6 - OCD & Related

What is the difference in diagnosis for OCD in DSM-IV and DSM5?

• Used to be part of anxiety disorders

• New category: OC & RD

• Also: body diysmorphic, body-focused repetitive behaviours, olfactory reference disorder

What is excoriation disorder and explain the DSM-5 criteria

• skin picking disorder, under OCRD

• Skin lesions due to skin picking

• Attempts to decrease/stop

• Causes clinically significant distress/impairment in functioning

• Not attributed to substance/other medical condition, not better explained by other mental disorder

What is olfactory reference syndrome and explain the DSM-5 criteria

• false belief of emitting foul body odor

• Culture-related (japan) - expanded

What is hoarding and explain the DSM-5 criteria

• accumulation of possessions due to ↑ acquisition or difficulty discarding possessions

• Excessive acquisition = repetitive urge to buy

• Difficulty discarding = distress w discarding, perceived need to save

• Results in clutter, safety compromised, significant distress/impairment

What are intrusive thoughts?

• unwanted thoughts that cause distress

• 94% of participants experienced in last 3 months

• Intrusive thoughts become obsessional for OCD

What is OCD characterised by? What are the criteria?

• intrusive, recurring, unpleasant thoughts (obsessions)

• Repetitive, irrational behaviours (compulsions)

• Time consuming (more than 1 hr), significant distress/impairment

• 1.6~2.3 lifetime prevalence, fairly equal gender ratio, chronic

• cultural differences (diff OCD compulsions)

What are rituals and how do they differ from OCD?

• rituals are developmentally normal

• E.g. children (2-6 y/o) with rituals

• Adults also have ritualised behaviours

• Becomes issue of concern if causes distress/impairment

Obsessions vs Compulsions

• obsessions: unwanted thoughts, pictures, urges

  • Unpleasant, repetitive - feel out of control, uncomfortable, anxious

  • E.g. violent urges, religious thoughts, need for order, doubts about locking the door

• Compulsions: repetitive physical/mental behaviours/avoidance

  • Feeling of need to do smthn over again, even if you don’t want to or doesn’t make sense

  • E.g. prayer, checking doors, counting/repeating everything

  • Behaviours = safety strategies / neutralising actions (to feel less responsible) / looking for danger (attention/reasoning biases)

Four common OCD themes

• contamination

• Harm

• Order and symmetry

• Unacceptable thoughts

Explain the model of causes of OCD

• generalised psych + bio vulnerability → stress → intrusive thoughts/images/impukses

• Specific psych vulnerability → anxious apprehension / false alarm + learned alarms

• Anxious apprehension → cognitive/behavioural rituals → OCD

Causes OCD

• biological

• Stressful/unpleasant event - learned experience

• Assumptions & belief - cognitive style

What is meant by over valued ideas and how does it contribute to OCD?

• strongly held, rigid/consistent abnormal belief, preoccupying life

  • Idealised value, identified with self, fail to adapt

• Examples: hoarding, appearance, order, symmetry

What is meant by an over inflated sense of responsibility and what ole does it play in OCD?

• obsessions 0 intrusive thoughts

• Vulnerable indv interpret as indicating they may be responsible for serious harm

Explain the cognitive model for checking

• Perceived responsibility + probability of harm + seriousness of harm → anxiety → preventative checking ↑ responsibility & uncertainty → consequences = feeling out of control, lack focus, more careful → strengthen belief about incompetence

Explain how obsession, anxiety, and compulsion interact with each other

• obsessions → anxiety → compulsion → short term relief → obsession …

• Vicious cycle

What is meant by thought action fusion?

• Likelihood TAF = belief that simply having thought about even = more likely to occur

• Moral TAF = thinking about action is morally equivalent to actually performing action

• (Emotional reasoning - reasoning based on presence of emotion)

Two main treatment methods for OCD

• medication (SSRI) - high relapse when discontinued

• CBT (exposure and response prevention - ERP)

What are some problems with medication

• 40-60% patients remain symptomatic/no improvement - non-response

• Side effects with clomipramine

• High rates of relapse after discontinuation

Explain the exposure and response prevention treatment

• Hierarchy of fears

• Exposure - habituation (getting used to feeling)

• Prevent compulsion, aversion, neutralisation

• Task list created, gradual steps