Sectional 3 Exam

Question 1

Describe the potentially adaptive value of fear and the difference between fear and anxiety (and how this applies across disorders within this topic).

Answer 1

• “Fight-or-flight” response
• Fear is a defense system against immediate threats

Fear vs. Anxiety

Fear:
- Specific emotional response
- Caused by specific, known stimulus
- Caused by external stimulus
- Involves fight or flight

Both:
- An alerting response to perceived threat
- Share biological processes
- Can be adaptive in some situations

Anxiety:
- General mood state
- Caused by vague, unknown stimulus
- Caused by internal stimulus
- Physiological state of readiness for something bad to occur

Question 2

Explain the fight-or-flight response (including physiological components, e.g. role of amygdala, autonomic nervous system, HPA axis, cortisol).

Answer 2

“Fight-or-flight” Response

Amygdala -> Hypothalamus -> Autonomic nervous system or endocrine system -> through autonomic nervous system you go to sympathetic nervous system

Endocrine System:

HPA Axis -> Cortisol & Adrenaline -> Changes in internal organs and muscles

hypothalamus -> pituitary gland -> adrenal cortex (where cortisol is produced

HPA Axis Response

Hormone functions:
Cortisol
- Increase glucose in the blood
- Provide negative feedback to hypothalamus
and pituitary gland to shut of HPA axis
response

Question 3

Identify common, core thinking errors of anxiety disorders.

Answer 3

Thinking errors:
- likelihood
- consequences

Normal vs. Pathological Fears:

1. Realistic in this situation?
2. Proportional to threat?
3. Persist in absence of threat?
4. Distressing/impairing?

Question 4

Explain the role of negative reinforcement, avoidance, and safety behaviors in anxiety disorders.

Answer 4

Avoidance is negatively reinforcing
- In short-term, it reduces anxiety

Safety Behaviors: action to avoid/ reduce anxiety-provoking situations
- Negative reinforcement
- False attribution of safety
- Avoidance of disconfirming evidence

Question 5

Describe the rationale for and the components of exposure therapy.

Answer 5

Best treatment for anxiety disorders
Involves repeated exposure to anxiety-producing stimulus/situation
- Carefully controlled, gradual exposures to
increasingly anxiety-producing
situations/stimuli
- Phases out use of safety aids

Reinforcing cycles

You have an increase in fear and anxiety so you avoid it then you have that increase of fear and anxiety about that particular thing again

Exposure therapy uses this reinforcing cycle to try to reverse it, you have decrease in fear and anxiety so you have exposure which then decreases fear and anxiety

Question 6

Explain the difference between panic attacks and Panic Disorder (PD).

Answer 6

Panic Attacks

• amps up within few minutes
• distinct period (<10 minutes)

4+ symptoms:
1) Heart racing/skipping
2) Sweating
3) Trembling
4) Shortness of breath
5) Choking feeling
6) Chest pain
7) Nausea
8) Dizziness
9) Chills/hot flash
10) Numbness/tingling
11) Derealization/depersonalization
12) Fear of going crazy
13) Fear of dying

Cued (expected) – usually within context of another disorder
Uncued (unexpected) – usually in context of panic disorder

Panic Disorder
- Repeated, unexpected panic attacks
- Two or more uncued panic attacks
- With one other symptom of 3 symptoms

Question 7

Identify the key diagnostic criteria of PD (e.g. uncued panic attacks).

Answer 7

Repeated, unexpected panic attacks
One unexpected attack followed by at least 1 month of any of the following:
- Persistent concern about having another
attack
- Continuous worry about consequences
- A significant change in behavior related to
panic attacks

Not due to substance
Not better explained by medical condition
Not restricted to a phobic context

They can also have cued panic attacks, but they must have at least two uncued panic attacks

Question 8

Identify biological and psychological theories of PD.

Answer 8

Biological Theories & Treatment of PD

• Genetic factors: ~50% heritable
• Neurotransmitters: dysregulated norepinephrine
• Brain structure & function: limbic abnormalities

Psychological Theories of PD

Anxiety Sensitivity (AS): fear of anxiety symptoms
- Physical
- Cognitive
- Social

More attuned to these sensations and thoughts AND interpret them as dangerous

Cognitive-Behavioral Model of PD

Behavioral:
- Avoidance of bodily sensations
- Avoidance of feared situations
Cognitive:
- Attenuation to bodily sensations
- Catastrophic beliefs about bodily sensations

Question 9

Describe the concept of anxiety sensitivity and how it relates to PD.

Answer 9

Anxiety Sensitivity (AS): fear of anxiety symptoms
- Physical
- Cognitive
- Social

“My heart is racing… I’m having a heart attack.”

“Nothing feels real… I’m going crazy.”

Question 10

Identify the most effective treatments for PD.

Answer 10

Antidepressant medications (to prevent)
- e.g. SSRIs (Prozac, Zoloft) or SSNRIs (Effexor)
Anti-anxiety medications (during)
- Benzodiazepines (Xanax, Valium)

(could become a safety behavior though, not really effective)

Cognitive-Behavioral Therapy (most effective treatment for PD)

<-> Thoughts <-> Behaviors <-> Feelings

CBT targets Thoughts and Behaviors

When it targets thoughts it is Cognitive Restructuring

Bring awareness to thinking patterns
- How do your thoughts relate to panic?
Challenge thinking
- Evidence for/against thought
- “How many times have you had a heart
attack during a panic attack?”
- “You’re worried about losing control. What
does it mean to lose control?”
- “What’s the worst-case scenario here?”
- “A thought is just a thought.”
Establish adaptive thinking patterns
- Based in REALITY

When CBT targets Behaviors it is called Interoceptive Exposure

Question 11

Explain what Interoceptive Exposure is and how it works.

Answer 11

It is the part of CBT that targets Behaviors

What does it do?

Normalizes sensations brought on by ordinary exertion or excitement.
Targets cognitive misinterpretation of physical sensations.
- Learn that feared outcome does not happen.

How?

Repeated “exposure” to production of physical symptoms
- Followed by reduction of these symptoms
Tolerance to these experiences increases over time

Interoceptive Exposure treats Panic Disorder through:
- Repeated exposure to distressing physical
symptoms
- Habituation to these physical symptoms
- Targeting catastrophic beliefs about physical
symptoms

Question 12

Describe how to target physical fears related to PD.

Answer 12

You target physical fears related to PD by inducing those physical fears to happen, by spinning in circles to induce dizziness and by having the person walk up and down stairs to induce breathing problems.

Question 13

Describe the primary features of Agoraphobia and distinguish it from PD.

Answer 13

Panic Disorder

Repeated, unexpected panic attacks
One unexpected attack followed by at least 1 month of any of the following:
- Persistent concern about having another
attack
- Continuous worry about consequences
- A significant change in behavior related to
panic attacks

Not due to substance
Not better explained by medical condition
Not restricted to a phobic context

They can also have cued panic attacks, but they must have at least two uncued panic attacks

Agoraphobia

Anxiety about 2+ situations:
- Using public transportation (e.g.,
automobiles, buses, trains, ships, planes).
- Being in open spaces (e.g., parking lots,
marketplaces, bridges).
- Being in enclosed places (e.g., shops,
theaters, cinemas).
- Standing in line or being in a crowd.
- Being outside of the home alone.

Anxiety about 2+ situations IS DUE TO:
- Fear that escape might be difficult or help
might not be available in the event of
developing panic attack symptoms (or other
incapacitating or embarrassing symptoms;
e.g., fear of falling or of incontinence in the
elderly)
- These situations are then persistently
avoided (or require the presence of a
companion or are endured with intense
fear)

Other criteria:
- Situations almost always provoke fear or
anxiety
- Fear or anxiety is out of proportion to actual
danger of the situation
- Distress and/or impairment
- Fear or anxiety lasts for 6 months or more
- Not better explained by another diagnosis

A LOT of comorbidity
- In agoraphobia – fear could be related to having panic attacks, or could be other incapacitating/embarrassing symptoms (e.g. having a seizure and not being able to get help in crowd)
- In PD – may result in avoiding specific places, etc., but not necessarily
- e.g. avoiding exercise because it elicits
similar physical sensations

Question 14

Describe prevalence and demographics of Agoraphobia and PD.

Answer 14

Agoraphobia

• ~50% of people with agoraphobia have history
  of panic attacks, many also have PD
• More common in women than men
• Typical age of onset: early 20s
• Increased substance use

Panic Disorder

-Attacks: 28% lifetime
-Disorder: 3-5% lifetime
-Onset: late teens to mid-30s
-Often: First time -> ER
-Relapsing/remitting
-80% have comorbid condition

• More common in women
  
  • 2.5 women: 1 man
• More common in LGBTQ+ population, especially among men
• Slightly more common in white Americans

Question 15

Identify the diagnostic criteria of Specific Phobias.

Answer 15

A. Excessive or unreasonable fears cued by a specific object or situation.
B. Phobic situation or object must always or almost always produce feared response
C. Fear is out of proportion to actual danger
D. Avoidance OR intense anxiety/distress.
E. 6+ months
F. Distress and/or impairment.

Question 16

Name the four categories of Specific Phobias.

Answer 16

• Animals (or insects)
• Natural environment
• Situational
  These three all produce ‘normal’ physiological fear reactions (e.g. increased heart rate, blood pressure, and adrenaline)
• Blood-injection-injury (BII)
  
  • Seeing blood or an injury or receiving an
    injection

Question 17

Explain how the physiological fear response in blood-injection-injury phobia differs from others, and how this influences treatment.

Answer 17

• Different from other types:
  - Physiological response involves drop in
  blood pressure
  - Much more difficult to treat (because
  habituation can’t happen if you’re passed
  out)

Question 18

Describe onset, prevalence, and demographics of Specific Phobias.

Answer 18

• Specific Phobia: ~11% Lifetime Prevalence
• 62% have comorbid condition
• 90% do not seek treatment
• Onset Varies:
  
  • Most during childhood
  • Some during the mid-20s
• Women ~2x more likely to have specific phobia than men
  
  • Some more evenly split (e.g. heights, blood-
    injection-injury)
• More common in sexual minority groups (e.g.Bostwick et al., 2008)
• No major differences by race/ethnicity (Breslau et al., 2006)

Question 19

Compare and contrast theories explaining Specific Phobias (genetic component, evolutionary theory biological preparedness, classical and operant conditioning).

Answer 19

Biological Theories

• BII runs slightly more strongly in families than other types
  
  • BII 35% heritable vs. other specific phobias
    25-30% heritable
• Temperament (biological basis) characterized by chronic, low-key anxiety
• BII: Applied muscle tension

Psychological Theories:

Behavioral

Classical Conditioning
John B. Watson
- Demonstrated how phobias could be
conditioned
- “Little Albert” experiment

Evolutionary Theory

• Biological preparedness: animals are genetically programmed to fear specific objects.
• “Prepared” Classical Conditioning

Operant Conditioning
- Negative reinforcement
- Avoidance -> decreased anxiety
- Decreased anxiety = short-term reward

Diathesis-Stress Model

Vulnerability (Diathesis) + Stress –> Specific Phobia

Stress - (negative) experiences with object or situation (classical conditioning)

Specific Phobia - maintained via negative reinforcement (operant conditioning)

Question 20

Identify the most effective treatment for phobias and explain their components (e.g. systematic desensitization); apply components of treatment to cases/scenarios (e.g. generate examples of what could be on a fear hierarchy).

Answer 20

Behavioral (Exposure) Therapy
- Fear hierarchy
- Systematic desensitization: The client is gradually exposed to increasingly fear-provoking stimuli
- Repeated trials at each step
- Distress ratings (Subjective Units of Distress, SUDs; 0-100) used to anxiety & highlight habituation

-Flooding: Start with the most intense stimulus. –> great treatment if the client actually sticks with it even though therapist and client have no connection

Question 21

Identify the diagnostic criteria of Social Anxiety Disorder (SAD).

Answer 21

1. Marked fear about one or more social situations in which the individual is exposed to possible scrutiny of others
2. The individual fears negative evaluation
   
   • Actions
   • Showing anxiety symptoms
3. The social situations almost always provoke fear and anxiety
4. The social situations are avoided OR endured with intense fear or anxiety
5. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
6. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
7. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Performance-only
- Public speaking, music/dancing, sports, etc.
- Most common non-clinical fear; for SAD
diagnosis must be beyond what typically
experienced
- Often diagnosed when impairing school or job
performance

Question 22

Compare and contrast shyness with SAD.

Answer 22

• 48% of college students classified as “shy.”
• Only 18% of those had symptoms qualifying
  them for SAD.
• What differentiates shyness from SAD?
• shyness and introversion is typical, though SAD always provokes fear and anxiety, shy people can still be social without fear and it comes without distress or impairment

Question 23

Discuss the typical prevalence and course of SAD.

Answer 23

• ~10% (lifetime dx)
• Adolescent/young adult onset
• 80% never seek treatment
• High comorbidity w/ other disorders
  
  • Comorbid depression -> more severe
    course/worse outcomes

Question 24

Explain the role of cognitive and behavioral factors in SAD (e.g. avoidance, common cognitive distortions).

Answer 24

Biological Theories

Genetic influences: moderately genetic
- Social anxiety/shyness runs in families
- Partially shared w/ negative affect

Neurotransmitters (limbic system):
- Serotonin
- Dopamine
- GABA
- Reduced activity -
- Glutamate
- Increased activity -

• Greater amygdala & insula activation when presented with emotional faces
• Hyperactive prefrontal cortex anticipating social situations, lower when actually in social situations (why emotional over-reaction during social situations)

Cognitive Theories

• Exaggerated likelihood of negative evaluation
• Exaggerated costs of negative evaluation
• Attentional Biases:
  
  • Self-focused attention
    
    • Wholly focused on how they are feeling
    • Bullying themselves

“I got the answer wrong; everyone thinks I’m an idiot.”
“They’re going to avoid me and tell everyone.”

Behavioral Theories

Safety Behaviors:
- Over-prepare for speech
- Avoid eye contact
- Makeup
- Alcohol use
- Phones
- Stay close to familiar people

Question 25

Identify and be able to apply components of treatments for SAD.

Answer 25

Biological Treatments SSRIs and SNRIs have been shown to be relatively efficacious (40-70% response rate) - However, symptoms return when patients stop taking medications Psychological Treatments Cognitive-behavioral therapy* (best treatment) - Cognitive restructuring - Behavioral exposure: in session & in vivo - Test hypotheses - End avoidance cycle - Social skills practice* *Most with SAD already have. adequate/normal social skills - Individual or group CBT Cognitive Restructuring - Identifying automatic thoughts - Directly challenge thoughts Exposure! - Systematic, graduated exposure to feared situations - Both in-session and in-vivo - How does exposure work? - Habituation of fear - Stops reinforcing avoidance - Allows practice of skills - Provides evidence against dysfunctional thoughts/beliefs - Reverse avoidance cycle CBT Group Therapy - Small groups (~6 people) treated together with CBT - Can be more effective than individual treatment because… - Observational learning - It is an exposure! Comparing Treatments Effect for SSRIs ≈ CBT - 50-70% respond - No added benefit of combination Medications may work faster initially, but gains won’t continue if stop taking meds vs. CBT which has lasting benefit

Question 26

Identify the key diagnostic criteria/features of Generalized Anxiety Disorder (GAD).

Answer 26

A. Excessive, uncontrollable worry about a variety of domains, more days that not, for 6+ months B. 3+ associated tension symptoms (more about this on next slide) C. Distress and/or impairment B. 3+ associated tension symptoms: 1. Restlessness, or feeling keyed up or on edge 2. Easily fatigued 3. Difficulty concentrating, or mind going blank 4. Irritability 5. Muscle tension 6. Sleep problems (trouble falling asleep, or restless, unsatisfying sleep)

Question 27

Differentiate between common worries and GAD.

Answer 27

Normative worrying : worries about 1 hr per day GAD worrying: worries about 6 hrs more than that during the day --> uncontrollable worry, "what if?", worry spiral/train --> Often also about ‘little’ things, like being late for appointments, when they’re going to have time to take their car to get washed, etc.

Question 28

Describe the typical prevalence, demographics, and course of GAD.

Answer 28

- 4% (lifetime) - 50% onset in childhood/adolescence - Course is chronic, but fluctuates - Often worse during times of stress - High rates of comorbidities, particularly other anxiety disorders (>50%), mood disorders (~70%), and SUDs (~33%) - GAD perhaps shares more with depression (GAD as “distress disorder” not “fear disorder”; Kotov et al., 2017) - 1.5-2x more common in women - More common in sexual orientation minorities, particularly men - May be moderated by social support - More common in White Americans

Question 29

Explain biological and cognitive theories of GAD.

Answer 29

*Genetic factors*: 15-30% heritable - Inherited vulnerability to internalizing tendencies (including negative affect and/or trait anxiety), not specific to GAD *Neurotransmitters*: - Deficiencies in GABA (inhibitory) -> excessive firing of neurons, especially in limbic system -> excessive worry *People with GAD think about threat constantly* - Over-predict likelihood and cost of aversive outcomes - Under-predict their ability to cope with outcomes *Beliefs about worry* - That it will prevent bad things from happening - Sometimes logical, sometimes not *Cognitive Avoidance Model* GAD participants more likely to endorse: “Worrying about most things I worry about is a way to distract myself from worrying about even more emotional things” - Worries prevent habituation to negative emotions & prevent consideration of ways could cope *Contrast Avoidance Model of GAD* - individuals with GAD fear and avoid sharp or sudden negative emotional contrasts (shift from a neutral or positive emotion to negative emotion) - Worrying sustains negative emotion in order to avoid a sharp negative emotional contrast 

Question 30

Describe biological and psychological treatments for GAD.

Answer 30

Biological Treatments *Benzodiazepines (e.g., Xanax, Valium)* - Short-term relief only, potential safety behavior, addictive, many side effects - Not used long-term *SSRIs (e.g. Paxil) & SSNRIs (e.g. Effexor)* - Reduces anxiety better than benzodiazepines - Reduces anxiety and worry Psychological Treatments: CBT Cognitive restructuring Self-monitor worrying Schedule “Worry time” Worry exposures - Both cognitive and behavioral exposures Relaxation Techniques - Progressive Muscle Relaxation (PMR) - Breathing retraining

Question 31

Identify examples of DSM-5 traumatic stressors.

Answer 31

Criterion A: exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: - Directly experiencing the traumatic event - Witnessing, in person, the event(s) as it occurred to others - Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental - Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposure to details of child abuse)

Question 32

Define Post-Traumatic Stress Disorder (PTSD) and acute stress disorder. Compare and contrast the two.

Answer 32

PTSD Diagnostic Criteria 1. Traumatic event PLUS... 2. 1+ intrusion/re-experiencing symptoms 3. 1+ avoidance symptoms 4. 2+ thought/mood change symptoms 5. 2+ reactivity symptoms 6. Distress/impairment PTSD = 1+ month Acute Stress Disorder 1. Traumatic event PLUS... 2. 9+ symptoms from any category 3. Distress/impairment ASD = 3 days – 1 month

Question 33

Identify symptom clusters of PTSD.

Answer 33

Criterion A: exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event 2. Witnessing, in person, the event(s) as it occurred to others 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposure to details of child abuse) Criterion B: 1+ recurrent intrusion/re-experiencing symptom related to trauma - Intrusive thoughts or memories of the event - Nightmares of (or related to) the event - Flashbacks Criterion C: 1+ symptoms of persistent avoidance External: - Places - People Objects - Situations Internal: - Thoughts - Feelings - Memories Criterion D: 2+ symptoms of thought/feeling changes - Changes in beliefs about self and/or world - Persistent negative emotions - Numbness towards/lack of positive emotions - Detachment or decreased interest in activities Criterion E: 2+ symptoms of altered reactivity - Irritability or outbursts of anger - Reckless or self-destructive behavior - Hypervigilance - Exaggerated startle response - Difficulty falling or staying asleep - Difficulty concentrating

Question 34

Describe prevalence and demographics of PTSD, as well as factors influencing the course and prognosis of PTSD.

Answer 34

- 60-70% exposed to trauma - 7% meet PTSD criteria (lifetime) - Persistent & chronic (unless treated) - Women at 2x risk over men - LGBTQ+ individuals especially high risk - African Americans, White Americans, Hispanic Americans, Asian Americans Burdens of PTSD - Occupational - Social - Distress - Associated problems: - Sleep Disturbance - Depression - Substance Use – WHY? - Suicidality - Anxiety Disorders (Panic) - Only ~40% seek treatment

Question 35

Explain how PTSD develops according to sociological, psychological, & biological theories.

Answer 35

Sociocultural Risk Factors Trauma characteristics - Severity - More severe - Duration - Longer/higher frequency - Proximity - Direct trauma - Social support Psychological Risk Factors Pre-existing beliefs about the world - “Just world” hypothesis Pre-existing distress Coping styles - Avoidance - Substance use - Social isolation Biological Risk Factors Genes - Negative affect? Small hippocampus HPA abnormalities due to prior PTSD Biological Differences in PTSD Physiological hyper-reactivity - Amygdala hyper-reactivity to emotional pictures - Simultaneously - prefrontal cortex decreased activity Increased heart rate response to loud tone - Along with increased secretion of epinephrine and norepinephrine Psychological Maintaining Factors Cognitive factors: Dysfunctional beliefs about self, others, world - Distorted attributions of blame - Often related to just-world hypothesis – backwards reasoning: “since this happened to me, I must’ve done something to deserve it” - Look for “if/then” statements: - If I had fought back harder, I wouldn’t have been raped - If had been more careful, my unit wouldn’t have been attacked - Overgeneralized beliefs - I’m incapable of protecting myself - I can’t leave the house at night - Stereotyping: All _________ are dangerous Behavioral Maintaining Factors Behavioral factors - Avoidance - Behavioral - Cognitive - Social isolation - Substance use

Question 36

Describe treatments for PTSD and how they work.

Answer 36

Biological Treatments *SSRIs*: mixed efficacy, high relapse rate *Benzos*: spotty efficacy, safety behavior Psychological Treatments Efficacious CBT adaptations - Prolonged exposure - Cognitive processing therapy Conditionally Recommended - Eye Movement Desensitization and Reprocessing 40-60% improvement rate Prolonged Exposure (PE) Clients asked to write or audio record narratives of the trauma - Focus is usually on the worst trauma that they experienced if there are multiple, or on the one that impacted them the most Repeatedly confront the trauma by reading or listening to the narrative Also exposure to avoided places or people - VR may be used for this Cognitive Processing Therapy (CPT) CBT-based therapy for PTSD Clients first write a narrative of the impact of the trauma on their lives at the beginning of treatment Otherwise, the bulk of treatment is on identifying and challenging distortions – called “stuck points” - trust, safety, power/control, esteem, and intimacy Also includes behavioral experiments to challenge stuck points They revisit and rewrite the narrative following treatment Eye Movement Desensitization and Reprocessing CBT-based therapy for PTSD Pairs bilateral stimulation with repeated exposure to (PE) and cognitive processing of (CPT) the traumatic memories The bilateral stimulation (left-right eye movements, taps, tones, etc.) is proposed to facilitate information processing and integration Efficacy is controversial *** - Definitely better than nothing/placebo - Mechanism of change may just be exposure and/or cognitive processing – bilateral stimulation may be unnecessary

Question 37

Explain the difference between obsessions and compulsions; be able to generate and distinguish examples of each.

Answer 37

Obsessions: Thoughts, images, or urges experienced as intrusive and unwanted - Recurrent and persistent - Cause anxiety or distress - Individual tries to ignore/suppress or eliminate/neutralize them with some other thought or action (all these are needed for it to be known as an obsession) Compulsions: Repetitive behaviors or mental acts - Individual feels driven to perform in response to an obsession or according to rigid rules - Goal: prevent or reduce anxiety/distress, prevent a feared event or situation - BUT acts are excessive and/or not connected realistically to the feared event Subtype: Symmetry/Exactness Obsession: “I need things to be aligned just right.” “I need to tap my fingers just right.” Compulsion: Put things in certain order Repeat rituals Subtype: Forbidden thoughts or actions Obsession: “I am going to murder my mom.” “I am going to go to hell.” “I am going to stab my child.” Compulsion: Checking Excessive praying Request reassurance Subtype: Cleaning/Contamination Obsession: “I am going to get sick.” “I am going to be contaminated.” Compulsion: Excessive washing Wearing gloves or masks

Question 38

Describe the diagnostic criteria for Obsessive-Compulsive Disorder (OCD).

Answer 38

A. Presence of obsessions and/or compulsions. B. Obsessions or compulsions are time-consuming (more than 1 hour per day) OR cause significant distress or impairment. C. Not better accounted for by another condition, the physiological effects of a substance, or a medical condition.

Question 39

Describe the prevalence, demographics, and course of OCD.

Answer 39

Lifetime: 1.6-2.3% Onset: ~20 years old - Females later than males Gender: Equally common among men and women - Gay men at increased risk Chronic No racial differences High comorbidity rates with anxiety disorders (76%) and mood disorders (63%)

Question 40

Discuss how the biopsychosocial model applies to OCD (e.g. genetic influences, operant conditioning, etc.).

Answer 40

Biological Factors Genetics: Family heritability - Rate of OCD of first-degree adult relatives of individuals with OCD 2x higher than among those without - Negative affect and behavioral inhibition are possible temperamental risk factors Structural factors: - *Caudate* (brain structure involved in suppressing impulses) is smaller & has structural abnormalities in people with OCD - Inability to “turn off impulses” Psychological Factors *Rigid, moralistic thinking* - Guilt and anxiety surrounding thoughts *Failure of thought suppression* *Thought-action fusion* - “Thinking about something unacceptable is the same as doing something unacceptable.” - Very difficult to accept “a thought is just a thought” Behavioral Factors *Behavioral reinforcement* - Compulsions are negatively reinforced - They take away the anxiety and distress Obsessive-Compulsive Disorder: Cycle -> 1. Anxiety -> 2.Compulsion -> 3. Relief -> 4.Obsession -> Social Factors Strong religious or moral beliefs - May be associated with thought-action fusion and increase severity of OCD - Take responsibility for thoughts - Fear of unacceptable thoughts

Question 41

Describe common OCD treatment approaches, and explain how components of treatment target maintaining factors.

Answer 41

Biological Treatments *Selective Serotonin Reuptake Inhibitors (SSRIs)* - Benefit up to 50-80% of OCD patients - Symptoms return when drugs withdrawn Psychological Treatments *Exposure and Response Prevention (ERP)* -Decreased focus on cognitive aspect (logical/rational approach to challenging thoughts) -Increased focus on behavioral exposures - Exposure to the content of obsessions - Exposure to the experience of anxiety - Prevention of compulsive response

Question 42

Identify the key features of other OC spectrum disorders, namely Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania Disorder, and Excoriation Disorder; explain the main similarities and differences between OCD and other OC spectrum disorders.

Answer 42

Commonality – characterized by preoccupations and *repetitive behaviors* or mental acts Body Dysmorphic Disorder Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.  - NOT weight concerns – SPECIFIC perceived defects - Repetitive behaviors (e.g., mirror checking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to appearance concerns. Hoarding Disorder Persistent difficulty discarding or parting with possessions, regardless of their actual value - due to a perceived need to save the items and the distress associated with discarding them Trichotillomania Recurrent pulling out of one’s hair, resulting in hair loss. Repeated attempts to decrease or stop hair pulling. Excoriation Disorder Recurrent skin picking resulting in skin lesions. Repeated attempts to decrease or stop skin picking.