Psych Disorders Exam 3 (OCD)

Obsession

 recurrent intrusive thoughts, impulses, or image that causes anxiety and cannot be dismissed or put out of one’s mind

Compulsion

 Repetitive action (ritual) person feels compelled to do to relieve/get rid of the obsession (intrusive thought)

True or False: If you’re trying to dismiss a thought, the more likely you are to think about it

True

Ego dystonic

impulses and consciousness DOES NOT match their identity

• ^ e.g. is Steve’s patient who had OCD; thoughts are telling her she’s going to hurt people but she doesn’t actually want to; brain just likes to simulate the future

• The average person suffers about ____ before receiving actual treatment, and they become very good at hiding it and becomes part of their identity

30 years

Research shows that ___ of people are likely to have intrusive thoughts 

^ person with OCD has this, but it’s taken ver,y very seriously; the thought isn’t dismissed

80%

OCD Cycle

Stimulus (triggers) → obsession → Anxiety → Compulsion → BACK to anxiety

Stimulus

triggers obsession

E.g., stimulus is driving at night; the obsession is intrusive/dangerous thoughts of running somebody over 

Compulsion is another form of

Negative Reinforcement 

you’re taking away something inversive, and  in this case it’s their anxiety 

Compulsion and Negative reinforcement doesn’t cure OCD because

• they’re constantly avoiding it, meaning they never get exposure to the triggers long enough to habituate

• Exposure is needed while you agree to not to do avoidance ritual

___a week visits with a therapist is the most effective compared to only once a week 

2x 

True or False:  Experience/exposure changes the brain, even if OCD is considered a brain disorder

True 

Best treatments for OCD

• CBT and Cognitive Therapy

• Exposure and ritual prevention

• Speaking to the amygdala/emotional side of the patient

Anafril 48% response

largest RCT (randomized control trial), but not used anymore bc it can be lethal

SSRI/SNRI response rate for OCD 

40-50% across studies, but we can do so much better with other treatments like exposure therapy

Common Themes in OCD 

• Aggregation

• contamination 

• religious and blasphemy

• pathological loss/doubt

• sexuality

• symmetry 

True or False: One DSM-5 Diagnosis for OCD is that both obsession and compulsions must be present to be diagnosed 

False: only one has to be present to be diagnosed 

• About 90% of the time it is present

• Sometimes, compulsive rituals are unknown to the person

• The highest order of reasoning doesn’t make sense rationally, but inside, viscerally, it feels true

  ^In other words, the OCD patient understands that it isn’t fully rational, but emotionally it feels true; at war with themselves

Most people who get OCD get clinically depressed because

of the tendency to AVOID and spends hours hiding away doing compulsive rituals

Lifetime prevalence for OCD 

2%

Striatum

regulates what things in the cortex get attended to or not

• Ground 0 for conscious awareness

• The thalamus “brain locks” it, so now that’s all that you think about

anterior cingulate

• ERROR DETECTION

• CSTC circuit in and serves at the brain lock

OCD Spectrum Disorder

• Hoarding disorder

• Trichotillomania

• Body Dysmorphic Disorder

Hoarding Disorder

• Originally thought as OCD; similar but it’s not

• Its ego is syntonic rather than ego-dystonic

• Because their intrusive thoughts do NOT cause anxiety or depression

Trichotillomania

• Pulling of hair, eyelashes, fingernails, face, etc.

• People do it as a habit when they’re distressed

• In the brain, the pain triggers endorphins to numb pain, which also numbs emotional pain which is a relief; happens because opium is crosswired (reason why some do self harm)

• Also ego-syntile

Body Dysmorphic Disorder

Has a lot of genetic overlap, and same with anxiety and OCD

Moderate genetic loading

40-50% heritability

OCD is NOT 

OCPD

Opioid system releases ____ when exposed to self-harm

endorphins

Numbing physical pain -> numbing emotional pain, due to

opium wires of emotional and physical pain being cross-wired

Reason why people get addicted to the feeling of heroine and/or self harm

Both processes blocks pain signals by numbing emotional and physical pain receptors

Endorphine

Body’s natural painkiller

• blocks pain reception

• increases pleasure

• Released by opioid system

Opiate

Drugs that initiate what endorphines do but more powerfully

• decrease pain reception

• increases pleasure and euphoria 10x 

• e.g. morphine, heroine, etc