OCD, PTSD, and Anxiety Flashcards
Introduction
- OCD and PTSD, once conceptualized as anxiety disorders, each get its own chapter in DSM-5.
- How and why do we separate one disorder from another? Why do we
construct distinct categories to explain suffering? - Is it because symptoms are different?
- But what about symptom overlap?
- Is it because each disorder would benefit from distinct treatment?
- But what about treatment overlap?
- Is it because the various disorders each have their own causes?
- But we don’t know/agree on causes.
- Key question: when we categorize distress into different diagnostic labels, what are we seeking to accomplish? In other words, why do we create discrete disorders? What are the consequences of doing so?
Post Traumatic Stress Disorder (PTSD)
To be diagnosed, a person (or loved one) must have been exposed to a traumatic event, involving actual or threatened death, serious injury, or sexual violation.
- Could have occurred to others (e.g. witnessing or learning about it).
- Could involve repeated exposure to details of event.
- But exposure can’t simply happen via electronic media (unless exposure work related).
- Scope of PTSD has widened.
- E.g. ICD-11 introduces CPTSD, whereas DSM 5 has not.
- Four main DSM symptom clusters: re-experiencing, avoidance, arousal, and cognitive/mood
changes.
PTSD – 1. Re-experiencing
- Person experiences feeling that event is
reoccurring. - E.g. Reliving experience, experiencing hallucinations, repetitive play, recurrent dreams.
- Dissociative episodes, like flashbacks:
- Can cause individual to feel detached or unreal, have “déjà vu” or numbness to events.
- Person may experience distress if exposed to a situation that may trigger re-experiencing.
PTSD – 2. Avoidance
- Avoidance of stimuli associated w/ event (e.g. memories, people, objects, thoughts, etc.).
PTSD – 3. Arousal
- Increased arousal & anxiety.
- Recklessness, self- destructiveness.
- Sleep disturbances, trouble concentrating.
PTSD – 4. Cognitive and Mood Changes
- Cognitive and mood changes associated w/ PTSD, including:
- Inability to recall specifics related to event.
- Estrangement.
- Anhedonia.
- Feeling that life is pointless or insignificant.
- Persistent feelings of fear, horror, anger, shame, guilt.
- Like most diagnostic categories, a great degree of heterogeneity possible among those diagnosed w/ PTSD.
An inconvenient diagnosis?
- Veterans’ groups pushed for inclusion in DSM-III (1980).
- Governments often been reluctant to recognize PTSD, why?
- Should we really be sending people off to fight?
- Invincibility of soldiers?
- Cost of treatment?
- Malingering?
- Now there is pressure within some militaries to rename it post-
traumatic stress injury. Why? - PTSD serves as a reminder that what counts as illness, how we
define it, and who legitimizes it are all socially-dependent.
Context matters!
Obsessive Compulsive Disorder (OCD)
- First “neuroses,” then “an anxiety disorder,” OCD independent in DSM-5.
Obsessions: intrusive, recurring thoughts or images that a person
struggles to resist, feeling anxiety over inability to control them.
- May result in physical/social/other consequences.
- Content often socially unacceptable.
Compulsions: thoughts/actions that provide relief from obsessions.
- Often excessive, not realistically connected to obsession.
- Despite irrationality, difficult to resist.
- Recognition that thoughts are unreasonable.
- Only need either obsessions or compulsions for diagnosis.
Other OCD-related disorders
Hoarding Disorder (persistent difficulty & distress discarding possessions due to perceived need).
- Rather than intrusive thoughts, motivated by personal values, and distress over relinquishing objects others see as worthless.
Cooper: why does hoarding specifically deserve its own disorder?
* Many other unwise habits go unpathologized.
* What counts as “junk” is subjective.
* Is this a medical problem? If hoarders had larger homes…
* While some would say that a diagnosis is necessary to indicate that
hoarding could be harmful, is a diagnosis necessary when laws already
exist to deal w/ potential problems?
Somatic Symptom Disorder / Illness Anxiety Disorder
(SSD / IAD)
- SSD’s key criteria:
- At least one chronic somatic symptom that causes excessive preoccupation.
- Symptoms are usually medically unexplained, although excessive worry about explainable symptoms might be enough.
- Although a person may frequently use healthcare services, they don’t necessarily feel better after doing so.
- IAD’s key criteria:
- Heightened bodily sensations.
- Anxiety over a potentially undiagnosed illness.
- “Obsessive” research on illnesses and diseases.
- Not easily reassured by physicians.
*implies there is something wrong with people for not blindly trusting medical authorities
Problematizing SSD and IAD
- Some critique the notion that the person’s problems do not
have to be medically unexplained. Rather, it is a sign of mental illness if worry and thoughts are deemed “excessive.” - “What do we do w/ things that cannot be validated and seen
by medicine (e.g. pain)? - Are we conditioned to obsess and worry over the body?
- Why do we assume that people should always feel better
after accessing healthcare?
Anxiety as a Multidimensional Phenomenon?
- Some have suggested that OCD, PTSD, etc. should be thought of as
anxiety disorders. Why? - Obsessions and compulsions usually accompanied by fear and distress, sometimes to the point of panic.
- Centrality of avoidance.
- In the same way that stress may increase anxiety, it might also increase the likelihood of intrusive thoughts or re-experiencing episodes.
- OCD, PTSD, and anxiety disorders all have high co-morbidity w/ depression.
- OCD and anxiety disorders tend to respond to similar treatments.
- In light of sharing so much w/ the anxiety disorders, should we
understand these things as distinct?
(Case for distinctness on the back)
The Case for Distinctness
- Others: we should categorize distress in most precise and distinct way
possible, separating PTSD and OCD from the anxiety disorders. Why? - Core symptoms (obsessiveness and re-experiencing) as unique.
- Some secondary symptoms of OCD (e.g. magical thinking) also quite different.
- Although anxiety often accompanies obsessions and reliving trauma, the same could be said for many mood disorders, substance use disorders, psychotic disorders, and so on. Following the logic of shared anxiety to its conclusion would mean erasing the boundaries between almost all disorders.
- There are compelling arguments both for imagining all of these disorders as distinct from one another, as well as grouping them together as one.
- Thus, we return to our key questions: why do we categorize psychological distress? What is gained in the process of delineating one disorder from another? What might be lost?
Conclusions: does categorization matter?
- In theory, categorization (in terms of where something appears in the DSM) shouldn’t really affect who is diagnosed.
- What about diagnostic bias?
- Categorization may affect how a disorder is understood and treated.
- What type of interventions? What potential causes? Who should treat it? Being placed alongside another disorder within one chapter might shape how we think about a disorder.
- Issues of identity and self-concept.
- People often form identities around their disorders. E.g. the story of autism spectrum disorder.
- Debates on categorization underscore the ways in which our ideas about mental disorders are constructed, subject to continual change.
