Chapter 15 Obsessive–Compulsive and Related Disorders

body dysmorphic disorder:

preoccupation with an imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life

body identity integrity disorder

feeling of being "overcomplete," or alienated from a part of the body, and desiring amputation; apotemnophilia; amputation identity disorder

compulsions:

ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety

dermatillomania:

compulsive skin picking, often to the point of physical damage; an impulse control disorder

exposure:

behavioral technique that involves having the client deliberately confront the situations and stimuli that they are trying to avoid

hoarding:

compulsive and excessive acquisition of animals or apparently useless things, resulting in cluttered living spaces that become uninhabitable

kleptomania:

compulsive stealing for the thrill or reward of doing so and not getting caught; does not include stealing for survival (i.e., food, blankets, etc.)

obsessions

recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function

oniomania:

compulsive buying; possessions are acquired compulsively without regard for cost or need for the item

onychophagia:

compulsive nail biting

response prevention:

behavioral technique that focuses on delaying or avoiding performance of rituals in response to anxiety-provoking thoughts

trichotillomania:

compulsive hair pulling from scalp, eyebrows, or other parts of the body; leaves patchy bald spots that the person tries to conceal

OCD is diagnosed only when

these thoughts, images, and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational functions

Onset and Clinical Course

-OCD can start in childhood, especially in males.

-In females, it more commonly begins in the 20s.

-Overall, distribution between the sexes is equal.

-Onset is typically in late adolescence, with periods of waxing and waning symptoms over the course of a lifetime. -Individuals can have periods of relatively good functioning and limited symptoms.

-Other times, they experience exacerbation of symptoms that may be related to stress. -Small numbers of people exhibit either complete remission of their symptoms or a progressive, deteriorating course of the disorder

what do you teach for OCD

sx

if a patient is actively doing a compulsion what do you do

you don't stop them

-this would cause more anxiety

self soothing behavior

excoriation, trichotillomania, onychophagia

excoriation

excessive skin picking

Trichotillomania

hair pulling disorders

onychophagia

chronic nail biting

Body dysmorphic disorder

a disorder characterized by the unrealistic perception of physical flaws when they are normal

hoarding disorder

Persistent difficulty discarding or parting with possessions, regardless of their actual value

-loss has happened or major neglect as kids

-fear of loss

reward seeking behaviors

-Kleptomania (compulsive stealing)

-Oniomania (compulsive buying)

body identity integrity disorder

feeling alienated from a part of the body to the extent of seeking amputation of the identified body part

etiology of OCD and related disorders

-cognitive model: aaron beck focuses on childhood and environmental experiences growing up

-developed CBT (teach people they can stop poor thinking and stop behaviors that are ineffective)

-Hereditary: several genes may contribute to genetic risk of OCD

highly religious individuals both christians and muslims

-have alot of guilt

-pre-built anxiety

pharmacological tx for OCD

1. first line: SSRIs (setraline, fluvoxamine)

2. SNRI: venlafaxine

for tx ressistant OCD:

SECOND GEN ANTIPSYCHOTICS

-RISPERIDONE, OLANZAPINE

BEHAVIORAL THERAPY

-exposure

-response prevention

exposure has 2 types

flooding: throwing fear of pool ion the pool, need to have HCP present (all at once)

systemic desensitization: (little by little): talk about it, go near it, go closer. slow exposure to thing you are afraid of overtime.

thought process for OCD patients

describe obsessions as rising out of nowhere

-if patient is stuck on a thought document

-suicide assessment

how does the OCD client appear

-tense, anxious, embarrassment

OCD mood and affect

overwhelming anxiety

-congruent

OCD judgement and insight

recognizes obsessions are irrational but cant stop

self concept OCD

powerless, low self-esteem

always check what is ____ from the persons _____

different from the persons norm