HD 3700 Prelim 2- OCD

Intrusive thought

• fleeting, unwelcome thought or image; often inappropriate in content or given the situation 

  • most will experience at one point  (90%)

• people with OCD can’t dismiss these and are very intense

Obsession compulsive disorder

presence of obsessions, compulsions or both

• time consuming

• cause clinically significant distress or impairment areas of functioning

• not attributable to the physiological effects of a substance or another medical condition

• not explained by symptoms of another mental disorder

Obsessions

• recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance as intrusive and unwanted

• cause marked by anxiety or distress 

• individual attempts to ignore or suppress them with thoughts or other actions

4 main themes of obsessions

• contamination

• symmetry

• forbidden thoughts

• harm

contamination

• center on cleanliness of self, physical environment, or objects

forbidden thoughts

tend to have aggressive, sexual, religious, or “tabboo” content

symmetry

items need to be aligned or positioned in a certain way

• behaviors too

harm

• terrible things happening to self or loved one

compulsions

• repetitive behaviors or mental acts that individual feels driven to perform in repsonse to an obsession or according to rules that must be applied rigidly

• these behaviors or acts are NOT connected in a realistic way or clearly excessive

• often eliminate anxiety or distress evoked by obsession

Not Just Right Experience (NJRE)

• if obsessions are not experienced as distressing but instead unsettling or uncomfortable

• perception that something is not the way it should be 

Core Dimensions Model

• harm avoidance

• incompleteness

• explains why people might use the same compulsion for different obsessions and why the same obsession might result in different compulsions

OCD cycle

intrusive thought → anxiety, distress, NJRE → compulsion → relief (temporary)

Thought- Action Fusion (TAF)

• belief that thinking about something is equivalent to doing it

• frequent and often overpowering in people with OCD

What are the 2 types of TAF?

• likelihood

• moral

likelihood TAF

• having a thought about an event (especially a catastrophic event) means the event will occur

Moral TAF

• having a thought about doing something wrong (forbidden thought) is the same as actually doing that thought 

Inflated Responsibility Beliefs

when people think they’re to blame for or responsible for a terrible event that MIGHT happen

• establish connections that aren’t true

prevalence and occurrence 

• chronic 

• 2-3%

• equal among both genders 

  • but males earlier

comorbidity

• high with MDD: 2/3 with OCD will develop depression

• 10-30% will also have tic disorder

Tic

• involuntary sudden sound or movement

premonitory urge

• uncomfortable tension that precedes a tic

  • vanishes once tic occurs and is replaced by temporary relief

What % likelihood of developing OCD is related to genetic influences?

40-50

• genes related to OCD are also linked to tic disorder

CSTC

• cortico striato thalamo cortical pathway

• Basal ganglia: inhibiting and controlling responses

  • striatum and caudate

Basal Ganglia

• communicates with other parts of the brain

  • frontal cortex 

  • thalamus (limbic system: relays and interprets sensory info)

  • anterior cingulate cortex: impulse control, emotional reactions, processing pain

• parts of circuit are hyperactive in people with OCD 

Is there any relationships with Culture and OCD

• doesn’t determine whether someone will have OCD 

• shapes HOW OCD presents

Scrupulosity

• thinking or doing something against religious beliefs

Historical examples

• 1980s and 90s: AIDs

• 2009: H1N1 (swine flu)

• 2020: COVID

medical treatments?

• ssri’s and antidepressants (high dose)

• fluoxetine (Prozac) is associated with significant declines in activity in the caudate and thalamus

where can we intervene for OCD therapy?

• the compulsions

What is the goal of OCD treatment

• to have people tolerate and accept discomfort of an obsession

Exposure and Response Prevention

• provokes obsessions via exposure: clients initiate situations which produce obsessive thoughts

• but DON’T preform compulsion (response prevention)

• uses exposure hierarchy

Which treatment?

• depends on severity 

• therapy is more successful than medications when symptoms are mild or moderate but not when severe 

What to do for severe OCD symptoms?

• first stabilize symptoms on SSRIs and then add EX/RP

• combined treatment is more effective but start with medications first

• with EX/RP, around 60% of people show complete remission of symptoms for at least up to 7 yrs