Abnormal Psychology Module 5: OCD and PTSD PDF

Abnormal Psychology Module 5: Obsessive Compulsive Disorder and Stressor Related Disorders Module Learning Outcomes Examining OCD and PTSD 5.1: Describe obsessive-compulsive and related disorders 5.2: Describe trauma and stressor-related disorders 5.3: Explain psychological perspectiv...

Abnormal Psychology Module 5: Obsessive Compulsive Disorder and Stressor Related Disorders Module Learning Outcomes Examining OCD and PTSD 5.1: Describe obsessive-compulsive and related disorders 5.2: Describe trauma and stressor-related disorders 5.3: Explain psychological perspectives and treatment methods for OCD and PTSD OCD and Related Disorders Obsessive-Compulsive and Related Disorders 5.1: Describe obsessive-compulsive and related disorders 5.1.1: Describe the main features and development of obsessive-compulsive disorder 5.1.2: Describe symptoms associated with body dysmorphic disorder 5.1.3: Describe the main symptoms and development of hoarding disorder 5.1.4: Describe the symptoms and diagnosis of trichotillomania 5.1.5: Describe some of the main features and factors in the development of excoriation disorder Features of OCD Obsessive-compulsive disorder (OCD): experiencing thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviors or mental acts (compulsions). Obsessions are characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing. Compulsions often include such behaviors as repeated and extensive hand washing, cleaning, checking (e.g., that a door is locked), and ordering (e.g., lining up all the pencils in a particular way) also include such mental acts as counting, praying, or reciting something to oneself 1-2% of U.S. population suffer from OCD in a given year; as many as 3% over a lifetime. Development of OCD Concordance rate: Identical Twins – 57% & Fraternal Twins – 22% (five times more frequent to first-degree) Orbitofrontal Cortex: area in frontal lobe for learning and decision making becomes hyperactive in provoking tasks. The symptoms of OCD have been theorized to be learned responses, acquired and sustained as the result of a combination of two forms of learning: classical conditioning and operant conditioning. Acquisition of OCD may occur first as the result of classical conditioning, whereby a neutral stimulus becomes associated with an unconditioned stimulus that provokes anxiety or distress. Body Dysmorphic Disorder Body dysmorphic disorder (BDD) involves being preoccupied with a perceived flaw in one’s physical appearance that is either nonexistent or barely noticeable to other people. These perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as: constantly looking in the mirror trying to hide the offending body part comparisons with others in some extreme cases, cosmetic surgery. Patients often are unaware that effective treatments are available and will hide symptoms because of feelings of shame or guilt. The prevalence of BDD in the general population is approximately 2% with slightly higher rates in women, and is strongly associated with a history of cosmetic surgery and higher rates of suicidal ideation and suicide attempts. BDD has been reported to occur in children as young as 5 and in adults as old as 80. Causes Potentially Include: Chemicals in the Brain (low serotonin), OCD, GAD, and Childhood Abuse and/or Trauma Hoarding Disorder Hoarding disorder (HD): an inability to part with personal possessions, regardless of how valueless or useless these possessions are. Below are characteristics of those with HD: Do not allow visitors in, such as family and friends, or repair and maintenance professionals, because the clutter embarrasses them Are reluctant or unable to return borrowed items Keep the shades drawn so that no one can look inside Have arguments with family members regarding the clutter Are at risk of fire, falling, infestation, or eviction Feel depressed or anxious due to the clutter Have suspicions of other people touching items Fear they’ll run out of an item or need it in the future Check the garbage for accidentally discarded objects Prevalence rates: 2% to 5% of population (starts at adolescence and worsens by advancing age – affects 6% of age 70 above) Trichotillomania Trichotillomania (TTM), also known as hair- pulling disorder or compulsive hair pulling, is a psychological disorder characterized by a long-term urge that results in the pulling out of one's hair. Trichotillomania is usually confined to one or two areas of the body, but can involve multiple sites. The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, and legs. TTM affects approximately 3.5% of women, or 3.7 million people in the United States. “automatic” versus “focused” hairpulling. Treatment: CBT, clomipramine (tricyclic antidepressant), Habit reversal therapy (HRT) Excoriation Disorder Excoriation disorder: an obsessive-compulsive spectrum disorder that is characterized by the repeated urge or impulse to pick at one's own skin to the extent that either psychological or physical damage is caused. Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. A common hypothesis is that excoriation disorder is often a coping mechanism to deal with elevated levels of turmoil, arousal or stress within the individual, and that the individual has an impaired stress response. Clinical studies have also shown that there is a strong link between traumatic childhood events and this disorder. Studies have shown a linkage between dopamine and the urge to pick. Central nervous system stimulants may create the sensation of formication. Prevalence range from 1.4 to 5.4% in the general population. Practice Question Which of the following best illustrates a compulsion? A. persistent fear of germs B. thoughts of harming a neighbor C. mentally counting backward from 1,000 D. falsely believing that a spouse has been cheating Practice Question Research suggests that one of the main causes of obsessive-compulsive disorder is due to A. a traumatic experience. B. a brain injury that affects the orbitofrontal cortex. C. a genetic component. D. a learned fear of germs. Practice Question Research indicates that the symptoms of OCD A. are reduced if people are asked to view photos of stimuli that trigger the symptoms. B. are triggered by low levels of stress hormones. C. are similar to the symptoms of panic disorder. D. are related to hyperactivity in the orbitofrontal cortex. Practice Question Which example below best demonstrates how someone might exhibit symptoms of body dysmorphic disorder? A. Malik has a difficult time leaving his home to enjoy outings with his friends because they always want to go to bars or sports arenas; places Malik views as filthy. He is very concerned about contaminants and washes his hands so frequently that, on occasion, they become raw and he needs to apply a special ointment to heal them. Additionally, when he does leave the house, it’s never without hand sanitizer. B. Davina considers herself a cosmetic “fanatic” and has an extensive collection of mascaras, eye shadows, lipsticks, etc. She is often experimenting with different colors to find the “perfect” look and always carries a compact mirror everywhere she goes. She never leaves the house without makeup, even to check the mail. C. Paulo has recently started a new exercise routine and now all he talks about is working out and protein drinks and burning fat. His friends think he’s overdoing it and though he admits this is his new “obsession,” he doesn’t want to stop. He enjoys how the workout makes him feel and often glances at his reflection in car windows or storefronts. D. Marissa has tried many different clothing brands, started and stopped numerous diets, and holds a vigorous exercise routine, but she believes nothing is working to fix what she sees as a misshapen body form. In fact, this causes so much embarrassment for her, that she started a new job working from home to avoid having to leave her house often. Also, she started budgeting for a third plastic surgery because the first two, in her opinion, weren't sufficient. Practice Question Barry has an issue with throwing things in the garbage. Barry has collected newspapers at his house and has not recycled or thrown away any copies for the past two years. Barry’s house is becoming extremely cluttered and there tends to be a lack of space in any room for anything. What would Barry’s diagnosis consist of? A. Hoarding Disorder B. Body Dysmorphic Disorder C. Excoriation Disorder D. OCD Practice Question Which of the following individuals is most likely to have hoarding disorder based on the description of symptoms alone? A. Min has such a vast collection of items that he must walk through narrow pathways in his small home. These paths are walled high with items - stacks and stacks of books, magazines, boxes, etc. In the past, he had worked in computer repair and has saved thousands of spare computer parts. His parents both died within a year from each other, and after their deaths, he moved all their items into his own home before the house went for sale. He has had difficulty navigating in his own home due to his increasing weight since he often orders pizza and Chinese food because he can no longer access his kitchen. A surprise visit from an old friend gave him a panic attack when his friend - shocked at what he saw - tried hard to convince Min to recycle the computer parts and have a yard sale. B. Donny's wife recently left him and is filing for divorce. They'd been fighting over the last several months regarding his new "hobby" of refurbishing old furniture. He insists that this could be a lucrative side business but she feels it's another obsession that will continue to take over the garage and consume his time. There is no room in the garage to park the car anymore, and now there's an antique dresser taking up space in the bedroom. He believes she's just a "clean freak" who constantly gets rid of things she considers they "don't need" and has been frustrated she doesn't check with him first. Tools he needed - that he often left lying around - have gone missing, which ended up creating a financial burden because he would simply buy another one when he couldn't find it immediately. Practice Question Though researchers don't know the exact cause for HD, what we do know, regarding its development, is that the disorder: A. is likely to affect men significantly more than women. B. increases in prevalence and severity with age. C. only occurs in those whose parent(s) also exhibited symptoms of HD. D. mainly develops in those who experienced a lack of security and/or had a traumatic childhood. Practice Question Which of the following descriptions best explains the signs and symptoms of trichotillomania? A. People with this disorder will often pull only one hair at a time, from various parts of the body such as the scalp or eyebrows, and these episodes can last for hours. This hair-pulling can be focused or automatic (sub-conscious) and may be a way to release tension for those who do it. B. Trichotillomania is difficult to diagnose because most people with this disorder pull hair from discrete areas (underarms, pubic area) that are easily covered up. Additionally, they rarely admit to the issue and present with other symptoms like anxiety or depression. C. People with this disorder are unconscious of their actions, meaning, they're never aware of their actions of hair-pulling. Often, when plucking hair, they use tweezers or other tools and will continue until a patch appears (i.e, an eyebrow is gone or a bald patch appears on their scalp). D. People with this disorder will often pull hair from various parts of the body such as the scalp or eyebrows, (and in rare cases, pubic areas), but only when under a lot of stress or undergoing an activity that makes them very uncomfortable. Often, they're not even aware that they're doing it. Practice Question Which of the following best describes the symptoms and features in the development of excoriation disorder? A. Episodes may last for hours or occur throughout the day and often the person will pluck one hair out at a time, leaving bald patches on the scalp or other areas of the body. There is a sense of relief following the episode. B. Prior to an episode of skin-picking, a person often feels stressed; during these moments of anxiety and tension, there is an urge to pick, squeeze, or scratch at the skin - whether it be the face, scalp, or other region of the body, usually at the site of a perceived skin defect. When picking, the person may feel a sense of relief. C. When a person with excoriation disorder feels high levels of anxiety or stress, they may begin to scrub their skin so frequently, using water that's too hot, and/or scrub so hard with soap or a washcloth that their skin becomes raw and chafed. Though it may cause pain, there is a sense of relief that follows when the episode is complete. D. Excoriation disorder specifically involves the compulsive urge to pick at scabs, acne, or other blemishes. The person may use fingernails to do so, or a tool such as tweezers. Once the blemish is gone, covered up, or bleeding, the individual feels a sense of relief and is able to stop. Trauma and Stress-Related Disorders Trauma and Stressor-Related Disorders 5.2: Describe trauma and stressor-related disorders 5.2.1: Describe different types of possible stressors, including major life readjustments and trauma 5.2.2: Describe the diagnosis and symptoms associated with posttraumatic stress disorder 5.2.3: Describe risk factors and possible causes of PTSD 5.2.4: Describe the diagnostic symptoms of acute stress disorder 5.2.5: Explain the symptoms and treatment options for adjustment disorders 5.2.6: Describe healthy attachment and identify the four types of attachment styles 5.2.7: Differentiate between reactive attachment disorder and disinhibited social engagement disorder Types of Stressors and Trauma Chronic stressors include events that persist over an extended period of time, such as caring for a parent with dementia, long-term unemployment, or imprisonment. Acute stressors involve brief focal events that sometimes continue to be experienced as overwhelming well after the event has ended, such as falling on an icy sidewalk and breaking your leg Daily Hassles: the minor irritations and annoyances that are part of our everyday lives (e.g., rush hour traffic, lost keys, obnoxious coworkers)—can build on one another and leave us just as stressed as life change events Eustress: Many life events that most people would consider pleasant (e.g., holidays, retirement, marriage – Life Changes) may be stressful according to the Social Readjustment Rating Scale (SRRS) Other Stressors: Frequently exposed to challenging and unpleasant events, such as difficult, demanding, or unsafe working conditions (e.g., Job Burnout / Job Strain). Stressors and Trauma Some stressors involve traumatic events or situations in which a person is exposed to actual or threatened death or serious injury. Stressors in this category include: exposure to military combat threatened or actual physical assaults (e.g., physical attacks, sexual assault, robbery, childhood abuse) terrorist attacks natural disasters (e.g., earthquakes, floods, hurricanes) automobile accidents. Men, non-whites, and individuals in lower socioeconomic status (SES) groups report experiencing a greater number of traumatic events than do women, whites, and individuals in higher SES groups (Hatch & Dohrenwend, 2007). Symptoms of PTSD Post-Traumatic Stress Disorder (PTSD): extremely stressful or traumatic events, such as combat, natural disasters, and terrorist attacks, place the people who experience them at an increased risk for developing psychological disorders. Symptoms of PTSD include: intrusive and distressing memories of the event flashbacks avoidance of stimuli connected to the event persistently negative emotional states (e.g., fear, anger, guilt, and shame) feelings of detachment from others irritability proneness toward outbursts exaggerated, startled responses (jumpiness) Roughly 7% of adults in the United States, including 9.7% of women and 3.6% of men, experience PTSD in their lifetime. Diagnosis of PTSD Diagnosis of PTSD: An individual must experience at least some symptoms among four different categories for at least a month after a traumatic event: intrusion symptoms (recurrent/distressing memories), avoidance of stimuli related to the event, negative changes in mood, and changes in arousal/reactivity. Must exposed to, witness, or experience the details of a traumatic experience (e.g., a first responder), one that involves “actual or threatened death, serious injury, or sexual violence.” For example: combat threatened or actual physical attack sexual assault natural disasters terrorist attacks automobile accidents PTSD was called shell shock and combat neurosis because its symptoms were observed in soldiers who had engaged in wartime combat. By 1980, it had become clear that people who had experienced sexual traumas (e.g., rape, domestic battery, and incest) often experienced the same set of symptoms as did soldiers. Acute Stress Disorder Acute stress disorder is similar to PTSD, but describes a disorder that lasts between 3 days and 1 month of a traumatic event. After one month, a diagnosis of Acute Stress Disorder would be considered PTSD. The diagnostic symptoms are similar to that of PTSD. Diagnosis requires at least nine of the symptoms from any of the following five categories, beginning or worsening after the traumatic event(s) occurred: intrusion negative mood dissociation avoidance arousal Adjustment Disorders Symptoms and Treatments Adjustment disorder (AD) represents an abnormal stress response that is different from normal adaptive reactions that occurs within three months of the onset of an outside stressor. AD usually follows a stressful event such as: losing a job ending a relationship financial conflict changing environments feeling overwhelming school or job stress living in a dangerous situation death of friends or family illness, etc. DSM-V categorization is: (A) emotional or behavioral symptoms in response to an identifiable stressor that (B) are of clinical significance and (C) do not meet the criteria for another mental disorder, and (D) do not represent normal bereavement. Prolonged Grief Disorder In March 2022, prolonged grief disorder (PGD) was added as a mental disorder in the DSM-5-TR. It is characterized by a distinct set of symptoms following the death of a family member or close friend (i.e.. bereavement). People with PGD are preoccupied with grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance, and difficulty in managing interpersonal relationships. PGD is estimated to be experienced by about 10 percent of bereaved survivors. Prolonged Grief Disorder Along with bereavement of the individual occurring at least one year ago (or six months in children and adolescents), there must be evidence of one of two “grief responses” occurring at least daily for the past month: Intense yearning/longing for the deceased person. Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death). Additionally, the individual must have at least three of the following symptoms occurring at least daily for the past month: Identity disruption (e.g., feeling as though part of oneself has died) since the death A marked sense of disbelief about the death Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders) Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future) Emotional numbness (absence or marked reduction of emotional experience) as a result of the death Feeling that life is meaningless as a result of the death Intense loneliness as a result of the death Four Types of Attachment Styles The words attachment style or pattern refer to the various types of attachment arising from early care experiences, known as either secure, insecure-avoidant, resistant, or disorganized. Secure: Toddlers prefer their parent over a stranger. The attachment figure is used as a secure base to explore the environment and is sought out in times of stress. Avoidant: Children are unresponsive to the parent, do not use the parent as a secure base, and do not care if the parent leaves. Resistant: Children tend to show clingy behavior, but then reject the attachment figure’s attempts to interact with them Disorganized: Children behave oddly in a Strange Situation. Children freeze, run around the room in an erratic manner, or try to run away when the caregiver returns. Reactive Attachment Disorder & Disinhibited Social Engagement Disorder Reactive Attachment Disorder (RAD): characterized by a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both a child rarely seeking comfort or responding to comfort when distressed. a stressor-related disorder caused by social neglect during childhood (meaning a lack of adequate caregiving). RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. Disinhibited Social Engagement Disorder (DSED): characterized by a consistent pattern of uninhibited, open, overly familiar, and unhesitant behavior toward adult caregivers. the uninhibited form, which manifests as a lack of inhibitions or externalizing behavior are consistent. Practice Question Post-Traumatic Stress Disorder affects many in different ways. And trauma may affect someone indirectly as well (such as 9/11). Which of the following may be a potentially first or second-hand experience that may not be traumatic for someone? A. Car Accident B. Trip to a Restaurant C. Hurricane D. COVID Practice Question While waiting to pay for his weekly groceries at the supermarket, Paul had to wait about 20 minutes in a long line at the checkout because only one cashier was on duty. When he was finally ready to pay, his debit card was declined because he did not have enough money left in his checking account. Because he had left his credit cards at home, he had to place the groceries back into the cart and head home to retrieve a credit card. While driving back to his home, traffic was backed up two miles due to an accident. These events that Paul had to endure are best characterized as ________. A. chronic stressors B. daily hassle C. acute stressors D. readjustment occurrences Practice Question Symptoms of PTSD include all of the following except ________. A. avoidance of things that remind one of a traumatic event B. intrusive thoughts or memories of a traumatic event C. jumpiness D. physical complaints that cannot be explained medically Practice Question Which of the following elevates the risk for developing PTSD? A. social support B. severity of the trauma C. frequency of the trauma D. high levels of intelligence Practice Question Which of the following individuals is likely experiencing symptoms most closely related to acute stress disorder? A. On her way home from work, Fatima was carjacked by two men who took her purse and keys at gunpoint. They forced her to drive them to the outskirts of town, threatening to kill her if she didn't comply, then threw her from the car and sped off. Now, a week later, she is still shaken by the event. She never travels alone - not even to and from work. She usually travels by taxi and requests a different route to avoid the area where she was attacked and has a hard time concentrating at work because of how frequently the thoughts of what occurred plague her mind. She's had difficulty sleeping, refuses to talk about what happened, and has frequent, unprovoked crying spells. B. Jarome was seven years old when his house caught fire and his family had to live out of a motel for a few months. Though he seemed resilient and positive at first, despite the loss, he has suddenly begun having night terrors now that his family has moved to a new house. He dislikes the new neighborhood, refuses to make friends, and seems depressed, even his schoolwork is suffering. Practice Question Select the best statement describing the types and symptoms of adjustment disorder. A. The symptoms of adjustment disorder include six types: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. Someone may feel anxious or depressed, but these symptoms don't usually have a stressor attached to them, in some cases, a person may simply experience AD without a stressful or traumatic event. B. Symptoms of adjustment disorder are similar to that of PTSD, except diagnosis requires at least nine symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred. C. There are six types of adjustment disorder: depressed mood, schizoid/paranoid type, disturbance of conduct, bereavement, and unspecified. Though symptoms vary, they usually include anxiety, depression, paranoia, and delusions, and these symptoms follow a stressful event. D. There are six types of adjustment disorder: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. Though symptoms vary, they usually include anxiety, depression, feelings of hopelessness, suicidal thoughts, and these symptoms follow a stressful event. Practice Question There are four types of attachment styles, according to attachment theory. These are: A. secure attachment, avoidant attachment, disorganized attachment, and reactive attachment disorder. B. secure attachment, avoidant attachment, insecure-avoidant attachment, and resistant attachment. C. secure attachment, avoidant attachment, disorganized attachment, and resistant attachment. D. secure attachment, avoidant attachment, disinhibited attachment, and resistant attachment. Practice Question One of the main differences between reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) is________. A. Children with DSED don't experience patterns of extreme insufficiency in care, such as social neglect, constant changes of caregiver, and being raised in various, unusual settings. Additionally, they are more outgoing than children with RAD. B. Children with DSED exhibit patterns of emotionally withdrawn behavior toward adult caregivers as well as social and emotional disturbance such as minimal social responsiveness to others, limited positive affect, and episodes of unexplained irritability or sadness. C. Children with DSED are more outgoing and more likely to talk to strangers than those with RAD. They may have little to no fear of interacting with people they don't know, to the point where they will venture away with them to somewhere new and unfamiliar. D. Children with RAD have an "uninhibited form" of attachment, which manifests as a lack of inhibitions, resulting from extreme patterns of insufficient care by a caregiver. Psychological Perspectives and Treatments of OCD and PTSD Perspectives and Treatments for OCD and PTSD 5.3: Explain psychological perspectives and treatment methods for OCD and PTSD 5.3.1: Describe views on OCD from the major psychological perspectives 5.3.2: Describe views on stress-related disorders from the major psychological perspectives 5.3.3: Examine methods used in treating OCD and related disorders, including habit reversal training 5.3.4: Describe cognitive behavioral therapy treatment methods for PTSD, including eye movement desensitization and reprocessing 5.3.5: Explain how memory reconsolidation is used to treat PTSD or anxiety disorders Perspectives on OCD Biological Perspective: As you already learned, results of family and twin studies suggest that obsessive-compulsive disorder has a moderate genetic component The disorder is five times more frequent in the first-degree relatives of people with OCD than in people without the disorder. Sociocultural Perspective: Some cultures in which religion and customs are held to a very high standard may be connected to OCD These factors are so ingrained and so varied that they can influence the onset, outcome, and response to treatment for OCD. Humanistic Perspective: Emphasis on the potential for good and self-actualization in all people Those suffering OCD and PTSD are likely undergoing an existential crisis and stuck and unable to move forward to self-actualization. Perspectives on OCD Continued Psychodynamic Perspective: suggests that there are 3 areas at work in determining a person's personality and behavior: the id, superego, and ego. The id represents our unconscious, primitive drives or urges. The superego is what we learn as we grow: societal rules, what is or isn't acceptable—our "moral compass" essentially. When we fail to live up to the standards of the superego, we may experience shame or guilt. Cognitive Perspective: OCD falsely assumes that: (i) thinking about an action is the same as doing it (ii) failing to prevent harm is morally equivalent to causing harm (iii) responsibility for harm is not diminished by extenuating circumstances (iv) failing to ritualize in response to a thought about harm is the same as an intention to harm (v) one should exercise control over one's thoughts. Behavioral approach: a neutral event comes to elicit fear or stress when it is paired with a stressful event (a UCS) Perspectives on Stress Related Disorders Biological Perspective: Researchers have found that genetics and environment play an important role in one's risk for developing PTSD due to trauma estimates for the genetic influences for PTSD account for 30% to 73% of vulnerability for the disorder. Sociocultural Perspective: different cultures and belief systems may help or hinder the prevalence of the disorder. Cultural beliefs may influence an individual's personal meanings of trauma and their attempts to come to terms with trauma memories in helpful and unhelpful ways. Locus of Control: Lower for people with Internal Locus of Control Psychodynamic perspective: attempts to bring repressed traumatic experiences out of the unconscious, where they are perceived as more toxic, and address them by helping patients to understand the relationship between hidden impulses, anxiety, and defense mechanisms. Perspectives on Stress Related Disorders Continued Humanistic Perspective: One in which a basic need was severely threatened (i.e., their life), and therefore, they may feel helpless to move forward because of the difficulty with never truly feeling safe. Cognitive Perspective: traumatic events disrupt a person's perspective on life and the world around them, which ultimately creates a negative viewpoint that has lasting damage, resulting in chronic stress symptoms seen in PTSD. Behavioral Perspective: suggests that some symptoms are developed and maintained through classical conditioning. The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety. Treatments of OCD and Related Disorders OCD is typically treated with medication, psychotherapy, or a combination of the two. Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SSRIs often require higher daily doses in the treatment of OCD than of depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Exposure and Response Prevention (ERP) is a type of CBT treatment in which a patient first identifies the things that trigger obsessive thoughts, such as external situations like people or places and thoughts, then spending time facing those fears to lower stress levels. Habit reversal training (HRT) is a multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders that focuses on re- training responses to habits. Treatments for PTSD Perhaps the most widely practiced approach for treating PTSD is cognitive behavioral therapy (CBT). The goal is that patients identify the sources of their trauma and cope with them thereby eliminating negative emotional reactions associated with the memories. Eye movement desensitization and reprocessing (EMDR): a form of psychotherapy in which the person being treated is asked to recall distressing images the therapist then directs the patient in one type of bilateral stimulation, such as side-to-side eye movements or hand tapping with the goal of reprocessing and coping with the stress. Virtual Reality Therapy (VRT) is currently being used as treatment for various psychological disorders. Ranging from anxiety disorders to stroke rehabilitation, VRT is being utilized to eliminate debilitating symptoms and to create simulations to help confront and treat mental disorders, such as PTSD. Memory Reconsolidation Treatment Nader et al. (2000) taught their animals a fear memory by pairing a particular sound with a mild, but unpleasant shock using classical conditioning. The changed memories can be disrupted (e.g., by trauma to the brain, by drugs, and by other means), but once they have reconsolidated, they become the new version of the memory. The newer theory of memory says that our memories are not really like books, which don’t change after the print has dried. Practice Question Pete was diagnosed about six months ago with PTSD from his time served in Iraq. Pete did not realize the issues and symptoms he was having such as flashbacks, nightmares, sweating profusely and lack of concentration were an issue as he drank a great deal of alcohol to block out the trauma. Pete was assessed further and suggested treatment was needed. What may NOT have been a potential treatment for Pete? A. Virtual Reality Therapy B. Eye Movement Desensitization and Reprocessing C. CBT D. Anti-Anxiety Medications Practice Question Which of the following statements best describe the behavioral perspective in regards to OCD? A. People with OCD have learned to fear a neutral stimulus through conditioning; they participate in rituals which reduce their anxiety and since this reduction in stress is a relief, it acts as a "reward" for their behavior, thus reinforcing it. B. People with OCD believe that thinking about something bad is the same as doing it and therefore, they perform rituals to try and neutralize or stop the obsessive thoughts. C. People with OCD have experienced a severely traumatic event that acted as an unconditioned stimulus which elicited an unconditioned response characterized by extreme fear and anxiety. This unconditioned response becomes a conditioned response when anything occurs that triggers a reminder of the event. D. People with OCD have "unconscious conflict" that they are trying to cope with, and this conflict comes from a clash between the id (usually a sexual or aggressive urge) and the superego (the desire to do the right thing and follow socially acceptable behavior). Practice Question For those with PTSD, different cultures and belief systems may help or hinder the prevalence of this disorder. Cultural beliefs can influence someone's personal interpretation of trauma and their attempt to come to terms with trauma memories in helpful and unhelpful ways. A. behavioral perspective B. psychodynamic perspective C. sociocultural perspective D. humanist perspective Practice Question A recommended treatment option for OCD is A. exposure and response prevention. B. exposure and ritual prevention. C. self-help and talk therapy. D. exposure and relapse program. Practice Question Which sentence best describes habit reversal training? A. Habit reversal training is commonly used to help people with hoarding disorder and includes five elements: awareness training, competing response training, contingency management, relaxation training, and generalization training. With HRT, the individual is trained to recognize their impulse to hoard or save items and teaches them to redirect this impulse. B. Habit reversal training is commonly used to help people with body-focused repetitive behavior and includes five elements: awareness training, competing response training, contingency management, relaxation training, and generalization training. With HRT, the individual is trained to recognize their impulse to pull and also teach them to redirect this impulse. C. Habit reversal training is a common treatment for most disorders and includes the following elements: talk therapy, relaxation training, and medication management. With HRT, the individual is trained to recognize their negative thought process and redirect it. D. Habit reversal training is used to treat people with bad habits - such as poor dietary choices, oversleeping, exercising less - and helps them reverse these habits through alternative treatments such as hypnosis. Practice Question Each of the following scenarios describes a patient undergoing treatment for PTSD. Select the option closest to describing eye movement desensitization and reprocessing. A. During her therapy session, Maria wears a VR headset and walks around a virtual setting that looks like the location where she deployed six months ago. She watches a car explode and is asked to describe her level of anxiety throughout the session. B. Jamal is asked by his therapist to talk about his traumatic experience and as he does, he tries to keep up with her finger as it moves back and forth rapidly. She explained to him that this process will help him reprocess his memories to lessen the fear he has surrounding the traumatic event. C. Amaya begins each session with the therapist by closing her eyes and recalling the trauma as if the event is presently occurring. She is asked to retell all of her emotions and describe the even with as much detail as possible, including the senses. Usually, she receives homework assignments to complete for the following session. D. In his therapy session, Marc is asked to recall the traumatic events he faced. He describes them in as much detail as he can handle, and once complete, he sits quietly and moves his eyes back and forth, rapidly following his therapist's finger as it sweeps across his vision. Reference Videos - Obsessive-Compulsive and Related Disorders Debunking the myths of OCD - Natascha M. Santos Obsessive Compulsive Disorder Special Report: Imperfect Me - the impact of Body Dysmorphia Hoarding: Designated Discrete Disorder in New Psychiatry 'Bible' Overcoming Trichotillomania: The Power of Awareness | Aneela Idnani | TEDxFargo What it's like to have a skin-picking disorder Reference Videos - Trauma- and Stressor-Related Disorders How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED Posttraumatic stress disorder (PTSD) - causes, symptoms, treatment & pathology Acute Stress Disorder | Mood Disorders What is Adjustment Disorder? (Symptoms Occurring from a Stressful Life Event) The Strange Situation | Mary Ainsworth, 1969 | Developmental Psychology Reference Videos - Treatments A guide to Cognitive Behavioural Therapy (CBT) Can Moving Your Eyes Re-Code Your Memories? PTSD Therapy Session at VA using Virtual Iraq Erasing fear memories