Obsessive Compulsive Disorder

Question 1

Describe disordered aversive functioning

Answer 1

Enhanced identification of aversive or threat stimuli
Increased arousal/hypervigilance
Inability to relax or sleep, move more, eat less, lose weight, less sexual interest
Reduced contact with previously rewarding stimuli
Tense, anxious or fearful mood
Previously neutral stimuli become aversive
Avoidance of previous neutral or even appetitive environments
Avoidance of stimuli, places, people, risks
Increased use of anxiety management techniques, alcohol or drugs & avoidance
Rehearsal of safety behaviours
Intolerant of frustration

Question 2

Describe OCD

Answer 2

A common, chronic and disabling disorder, marked by obsessions and/or compulsions that are egodystonic and cause significant distress for patients and their families

Question 3

Describe obsessions

Answer 3

Recurrent, intrusive and distressing thoughts, ideas, images, memories, impulses
Unwanted
Usually resisted
Recognised as originating from own mind
Associated with the emergence or increase of anxiety

Question 4

What are some common obsessions in OCD?

Answer 4

Contamination from dirt, germs, viruses etc
Fear of harm
Concern with order/symmetry
Obsessions with body/physical symptoms
Religious, sacrilegious or blasphemous thoughts
Sexual thoughts (being a paedophile/homosexual)
Urge to hoard
Thoughts of violence of aggression

Question 5

What are compulsions?

Answer 5

Repetitive, seemingly purposeful behaviours that individual feels driven to perform.
Can include physical and mental rituals
Carrying out compulsions tends to reduce anxiety – e.g. handwashing
Resistance to performing a compulsion increases anxiety
Usually recognised as ‘irrational’

Question 6

What are some common compulsions in OCD?

Answer 6

Checking
Cleaning, washing
Repeating acts
Mental compulsions
Ordering
Hoarding/collecting
Counting

Question 7

What is the gender ratio in OCD?

Answer 7

M:F 1:1.5

Question 8

When is the usual onset of OCD?

Answer 8

Any age- average is 20

Question 9

Do socioeconomic status, educational achievement of ethnicity effect OCD?

Answer 9

No

Question 10

What is the inheritance of OCD?

Answer 10

Familial- but no clear model

Question 11

What comorbidities are associated with OCD?

Answer 11

OCDP
Autism Spectrum
Schizophrenia
Hypochondriasis
BDD

Question 12

What are the features of OCPD?

Answer 12

Preoccupation with rules, lists, order, schedules
Perfectionism interfering with task completion
Excessive devotion to work
Overconscientious, scrupulous and inflexible
Unable to discard worthless objects
Reluctance to delegate, need to be in control
Miserliness
Rigidity and stubbornness

Question 13

What indicates a poorer prognosis in OCD?

Answer 13

Early onset, male gender, tics and multiple symptoms

Question 14

What are the possible causes of OCD?

Answer 14

Genetics- MZ twins 63-87%, DZ 15-45
AI- b-haemolytic strep infection & autoantibodies to basal ganglia
Increased metabolism and blood flow in orbitofrontal cortex, caudate nucleus and cingulate cortex

Question 15

What are the 3 domains of dysfunctional beliefs in OCD?

Answer 15

Overestimation of threat/inflated sense of responsibility
Beliefs about the importance of, and need to control, intrusive thoughts
Perfectionism and intolerance of uncertainty

Question 16

Describe exposure and response prevention as a psychotherapeutic intervention for OCD

Answer 16

Deliberate exposure to obsessional stimuli
Prevention of compulsions typically used to lessen distress associated with feared stimuli
Repeated exposure to obsessional cues whilst employing strict response prevention leads to habituation
Very effective treatment

Question 17

What are 5 screening questions to help identify OCD?

Answer 17

Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you would like to get rid of but can’t?
Do your daily activities take along time to finish? Are you concerned about orderliness or symmetry?