Psychology 101: OCD, PTSD, Mood Disorders, and Personality Disorders Study of Personality Disorders

Obsessive-Compulsive Disorder (OCD): Overview and Characteristics

• Conceptual Definition: Obsessive-Compulsive Disorder is characterized by a cycle of obsessions and compulsions that interfere with daily life.

• Obsessions: These are defined as unwanted, repetitive thoughts that serve to increase an individual's anxiety. Common themes include:

  • Contamination/Cleanliness: Preoccupation with germs or dirt.

  • Perfectionism: A need for things to be exact or a certain way.

  • Fear of Harm: Worries regarding harm coming to oneself or to others.

• Compulsions: These are defined as unwanted, repetitive behaviors that are typically caused by obsessions. The primary purpose of performing these behaviors is to reduce the anxiety triggered by the obsession. Examples include:

  • Washing/Cleaning: Repetitive handwashing or sanitizing.

  • Checking: Repeatedly verifying things, such as whether a door is locked.

  • Repeating: Engaging in the same action multiple times.

OCD: Psychological and Biological Explanations

• Psychological Explanations:

  • Classical Conditioning: Anxiety is paired with specific events or stimuli, creating a conditioned response.

  • Operant Conditioning: When a behavior (the compulsion) successfully reduces anxiety, the behavior is negatively reinforced. This makes it more likely that the behavior will be repeated whenever the anxiety returns in the future.

• Biological Explanations:

  • Genetic Factors: Evidence for a genetic origin is found in twin studies and family histories. Specific OCD-related genes appear to influence the control of glutamate, which is the major excitatory neurotransmitter in the brain.

  • Brain Systems: Structural differences have been observed, specifically that the caudate is smaller in individuals diagnosed with OCD.

• Personality Links: OCD has strong ties to the trait of conscientiousness. This involves a strong preference for rules, order, and control. Characteristics include:

  • Perfectionism.

  • Workaholism.

  • Difficulty throwing away useless items (hoarding tendencies).

  • Lack of flexibility and generosity.

  • Preoccupation with lists, rules, and minor details.

Posttraumatic Stress Disorder (PTSD)

• Development: PTSD develops after an individual experiences or witnesses a traumatic or excessively stressful event.

• Causality: There is a CLEAR environmental cause or factor identified for PTSD. Genetic and other factors are less understood, though they are considered under the diathesis-stress model.

• Symptom Duration: Stress-related reactions linger for $4+\text{ weeks}$, do not improve over time, and significantly interfere with daily life functionality.

• Psychological State: Individuals with PTSD continue to feel terrified and stressed long after they are no longer in immediate danger.

• Primary Theory (Neurobiology): The condition is thought to involve the overlearning of a fearful event by the amygdala. The traumatic event becomes overconsolidated in the brain, making it extremely difficult to forget.

• Treatments:

  • Cognitive Behavioral Therapy (CBT).

  • Prolonged Exposure: A process involving habituation to the trauma.

  • Cognitive Processing Therapy.

  • Medication: Especially Selective Serotonin Reuptake Inhibitors (SSRIs).

Depressive Disorders: Foundations and Major Depressive Disorder (MDD)

• Core Features: Depressive disorders feature persistent and pervasive feelings of sadness or emptiness.

• Distinction from Anxiety: If anxiety is viewed as a response to the threat of a future loss, then depression is often a response to past and current loss.

• Major Depressive Disorder (MDD):

  • Duration: Characterized by persistent and extreme feelings of sadness that persist for $2+\text{ weeks}$.

  • Common Symptoms: Fatigue, weight changes, sleep changes, feelings of worthlessness, and difficulty concentrating.

  • Extreme Symptoms: Includes anhedonia, which is the inability to feel pleasure (numbness). This involves a total loss of interest in daily activities and things once enjoyed.

  • Fatalities: May involve thoughts of death or suicide.

Variants of Depression: Dysthymia, SAD, and PPD

• Persistent Depressive Disorder (Dysthymia): Symptoms of depression that last for $2+\text{ years}$. While long-lasting, these symptoms are typically less intense and less debilitating than those found in MDD.

• Seasonal Affective Disorder (SAD):

  • Triggers: Depression recurring only during winter months due to a lack of sunlight.

  • Biology: Linked to changes in melatonin levels, disruptions to the circadian rhythm, and a decrease in serotonin production.

  • Treatment: Most effectively treated with light therapy. Other interventions include going outside, diet and exercise, CBT, and medication.

• Postpartum Depression (PPD):

  • Timeline: A major depressive episode beginning in late pregnancy or the first few weeks after a child's birth, though it can occur up to a year after birth.

  • Demographics: Can affect both men and women.

  • Causes: Significant drops in estrogen and progesterone, combined with a lack of sleep.

Explanatory Models for Depression

• Biological Explanation:

  • Genetics: Heritability is estimated at $37\%$. It involves genetic predispositions and chemical imbalances, specifically involving serotonin.

  • Natural Course: Most major depressive episodes eventually end on their own.

  • Trigger: Stressful events often precede the onset of depression.

  • Brain Activity: Brain activity slows during depression and increases during mania.

• Psychological Factors:

  • Depression involves negative biases for attention and interpretation of events, alongside self-destructive strategies for managing emotions.

• Aaron Beck’s Cognitive Triad Model: Depressed people think negatively about three specific areas:

  1. The Situation: Characterized by helplessness, lack of motivation, and exaggerating the seriousness of bad events (extremes).

  2. The Self: Focusing on personal defects.

  3. The Future: A sense of timelessness; the belief that feelings will last forever.

• Learned Helplessness: A secondary cognitive theory where people see themselves as unable to have any effect on events in their lives, leading to a perceived loss of control.

• Sociocultural Factors:

  • Social Support: People with a close friend or group of friends are less likely to develop depression.

  • Reporting: In some cultural contexts, people are hesitant to admit to being depressed.

  • Gender Differences: Depression is more common in women because they tend to internalize stressful feelings. Men are more likely to externalize feelings through alcohol, drugs, and violence.

Bipolar Disorders

• Core Definition: Characterized by alternating cycles of depression and mania.

• Mania: An excessively expansive mood characterized by:

  • Increased energy and productivity.

  • Heightened activity and talkativeness.

  • Grandiose thinking.

  • Hallucinations and delusions.

  • Engaging in excessive pleasurable and foolish activities.

• Bipolar I Disorder: Characterized by extremely elevated moods during manic episodes.

  • Diagnosis: Does not require depressive episodes for a diagnosis.

  • Impact: Significantly impairs daily life and often results in hospitalization.

• Bipolar II Disorder: Characterized by alternating periods of extremely depressed and mildly elevated moods.

  • Hypomania: A moderately elevated mood.

  • Diagnosis: Requires at least one depressive episode.

  • Impact: It is the depressive episodes, rather than the hypomanic episodes, that typically impair daily life.

• Demographics and Genetic Patterns:

  • Affects $3-4\%$ of the population.

  • Equally present in men and women.

  • Typically emerges in late adolescence or early adulthood. Bipolar I is generally diagnosed earlier than Bipolar II.

  • Genetics: Strong genetic component linked to multiple genes. In families with bipolar disorders, the condition tends to become more severe and appear at younger ages in successive generations.

Personality Disorders: Classification and Cluster A

• Definition: Occurs when an individual's identity causes them to interact with the world in maladaptive and inflexible ways that are long-lasting and cause problems in work or social situations.

• Cluster A (Odd/Eccentric):

  • Paranoid: Pervasive distrust and suspiciousness.

  • Schizoid: Detachment from social relationships and restricted emotional expression.

  • Schizotypal: Peculiarities of thought, appearance, and behavior that are disconcerting to others; acute discomfort in social relationships.

  • General Cluster A Traits: People are reclusive and suspicious. They have difficulty forming relationships because others find them strange or aloof. Symptoms are similar to schizophrenia but less extreme.

Cluster B Personality Disorders (Dramatic/Emotional/Erratic)

• Antisocial Personality Disorder (ASPD):

  • Characterized by a disregard for and violation of the rights of others.

  • Linked to the "Dark Triad."

  • Physiology: Individuals do not become anxious when anticipating unpleasant stimuli.

  • Psychopathy: Related to psychopathy, which is an extreme form of ASPD. It is characterized by high self-worth, cunning/manipulativeness, fearlessness, and not caring about the welfare of others.

• Borderline Personality Disorder:

  • Characterized by unstable moods, personal relationships, self-image, and impulsivity.

  • Sense of Self: Individual lacks a clear sense of self.

  • Relationships: Desperate desire for exclusive, dependent relationships; can be manipulative to maintain them.

  • Moods: Swings occur for no obvious reason.

  • Environmental Component: Strong correlation with trauma or abuse. Caretakers may have been unreliable, unaccepting, or encouraged dependence.

• Histrionic: Excessive emotionality and attention-seeking.

• Narcissistic: Pattern of grandiosity, need for admiration, and a lack of empathy.

Cluster C (Anxious/Fearful) and the OCD vs. OCPD Distinction

• Cluster C Disorders:

  • Avoidant: Social inhibition, feelings of inadequacy, and being easily hurt or embarrassed.

  • Dependent: Submissive and clinging behavior with an excessive need to be taken care of.

  • Obsessive-Compulsive Personality Disorder (OCPD): Perfectionistic and preoccupied with orderliness and control.

• Distinguishing OCD from OCPD:

  • OCD (Obsessive-Compulsive Disorder): Involves true obsessions and compulsions that cause significant distress. Symptoms fluctuate in intensity with anxiety levels (e.g., constant handwashing due to germ obsession).

  • OCPD (Obsessive-Compulsive Personality Disorder): This is NOT the same as OCD. The behavior is less extreme and traits are stable. It rarely interferes with day-to-day life. The individual does not have true obsessions/compulsions; the behavior only becomes distressful if it interferes with daily tasks (e.g., being excessively neat or organizing clothes in a specific way by choice).