ocd, body dysmorphic disorder, and ptsd - psy0205

ocd diagnostic criteria

presence of obsessions, compulsions, or both that are time consuming and cause clinically significant distress or impairment for at least an hour a day

good or fair insight

ocd diagnostic specifier; people recognize disorder-related beliefs are not true

poor insight

ocd diagnostic specifier: people think disorder-related beliefs are true

absent insight/delusional beliefs

ocd diagnostic specifier; people are completely convinced disorder-related beliefs are true

tic-related

ocd diagnostic specifier; somebody has had current/past history of tic disorder and compulsions related to tics

tics

sudden, rapid, recurrent motor movements or vocalizations

ocd obsessions

recurrent and persistent thoughts, urges, images

common obsession themes

(ocd) contamination, uncertainty of daily behavior, violence, orderliness

ocd obsession reactions

attempts to ignore/suppress, engaging in compulsions to neutralize anxiety

compulsion

repetitive behavior or mental act that individual feels driven to perform in response to an obsession or according to rigid rules

compulsion goal

reduce/prevent anxiety/distress or prevent dreaded event/situation, but only provides temporary relief

ocd onset

adolescence or early adulthood

ocd course

often chronic, frequently lasting into adulthood

ocd comorbidity

anxiety disorders, mood disorders, body dysmorphic disorder

ocd genetic etiology

first degree relative 2x risk; obsessions run in families more than compulsions

ocd biochemical etiology

serotonin, glutamate, gaba, dopamine

ocd neuroanatomical etiology

overactivity of orbitofrontal cortex, caudate nuclei, thalamus

ocd treatment

exposure and response prevention (most effective), SSRIs, TCAs

exposure and response prevention (ERP)

exposing patient to fear caused by obsession and not allowing patient to engage in compulsions when exposed to feared stimulus

body dysmorphic disorder

preoccupation w one or more perceived defects/flaws in physical appearance, performs repetitive behaviors or mental acts in response to concerns, preoccupation causes significant distress in functioning, not better explained by eating disorder

bdd obsession

perceived defects/flaws, not/barely noticeable to others, common areas are skin, hair, nose

bdd compulsion

repetitive behavior (mirror checking), mental acts (comparing oneself to others), significant distress or impairment (avg. 3-8hrs engaged w/ obsessions/compulsions)

bdd prevalence

symptoms appear cross culturally, similar in males and females

bdd onset

adolescence

bdd course

chronic, particularly w/ muscle dysmorphia specifier

bdd comorbidity

mdd following diagnosis, social anxiety, OCD, substance use disorder

bdd biological etiology

genetics, potential shared influence w/ ocd

bdd psychological etiology

attention bias towards beauty standards, attractiveness, etc.; dysfunctional beliefs

bdd sociocultural etiology

societal emphasis on appearance, negative life events (bullying, abuse)

bdd treatment

exposure and response prevention, SSRIs, plastic surgery (not clinically prescribed and usually fails)

ocd related disorders

hoarding disorder, trichotillomania, excoriation

ptsd traumatic event

at least one exposure req. for diagnosis; exposure to actual threatened death, serious injury, or sexual violence (either through direct experience, witnessing in person, learning event occurred to close friend/family member, or repeated/extreme exposure to aversive details)

acute stress disorder

ptsd symptoms for 3 days to 1 month following traumatic event; after 1 month diagnosis will change to ptsd

ptsd diagnostic specifiers

re-experiencing or intrusion symptoms, avoidance or efforts to avoid internal and/or external reminders of event, cognition and mood symptoms, arousal and reactivity symptoms, distress/impairment

ptsd symptoms must

…persist for 1+ months following traumatic event

re-experiencing or intrusion symptoms

• Recurrent, involuntary, and intrusive distressing memories

• Recurrent distressing dreams

• Flashbacks (feeling/behaving like traumatic event is happening in the moment)

• intense/prolonged psychological distress and/or marked physiological reactions when exposed to cues resembling event

avoidance or efforts to avoid

…at least one of the following:

• external reminders of event

• memories, thoughts, and/or feelings related to the event

2+ cognition/mood symptoms

• Inability to remember important aspects of the event (cognitive)

  • Cannot be due to head injury/substances

• Persistent and exaggerated negative beliefs about self, others, or the world

• persistent/distorted cognitions about causes/consequences of event

• Persistent negative emotional state (ex. Fear, anger, guilt, shame)

• Diminished interest or participation in activities

• Feelings of detachment or estrangement from others

• Persistent inability to experience positive emotions

2+ arousal/reactivity symptoms

usually constant throughout diagnosis

• Irritability and anger outbursts w/ no provocation or inciting incident; out of context to situation

• Reckless and/or self-destructive behavior

• Hypervigilance 

• Exaggerated startle response

• Difficulty concentrating

• Trouble sleeping

experiences trauma

not everyone who _________ __________ has ptsd

dissociative symptoms

ptsd diagnostic specifier; depersonalization and/or derealization

delayed expression

ptsd diagnostic specifier; full symptoms are not realized until 6+ months after traumatic event

ptsd prevalence

rates vary across and w/i countries, 12% of troops from iraq and afghanistan have PTSD

ptsd course

50% recover within 3 months, 1/3 experience symptoms 10 years after

ptsd comorbidity

substance use disorder, traumatic brain injury, childhood separation anxiety, childhood oppositional defiant disorder; 80% more likely to have another disorder

necessary

trauma __________ but not sufficient for PTSD diagnosis

ptsd biological etiology

genetics, amygdala and hippocampus

ptsd psychological etiology

feeling unprepared, lack of purpose, blame, lack of emotional engagement with trauma

ptsd sociocultural etiology

exposure type/level, intensity of trauma, level of social support, childhood adversity and prior trauma

ptsd intergenerational transmission

methods of transmission:

• how families discuss trauma

• environmental changes

• effects of trauma on parenting

ptsd treatment

cognitive processing therapy, prolonged exposure, prevention

cognitive processing therapy

• “Rewriting” trauma to help them rework their narrative in relation to how they view themselves and their symptoms

• Developed specifically to work w/ veterans

prevention (ptsd)

immediate psychotherapy following event (regular rather than intense), encouraging return to regular routine, skills-based training