OCD & Related Disorders

obsessions

• cognitive experiences

• thoughts, images, urges

• intrusive & unwanted

compulsions

• repetitive behaviors

• excessive, not realistic

• overwehlming distress if resisting to perform

• ritualized way

6 Obsession Types

1. Agression / Harm

2. Contamination

3. Se*ual

4. Religiosity / Scrupulosity

5. Need for Symmetry / Exactness

6. Somatic

Agression / Harm

• checking (locks, appliances, safety)

• reassurance seeking (friends/family)

• mental rituals (counting/praying)

contamination

• cleansing, washing

• reassurance seeking (friends/family, internet)

• avoidance

Se*tual

• checking

• reassurance seeking

• metnal rituals (praying, neutralizing/non-sexual thoughts, counting)

Religiosity / Scrupulosity

• checking

• reassurance seeking (confession, clergy)

• mental rituals (praying, repeating)

Need for Symmetry / Exactness

• ordering, arranging

• counting

• repeating (actions until “just right)

Somatic

• checking (body, symptom monitoring)

• reassurance seeking (healthcare providers, internet)

• mental rituals (reviewing, counting)

Vicious Cycle of OCD

1. Obsessive Thought

2. Anxiety

3. Compulsive Behavior

4. Temporary Relief

Obsessive-Compulsive Disorder (OCD)

A. Presence of either obsessions OR compulsions OR both

B. are time-consuming (take up more than 1 hour a day)

Body Dysmophic Disorder (BDD)

A. Preoccupaiton with 1> perceived defects or flaws in physical appearance that are not observable to others

B. Individual has performed repetitive behaviors or mental acts in response to appearance concerns

**Not better explained by Eating Disorders

Trichotillomania

A. Recurrent pulling one’s hair, resulting in hair loss

B. Repeated attempts to decrease or stop hair pulling

Excortiation Disorder

A. Recurrent skin picking resulting in skin lesions

B. Repeated attempts to decrease or stop skin picking

Hoarding Disorder

A. Persistent difficulty discarding/parting with possessions

B. Difficulty is due to perceived need to save the items + distress associated with discarding them

C. Accumulation of possessions that congested + clutter living areas and compromise their intended use

_____ genetic predisposition

STRONG genetic predisposition

birth…

prenatal & birth complication

• ex: smoking when pregnant

• baby coming out feet-first instead of typical head-first

PANDAS

streptococcal disease → immune system attacks delicate & vital brain tissue → OCD

parietal lobe in OCD

reduced parietal lobe

Orbitofrontal Cortex in OCD Brain

• detects “error” when there isn’t one

• sends “worry” signals

Basal Ganglia

compulsions

Which part of brain causes compulsions?

Basal Ganglia

Caudate Nucleus

Fails to filter anxious thoughts

Cingulate Gyrus

Adds unpleasant emoitons to anxious thoughts

Internalizing Symptoms

directing distress towards oneself

3 Cognitive Distortions

1. Thought Fusion

2. Disconfirmation Bias

3. Exaggerated Estimates of Harm

Thought Fusion

believing that having the thought is just as dangerous/shameful as acting on it

Disconfirmation Bias

work harder to refute information that contradicts your pre-existing beliefs

Exaggerated Estimates of Harm

believing all outcomes are always bad

classical conditioning

paired from obsessional fear + anxiety response

operant conditioning (psychological)

compulsion acts as a coping mechanism that reduces the anxiety and causes temporary relief that negatively reinforces the obsession

Parental in OCD

parental non-responsiveness or overprotective nature

operant conditioning (social)

reinforcement of compulsive behaviors by others

Gender Differences in OCD & Related Disorders

Women: trichotillomania, excoriation disorder, hoarding

Men: OCD at young age

Both: OCD as adults, BDD

in Treatment, we’re trying to…

interrupt compulsive behaviors

Exposure & Response Prevention Curve

Anxiety initally RISES, but naturally habituates and DECREASES to a lower baseline than the temporary relief provided by repeated ritualization

how does EXRP work

preventing patient from performing compulsive ritual and undergoing discomfort

prevents negative reinforcement

targets obsessions + compulsions