OCD Flashcards
What disorders are within the DSM-5 Obsessive-Compulsive and Related Disorders?
What do these disorders involve?
- OCD
- Hoarding Disorder
- Excoriation (Skin-picking) disorder
- Trichotillomania (Hair-pulling disorder)
- Body Dysmorphic Disorder
OCD and Related disorders involve repetitive behaviours or mental acts and difficulty stopping them
- All are highly comorbid with each other
Describe DSM-5 Hoarding Disorder
A: Persistent difficulty discarding or parting with posessions, regardless of actual value
B: Difficulty due to a perceived need to save items and reduce distress associated with discarding them.
C: Results in the accumulation of posessions that congest and clutter active living spaces and substantially compromises their intended use. If living areas are uncluttered, this is only due to third party intervention.
D: Causes clinically significant distress or impairment in social, occupational, or other areas of functioning (including maintaining a safe environment for self and others)
E: Not attributable to any other medical condition
F: Not better explained by the symptoms of another mental disorder
- Hoarding disorder tends to respond least to treatment compared to others within this category
Describe the Criteria for Trichotillomania
A: Recurrent pulling out of ones hair, resulting in hair loss
B: Repeated attempts to decrease or stop hair pulling
C: The hair pulling causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
D: Hair pulling not attributed to another medical condition
E: Hair pulling is not better explained by the symptoms of another mental disorder
- Maybe associted with particular rituals
- May be triggered by an unpleasant emotion, and usually followed by a pleasant emotion
- Varying conscious awareness
- Varying hair loss patterns
Describe Excoriation (Skin-picking) Disorder and its diagnostic criteria
A: recurrent act of skin-picking resulting in skin-lesions
B: Repeated attempts to decrease or stop skin picking
C: The skin picking causes clinically significant distress or impairment in social, occupational or other important areas of functioning
D: The skin picking is not attributable to the physiological effects of a substance or another medical condition
E: The skin picking is not better explained by the symptoms of another mental disorder
Describe Obsessive Compulsive Disorder (OCD) and the diagnostic criteria
List the 4 dimensions of obsessions identified by factor analytic studies
Obsessions: Anxiety provoking thoughts, urges or images which:
- Are egodystonic
- Lead to efforts to resist/suppress the obsession
Compulsions: Rrepetitive behaviours/mental acts which are performed in response to an obsession to:
- Prevent a feared outcome
- Neutralise anxiety
Criterion A: Compulsions are defined by (1) and (2):
(1) Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
(2) The behaviours or mental acts are aimed at reducing or anxiety or distress, or preventing some dreaded event or situation; however these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralise or prevent or are clearly excessive
Criterion B:
The Obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupation or other important areas of functioning.
Criterion C: The obsessive-compulsive symptoms are not attributable to the physiological effects of substance abuse or another medical condition
Criterion D: The disturbance is not better explained by the symptoms of another mental disorder.
Dimensions: Contamination, Harm, Symmetry/order, Forbidden/Taboo
What maintains OCD?
Operant reinforcement:
Obsession -> Anxiety -> Compulsion -> Relief
Describe the Cognitive theory of Obsessions
- Expansion of Clark’s (1986) cognitive theory of panic
- Intrusive thoughts are nearly universally experienced
- Thought-action fusion (likelihood and morality)
Describe the Cognitive behavioural model of OCD (Salkovskis, 1985)
Obsessions are not qualitatively different from instrusive thoughts in the general population
BUT
Response to thoughts is different
OCD results from misinterpretation of instrusive thoughts
- Believed cognitive theories of OCD were insufficient
- Unpleasant/unwanted intrusions part of normal human experience (but not typically associated with feeling of blame)
- Intrustions start to disturb mood when they are interpreted negatively (may activate pre-existing dysfunctional schema, obsessional thoughts revolve around personal responsibility)
“Impulses are similarly not particularly disturbing unless there is some belief in the possibility that they might be carried through, and blame being likely to fall on the individual as a result of failing to control the impulse”
Compulsions are an attempt to neutralise obsessions
- Avoiding the possibility of blame
- Seeking reassurance = “spreading the responsibility”
What are the 6 cognitive factors associated with OCD
- Inflated sense of personal responsibility
- Intolerance of uncertainty
- Over importance of thoughts
- Overestimate threat
- Need to control thoughts
- Perfectionism
- May involve magical ideation
Describe the Treatment for OCD (Rosa-Alcazar, 2008)
Meta analysis (Rosa-alcazar, 2008) conducted on the effectiveness of ERP, CR and ERP + CR for OCD
- All three treaments were effective
Knopp et al. (2013)
Predictors for worse treatment outcomes included: hoarding, increased anxiety and OCD severity, unemployment, being single/not married
Variables with no association: medication use, age of onset of OCD, educational level
Cognitive strategies for OCD (Whittal & McLean, 1999)
Overestimation of danger: logical vs subjective probabilities; talking to an expert
Inflated responsibility: pie charting; courtroom procedure
Over importance of thoughts: normalising/surveying others; thought sampling
Intolerance of uncertainty/need for control/perfectionism: cost/benefit analysis
Thought action fusion: demonstrating that thoughts does not result in action
Describe the Behavioural experiments that can be introduced in a clinical setting for OCD
Trying to show the patient that their thoughts and actions are completely separate from one another
Often people think that their thoughts CAN’T make positive things happen, but they CAN make negative things happen (try to get them to think really hard about thinking they can break my arm this week, then disproving that event the next session)
Describe Exposure and Response Prevention (ERP)
Most effective treatment for OCD
- Derived from Learning theory (compulsions are essentially safety behaviours)
- Exposure to feared situation, then preventing them from engaging in that safety behaviour (take into account hierarchy of feared situations)
- Not purely behavioural and habituation based
ERP provides the opportunity to disconfirm beliefs
- Making them believe that upon exposure to uncomfortable situation/thought, this feeling can go away on its own if we can refrain from engaging in compulsion
