PSY110P-Chapter-5c-Obsessive-Compulsive-and-Related-Disorders.pptx

Obsessive Compulsive and Related Disorders  Obsessions are intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and that usually appear irrational to the person experiencing them. › 60% have multiple obsessions  Need for symmetry  Forbidden thoughts or...

Obsessive Compulsive and Related Disorders  Obsessions are intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and that usually appear irrational to the person experiencing them. › 60% have multiple obsessions  Need for symmetry  Forbidden thoughts or actions  Cleaning and contamination  Compulsions are repetitive, clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring. › Four major categories     Checking Ordering Arranging Washing/cleaning Specifiers for OCD     With good or fair insight: the individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessivecompulsive disorder beliefs are probably true. With absent insight/delusional: the person is completely convinced that obsessive-compulsive disorder beliefs are true. Tic-related: The individual has a current or past history of a tic disorder.  Statistics › › › › 1.6% to 2.3%(life); 1% (year) Female = Male Chronic Onset = childhood to 30s medial 19 Biological Etiology of ObsessiveCompulsive and Related Disorders      Hyperactivity of three regions of the brain: 1. orbitofrontal cortex (an area of the medial prefrontal cortex located just above the eyes), 2. The caudate nucleus (part of the basal ganglia), 3. The anterior cingulate Etiology of OCD A. Cognitive and Behavioral Contributions  1. Deficit in Yedasentience  Yedasentience is defined as this subjective feeling of knowing (Woody & Szechtman, 2011). Just like you have a signal that you have eaten enough food, yedasentience is an intuitive signal that you have thought enough, cleaned enough, or in other ways done what you should to prevent chaos and danger.    2. Behavioral models emphasize operant conditioning of compulsions. That is, compulsions are reinforced because they reduce anxiety. For example, compulsive handwashing would provide immediate relief from the anxiety associated with obsessions about germs. 3. Mistrust of memory One theory is that they mistrust their memory. Although people with OCD do not show deficits in their memory, they often describe feeling a lack of confidence about their memories (Hermans, Engelen, Grouwels, et al., 2008). This lack of certainty could drive people to repeat rituals. 4. Thought Suppression  People with OCD tend to give more reasons why they should try to suppress thoughts than do people without OCD.  Body Dysmorphic Disorder  A preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal › › › › › Comorbid with OCD 10% Course lifelong Onset – early adolescence through 20s Reaction to a horrible or grotesque feature Two treatments  SSRIs  Exposure and response prevention   People with body dysmorphic disorder (BDD) are preoccupied with an imagined or exaggerated defect in their appearance. Although people with BDD may appear attractive to others, they perceive themselves as ugly or even “monstrous” in their appearance. Like persons with OCD, people with BDD find it very hard to stop thinking about their concerns. On average, people with BDD think about their appearance for 3 to 8 hours per day  In BDD, the most common compulsive behaviors include checking their appearance in the mirror, comparing their appearance to that of other people, asking others for reassurance about their appearance, or using strategies to change their appearance or camouflage disliked body areas (grooming, tanning, exercising, changing clothes, and applying makeup)  People with BDD often experience high levels of shame, anxiety, and depression about their appearance, and several behavioral responses to those powerful feelings are common. Some may avoid contact with others because they are so concerned about being evaluated for their appearance, and sometimes these fears are so overwhelming that the person becomes housebound  Nearly all people with BDD meet the diagnostic criteria for another disorder. The most common comorbid disorders include major depressive disorder, social anxiety disorder, obsessivecompulsive disorder, substance use disorders, and personality disorders. Specifiers     With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true. With absent insight/delusional beliefs: the individual is completely convinced that the body dysmorphic disorder beliefs are true. With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case. Plastic Surgery and Other Medical Treatments  Fully 76.4% had sought this type of treatment and 66% were receiving it  8% to 25% of all patients who request plastic surgery may have BDD Etiology of BDD Cognitive Etiology of BDD  those with BDD are more attuned to features that are important to attractiveness, such as facial symmetry, than are those without BDD (Lambrou, Veale, & Wilson, 2011). Hoarding Disorder  Estimates of prevalence range between 2% and 5% of the population, which is twice as high as the prevalence of OCD › Men = women › Individuals usually begin acquiring things during their teenage years and often experience great pleasure, even euphoria, from shopping or otherwise collecting various items › OCD tends to wax and wane, whereas hoarding behavior can begin early in life and get worse with each passing decade  Hoarding led to extremely filthy homes for about a third of people, characterized by overpowering odors from rotten food or feces. More than 40 percent had accumulated so many items that they were no longer able to use their refrigerator, kitchen sink, or bathtub, and about 10 percent were unable to use their toilet. Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking Disorder)  The urge to pull out one’s own hair from anywhere on the body, including the scalp, eyebrows, and arms, is referred to as trichotillomania  Excoriation (skin picking disorder) is characterized by repetitive and compulsive picking of the skin, leading to tissue damage › Habit reversal training, show best results Treatment of ObsessiveCompulsive and Related Disorders    1. Medications - Use of SSRI 2. Psychological Treatment Exposure and response prevention (ERP) Meyer developed ERP by tailoring the exposure treatment to address the compulsive rituals that people with OCD use to reduce anxiety.  Exposure – exposure to feared objects  Response prevention – consciously preventing doing the response to the feared object. For OCD › Exposure – the person touches a dirty dish › Response Prevention - refrains from washing his or her hands. For BDD › Exposure - clients might be asked to interact with people who could be critical of their looks. › Response Prevention - clients are asked to avoid the activities they use to reassure themselves about their appearance, such as looking in mirrors and other reflective surfaces. For HD › Exposure - getting rid of their objects. › Response Prevention - focuses on preventing the rituals that they engage in to reduce their anxiety, such as counting or sorting their possessions.