Task 4 - OCD

Question 1

DSM 5

Answer 1

A) presence of obsessions, compulsions or both
B) obsessions/compulsions are time consuming/cause clinically significant distress or impairment in social/occupational/other important areas of functioning
C) not attributable to physiological effects of a substance/other medical condition
D) not better explained by another medical disorder

Question 2

specify if… insight..

Answer 2

1) with good/fair insight: individual recognizes that OCD beliefs are definitely/probably not true or that they may/may not be true
2) poor insight: thinks OCD beliefs are probably true
3) absent insight/delusional beliefs: completely convinced that beliefs are true

Question 3

specify if..tic related

Answer 3

the individuals has a current/past history with a tic disorder

Question 4

Prevalence

Answer 4

• 1 to 3 p of people
• often begins at young age
• peak of age males: 6-15, females: 20-29
• 66p are also significantly depressed
• some studies found higher rates in women, others did not find this

Question 5

symptoms

Answer 5

• most common thoughts: dirt and contamination
• other commons: aggressive impulses, sexual thoughts, impulses to do smth against one’s moral code, repeated doubts
• sometimes compulsion is logically tied to obsession
• magical thinking: believe that repeating behavior will ward off danger to themselves

Question 6

Biological brain theories

Answer 6

• circuit in brain executing primitive patterns of behavior (aggression, sexuality, bodily excretion)
• > begins in orbital region of PFC
• > impulses are carried to caudate in basal ganglia
• strongest impulses flow to thalamus

in OCD: dysfunction
-PET scans show more

Question 7

Biological brain theories

Answer 7

• circuit in brain executing primitive patterns of behavior (aggression, sexuality, bodily excretion)
• > begins in orbital region of PFC
• > impulses are carried to caudate in basal ganglia
• strongest impulses flow to thalamus

in OCD: dysfunction

• PET scans show more activity in this primitive cricuit
• drugs that regulate neurotransmitter seretonin can help (plays role in circuit)
• runs in families

Question 8

Cognitive behavioral theories

Answer 8

-inability to turn off negative, intrusive thoughts because:

1) may be depressed/generally anxious much of the time
2) tendency toward rigid, moralistic thinking -> judge negative, intrusive thoughts as more unacceptable -> feel more responsible
3) believe they should be able to control all thoughts and have trouble accepting that everyone has horific notions from time to time

-compulsions through operant conditioning (if engaging in certain behavior, anxiety is reduced)

Question 9

Biological treatment OCD

Answer 9

• antidepressants effecting levels of seretonin
• Clomipramine was first
• then SSRIs
• 50 to 80p of OCD patients experience decreases
• tend to relapse when discontinue
• side effects

Question 10

Behavioral Treatments - exposure and ritual prevention treatment (ERP)

Answer 10

-exposure and response prevention
-repeatedly expose client to focus of obsession (gradual exposure to triggers) and prevent compulsive responses to resulting anxiety
prevent compulsion -> allows extinction to take place
-client learns that NOT engaging in compulsive behavior does not lead to a terrible result
-improvement in 60 to 90p
-can be adapted to group, self-help, family, computer etc.
–in most clients improvement remains up to 6y

Question 11

OCD subtypes (5)

Answer 11

1) early on-set
2) just-right
3) primary obsessional
4) scrupulosity
5) tic-related

Question 12

Early on-set

Answer 12

• symptom onset before puberty
• higher frequency of tics and other pyschiatric comorbidities
• compulsions often frequent and severe
• strong familial risk

Question 13

hoarding - related disorders

Answer 13

• less insight than in other OCD subtypes
• higher rates of psychiatric comorbidities, especially social phobia
• may be less responsive to psychological treatment
• thoughts about possessions
• > less intrusive/unwanted/distressing than OCD
• > part of natural stream of thought
• anxious, sad or angry when pressured to get rid of possessions
• emotional attachment to possessions
• > equating them with their identity/ giving them human characteristics.

Question 14

just right

Answer 14

• patients wish to have things perfect, certain or under control
• results in need to repeat certain actions until the uncomfortable feelings subside

Question 15

primary obsessional

Answer 15

• 25p lack overt compulsions
• patients are not free from rituals, which may be mental (praying, counting, reciting ‘good words’)
• common themes of obsessions: sex, violence, religion

Question 16

scrupulosity

Answer 16

• religious or moral obsessions
• obsessions focus on whether one has committed a sin, or involves blasphemous (heiliges/göttliches verlästernd/verhöhnend)
• compulsions include prayer, reassurance-seeking, excessive confession

Question 17

tic related

Answer 17

• significant overlap with early onset OCD
• many patients meet criteria for Tourette syndrome
• high comorbid conditions (ADHD, body dysmorphic disorder, social anxiety, mood disorders)

Question 18

CBT

Answer 18

• for patients that find ERP too difficult
• targeting and modifying dysfunctional beliefs about their fears, thoughts and significance of rituals
• beliefs that are challenged:
  1) responsibility appraisal = sufferer believes they are responsible for preventing harmful outcomes
  2) Over-importance of thoughts = believe that having thought about action is like performing it
  3) Exaggerated performance = having inflated estimates of likelihood of outcomes

Question 19

inflated responsibility

Answer 19

• belief that one has power to bring about/prevent subjectively crucial negative outcomes
• > negative outcomes may be actual: that is, having consequences in real world and/or at moral level

Question 20

thought-action fusion

Answer 20

dysfunctional assumption held by OCD sufferers

-> having a thought about an action is like performing it

Question 21

mental contamination

Answer 21

feelings of dirtiness can be provoked without any physical contact with a contaminant

• > can be caused by images, thoughts, memories
• > may be associated with compulsive washing and even betrayal experiences

Question 22

thought suppression

Answer 22

• defense mechanism to suppress obsessive thoughts
• explains why intrusive thoughts are uncontrollable
• actively suppressing unwanted thought -> cause it to occur more frequently (rebound effect)
• suppressing unpleasant thought -> induces strong negative emotional state -> resulting in suppressed thought becoming associated with that negative mood state

Question 23

mood-as-input hypothesis

Answer 23

• people use concurrent mood as info about whether they have successfully completed task or not
• OCD sufferers persevere with compulsive activities until they are certain to have fully completed task
• endemic negative mood is interpreted as providing info that they have not completed task -> so they preserve

Question 24

Article: checking and memory deficits - Radomsky method

Answer 24

• 2 groups:
  1) relevant checking -> kitchen stove
  2) irrelevant checking -> kitchen faucet
• pre test and posttest
• assessed memory confidence, vividness, details and memory source (knowing vs remembering)

Question 25

Article: checking and memory deficits - Radomsky - expectations

Answer 25

- repeated relevant checking -> reduce memory confidence, vividness and detail - irrelevant checking -> no effect - NOT expected that task repetition would lead to decreased memory accuracy

Question 26

Article: checking and memory deficits - Radomsky - findings

Answer 26

- memory accuracy: high for both conditions for pre and posttest - memory confidence - > relevant checking: less confident, reported knowing knobs they checked (source and quality of memory were reduced) - > irrelevant checking: more confidence, remembering knobs they checked

Question 27

Likelihood Thought-act-fusion (TAF)

Answer 27

- belief that having unwanted, intrusive thought increases likelihood that specific adverse events will occur - can involve the self (=Likelihood-Self) or someone else (Likelihood-Other)

Question 28

Moral Thought-act-fusion (TAF)

Answer 28

-belief that having unacceptable, intrusive thought is almost the moral equivalent of carrying out particular act -

Question 29

relation TAF and OCD

Answer 29

- not necessary nor sufficient for maintenance of obsessional thoughts - TAF increases likelihood to misinterpret thought in catastrophic way - believing one's thoughts can have real-world consequences -> transforms normal thoughts in obsessions - TAf could maintain OCD by eliciting urge to neutralize - TAF decreased with successful treatment of OCD

Question 30

difference Normal and abnormal obsessions

Answer 30

-Similar in: form, content, expressed relation to mood and meaningfulness to respondent different in: - frequency -> abnormal obsessions are more frequent and last longer - intensity -> more intense, strongly resisted, threshold of acceptability is higher for abnormal obsessions - consequences -> abnormal obsessions produce more discomfort and provoke more urges to neutralize, also easier to dismiss

Question 31

maximizing exposure therapy - inhibitory learning approach (Craske) - 8 strategies

Answer 31

1) maximize expectancy violation ( regarding frequency + intensity of aversive outcome) 2) Deepened extinction: multiple fear CSs are first extinguished separately before being combined during extinction 3) Occasional reinforced extinction 4) removal of safety signals/behaviors (presence of another person, therapist, cell phone, medications) 5) stimulus variability: vary stimuli and contexts 6) Retrieval cues: use a cue present during extinction or imaginally reinstate previous successful exposures (risk that cues become safety signals) 7) Multiple contexts: - return of fear in context different than therapy 8) reconsolidation: retrieving already stored memories induces reconsolidation

Question 32

difference retrieval cue and safety signal

Answer 32

- retrieval cues: retrieve CS-no US relationship | - safety signals: directly associated with non-occurrence of US

Question 33

inhibitory learning model - CS and US

Answer 33

- original CS-US association is not erased during extinction -> left intact - secondary inhibitory learning: CS no longer predict US After extinction, CS possesses 2 meanings: 1) original excitatory meaning CS-US 2) additional inhibitory meaning CS-no US

Question 34

Related disorders to OCD (4)

Answer 34

1) Hoarding 2) Body Dysmorphic 3) skin-picking 4I Hair pulling

Question 35

Hoarding (as related disorder)

Answer 35

..

Question 36

Body dysmorphic - related disorder

Answer 36

-excessive preoccupation with part of their body they believe is defective -but believe other see it as normal/only slightly unusua l -results in a lot of time spent checking themselves in mirror, hide or change body part or seeking reassurance - women: more concerned with breasts, hips, legs, weight - men: body build, genitals, body hair and thinning hair - 30p attempt suicide - high comorbidity with anxiety, depression, PDs, substance use and OCD - onset: 16y

Question 37

Skin picking - related disorder

Answer 37

- recurrently pick at scabs or places on skin - creating significant lesions that often become infected and cause scars - tend to feel tension before/while attempting to resist impulsive - pleasure/relief when giving in to it - 2-5p - onset: adolescence

Question 38

Hair-pulling - related disorder

Answer 38

- history of recurrent pulling out their hair - resulting in noticeable hair loss - 1-3p - onset: 13y