OCD Flashcards
the vicious cycle of OCD
- obsessive thought
- anxiety
- compulsive behaviour
- temporary relief
what is OCD
OCD is a chronic disorder in which the mind is flooded
with persistent and uncontrollable thoughts
(obsessions) and the individual is compelled to repeat
certain acts again and again (compulsions)
typical age of onset for OCD
20 years
late onset for OCD
early 30s
“OCD with good or fair insight
the individual recognizes
that beliefs are definitely or probably not true or that they
may or may not be true
OCD with poor insight”
the individual thinks beliefs are
probably true
“OCD with absent insight/delusional beliefs”
the individual
is completely convinced that beliefs are true.
According to Rachman (2002), three “multipliers” that
increase the intensity and frequency of compulsive
checking are
- An inflated sense of personal responsibility
- The probability of harm if checking does not take place
- The predicted seriousness of harm.
Behavioural and Cognitive Theories of OCD
- Learned behaviours reinforced by fear reduction
- Compulsive checking may result from a memory deficit
Behavioural Approaches to
Treatment of OCD
Exposure and Response Prevention (ERP) for OCD
* the person exposes himself or herself to situations that
elicit the compulsive act—such as touching a dirty dish—
and then refrains from performing the accustomed
ritual—hand washing.
Inhibitory Learning Model
- Effective ERP helps people with OCD learn safety in
a way that is strong enough to block (inhibit) the
original fear. - Focusing on anxiety tolerance instead of
habituation - Disconfirming expectations
Cognitive-Behavioural Approaches to
Treatment for OCD
- A combined CBT approach is clearly required when treating
OCD rather than just a cognitive approach because an inherent
part of any cognitive therapy is exposure and response
prevention - Cognitive procedures can eliminate the dysfunctional beliefs
that contribute to the OCD clients’ faulty appraisals
Biological Theories of OCD
Genetic evidence
* High rates of anxiety disorders occur among the first-degree relatives
(10.3%) than control relatives (1.9%)
Brain structure
* Encephalitis, head injuries, and brain tumours associated with the
development of OCD
* PET scan studies shown increased activation in the frontal lobes
* PET findings show a link to the basal ganglia
Neuropsychological Testing Research
* Patients with long-term OCD show attention and memory
deficits (Nakao et al., 2009)
Hypotheses related to SSRI drug treatment
* Suggests OCD is related to decreased serotonin
* However, 40-60% of OCD clients treated with SSRIs do not
show improvement
Biological Approaches to
Treatment for OCD
Brain surgery
* Cingulotomy - involves destroying two to three
centimetres of white matter in the cingulum, an
area near the corpus callosum
Deep brain stimulation
* Bilateral (not unilateral) subthalamic nucleus deep
brain stimulation is used for OCD treatment non-
responders
Psychoanalytic Approaches to
Treatment of OCD
- Attempt to uncover the repressed conflicts
- Resembles approach used for anxiety disorders (e.g.,
phobias) - The intrusive thoughts and compulsive behaviour protect
the ego from the repressed conflict; however, they are
difficult targets for therapeutic intervention. - Psychoanalytic procedures have not been effective in
treating this disorder.
Hoarding Disorder Specifiers
specify if: with excessive acquisition: if difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space
specify if:
with good or fair insight: the individual recognizes that hoarding beliefs and behaviours are problematic
with poor insight: the individual is mostly convinced that hoarding related beliefs and behaviours are not problematic despite evidence
with absent insight/delusional beliefs: the individual is completely convinced that these beliefs and behaviours are not problematic
prevalence of hoarding disorder
2-5%, twice as prevalent as OCD
Etiology of Hoarding Disorder
Cognitive factors:
- faulty information processing (i.e., distractibility
and difficulty thinking about categories), - erroneous cognitions about the importance and
meaning of possessions, - and misguided attachments with objects to
seemingly compensate for emotional deficits in
attachment to people
CBT for Hoarding Disorder
- Uses exposure aimed at not acquiring items as well as
discarding items - Cognitive restructuring targets beliefs that are problematic for
hoarding. - Skills training which focuses on organizing, problem solving,
and making decisions. - Motivational interviewing techniques for ambivalence
- Finally, the therapist makes home visit for more intensive
exposure, lasting hours for some clients with severe hoarding
Body Dysmorphic Disorder (BDD)
- A person is preoccupied with an imagined or
exaggerated defect in appearance, frequently in the
face; for example, facial wrinkles, excess facial hair, or
the shape or size of the nose
BDD specifiers
specify if: with muscle dysmorphia: the individual believes his body build is to small or insufficiently muscular.
with good or fair insight: the individual recognizes that BDD beliefs are probably not true
with poor insight: the individual thinks that the body dysmorphic disorder beliefs are probably true
with absent insight/delusional beliefs: the individual is completely convinced that the BDD beliefs are true
Treatment of BDD
Behavioural interventions typically focus on exposure and
response prevention, similar to OCD.
* For example, staying in the situation without engaging in
mirror checking
* Cognitive strategies focus on identifying maladaptive, self-
defeating thoughts, and core beliefs, such as “If I don’t
look perfect,” “it’s impossible to be happy,” or “I’m
unlovable,” that seem to maintain body-dysmorphic
thoughts and behaviours;
* Evaluating the accuracy of these negative thoughts and
irrational beliefs; and assisting the development of more
realistic thoughts and beliefs.
* Final sessions typically focus on relapse prevention.
trichotillomania
recurrent pulling out of ones hair
repeated attempts to decrease or stop hair pulling
excoriation disorder
recurrent skin picking resulting in skin lesions
Etiology of Body-Focused
Repetitive Disorders
Biological factors:
* Genetics: trichotillomania and excoriation were found to be
influenced by the same genetic factor, which was different
than OCD, hoarding disorder, and BDD
- Excess cortical thickness in areas related to inhibitory control
has been implicated in trichotillomania - Excoriation - ↑ volume of the ventral striatum, compared to
patients with trichotillomania. Possible involvement of the
reward system with skin picking disorder. - Trichotillomania - ↓ thickness of the right Para hippocampal
gyrus. Possible link to dissociative symptoms
Emotion Regulation Model
* Emotion regulation model states that hair-pulling and skin-picking
behaviours are triggered by negative emotions.
Frustrated Action Model
* Hair-pulling and skin-picking behaviours are triggered by frustration
and boredom
