OCD Flashcards
What are obsessions in OCD?
recurrent and persistent thoughts, impulses or images that are intrusive and unwanted that cause marked anxiety or distress
Do obsessions or compulsions cause marked distress in OCD?
yes, take > 1 hour/day or cause clinically significant distress or impairment in function
What are compulsions in OCD?
Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rigidly applied rules.
Do the compulsions reduce anxiety in OCD?
no they increase it
does OCD spread?
yes
what % of general pop has OCD?
2%
what is the mean onset of OCD?
Mean onset 19.5 years, 25% start by age 14!
what is the ratio for men and women in OCD?
1:1
Do men or women have an earlier onset of OCD?
men
what are the comorbidities in OCD?
> 70% have lifetime diagnosis of an anxiety disorder such as PD, SAD, GAD, phobia
60% have lifetime diagnosis of a mood disorder MDD being the most common
Up to 30% have a lifetime Tic disorder
12% of persons with schizophrenia/ schizoaffective disorder
what is the source of repetitive behaviour in OCD?
anxiety
What are the different types of OCD?
1) Cleaning/contamination (most common) - thoughts of becoming contaminated or accidentally spreading contamination (e.g. public restrooms, shaking hands)
2) Symmetry/Order (e.g. counting steps, taps)
3) Checking (e.g. leaving door unlocked or lights on)
4) Hoarding
5) Purely obsessionals (usually neg): Sexual, harming, religious obsessions and mental rituals
- Different variants may have different etiological pathways
How does one deal with obsessions in OCD?
The person attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (i.e. compulsion)
Do compulsions disregard safety of others in OCD?
no, there is an act of responsibility of safety of others and fear they will be responsible for harm to others
Why do patients with OCD engage in compulsions?
The behaviors or acts are aimed at reducing distress or preventing some dreaded situation however these acts or behaviors are not connected in a realistic way with what they are designed to neutralize or prevent.
What is the etiology theory of OCD?
OCD patients and close relatives show under-activation of areas related to stopping habitual behaviors (e.g. lateral orbitofrontal cortex)
Brain activation in OCD patients for:
Disgust-inducing vs. neutral stimuli (right-top): insula, ACC
Threat-inducing (right-bottom) vs. neutral stimuli: mPFC, basal ganglia
Are there consistent findings for the etiology theory in OCD?
no
What is the heritability estimate for OCD?
26-47%
What are the results of the multi-site family study for OCD?
80 proband cases in 5 specialty OCD clinics and 73 control probands in the community, and their first degree relatives 343 case and 300 control)
5-fold difference in lifetime prevalence of OCD in proband relatives vs. control relatives (11.2% vs. 2.7%)
Case relatives had higher rates of both obsessions and compulsions, but a stronger association with obsessions
Early onset associated with familiality (No cases of OCD symptoms detected in the relatives of probands whose age of onset was 18 or older)
What do twins study show for OCD?
OCD symptoms are substantially greater in MZ twin pairs (80-87%) than DZ twin pairs (47-50%) (Carey & Gottesman, 1981)
What is the most likely answer for heritability in OCD?
Learning OCD actions and thoughts from parents
Arousable one will more likely model than non-arousable child
what are the biological models for OCD?
Genetics
Dysfunctional brain structures
Neurochemistry
What is problematic about the biological theories for OCD?
Mixed results
Lack of replication
Animal studies
Does NOT explain all OCD (Heterogeneities)
Are there medications to treat OCD?
no, OCD will often take SSRIS but not effective
what is the best model for OCD?
CBT:
increased empirical support
Person specific intrusive thoughts
Accounts for heterogeneity
Can explain why ppl may have diff types of fears
What is the process of OCD according to CBT?
- Dysfunctional beliefs
Unwanted cognitive intrusions - Attempt to prevent or suppress thoughts
Efforts leads to compulsions
What are the dysfunctional thoughts of OCD?
Perfectionism – mistakes are intolerable
Overestimation of threat – occurrence of negative events are likely and especially awful
Thought-action fusion - Thoughts, desires, and impulses are equivalent to actions
Inflated sense of responsibility – duty to prevent negative outcomes
Cognitive self-consciousness (CSC) – tendency to focus on thought
what is the process of OCD?
- Have intrusive thoughts, images, urges, and doubts
- misinterpret the threat/significance of intrusions leading to responsibility for actions (harm others)
- leads to engaging in compulsions to neutralize behaviours and causes adverse mood (distress, anxiety, depression)
How does OCD develop?
have a fear and start obsessing
act of compulsions to reduce fears increasing fears enhancing obsessions and starting a cycle
Where do we believe OCD comes from?
- A lot of it is modeling, early life experiences of growing up in env of fear of bad things happening, who I am contributes to how I interpret these experiences
- can also be an early life traumatic event that is out of control and tries to control so nothing else bad will happen to neutralize fear cause something horrible happened to them
- these lead to assumptions /general beliefs causing the cycle
What is the compulsion process of OCD?
Performing compulsions leads to temporary removal of intrusion
1. immediate stress reduction
2. Compulsions reinforced (act of compulsing tells brain there was something to compulse about)
3. Problematic appraisals (must be that thoughts are true= act of doing something reinforces fear)= maladaptive beliefs
4. increases responsibility and anxiety
5. Compulsions trigger obsessions through association (new obsessions related with old one) cause obsessions are amplified= Cycle repeats
what is the Exposure response prevention treatment?
Expose to what they are afraid of and gradually delay compulsional acts
Separate compulsion from obsession= will realize belief goes down even without compulsion
if just leave obsession alone anxiety will go down by itself
What are the OCD related disorders?
Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania
Excoriation Disorder
Prevalence of OCD related disorders:
Body Dysmorphic Disorder-2.4%
9-15% of dermatologic patients
7% of cosmetic surgery patients
10% of patients presenting for oral or maxillofacial
surgery!
Hoarding Disorder- est. 2-6% F<M
Trichotillomania 1-2% F:M 10:1!
Excoriation Disorder 1.4% F>M
What is the categorization of OCD?
Obsessive Compulsive Spectrum
Disorders similar to OCD in:
Etiology
Phenomenology
Response to treatment
increased comorbidity with OCD
Family studies
Impulse control is central
