Module 9 - Obsessive and Compulsive Related Disorders

is OCD chronic or episodic? What are common comorbidities with OCD?

- Chronic, only 20% make a full recovery Common co-morbidities: - 75% have anxiety disorder - 66% have depression

Obsessive Compulsive Disorder Media Video

- OCD affects relationships - OCD is a serious condition and not what you see on social media - The mother of a daughter with OCD presented the OCD as a hungry monster. Do NOT feed the monster. - OCD is not an aspiration

Case Example OCD Disorder Video

- OCD that happens to new mothers to protect their babies - She knows that her thoughts are irrational - Her baby seemed to pick up on her OCD behavior like washing his hands

What are the types of compulsive rituals? - What are the two most common ones?

1. Cleaning 2. Checking

What are the five most frequent content areas for obsessions?

1. Dirt, Germs, and contamination 2. Aggressive behavior 3. Sexual behavior 4. Religious matters 5. Orderliness of inanimate objects

What are the five forms of obsessions?

1. Doubts 2. Images 3. Thoughts 4. Impulses 5. Fears DIIFT

What is the cognitive-behavioral etiology for OCD?

1. Extremist (black-white) thinking - 2. Magical Thinking - Believe that their thinking that lead to specific consequences. Most people with OCD will understand that these thoughts are irrational but they cannot dismiss them. 3. Operant Reinforcement - Compulsions negatively reinforced by a reduction in anxiety 4. Cognitive factions i. People with OCD have yadasentience deficit, that feeling of completion (I have cleaned enough, thought about something enough, etc) ii. Lack of satiety signal iii. Attempts to suppress intrusive thoughts

What is the Psychodynamic Explanation etiology?

1. Fixation at the anal stage of development because of "adiple" conflict at the fallic stage 2. Reaction formation - Transform unacceptable feelings into more socially acceptable thoughts

What is the Biological etiology for OCD?

1. Genetic factors - The rate of OCD is 5-10x higher with people with families with OCD - More than 20X higher in monozygotic twins 2. Dysfunction in the circuitry involving the frontal cortex

What are the four similar disorders seemingly related to OCD?

1. Hair pulling 2. Skin pulling 3. Hoarding 4. Body dysmorphic

List the types of treatments for OCD

1. Medications 2. Psychological therapy 3. Other biological treatments - Psychosurgery

What are the brain regions that are dysfunctional in people with OCD

1. Orbital frontal cortex 2. Caudate nuclei of the basal ganglia 3. Cingulate gyrus - These structures filter which impulses get to the thalamus which then turn those impulses into action. These structures above fail to filter in people with OCD - Orbital frontal cortex, cingulate gyrus, and Caudate nuclei of the basal ganglia are overactive

What are the theories on the etiology of OCD

1. Psychodynamic Explanation 2. Biological Model 3. Cognitive- Behavioral Model

What medication treatments are used on people with OCD

1. SSRIs 2. Tricyclic antidepressants - Most patients improve with SSRIs and it can prevent future attacks.

What specifications do we need to make when diagnosing OCD (Why is specifying tic important?)

1. Specify of Insight - Good: Person knows that the compulsions are not true - Absent: Person is delusional and believes that their compulsions/ obsessions are true 2. Specify if tic-related - Up to 30% of people with OCD have tic disorder (most common in males). - Tend to differ in themes of OCD, co-morbidity, and the family history

What is the minimum length of an obsession or compulsion for it to be problematic

1. Take a specific amount of time out of your day to do them (like an hour a day) 2. Or cause clinical distress or impairment to their lives

What are the goals with exposure with response prevention

1. Want to break the negative reinforcing value of the compulsion 2. To extinguish the anxiety caused by the contaminated object 3. To enhance the patient's self efficacy in coping with this kind of situation

What is the prevalence of OCD symptoms in terms of obsessions and compulsions?

69% of people with OCD have both obsessions and compulsions

Exposure plus response prevention????

A particular form of exposure therapy—and an example of an evidence-based practice—that has received substantial empirical support for the treatment of obsessive-compulsive disorder

What are the DSM-5 criteria for OCD

A. Presence of obsessions and/or compulsions B. The obsessions/ compulsions are time consuming (around 1Hr) or cause significant distress of impairment in areas of functioning C. Not due to the physiological effects of drugs or another medical condition D. Symptoms cannot be explains better via another mental disorder (This is especially important with OCD)

What is exposure with response prevention

Asks client to challenge their symptoms by imagining situations where their obsessions occur. Then they will block their compulsions - Gradually move through more instense anxiety provoking stimuli - Empowers the patient by increasing self-efficacy

When does OCD develop?

Before age 10 or during late adolescence/early adulthood

What is the psychosurgery done with OCD? - When is this done? - How effective is it?

Cingulotomy, Connection between the frontal lobe and basal ganglia is severed - This is done when medication and psychological therapies do not work. - Up to 40% benefitted from this surgery

When comparing checking to cleaning, which one leads to a reduction of anxiety when completed?

Cleaning

What are the sex differences in compulsions

Cleaning = Most common is female Checking = Most commonly male

A more detailed definition of compulsion

Eating and gambling do NOT count

T or F Cleaners prefer to perform their tasks alone

False

Readings

Go!

How does OCD differ by sex?

It doesn't

Do you need both obsessions and compulsions for OCRDs?

No, you can just have one

Define egodystonic

Not under one's voluntary control

Define obsession

Obsessions: - Recurrent intrusive unwanted thoughts, urges, and images. (Egodystonic) - Person attempts to suppress these thoughts, images, and urges.

Define compulsions (Make sure to understand all parts of this definition)

Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly in order to prevent distress or a dreaded event. 1. Individual tries to ignore to suppress the obsession by performing another thought or action, this is a compulsion. 2. Must be driven by an obsession or a rigid rule 3. Behaviors are repetitive and regarded by the individual as out of control 4. The purpose of compulsions are to prevent a certain discomfort

What are the main features of OCD?

Strong, unwanted thoughts that cause significant anxiety and drive repetitive behavior that is excess and unnecessary beyond the person's voluntary behaviors.

What psychological treatments are used on people with OCD

Traditional psychotherapy does not work BUT... 1. Exposure with response prevention works 2. Cognitive therapy

(T or F) OCD is a new disorder that previously used to be labelled as an anxiety disorder

True

T or F Checkers prefer to perform their tasks alone

True, they modify their behavior in the presence of others

Does Seratonin always work with OCD?

Unfortunately a lot of patients do not benefit