DSM examples Flashcards

Question

How do the DSM define it?

Answer 1

Recurrent and persistent thoughts, impulses or images that are experienced as intrusive, disturbing, inappropriate and uncontrollable. Person attempts to resist, suppress or neutralise them with some other thought or action Person recognises they are a product of his or her own mind

Answer 2

``` Contamination Frequent types Repeated doubts Ordering Aggressive or blasphemous impulses to shout an obscenity in church to hurt a loved one Sexual thoughts and imagery a recurrent pornographic image (…that violates one’s morals or runs counter to one’s sexual preferences) ```

Answer 3

Repetitive behaviours or mental acts the person feels driven to perform in response to an obsession, or according to rigid rules Behaviours or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation Not to provide pleasure and/or gratification Behaviours are excessive or not realistically connected to what they are intended to prevent.

Answer 4

behaviours: Hand washing Ordering Checking Cleaning Repeating Hoarding Acts: Counting Praying Saying words silently Thinking good thoughts to undo bad thoughts The person with OCD feels compelled to perform acts repeatedly that often seem pointless and absurd even to them and that they in some sense don’t want to perform Rituals in eating and dressing Washing rituals: •Washing hands for about 20 minutes after using the toilet •Washing hands for hours with disinfectants up to the point of bleeding Checking: •All the lights, appliances, and locks two or three times before leaving the house •Going back to a junction where one thinks one may have run over a pedestrian and spending hours checking for any sign of the imagined accident

Answer 5

A. Either Obsessions or Compulsions B. Obsessions or compulsions are timeconsuming (>1hr/day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The O-C symptoms are not attributable to the physiological effects of a substance or another medical condition D. Disturbance is not better explained by the symptoms of another mental disorder

Answer 6

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. …many With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. …some With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. …<4%

Answer 7

Usually begins in late adolescence or early adulthood Estimated UK prevalence 1-2% of general pop. Equally common in men and women In childhood onset the disorder is more common in boys than in girls At least 50% of sufferers have at least one other psychological disorder Themes of sexuality, exactness and symmetry more common in men; contamination & cleaning more so in women Culture may influence the themes of obsessions and compulsions. E.g., religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance

Answer 8

Unwanted cognitive intrusions are experienced by most people. (i.e., unpleasant thoughts, images, and impulses that intrude into consciousness) These intrusions typically have similar contents to clinical obsessions. BUT it is the Apprasisal or thoughts about the thought that are critical Misappraisals are due to dysfunctional beliefs, e.g., beliefs about: (1) inflated personal responsibility over one’s own and other's safety. (2) thought-action-fusion (TAF): (1) thinking about an unacceptable or disturbing event makes it more likely to happen. (2) obsessional thoughts are morally equivalent to forbidden actions. (3) excessive concerns about the importance of controlling one's thoughts. The strength of such beliefs affects the risk that a person will develop obsessions and compulsions Intrusive thought Stabbing one’s child with a carving knife +Dysfunctional belief Thinking of something = having done it=Distress

Answer 9

Tolin et al. (2003, 2008): dysfunctional beliefs were associated with OCD symptoms in both clinical and nonclinical samples. Abramowitz et al. (2006): A prospective study. Scores on a measure of dysfunctional beliefs predicted the later development of obsessions and compulsions.

Answer 10

Distress motivates attempts at suppression If thought suppression works, it should leave no vestige of the unwanted thought at all. Try to pose for yourself this task: not to think of a polar bear, and you will see that the cursed thing will come to mind every minute Wegner et al. (1987): white bear study. Texan undergraduates. 5-minute suppression session, participants had to ring a bell each time a white bear came to mind. PPTS thought about bear more than once/ min

Answer 11

Post supression rebound : After suppression task subjects asked to think about the white bear for 5-mins. These subjects signaled more white bear thoughts than controls who were asked to think about a white bear from the outset. Paradoxical rebound effect: attempts to suppress thoughts can “rebound” and result in an increased occurrence of the thoughts.

Answer 12

Thought suppression attempts result in more rather than less intrusions. This paradoxical effect of thought suppression may result in full blown obsessions. There is some evidence that OCD symptoms are associated with a general failure of suppression. Paradoxical rebound effects may be stronger for patients with OCD. E.g., Tolin et al. (2002): Participants pressed one button for a word (e.g, “HOUSE”) and a different key for a non-word (e.g., “JWOSE”). Words: BEAR, VINE, CURB, SCAR, GOWN Non-words: REKM, BLOY, NOFE, POSC, WATI. “In this experiment, you will be asked to suppress all thoughts of a bear. Do not allow a thought of a bear to enter your mind, and if the thought should come into your mind, please remove it from your mind immediately. Between trials, the computer will remind you to suppress the thought. When you see this, it is very important that you suppress all thoughts of a bear.” OCD patients showed faster responses to the word BEAR than to other words. This effect was not seen in controls.

Answer 13

Attempts to prevent any harmful consequences (e.g., by avoiding knives and continually asking other people to check on the safety of the child). Compulsive rituals develop as eﬀorts to remove intrusions and to prevent any perceived harmful consequences. Compulsions become persistent and excessive because they are negatively reinforced by immediate distress reduction and by the temporary removal of the unwanted thought Compulsions also prevent people with OCD from learning that their appraisals are unrealistic (e.g., the aﬀected individual fails to learn that unwanted harm-related images do not lead to acts of harm). Finally, compulsions can strengthen dysfunctional beliefs about responsibility. The absence of the feared consequence after performing the compulsion reinforces the belief that the person is responsible for removing the threat

Answer 14

intrusive though or image --> misappraisal as important/threatening -> distress --> attempts to supress thought and consequences -> distress reduction --> maladaptive core beliefs

Answer 15

Exposure and response prevention Expose the individual to the triggering stimuli (obsession) and block the neutralising behaviour (compulsion) Exposure Systematic, repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge to perform compulsive rituals. Response Prevention Person refrains from performing compulsive rituals The individual learns: • Anxiety is temporary • The feared catastrophic consequence never transpires • Their interpretation of the obsession weakens • Obsessional thoughts are harmless

Answer 16

Session 1: Walk with therapist through the building touching doorknobs, holding each for several minutes • Session 2: Repeat above and add contact with sweat by having patient touch armpit and inside of shoe • Session 3: Repeat above but introduce having patient touch toilet seats • Session 4: Repeat above but introduce urine by having patient hold a paper towel dampened in her own urine • Session 5: Repeat above but introduce fecal material by having patient hold toilet paper lightly soiled with her own fecal material • Sessions 6-15: Daily exposure to the three most fearprovoking activities are repeated.

Answer 17

RCTs have demonstrated that exposure and response prevention (E/RP) is more effective than other forms of psychotherapy and placebos. Meta-analyses reveal large effect sizes. However, E/RP provokes anxiety in patients: approx. 25% drop out of treatment. For patients who undergo E/RP, eﬀects often last at least 2 years. CBT also involves challenging the moralistic thoughts and excessive sense of responsibility