Obsessivecompulsive disorder (OCD)

Transcription

1 Obsessivecompulsive disorder (OCD) OCD is concerned with the inability of the person to inhibit fear and anxiety-reducing behavior. The person engages in repetitive fear-reducing attempts. Definitions: Obsessions: Persistent and/or intrusive thoughts, ideas, impulses, or images that cause distress. Cause anxiety and distress Compulsions: Repeated and often excessive and rigid behaviors or mental acts that that a person feels driven to perform in response to an obsession. Aimed at reducing the distress of obsessions, and/ or of preventing a dreaded event with which the person is obsessed. DSM-5: OCD is the presence of obsessions, compulsions, or both that are: exceedingly time consuming and/ or cause the person dysfunction, distress, and/or impairment. ICD-10: recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist. Anxiety is almost invariably present. If compulsive acts are resisted the anxiety gets worse.

2 Obsessions repetitive thoughts, worries typical obsessions concern: cleanliness doing things right or perfectly having forgotten something important* impulse/need to check or repeat behavior safety worries that something terrible has happened, that the person did something horrible** *short-term memory problems or difficulty reassuring oneself that an activity has been performed **particularly distressing, can lead to suicidality compulsions Voluntary behaviors or mental acts Feel mandatory/unstoppable Person may recognize that behaviors are irrational Believe that catastrophe will occur if they don t perform the compulsive acts Performing behaviors temporarily reduces anxiety Behaviors often develop into rituals Common Forms/Themes Cleaning Checking & rechecking Order or balance Touching, verbal, and/or counting Hoarding, collecting (separate Dx in DSM-5) gambling (separate Dx in DSM-5)

3 ~2% of U.S. population has OCD in a given year Often seen as anxiety disorder because obsessions cause anxiety, while compulsions are aimed at preventing or reducing anxiety however, OCD has many features that are not typical of other anxiety disorders: atypical anxiety features of OCD Ratio of women to men is 1:1 OCD is responsive to SSRI medications OCD is linked to the orbital region of the frontal cortex the caudate nuclei (frontal parts of the basal ganglia) Low serotonin activity seems to occur in these brain regions atypical anxiety features of OCD Other s Hoarding disorder Body Dysmorphic Trichotillomania (Hair-pulling), Excoriation (Skin-picking)

4 Hoarding video developmental psychopathology onset of symptoms in middle childhood or early adolescence. obsessions precede and dictate onset of compulsions. an initial struggle with the obsessions, then a phase of acquiescence with the obsessions (command responding) developmental psychopathology vague obsessive concerns precede specific obsessions ("rigidifying"). initial obsessions become disinhibited Diagnosis usually occurs late. Appears to be under-diagnosed due to concealment of symptoms or shame. OCD: CBT Exposure and response prevention (ERP) Clients are repeatedly exposed to anxiety-provoking stimuli and prevented from responding with compulsions Therapists often model the behavior while the client watches

5 OCD: CBT Homework is an important component Habituation training Covert-response prevention OCD: Medication Serotonin-based antidepressants Anafranil, Prozac, Luvox Bring improvement to 50 80% of those with OCD many clients complain that therapy and medications are only partially effective; even with Tx often still have sub-clinical Sx Relapse occurs if medication is stopped Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective Conclusions on OCD