Obsessive Compulsive and Related Disorders

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Betty Dorsey
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1 Obsessive Compulsive and Related Disorders

2 Obsessive-Compulsive and Related Disorders Obsessive-Compulsive and Related Disorders Obsessive -Compulsive Disorder (OCD) Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair Pulling) Excoriation (Skin Picking) Disorder

3 DSM 5 Criteria for OCD Obsessions 1. Intrusive, persistent, and uncontrollable A. Presence of obsessions, thoughts or urges. compulsions or both 2. The person tries to ignore, suppress or neutralise them. Compulsions 1. Repetitive behaviours 2. Behaviors or mental acts to avoid anxiety B. Obsessions or compulsions are time consuming (take more than 1 hour per day) Specify if: with good/fair insight with poor insight with absent insight Tic related

4 OCD Obsessions Intrusive, persistent, and uncontrollable thoughts or urges The person tries to ignore, suppress or neutralise them. Most common: Contamination, sexual and aggressive impulses, religion, symmetry

5 OCD Compulsions Impulse to repeat certain behaviors or mental acts to avoid distress (cleaning, counting, touching, checking) May involve elaborate behavioral rituals The person feels driven to repetitive behaviours according to rigid rules Compulsive gambling, eating NOT considered compulsions, since pleasurable

6 OCD 2-3 % of the individuals meet criteria for OCD at some point in their lifetime. Most of the studies indicate no gender difference, but some indicates 1.4 (F) to 1 (M).

7 DSM 5 Criteria for Body Dysmorphic Disorder A. Preoccupation with one or more perceived defects or flaws in appearence that are not observable or slight to others. B. Individuals perform repetitive behaviours. C. Preoccupation causes significant distress. D. Preoccupation is not better explained with body fat or weight.

8 Body Dysmorphic Disorder Preoccupied with an imagined or exaggerated defect in appearance Perceive themselves to be ugly or monstrous Women focus on: skin, hips, breasts, legs Men focus on: height, penis size, body hair, muscularity 8

9 Body Dysmorphic Disorder Engage in compulsive behaviors Check their appearance in mirrors often Camouflage their appearance (tanning, makeup, plastic surgery) High levels of shame, anxiety, and depression Occurs slightly more often in women 2% prevalence rate; 5-7% for women seeking plastic surgery Nearly all have another comorbid disorder

10 Hoarding Disorder 10

11 Hoarding Disorder Persistent difficulty discarding or parting with possessions, regardless of their actual value Perceived need to save items Distress associated with discarding The symptoms result in the accumulation of a large number of possessions that clutter active living spaces of the home or workplace to the extent that their intended use is compromised unless others intervene

12 Hoarding Disorder Most objects are worthless Extremely attached to objects Resistant to discard objects 66% are unaware of severity of problem 33% engage in animal hoarding Animals often receive inadequate care Severe consequences Severe living conditions Negatively impacts relationships Compulsive hoarding occurs 3-5% of the adult population. 12

13 Trichotillomania Also known as compulsive hair pulling The urge to pull out one s hair from anywhere on the body (scalp, eyebrow or arms) Resulting in noticeable hair loss The hair pulling is preceded by increasing tension followed by pleasure, gratification. Usually occurs when alone or with family members. The onset is mostly in the childhood or later. 13

14 Excoriation (Skin Picking) Disorder Picking the scab or the skin around the nails. It can be so frequent so result in bleeding, sores, scars. Individuals feel upset about the result on their skin. Individuals spend excessive time to cover the scars, avoid going beach or gym. 14

15 Etiology of OCD: Behavioral & Cognitive Factors Operant reinforcement Compulsions negatively reinforced by the reduction of anxiety Cognitive factors Lack of a satiety signal Attempts to suppress intrusive thoughts Trying to suppress thoughts may make matters worse Trying to suppress unwanted thoughts. Inflated sense of responsibility (thought-action fusion) 15

16 Etiology of Body Dysmorphic Disorder: Behavioral & Cognitive Factors Focus on details of appearance No actual distortion of physical features Attend to physical attractiveness features Miss the gestalt, or the whole picture Believe in an exaggerated importance of appearance If my appearance is defective, I am worthless. 16

17 Etiology of Hoarding Disorder Evolutionary perspective Adaptive to stock vital resources Cognitive-behavioral factors Poor organizational abilities Unusual beliefs about possessions Avoidance behaviors 17

18 Treatment of the Obsessive-Compulsive and Related Disorders Medications SSRIs, Tricyclic antidepressants Exposure plus response prevention (ERP) Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus The exposure results in the extinction of anxiety Cognitive therapy Challenge beliefs about anticipated consequences of not engaging in compulsions 18

19 Trauma-Related Disorders 19

20 Trauma and Stress Related Disorders Post Traumatic Stress Disorder Acute Stress Disorder 20

21 Posttraumatic Stress Disorder (PTSD) The person exposed to actual or threatened death, serious injury or violence: experiencing the event witnessing the event learning that a violent or accidental death or threat of death to a close other experiencing repeated or extreme exposure to aversive details of event other than media reports 21

22 PTSD Four categories of symptoms: Re-experiencing the traumatic event Nightmares, intrusive thoughts, or images Avoidance of stimuli Refuse to walk on street where rape occurred Other signs of mood and cognitive changes Memory loss, negative thoughts and emotions, self-blame, blaming others, withdrawal Increased arousal and reactivity Irritability, aggressiveness, recklessness or self-destructiveness, insomnia, difficulty concentrating, hypervigilance, exaggerated startle response Tends to be chronic (at least 1 month) High risk of suicide and self-injuries, illness 22

23 Acute Stress Disorder The person exposed to actual or threatened death, serious injury or violence: experiencing the event witnessing the event learning that a violent or accidental death or threat of death to a close other experiencing repeated or extreme exposure to aversive details of event other than media reports 23

24 Acute Stress Disorder 9 of the following symptoms 3 to 31 days: Intrusive distressing memories Distressing dreams Flashback Prolonged stress for reminders In ability to experience positive events Avoid reminders Sleep disturbance Hypervigilance Irritability Startle response Agitation, restlessness Problems with concentration 24

25 Etiology of PTSD Common risk factors with other anxiety disorders Genetic, overactive amygdala, childhood exposure to trauma, Selective attention, neuroticism/negative affectivity Two-factor model of conditioning also applicable Unique factors Severity and type of trauma Neurobiological Smaller hippocampal volume linked to PTSD Avoidance coping, dissociation, memory suppression Intelligence, social support, and ability to grow from the experience enhance coping 25

26 Psychological Treatment of PTSD Exposure to memories and reminders of the original trauma Either direct (in vivo) or imaginal Virtual reality (VR) effective Cognitive therapy Enhance beliefs about coping abilities Treatment of ASD may prevent PTSD Shows benefits even 5 years after the traumatic event 26

Who has Schizophrenia? What is Schizophrenia? 11/20/2013. Module 33. It is also one of the most misunderstood of all psychological disorders!

Who has Schizophrenia? What is Schizophrenia? 11/20/2013. Module 33. It is also one of the most misunderstood of all psychological disorders! What is Schizophrenia? Module 33 It is also one of the most misunderstood of all psychological disorders! Who has Schizophrenia? A middle-aged man walks the streets of New York with aluminum foil under