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Adv. Psychopathology Final > OCD and Related Dxs > Flashcards

OCD and Related Dxs Flashcards

1
Q

The WHO ranks OCD as one of the 10 most what?

A

Handicapping conditions because of lost income and decreased quality of life

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2
Q

Explain the difference between impulsive and compulsive

A

Impulsive - Temptation that individual falls into independent of the consequences.

Compulsive - Person resists behavior initially but engages behavior to avoid harm being done. They feel driven or pushed to do the behavior. Often, it’s an over-controlled person.

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3
Q

Is OCD ego-dystonic or ego-syntonic?

A

Ego-dystonic. The person doesn’t want to do these things but if they don’t, they believe horrible things will happen.

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4
Q

OCD Criteria:

A. Presence of _______, _________, or both

A

Obsessions, compulsions

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5
Q

Define obsessions. There are two related definitions for DSM criteria.

  1. _______ & ________ thoughts, urges, or images that are experienced, at some time during the disturbance, as _______ & __________ and that in most individuals cause marked anxiety or distress.
  2. The individual _________ or _________ such thoughts, urges, or images, or _________________ (i.e., by performing a ___________).
A
  1. Recurrent & persistent; intrusive & unwanted

2. Attempts to ignore or suppress ; to neutralize them with some other thoughts or action; compulsion

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6
Q

Define compulsions. There are two related definitions for DSM criteria.

  1. _____________ (e.g. hand washing, ordering, checking) or _________ (e.g. praying, counting, repeating words silently) _________________ in response to an obsession, ____________ that must be applied rigidly.
  2. The ___________ are aimed at preventing or reducing ____________, or preventing some ____________; however, these _______________ are either not connected in __________ with what they are designed to neutralize or are clearly _________.
A
  1. Repetitive behaviors; mental acts; that the person feels driven to perform; or according to rules
  2. Behaviors or mental acts; anxiety or distress; dreaded event or situation; behaviors or mental acts; in a realistic way; excessive
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7
Q

OCD
Criteria:

How time consuming are obsessions or compulsions?

OR

They cause clinically significant ________ or _________ in functioning

A

> 1 hr/day

OR

Distress or impairment

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8
Q

OCD
Criteria:

OCD has complex hierarchy rules and the disturbance cannot be better explained by the Sxs of another mental Dx.

Name at least 7. (There are at least 15 in total that could better explain OCD Sxs)

A

GAD - excessive worries

Body Dysmorphic - preoccupation with appearance

Illness Anxiety - preoccupation with having an illness

Paraphilic Dxs - preoccupation with sexual urges or fantasies

MDD - guilty ruminations

Schizophrenia - thought insertion or delusional
preoccupations

Gambling Dx - preoccupation with gambling

Substance Dxs - preoccupation with substances

Disruptive/Impulse Control/ CD - impulses

Autism - repetitive patterns of behavior

Hoarding - difficulty discarding or parting with possessions

Trichotillomania - hair pulling

Excoriation - skin picking

Stereotypic Movement Dx - stereotypes

Eating Dx - ritualized eating behaviors

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9
Q

OCD
Specifiers:

  1. With _____ or _____ insight - Person recognizes that O-C beliefs are definitely or probably not true or that they may not be true.
  2. With ______ insight - Person thinks the beliefs are probably true
  3. With ________ insight/________ beliefs - Person is convinced that the beliefs are true.
  4. Could also be ________ (30% of people with OCD also have a Hx of a this disorder at some point.)
A
  1. Good or fair
  2. Poor
  3. Absent; delusional
  4. Tic-related - current or past Hx of a tic Dx
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10
Q

OCD:

Explain complex motor tics and why they are confounding.

A

They can be vocal or motor and the behavior looks intentional. It’s difficult to determine whether it’s a complex tic or if the behavior is a compulsion. Especially if the individual is not able to articulate what precipitates the behavior.

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11
Q

OCD:

There is a controversy about how many types of OCD there are.
They are generally grouped into these types:

  1. Symmetry & _______ (this is the most common)
  2. Over Responsibility for _______
  3. ______/______ thoughts
  4. Con_______
A
  1. ordering
  2. harm
  3. Forbidden/taboo (aggressive/sexual/religious (scrupulosity) obsessions. Since these are more stigmatized; people are less willing to seek Tx for them.
  4. Contamination
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12
Q

OCD
Basic Info:

Lifetime prevalence:
Course:
Onset for preadolescent and Late adolescent/adult

A

Prevalence: 2.3%
Course: Waxing and waning
Onset for preadolescent: (1/4th of cases)
- More common in males
- More comorbid with Tic and ADHD
Onset for late adolescent/adult: 20-29) more equally distributed across sexes at this age of onset

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13
Q

OCD
Etiology:

Genetic: 1st degree relatives have a _____ greater prevalence than general population and a ____ greater likelihood when male and childhood onset

A

2x; 10x

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14
Q

OCD:

Explain the OCD cycle

A

Obsession (unwanted distressing thoughts, urges, mental images, doubts) ===> Anxiety (feelings of distress, fear, worry or disgust. Feel the need to do something) ===> Compulsions (any behaviors performed to alleviate anxiety, including checking) ===> Relief (temporary relief. Obsessions return) ===> Obsession…

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15
Q

OCD Etiology:

Describe the Cognitive Theory of OCD (4 parts)

A

Thought occurs (the more they try to ignore it the more the thought dominates thinking)

Preexisting cognitive distortions (over-estimating threats. Excessive responsibility)

Performing compulsion (leads to decreased anxiety)

Compulsion decreased anxiety (It gets repeated as a result of reinforcement)

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16
Q

OCD
Treatment:

Name the two types of psychotherapy used for OCD and how they work to treat it.

A

Exposure and Response Prevention (ERP):

  1. Prolonged exposure to obsessive stimuli
    a. In-vivo or imagery
  2. Prevents compulsive ritual

Cognitive Therapy (CT)
(Normally added to ERP)
1. Address cognitive distortions
a. Responsibility for harm; overestimation of danger
b. often includes brief vs. lengthy exposures in the form of behavioral experiments to test beliefs rather than to alter habitual associations.
2. Increased tolerance of distress
3. Decreased drop-out/increased Tx adherence

17
Q

OCD
Treatment:

  1. Explain ERP Tx method in detail.
  2. Does adding CT to ERP increase or decrease efficacy?
  3. For which type of OCD does ERP + CT not work as well for?
A
  1. Therapist establishes good, trusting relationship and then exposes them to the things they fear. They help guide them through not checking, not washing, w/e the therapy is intending to treat. Point is, individual cannot engage with compulsions and therapist helps guide them through the difficulty.
  2. Adding CT to ERP improves efficacy.
  3. Taboo thoughts
18
Q

OCD
Treatment:

Does adding Meds (SSRIs and sometimes antipsychotics) help ERP + CT?

A

Unclear whether they help. Lack of clarity may reflect % of child cases in meta-analysis because meds are less effective for child chases.

When using all 3 (ERP + CT + Meds) 40-60% of patients still report disabling residual Sxs

19
Q

OCD
Treatment:

Why does therapy have to involve family that are involved in individual’s O-C behaviors?

A

Family can often undo what is occurring in treatment because they may be reinforcing the compulsions through enabling patterns of accommodating the individual.

20
Q

Body Dysmorphic Dx (BDD)
Criteria:

  1. ________ ____ ______ _______ or _____ in appearance not observable or perceived as slight by others.
  2. Performs ______ ______ (e.g., mirror checking, excessive grooming, reassurance seeking) or mental acts (e.g., comparing appearance to others) in _______ to _______ _______
A
  1. Preoccupation with perceived deficit; flaw

2. repetitive behaviors; in response to appearance concerns

21
Q

Body Dysmorphic Dx (BDD)
Specifiers:

  1. Same insight specifiers as OCD. What are they?
  2. With ______ dysmorphia specifier. Explain this dysmorphia.
A
  1. Good, fair, poor, or absent.
  2. muscle dysmorphia.
    - Preoccupation with the idea that one’s body build is too small or insufficiently muscular.
    - Specifier is used even if individual is preoccupied with other body areas as well.
    - More common in males
22
Q

BDD
Basic Info:

Prevalence
Sex Ratio
Onset
Course
Risk Factors
A 
Prevalence - 1.9%
Sex Ratio - Equal
Onset - Avg. 16 years
Course - Chronic
Risk Factors - Among U.S. samples recent data suggest sexual minorities may be at elevated risk for BDD
23
Q

BDD
Etiology and Tx:

Etiology: ____ to ____% attributed to _____ factors.

Treatment:

  1. Found _____ (containing Exposure Response Prevention elements) to be effective
  2. SSRIs may be useful but require _________
A

Etiology: 42-44%; genetic factors

  1. CBT
  2. require high dose level
24
Q

Hoarding Dx
Criteria:

A. Persistent difficulty _____ or parting w/ ______, regardless of actual value
B. Due to _______ need to _____ them and ______ when discarding.
C. Results in _______ of possessions that ______ & ______ active living areas, substantially compromising intended use.

A

A. discarding; possessions
B. perceived; save; distress
C. accumulation; congest & clutter

25
Q

Hoarding Dx
Specifiers:

Same insight specifiers for OCD. What are they?

1/2 of the cases have _____ insight

A

Good, fair, poor, absent

poor

26
Q

Hoarding Dx
Basic info:

Prevalence
Course
Comorbidity
Evidence that hoarding presents ________

A

Prevalence: 1.5-5% (more common in older adults

Course: chronic

Comorbidity: ~50% overlap with depression

Evidence that hoarding presents across cultures

27
Q

Hoarding Dx
Treatment:

Explain the multi-modal approach. What are the four elements and what function do they serve?

What is the most important feeling element to help build in a client when treating this Dx?

A

CBT - addresses over valuing of objects.

Behavioral - sorting and graded exposure to discarding objects (Important to engage person in doing this themselves. Without this, they will quickly revert to prior situation.

SSRIs - Calming

Support from the family - Family members work on moderate goals - basic fire safety, sanitation, etc. Not “house beautiful”.

Helping the individual feel that they have control, especially over their lives and their hoarding behavior.

28
Q

OCD Related Dxs:

Trichotillomania is _______ despite repeated attempts to stop.

A

recurrent hair pulling

29
Q

OCD Related Dxs:

Excoriation is _______ resulting in lesions despite repeated attempts to stop.

A

recurrent skin picking

30
Q

OCD Related Dxs
Trichotillomania:

Onset
Course
Prevalence
Gender Ratio

A

Onset: Associated w/ puberty
Course: chronic/wax and wane
Prevalence: 1-2%
Gender Ratio: 10F:1M

31
Q

OCD Related Dxs
Excoriation:

Onset
Course
Prevalence
Gender Ratio

A

Onset: Associated with puberty and often onset associated with dermatological condition
Course: chronic/wax & wane
Prevalence: 1-4%
Gender Ratio: 3/4th of sufferers are female.

32
Q

OCD Related Dxs
Trichotillomania and Excoriation:

  1. Etiology: Genetic _______
  2. Tx - Habit _______. Explain two elements of this treatment.
A
  1. vulnerability. More common in people with OCD and their first degree relatives
  2. reversal.
    a. awareness of when urge is elicited (circumstances that increase risk of picking or pulling)
    b. replace picking or pulling with a competing response
    (behavior competes because the individual cannot engage in both behaviors at the same time)
33
Q

OCD Related Dxs
Trichotillomania:

Behavioral Techniques - Habit _______ - have a large effect size in reducing ______

Medication - has a _____ effect size. Clomipramine (a ___________ anti-depressant) - about the same to slightly better than SSRIs

A

reversal; hair pulling

medium effect size; tricyclic

Adv. Psychopathology Final (7 decks)

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