PSY 350 - Obsessive Compulsive Disorders

How many OC related disorders are there? How are they grouped?

1. 5 disorders under the DSM-5

2. Grouped because of shared features

- obsessive thoughts and/or

- compulsive behaviors

3. Include OCD, hoarding disorder, body dysmorphic disorder, trichotillomania, excoriation

What is obsessive-compulsive disorder (OCD)?

1. Obsessions

- intrusive, upsetting, or nonsensical thoughts, images, or urges

- causes a lot of distress!

- when a door opens --> we are all covered in germs --> we are all gonna die

2. Compulsions

- thoughts or actions to neutralize anxious thoughts (the obsession)

- bring about immediate relief from anxiety

- cause most of the dysfunction

- girl who thought she was running over a child but it was a speed bump

3. Vicious cycle of obsessions and compulsions

- Cleaning/washing/checking rituals are common

- Ego-dystonic --> Many know it's not right/rational

- Causes extreme distress

When does OCD show up?

Typically in early adolescence or young adulthood

- Tends to be CHRONIC

- don't see it much later in life

- Similar incidence and presentation across cultures --> might be culturally influenced

What did the movie clip about OCD show?

Jack Nicholson counting the number of times the lights are turned on & off, constantly using a new soap bar to wash hands

Leonardo DiCaprio washing his hands until they bleed in the Aviator

What are the causes of OCD?

1. Parallels the other anxiety disorders

- obsessions are distressing; compulsions are relieving

2. Early life experiences

3. Learning that some thoughts are dangerous/unacceptable

- make thought go away by doing smthing --> negative reinforcement

4. Thought-action Fusion

- the thought is similar to the action; thinking smthing will make it more likely to happen

What is the biological treatment for OCD? (2)

1. SSRIs (Luvox & Prozac)

- benefits up to 60% of patients

- increased serotonin stabilizes thoughts and regulates obsessions

2. Clomipramine --> TCA

- trycylcic

- worst side effects, sedation

- if they can't accept the SSRIs

*Relapse is common with medication discontinuation

What is the psychological treatment for OCD?

1. Cognitive-behavioral therapy

2. Exposure and Response Prevention (ERP)

- involves exposure to anxiety-provoking cues and prevention of ritualized responses

Ex: touching door handles and not washing hands afterward

What are the characteristics of hoarding disorder?

1. Previously considered a type of OCD

- related to it

2. Characterized by excessively collecting or keeping items regardless of their value and difficulty discarding them, usually due to a fear that one will need them later

- usually know that its not rational, yet do it anyways

3. Causes clinically significant distress or impairment

- house too cluttered, arguments with family members

- Associated with high levels of disability -->

a. Unsanitary conditions

b. Social isolation

c. Eviction

d. Work disability

What is the age of onset for hoarding disorder?

Likely before 20; severity increases with age

Is hoarding disorder chronic? More common in men or women?

1. Chronic

2. May be more common in men

What are the cognitive-behavioral factors in hoarding disorder?

1. Faulty beliefs about one's possessions

- "I might need it someday"

2. Extreme attachments to possessions

3. Saving = avoidance behavior

- not throwing something out reduces distress associated with potentially making the wrong decision regarding the cherished possession

- saving/avoidance reduces anxiety

What are the characteristics of body dysmorphic disorder (BDD)?

1. A preoccupation with some imagined defect in appearance

- Ex: ears too big, muscles too small

2. Actual defect, if present, appears slight to others

3. Leads to clinically significant distress/impairment

4. Often leads to compulsive behaviors

- mirror checking

- hide, check, and/or try to improve perceived appearance flaws

- compulsive grooming rituals --> excessive clothing changes, excessive purchasing of beauty products

5. Frequent among plastic surgery and dermatology patients

What was Kraft's example of BDD in celebrities

Michael Jackson

When is the typical onset of BDD?

During adolescence

Is BDD more common in males or females?

Seen equally

What are Cognitive-Behavioral Factors in BDD?

Distorted cognitions and reinforcing

avoidance behaviors maintain symptoms

- Distorted cognitions may arise from

teasing or abuse, as well as a biological

vulnerability to anxiety

What is muscle dysmorphia?

A form of BDD found almost exclusively among men

- usually runs a lifelong chronic course

What is the treatment for BDD?

1. Cognitive behavioral therapy

2. Exposure to anxiety & preventing compulsions

- Ex: not wearing makeup and having no mirror available

3. Medication like SSRis provide some relief

What are the characteristics of Hair-Pulling Disorder (Trichotillomania)

1. Repetitive pulling out of one's hair despite repeated attempts to stop

- can happen all over the body

- usually scalp, eyelashes, eyebrows

2. Results in noticeable hair loss and significant distress or impairment

3. Diagnosed more in females

What is the typical age of onset for hair-pulling disorder?

During or after puberty

What are the characteristics of Skin-picking disorder (Excoriation Disorder)?

1. Recurrent skin picking despite repeated attempts to stop

2. Results in skin lesions and significant distress or impairment

3. More female than men

What are is the typical age of onset of Skin-Picking disorder

After puberty

- in early 20s

What are Cognitive-Behavioral Factors in Hair-Pulling and Skin-Picking Disorders?

Pulling hair/picking skin may be a strategy to manage undesirable emotions

Negative reinforcement

• Negative emotions are reduced while hair is pulled/skin is picked (but negative emotions tend to precede and follow the pulling/picking)

What is the role of genetics in causing obsessive-compulsive and related disorders?

There may be an inherited genetic diathesis for OCD and anxiety

1. Twin and family studies support a significant genetic contribution to OCD and related disorders

2. People with OCD may be increased genetic risk for any anxiety disorder

What are the cognitive-behavioral factors in obsessive-compulsive and related disorders?

1. Physiological reactivity and obsessive thinking icnrease during times of stress

- anxiety sensitivity

2. Obsessive thinking is experienced as "bad" or "unacceptable" and provokes more anxiety

3. Compulsive responses are used to neutralize anxiety

4. Compulsive responses are reinforced and become persistent because they lower anxiety