Obsessive Compulsive Disorder

Obsessive compulsive disorder(OCD)

  • obsession: cognitive aspects

  • Compulsion: behavior

  • role of negative reinforcement→ maintains the cycle

chronic

  • in a given year, 1.6-2.7% of US population suffers from OCD

  • some obsession is good→ you want your surgeon to be a little bit obsessive but if it affects your success than its abnormal(miss deadlines)

  • comorbidity 50% usually anxiety disorders

4 general themes:

  1. contamination/washing,

    1. washing hands obsessively

  2. uncertainty/doubt about accidental harm

    1. “step on a crack and break your mothers back”

  3. unwanted impulses/taboo thoughts and mental rituals(rare)

    1. unwanted impulses to knives→every time she saw knives she was afraid that she would impulsively stab herself

    2. in order to do something correctly they have to do a ritual first→ count all the ceiling tiles before taking a test or else they will fail

  4. orderliness/symmetry, arranging and counting

    1. individuals have to chew 5 times on each side of their mouth before they swallow their food

      1. if mess up the ritual they have to start over

onset:

  • late adolescence or early adulthood

  • still possible for childhood onset

    • themes different→ invisible monster instead of germs they cant see

  • in most cases, the disorder has a gradual onset(not always)

  • may start after significant life event or evolve from childhood rituals

etiology of OCD:

  • biological

    • high heredity 48-58%→ higher concordance rates(runs in families)

    • increased metabolic activity in front lobe(orbital prefrontal cortex) with decrease activity in caudate nuclei (one of multiple structures that regulate learning and inhibitory control of action)

  • psychological

    • freud: obsessional neurosis→ conflicts between ID and Ego

    • behavioral: mowrers two factor theory of fear acquisition

      • classical conditioning

      • operant conditioning

    • cognitive

      • inflated personal responsibility

        • take more responsibility for things that they really should

      • over importance of thoughts

        • think thoughts are facts→ just because you think you leave your door unlocked then someone is going to break in does not mean its true

      • need to control thoughts

        • not comfortable with sitting with anxious thoughts

      • overstimulation of threats

        • locking the doors→ they will say that the chances of someone breaking in are higher than they actually are

      • intolerance for uncertainty

      • perfectionism

    • social and sociocultural

      • family upbringing→ authoritative parenting

      • trauma?→ some research that suggests trauma(not super strong)

      • OCD is more common among young individuals who are divorced, separated, or unemployed

        • not causation

  • treatments:

    • behavioral and cognitive-behavioral treatment

      • most effective: exposure and response prevention: involves having patients encounter the source of their obsessions and preventing them from engaging in compulsive behaviors

        • Ex: germaphobe→ put their hands in dirt and not allow them to wash their hands afterwards. show them that nothing bad will happen if they don’t wash their hands(eases anxiety)

      • medications:

        • responds best to medications that affect the serotonin system-clomipramine (anaranil) and fluoxetine(prozac)

        • problem with medication: relapse rates are high when medication is discontinued

          • also side effects of medications

Obsessive-Compulsive Related Disorders

body dysmorphic disorder/muscle dysphoria

  • dysphoria=disordered shape - delusional?

  • most common in: hair, nose, skin

    • most common example, michael jackson

  • symptoms

    • chronic checking(looking in the mirror at the imperfection)

    • 1/3 are risk for suicide

    • 30% show no insight in the pathology

    • chronic disorder

  • something that plastic surgeons have to be aware of

  • muscle dysphoria→ believe their muscles aren’t big enough

    • spend hours and hours in the gym

  • where is the line to abnormal

    • when someone starts to spend inordinate time checking (hours)

trichotillomania

  • hair pulling in reaction to emotional experiences

    • feel sense of temporary relief from anxiety

  • hair pulling not uncommon→reaching diagnostic criteria rare(less than 1%) females>males

    • pulling hair down and chewing on

skin picking disorder

  • unable to control→ when they get anxious they start picking at skin

  • various reasons → correct a blemish or address unpleasant emotion

  • scabs dont heal because they pick at the scab obsessively

hoarding disorder

  • acquire and fail to discard many possessions that seem useless or of very limited value

    • new disorder in DSM-5

    • difficult to treat→ medications used to treat OCD are generally not effective in treating people with hoarding disorder

      • traditional behavior therapy is also less effective

    • “I cant throw this away because I may need it some day”

    • treatment process

      • remove person from problematic possessions

      • prevent them from bringing things back in

    • complications associated with hoarding disorders

      • difficulty functioning day to day activities

      • lack of hygiene

      • poor diet

      • not allowing people in their house

      • financial issues