OCD and PTSD

Question 1

What are common features amongst OCD and related disorders?

Answer 1

• Fronto-striatal irregularities
  
  • Differences in processing of threat cues among individuals with OCD compared to controls
• Increased risk for depression
• Inheritance factor

Question 2

Name the primary OCD and OCD related disorders

Answer 2

• Obsessive-compulsive disorder
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania (Hair-pulling disorder)
• Excoriation (skin-picking) disorder

Question 3

Define obsession.

Answer 3

An obsession is intrusive and nonsensical thoughts, images, or urges (and often nonsensical)

Question 4

Define compulsion.

Answer 4

A compulsion is a thought or action to neutralize thoughts (often obsessions)
- Function of compulsive behaviors to reduce anxiety or distress, as well as to prevent feared outcome

Question 5

What are the primary domains of obsessions?

Answer 5

Doubting/Checking (79%)
Need for Symmetry/Order (57%)
Religious & Sexual (30%)
Contamination (26%)
Harming (24%)
   - Accidental
   - Intentional

[Other- 
Nonsensical impulses
Nonsensical thoughts/images
Horrific imagery
"Not just Right" Experience]

Question 6

What are the major domains of compulsions?

Answer 6

Washing/Cleaning
Checking
Counting
Mental Neutralizing
   e.g., internal repetitions, prayers, phrases, etc.
Ordering/symmetry

Question 7

How is OCD assessed?

Answer 7

Yale-Brown obsessive compulsive scale (Y-BOCS)

• 10 item gold standard measure of OCD symptoms
• Clinician administered and self-report versions

Question 8

What is the yearly and lifetime prevalence of OCD

Answer 8

1. 2% yearly

2. 6 lifetime prevalence

Question 9

Describe the gender prevalence of OCD

Answer 9

Male»females in childhood years

females> males in adulthood

Question 10

What is the typical age of onset for OCD?

Answer 10

• typically adulthood
  
  • 25% of cases in early adolescence, but generally diminish

*generally chronic onset

Question 11

What are major causes of OCD?

Answer 11

• Early life experiences (direct, vicarious, or informational)
• Learning that some thoughts are dangerous/unacceptable
• Believing that the thought equals the action
• Classical conditioned anxiety
• Operant conditioning of avoidance
• Intrusive thoughts as significant or threatening

Question 12

Describe the neurocircuitry/biology of OCD.

Answer 12

• Suggested disruption in the cortico-striatal-thalamic-cortical circuit
• Within OCD specifically, difference sin neurocircuitry may reflect difference sin symptom subtypes with different functions for implicated regions

Question 13

What perpetuates OCD?

Answer 13

• Obsessive beliefs
  
  • responsibility/threat estimation
  • importance/control of thoughts
  • perfectionism
• Intolerance of uncertainty
• Overvalued ideation
• Reinforcement from others

Question 14

What psychological treatment is used for OCD?

Answer 14

Psychological treatment

• Cognitive-behavioral therapy is most effective
• CBT involves exposure and response prevention

Question 15

What medical treatment is used in OCD?

Answer 15

Medication treatment

• Clomipramine and other SSRIs – benefit up to 60% of patients
  
  • Relapse is common with medication discontinuation

Question 16

What invasive/surgical procedures are used as treatment in OCD?

Answer 16

• Psychosurgery (e.g., cingulotomy) is used in extreme cases
• Deep brain stimulation (e.g., anterior limb of internal capsule)
• Transcranial magnetic stimulation

Question 17

Describe body dysmorphic disorder.

Answer 17

Characterized by preoccupation and intrusive thoughts related to a perceived physical flaw or abnormality

• Any observable flaws are grossly disproportionate to the degree of distress
• There is often a behavioral response to concerns

Question 18

What mental health risk is elevated in BDD (body dysmorphic disorder)?

Answer 18

Suicide

Question 19

What is the treatment for BDD?

Answer 19

Psychotherapy

• Cognitive intervention to reduce maladaptive beliefs associated with appearance
• Exposure to feared situations
• Attention retraining focused on whole person
• Secondary aim of decreasing preoccupation with “corrective procedures”

Question 20

Define hoarding disorder.

Answer 20

Difficulty discarding possessions regardless of value due to perceived need to save
- Accumulation and saving results in clinically significant impairment or distress

Question 21

What is the prevalence of hoarding?

Answer 21

2-6% point prevalence

Question 22

What is trichotillomania?

Answer 22

Characterized by irresistible urge to pull or pluck hair

• Followed by subjective sense of relief or pleasure
• Pulling is commonly from scalp, but may include eyebrows, eyelids, and forearms

Question 23

What is the yearly prevalence for trichotillomania?

Answer 23

1-2% yearly

10:1 female to male

Question 24

Describe excoriating

Answer 24

Picking often in response to subjective sensation on skin, including past picked areas

• Picking is not done to relieve subjective sense of anxiety
• Described as pleasurable; done until a subjective sense of satisfaction is reached

Question 25

What is the lifetime prevalence of excoriating?

Answer 25

Lifetime prevalence of 1.4%

Question 26

Define PTSD.

Answer 26

- Witness or experience a traumatic or life-threatening event - Symptoms from each of four “clusters”: - Intrusions - Avoidance - Alterations in cognition/mood - Hyperarousal - Symptoms last for more than one month - Impairment and/or distress - Specifiers for “depersonalization” and “derealization”

Question 27

What is the rate of trauma in the U.S.?

Answer 27

60%

Question 28

What is the yearly and lifetime prevalence of PTSD?

Answer 28

lifetime: 8.7% yearly: 3.5% * trauma does NOT equal PTSD

Question 29

Define trauma.

Answer 29

The person was exposed to the following event(s): - Death or threatened death - Actual or threatened serious injury - Actual or threatened sexual violence

Question 30

What are the intrusion criteria for PTSD?

Answer 30

1 symptom of intrusion: - Recurrent, involuntary and intrusive distressing memories of the traumatic event(s) - Recurrent distressing dreams in which the content and/or affect of the dream is related to the event(s) - Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event were recurring. - Intense or prolonged psychological reaction to traumatic reminders - Marked physiological reactivity to traumatic reminders

Question 31

What are the avoidance criteria for PTSD?

Answer 31

1. Efforts to avoid distressing thoughts or feelings closely associated with the traumatic event(s) 2. Efforts to avoid external reminders (e.g. people, places, conversations, activities, objects or situations) - began or worsened after event(s)

Question 32

What are the negative alterations in cognition associated with PTSD?

Answer 32

Need 2 of the following: - Inability to remember an important aspect of the traumatic event (typically dissociative amnesia; not due to head injury, alcohol or drugs) - Persistent & exaggerated negative expectations about one’s self, others or the world (e.g. “I am bad,” “no one can be trusted,” etc.) - Persistent distorted blame of self or others about the cause or consequences of the traumatic event (e.g. self-blame) - Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). - Markedly diminished interest or participation significant activities - Feeling detached or estranged from others - Persistent inability to experience positive emotions (e.g., unable to have loving feelings)

Question 33

What are the alterations in arousal that are association with PTSD?

Answer 33

At least 2 needed: 1) Irritable or aggressive behavior (e.g. yelling at other people, getting into fights or destroying things) 2) Reckless or self-destructive behavior (e.g. driving too fast or while intoxicated, heavy drug or alcohol use, risky sexual behavior, or trying to injure or harm oneself) 3) Hypervigilance 4) Exaggerated startle response 5) Problems in concentration 6) Sleep disturbance associated with falling asleep, restless sleep or staying asleep

Question 34

What is the gold standard for PTSD assessment?

Answer 34

- Clinician Administered PTSD Scale | - “Gold standard” semi-structured clinical interview

Question 35

What are the causes of PTSD?

Answer 35

- Intensity of the trauma and one's reaction to it (i.e., true alarm) - Learn alarms – direct conditioning and observational learning - Biological vulnerability - Uncontrollability and unpredictability - Extent of social support, or lack thereof, post-trauma

Question 36

What are the multiple forms of impairment associated with PTSD?

Answer 36

- Employment-related problems - Family dysfunction - Increased risk for suicide

Question 37

What are common presentations of PTSD?

Answer 37

``` Anxiety and fear predominant Disgust predominant Guilt/shame predominant Anger and aggression predominant Sadness and dysphoria ``` Isolation and avoidance is common across all presentations

Question 38

What are effective psychotherapies for PTSD?

Answer 38

- Prolonged Exposure (Strongest evidence; first-line tx) - Cognitive Processing Therapy (Strongest evidence; first-line tx) - Stress inoculation training - Trauma-focused psychodynamic therapy - Hypnosis (to promote desensitization) - EMDR

Question 39

Describe the learning theory for PTSD.

Answer 39

- Traumatic event = True Alarm - Behavioral and emotional avoidance reinforces the response (operant conditioning) - Anxiety and intrusive symptoms become conditioned aversive stimuli - Repeated exposure to objectively harmless conditioned stimuli, including the traumatic memory, leads to extinction of anxiety and fear responses

Question 40

What drugs are suggested in PTSD?

Answer 40

- SSRIs | - SNRIs