Abnormal Psych OCD

Test 3

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

Most common compulsions

• 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%)

OCD theories Biological

• 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*

OCD related disorders

hoarding disorder, Trichotillomania, Body dysmorphic disorder, Excoriation disorder

Collectively, these disorders are seen in 5% of the population

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

Trichotillomania

hair pulling disorder

Body dysmorphic disorder

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

Excoriation disorder

skin picking

* can lead to infections and abbesses with over-picking

Fight-or-flight response

2 Pathways used by the autonomic nervous system (ANS) ( sympathetic and parasympathetic) and endocrine system to produce arousal and fear reactions:

Activity begins with activation of the hypothalamus

Fight-or-flight response pathways

1\. Sympathetic nervous system

2\. Hypothalamic pituitary-adrenal (HPA) pathway

sympathetic vs parasympathetic nervous system response

1\. Sympathetic nervous system

• Nerve fibers of ANS that produce physiological changes we experience as fear or anxiety

• Stimulate organs directly or indirectly (epinephrine & norepinephrine)

2\. Hypothalamic pituitary-adrenal (HPA) pathway

Secrete hormone (ACTH)

→ stimulates adrenal glands

→ release corticosteroids (e.g., cortisol)

→ produce fear reaction

sympathetic nervous system stress pathway

Patterns of autonomic and endocrine functioning are…

particular to every person

trait anxiety, situation anxiety

Trait Anxiety: what we enter the world with

* Individualized and general level of arousal and anxiety

Situation/state anxiety: Individualized sense of which situations are threatening