wk5-6 obbsession/preoccupation

Definition: Characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life.
Criteria:
- A. Symptoms: 1+ somatic symptoms that cause distress.
- B. Excessive Reactions: Related to somatic symptoms or health concerns manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
- C. Duration: The state of being symptomatic is persistent, typically for 6 months or longer.

Features:
- Severe pain that may be exacerbated by psychological factors.
- Leads to anxiety and distress.
- There may not be a clear physical reason for the pain.
DSM-5 Focus: Emphasizes the psychological symptoms accompanying the disorder.

Formerly Known As: Hypochondriasis.
Characteristics:
- Physical symptoms are absent or mild, but there's a concern about serious illness.
- Reassurance from physicians tends not to be helpful.

A. Preoccupation: With having or acquiring a serious illness.
B. Presence of Symptoms: Somatic symptoms are not present or are mild; the preoccupation is excessive or disproportionate.
C. Anxiety Level: High level of anxiety about health, easily alarmed regarding health status.
D. Behavioral Responses: Engages in excessive health-related behaviors or avoids health-related situations.
E. Duration: Illness preoccupation must be present for 6 months or longer.

Factors Contributing to Development:
- Enhanced perceptual sensitivity to illness cues.
- Tendency to interpret ambiguous stimuli as threatening.
- Genetic predispositions.
- Negative life events contributing to the disorders.
- Possible attention-seeking behaviors linked to illness.

Challenges: This disorder is hard to treat effectively.
Key Treatments:
- Cognitive Behavioral Therapy (CBT).
- Involves strategies to reduce stress.
- Minimize compulsive help-seeking behaviors.
- Improve interpersonal relations.

Definition: The unconscious conflicts are expressed through physical symptoms, serving as a mechanism to handle extreme stress.
Characteristics of Conversion Disorder:
- Severe physical dysfunction with no identifiable organic cause.
- Also known as Functional Neurological Symptom Disorder.

A. Symptoms: 1+ symptoms of altered voluntary motor or sensory function.
B. Clinical Findings: Must provide evidence that the symptom is incompatible with any recognized neurological or medical conditions.
C. Exclusion: The symptom or deficit cannot be better explained by another medical or mental disorder.

Related disorders include:
- Malingering: Intentionally faking symptoms for external gain.
- Factitious Disorders: Inducing or feigning illness, with one variant being factitious disorder imposed on another.

Criteria for OCD:
- A. Presence of Obsessions and/or Compulsions:
1. Obsessions: Recurrent, persistent thoughts, urges, or images that are intrusive and cause marked anxiety or distress.
2. Attempts to Neutralize: Efforts to ignore or suppress these thoughts with alternative thoughts or actions.
- Compulsions involve:
1. Repetitive behaviors or mental acts performed in response to the obsession or rigid rules.
2. Behaviours/mental acts used to prevent or reduce distress, although they are not realistically connected with what they are meant to neutralize.
- B. Time Commitment: Obsessions or compulsions take up more than 1 hour per day or cause significant clinical distress.

Conceptual Framework:
- Negative reinforcement leads to temporary relief of anxiety through compulsive behavior, which results from obsessive thoughts:
- Obsessive Thought triggers Anxiety/Fear/Discomfort.
- Engaging in Compulsion gives a sense of temporary relief.
- This cycle feeds back, perpetuating the obsession and compulsion.

Effective Approaches:
- Exposure and Response Prevention (ERP): Helps expose individuals to their fears and prevents the response of compulsion.
- Medication:
- Use of Serotonin-Based Antidepressants (SSRIs): About a 50% chance of response. If effective, patients may experience a 20-40% reduction in obsessions and compulsions (Abramowitz, 2018; Foa et al., 2015).
- Consideration of Relapse: Approximately 90% relapse rate when medication is discontinued without additional treatment.

Statistics:
- Lifetime prevalence of OCD is between 1.6% and 2.3%.
- Gender differences: Male-to-female ratio is 1:1; however, childhood cases show more boys than girls.
- Gender minority groups are 4-6 times more likely to seek treatment for OCD (Pinciotti et al., 2022).
- Onset typically occurs in early adolescence to mid-20s; it is often chronic once established.

Common OCD Themes:
- Symmetry and Exactness: Need for items or situations to be ‘just right’.
- Checking Behaviors: Repeatedly checking to ensure safety or prevent harm.
- Forbidden Thoughts: Involving fears of harm, sexual thoughts, or religious scrupulosity.
- Cleaning and Contamination: Extreme fear of germs leading to excessive cleaning behaviors.
- Hoarding: Inability to discard items, leading to clutter and distress.

Harming Thoughts:
- Urges to harm oneself or others (e.g., jumping in front of cars, wishing harm would come to others).
Contamination Fears:
- Anxiety about diseases from public places or items (e.g., fear of catching diseases from toilet seats).
Inappropriate Behaviors:
- Thoughts of embarrassing acts in public settings.
Doubts About Safety:
- Recurrent doubts about securing a home or appliances (e.g., whether the stove was turned off).

Definition: Preoccupation with an imagined defect in appearance, referred to as 'imagined ugliness.'
Common Behaviors:
- Individuals may engage in repeated behaviors such as checking their appearance in mirrors or comparing themselves to others.
Co-occurrence: Often co-occurs with OCD, indicating it may be on a continuum of related disorders.