HSCI 214 chapter 7 pt 2

The presence of both obsessions and compulsions is needed as part of meeting diagnostic criteria for OCD - True or False?

True

PTSD extends beyond the context of war and can follow the experience of any type of stressful or traumatic event

true

What does OCD symptom dimensions rely on? (what’s the most comprehensive symptom checklist called?)

The Yale-Brown Obsessive Compulsive Scale

List the 7 types of obsessions and the 6 types of compulsions in the Yale-Brown Obsessive Compulsive Scale

7 types of obsessions

→ aggressive, contamination, sexual, hoarding, religious, symmetry, and somatic

6 types of compulsions

→ cleaning, checking, repeating, counting, ordering and hoarding

What are obsessions?

unwanted ideas, images, or impulses that intrude on thinking against your wishes/efforts to resist them

• usually involve harm, risk, danger

What are examples of common obsessions?

• fear of contamination/obsession w cleaning

• recurring doubts abt danger

• extreme concern w order, symmetry, or exactness

• fear of losing important things

• religious obsessions

What are examples of somatic obsessions

• concern with illness and disease

• excessive concern w body part or aspect of appearance (dysmorphia)

What is the concern with the Yale-Brown Obsessive Compulsive Scale?

categories (to date) are not based on empirical evidence but rather on clinical experience/researchers’ assumptions

• rationally rather than empirically

What is Autogenous vs Reactive symptoms for OCD symptom dimensions?

Autogenous → self-generated triggers (sexual or aggressive thoughts)

Reactive → response to external stimuli (triggers regarding contamination or symmetry)

What is the Core Dimensions Model for OCD symptoms dimensions?

defines dimensions based on symptom theme

• allows for possibility of heterogeneity of symptoms, yet still identifies core or key dimensions in classification of OCD

Define Harm Avoidance

thoughts and actions to avoid harm → may lead to checking believed to ensure safety

What is Fear of Incompleteness?

one’s actions or intentions have not been correctly achieved

What are examples of unresolved questions abt OCD? How can we answer these questions?

• is OCD 1 condition w many diff variations or is it actually multiple diff disorders

• should the DSM break up OCD into not just subtypes but diff disorders?

Answer:

• improved symptom measures

• larger samples of patients, and investigation of alternate models (core dimensions model)

What % of people w PTSD experience symptoms of dissociation? What might they be diagnosed with?

15-30% → may be diagnosed w PTSD-DS (Dissociative Subtype)

What evidence supports distinction of PTSD-DS compared to PTSD?

• differences in duration and severity of illness

• differences in brain activity (in imaging studies)

What is PTSD-DS associated with?

• greater disease severity, increased suicidality, more comorbidities, greater illness burden

• part due to cognitive impairment associated w dissociation

Difficulties associated with dissociation & cognitive impairment of PTSD-DS include what?

• lowered attention, memory, executive function

• executive function = cognitive processes related to organizing thoughts, time management, problem solving, decision making

• poorer social cognition (understanding others emotions/intentions)

• poorer treatment response (especially w exposure-based treatment)

T/F? - some researchers don’t believe that PTSD-DS is a meaningful distension in diagnosis → argue including the subtype in the DSM-5 was a mistake

true

T/F - some studies do NOT show differences in treatment outcomes when ppl w PTSD and PTSD-DS are compared

true

T/F - current literature on effects of dissociative symptoms on treatment is inconsistent

true

Explain and contrast the emergence of PTSD during WW1 and Post-WW1

WW1 → understood as “Shell Shock”

• very broad range of symptoms w biological and psychological explanations

• questioned whether they were truly sick or wounded (deserving compensation & treatment or not)

Post-WW1 → Shell shock diagnosis was declined & banned

• militaries argued non-medical conditions were cause (cowardliness, poor morale) enacting screening to reduce problems stemming from psychological weakness - setting up barriers to claiming compensation

• military response → attempts to root out recruits & soldiers “predisposed” to shell shock

What is WWII “Combat Neurosis” & “Battle Exhaustion” diagnoses?

even healthy individuals could break down under stress of war (everyone has a breaking point)

What are the symptoms for WWII “Combat Neurosis” & “Battle Exhaustion” → What was the military response?

restlessness, irritability, aggression, fatigue, sleep difficulties, anxiety rather than tremors, blindness, and paralysis of shell shock

military response → quick attention to problems, rest, return to duty

T/F - during WW2 some former soldiers received compensation for psychiatric injury but American psychiatry relied on psychoanalysis which located problems in ex-soldiers -. ex: childhood experiences instead of combat related stress/trauma

true

What happened to soldiers who went through psychoanalysis to locate their problems resulting in childhood experiences rather than combat related stress/trauma?

“combat neurosis” diagnosis was declined

explain the emergence of PTSD during the 1960s Vietnam War

Emerging understanding of the effects of trauma

• lack of a diagnostic category made accessing treatment difficult

T/F? - All ppl experiencing PTSD toady would meet diagnostic criteria for shell shock

false

what are the similarities of shell shock, combat neurosis, and PTSD

• similar causes

• significant distress

• impairment stemming from trauma

what differentiates out diagnosis of shell shock, combat neurosis, and PTSD?

our understanding of symptoms has changed

As war grew more unpopular, what were the ideas from veterans & medial figures regarding mental health problems/emergence of PTSD?

veterans & sympathetic medical figures argued that conditions in war were producing mental health problems

• DSM-II did not have diagnosis related to combat trauma → lack of access to mental healthcare for ex-soldiers

when did advocacy for PTSD in the DSM-III begin to increase?

1980s - partially due to demands that APA recognize suffer and illness related to combat

• cause was attributed to experience of war (being inherently insanity provoking ) as opposed to the characteristics of individual

what symptoms were identified to be new and key symptoms to help understand the causes of PTSD?

flashbacks and dissociative episodes (reliving traumatic episodes) = new/key symptoms

• range of traumatic events other than war were understood to be causes of PTSD

What was the initial understanding of PTSD?

relation tp extreme stressors such as military combat, severe assault, and natural or manmade disasters

What has our understanding of PTSD evolved into (includes what types of new triggers?)

hearing hate speech, learning of a relative’s death, or watching a catastrophe unfold on TV