Clinical Psych - Chapter 7 (OCD/BDD/Hoarding)

Obsessions

Intrusive, recurring thoughts/images/impulses that are uncontrollable

Compulsions

Behaviours or mental acts that the person feels driven to perform repetitively and excessively to reduce the anxiety caused by obsessive thoughts

OCD symptoms

* Obsessions and/or compulsions
* Obsessions defined by:
* Recurrent, intrusive, persistent, unwanted thoughts, urges or images
* The attempt to ignore, suppress, or neutralise such thoughts, urges or images
* Compulsions defined by:
* Repetitive behaviours or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules
* Behaviors/acts are performed to reduce stress or prevent a dreaded event
* The behaviours/acts are excessive or unlikely to prevent the dreaded event
* Thoughts or activities are time-consuming, at least 1h a day, or cause distress/impairment/dysfunction

BDD symptoms

* Preoccupation with one or more perceived defects in appearance
* Other find the perceived defect(s) slight or unobservable
* Performance of repetitive behaviours or mental acts (e.g., mirror checking, seeking assurance etc.) in response to the appearance concerns
* Preoccupation is not restricted to weight or body fat concerns

Hoarding disorder symptoms

* Persistent difficulty discarding or parting with possessions, regardless of their actual value
* Perceived need to save items
* Distress associated with discarding items
* Accumulation of possessions clutters activate living spaces to the extent that their intended use is compromised unless others intervene

All 3 disorders comorbid with … and … disorder

Prevalence of OCD

1\.3%

Prevalence of BDD

3%

Prevalence of hoarding disorder

1,5%

OCD & BDD slightly more common in … than in … (hoarding = …)

women, men (equal)

OCD, BDD & hoarding heritability

0,4-0,5

Fronto stratial circuit 3 regions

1. Orbitofrontal cortex
2. Caudate nucleus
3. Anterior cingulate cortex

Brain activity in fronto stratial circuit (OCD)

All 3 regions (orbitofrontal cortex, caudate nucleus, anterior cingulate cortex) increase in activity

Brain activity in fronto stratial circuit (BDD) 

Hyperactivity in orbitofrontal cortex & caudate nucleus

Brain activity in fronto stratial circuit (hoarding)

Hyperactivity in orbitofrontal cortex & anterior cingulate cortex

Etiology of OCD; behaviour model

* People with OCD have a hard time inhibiting behavior that previously reduced threat (behavior has become habitual)

Etiology of OCD; cognitive model

* Thought-action fusion
* Thought suppression

→ possibly leads to more thoughts

It’s about the way the client responds to the threat, not the threat itself

Etiology of BDD; cognitive model

* BDD clients pay more attention to detail (therefore pick up tiny flaws better)
* Appearance is highly important

Etiology of hoarding: evolutionary model

Storing resources to prepare for possible dire times is helpful

Etiology of hoarding; cognitive model

* Attention problems
* Difficulty organising objects
* Unusual potential in objects
* Extreme emotional attachment
* Especially in animal hoarding
* Avoidance of the problem

OCD medications

Antidepressants, SSRI’s

* Higher dose & duration than depression
* Mild symptoms may still occur after treatment

BDD medications

Antidepressants (little research)

Hoarding medications

Antidepressants (little research)

* Poorer response to treatment than OCD clients

Most common psychological treatment method

Exposure and response prevention (ERP)

OCD ERP reasoning

1. Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus
2. The exposure promotes extinction of conditioned response (anxiety)
3. Facing the feared stimulus helps a person develop new, more positive thoughts in response to stimulus

2 types of brain stimulation for treatment resistance of OCD

* Deep transcranial magnetic stimulation (dTMS)
* Deep brain stimulation (DBS)

About …% report relief of symptoms after brain stimulation

50