W5: Obsessive-compulsive & Related Disorders Flashcards
What are obsessions?
Recurrent and unwanted thoughts, images, urges, or doubts that are distressing to the individual
(Thought processes)
What are compulsions?
Repetitive and time consuming mental or overt behaviours that serve to reduce the anxiety/distress caused by the obsessions
Objective: reduce stress
What is OCD characterised by?
Obsessions and compulsions
What does the DSM say about OCD?
The presence of obsessions, compulsions or both
- Obsessions a recurrent and persistent thoughts, urges or images that cause marked anxiety or distress the individual attempts to ignore or suppress these or to neutralise them with some other thought or action
- Compulsions a repetitive behaviours or mental acts that the individual performance aimed at preventing or reducing anxiety or distress or some dreaded event or situation
Obsessions and compulsions must be time consuming and cause significant distress or impairment
Not due to a substance or medical condition or another mental disorder
What is the prevalence of OCD in Australia
2%
When is the typical onset of OCD
Adolescence to early adult hood most develop symptoms by the age of 20
Are there any gender differences in OCD
No there are no gender differences but males are more likely to have childhood onset
What are some types of obsessions and associated compulsions
Cleaning and contamination
Forbidden thoughts or actions
Symmetry
Explain cleaning and contamination obsessions and compulsions
They generally have concerns with dirt or germs bodily waste or contracting a disease as well as environmental contaminants such as lead asbestos or chemicals
Generally perform excessive washing of hands body and environment. May use safety behaviours to encounter feared items such as wearing gloves, using paper towel to touch things and lots of avoidance
Explain the forbidden thoughts or actions type of Obsession and associated compulsions
Intrusive or impulsive thoughts that relate to saying or doing something socially inappropriate, often violent, religious, or sexual in nature
People with this type of obsession often engage in mental ritual such a saying a prayer, reassuring themselves that they are not a bad person, trying to figure out what they would act on the thoughts or whether it was true
Commonly associated with repeating and checking behaviours
Explain the symmetry obsession and associated compulsion
A persistent desire to have objects aligned or actions performed perfectly
They generally have some thoughts about things needing to be a certain way
some have a sense of incompleteness if it is not done this way but others has a fear that something bad will happen
Order and arrange things in a symmetrical ordered fashion may also occur in needing things to be even example if you touch something with your right hand you need to touch it with your left hand too
Which part of the brains to individuals with OCD tend to have a dysfunction in
And over activation in the orbitofrontal cortex, caudate nucleus, anterior cingulate cortex
Which neurotransmitters are involved in OCD
Dopamine and serotonin
What is the OCCWG cognitive model of OCD
Model considers that there are six main cognitive bias is in OCD that maintain symptoms:
Inflated responsibility
Over importance of thoughts so they think they’re more meaningful than they are
Over importance of controlling one’s thoughts
Over estimation of threat which leads to hypervigilance
Intolerance of uncertainty
High levels of perfectionism
What are some controversies surrounding OCD diagnosis
You can be diagnosed with either obsessions or compulsions but the link between them is what is important and differentiates between OCD and things like repetitive behaviours in autistic disorders and compulsive behaviours in impulse control disorders
What is body dysmorphic disorder
A preoccupation with a perceived deficit in physical appearance
Areas of concern often include the face, arms, skin, body hair, breast, muscles
How is body dysmorphic disorder compulsive
They engage in compulsive behaviours to reduce concerns such as checking the mirror or mirror avoidance, measuring body parts, seeking reassurance from others about the body part, camouflaging an area of concern, comparing appearance with others
What does the DSM say for body dysmorphic disorder
Preoccupation with one or more physical deficits or flaws in physical appearance that is not observable or appear slight to others
At some point the individual has performed repetitive behaviours or mental acts in response to the appearance concerns
The preoccupation causes clinically significant distress or impairment and it is not better explained by body fat or weight in an individual who symptoms meet diagnostic criteria for an eating disorder
What is the prevalence of body dysmorphic disorder
2%
When is the typical onset of body dysmorphic disorder
Late adolescence
Are there any gender differences in body dysmorphic disorder
More common in females
Is comorbidity common in body Dysmorphic disorder
Comorbidity with other disorders is common such as anxiety and mood disorders
Explain plastic surgery in body dysmorphic disorder
Clients often present to plastic surgery to fix a concern and are often dissatisfied with the result this leads to a cycle of trying to fix things
How do you tell that it is body dysmorphic disorder and not OCD
If obsessions only concern the perceived defect and compulsions of those commonly seen in body dysmorphic disorder
Not contamination of body parts and cleaning etc
How do you know it is body dysmorphic disorder and not social anxiety disorder
Concerns in social anxiety disorder are related to social evaluation in general
people with body dysmorphic disorder only concerned about social evaluation specific to their perceived flaw in appearance
How do you know it is body dysmorphic disorder and not an eating disorder
If weight or shape is the only concern then an eating disorder maybe the more appropriate diagnosis
What is hoarding disorder
Characterised by the presence of excessive clutter that makes using a home in a normal, reasonable way impossible
It is not distressing to the person but to those around them and can lead to relationship break Downs
It can get to a point where they feel stuck because they have so much and get overwhelmed
What does the DSM say about hoarding disorder
Persistent difficulty in discarding or parting with possessions regardless of the actual value. This is due to the perceived need to save the items and to the distress associated with discarding them
The difficulty in discarding possessions results in the accumulation of possessions that congest and clutter active living areas and compromises their intended use
The hoarding causes clinically significant distress or impairment and it is not attributable to another medical condition or another disorder
When is the typical onset of hoarding disorder
Usually begins in childhood or adolescence but severe hoarding is seen late in life
Are there any gender differences in hoarding disorder
It is more common among men than women but men seek treatment less often than women
What else does hoarding disorder put someone at risk of in their home
Fire hazards and Falls
Explain comorbidity in hoarding disorder
Most clients approximately 90% will meet the criteria for another disorder
Some common comorbidities include MDD (with a reduced motivation to clear things but they will allow someone else to without distress), generalised anxiety disorder, social anxiety disorder, impulse control, ADHD (trouble organising themselves to declutter)
ALSO health conditions such as respiratory issues if it’s animal hoarding with fecal matter
What is trichotillomania?
Characterised by repetitive and uncontrollable hair pulling resulting in noticeable hair loss
May pull at the hair on the head, pubic region, arms, legs, eyelashes and eyebrows
May also ingest the hair causing medical complications
What are the two types of hair pulling in trichotillomania
Focused versus unfocused
Focused is when they’re aware of the behaviour when they are doing it
Unfocused is when they aren’t aware. This is the more common type at 75%
What is excoriation?
Repeated and compulsive picking at skin leading to tissue damage
It must result in tissue damage and cause the person significant distress or functional impairment to be diagnosed
How do you know that it is Excoriation and not body dysmorphic disorder?
Body dysmorphic disorder may also be associated with skin picking but in body dysmorphic disorder this is motivated by an effort to improve appearance
What does the DSM say about trichotillomania?
Recurrent pulling out of ones hair resulting in hair loss
Repeated attempts to decrease or stop pulling hair
Causes clinically significant distress or impairment not attributable to another medical condition or another mental disorder
What is the prevalence of TMM and excoriation
Approximately 1 - 5%
When is the typical onset of TMM and excoriation
After the onset of puberty
TMM and excoriation is an understudied disorder most clients will meet a criteria for an additional disorder what are these
Another obsessive compulsive or related disorder
Mood disorders
anxiety disorders
substance use disorders
eating disorders or
personality disorders
What medication is used for OCD
SSRIs have been shown to be effective
What medication is used for body dysmorphic disorder
SSRIs have been shown to be effective
What medication is used for hoarding disorder
There are no randomised controlled trials at this stage
What medication is used to treat TMM and excoriation?
Medication is not effective
What form of cognitive behavioural therapy is used for OCD
Exposure and Response prevention of compulsive disorder can be extreme and confronting but it works
What cognitive behavioural therapy is used for body dysmorphic disorder
Exposure and Response prevention
What cognitive behavioural therapy is used for hoarding disorder
Cognitive challenging, skills training, stimulus control
This makes them question their thinking patterns and stop getting a sense of reward from hoarding
What cognitive behaviour therapy is used for TMM/excoriation
Stimulus control (behaviour triggered by the presence of some stimuli) and competing response techniques (finding something to do in place of the habit)
What is exposure and response prevention
Involves gradual response to the feared stimuli and preventing the compulsive behaviour until habituation occurs
For example a person with OCD with fears about contamination will touch a dirty floor without washing their hands
A person with body dysmorphic disorder will be asked to walk around in a public area without being able to check their appearance
What is psycho surgery
In extreme cases psychosurgery maybe recommended to OCD this includes things like deep brain stimulation, ablation and capsulotomy
What is deep brain stimulation
Probes send electrical current to the anterior limb of the internal capsule
What is ablation?
Surgical destruction of small regions in one of four areas so that they’re not functioning and the OCD behaviours go away
Interior cingulate
Internal capsule
Limbic
Subcaudate
What is capsulotomy?
Specific lesions to reduce the symptoms of severe medication resistant OCD
A study in 2008 looked at the long-term outcomes in 25 patients approximately 50% of very good recovery however some side-effects include weight gain some executive and short-term memory dysfunction and severe disinhibition
