Obsessive-Compulsive Disorder (OCD) PDF

Chapter 6: Obsessive Compulsive disorder & related disorders Obsessive Compulsive Disorder (OCD) Facts: Less common than anxiety disorder · Life prevalence about 2% O 10% of OCD attempt suicide & Often misdiagnosed Obsessions: = intrusiv...

Chapter 6: Obsessive Compulsive disorder & related disorders Obsessive Compulsive Disorder (OCD) Facts: Less common than anxiety disorder · Life prevalence about 2% O 10% of OCD attempt suicide & Often misdiagnosed Obsessions: = intrusive and recurring thoughts, impulses, and images Most frequent obsessions: fears of contamination (= fear of germs from other people or using public toilets · fears of expressing some sexual or aggressive impulse, and hypochondriacal fears of bodily dysfunction e E.g. violent obsessions could include a thought about stabbing a person in restaurant with steak knife & Sexual obsession include taking body parts in subway & Some obsessions can involve symmetry Compulsion: & Involve repetitive behaviour & mental acts to reduce distress caused by obsessive thoughts & Activity often not realistically connected with its apparent purpose and is clearly excessive : E.g. checking cleanliness, count cars before leaving room, brushing hair exact amount of times Howie Mandels e.g. has to bump fist, can not stuff that has already been touched 3 multipliers making compulsions worse: A sense of personal responsibility Beliefs about the probability of harm if checking does not take place the predicted seriousness of harm Etiology of OCD: Behavioral & cognitive Theories: & Inability to remember previous actions correctly & distinguish between actual or imagined behaviour Rachman’s Theory of Obsessions in OCD & Rachman and Shafran identified a range of cognitive factors & involved in OCD in addition to the obsessions themselves, including an inflated sense of personal & responsibility for outcomes and a cognitive bias involving thought- action fusion Thought action-fusion (1) the mere act of thinking about unpleasant events increases the perceived likelihood that they will & actually happen g (2) at a moral level, thinking something unpleasant (e.g., imagining the self hurting others) is the same as actually having carried it out Meta-Cognition of OCD: Thinking about thinking itself S Patients with OCD has highly developed cognitive self-consciousness so they think too often about thinking itse ~ Biological factors: = Genetic evidence for first-degree relatives but no genomewide significant findings & Encephalitis, head injuries, and brain tumors associated with the development of OCD & Higher activation in frontal lobes & link to basal ganglia (linked to control motor behaviour ) ↑ Often Patients with Tourette also have OCD Patients with long term OCD show deficit in memory & attention · SSRI doesn’t work for OCD even though they have low serotonin  Pandas syndrome: & autoimmune condition that affects brain after strep disease i Sudden onset of symptoms of anxiety, moodiness, OCD 8 Also develop symptoms of adhd, separation anxiety, joint paint, temper tantrums e One strep in one kid could cause it, Immunsystems creates antibody -> but they attack healthy ones & Immunsystems attacks brain! & Some recover, some don’t. 5 Treatment: antibiotics, prevent inflammation & To child-hospital Psychoanalytic theory: & Compulsion & obsession are similar & Result from instinctual forces, sexual & aggressive ① OCD caused by feeling of incompetence to inferiority complex -> compulsive rituals to maintain control & feeling of competence Negative reinforcement: Escape & avoidance conditioning in COD · Reward is not nice, but for escape & avoidance Action that brings escape is reinforced Reinforcer is the situation where u want to be escapes from E.g. child wants candy in supermarket but he doesn’t are allowed to so he get a trantum and as a mother you think about what you can do to escape the embarrassing situation in supermarket and gives the candy & Reinforced action: giving the candy Reinforcer: embarrassing situation & tantrum -OCD person does his rituals to avoid / escape from his distress of obsessive thoughts Behavioural approaches to treatment - Exposure & Responses Prevention (ERP) for OCD: Exposure himself to situation that requires compulsive act but not do ritual performing e.g. touch dirty table but not clean hands afterwards S Assumption: ritual performing is reinforced! & Unpleasant for clients because of many sessions of exposure takes at least 90 min & Many refuse treatment or drop out Cognitive approaches to treatment: & combined CBT approach is required for treating OCD, not just cognitive approach er Client has to stop performing ritual in order to get evaluated about consequences Cognitive procedures can eliminate the dysfunctional beliefs that contribute to the OCD clients’ faulty appraisals ~ Issues: - no differences between individuals & group processes of CBT & ERP & High drop out Rates for CBT = CBT affects volumes of brain regions that are abnormal in patients with OCD thalamus volumes↓ , orbito-frontal cortex volumes ↑ e Adding a structured physical exercise program to CBT for OCD can improve OCD  Biological approach: Psychosurgery only in worst case!!! · Cingulotomy - destroying 2-3 cm of white matter in the cingulum near the corpus callosum Only used in worst case scenario because it’s permanent and non-reversible, j Deep brain stimulation is used for some OCD treatment non- responders Psychoanalytic approach: A Tries to uncover repressed conflicts Intrusive thought & compulsive behaviour protect ego from repressed conflict · & BUT: Difficult targets for intervention! -> Ineffective!!! Hoarding disorder & = acquisition of and failure to discarding objects & Strong genetic opponent Associated with molding, accidents Comparison to OCD: & Double amount of prevalence compared to OCD & OCD patients feel distressed, hoarders feel excited # Genetic, physiological & neurological research show difference between OCD & hoardering Differences hoarding vs collecting: : Collectors are more selective with narrower range of items, more organized BUT collectors also establish attachment to item & difficulty to discard items Cognitive factors in hoarding disorders: faulty information processing (i.e., distractibility and difficulty thinking about categories) erroneous cognitions about the importance and meaning of possessions misguided attachments with objects to seemingly compensate for emotional deficits in attachment to people Pharmacotherapy: Causes: : Often used: SSNRI Over 50% react to treatment Natural cause to focus on details in common Not organizing in categories, but by remembering in space, Visualizing CBT for hoarding disorders: : Target: not acquiring items & discarding items Cognitive restructuring Developing skills for organization & making decisions & Therapists making home visits & Body Dysmorphic Disorder (BDD) = imagined or exaggerated defect in appearance, frequently in the face Characteristics: * Spending hours in mirror & checking defect Taking steps to not being reminded of defect e.g. remove mirrors, wearing loose clothes : Women experience BDD more often, linked to eating disorder, depression, suicidal thoughts with often relapse  Etiology of BDD Biological factors: Possible genetic link Brain volume of CBB patients: ↓ volume right orbitofrontal cortex (reasoning, impulse control, emotion) ↓ volume left anterior cingulate cortex (social awareness, understanding the feelings of others) - exam ! Cognitive factors: Catastrophic interpretations of appearance-related thoughts Focus on unwanted thoughts Efforts to regulate the resulting emotions are not adaptive: they avoid social situations, engage in mirror checking, and apply make-up to hide imperfections Treatment for BDD: * Behavioural -> focus on exposure response prevention O Cognitive -> person evaluates accuracy of negative thoughts & irrational beliefs, target involved developing realistic thoughts Efficacy for treatment: & CBT is effective especially with use of different modules (specific) & Inference-based therapy was found to be effective for improving BDD symptoms & Use of SSRI is effective Trichotillomania (Hair-Pulling Disorder) When experience shame then hair-pulling episode · Hide it with hats, makeup f On-set often adolescence & In teen age: girls=boys e In adolescence: women > men Excoriation (Skin Picking Disorder) One of the BDD disorders To meet diagnostic criteria: skin-picking behaviour must be chronic such that it leads to lesions on skin Co-morbid with BDD & depression Co-occurs with trichotillomania Etiology of body related disorders: Biological factors Genetics: trichotillomania & excoriation influenced by the same genetic factor, which was different than OCD, hoarding disorder, and BDD Emotion Regulation Model -> triggered by negative emotions & try to decrease them Frustration Action Model -> triggered by frustration & boredom Habit Reversal Training: behavioral treatment most often used for body-focused repetitive behaviour disorders 1) Awareness training: involves the identification of triggers or high-risk situations; stress & boredom are common triggers; early-warning training – identify the first signs that you are going to engage in the problematic behaviour 2) Competing response training – for one minute 3) Establishing motivation & support Add-on Stimulus control – reduce the things in your environment that can trigger the habit e.g. nail biting -> wear gloves