MHM108.pdf

11/16/23, 11:25 AM Realizeit for Student Onset and Clinical Course OCD can start in childhood, especially in males. In females, it more commonly begins in the 20s. Overall, distribution between the sexes is equal. Onset is typically in late adolescence, with periods of waxing and waning symptoms o...

11/16/23, 11:25 AM Realizeit for Student Onset and Clinical Course OCD can start in childhood, especially in males. In females, it more commonly begins in the 20s. Overall, distribution between the sexes is equal. Onset is typically in late adolescence, with periods of waxing and waning symptoms over the course of a lifetime. Individuals can have periods of relatively good functioning and limited symptoms. Other times, they experience exacerbation of symptoms that may be related to stress. Small numbers of people exhibit either complete remission of their symptoms or a progressive, deteriorating course of the disorder (Stein & Lochner, 2017). Individuals with early-onset OCD (average age of 11) and those with late-onset OCD (average age of 23) differ in several ways. Early onset is more likely to affect males, has more severe symptoms, more comorbid diagnoses, and a greater likelihood of a family history of OCD (Stein & Lochner, 2017). DSM-5 DIAGNOSTIC CRITERIA:Obsessive–Compulsive Disorder 300.3 (F42) A. Presence of obsessions or 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 unwanted and that in m 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 perform 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 d 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 be connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. B. The obsessions or compulsions are time-consuming (e.g., take > 1 hour/day) or cause clinically significant distress or impairment in social, occupationa 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 m D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preocc BDD; difficulty discarding or parting with possessions, as in hoarding disorder; hair-pulling, as in trichotillomania [hair-pulling disorder]; skin-picking, as in stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in sub disorders; preoccupation with having an illness, as in illness–anxiety disorder; sexual urges of fantasies, as in paraphilic disorders; impulses, as in disrupti disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psy patterns of behavior, as in autism spectrum disorder). Reprinted with permission from the American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author. Etiology The etiology of OCD is being studied from a variety of perspectives. Different studies show promise but have yet to definitively explain how or why people develop OCD. Cognitive models of OCD arise from Aaron Beck’s cognitive approach to emotional disorders. This has long been accepted as a partial explanation for OCD, particularly since CBT is a successful treatment. The cognitive model describes the person’s thinking as (1) believing one’s thoughts are overly important, that is, “If I think it, it will happen,” and therefore having a need to control those thoughts; (2) perfectionism and the intolerance of uncertainty; and (3) inflated personal responsibility (from a strict moral or religious upbringing) and overestimation of the threat posed by one’s thoughts. The cognitive model focuses on childhood and environmental experiences of growing up. However, environmental influences are not solely responsible for the development of OCD (Stein & Lochner, 2017). It is important to remember that the client is trying to deal with overwhelming urges and emotions, including anxiety. The compulsive behavior may seem purposeless and senseless, even to the client. But it is the client’s attempt to ward off feared consequences or manage/decrease overwhelming feelings that are escalating out of control. It is not possible to reason with or tell the patient to simply stop. Population-based studies have confirmed substantial heritability in OCD. Genome-wide and candidate gene association studies have found variations that may be involved in OCD pathology and support the idea that a complex network of several genes may contribute to the genetic risk for OCD (Yue et al., 2016). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/2 11/16/23, 11:25 AM Realizeit for Student Cultural Considerations OCD is generally thought to be fairly similar or universal among different countries. Several studies found that OCD was consistent across cultures in terms of diagnosis, but variances exist in symptom expression or beliefs about symptoms. Highly religious individuals, both Christian and Muslim, may have a heightened sense of personal guilt (about their symptoms) and beliefs that they should be responsible for controlling unwanted, threatening thoughts. Shame and guilt are prominent feelings among people with OCD and OCD-related disorders (Candea & Szentagotai-Tata, 2018). In some cultures, patients with OCD believe a supernatural cause exists and therefore are much more likely to contact a faith healer for help. Ethnic differences may also be found in the types of OCD symptoms or beliefs that people experience. Some report more contamination-related OCD symptoms, while others have higher levels of obsessional beliefs. This may indicate a need to tailor treatment approaches to accommodate such differences where they exist. Despite the universality of the existence of OCD, pharmacologic treatment varies a great deal. In seven different countries, the use of SSRIs was most prevalent but varied from 59% to 96% overall. These authors suggested the need to study such variances and compare them with treatment outcomes (Brakoulias et al., 2016). Treatment Behavioral therapy specifically includes exposure and response prevention. Exposure involves assisting the client in deliberately confronting the situations and stimuli that he or she usually avoids. Response prevention focuses on delaying or avoiding performance of rituals. The person learns to tolerate the thoughts and the anxiety and to recognize that it will recede without the disastrous imagined consequences (Albano & Pimentel, 2017). Other techniques, such as deep breathing and relaxation, can also assist the person with tolerating and eventually managing the anxiety. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/2