OCD and Related Disorders - Lectures + Notes

DSM criteria for OCD

A. Presence of obsessions, compulsions, or both

B. Obsessions or compulsions are: Time consuming (>= 1 hour/day) Cause clinically significant distress or impairment

Define obessions

• Intrusive, persistent, and uncontrollable thoughts, images or urges

• Person attempts to ignore, suppress, or neutralize them

Define compulsions

• Repetitive behaviours or mental acts to avoid distress or dreaded event

• Driven to preform in response to obsessions or according to rigid rules

Do you need both obessions and compulsions for OCD

No

What are the main criteria for OCD diagnosis

Evidence of ignoring, avoidance, or supression

OCD: Onset age, Women v Men, Prognosis?

Onset: Before age 10 or during late adolescence/early adulthood

Women > men

Chronic without treatment

How does OCD compared across cultures?

Pattern of symptoms is similar across cultures. With taboo obsessions influenced by taboss of that culture

Why do people continue to engage in compulsions?

Engaging in compulsions → neutralizes their urge/thought.

Providing relief - Acts as negative reinforcement

Thought suppression and its role in maintaining obsessions

Thought suppression paradoxically increases the frequency of unwanted thoughts

State the DSM criteria for Body Dysmorphic Disorder

A. Preoccupation with a perceived defect or markedly excessive concern over a slight defect in appearance

• Preoccupation: Intrusive, unwanted, time-consuming, difficult to control

B. Repetitive behaviors or mental acts in response to appearance concerns

C. Clinically significant distress or impairment

D. Preoccupation is not restricted to concerns about weight or fat

In BDD what do women typically focus on

Women focus on: skin, hips, breasts

In BDD what do men focus on typically

Men focus on: height, penis size, body hair, muscularity

How does BDD differ cross culturally

Seen in other cultures, part of focus can differ by culture

DSM Criteria for Hoarding Disorder

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value

B. Impairs use of active living areas

What do would you state if someone has an excessive need to acquire new things

Add the excessive acquisition specificer

Different types of treatment of OCD and related disorders

Exposure + response prevention (ERP)

Cognitive Therapy

Medication

What are the two types of medication used for ODC and related disorders

• SSRIs

• Tricyclic Antidepressants

Define traumatic event

Exposure to actual or threatened death, serious injury, or sexual violence via:

• Directly experiencing

• Witnessing (in person)

• Learning it occured to a close family/friend → must be violent/accidental

• Repeated or extereme exposure to details

For a traumatic event what can't you be exposed through, exception?

Not through media, TV, movies, or picture. UNLESS part of work (First responders)

What if you experience a traumatic event, but doesn't fall under any of the categories

Falls under Adjustment Disorder

What are the required symptoms for PTSD? (+ duration)

• Intrusively re-experiencing the traumatic event

• Avoidance of stimuli

• Other signs of mood and cognitive changes (Ex: Memory Loss, Social Withdrawl)

  • Atleast 2

• Increased arousal and reactivity

  • Atleast 2

Symptom present >1 month

PTSD: Age of onset, Women v Men, Prognosis?

Age of onset: Occuring at any age after 1

Women > Men

Chronic → ~treatment

ASD vs PTSD

Must met all symptoms as PTSD

Duration is only between 3 days - 1 month.

Pros around having ASD diagnosis

Allow treatment early → issurance requires diagnosis for treatment

Cons around having an ASD diagnosis

Natural response to tramuatic event → seen as pathological

How does the predictive validity for ASD compare to PTSD?

ASD → doesn't have any predictive validity for PTSD

Etiology of PTSD, shared with other anxiety disorders

Neurobiological (greater amygdala, lower medial prefrontal cortex)

Genetic

Childhood exposure to trauma

Two-factor model of conditioning also applicable

What are some unique factors for PTSD

Neurobiological → Hippocampus is smaller in volume

Avodiance coping

Severity and type of trauma → if PSTD is developed

What are some treatments of PSTD?

Medication (SSRI's)

Exposure to memories and reminders of the original trauma

Cognitive Therapy

How does Exposure for PTSD fair?

More effective than medication or supportive therapy

How does adding cognitive therapy to exposure for PSTD fair?

Adding CT to exposure does not improve treatment response

How does treatment of ASD related to PTSD?

Treatment of ASD → prevents PTSD

How do BDD and eating disorders differ

Eating disorders → central concern is about weight/fat

BDD → central concern in about appearance

How long (per day) must the obsessions occur BDD?

3 - 8 hours per day thinking about appearance

State two common compulsive behaviours in BDD

1. Mirror Checking

2. Seeking reassurance about appearance

How does BDD differ cross culturally?

Focus of body part differs cross culturally: Japan → eyelids

What are the three shared brain regions in OCD and related disorders? Why do the matter?

Hyperactivity response to symptom-provoking stimuli:

1. Orbitofrontal cortex (OFC)

2. Caudate nucleus

3. Anterior cingulate cortex

How do CBT and antidepressants effect brain regions for OCD and related disorders?

reduces activation of the OFC and caudate nucleus

What is thought-action fusion?

The belief that:

• Thinking about something is as morally wrong as doing it, OR

• Thinking about an event makes it more likely to occur

Etiology of BDD

• Detail-Oriented Analytic Style

• Appearance Overvaluation

Etiology of Hoarding Disorder

• Evolutionary Perspective

• Poor Organizational Abilities

• Unusual Beliefs About Possessions

• Avoidance

What is the primary medication for OCD and related disorders

Antidepressants

What is the first-line treatment for OCD and related disorders?

ERP

What is the rational behind ERP

1. Not performing the ritual exposes the person to the full force of the anxiety

2. promoting extinction of the conditioned fear response

What are additional psychological treatment options for BDD

1. Perceptual retraining → whole appearance, with non-evaluative language

2. Attention refocusing → Shift attention externally

What is the downside for medication in PTSD?

Many patients relapse after medications are discontinued

What is the front line treatment for PTSD?

Exposure Therapy

What is Cognitive processing therapy (CPT)

Therapy to dispute self-blame tendencies

When might CPT be effective

• Rape victims and childhood sexual abuse survivors

• Reducing guilt and dissociation

What is Critical Incident Stress Debriefing (CISD)

Single long group exposure session within 72 hours of trauma

Why might CISD perform poorly?

treating them may interfere with natural coping

How does the exposure part for ERP work? IN OCD

Client deliberately confronts situations that trigger obsessions and the associated anxiety.

How does the response prevention part for ERP work?

Client refrains from performing any compulsive ritual — behavioral OR mental — during the exposure