Obsessions
Recurrent and persistent thoughts, ideas, urges impulses, or images that are repeatedly experienced, intrusive, and cause anxiety or distress
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other though or action (often compulsions)
most common: The need for things to be “in order;” symmetrical, Cleanliness obsessions, Hoarding
issue in ocd is not intrusive thoughts themselves but the response to it
Compulsions
Repetitive and rigid behaviors or mental acts (might be invisible) that a person feels driven to perform in order to prevent or reduce anxiety (neutralize obsessions)
Behaviors are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
Cleaning and washing: if it takes up lots of times, if it is upsetting, if they are using harsh chemicals repetitively
Checking: checking if things are still there, car bump=hit someone
Arranging and organizing things
Repetitive counting: mental ritual not visible to others
Hoarding or collecting things
Obsessive-compulsive disorder (characteristics & diagnostic criteria)
Characterized by:
Recurrent and unwanted thoughts (obsessions)
A need to perform repetitive and rigid actions (compulsions)
Or both (don’t need both)
insight if often variable and inconsistent
Diagnostic Criteria:
Obsessions or compulsions are time-consuming (more than 1 hour/day) or cause clinically significant distress or functional impairment
Symptoms are not attributable to the physiological effects of a substance or another medical condition
Disturbance is not better explained by:
GAD
Dysmorphia
Hoarding
Trichotillomania
Impact on everyday functioning
self-care
parenting
social functioning
relationships
capacity for education and work
links with avoiding medical settings (contamination), school refusal, difficult for young adults leaving home
sometime contamination is a specific person
burden on family to follow person’s rules and prohibitions
OCD epidemiology (prevalence, cult. consideration, age of onset)
1-3% yearly prevalence
Cultural considerations: Similar across gender and cultures
Typical onset 4-25 years, gradual (2/3 before age 22)
Ritual behavior is common in childhood to a certain extent
Symptoms in children are similar, but are less likely to be ego-dystonic (inconsistent with one’s personality or beliefs)
poorly recognized and there are high fates of treatment resistance
OCD symptom profiles
checking (79%)
hoarding 62%
ordering 57%
moral concerns 43%
sexual/religious concerns 30%
contamination 26%
harming 24%
concerns about illness 14%
other 19%
81% present multiple symptoms
ODC and Co-occurring conditions
any anxiety disorder (75%)
panic disorder (20%)
social phobia (44%)
PTSD (19%)
separation anxiety (37%)
mood disorder (63%)
major depressive disorder (40%)
impulsive disorder (56%)
serotonin (SSRI half relief), glutamate, GABA & dopamine (reward related) helps 50-60% of people
orbitofrontal cortex and caudate nuclei are part of a circuit that may be overactive in OCD taking ssri reduces the circuit
supported by genetic evidence (up to 53 percent concordance rate in monozygotic twins) high heritability
streptococcal infections (repeated) in childhood may be related to OCD-like behavior
OCD theories Psychological (cognitive)
maladaptive thought patterns related to control and responsibility
Inflated responsibility- failing to prevent harm is the same as causing harm
-Thought-action fusion – people confuse or conflate having a thought with acting upon that thought
-Thought suppression – pushing away the thoughts that are unwanted actually makes them come back stronger
mowrer’s two-factor theory
problems with mowrer’s two-factor theory
mainly describes phobias but somewhat applicable
no traumatic event that could act as conditioning experience
stage 1 cannot explain distinctive contents of intrusive thoughts
symptoms can change over time
doesn’t explain the varying degree of self insight
Beck cognitive specificity hypothesis
different types of psychopath arise from different kinds of dysfunctional beliefs
The specificity hypothesis led other researchers to examine psychological disorders in an attempt to identify the key pathological beliefs
Assessment- clinical interview
description of difficulty
first episode
triggering context/onset
Physiological / Emotional / Behavioural / Cognitive / Meta-Cognitive
Length of current episode / previous episodes
When / where / with whom does it happen (e.g. hand washing compulsion)
Coping strategies / safety behaviours
Functional consequences of anxiety disorder
Impact on other people
Previous treatment
assessment- psychometric
Maudsley Obsessional-Compulsive Inventory (MOCI)
Padua Inventory (PI)
Yale Brown Obsessive-Compulsive Scale (Y-BOCS)
Obsessive Compulsive Inventory (OCI)
OCI-R
Psychological treatment
Though stopping (behavioral, operant): pair unwanted thoughts with negative consequences
Exposure and response (ritual) prevention: clients experience high - risk situations without engaging in compulsive behaviors (behavioral, two - factor)
pharmacological: SSRI’s anti-psychotics
other CBT interventions
Reducing dependence on coping strategies / safety behaviours
Model of habituation to anxiety
Hierarchy of fears
Cognitive restructuring
Inverted pyramids
Pie-chart technique
Downward arrow
Collecting evidence – diary work
Externalization
Relaxation and applied tension – learning to tolerate distress during exposure sessions
Mindfulness practice
treatment resistance
cogbehav doesn’t perfectly fit
difficulty accessing thoughts
tolerating anxiety & distress durring exposure work
secondary gain
covert or tacit neutralisation
other theories and stuff*
Hoarding disorder
compulsive saving of possessions
Rooms in the house can gradually become so cluttered that they can no longer be used
Even as you help the person rid themselves of some hoarded materials, new items can be added to the collection
Impact sleeping, cooking, personal hygiene
May or may not be associated with obsessional thoughts
people perceive part of their body as ugly or flawed and spend significant time masking the “defect”
Associated with seeking plastic surgery and dissatisfaction with surgical results
Associated with high suicide rates
Nerve fibers of ANS that produce physiological changes we experience as fear or anxiety
Stimulate organs directly or indirectly (epinephrine & norepinephrine)