Obsessive-Compulsive Related and Trauma-Related Disorders

Obsessive Compulsive Disorder

Occurrence of repeated obsession, compulsions, or both that take up considerable time.

• obsessions = repetivie thoughts, impulses, images

• compusions = actions that must be repeated

Common Obsessions

1. contamintion

2. doubts

3. symmetry

4. aggressive or horrific impulses

5. sexual imagery

Common compulsions

1. checking

2. cleaning

3. ordering/arranging

OCD Behavioral Etiology

operant conditioning

• compulsions are learned behaviors reinforced by their consequences

  • doing the compulsion decreases anxiety

• neutral stimuli become frightening, and it can be hard to remove these behaviors

• exposure should help decrease sx

4 cognitive factors for OCD

1. depressed mood

2. strict code of acceptibility

3. dysfunctional beliefs about responsibility and harm

4. dysfunctional beliefs about the control of thoughts

2 additional cognitive characteristics of OCD

1. probability bias

   • having the thought increases the likelihood it will happen

2. Morality Bias aka thought-action fusion

   • the thought is just as bad as if you actually did the action

OCD NTs

• serotonin dysfunction (increased)

OCD Genetics

• runs in families 40-50%

OCD Brain Structures

cortico-striatal-thalamic circuit

• orbital region = primitive impulses

• caudate nucleus = filters out some impulses

• thalamus = where powerful impulses reach

maybe too many impulses or maybe bad filtering

could also be an injury to this circuit

OCD Medication & Effect

• SSRIs

  • increases serotonin

  • decreases orbital and caudate

exposure with response prevention (ERP)

• behavioral treatment

• OCD and BDD (better for OCD)

• put them in a situation where they want to complete a compulsion but don’t allow them to do so and teach them how to manage their anxiety

• only works for compulsions not obsessions

• many drop out or refuse this type of treatment but those who complete it do really well

body dysmorphic disorder

• preoccupation with some imagined defect in appearance in a normal-appearing person NOT related to weight or body fat

• person performs repetitive behaviors or thoughts in response to their concerns

BDD Comorbidities

1. depression (80%)

2. anxiety (75%, esp SAD)

3. avoidant PD

4. OCD (1/3)

BDD and OCD similarities

1. obsessions and compulsions

2. appear in adolescence

3. chronic

4. runs in families

BDD and OCD differences

1. BDD just focus on appearance

2. BDD have lower self-esteem and are more concerned with rejection

BDD course

• not a lot known

• may shift over time

• 90% still qualify within 1 years

• 75% don’t qualify after 8 years

BDD impairment

• social

  • difficulty with friends and dating

• occupational

  • withdraw from school

Unique BDD complication

unnecessary plastic surgery

• never happy with how it turns out or just switch to focusing on another part of their body

BDD personality traits

1. high levels of neuroticism

2. perfectionism

3. insecurity

4. oversensitivity

Sociocultural context of BDD

• BDD pts hold attractiveness as a primary value which they may have picked up from society

• may have been reinforced for their appearance more than behavior

• teased as a child

BDD information processing biases/defecits

1. biased attention to attractiveness

2. functional differences in visual processing (focus on faces)

3. orbitofrontal cortex and caudate nucleus are more active when they look at their own face

BDD Medication

1. SSRIs

   • need higher doses than those with MDD

   • similar to OCD

Post-Traumatic Stress Disorder

1. experience a traumatic event

2. 1+ intrusive sx

3. avoid trauma linked stimuli

4. 2+ negative changes in cognitions and mood

5. 2+ alterations in arousal and reactivity

6. distress or impairment

PTSD: intrusively re-experiencing the traumatic event

• dreams/nightmares

• flashbacks

• memories

PTSD: avoidance

• avoid activities that remind them of the event

PTSD: mood and cognitive changes

• reduced responsiveness, detachment

• blame yourself

• survivor guilt

PTSD: increased arousal and reactivity

• irritable/aggressive

• hyper-alert

• exaggerated startle response

• sleep disturbance

• trouble concentrating

• self-destructive behavior

PTSD vs Acute Stress Disorder

Acute Stress = within the first month after the event

PTSD = greater than one month

factors for development of PTSD

1. severity of stressor

   • more severe = PTSD

2. generalized psychological functioning

   • previous mental health issues

   • diathesis-stress

3. social support

   • less = PTSD

4. hardiness

   • less hardy = PTSD

5. premorbid psychological functioning

   • family history

   • what disorders you had at the time

6. avoidance, dissociation

   • increased = PTSD

7. human induced vs natural disaster

   • human = PTSD

PTSD Behavioral Treatment

• exposure

• difficult to tolerate

• “in vivo” is better than just talking about it, use VR

PTSD Cognitive Treatment

• cognitive therapy

• help cope, change cognitions, reduce guilt and self-blame

PTSD Medication

1. antidepressants

   • better than benzos

2. benzodiazepines

   • addictive, side effects

3. Beta-clockers

   • prevent adrenaline surges via calming ANS

4. ectasy

   • not in US

use meds to decrease sx intensity to be able to go through therapy

Sx of Hoarding Disorder

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

2. perceived need to save items

3. distress associated with discarding items

4. the accumulation of possessions clutters active living spaces to the extent that their intended use is compromised unless others intervene