OCD and related disorders Flashcards
OCD facts and prevalence
less common than anxiety
lifetime prev 2%
- 10% attempt suicide
- equally affects women and men
- typical onset 20ys
- late onset past 30s is VERY RARE
obsessions vs compulsions
obsessions: intrusive and recurring thoughts, impulses, images
- common: contamination, sexual, aggressive, fear of health
- can be checking, procrastination, indecision, doubting
compulsions: repetitive behavs to dec distress caused by obsessions
compulsions worsened by:
1. sense of personal responsibility
2. predicted seriousness of harm
3. beliefs abt probability of harm
cog theories OCD
inability to remember action i.e. lock door, or distinguishing actual vs imagined behaviour
deficits in prospective memory: look forward and remember to perform a task
rachman’s theory of obsessions
misinterpret importance and significance of -ve thoughts
range of cognitive factors .e. inflated self responsibility
thought-action fusion: act of thinking abt event inc likelihood of it happening…thinking is morally as wrong as doing
metacognition
overthink about self, inc self consciousness
genetics in OCD
inc anxiety in relatives…possible genes for OCD
head injury and tumours assoc w OCD
PET finindgs of OCD
inc activation frontal lobe, inc activation basal ganglia
basal ganglia related to tourette’s, which commonly assoc w OCD
neuropsychological testing research
ppl w OCD have attention and memory deficits
impaired executive function
SSRI
suggests OCD is related to dec serotonin
however, SSRI doesn’t work in treatment
psychoanalytic theories of OCD
O and C result from instinctual forces
alref adler: saw OCD occur due to inferiority complex
- to maintain dominance, have compulsive rituals to feel in control
PANDAS
pediatric autoimmune neuropsychiatric disorders associated w strepococcol infections
disorder impacting brain w SUDDENLY onset of symptoms of anx, moody, OCD
may dev ADHD, anxiety disorders, joint pain, temper
negative reinforcement and OCD
reinforced when aversive situation is avoided
action that brings escape is reinforced
ERP
exposure and repsonse prevention: expose self to compulsive act i.e. dirt dish
don’t perform ritual
unpleasant, needs practice time
19% refuse, and has high drop out
assumptions of ERP
ritual is -vely reinforcing, decreases anxiety
exposure allows anxiety to be processed and decrease
cog treatment OCD
combines CBT rather than only cog treatment
client stops ritual to see consequences
dec dysfunctional beliefs
effectiveness: equalyl effective as ERP
issues in OCD treatment
high dropout
CBT sffects abnormal brain region volumes
- thalamus dec, orbito-frontal cortex inc
cingulotomy
surgically destroy 2-3cm white matter in cingulum near corpus callosum
high risk, last resort
bio treatments of ocd
cingulotomy
deep brain stim
psychoanalytic treatment of ocd
uncover repressed conflicts, since O and C protect ego from conflict
hoarding disorder
acquisition and failure to discard, worldwide disorder
strong genetic component
2-5% prevalence, 2x as much as OCD
ppl w hoarding are excited abt new items, while ppl w object obsessions are distresed
features:
1. onset before 20yrs
2. worsens w age
3. 15% have OCD
4. assoc w depression, up to 50%
5. depression may be response to hoarding
cognitive factors of hoarding
faulty info processing: i.e. distractibility, difficulty thinking abt categories
- dysfunctional cognitions abt importance and meanings of items
- emotional deficits lead to misguided attachments
treatments of hoarding
SSNRI: over half ppl respond well
CBT: exposure to not acquiring while discarding
- home visit by therapist
- cog restructure beliefs focused on problem solving, decision aking
- more diff for older adults
body dysmorphic disorder
BDD: preoccupied w imagined defect in appearance, especially face, body, gentials, height
have poor insight and delusional thoughts
characteristics: mirror checks linked to OCD, loose clothes, cover w makeup
mainly women in adolescence
comorbid w : depression, ED, subs abuse
1/5 full remission, high relapse
etiology of BDD
bio factors:
- genetics
- brain volume: dec in orbitofrontal cortex vomume and left anterior cingulate cortex
cog factors:
- focus on unwanted thoughts
- catastrophic interpretation of appearance
- maladaptive efforts to regulate emotions i.e. avoid ppl, wear makeup
treating BDD
behavioural interventions: exposure and response like in OCD
- be in room w mirror w/o looking
cog strats i.e. identify dys thoughts
efficiency: CBT good, SSRI good
trichotillomania
onset: adolesence
- equal for boys and girls, but greater in adult women than men
over day or in long sitting
excoriation
chronic, leads to skin lesions
comofrbid w BDD, depressionm tricho
inc mood, anx, eating disorder
etiology of body focused repetitive disorders
genetics: trich and excor influenced by same gene, which is different from the gene assoc w OCD, hoarding, BDD
emotion regulation model: dec -ve emotions that lead to pulling
frustrated action model: behavs triggered by frustration and boredom
- engaging in behav dec these, so engage more
habit reversal training
for body focused disorders
- awareness training: ID triggers and high risk situations
- response training
- estbalish motivation and support: stim control to reduce things in environ that trigger habit
