Sectional 3 Exam Flashcards
Describe the potentially adaptive value of fear and the difference between fear and anxiety (and how this applies across disorders within this topic).
- “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
Explain the fight-or-flight response (including physiological components, e.g. role of amygdala, autonomic nervous system, HPA axis, cortisol).
“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
Identify common, core thinking errors of anxiety disorders.
Thinking errors:
- likelihood
- consequences
Normal vs. Pathological Fears:
- Realistic in this situation?
- Proportional to threat?
- Persist in absence of threat?
- Distressing/impairing?
Explain the role of negative reinforcement, avoidance, and safety behaviors in anxiety disorders.
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
Describe the rationale for and the components of exposure therapy.
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
Explain the difference between panic attacks and Panic Disorder (PD).
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
Identify the key diagnostic criteria of PD (e.g. uncued panic attacks).
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
Identify biological and psychological theories of PD.
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
Describe the concept of anxiety sensitivity and how it relates to PD.
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.”
Identify the most effective treatments for PD.
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
Explain what Interoceptive Exposure is and how it works.
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
Describe how to target physical fears related to PD.
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.
Describe the primary features of Agoraphobia and distinguish it from PD.
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
Describe prevalence and demographics of Agoraphobia and PD.
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
Identify the diagnostic criteria of Specific Phobias.
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.
Name the four categories of Specific Phobias.
- 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
- Seeing blood or an injury or receiving an
Explain how the physiological fear response in blood-injection-injury phobia differs from others, and how this influences treatment.
- 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)
Describe onset, prevalence, and demographics of Specific Phobias.
- 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)
- Some more evenly split (e.g. heights, blood-
- More common in sexual minority groups (e.g.Bostwick et al., 2008)
- No major differences by race/ethnicity (Breslau et al., 2006)
Compare and contrast theories explaining Specific Phobias (genetic component, evolutionary theory biological preparedness, classical and operant conditioning).
Biological Theories
- BII runs slightly more strongly in families than other types
- BII 35% heritable vs. other specific phobias
25-30% heritable
- BII 35% heritable vs. other specific phobias
- 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)
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).
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
Identify the diagnostic criteria of Social Anxiety Disorder (SAD).
- Marked fear about one or more social situations in which the individual is exposed to possible scrutiny of others
- The individual fears negative evaluation
- Actions
- Showing anxiety symptoms
- The social situations almost always provoke fear and anxiety
- The social situations are avoided OR endured with intense fear or anxiety
- The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
- 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
Compare and contrast shyness with SAD.
- 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
Discuss the typical prevalence and course of SAD.
- ~10% (lifetime dx)
- Adolescent/young adult onset
- 80% never seek treatment
- High comorbidity w/ other disorders
- Comorbid depression -> more severe
course/worse outcomes
- Comorbid depression -> more severe
Explain the role of cognitive and behavioral factors in SAD (e.g. avoidance, common cognitive distortions).
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
- Self-focused attention
“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
Identify and be able to apply components of treatments for SAD.
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
Identify the key diagnostic criteria/features of Generalized Anxiety Disorder (GAD).
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)
Differentiate between common worries and GAD.
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.
Describe the typical prevalence, demographics, and course of GAD.
- 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)
- GAD perhaps shares more with depression (GAD
- 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
Explain biological and cognitive theories of GAD.
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 GADfear 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
Describe biological and psychological treatments for GAD.
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
Identify examples of DSM-5 traumatic stressors.
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)
Define Post-Traumatic Stress Disorder (PTSD) and acute stress disorder. Compare and contrast the two.
PTSD Diagnostic Criteria
- Traumatic event PLUS…
- 1+ intrusion/re-experiencing symptoms
- 1+ avoidance symptoms
- 2+ thought/mood change symptoms
- 2+ reactivity symptoms
- Distress/impairment
PTSD = 1+ month
Acute Stress Disorder
- Traumatic event PLUS…
- 9+ symptoms from any category
- Distress/impairment
ASD = 3 days – 1 month
Identify symptom clusters of PTSD.
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
Describe prevalence and demographics of PTSD, as well as factors influencing the course and prognosis of PTSD.
- 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
Explain how PTSD develops according to sociological, psychological, & biological theories.
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
Describe treatments for PTSD and how they work.
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
Explain the difference between obsessions and compulsions; be able to generate and distinguish examples of each.
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
Describe the diagnostic criteria for Obsessive-Compulsive Disorder (OCD).
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.
Describe the prevalence, demographics, and course of OCD.
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%)
Discuss how the biopsychosocial model applies to OCD (e.g. genetic influences, operant conditioning, etc.).
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
Describe common OCD treatment approaches, and explain how components of treatment target maintaining factors.
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
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.
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.
