Chapter 6: Obsessive Compulsive Disorder

5 Most Common Compulsions

1. Cleaning (hand washing and showering) 2. Repeated Checking 3. Repeating 4. Ordering or arranging 5. Counting

Criteria for OCD Compulsions

1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be rigidly applied 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing dreaded situation but are not connected in realistic way or are clearly excessive B. Must be time consuming at least 1 hour a day

Prevalence, Age of Onset, and Gender Differences

2.3 % Lifetime prevalence Occurs late adolescence/ early adulthood Onset is more common in boys than girls and in greater severity F=M

Comorbidty

25 to 50% of people with OCD have depression

Criteria OCD Obsessions

A. Presence of obsession, compulsions, or both Obsessions are defined by: 1. Recurrent and persistent thoughts, urges, or images and are intrusive and unwanted with marked anxiety and distress 2. Attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action

Compulsions

Can involve either overt repetitive behaviors that are performed as lengthy rituals (such as hand washing, checking, putting things in order over and over) or mental rituals like praying or saying a word over and over performed with the goal or preventing or reducing distress or preventing some dreaded event or situaion

OCD

Defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images accompanied by compulsive behavior to neutralize obsessive thoughts

Treatment

Exposure and response prevention Gamma knife Medication

Etiology

Learned behavior -> develop fear --> obsess --> creates anxiety --> compulsion relieves --> reinforce Evolutionary preparedness --> things people obsess about are evolutionarily beneficial Efforts to surpress Inflated Sense of Responsibility Biased attention towards disturbing material Structural abnormalities --> over activation or orbital frontal cortex "leaks" Neurotransmitters --> serotonin

Medications

Medicines that affect serotonin

Genetic Factors

Moderately high concordance rate amongst identical twins

OCD as a Learned Behavior

Neutral stimuli become associated with frightening thoughts or experiences through classical conditioning which come to elicit anxiety Door knob, scary germs, anxiety about germs is reduced by washing which reinforced Hard to extinguish

Exposure and Response Prevention

OCD clients develop hierarchy of upsetting stimuli and then expose themselves repeatedly to stimuli that will provoke obsession and are told to not engage in rituals they would ordinarily do

OCD and Evolution

Overall consensus seems to be that humans's obsessions about dirt and contamination and other dangerous situations arose from evolutionary roots

Obsessions

Persistent and recurrent intrusive thoughts, images, or impulses that are experienced as disturbing, inappropriate, and uncontrollable Most involve contamination, fears of harming oneself or another, and pathological doubt

Cognitive Causal Factors

Surpressing thoughts leads to more general increase in OCD thoughts

OCD and the Brain

The cortico-basal-ganglionic-thalmic circuit is normally involved in the prep of complex sets of interrelated behavioral responses, but when not functioning properly, repeated sets of behavior occur Serotonin strongly implicated in OCD