Chapter 3 Obsessive-Compulsive Disorders PDF

8/4/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 3 OBSESSIVE-COMPULSIVE DISORDERS Copyright © 2017 McGraw-Hill Educatio...

8/4/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 3 OBSESSIVE-COMPULSIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-2 2 1  8/4/2024 Anxiety and Related Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-3 3 Obsessive-Compulsive Related Disorders As noted, the DSM-5 has removed OCD from its original place amongst the anxiety disorders, and placed it into a new category termed obsessive-compulsive and related disorders (OCRDs) This includes: i. Body dysmorphic disorder (BDD) ii. Hoarding disorder iii. Trichotillomania (TTM) - Hair pulling disorder iv. Excoriation - Skin picking disorder (SPD) One impetus for this change in the DSM-5 is the fact that all disorders in this group involve repetitive thoughts or behaviours. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-4 4 2  8/4/2024 Obsessive-Compulsive Related Disorders Many researchers (e.g., Abramowitz & Jacoby, 2015) have argued against the validity of that category. Tolin and Springer (2018) argued that there are three groups of disorders: – Compulsive: OCD and BDD – Impulsive: TTM and SPD – Hoarding: largely unique Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-5 5 CHAPTER 3 OBSESSIVE-COMPULSIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-6 6 3  8/4/2024 LEARNING OBJECTIVES 3.1 Describe the nature and diagnostic criteria for obsessive-compulsive disorder (OCD). 3.2 Describe the epidemiology and aetiological accounts of OCD. 3.3 Describe the essential elements of contemporary treatment approaches to OCD. 3.4 Describe the nature and diagnostic criteria for hoarding disorder, body dysmorphic disorder, trichotillomania and excoriation disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-7 7 Obsessive-Compulsive Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-8 8 4  8/4/2024 The Diagnosis of Obsessive-Compulsive Disorder (OCD) Obsessions – Intrusive impulses or images of a distressing nature – Most common:  Contamination, sexual, and aggressive impulses Compulsions – Repetitive behaviours that the person feels compelled to perform – e.g., cleaning, checking, repeating a word, counting Disorder causes marked interference with person’s functioning. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-9 9 DSM-5 Diagnostic Criteria For OCD A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwarranted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-10 10 5  8/4/2024 DSM-5 Diagnostic Criteria For OCD A. Presence of obsessions, compulsions, or both: Compulsions are defined by (1) and (2) 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-11 11 DSM-5 Diagnostic Criteria For OCD B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D. The disturbance is not better explained by another mental disorder…. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-12 12 6  8/4/2024 DSM-5 Diagnostic Criteria For OCD You can specify level of insight – Specify if:  With good or fair insight.  With poor insight.  With absent insight/delusional beliefs This applies to other OCRDs too Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-13 13 Content of Obsessive Thoughts Doubting (turning appliance off) Contamination (germs from doorknobs) (self or others) Non-sensical (e.g., shouting, undressing) Aggressive (hurting self or others) Sexual (“obscene”) Religious (“blasphemous”) Accidental Harm to Others Horrific images (e.g., mutilated bodies) Nonsensical thoughts (e.g., numbers, letters, songs) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-14 14 7  8/4/2024 Types of Compulsions Counting Checking Washing Hoarding Internal repetition Adhering to certain rules or sequences Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-15 15 Obsessive-Compulsive Disorder (OCD) Concern/Obsession Compulsion Cleanliness (contamination) Excessive bathing, washing, cleaning Body secretions Rituals to remove contact – avoid touching Sexual obsessions Ritualised and rigid sexual relationships Fears of harming self or others Repeated checking of doors, ovens, fire alarms, locks, retracing route when driving Exactness, symmetry Ritualised arranging, rearranging Health Checking and rechecking vital signs, rigid dietary intake, seeking info about health, death, dying Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-16 16 8  8/4/2024 Interpersonal Aspects of OCD Frequently has negative effects on individual’s interpersonal relationships In turn, dysfunctional relationship patterns can promote the maintenance of OCD symptoms so that a vicious cycle develops. An example of the latter is called symptom accommodation. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-17 17 Interpersonal Aspects of OCD: Symptom Accommodation Friend or relative participates in the loved one’s rituals, facilitates avoidance strategies, assumes daily responsibilities for the sufferer, or helps to resolve problems that have resulted from the patient’s obsessional fears and compulsive urges. Because avoidance and compulsive rituals prevent the natural extinction of obsessional fear and ritualistic urges, accommodation by a relative or close friend perpetuates OCD symptoms. Researchers have found that family accommodation predicts an attenuated response to cognitive-behavioural treatment for OCD. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-18 18 9  8/4/2024 Interpersonal Aspects of OCD: Symptom Accommodation Resick, Monson, & LoSavio (2017) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-19 19 Interpersonal Aspects of OCD: Relationship Conflict Relationship stress and conflict plays an important role in the maintenance of OCD. Couples in which one suffers from OCD often report problems with interdependency, unassertiveness, and avoidant communication patterns that foster stress and conflict. Aspects of a relationship that might increase distress and contribute to OCD maintenance include poor problem-solving skills, hostility, and criticism. Criticism, hostility, and emotional overinvolvement are associated with premature treatment discontinuation and symptom relapse. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-20 20 10  8/4/2024 Obsessive-Compulsive Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-21 21 The Epidemiology of Obsessive-compulsive Disorder (OCD) General consensus now is that OCD is a relatively common disorder, with a prevalence rate in the 2–3 per cent range Can be associated with a lifetime of impairment Average age of onset is 10.3 years – Develops either before age 10 or during late adolescence/early adulthood – Men  Early onset more common – Women  Cleaning compulsions and later onset more common Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-22 22 11  8/4/2024 Anxiety-Related Disorders in Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-23 23 Obsessive-Compulsive Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-24 24 12  8/4/2024 Aetiology of OCD: Neuropsychological Model Failure of inhibitory pathways in the brain to stop 'behavioural macros' in response to internal or external stimuli Observed differences in brain functioning could be a result of having OCD rather than causing it. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-25 25 Aetiology of OCD: Serotonin Hypothesis The Serotonin hypothesis is that obsessions and compulsions arise from abnormalities in the neurotransmitter system, specifically a sensitivity of the postsynaptic serotonergic receptors. Pharmacotherapy literature suggests that selective serotonin reuptake inhibitor (SSRI) medications are more effective than medications with other mechanisms or action in reducing OCD symptoms. Generally, however, different findings have been incompatible. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-26 26 13  8/4/2024 Aetiology of OCD: Cognitive Deficit Models: Memory Some researchers have suggested that OCD symptoms arise from abnormally functioning cognitive processes, such as memory. Researchers have not found evidence to support this notion. In fact, OCD patients appear to have a selectively better memory for OCD-related information relative to non-OCD- relevant stimuli. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-27 27 Aetiology of OCD: Cognitive Deficit Models: Reality Monitoring Some researchers have proposed that OCD stems from a problems with reality monitoring - the ability to discriminate between memories of actual vs. imagined events. Compulsive checking could be prompted by difficulties discerning whether an action (e.g., locking the door) was really carried out or imagined. Again, no significant differences in reality monitoring between OCD patients and comparison groups have been found. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-28 28 14  8/4/2024 Aetiology of OCD: Cognitive Deficit Models: Inhibitory Deficits Some researchers suggest that OCD is characterised by deficits in cognitive inhibition – the ability to dismiss extraneous mental stimuli. Studies examining recall and recognition suggest that people with OCD indeed have difficulty forgetting negative material and material related to their obsessional fears, relative to other sorts of information. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-29 29 Aetiology of OCD: Behavioural/Learning Models Conditioning/learning models of OCD based on Mowrer’s two-stage theory of fear acquisition and maintenance – Stage 1 (classical learning): previously neutral stimulus (conditioned stimulus) is associated with an aversive stimulus (unconditioned stimulus; e.g., traumatic experience), so that the CS comes to elicit a condition fear response (conditioned response) – Stage 2 (operant learning): avoidance behaviours develop as a means of reducing anxiety; avoidance is negatively reinforced by the immediate (albeit temporary) reduction in distress it engenders Avoidance and escape behaviours prevent the natural extinction of obsessional fears, and thereby maintain such fear. Conditioning explanation has fallen out of favour as an explanation for OCD development, however operant learning (negative reinforcement) still appears to play a role in the maintenance of OCD symptoms). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-30 30 15  8/4/2024 Aetiology of OCD: Cognitive Factors Cognitive factors – Intrusive thoughts relatively universal  Rachman and De Silva (1978) – Attempts to suppress intrusive thoughts may be the problem.  Trying to suppress thoughts may make matters worse  Wegner (1987): “Try to pose for yourself this task: not to think of a polar bear, and you will see that the cursed thing will come to mind every minute.” (Dostoevsky's 1863) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-31 31 Aetiology of OCD: Cognitive Factors Dysfunctional Assumptions of Persons with OCD (Salkovskis) Having a thought about an action is like performing the action. Failing to prevent (or failing to try to prevent) harm to self or others is the same as having caused the harm in the first place. Responsibility is not attenuated by other factors (e.g., low probability of occurrence). Not neutralizing when an intrusion has occurred is similar or equivalent to seeking or wanting the harm involved in that intrusion to actually happen. One should (and can) exercise control over one’s thoughts. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-32 32 16  8/4/2024 Obsessive-Compulsive Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Other epidemiological information – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-33 33 Treatment of Obsessive-Compulsive Disorder (OCD) Cognitive-behaviour therapy is probably the treatment of choice. – exposure and response prevention – cognitive therapy Medication – Only 40–60 per cent of sufferers seem to benefit from medication. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-34 34 17  8/4/2024 Treatment of OCD: Cognitive-Behavioural Models The cognitive behavioural model implies that successful treatment for OCD symptoms must accomplish: 1. Correction of maladaptive beliefs and appraisals that lead to obsessional fear 2. Termination of avoidance and compulsive rituals that prevent the self- correction of maladaptive beliefs and extinction of anxiety Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-35 35 Treatment of OCD: CBT Exposure plus ritual [or response] prevention – Most empirically supported treatment – Not easy to do and considered aversive by many – Hard or impossible to do if only obsessions Cognitive therapy – Challenge beliefs about anticipated consequences of not engaging in compulsions  Usually also involves exposure Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-36 36 18  8/4/2024 Psychological Treatment: Exposure and Response Prevention Set of techniques derived from the cognitive-behavioural theoretical model are considered most effective in psychological treatment of OCD Entails confrontation with stimuli that provoke obsessional fear, but that objectively pose a low risk of harm. Exposure can occur in the form of repeated actual encounters or in the form of imagined confrontation. This can evoke anxiety, and patients are encouraged to engage in such tasks completely, allowing themselves to experience obsessional distress without resisting feelings of anxiety. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-37 37 Psychological Treatment: Exposure and Response Prevention continued… Over time, anxiety naturally subsides, possibly through habituation (but maybe through cognitive change – as with phobias) Response prevention component of ERP = refraining from compulsive rituals and other subtle avoidance behaviours that serve as an escape from obsessive fear. Response prevention helps to prolong exposure and to facilitate the eventual extinction of obsessional anxiety. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-38 38 19  8/4/2024 Psychological Treatment: The Delivery of ERP ERP delivery can vary widely One particularly successful approach includes a few hours of assessment and treatment planning followed by 15 (daily or twice-weekly) treatment sessions, lasting ~90 minutes each. Course of ERP ordinarily begins with the assessment of obsessions, compulsive rituals, avoidance strategies, and anticipated consequences of confronting feared situations Gathered information is then used to plan the specific exposure exercises that will be pursued Exposure exercises might begin with moderately distressing situations, stimuli, and images, and progress to the most distressing situations, although such hierarchy- driven progression is not essential. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-39 39 Psychological Treatment: Efficacy of ERP Numerous trials evaluating the effects of ERP for OCD consistently show that patients who receive and complete this intervention attain clinically significant and durable improvement. Average improvement rates are typically from 50% to 70% in these studies. Effectiveness studies suggest that over 80% of patients who complete ERP achieve clinically significant improvement. Although ERP is effective for most people with OCD, about 20% do not respond and about 25% to 30% drop out of therapy. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-40 40 20  8/4/2024 Psychological Treatment: Cognitive Therapy (CT) Therapist presents a rationale for treatment that incorporates the notion that intrusive obsessional thoughts are normal experiences and not harmful or significant. Aim to reduce obsessional fear and the need for compulsive rituals Helping the patient correct dysfunctional thinking and behavioural responses to obsessional stimuli so that such situations no longer require avoidance and intrusive thoughts are no longer perceived as needing to be controlled or neutralised via rituals Various CT techniques are used such as didactic presentation of educational material, Socratic dialogue, and cognitive restructuring, all aimed at helping patients recognise and remedy dysfunctional thinking patterns Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-41 41 Psychological Treatment: Cognitive Therapy (CT) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-42 42 21  8/4/2024 Psychological Treatment: CT vs. ERP Although most studies have found that CT and ERP produce equivalent treatment effects, methodological problems have prevented definitive conclusions. Some researchers have found that including CT was useful in reducing dropout from ERP. Thus, there are likely benefits to incorporating CT techniques alongside ERP. Remember that some people cannot or will not do ERP. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-43 43 Obsessive-Compulsive Related Disorders (OCRDs) As noted above, the DSM-5 has removed OCD from its original place amongst the anxiety disorders, and placed it into a new category termed obsessive-compulsive and related disorders (OCRDs) This includes: i. Body dysmorphic disorder (BDD) ii. Hoarding disorder iii. Trichotillomania (TTM) - Hair pulling disorder iv. Excoriation - Skin picking disorder (SPD) Let’s briefly discuss them (with the most on BDD) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-44 44 22  8/4/2024 OCRDs: Body Dysmorphic Disorder (BDD) Both BDD and OCD can involve intrusive, distressing thoughts concerning one’s appearance, and repeated checking might also be observed in both disorders. However, focus of BDD symptoms is limited to one’s appearance, whereas individuals with OCD also have other obsessions. Similar psychological treatments can be effective for both conditions. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-45 45 Body Dysmorphic Disorder – DSM-5 A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking) or mental acts in response to the appearance concerns. C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. With variable degree of insight and possibly with muscle dysmorphia Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-46 46 23  8/4/2024 Body Dysmorphic Disorder (“Imagined Ugliness”): Overview and Defining Features – Previously known as dysmorphophobia – Preoccupation with imagined defect in appearance – Either fixation or avoidance of mirrors – Suicidal ideation and behavior are common – Often display ideas of reference for imagined defect Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-47 47 Body Dysmorphic Disorder (“Imagined Ugliness”): Facts and Statistics – More common than previously thought (probably under-diagnosed) – Prevalence is estimated at 2.5 per cent, with similar numbers of males and females (but maybe with different focus) – Up to 15 per cent of those seeking cosmetic surgery meet DSM-5 criteria for BDD – Onset usually in early 20s – Most remain single, and many seek out plastic surgeons – May run a lifelong chronic course if untreated Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-48 48 24  8/4/2024 BDD - Areas of Concern Usually multiple areas – Head and hair – Facial features – Skin blemishes – Thighs – Stomach – Breasts – Buttocks – Genitals Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-49 49 BDD - Muscle Dysmorphia Pathological obsession with not being muscular enough Bigorexia? May be associated with anabolic steroid abuse More common in men but reported cases in women too Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-50 50 25  8/4/2024 Body Dysmorphic Disorder: Causes and Treatment Causes – Little is known – Shares similarities with obsessive-compulsive disorder and also anorexia nervosa Treatment – Parallels that for obsessive-compulsive disorder – Medications (i.e., SSRIs) provide some relief – Exposure and response prevention is also helpful – Plastic surgery is often unhelpful (and may backfire). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-51 51 OCRDs: Hoarding Disorder Once considered to be a symptom of OCD, hoarding is now classified as a separate problem. Typically involves thoughts about acquiring and maintaining possessions, thoughts that are not particularly intrusive or unwanted, and are generally emotionally positive or neutral and thus do mot meet criteria for obsessions. Persistent difficulty in discarding possessions, and high level of distress associated with removing items. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-52 52 26  8/4/2024 OCRDs: Hoarding Disorder Can specify level of insight. Prevalence is estimated at 2–6 per cent Risks to health and safety, e.g., death from house fires stemming from hoarded newspapers Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-53 53 OCRDs: Trichotillomania (TTM) Trichotillomania (Hair-Pulling Disorder) Recurrent pulling out of one’s hair, resulting in hair loss. Repeated attempts to decrease or stop hair pulling. The hair pulling causes distress or impairment. It’s not due to a medical condition. It’s not better explained by another mental disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-54 54 27  8/4/2024 OCRDs: Trichotillomania (TTM) Recurrent pulling out of one’s own hair, resulting in hair loss Urge to remove hair is often associated with anxiety or worry. 12-month prevalence is approx. 1–2 per cent Estimated female to male ratio is 10:1 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-55 55 OCRDs: Excoriation (Skin-picking) Excoriation (Skin-Picking) Disorder (SPD) Recurrent skin picking resulting in skin lesions. Repeated attempts to decrease or stop skin picking. The skin picking causes distress or impairment It’s not due to a substance or a medical condition It’s not better explained by another mental disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-56 56 28  8/4/2024 OCRDs: Excoriation (Skin-picking) Often comorbid with OCD or trichotillomania Recurrent skin picking resulting in lesions: – Often picking is on the face, hands or arms Lifetime prevalence is approx. 1.5 per cent Up to 75 per cent of sufferers are female Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-57 57 Treatment of OCRDs Fewer clinical trials for OCD-related disorders, compared to OCD CBT procedures are central in managing these disorders: – Including exposure and response prevention, and cognitive restructuring Medications that increase availability of serotonin are also widely used Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-58 58 29  8/4/2024 Obsessive-Compulsive Personality Disorder (OCPD) Involves presence of personality traits such as: 1. Excessive perfectionism 2. Inflexibility 3. Need for control that negatively impact interpersonal relationships, occupational functioning, or other important domains of an individual’s life Often maintain strict principles/intolerant of others who do not conform to their standards Similarities between OCD and OCPD are sometimes observed, such as excessive list making and arranging Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-59 59 OCPD continued The experience of individuals with OCPD is ego-syntonic – they consider their behaviours and urges as rational and appropriate The experience of individuals with OCD is ego-dystonic – their experiences are unwanted, upsetting, and personally repugnant Although distinct, OCD and OCPD can co-occur Between 23% and 32% of OCD patients also display one or more symptoms associated with OCPD Some studies suggested that comorbid OCPD is associated with poorer treatment outcome for OCD Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-60 60 30  8/4/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 3-61 61 31