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Clinical Psychology > W5: Obsessive-compulsive & Related Disorders > Flashcards

W5: Obsessive-compulsive & Related Disorders Flashcards

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1
Q

What are obsessions?

A

Recurrent and unwanted thoughts, images, urges, or doubts that are distressing to the individual

(Thought processes)

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2
Q

What are compulsions?

A

Repetitive and time consuming mental or overt behaviours that serve to reduce the anxiety/distress caused by the obsessions

Objective: reduce stress

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3
Q

What is OCD characterised by?

A

Obsessions and compulsions

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4
Q

What does the DSM say about OCD?

A

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

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5
Q

What is the prevalence of OCD in Australia

A

2%

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6
Q

When is the typical onset of OCD

A

Adolescence to early adult hood most develop symptoms by the age of 20

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7
Q

Are there any gender differences in OCD

A

No there are no gender differences but males are more likely to have childhood onset

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8
Q

What are some types of obsessions and associated compulsions

A

Cleaning and contamination

Forbidden thoughts or actions

Symmetry

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9
Q

Explain cleaning and contamination obsessions and compulsions

A

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

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10
Q

Explain the forbidden thoughts or actions type of Obsession and associated compulsions

A

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

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11
Q

Explain the symmetry obsession and associated compulsion

A

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

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12
Q

Which part of the brains to individuals with OCD tend to have a dysfunction in

A

And over activation in the orbitofrontal cortex, caudate nucleus, anterior cingulate cortex

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13
Q

Which neurotransmitters are involved in OCD

A

Dopamine and serotonin

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14
Q

What is the OCCWG cognitive model of OCD

A

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

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15
Q

What are some controversies surrounding OCD diagnosis

A

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

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16
Q

What is body dysmorphic disorder

A

A preoccupation with a perceived deficit in physical appearance

Areas of concern often include the face, arms, skin, body hair, breast, muscles

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17
Q

How is body dysmorphic disorder compulsive

A

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

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18
Q

What does the DSM say for body dysmorphic disorder

A

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

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19
Q

What is the prevalence of body dysmorphic disorder

A

2%

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20
Q

When is the typical onset of body dysmorphic disorder

A

Late adolescence

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21
Q

Are there any gender differences in body dysmorphic disorder

A

More common in females

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22
Q

Is comorbidity common in body Dysmorphic disorder

A

Comorbidity with other disorders is common such as anxiety and mood disorders

23
Q

Explain plastic surgery in body dysmorphic disorder

A

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

24
Q

How do you tell that it is body dysmorphic disorder and not OCD

A

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

25
Q

How do you know it is body dysmorphic disorder and not social anxiety disorder

A

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

26
Q

How do you know it is body dysmorphic disorder and not an eating disorder

A

If weight or shape is the only concern then an eating disorder maybe the more appropriate diagnosis

27
Q

What is hoarding disorder

A

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

28
Q

What does the DSM say about hoarding disorder

A

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

29
Q

When is the typical onset of hoarding disorder

A

Usually begins in childhood or adolescence but severe hoarding is seen late in life

30
Q

Are there any gender differences in hoarding disorder

A

It is more common among men than women but men seek treatment less often than women

31
Q

What else does hoarding disorder put someone at risk of in their home

A

Fire hazards and Falls

32
Q

Explain comorbidity in hoarding disorder

A

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

33
Q

What is trichotillomania?

A

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

34
Q

What are the two types of hair pulling in trichotillomania

A

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%

35
Q

What is excoriation?

A

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

36
Q

How do you know that it is Excoriation and not body dysmorphic disorder?

A

Body dysmorphic disorder may also be associated with skin picking but in body dysmorphic disorder this is motivated by an effort to improve appearance

37
Q

What does the DSM say about trichotillomania?

A

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

38
Q

What is the prevalence of TMM and excoriation

A

Approximately 1 - 5%

39
Q

When is the typical onset of TMM and excoriation

A

After the onset of puberty

40
Q

TMM and excoriation is an understudied disorder most clients will meet a criteria for an additional disorder what are these

A

Another obsessive compulsive or related disorder

Mood disorders

anxiety disorders

substance use disorders

eating disorders or

personality disorders

41
Q

What medication is used for OCD

A

SSRIs have been shown to be effective

42
Q

What medication is used for body dysmorphic disorder

A

SSRIs have been shown to be effective

43
Q

What medication is used for hoarding disorder

A

There are no randomised controlled trials at this stage

44
Q

What medication is used to treat TMM and excoriation?

A

Medication is not effective

45
Q

What form of cognitive behavioural therapy is used for OCD

A

Exposure and Response prevention of compulsive disorder can be extreme and confronting but it works

46
Q

What cognitive behavioural therapy is used for body dysmorphic disorder

A

Exposure and Response prevention

47
Q

What cognitive behavioural therapy is used for hoarding disorder

A

Cognitive challenging, skills training, stimulus control

This makes them question their thinking patterns and stop getting a sense of reward from hoarding

48
Q

What cognitive behaviour therapy is used for TMM/excoriation

A 
Stimulus control (behaviour triggered by the presence of some stimuli)
and 
competing response techniques (finding something to do in place of the habit)
49
Q

What is exposure and response prevention

A

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

50
Q

What is psycho surgery

A

In extreme cases psychosurgery maybe recommended to OCD this includes things like deep brain stimulation, ablation and capsulotomy

51
Q

What is deep brain stimulation

A

Probes send electrical current to the anterior limb of the internal capsule

52
Q

What is ablation?

A

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

53
Q

What is capsulotomy?

A

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

Clinical Psychology (15 decks)

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