TASK 4 - OCD

Question 1

OCD

Answer 1

= obsessive-compulsive disorder
= neuropsychiatric disorder; recurrent distressing thoughts and repetitive behaviours/mental rituals performed to reduce anxiety
- anxiety as a result of obsessional thoughts and inability to carry out compulsive behaviours

Question 2

DSM-5

A.

Answer 2

presence of obsessions, compulsions, or both

Question 3

A.

1. obsessions

Answer 3

obsessions are defined by (1) and (2):

1. recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
2. individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action (i.e., by performing a compulsion)

Question 4

A.

2. compulsions

Answer 4

compulsions are defined by (1) and (2):
1. repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralise or prevent or are clearly excessive
–> young children may not be able to articulate the aims of these behaviours or
mental acts

Question 5

DSM-5

B.

Answer 5

obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- impairment

Question 6

DSM-5

C.

Answer 6

obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
- medical exclusion

Question 7

DSM-5

D.

Answer 7

disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalised anxiety disorder; ritualised eating behaviour, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders)
- psychopathological exclusion

Question 8

subtypes

Answer 8

1. with good or fair insight: individual recognises that obsessive-compulsive disorder beliefs are definitely/probably not true
2. with poor insight: thinks obsessive-compulsive disorder beliefs are probably true
3. with absent insight/delusional beliefs: individual is completely convinced that obsessive-compulsive disorder beliefs are true
4. tic-related: individual has a current or past history of a tic disorder
   - contamination fear
   - compulsive checking
   - pure obsessions

Question 9

magical thinking

Answer 9

unreasonable and irrational thought patterns that are characterised by connecting actions and events that have no relation (no relation between obsession and compulsion; does not make them functional)

Question 10

prevalence

Answer 10

1-3% (2.5%)

• begins at young age
• children often hide their symptoms = remain undiagnosed for some time
• 70% report continuous course; 30% waxing-and-waning course
• chronic if not treated
• co-morbidities: 66% of people also have symptoms of depression; high: panic attacks, phobias and substance abuse
• suicide risk is high

Question 11

normal vs. abnormal obsessions

Answer 11

• similar in form and content; relation to mood and meaningfulness to respondent
• different in frequency, intensity and consequences

Question 12

intrusive thoughts

Answer 12

= short, often visual image + unpleasant content

• working mechanisms of OCD
• no control over thoughts –> unconscious product of brain
• we all have intrusive thoughts

Question 13

causes

- biological

Answer 13

• dysfunction in areas of brain that regulate primitive impulses (aggression, sexuality, bodily excretion) –> due to depletion of serotonin
  1. orbital region of frontal cortex
  2. caudate nucleus/basal ganglia –> strongest impulses flow through to thalamus
  3. impulses that reach thalamus motivate to think further about them and possibly act on them
  4. once behaviour executed, impulse diminishes
• system is not able to turn off primitive impulses/execution of behaviour = impulse is not diminished
• primitive impulses break through to consciousness and motivate execution of obsessions more often
• genes increase vulnerability

Question 14

causes

- cognitive-behavioural

Answer 14

inability to turn off negative, intrusive thoughts –> reasons:

1. depressed or generally anxious much of the time –> minor negative events are likely to invoke intrusive thoughts
2. tendency towards rigid, moralistic thinking –> judge their intrusions as more unacceptable –> more anxious about intrusions –> anxiety makes thoughts harder to dismiss (vicious cycle)
3. overestimation of responsibility: feel more responsible for events that happen –> more trouble dismissing thoughts
4. overestimation of control: believe that they should be able to control all thoughts + trouble accepting that everyone has them –> think they are crazy –> more anxious
5. overestimation of risk

Question 15

theories

- learning theory/two factor theory

Answer 15

= at one point association between intrusive thought and anxiety (classical conditioning)
- reinforcement of situation due to avoidance (operant conditioning)

Question 16

theories

- cognitive theory

Answer 16

= thoughts determine emotions + behaviour; how you interpret situation determines your feelings + behaviour

1. situation/trigger (use public toilet)
2. intrusion (contamination, infection)
3. automatic thought = obsession (need to wash hands, otherwise AIDS)
4. emotion (fear)
5. behavioural = compulsions (wash hands over again, don’t use public toilet again)

Question 17

theories

- thought action fusion (TAF)

Answer 17

= if I think about it, I want to/actually do it; belief that unpleasant, unacceptable thoughts influence events in the world

• likelihood TAF: having an unwanted, unacceptable intrusive thought increases the likelihood that a specific adverse event will occur
  a) likelihood self: event is related to oneself
  b) likelihood other: event involves someone else; more closely connected to exaggerated sense of responsibility
• moral TAF: having an unacceptable intrusive thought is almost the moral equivalent of carrying out that particular action

Question 18

theories

- memory distrust

Answer 18

• repeated relevant (checking for turned off stove) does lead to memory distrust (= meta-memory)
• vicious cycle: repeated checking –> memory distrust –> renewed checking …
• also very small declines in memory accuracy
• reasons: repeated checking promotes shift from primary perceptual processing (remembering) to primarily conceptual processing (knowing) –> shift reduces memory vividness and detail = reduce in memory confidence

Question 19

treatment

- biological/medication

Answer 19

antidepressant drugs affecting serotonin levels (SSRI’s)
- 50-80% decreased obsessions and compulsions while on these drugs
- adding an atypical antipsychotic help those who do not respond
x many patients do not respond, relapse is high, side effects

Question 20

treatment

- behavioural

Answer 20

exposure and response prevention therapy:
- repeatedly exposes client to focus of obsession + prevents compulsive responses to the resulting anxiety
- repeated exposure to content of obsession + prevent engaging in the compulsive behaviour –> extinguish anxiety
- often paired with medication
- learn that not engaging in compulsion does NOT lead to terrible result
√ long-term improvement in about 60-90% (can remain for up to 6 years)

Question 21

exposure therapy

- optimisation strategies

Answer 21

1. expectancy violation = exposures that maximally violate expectancies regarding frequency or intensity of aversive outcomes
   - mismatch between expectancy and outcome is critical for new learning + development of inhibitory expectancies that will compete with excitatory expectancies
   - the more the expectancy can be violated by experience, the greater the inhibitory learning.
2. deepened extinction = present two cues during same exposure after conducting initial extinction with at least one of them
   - reduces spontaneous recovery and reinstatement of fear
3. occasional reinforced extinction = occasional CS-US pairings during extinction training
   - benefits from expectancy violation effect
   - may enhance salience of CS –> in turn contributes to new learning about CS
4. removal of safety signals/behaviours
5. stimulus variability
   - less triggers as context varies.
6. retrieval cues = use cue present during extinction
   - difference with safety signal: retrieval cues retrieve CS-no US relationship vs. safety signals are directly associated with non-occurrence of US
7. multiple contexts: conducting interoceptive, imaginal and in vivo exposures in multiple different contexts
8. reconsolidation: retrieving already stored memories –> change memories during reconsolidation
9. affect label = verbalise internal emotions to therapist –> regulate emotion, reduce activity in amygdala