Task 4 - OCD Flashcards
DSM 5
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
specify if… insight..
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
specify if..tic related
the individuals has a current/past history with a tic disorder
Prevalence
- 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
symptoms
- 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
Biological brain theories
- 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
Biological brain theories
- 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
Cognitive behavioral theories
-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)
Biological treatment OCD
- 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
Behavioral Treatments - exposure and ritual prevention treatment (ERP)
-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
OCD subtypes (5)
1) early on-set
2) just-right
3) primary obsessional
4) scrupulosity
5) tic-related
Early on-set
- symptom onset before puberty
- higher frequency of tics and other pyschiatric comorbidities
- compulsions often frequent and severe
- strong familial risk
hoarding - related disorders
- 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.
just right
- patients wish to have things perfect, certain or under control
- results in need to repeat certain actions until the uncomfortable feelings subside
primary obsessional
- 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
scrupulosity
- 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
tic related
- significant overlap with early onset OCD
- many patients meet criteria for Tourette syndrome
- high comorbid conditions (ADHD, body dysmorphic disorder, social anxiety, mood disorders)
CBT
- 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
inflated responsibility
- 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
thought-action fusion
dysfunctional assumption held by OCD sufferers
-> having a thought about an action is like performing it
mental contamination
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
thought suppression
- 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
mood-as-input hypothesis
- 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
Article: checking and memory deficits - Radomsky method
- 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)
Article: checking and memory deficits - Radomsky - expectations
- repeated relevant checking -> reduce memory confidence, vividness and detail
- irrelevant checking -> no effect
- NOT expected that task repetition would lead to decreased memory accuracy
Article: checking and memory deficits - Radomsky - findings
- 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
Likelihood Thought-act-fusion (TAF)
- 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)
Moral Thought-act-fusion (TAF)
relation TAF and OCD
- 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
difference Normal and abnormal obsessions
-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
maximizing exposure therapy - inhibitory learning approach (Craske) - 8 strategies
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
difference retrieval cue and safety signal
- retrieval cues: retrieve CS-no US relationship
- safety signals: directly associated with non-occurrence of US
inhibitory learning model - CS and US
- 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
Related disorders to OCD (4)
1) Hoarding
2) Body Dysmorphic
3) skin-picking
4I Hair pulling
Hoarding (as related disorder)
..
Body dysmorphic - related disorder
-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
Skin picking - related disorder
- 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
Hair-pulling - related disorder
- history of recurrent pulling out their hair
- resulting in noticeable hair loss
- 1-3p
- onset: 13y
