BES31412 Finals MA: L7: Obsessive-Compulsive and Related Disorders

Obsessions

• Intrusive, distressing thoughts and mental images that repeat over and over.

• They are ego-dystonic (experienced as unpleasant).

• Common _______:

  • Dirt and contamination 

  • Need for symmetry

  • Hoarding

  • Sexual content

  • Scrupulosity

  • Aggressive content

  • Superstitious fears 

Ego-dystonic

• Refers to something experienced as unpleasant

• Obsessions can be described as this.

Compulsions

• Behaviors people perform in order to try and reduce or remove the fear and anxiety caused by obsessions.

• Common ________:

  • Cleaning and washing

  • Arranging until things are “just right”

  • Hoarding

  • Checking

  • Mental rituals (prayers, counting etc.)

Body Dysmorphic Disorder (BDD), Hoarding Disorder

What are 2 Obsessive-Compulsive Related Disorders?

Body Dysmorphic Disorder (BDD) or Body Dysmorphia

Obsessive-Compulsive Related Disorders

• A mental health condition where a person spends a lot of time worrying about flaws in their appearance.

  • These flaws are often unnoticeable to others. 

Body Dysmorphic Disorder (BDD) or Body Dysmorphia

Obsessive-Compulsive Related Disorders

• When you have this disorder, you intensely focus on your appearance and body image, repeatedly checking the mirror, grooming, or seeking reassurance, sometimes for many hours each day.

Body Dysmorphic Disorder (BDD) or Body Dysmorphia

Obsessive-Compulsive Related Disorders

• Your perceived flaw and the repetitive behaviors cause you significant distress and impact your ability to function in your daily life.

Hoarding Disorder

Obsessive-Compulsive Related Disorders

• A mental health condition in which a person feels a strong need to save a large number of items, whether they have monetary value or not, and experiences significant distress when attempting to get rid of the items.

• The hoarding impairs their daily life.

Hoarding Disorder

Obsessive-Compulsive Related Disorders

• Typical hoarded items include newspapers, magazines, household goods, and clothing.

• Sometimes, people with this disorder accumulate a large number of animals, which are often not properly cared for.

Obsessive-Compulsive Personality Disorder

• Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

• Preoccupation with details, rules, and lists, so that the point of the activity is lost

Obsessive-Compulsive Personality Disorder

• Perfectionism that interferes with task completion.

• Excessively devoted to work so that leisure activities and friendships suffer.

between 2 and 3%

What is the lifetime prevalence of OCD?

1 to 2.3%

What is the child/adolescent prevalence of OCD?

Europe, Asia, Africa

There is similar epidemiology of OCD among diverse cultures (studies in _____, ______, and _______ have confirmed rates).

adults, children and adolescents

Epidemiology of OCD

In ______, male and female prevalence is the same. In ________, males are more likely than females to be affected.

Orbitofrontal Cortex, Basal Ganglia, Anterior Cingulate

3 parts of the Brain Lock

Orbitofrontal Cortex

Brain Lock

• The error detector

Orbitofrontal Cortex

Brain Lock

• Functions of the superego are implemented by the OFC-amygdala circuitry.

Orbitofrontal Cortex

Brain Lock

• Evolved to temper pursuit of pleasure (limbic system) with consideration of context and risk.

Basal Ganglia

Brain Lock

• Caudate: The “thought gear shift.”

Anterior Cingulate

Brain Lock

Gut feelings

Anterior Cingulate

Brain Lock

• Appropriate response to internal and external stimuli.

Anterior Cingulate

Brain Lock

• Projects to autonomic, visceromotor, and endocrine systems.

Pharmacotherapy, Cognitive-Behavioral Therapy, Psychosurgery, Deep Brain Stimulation

4 forms of treatment in OCD

SSRI, Clomipramine

2 types of Pharmacotherapy

SSRI

Pharmacotherapy Treatment

• First line, no major difference in class.

• Higher doses than for MDD (for example, 80 mg fluoxetine).

• 10 to 12 weeks before switching.

Clomipramine

Pharmacotherapy Treatment

• First FDA approved, most serotonin specific of TCA’s, side effects.

• Augmentation, no to Li, atypical antipsychotics, e.g., risperidone (5HT2A blockade suggests there’s more to it than just “low serotonin”).

Exposure and Response Prevention (ERP), Psychodynamic therapy, Cognitive-Behavioral Therapy

3 types of Psychotherapy Treatment

Exposure and Response Prevention (ERP)

Psychotherapy Treatment

• Developed by Victor Meyer (1966).

• The most widely used psychological treatment.

Victor Meyer

Developed the Exposure and Response Prevention (ERP) in 1966, the most widely used psychological treatment.

Psychodynamic therapy

Psychotherapy Treatment

Low efficacy

Cognitive-Behavioral Therapy

Psychotherapy Treatment

• RCT supported

• Longer lasting than pills

• Cognitive

  • Challenges faulty reasoning

  • Example: “Magical thinking”

• Behavioral

  • Exposure and Response Prevention

  • List of things that make you go “ugh!” in rank order.

  • Loop tapes for the pure obsessionals.

  • Caveats

    • Dropout rates significant, shoot for 12-20 sessions

Psychosurgery

If the OCD resists or does not respond to treatment (Treatment Refractory), we use…

Psychosurgery

Treatments

• For patients who have failed meds and therapy.

• Response rate approximately 50%.

Psychosurgery

Treatments

• Four surgical procedures:

  • Cingulotomy

  • Subcaudate tractotomy

  • Limbic leukotomy

  • Capsulotomy

• Interrupt signals from OFC to basal ganglia

• Gamma Knife

  • Anterior limb of internal capsule

Biological, Psychological, Social

3 branches of OCD Etiology

Post-Traumatic Stress Disorder

A complex health condition that can develop in response to a traumatic experience such as a life-threatening or extremely distressing situation that causes a person to feel intense fear, horror, or a sense of helplessness. 

Persistent re-experiencing of traumatic event, Consistent avoidance, Amplified stimulation

3 symptoms of PTSD

Biological Factors, Family Factors, Social Factors

What are the 3 different factors that may cause PTSD?

Biological Factors

PTSD Different Factors

• Women are more likely to suffer from PTSD than men.

Biological Factors

PTSD Different Factors

• A person’s temperament may play a role in the development of PTSD too.

  • A person may have a more difficult time dealing with trauma due to their temperament.

  • A person with a difficult temperament is more likely to develop PTSD.

  • This may be because they have little or no coping skills.

Biological Factors

PTSD Different Factors

• Experts believe that people suffering from PTSD can develop changes in brain chemistry which will result in the development of some of the symptoms. 

Family Factors

PTSD Different Factors

• Genetics are a factor in the development of PTSD.

  • Research has found that a person is more likely to suffer from PTSD when faced with a traumatic experience if a family member has previously suffered from PTSD.

Family Factors

PTSD Different Factors

• Families that live in high risk areas are more likely to have a family member develop PTSD.

  • Some high risk areas include violent neighborhoods, low socioeconomic areas, and areas with a lot of drug activities.  Here, research shows that individuals in high risk areas are more likely to observe or be involved in a traumatic event. 

Family Factors

PTSD Different Factors

• Family support and parental coping have also been shown to affect PTSD symptoms in children.

  • Studies show that children and adolescents with greater family support and less parental distress have lower levels of PTSD symptoms.

Family Factors

PTSD Different Factors

• A parent’s parenting style may increase a child’s risk for developing PTSD.

  • For example if a parent is anxious and avoids dealing with issues that parent will teach those traits to their child.

  • Anxiety and avoidance are key symptoms of a person with PTSD.

  • If a trauma would happen to that child; the child would not have the appropriate coping skills needed to deal with the trauma.

Social Factors

PTSD Different Factors

• The following indicators are signs that a student may be suffering from PTSD:

  • Dropping grades

  • Lack of concentration

  • Late or missing homework

  • Easily irritated

  • Avoidance of peers

  • Aggression/violence

  • More issues with discipline

Social Factors

PTSD Different Factors

• Students that are diagnosed with PTSD have a difficult time in the school setting. 

  • The students have issues with:

    • Emotional regulation 

    • Developing problem-solving skills 

    • Conflict resolution skills 

    • Social skills 

    • Poor decision-making skills

    • Developing close and trusting relationships with peers or authority figures

Social Factors

PTSD Different Factors

• Students suffering from PTSD can misinterpret their peer’s words or actions as threatening.

  • This causes the student with PTSD to become defensive and further alienate themselves from their peers.

• The above problems make it even harder for a student with PTSD to function in appropriate ways in school. 

Cognitive Behavioral Therapy (CBT), Exposure Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Medication

What are the 4 Psychological Treatments for PTSD?

Cognitive Behavioral Therapy (CBT)

PTSD Psychological Treatments

This therapy changes the way a person thinks and feels about the traumatic event. 

Exposure Therapy

PTSD Psychological Treatments

• This is used to teach people to have less fear about the memories.

Eye Movement Desensitization and Reprocessing (EMDR)

PTSD Psychological Treatments

• While talking about your memories, you’ll focus on distractions like eye movements, hand taps, and sounds.

Medication

PTSD Psychological Treatments

• Medication can be used to help control the symptoms, such as anti-depressants or anti-anxiety.

• Prozac, Paxil, Zoloft, or Xanax

Prozac, Paxil, Zoloft, Xanax

4 examples of medication for PTSD

Cognitive Behavioral Therapy (CBT)

Type of psychotherapy based on changing thoughts, assumptions, beliefs, and behaviors, with the aim of influencing disturbed emotions.

Dissociative Flashback Episodes

• This is when a person with PTSD experiences the trauma like it was happening all over again.

• This is usually caused by a trigger that reminds the person of the original trauma.  

Exaggerated Startle Response

• The response of mind and body to a sudden unexpected stimulus, such as being easily frightened by a noise.

Exposure Therapy

• Used to teach people to have less fear about their memories.

• It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event. 

Hyper Vigilance

• An enhanced state of sensory sensitivity accompanied by an inflated intensity of behaviors whose purpose is to detect threats.

• For example, a person suffering from PTSD will be constantly monitoring their environment, looking for danger.