Overview of disorders related to obsession and trauma.
DSM-5 introduces new chapters for:
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Types of Disorders:
Obsessive-Compulsive Disorder (OCD)
Characterized by:
Repetitive thoughts or images (obsessions)
Repetitive behaviors or mental acts (compulsions)
Hoarding Disorder:
Involves:
Repeated thoughts about possessions
Inability to discard unnecessary items.
Obsessions:
Intrusive, persistent, uncontrollable thoughts or urges
Interfere with normal activities.
Compulsions:
Impulses to repeat certain behaviors or mental acts to avoid distress.
Examples include:
Cleaning
Counting
Touching
Checking
Compulsions can lead to elaborate behavioral rituals.
Obsessions may include:
Contamination fears
Fears of harm (self or others)
The need for symmetry
Issues regarding sexuality, religion, and aggression.
Compulsions may include:
Cleaning
Checking
Repeating actions
Ordering/arranging
Counting.
Learned Behavior:
Mowrer’s two-process theory of avoidance learning explains OCD.
Acknowledges the evolutionary adaptive nature of fear and anxiety.
Cognitive Factors:
Attempts to suppress thoughts can increase their frequency.
Lifetime Prevalence:
Approximately 2% of the population experiences OCD (more prevalent in women).
Comorbidity:
High rates of co-occurrence with:
Hoarding Disorder
Body Dysmorphic Disorder (BDD)
Depression and anxiety disorder.
OCD also often coexists with substance use disorders.
Cognitive-Behavioral Treatments:
ERP (Exposure with Response Prevention) is a key method.
Medication Options:
SSRIs such as Prozac are often prescribed.
Characteristics (as per DSM-5):
Trauma Exposure:
Experienced or witnessed.
Reexperiencing Symptoms:
Nightmares and intrusive images.
Avoidance Symptoms:
Avoiding thoughts and reminders of trauma.
Negative Changes in Cognitions and Mood:
Feelings of detachment, shame, distorted self-blame, loss of interest.
Hyperarousal Symptoms:
Hypervigilance, exaggerated startle response, irritability, sleep disturbances.
Duration:
Symptoms must last for at least 1 month; can also present as Acute Stress Disorder.
Higher likelihood from trauma associated with human intent compared to natural disasters.
Prevalence in the U.S.: approximately 7% (4% men, 10% women).
Risk Factors:
Female gender, higher neuroticism, family history of psychological disorders, low social support.
Prolonged trauma exposure increases risk rates while higher cognitive ability may serve as a protective factor.
Common co-occurring disorders include:
Major Depressive Disorder
Alcohol Use Disorder
Generalized Anxiety Disorder
Medication:
Antidepressants show modest effectiveness over placebo.
Cognitive-Behavioral Treatments:
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have significant empirical support, showing similar treatment effectiveness.
Includes several homework assignments for clients:
Breathing practice and daily audiotape sessions for imaginal exposure.
In vivo exposure exercises to build up resilience against triggers.
Utilizes an ABC Worksheet to identify consequences of thoughts following traumatic events.
Help clients restructure unrealistic beliefs related to guilt and shame from past actions.
Virtual Reality Exposure Therapy and EMDR (with caution regarding mechanisms).
EMDR's effectiveness appears linked to exposure principles rather than the proposed mechanism.