OCD

Question 1

the vicious cycle of OCD

Answer 1

1. obsessive thought
2. anxiety
3. compulsive behaviour
4. temporary relief

Question 2

what is OCD

Answer 2

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)

Question 3

typical age of onset for OCD

Answer 3

20 years

Question 4

late onset for OCD

Answer 4

early 30s

Question 5

“OCD with good or fair insight

Answer 5

the individual recognizes
that beliefs are definitely or probably not true or that they
may or may not be true

Question 6

OCD with poor insight”

Answer 6

the individual thinks beliefs are
probably true

Question 7

“OCD with absent insight/delusional beliefs”

Answer 7

the individual
is completely convinced that beliefs are true.

Question 8

According to Rachman (2002), three “multipliers” that
increase the intensity and frequency of compulsive
checking are

Answer 8

• An inflated sense of personal responsibility
• The probability of harm if checking does not take place
• The predicted seriousness of harm.

Question 9

Behavioural and Cognitive Theories of OCD

Answer 9

• Learned behaviours reinforced by fear reduction
• Compulsive checking may result from a memory deficit

Question 10

Behavioural Approaches to
Treatment of OCD

Answer 10

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.

Question 11

Inhibitory Learning Model

Answer 11

• 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

Question 12

Cognitive-Behavioural Approaches to
Treatment for OCD

Answer 12

• 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

Question 13

Biological Theories of OCD

Answer 13

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

Question 14

Biological Approaches to
Treatment for OCD

Answer 14

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

Question 15

Psychoanalytic Approaches to
Treatment of OCD

Answer 15

• 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.

Question 16

Hoarding Disorder Specifiers

Answer 16

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

Question 17

prevalence of hoarding disorder

Answer 17

2-5%, twice as prevalent as OCD

Question 18

Etiology of Hoarding Disorder
Cognitive factors:

Answer 18

• 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

Question 19

CBT for Hoarding Disorder

Answer 19

• 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

Question 20

Body Dysmorphic Disorder (BDD)

Answer 20

• 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

Question 21

BDD specifiers

Answer 21

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

Question 22

Treatment of BDD

Answer 22

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.

Question 23

trichotillomania

Answer 23

recurrent pulling out of ones hair
repeated attempts to decrease or stop hair pulling

Question 24

excoriation disorder

Answer 24

recurrent skin picking resulting in skin lesions

Question 25

Etiology of Body-Focused
Repetitive Disorders

Answer 25

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