OCD and PTSD

Both OCD and PTSD were formerly known as

anxiety

HiTop organisation of PTSD

internalizing, distress

HiTop OCD

internalizing, fear

OCD was written about in 1691 under what title

religious melancholy

DSM criteria OCD: A-D

A. Presence of obsession, compulsions, or both

B. Obsesion/comp are time consuming 1+ hour or cause distress/imopariment in functioning

C. Symptoms are not attributatble to a substance or medical condition

D. The disturbance is not better explained by the symptoms of another mental disorder

• fair insight?

• tic related?

OCD: obsessions

persistent ideas, thoughts or images that are exoerienced as inappropriate and cause anxiety and distress.

Obsessions are egodystonic or syntonic

dystonic, an intrusive and impulsive

are obsessions a “natural” part of the OCD personality

no but they are reckognized as their own thoughts

How do you distinguish Obsessions form psychosis or schizophrenia?

there is no delusional thought systems

Common obsessions 1-6

1. COntamination

2. uncertainty

3. aggressive

4. symmetry/exactness

5. sexual

6. somatic

example of an uncertainty obsession

going back for stove, odds must be 100%

Somatic obsessions example

fear of aids

Is it common for people to act upon their obsessions?

no

how many obsessions do most OCD patients have

more than one

OCD: Compulsions, what are they

Repetitive behaviours or thoughts, eg think one bad thought than think 30 good ones

OCD: Compulsions, purpose

attempts to neutralize or supress the obsessions

• designed to reduce anxiety from obsessions

compulsions are ___ reinforced

negatively

why aren’t sexual or gambling compulsions considered OCD

because they are positively reinforced

Common compulsions: 3

1. washing

2. checking

3. repeating

4. mental

DO you need both obsession and compulasions to get a OCD diagnosis

no, it is more common to have obsessions but no compulsions

is it more common to to have obsessions and no compulasions or vice versa?

true, ¼ of ocd only have obsessions

OCD: Epidemiology (prevalence, adult vs children, W vs M)

• lifetime prevalence: 1.5

• same in Adult and child

• slightly more common in females to men

average age of onset for OCD

19, gradual

OCD: 40 year follow up study on recovery

natural study of course

• after 40 years, 20% recovered

• almost 30 % still had subclinical symptoms

• 50 percent experiencing clinically significant symptoms

Cognitive model of OCD

• obsessive thougts are common

• OCD= person experiences them as intrusive or upsetting

• inflated self blame

Models of OCD: ST memory

OCD is due to ST memory deficit

• ppl cant rememebr theyve checked

• hard to distinguish between real and imagined events

Models of OCD: Intolerance of uncertainty

Grayson

• intolerant of uncertainty believe they lack coping skills to effectively manage threatening situations

  • compulsions often attempt to increase uncertainty

Models of OCD: Thought action fusion 2 types

essentially magical thinking

• Moral TAF: inwanted thoughts about actions are equivalent to the actions themselves

• likelihood TAF: thinking about a disturbing event makes it more probable

Neutralization study

TAF study

• undergrads with some degree of TAF

• write an intrusive thought on a paper

  • condition 1: neutralizes immediatrly

  • 2: 20 minute delay

• results: both conditions anxiety decreases over time

• but DESIRE for neutralization is higehr for group 2

Disgust and OCD

Theory of OCD that ties disgust proness

• genetic and learning influences, disgust of the body/sole

• ocd as false contamination alarm

PTSD: which was the first DSM

DSM 3

• beforehand, stressors were seen as triggers of pre existing diathesis

what historical event triggered PTSD study

vietnam

• high rates of disorder in soldiers

how is ptsd different from other categories in the DSM

the disorder is centered around common ethology, trauma

DSM 5 criteria for PTSD: 6

1. exposure to a traumatic event

2. re experincing of the event in some way

3. avoidance

4. market alterations in arousal and reacticity iassociated with event

5. more than a month

to be diagnosed with PTSD your symptoms need to be going on for longer than was time period

a month

epidemiology of PTSD: prevalence and sex differences

7-8 % of people

2F:1M

following a trauma, what percentage of people develop PTSD

9%

cross cultural PTSD

higher in non western countries

Predictors of PTSD following trauma: 6

1. woman

2. familial non specific psychopathology

3. preexisting psychopathology

4. internalizing symptoms in chilhood

5. childhood trauma

6. low IQ

What about the nature of trauma predicts PTSD

• proximity

• duration

• level of risk

• intention

• dissociation

controversies in what constitutes a trauma

• is PTSD just a normal responses to an abnormal event?

• does it have to be outside the normal human experience

rates of PTSD symptoms were higher after __ ___ than for ___

life stressors than full blown trauma

Biological abnormalities and PTSD

• smaller hippocampal volume

  • belief that it intercts wuth amygdala during fear memory encoding, espceially context

• reduced amygdala volume

animal research showed that severe stree can damage what part of the brain

hippocampus

Issue with prospective design and PTSD

high levels of ppl who either didnt experience trauma, or experienced it but no PTSD

Twin study for PTSD

4 groups

• combat exposed vet w ptsd Exp+

• non combat exposed co twin (UxP+)

• combat exposed no ptsd Exp-

• UxP-

results: smaller hippocampal volumes in PTSD and exp

BUT their co twins also have smaller hippocampal size

issue with PTSD research

often funded by people who have vested interest in being diagnosed with PTSD

rodents with hippocampal lesions shwo stronger ___ fear

conditioned

smaller hippocampal size also associated with reduces regulation of what system

HPA axis, neuroendocrine system