Chapter 7 - OCD and Trauma-Related Disorders

Obsessive Compulsive Disorder (OCD)

characterized by the presence of:

• repetitive thoughts and urges

• irresistible need to engage in repetitive behavior and mental acts

can have obsession or compulsion to meet the diagnosis criteria (or both)

Obsessions

intrusive and persistent thoughts, images, or impulses that are uncontrollable

• often irrational

• hours spent immersed in obsessions

• attempt to ignore, suppress, or neutralize

Compulsions

repetitive, clearly excessive behaviors or mental acts to reduce anxiety

• extremely difficult to resist

• may involve elaborate behavioral rituals

Body Dysmorphic Disorder

preoccupation with imagined flaw in one’s appearance

• excessive repetitive behaviors regarding appearance

if shape/weight concerns are the only foci, the symptoms are better explained by eating disorders

Hoarding Disorder

excessive thinking about current and future objects

• inability to part with objects

Lifetime Prevalence of OCD and Related Disorders

• 1.3% OCD (more common in women)

• 3% BDD (more common in women)

• 1.5% Hoarding Disorder (no gender differences)

Cortico-striatal-thalamic-cortical (CSTC) loop

successful treatment shows changes in activity

• orbitofrontal cortex

• caudate nucleus

• anterior cingulate

Causes of OCD - Behavioral Model

• previously functional responses for reducing threat become habitual

  • difficulty eliminating response after the threat is gone

Causes of OCD - Transition Uncertainty

people with OCD are less confident in the adequacy of their actions

• included in the cognitive model

Causes of OCD - Thought-action fusion

thinking about something is as morally wrong as engaging in the action

• thinking about an event makes it more likely to occur

• tendency to feel responsible for preventing harm

Causes of BDD

• people with BDD are usually detail-oriented

• self-worth is dependent on appearance

• many have a history of appearance-related teasing

Causes of Hoarding Disorder

• poor organizational skills

• unusual beliefs about possessions

• avoidance behaviors

• evolutionary perspective

  • storing necessary resources for dire situations

Exposure and Response Prevention (ERP)

• not performing a ritual exposes the person to the full anxiety

• exposure promotes extinction of the conditioned response

• facing the feared stimulus helps a person develop more positive thoughts in response to the stimulus

  • hierarchical approach

Brain Stimulation Techniques for OCD

• transcranial magnetic stimulation (dTMS)

• deep brain stimulation (DBS)

Posttraumatic Stress Disorder (PTSD)

extreme response to a severe stressor

• last for at least 1 month

• intrusively re-experiencing the traumatic event

  • nightmares

  • flashbacks

• avoidance of stimuli associated with the event

• negative mood and thought

  • detachment

  • guilt

• increased arousal and reactivity

  • hyperaware

  • aggressive outbursts

  • sleep difficulty

Acute Stress Disorder (ASD)

response to a stressor; symptom criteria is broader

• lasts 3 days to 1 month

PProlonged Exposure Therapy

PTSD treatment

goal is to extinguish fear response and challenge belief that the person cannot cope

• focus on memories and reminders of trauma

• psychoeductation

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

PTSD treatment

exposure treatment in combination with instructed eye movements while processing trauma

Cognitive Procession Therapy (CPT)

PTSD treatment

goal is to reduce overly negative interpretations about trauma and its meaning

• form of CBT

• helpful in reducing guilt and dissociation