OCD Flashcards
Part of Exam 2 (on Mar. 24)
As defined by the DSM-V, what are obsessions? What are compulsions?
Obsessions = recurrent or persistent thoughts, urges, or images that are intrusive, unwanted, anxiety provoking, or senseless
Compulsions = urges to perform overt or mental rituals to reduce the distress caused by obsessions or prevent a dreaded event (usually perceived as senseless or excessive by the individual)
What are the diagnostic criterion for OCD? Are both obsessions and compulsions necessary for diagnosis?
The DSM-V now says that you don’t need both obsessions and compulsions for the diagnosis, but Dr. Mattson disagrees
What are the general themes around which researchers have classified obsessions in Obsessive-Compulsive Disorder (OCD)?
The general themes of obsessions can be organized into categories including: contamination; responsibility for harm; uncertainty; taboo thoughts about sex and violence; and the need for order and symmetry
In what ways are obsessions different from other types of repetitive thoughts?
They are unwanted or uncontrollable (the intrude into consciousness), incongruent with the person’s morals, and are resisted (individual believes the thought must be neutralized or avoided, or else something disastrous will happen)
What are the typical categories used to classify compulsions?
Decontamination, checking (or looking for reassurance), repeating routine activities, ordering/arranging, and mental rituals
What are the four separate subtypes of OCD identified by research?
Contamination (w/ decontamination rituals); Responsibility for harm and mistakes (w/ checking rituals); Incompleteness (w/ arranging rituals); Unacceptable violent, sexual, or blasphemous thoughts (w/ mental rituals)
What is symptom accommodation, why might it occur, and in what ways does it contribute to the maintenance of OCD symptoms?
When a loved one participates in the rituals, facilitates avoidance, assumes responsibilities, or resolves problems resulting from the patient’s obsessions and compulsions
- May be done at request, but is usually voluntary (out of love or concern for the patient)
- This behavior perpetuates avoidance and compulsive rituals, which prevent the natural extinction of obsessional fear and ritualistic urges
Why is hoarding no longer considered a form of OCD, but rather a related disorder?
Hoarding involves thoughts of acquiring and maintaining possessions, which aren’t particularly unwanted or intrusive. Plus, excessive saving isn’t an attempt to neutralize obsessional anxiety (and is therefore not compulsive)
What is the difference between ego-syntonic and ego-dystonic symptoms?
Ego-syntonic: individual believes their behaviors to be rational and appropriate (i.e. OCPD and low insight OCD)
Ego-dystonic: symptoms are unwanted, upsetting, and/or personally repugnant
How does two-factor theory purport to account for OCD symptoms?
Step 1: As a result of classical conditioning, situations, objects, thoughts, images, doubts, or impulses that pose no objective threat become conditioned to evoke obsessional fear
Step 2: Avoidance behaviors lead to an immediate (temporary) reduction in obsessional distress, serving as reinforcement for the behavior (this is how OCD symptoms are maintained)
Superstitious Conditioning
Anything present when a bad thing happens can be paired with that bad thing (even non-physical emotions or thoughts)
In general, what do cognitive deficit models of OCD propose as the root of the disorder and from what problems do these models collectively suffer?
Model: proposes that OCD symptoms arise from abnormally functioning cognitive processes, such as deficits in memory, reality monitoring, or cognitive inhibition
Problems:
- doesn’t account for heterogeneity of symptoms
- doesn’t address that similar mild deficits have been found in other disorders
Research suggests that much of the content underlying obsessions in OCD are normal (i.e., occur in the thoughts of non-OCD individuals). What does the cognitive-behavioral model suggest is the reason that these thoughts pose such a problem for those with OCD?
Proposes that normal intrusions develop into clinical obsessions when they are appraised (or perceived) as significant, harmful, and having serious consequences. This perception motivates compulsions (attempts to suppress or remove intrusive thoughts)
In what two ways are compulsive rituals reinforcing in OCD?
1) They are negatively reinforced by their ability to reduce distress
2) They prevent people from discovering that their perception of the intrusive thoughts is exaggerated and unrealistic (and that they do not actually pose danger)
What is the serotonin hypothesis of OCD?
OCD is caused by abnormalities in the serotonin neurotransmitter system, which can be effectively treated with serotonin agonists
What are some problems with biological accounts of OCD?
The Serotonin Hypothesis and Structural Abnormality account do not provide explanations for WHY these things cause obsessive-compulsive behavior
They are also unable to explain why certain themes and content in OC behaviors keep coming up over and over across cases
What are the key features of the cognitive-behavioral model of OCD?
Cognitions: people with OCD cannot tolerate or dismiss unpleasant mental intrusions because they appraise them as threats or abnormalities
Behaviors: compulsions in OCD persist because they are immediately reinforced by a reduction of anxiety
White Bear Phenomenon
Trying to inhibit certain thoughts (not think about something) has a paradoxical effect (it makes you think about it)
This is prevalent in OCD, where the fear of thinking certain things (obsessions) caused those thoughts to occur
What is the psychodynamic model of OCD?
Obsessive-compulsive behaviors represent unconscious conflicts between the id and the superego
- explains the general themes of obsessions (like aggression + sex)
- aligns with the general organization of the brain
What symptoms of OCD did Karen Rusa have in the case study?
- Intrusive, repetitive thoughts (obsessions) about her children’s safety
- Checking/counting rituals intended to avoid anticipated disasters (compulsions)
- Interference with daily life
- Anxiety if rituals aren’t performed
- Recognizes irrationality or excessiveness
What sorts of marriage and parenting difficulties was Karen having?
Her kids were having discipline issues and getting in trouble at school
Her husband, Tony, had health issues that led to unemployment and he doesn’t help around the house
What is the importance of religion in Karen’s social history?
Raised in a religious household with strict guidelines and routines = belief that guidelines must be strictly adhered to or else punishment would follow
Prayer became a mental ritual
What did Karen’s treatment focus on?
Development of interpersonal skills, assertion training, parent education (operant conditioning as a child management strategy), renewed participation in church, ERP
What is exposure and response prevention (ERP)?
A type of exposure therapy for OCD, involving purposefully exposing the individual to anxiety-provoking stimuli and preventing them from performing their rituals
