Lecture 5 - Clinical Psychology

obsessive-compulsive and related disorders in the DSM 5 (7)

• obsessive compulsive disorder (OCD)

• body dysmorphic disorder (BDD)

• hoarding disorder

• trichotillomania (hair pulling)

• excoriation disorder (skin picking)

• …substance/medical

• …other/non-specified

obsession

• recurrent and persistent intrusive and unwanted thoughts, urges, or images

• attempts to ignore, suppress or to neutralize

compulsion

• repetitive behaviors or mental acts in response to an obsession or according to rigid rules

• aimed at preventing or reducing anxiety or distress, or preventing event or situation; not connected in realistic way, or clearly excessive

obsessive-compulsive disorder (OCD)

• A disorder involving persistent and uncontrollable thoughts and/or the performance of certain acts again and again, causing significant distress and interference with everyday functioning.

OCD criteria (3)

• obsessions and/or compulsions

• time consuming (>1 hour), or distress/impairment

common themes in obsessions (3)

• aggressive

• sexual

• religious

mysophobia

• fear of contamination and germs

common themes in compulsions (5)

• cleaning

• order

• checking

• protective rituals

• (cognitive treatment as therapy can become new compulsion)

intrusion

• unwelcome, involuntary, and often distressing thoughts, memories, or images that force themselves into consciousness

How good are psychologists at identifying normal/abnormal intrusions?

• intrusions of people with OCD not identifiable in study compared to intrusions of people without, even by experienced psychologists

• identification of normal intrusions just above chance

Similarities between intrusions of people with and without OCD (2)

• most people have intrusions from time to time

• form and content quite similar

Differences of intrusions in OCD-patients (5)

• frequency: more often

• experienced as more intense

• duration: last longer

• more distress

• stronger urge to neutralize

How may the etiology of OCD be explained by general reasoning errors (cognitive styles)? (3)

• emotional reasoning → e.g. “I’m afraid, so there is danger.”

• magical thinking → e.g. “If I step on the cracks of the tiles, my mother will die.”

• dichotomous thinking → most people: omission (not do something) < commission (actively making something happen), in OCD often: omission = commission

How may the etiology of OCD be explained through “thought action fusion” (TAF)? (2)

• TAF-likelihood (self/other): thinking about it increases chances of its occurrence

• TAF-moral: thinking about something is equivalent to acting

How may the etiology of OCD be explained through behavior? (4)

• cognitive theory (Salkovskis)

• thought suppression (Wegner) → “white bear effect”

• excessive checking → increased memory distrust

• operant conditioning → neurotic paradox (short-term relief → reward, long-term pathology)

cognitive theory

• intrusions: ego-dystonic (perceived as strange, non-fitting, opposed to self)

• automatic thoughts: ego-syntonic (perceived as part of self)

• behavior: suppress, neutralize, compulsions

What is the current explanation of how OCD occurs?

• intrusions are normal, interpretation in OCD isn’t → problematizes (e.g. TAF)

• causes neutralizing/obsessions

• compulsive behavior: irrationality never shown (no chance to experience US or no-US)

• frequency increases, ritual formation

treatment options for OCD (4)

• exposure with response prevention → tough, but essential

• cognitive therapy → often used as supportive treatment for ERP

• medication: SSRIs → typically higher dosage then with mood, often used as supportive treatment

• deep brain stimulation → in therapy refractory cases

exposure and response prevention (ERP)

• most widely used and accepted treatment of obsessive-compulsive disorder and related disorders

• sufferer is prevented from engaging in compulsive ritual activity and instead faces anxiety provoked by stimulus, leading eventually to extinction of conditioned response (anxiety).

→ added to CBT

body dysmorphic disorder (BDD)

• A disorder marked by preoccupation with one or more imagined or exaggerated defects in appearance (obsessive part) —for example, facial wrinkles or excess facial or body hair.

• compulsions include e.g. excessive mirror-checking, observing single features intensely and focussing on details

hoarding disorder

• A disorder involving compulsive need to acquire objects and extreme difficulty in disposing of those objects.

How can hoarding disorders be treated? (1)

• modified ERP is investigated as treatment

caudate nucleus

• A nucleus within the basal ganglia that is involved in learning and memory and is implicated in body dysmorphic disorder and obsessive-compulsive disorder.

cortico-striatal-thalamic-cortical (CSTC) loop

• Neural circuitry linking cortical regions such as the orbitofrontal cortex and anterior cingulate cortex, the caudate nucleus and other parts of the striatum, and the thalamus, implicated in obsessive-compulsive and related disorders.

orbitofrontal cortex

• The portion of the frontal lobe located just above the eyes; one of the brain regions that is unusually active in individuals with obsessive-compulsive disorder when symptoms are induced during functional brain imaging.

thought suppression

• An attempt to stop a certain thought that has the paradoxical effect of inducing preoccupation with that thought; considered to intensify obsessions.

thought–action fusion

• The tendency to believe that thinking about something is as morally wrong as engaging in the action or can make the imagined event more likely to occur. Believed to contribute to the persistence of obsessions.

transition uncertainty

• A phenomenon theorized to contribute to OCD, in which people doubt the evidence for their decisions when the context changes (Fradkin et al., 2020).