Chapter 6: OCD

what are the disorders associated with a feeling of stuckness? (5)

• somatic symptom disorder: have disorder/symptoms, but think it’s worse than it is

• illness anxiety: excessively worrying about becoming ill

• psychological factors affecting medical condition: you have a medical condition, but some psychological factors make it worse

• functional neurological symptom disorder: have symptoms as if you had the condition, but you don’t to obtain psychological rewards (not consciously done)

• factitious disorder: faking/exaggerating symptoms to get external rewards

define “somatic symptom disorder”

when you have a symptom, but believe that it’s a sign of something terrible (ex: having a headache and thinking you have a brain tumour)

what are the diagnosis criteria of somatic symptom disorder? (3)

1. somatic symptoms: the symptoms are distressing and cause disruption in daily life

2. excessive thoughts: feelings and/or behaviours are

   1. disproportionate: persistent and excessive

   2. high anxiety

   3. excessive time and energy

3. persistent symptoms: +6 months

true or false: somatic symptom disorders can be fueled by the internet

true

define “somatic symptoms”

manifestation of physical symptoms often caused by stress or emotions

define “illness anxiety”

worrying excessively that you will become ill

• even though you have no physical symptom

• even when it’s a normal body sensation or something minor

the [excessive anxiety/physical symptoms] cause distress for someone with illness anxiety disorder

the excessive anxiety (they might not even have a physical symptom)

why do people with illness anxiety seek out doctors instead of psychologists?

because they think that the cause is medical (and when the doctor doesn’t find anything, they get referred to a psychologist)

what are the diagnosis criteria for illness anxiety disorder? (5)

1. excessive worry

2. minimal somatic symptoms

3. high health anxiety (worry about health issues)

4. maladaptive health behaviours

5. duration: +6 months

what are some maladaptive health behaviours found in illness anxiety disorder?

always checking your body for illness OR avoiding doctors

true or false: some events can be markers for illness anxiety disorder

true

what are the causes of somatic symptom disorder? (5)

• if your family always worried about their health

• thinking that it’s unpredictable and uncontrollable (and that you need to watch out)

• after a stressful period

• a lot of illness in your family

• positive consequences (worrying = taking care of yourself)

what does psychoanalysis think of somatic symptoms disorders?

that the symptoms aren’t the real problem, they hide the unconscious (real) problem

why do people with somatic symptoms disorder don’t seek psychological help?

they believe that their root of their problem is physical, not psychological

true or false: CBT doesn’t have any effect on somatic symptoms disorders

false: it does work but modestly

define “functional neurological symptom disorder”

having symptoms that look like you have a condition, but you don’t

what are the usual “symptoms” people with functional neurological disorders show? (5)

• functional seizures

• functional sensory symptoms (blindness, double vision)

• paralysis

• functional movement disorders

• functional speech disorders

what’s the difference between somatic symptom disorder and functional neurological symptom disorder?

• somatic: you have symptoms but not the condition associated

• functional: presenting as if you have a condition (you don’t actually have the conditions, only the symptoms)

what are the diagnosis criteria for functional neurological symptom disorder? (4)

1. symptoms alter motor or sensory function

2. incompatibility between the symptoms and a neurological/medical condition

3. symptoms aren’t better explained by another disorder

4. symptoms cause distress and impairment

what are the characteristics of functional neurological symptom disorders? (5)

• rare

• more likely in women

• likely in military after combat

• more likely to be seen by neurologists

• impacted by culture

according to Freud, how can psychological symptoms be converted into physical symptoms (and cause functional neurological disorders)?

• you experience a traumatic event

• you try to repress the event and make it unconscious

• what’s being repressed will be converted into physical symptoms

according to Freud, how could you solve neurological symptom disorders?

with catharsis: make conscious what was repressed

define “factitious disorder”

consciously acting as if you have an illness even though you aren’t sick

why do people with factitious disorder act like they have a disorder even though they are healthy?

not sure, but possibly because they unconsciously want to gain sympathy and be treated like a patient

define “malingering”

lying about medical presentation to get access to a resource

what’s the difference between functional disorder, factitious disorder and malingering?

• functional: real symptoms, not consciously produced

• factitious: induced symptoms, for psychological reasons (attention)

• malingering: fake or exaggerated symptoms, for external reward (financial help)

why do we think OCD has evolutionary advantages?

it’s easier to survive if you’re organized

define “obsessive-compulsive disorder” (OCD)

• obsessions: unwanted, intrusive thoughts

• compulsions: repetitive behaviour performed to reduce anxiety

how is obsessions different from phobia?

• obsessions: internal stimulus causes anxiety

• phobia: external stimulus causes anxiety

define “obsession”

intrusive, persistent and unwanted thoughts or urges that trigger intense anxiety

what are the types of obsessions for OCD? (4)

• need for symmetry and order

• forbidden or taboo thoughts

• cleaning and contamination

• hoarding

define “compulsisions”

repetitive behaviours or mental acts that you feel like you need to do in response to an obsession in order to reduce distress

true or false: compulsions can permanently reduce the distress caused by obsessions

false: it’s only temporary

what are the types of compulsions? (5)

• washing and cleaning

• checking (locks, appliances)

• ordering and arranging

• mental rituals (counting patterns, prayers)

• seeking reassurance

what’s the difference between “cleaning and contamination” (obsession) and “washing and cleaning” (compulsion)?

• cleaning and contamination: worrying about germs, diseases after touching things

• washing and cleaning: repeatedly washing hands, showering or cleaning things

what’s the difference between “need for symmetry and order” (obsession) and “ordering and arranging” (compulsion)

• need for symmetry and order: urge to have things in a precise arrangement

• ordering and arranging: arranging objects in a specific order

→ need VS action

what are the DSM5 criteria for obsessions? (4)

1. recurrent and persistent thoughts are intrusive and unwanted, which causes anxiety or distress

2. trying to ignore or suppress the thoughts OR neutralizing the thoughts with other thoughts or actions (compulsions)

3. repetitive behaviours or mental acts that must be applied

4. behaviours or mental acts are aimed to prevent or reduce stress but the acts aren’t connected in a relativity way to what they are trying to prevent

what are the obsessions (2) and compulsions (2) associated with symmetry/exactness?

obsession:

• need things to be symmetrical, aligned

• urge to do things over until they are right

compulsion:

• putting things in a certain order

• rituals

what are the obsessions (2) and compulsions (3) associated with forbidden thoughts?

obsessions:

• fear, urges to harm self or others

• fear of offending god

compulsions:

• checking

• avoidance

• repeated requests for reassurance

what are the obsessions (2) and compulsions (2) associated with cleaning and contamination?

obsessions:

• germs

• fear of germs or contaminants

compulsions:

• repetitive or excessive washing

• using gloves or masks to do daily tasks

what are the obsessions (1) and compulsions (1) associated with hoarding?

• obsession: fear of throwing things away

• compulsion: collective or saving objects with little or no sentimental value

define “psychological factors affecting medical conditions”

diagnosed medical condition is worsened because of a psychological or behavioural factor

*related to somatic symptom disorder

what are the DSM5 diagnostic criteria for factitious disorder? (4)

1. falsification of physical or psychological symptoms (deception)

2. presenting as ill, impaired or injured

3. deceptive behaviour is evident even in the absence of external rewards

4. behaviour isn’t better explained by another mental disorder (delusion, psychotic)

what are the possible episodes for factitious disorder? (2)

single and recurrent (two and more)

how can you treat factitious disorder? (3)

• identify traumatic or stressful life event

• removing the gain

• cognitive-behavioural therapy

what are the DSM5 diagnostic criteria for OCD? (4)

• presence of obsessions and/or compulsions

• obsessions or compulsions are time-consuming or cause significant distress or impairment

• OC symptoms are not attributable to physiological effects of a substance or another medical condition

• disturbance isn’t better explained by another mental disorder

what should you specify when making an OCD diagnosis? (4)

• tic-related: current or history of tic disorder

• good or fair insight: person thinks that their OCD beliefs are not true/may not be true

• poor insight: person thinks that their OCD beliefs are probably true

• absent insight/delusional beliefs: person is convinced that their OCD beliefs are true

*OCD belief like “i need to wash my hands 10 times to get rid of the germs”

true or false: tics can be compulsions

true

what are the treatments for OCD? (4)

• SSRI and clomipramine (inhibit reuptake of serotonin)

• exposure and ritual prevention (ERP): gradually exposing patient to feared thought or situation

• CBT: make the patient see the threats differently

• psychosurgery

true or false: drugs used to treat OCD are more efficient than exposure and ritual prevention

false: adding ERP after starting SRRI is more efficient (especially if there is a later withdrawal of SSRI)

define “body dysmorphic disorder” (BDD)

preoccupation with some imagined defect in appearance by someone who looks typical

what are the DSM5 diagnostic criteria for body dysmorphic disorder? (4)

1. preoccupation with one or multiple flaws in physical appearance that aren’t apparent to others

2. repetitive behaviour or mental acts in response to appearance concerns

3. preoccupation causes significant distress or impairment

4. preoccupation isn’t better explained by concerns with body fat or weight (for those meeting criteria of eating disorder)

define “muscle dysmorphia”

preoccupation with idea that body is too small or not muscular enough

what should you specify when making a diagnosis for body dysmorphic disorder? (4)

• muscle dysmorphia

• good or fair insight: person thinks that their body dysmorphic disorder beliefs are not true/may not be true

• poor insight: person thinks that their body dysmorphic disorder beliefs are probably true

• absent insight/delusional beliefs: person is convinced that their body dysmorphic disorder beliefs are true

define “trichotillomania”

pulling our your hair from anywhere on your body (scalp, eyebrows, arm…)

define “excoriation” (skin-picking disorder)

repetitive and compulsive picking of the skin

what are the features of OCD? (6)

• developed earlier in boys

• during adulthood, more prevalent in women

• high comorbidity with anxiety disorders and depression

• chronic course (tends to last)

• internally generated thought (instead of external factor)

• thought-action fusion: thought will cause the outcome

define “thought-action fusion”

magical belief that thoughts can cause an outcome you’re trying to avoid

what are the causes of OCD? (3)

• genetics: parents give you genes but also shape environment you grow up

• learning: bad thoughts = bad consequences

• unconscious (Freud)

how do we know that OCD has a heritable component? (2)

• family studies: OCD is more common among first-degree relatives

• twin studies: heritability for OCD is 45%-65% (high)

how can OCD be “learned”? (3)

• early experiences that some thoughts are dangerous and unacceptable

• misinformation: threat is perceived higher than it actually is

• consequence of thought suppression: more suppression = makes you think about it even more; avoidance = more anxiety

what happens during the anal stage fixation and what happens if the stage isn’t resolved?

• kid experience conflicts related to control and cleanliness

• if not resolved: OCD, anxiety, depression

what’s the defense mechanisms associated with OCD conflicts?

reaction formation: transformation an unacceptable impulse into something opposite (ex: a pedophile being against child pornography)

how does Freud perceive compulsions and obsession?

they have symbolic meanings and reflect deeper issues that aren’t consciously acknowledged

what are the steps of the development of OCD? (4)

1. presence of biological and psychological vulnerabilities

2. believing that some thoughts are unacceptable and need to be suppressed

3. experiencing higher degree of anxiety or unacceptable thoughts

4. engaging in cognitive or behavioural strategies to neutralize thoughts

explain Karen’s OCD (prof’s patient, obsessions & compulsion, treatments)

• obsession: if she thought about a relative dying, that relative will soon die

• compulsion: hand washing

• can’t think about her relative dying or else she would be the reason why they died (because it somewhat happened once)

• ERP not successful: can’t stop herself from hand washing

• CBT not successful: truly believed that she could stop their death

what are the features of body dysmorphic disorder? (3)

• onset (starts) from early adolescence with lifelong course

• most college students are dissatisfied with their body, but 4-28% of them meet the criteria for the disorder

• 1-2% of community and 2-13% students meet criteria for BDD

how is body dysmorphic disorder presented in men and women?

• men: body build, genetics, thinning hair (more severe)

• women: various body areas, eating disorder

what are the treatment for body dysmorphic disorder? (3)

• plastic surgery (because they don’t seek psychological help)

• maybe SSRI

• ERP for milder cases

why do we know little about the causes of body dysmorphic disorder?

because people suffering don’t seek help

define “hoarding disorder”

• acquiring things

• difficulty to discard things

• living in excessive clutter

what are the features of hoarding disorder?

• prevalence of 2-5%

• no sex difference

• begins in adolescence but gets worse with age

• collect as a form of mood management (store everything but get rid of nothing:

• distressed at the thought of throwing things away

what are the treatments of hoarding disorder?

CBT: rank order sentimental value of object to get rid of the less valuable

why were trichotillomania (hair pulling) and excoriation (skin picking) disorders classified under impulse-control disorders?

• we thought that that people did so to relieve stress or tension (but no, that’s not always the case)

• we see it being comorbid with OCD and BDD

what are the DSM5 diagnostic criteria for trichotillomania? (3)

1. must engage in recurrent hair pulling that leads to hair loss

2. repeated attempts to decrease or stop the behaviour

3. hair pulling causes clinically significant distress or impairment

what are the DSM5 diagnostic criteria for excoriating disorder? (4)

1. causes visible skin lesion by picking

2. make repeated attempts to decrease or stop the picking

3. experience significant distress or impairment

4. distress can include feelings of embarrassment or shame

what are the treatments for trichotillomania and excoriation disorder?

habit reversal training: patients are taught to be more aware of their repetitive behaviour and to substitute it with another behaviour