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Flashcards in Task 4 OCD Deck (44)
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1

Cormobidity

Around 66% of people with OCD are also significantly depressed; Panic attacks, phobias and substance abuse are also common

2

Prevalence

1-3% of people will develop it at some time; Does not seem to differ across countries; Some studies found slightly higher rates in women

3

Common types of thought

Aggression, sexuality and/or religion; Symmetry and ordering; Contamination often accompanied by cleaning compulsion

4

Rituals

 People with OCD believe that repeating behavior certain number of times will ward off danger to themselves or others – Ritual becomes stereotyped and rigid and they develop obsessions and compulsions about not performing them correctly.

5

Hoarding

Closely related to OCD but classified as separate diagnosis because of some distinct features & different biological correlates.
 Thoughts about possessions, not as intrusive, unwanted or distressing as OCD, but instead as part of their natural stream of thought.
 People with hoarding behavior may become anxious, sad or angry when pressured to get rid of possessions.
 They show emotional attachment to possessions, equating them with their identity or giving them human characteristics.
 2-5% of population engage in hoarding and a small subset of hoarders meet criteria for OCD.
 Significant comorbidity with depression, social anxiety and generalized anxiety disorder

6

body dysmorphic

Excessive preoccupation with part of their body they believe is defective but that others see it as normal or only slightly unusual.
 Preoccupation results in a lot of time spent checking themselves in mirror, attempting to hide or change body part, or seeking reassurance.
 Women are more concerned with breasts, hips, legs and weight; Men with body build, genitals, body hair and thinning hair.
 30% attempt suicide; High comorbidity with anxiety and depressive disorders, PDs, substance use & OCD; Average age of onset is 16.

7

Skin picking

Recurrently pick at scabs or places on their skin, creating significant lesions that often become infected and cause scars.
 Tend to feel tension before or while attempting to resist impulsive, and pleasure/relief when giving in to it (same for hair-pulling disorder).
 2-5% and often begins in adolescence.

8

Hair pulling

People diagnosed with it have history of recurrent pulling out of their hair, resulting in noticeable hair loss.
 1-3% with average age of onset 13.

9

DMS-5

Criterion A – Presence of obsessions, compulsions or both
CRITERION B – Obsessions or compulsions are time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
CRITERION C – Obsessive-compulsive symptoms are not attributable to physiological effects of substance or another medical condition.
CRITERION D – Disturbance is not better explained by symptoms of another mental disorder (excessive worries, like generalized anxiety; ritualized eating behavior, like eating disorders; preoccupation with appearance, like BDD).

10

Obsessions are defined by

-Recurrent and persistent thoughts, urges, or images that are experienced, at some time during disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
-Individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (= performing a compulsion).

11

Compulsions are defined by

-Repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession or according to rules that be applied rigidly.
-Behaviors or mental acts are aimed at preventing or reducing anxiety/distress or preventing some dreaded event/situation. However, these behaviors or mental acts are not connected in realistic way with what they are designed to neutralize/prevent or are clearly excessive.

12

Biological factors

 Caudate nucleus filters powerful impulses arising in OFC, so only most powerful ones reach thalamus. Possibly, OFC and/or CN are so active in OCD that numerous impulses reach thalamus, generating obsessive thoughts or compulsive actions.
 Example – Continuing to wash hands because brains cannot shut hand-washing behavior when it is no longer needed.
 Support for this brain circuit – Many obsessions and compulsions are related to contamination, sex, aggression and repeated patterns of behavior, which are issues that this brain circuit deals with.

13

Difference between normal and OCD

Main difference between people with and without OCD, is that people with OCD are unable to turn off negative & intrusive thoughts.

14

Why do they have trouble turning off their thoughts?

1. They may be depressed/generally anxious most of the time, so that minor negative events are likely to invoke intrusive, negative thoughts.
2. People with OCD have tendency toward moralistic thinking – Judging negative thoughts as more unacceptable than most would and feeling more anxious/guiltier for having them, making it harder to extinguish these thoughts.
3. People with OCD believe that they should be able to control all their thoughts and believe these will make them go crazy, making it harder to dismiss them.

15

Operant conditioning in OCD

 People with anxiety-provoking obsessions discover that if they engage in certain behaviors, their anxiety is reduced. Each time obsessions return, and person uses behaviors to reduce them, behaviors are negatively reinforced and thus, compulsions arise.

16

Clinical constructs and OCD

Clinical psychology researchers developed constructs to describe combination of thoughts, beliefs, cognitive processes and symptoms seen in different psychopathologies. These can be developed in a way that allows them to be objectively measured (= questionnaires).

17

inflated responsibility (clinical construct)

Belief that one has power to bring about/prevent subjectively crucial negative outcomes. These negative outcomes may be actual: that is, having consequences in real world and/or at moral level.

18

thought-action fusion (clinical construct)

Dysfunctional assumption held by OCD sufferers that having a thought about an action is like performing it.

19

Mental contamination

Feelings of dirtiness can be provoked without any physical contact with a contaminant. Mental contamination can be caused by images, thoughts, and memories and may be associated with compulsive washing and even betrayal experiences.

20

Thought suppression

Defense mechanism used by individuals with obsessive thoughts, to actively suppress them. Explains why intrusive thoughts are uncontrollable.
 There is good evidence that actively suppressing unwanted thought, will actually cause it to occur more frequently (= rebound effect).
 Suppressing unpleasant thought induces strong negative emotional state, resulting in suppressed thought becoming associated with that negative mood state.

21

Perseveration

OCD is one example of perseverative psychopathologies. These are characterized by dysfunctional perseveration of certain thoughts, behaviors and activities.

22

Mood as Input hypothesis

Claims that people use concurrent mood as information about whether they have successfully completed task or not.
 OCD sufferers persevere with compulsive activities until they are certain to have fully completed tasks. Their endemic negative mood is interpreted as providing information that they have not completed task, so they persevere.

23

Biological and Pharmacological treatments

Drug treatments are a short-term, effective and cheap way of reducing symptoms of OCD, but relapse is quite common.
 Serotonin & SSRIs – Most commonly prescribed and have effect of increased serotonin levels. Also effective on people with hoarding disorder and BDD.
 50-80% of OCD patients experience decreases in obsessions & compulsions while on these drugs (which are reduced only 30-40%).
 Side effects – Drowsiness, constipation, loss of sexual interest.
 Tricyclic antidepressants – Reduce persistence of compulsive rituals but seem to be effective only with comorbid depression.

24

Exposure and ritual prevention treatment

Most common and most successful therapy for OCD. It consists of two components: (1) Gradual exposure to situations and thoughts that trigger distress; (2) Ritual and response prevention, involving strategies such as practicing competing behaviors, habit reversal (for skin-picking and hair-pulling) or modification of compulsive rituals.
 Positive aspects – It allows anxiety to extinguish by habituating links between obsessions and their associated distress; It eliminates ritualistic behaviors that may negatively reinforce anxiety. Highly flexible therapy that can be adapted to group, self-help, inpatient, outpatient, family therapy and computer guided interventions.
 Effectiveness – It led to improvement in obsessions and compulsive behavior in 60-90% of OCD patients.

25

CBT

For patients that find ERP treatment too difficult, CBT is a good alternative. It is based on targeting and modifying dysfunctional beliefs that OCD sufferers hold about their fears, thoughts and significance of rituals.
 Dysfunctional beliefs that are challenged in CBT include: (1) Responsibility appraisals (= sufferer believes they are responsible for preventing harmful outcomes); (2) Over-Importance of thoughts (= sufferer believes that having thought about action is like performing it (TAF); (3) Exaggerated Perception of threat (= sufferer has inflated estimates of likelihood of harmful outcomes).

26

repeated checking and memory distrust

 Studies have found that as responsibility increased, memory confidence declined. However, this reduction was associated with increases in memory accuracy.
 Such findings are in line with Cognitive Model of Compulsive Checking – Proposes that increased responsibility, perceived severity of harm and perceived probability of harm, interact to produce checking behavior.

27

Repeated relevant checking leads to memory distrust

When participants were asked to repeatedly check stove, their memory confidence, vividness and detail, significantly declined. Results lead to conclude that incorporation of elevated threat, as well as conditions that promote increased responsibility, do not inhibit significant declines in meta-memory, following repeated relevant checking.

28

Normal obsessions

NON-PSYCHIATRIC SUBJECTS COMMONLY EXPERIENCE OBSESSIONS + PEOPLE VARY IN CRITERION OF WHAT IS ACCEPTABLE

29

Study 2 similarities

Sought to discover similarities and differences between clinical and non-clinical obsessions.
 Method – Structured interviews of obsessional patients and non-clinical subjects with obsessions (= positive respondents).
 Results – Total of 23 obsessions were reported by 8 participants from clinical sample. Total of 58 obsessions were listed by 40 subjects in non-clinical sample. Clinical obsessions were not all readily discernible by clinicians.
THEY ARE SIMILAR IN FORM, EXPRESSED RELATION TO MOOD, MEANINGFULNESS AND ALMOST IN CONTENT

30

Abnormal and normal obsessions conclusion

 Obsessions in the form of thoughts and/or impulses are a common experience and a large majority of people report experiencing them.
 Normal and abnormal obsessions are similar in form and content, as well as in expressed relation to mood and meaningfulness to respondent.
 Normal and abnormal obsessions differ in frequency, intensity and consequences.
• Frequency – Abnormal obsesses are more frequent and last longer.
• Intensity – These obsessions are more intense, but they are also more strongly resisted; Threshold of acceptability is higher for abnormal obsessions.
• Consequences – Abnormal obsessions produce more discomfort and provoke more urges to neutralize. They are also easier to dismiss.