OCD Flashcards
Obsessions
Intrusive and nonsensical thoughts, images, or urges that one tries to resist or eliminate
Compulsions
Thoughts or actions to relieve anxiety associated with obsession
Common OCD Subtypes
Contamination
Checking
Harming
Scrupulosity
Symmetry (superstition)
*Many persons with OCD display multiple obsessions
OCD Prevalence
Affects about 3% of the population
Medication Treatment of OCD
Preferential response to SSRIs (or TCAs with strong serotonin effects such as clomipramine)
Psychological Treatment of OCD
Cognitive-behavioral therapy – Most effective for OCD
Essential: exposure and response prevention (ERP)
OCD Assessment
YBOCS:
Obsession Scale: M=11, SD=3
Compulsion Scale: M=11, SD=3
OCI:
M= 27 SD=13
CBT: Overview
Psychoeducation (specific to each subtype)
ocfoundation.org, adaa.com
Cognitive Therapy
modify appraisals and address core beliefs
Exposure and Response Prevention
confront avoidance behavior (negative reinforcement)
extinguish association between the obsession/anxiety
and the compulsive behavior
Belief Domains (Core Schema) in OCD that Shape Appraisals
Inflated Responsibility
-belief one has power to bring about or prevent negative outcomes
Over-importance of Thoughts (thought-action fusion)
-belief that the presence of the thought indicates it is important
Overestimation of Threat
-exaggeration of the probability of severity or harm
Importance of Controlling Thoughts
-belief that one must be in complete control of intrusive, obsessive thoughts
Intolerance of Uncertainty
Perfectionism
-Belief that if not done perfectly serious consequences may occur
CONTAMINATION SUBTYPE (disgust, anxiety, guilt): Inflated Responsibility
I must remain perfectly clean to protect self and others from harm
CONTAMINATION SUBTYPE (disgust, anxiety, guilt): Over-importance of Thoughts
If I feel it is contaminated then it must be
CONTAMINATION SUBTYPE (disgust, anxiety, guilt): Overestimation of Threat
This contaminated item can lead to serious health consequences
CONTAMINATION SUBTYPE (disgust, anxiety, guilt): Intolerance of Uncertainty
I must be certain that I have not come in contact with that contaminated object
I must be certain that I’ve washed sufficiently to eliminate it
CONTAMINATION SUBTYPE (disgust, anxiety, guilt): Perfectionism
My hands, that object, etc. is either perfectly clean (safe) or contaminated (dangerous)
Treatment: Contamination
Psychoeducation
Cog Restructuring: address specific beliefs and appraisals
Systematic Exposure: – Hierarchy
Imaginal (inoculation)
In-vivo
Imaginal (disastrous consequences)
CHECKING SUBTYPE (anxiety, guilt) Inflated Responsibility
If I don’t check to be sure then I will be responsible if something happens
CHECKING SUBTYPE (anxiety, guilt) Over-importance of Thoughts
I have to control/eliminate this doubt
CHECKING SUBTYPE (anxiety, guilt) Overestimation of Threat
If my doubt is true, then a horrible consequence will happen
CHECKING SUBTYPE (anxiety, guilt) Importance of Controlling Thoughts
I must not feel this way - I can’t tolerate the thought
CHECKING SUBTYPE (anxiety, guilt) Intolerance of Uncertainty
I must make sure my doubt is untrue so I an be certain
CHECKING SUBTYPE (anxiety, guilt) Perfectionism
It must be done completely the way I want it or else it is not good enough
HARMING SUBTYPE (anxiety, guilt, shame) Inflated Responsibility
Belief one has power to bring about or prevent negative outcomes
HARMING SUBTYPE (anxiety, guilt, shame) Over-importance of Thoughts (thought-action fusion)
I must not have this thought – having it is just as bad as doing it
HARMING SUBTYPE (anxiety, guilt, shame) Overestimation of Threat
If I have this thought I will engage in the behavior
HARMING SUBTYPE (anxiety, guilt, shame) Importance of Controlling Thoughts
I must eliminate this thought
HARMING SUBTYPE (anxiety, guilt, shame) Perfectionism
I should never have a harming or aggressive thought
Treatment: Harming
Psychoeducation
Cog Restructuring: address specific beliefs and appraisals
Systematic Exposure:
Cognitive: to the thoughts themselves
In-vivo: cues that trigger obsessions
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Inflated Responsibility
If I do not meet this standard I, or loved ones, will be punished
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Over-importance of Thoughts (thought-action fusion)
If I have blasphemous, immoral thoughts I deserve to be punished
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Overestimation of Threat
Less than scrupulous behavior will lead to danger/punishment
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Importance of Controlling Thoughts
Blasphemous, immoral thoughts must be controlled or else I will be punished
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Intolerance of Uncertainty
Am I religious enough, moral enough?
SCRUPOLISTY – religiosity, morality (anxiety, guilt shame)
Perfectionism
I must be perfectly scrupulous, moral, religious
Anything less than perfect is not good enough
SYMMETRY w/magical ideation/superstition (anxiety, guilt)
Inflated Responsibility
Less than scrupulous behavior will lead to danger/punishment
Blasphemous, immoral thoughts must be controlled or else I will be punished
I must be perfectly scrupulous, moral, religious
Anything less than perfect is not good enough
Treatment Scrupulosity
Psychoeducation
Cog Restructuring: address specific beliefs and appraisals
Systematic Exposure:
Cognitive: to the blasphemous thoughts themselves
In-vivo: cues that trigger obsessions
