Psych 2621 Chapter 6 - obsessive compulsive and related disorders

Obsessive compulsive disorder

a chronic disorder in which the mind is flooded with persistent and uncontrollable thoughts (obsesssions) and the individual is compelled to repeat certain acts again and again (compulsions)

Lifetime prevalence of OCD

2%

OCD comorbidity with anxiety d/o

over 75% of people with OCD were found to meet criteria for an anxiety disorder.

OCD typical age of onset

20

Obsession

intrusive and recurring thoughts, impulses and images. Attempts to ignore or resist them trigger anxiety.

Compulsion

a repetitive behaviour or mental act that the person feel driven to perform to reduce the distress caused by obsessive thoughts or to prevent some calamity from occurring.

Rachman multipliers that increase intensity and frequency of compulsive checking

1) a sense of personal responsibility

2) the probability of harm if checking does not take place

3) the predicted seriousness of harm

egodystonic

Thoughts, urges, or images that are in conflict with the person's values, beliefs, or self-concept

Behavioural theory of OCD

Learned behaviours reinforced by fear reduction

Cognitive Theory of OCD

compulsive checking may result from a memory deficit

Rachman's Theory of Obsessions in OCD

identified a range of cognitive factors involved in OCD in addition to the obsessions themselves, including an inflated sense of personal responsibility for outcomes and a cognitive bias involving thought-action fusion.

thought-action fusion

involves two beliefs

1) The mere act of thinking about unpleasant events increases the perceived likelihood that they will actually happen

2) at a moral level, thinking something unpleasant is the same as actually having carried it out

Meta-Cognition in OCD

People with OCD have such highly developed cognitive self-consciousness that they reflect excessively on their own cognitive processes

Genetic evidence of OCD

High rates in first-degree relatives (10.3%) than control relatives (1.9%). Also higher concordance for MZ (68%) vs DZ (30%) twins

Brain Structures in OCD

Encephalitis, head injuries, and brain tumours associated with development of OCD

PET scan studies OCD

show increased frontal lobe activity and link to the basal ganglia

Neuropsychological Testing Research ODC

Patients with long term OCD show attention and memory deficits. impairment in executive functioning.

Hypothesis related to SSRI drug treatment of OCD

Suggests OCD is related to lowered serotonin. However 40-60% of treated with SSRI's show no improvement

Classical psychoanalysis of OCD

obsessions are the same as compulsions

is based on instinctual forces are are not under control due to harsh toilet training

Alfred Adler views on ocd

feeling of incompetence due to inferiority complex. adopt compulsions to exert control and allow mastery of something

Exposure and Response Prevention (ERP) for OCD

exposure to situations that elicit the compulsive act and then refrains from performing the accustomed ritual

cognitive behavioural therapy and ocd

client must stop preforming rituals in order to combat dysfunctional beliefs

Cingulotomy

Involves destroying 2-3cm of white matter in the cingulum, near the corpus callosum

Deep brain stimulation

Bilateral subthalamic nucleus deep brain stimulation is used for OCD treatment non-responders

Psychoanalytic approaches to OCD treatment

The intrusive thoughts and compulsive behaviour protect to ego from the repressed conflict. This conflict is hard to identify to treat

Hoarding Disorder

Difficulty discarding objects and the clutter has come to dominate his or her life

Hoarding disorder diagnostic criteria

1) persistent difficulty of discarding or parting with possessions regardless of their actual value.

2) Difficulty is due to perceived need to save the items and to the distress associated with discarding them

3) The difficulty discarding possessions results in the accumulation of possesion that congest and clutter active living areas

4) the hoarding causes clinically significant distress and impairment

5) The hoarding is not attributed to another medical condition

6) the hoarding is not better explained by symptoms of another mental disorder

Difference between hoarding disorder and OCD

- people with hoarding are excited, while people with OCD are distressed by their obsessions with objects

- Physiological, neural activity, and genetic research differences

Hoarding disorder prevalence

2-5%

Hoarding is examined under a ____ view

dimensional

Cognitive factors associated with hoarding behaviour

- Faulty information processing (difficulty thinking about categories)

- erroneous cognitions about the importance of possessions

- misguided attachments with objects seemingly compensate for emotions deficits in attachment to people

Pharmacotherapy for hoarding disorder

SSNRI meds often used

CBT for hoarding disorder

Often uses OCD protocol aimed on not acquiring items as well as discarding them. Targets beliefs that are problematic for hoarding

Body dysmorphic disorder

a person preoccupied with an imagine or exaggerated defect in appearance, frequently in the face

biological factors of BDD

Possible genetic link and lower brain volumes

Cognitive Factors in BDD

Catastrophic interpretations of appearance-related thoughts.

Behavioural interventions of BDD

typically focus on exposure and response prevention (ERP) similar to OCD

Medial treatment of BDD

SSRI's

Trichotillomania diagnositc criteria

Cannot resist the urge to pluck out his/her hair resulting in hair loss

Prevalence of trichotillomania

1-2%

Onset of Trichotillomania

Typically begins in adolescence, more common in women.

Excoriation diagnostic criteria

Skin-picking behaviour must be chronic such that it leads to lesions on the skin

genetic factors of body-focused repetitive D/O's

Trichoitillomania and excoriation both influence sby the same genetic factor, which is different than OCD, hoarding disorder, and BDD

Brain structure in Excoriation

increased volume of ventral striatum bilaterally (possible involvement of reward system)

Brain structure in trichotillomania

- excess cortical thickness in areas related to inhibitory control

- decreased thickness of the right parahippocampal gyrus (possible link to dissociative symptoms)

Emotion regualtion model

body-focused repetitive behaviours are negatively reinforcing (they decrease negative emotions)

Frustrated action model

hair pulling and skin picking behaviours are triggered by frustration and boredom

Habit Reversal Training

used for hair pulling, skin picking, tics, or other problem habits and that involves awareness training, competing response training, and social support