gad, anxiety pt 3

Obsessive-Compulsive Related Disorders

Overview of Disorders

• Categories of Disorders:

  • Obsessive-Compulsive Disorder (OCD)

  • Hoarding Disorder

  • Body Dysmorphic Disorder (BDD)

  • Mentioned to be discussed later in relation to eating disorders

Obsessive-Compulsive Disorder (OCD)

• Definition: A disorder characterized by both obsessions and/or compulsions, although not necessarily both.

• Symptoms:

  • Obsessions:

  • Defined as intrusive, inappropriate thoughts, impulses, or images that cause significant anxiety and distress.

  • Common types of obsessions include:

    • Fear of contamination.

    • Thoughts of harming oneself or others, such as a baby.

    • Unacceptable sexual thoughts, often tied to cultural perceptions of sexuality.

    • Fears regarding sexual orientation (e.g., fear of being gay) stemming from societal stigma.

  • Recognized by individuals as being their own thoughts but feeling uncontrollable.

  • Compulsions:

  • Behaviors that are repetitive and intended to relieve anxiety coinciding with obsessions.

  • Often performed according to specific rules.

  • Examples include:

    • Excessive hand washing, rituals resembling surgical scrubs.

    • Checking behaviors (e.g., repeatedly checking if doors are locked).

    • Counting or repeating words mentally to gain some relief from anxiety.

• The Cycle in OCD:

  • Obsession leads to anxiety, which leads to a compulsion intended to alleviate that anxiety.

  • These compulsive actions are generally perceived as ineffective in real-life contexts (e.g., washing hands does not truly alleviate the fear of contamination, especially when irrational).

• Biological Perspective:

  • Involvement of serotonin as a neurotransmitter.

  • SSRIs (Selective Serotonin Reuptake Inhibitors) are prescribed, typically at higher doses than for depression. Relapse rates are high upon discontinuation.

• Behavioral Perspective:

  • Viewed through the lens of the two-factor learning theory.

  • Classical conditioning associated with an anxiety-provoking experience leads to the use of compulsive behaviors to relieve that anxiety.

  • Example with hand washing as a compulsive behavior when actually there is no real contamination threat.

Treatment Approaches for OCD

• Effective Treatments:

  • Exposure and Response Prevention (ERP):

  • Real-life exposure to feared stimuli while preventing the compulsive response.

  • Begins with desensitization exercises; real-life engagement in activities causing anxiety without performing compulsions is crucial.

  • For instance:

    • Therapist models interacting with an anxiety-provoking situation (e.g., touching a counter).

  • Group format or individual therapy.

• Efficacy:

  • Generally high long-term improvement rates; however, there is a small percentage of individuals who may not respond well to these treatments.

Hoarding Disorder

• Definition:

  • Characterized by excessive collection of items, regardless of their actual value, due to a fear of discarding them which may lead to needing them later.

• Differences from OCD:

  • Hoarding is not effectively treated with typical OCD interventions such as ERP. It involves more complex psychological factors.

• Symptoms and Consequences:

  • Impaired functioning and potentially dangerous situations (e.g., a home filled with clutter may harbor dead animals or hazardous waste).

• Behavioral Aspects:

  • The behavior is driven by negative reinforcement due to fears associated with discarding items; the act of keeping items provides temporary relief.

• Cultural Implications:

  • Television portrayals may trivialize the suffering associated with hoarding by framing it in a sensational light.