCD

Answer 17

Hyperactive, over-perception of problems that must be responded to

Question 18

SSRIs and OCD

Answer 18

Effective in high doses, shows declines in activity in caudate and thalamus

Question 19

CBT for OCD

Answer 19

Trying to reduce intensity of intrusive thoughts, allow people to feel the anxiety but reduce the compulsive ritual because it doesn’t work
Goal to have people tolerate and accept the discomfort of an obsession, a compulsion is a way to avoid this distress

Question 20

EX/RP

Answer 20

Exposure and Response Prevention

Question 21

EX/RP how it works

Answer 21

Provokes obsessions via exposure- deliberately creating a situation in which an obsessive thought is likely to occur
But do not perform compulsion- called response prevention
Eventually people habituate
Starts within session and moves to in vivo HW
Uses an exposure hierarchy from least distress producing to most

Question 22

Best treatment for OCD

Answer 22

Therapy slightly better than meds but not huge difference
Combination therapy works better than meds alone but not better than EX/RP alone

Question 23

Neural mechanisms underlying CBT

Answer 23

EX/RP associated with declines in caudate and thalamus, same as SSRI