Pats Notes Flashcards
Treatment of OCD Medications
SSRIs produce more normal function in caudate nucleus and orbital region. Examples are Prozac and Luvox
◦ SRI (clomipramine)
◦ If medications is the only treatment, it is a problem when you stop taking it.
Exposure with response prevention (ERP) to treat OCD
◦ Remember that compulsions are negatively reinforced because anxiety goes down when you perform it. If you don’t perform the compulsion, that increases the anxiety. In this, expose them to whatever causes fear or anxiety, like a dirty doorknob. Make them touch a doorknob and then prevent them from washing their hands.
◦ The drawback to this is that it is not so effective with people that only have obsessions. It is much better if they have some compulsions as well.
◦ 25% of people refuse to do this treatment.
◦ Between 55 and 85 % of people improve tremendously
◦ 85% responded to ERP and 50% responded to SRI: no increase with combo
◦ OCD is rarely 100% cured; people learn to deal with their symptoms
Body Dysmorphic Disorder
Similar to OCD in some ways, so moved out of the somatiform category and into the OCD and related disorders in the DSM 5
Diagnostic Criteria for BDD
Essential feature is preoccupation with some imagined defect in appearance in a normal-appearing person
▪ Concerned about their skin, hair, nose, eyes, chest, breasts, nipples, stomach, face size or shape, any body part can be the focus of concern.
▪ May be preoccupied with different body parts at different times, several body parts at the same time, can vary.
• Prevalence, gender ratio, age of onset of BDD
◦ 2% is the best guess, tough to say because they don’t go to doctors saying i hate my ears, etc.
◦ 1.3 women for every 1 man. 1.3:1
◦ Most people with BDD are unmarried
◦ Age of onset is late adolescence
Comorbidty associated with BDD
◦ Major Depressive Disorder. About 80% of people with BDD have had depression at some point
◦ Social Anxiety Disorder. Concerned about what other people are going to do and say about your defect
◦ Avoidant Personality Disorder
◦ OCD. About 1/3 of people with BDD also have OCD.
• Comparison to OCD
◦ Both are chronic, occur in late adolescence, appear in the same families
◦ People with OCD have broader concern, while BDD are narrowly focused on their appearance
◦ BDD patients show lower self esteem and more concern about rejection.
Course of BDD
First hate your nose, then hate your eyes after years.
◦ 90% who were diagnosed still had it 1 year later.
◦ 75% did manage to recover over an 8 year period.
• 80% had a history of suicidal thinking, 28% had attempted suicide
• Social, occupational, etc. impairment
• People tend to seek out plastic surgery. Between 8 and 20% of those who go to a plastic surgeon have BDD.
Etiology of BDD Personality traits
High neuroticism: your emotions are a roller coaster, extremely sensitive
◦ Perfectionism, insecurity, and oversensitivity are traits that can cause increased risk of BDD
Sociocultural context and BDD
self-schemas focused on attractiveness as primary attribute. This means that people think that if their appearance is deficient then they are worthless. Not their intelligence, friendliness, warmth, skills, but rather attractiveness are all that matters.
Information processing biases/deficits and BDD
Biased attention and interpretation of information related to attractiveness
◦ Interpret ambiguous facial expressions as contemptuous or angry
◦ Differences in visual processing; focus more on details of the face, whereas normals focus more on the whole face.
Social Anxiety Disorde
Defined as persistent, irrational fear linked to the presence of other people; fear of embarrassment or humiliation
• Prevalence
◦ 1 year: 7%
◦ Lifetime: 12%
Gender ratio for social anxiety disorder
60% are women
Age of onset of social andxiety disorder
Late adolescence -> looking for approval of peers
SES differences and social anxiety
Poor people (50%) more likely to have social anxiety ◦ African/Asian Americans score higher, but not Hispanic
