TG

Week 5 OCD and PTSD

OCD, PTSD, and Trauma-Related Disorders

  • Overview of disorders related to obsession and trauma.

DSM-IV-TR vs. DSM-5

  • DSM-5 introduces new chapters for:

    • Obsessive-Compulsive and Related Disorders

    • Trauma- and Stressor-Related Disorders

Obsessive-Compulsive and 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.

Obsessive-Compulsive Disorder (OCD)

  • 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.

Common Obsessions and Compulsions

  • 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.

Psychological Factors Affecting OCD

  • 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.

Prevalence and Comorbidity

  • 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.

Treatment for OCD

  • Cognitive-Behavioral Treatments:

    • ERP (Exposure with Response Prevention) is a key method.

  • Medication Options:

    • SSRIs such as Prozac are often prescribed.

Posttraumatic Stress Disorder (PTSD)

  • 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.

Rates of PTSD Following Trauma

  • 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.

PTSD and Co-morbidities

  • Common co-occurring disorders include:

    • Major Depressive Disorder

    • Alcohol Use Disorder

    • Generalized Anxiety Disorder

Treatments for PTSD

  • 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.

Prolonged Exposure Therapy

  • 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.

Cognitive Processing Therapy (CPT)

  • 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.

Other Treatments for PTSD

  • Virtual Reality Exposure Therapy and EMDR (with caution regarding mechanisms).

  • EMDR's effectiveness appears linked to exposure principles rather than the proposed mechanism.