Module 10: OCD-related disorders Flashcards

Question

BDD screening in Utrecht

Answer 1

* New patients at the outpatient clinic of dermatology, plastic surgery and maxillofacial surgery * BDDQ-DV * Severity of defect scored by surgeon, dermatologist, or cosmetic doctor --This was important to find because if there was a severe defect, then patient did not meet criteria for BDD

Answer 2

combined all studies on prevalence and replication studies of the Utrecht study Results: One in three patients visiting clinics of rhinoplasty has BDD - quite serious because this is a high prevalence

Answer 3

* BDD DSM-5 criteria * 105 adolescents with acne (13-24 years old) * 12% BDD

Answer 4

found that: * Ppl with BDD have a much more detailed visual information processing compared to controls * They focus on details instead of being able to look at the bigger picture these correlated with brain activation * Overactivity in the VVS vs in the DVS * These correlate to enhanced detail processing and to severity of BDD symptoms

Answer 5

DA in BDD: * higher dopaminergic signal in the brain compared to controls * similar to OCD also seen in the serotonin system

Answer 6

* family members with BDD 8% * People who have OCD are more likely to have close family members who also have BDD, compared to people without OCD * Twin studies: 64% shared genetic vulnerability between BDD and OCD

Answer 7

Biases in selective attention * Focused on specific details (disorder relevant stimuli and self referent and aesthetic details like symmetry) * Others try to avoid details (e.g., looking in the mirror) Distorted cognition * Perfectionistic thinking and maladaptive beliefs (e.g., about importance of attractiveness), tendency to form conclusions without sufficient information and misinterpret ambiguous social scenarios as negative and threatening Memory deficits * inaccurate coding and recall of face and body stmiuli

Answer 8

* Perfectionistic tendencies * Neuroticism * Behavioral/social inhibition * Unassertiveness * Rejection sensitivity

Answer 9

* Higher prevalence of BDD symptoms: exposure to unrealistic beauty standards * High levels of family dysfunction/overprotection in families of individuals with obsessive compulsive and related disorders * Family accommodation can reinfroce the disorder, particularly in pediatric BDD * Gender: Women: focus on more areas of the body, increased distress, less illness insight, more sfaety behaviors, earlier age of onset Men: worse overall functioning * Greater rates of BDD symptomatology in queer individuals and in racial/ethnic minority individals * Suicidality is also increased - Esp.committing suicide In males with BDD

Answer 10

* physical abuse/neglect: 14-55% * Sexual trauma /abuse: 22-35% * Emotional neglect /abuse: 28-68% * Appearance and competence teasing

Answer 11

* "upward comparison" & BDD (judgement bias) -- People focus on those that "look better" Only a few studies: They show increased/worsened symptoms with social media use

Answer 12

with poor insight, patients do not feel they need psychiatric treatment, they want cosmetic treatments as they believe this is the only solution

Answer 13

* 48-76% of patients with BDD get cosmetic treatment before psychological treatment * 26-66% different cosmetic procedures * Little satisfaction in the long term * More procedures -> worse prognosis

Answer 14

Studies show mixed results in terms of improvement after cosmetic treatments -> no definitive answer BUT a lot of studies showing improvement have methodological limitations (only questionnaire) + the FU is really low (few weeks)

Answer 15

Only 8% developed BDD after a cosmetic procedure and all others improved on BDD * Now every professional working in cosmetic surgery required to screen for BDD * This is useful for filtering out those patients that will not benefit from your treatment

Answer 16

similar to OCD, SSRIs do help in BDD * 2 RCTs: 50-60% response (have a significant decrease in their symptoms) * Placebo controlled discontinuation: relapse 40% vs 18% (much higher in the placebo group) * Open label studies with fluvoxamin Good results

Answer 17

Clomipramine vs desipramine * 65% response vs 5% response

Answer 18

* 1 RCT: pimozide addition: No response * Should be repeated, to see for which patients it worked Combining SSRIs with antipyshocitcs then it worked a little bit

Answer 19

* 12 weeks FU: 58% of responders * Could add to possibility of treatment

Answer 20

1. genetics/personality/psychological factors 2. environment: social media, cultural and familiar factors 3. Trauma and stressful events

Answer 21

Main feature is the selective attention for appearance features: --> all kidns of negative thoughts and beliefs about their appearance --> leads to anxiety, shame, etc --> BDD rituals, avoidance Similar to OCD rituals

Answer 22

* personality dimension * trauma therapy

Answer 23

Hard to start, but once treatment is started patients report satisfaction Coming in contact with others with BDD can be very helpful as an experience 1. Theory A, Theory B Only when they are convinced to go for another theory , will they be able to start: - Theory A: the way they experience their symptoms now (e.g., cosmetic procedures and other rituals diminish other symptoms) - Theory B: tell patient that this way of thinking doesnt work --> go for a different theory, OUR theroy Inclusion of cognitive interventions to break rituals

Answer 24

- Agree with patient on goals to achieve - They are unable to make small goals (e.g., overshoot "i want to not have any compulsions anymore) - Compulsions are easier to target but obsessions do not change --> patients become better in dealing with

Answer 25

This is done in order for them to gain insight into their rituals and whether they are functional

Answer 26

in cognitive therapy the reasoning process of patients is what you try to uncover e.g., reasoning process 1. my nose looks ugly 2. other people see it 3. when others look at my nose they will have a negative judgement 4. the assumption that if others don't like one thing they will disapprove me completely

Answer 27

1) What you see is that most of their self worth is built in their appearance - The point is to see if there are any other qualities in the patient that tcontribute to self worth - Usually always yes (e.g., being a family member etc.) 2) Challenge core beliefs: multidimensional evaluation - Go to core belief (most times its a belief of feeling completely worthless) - ask to imagine a person they know that is worthless and valuable - then ask patient to write down what kind of characteristics make someone a valuable person or a worthless person - Make dimensions of these different characteristics - Now they have to score themselves again on these dimensions They see that if they have different dimensions within worthlessness They see that they score much higher on specific dimensions than others (??)

Answer 28

Automatic vs helpful thoughts - How can they change to helpful thoughts - Which situations trigger which thoughts

Answer 29

1. **all or nothing thinking** 2. catastrophizing 3. **mind reading** 4. mental filter 5. overgeneralization 6. emotional reasoning 7. should statements 8. ignoring the good 9. minimizing 10. blaming 11. personalization 12. **jumping to conclusions** 13. **measuring with double standards**

Answer 30

* automatic thoughts my nose/hair/skin look ugly others are also convinved that this is the case * basal assumptions/core cognition I am worthless * conditional assumptions If i do not look perfect, i will be rejected by others When i am not attractive, my life wont mean anything * instrumental assumptions I have to look into the mirror because I need to know how I look Nobody is allowed to disapprove my appearanc because I cant tolerate it --> you can identify these using a functional analysis You address these differently in therapy

Answer 31

* Social situations * Public transport * (eye) contact with others * Showing yourself without cap, glasses, make-up

Answer 32

* Not allowed to do compulsive rituals * Mirror gazing, skin picking * Make-up or hair rituals * Confirmation behavior * Checking/comparing/social media

Answer 33

Doing this increases BDD symptoms + other psychological symptoms --> in CBT essential to explain this to patients as well: Showing patients that hyperfocusing on a specific feature is detrimental

Answer 34

Teaching to avoid mirrors FIRSTLY 1. Explain that a mirror is not your friend 2. Explain that don't look into it that often 3. At least one arms reach away from it Mirror retraining: - Positive mirroring or objetive describing - Gradual exposure: start mirroring a body part distant fom the BDD focus - Gradually increase this area of tolerance Can also use this technique w/ pics and movies - Desrcibing a picture in general

Answer 35

1st part of treatment: offer medication as symptoms decrease more when medication used tgt with CBT - Compared to just CBT - Esp in the beginning this was used to ease the anxiety that patients experienced rgarding starting CBT but also anxiety that pre-existed

Answer 36

* CBT: Up to 84% of patients responding, still like in OCD 15-25% no remission --> we look for other ways * Trauma treatment & BDD: - Imaginary rescripting: Positive results * Supportive PT (SPT): also improved holistic and emotionally accurate processing * Acceptance and compassion focused therapy

Answer 37

* Schulte (2020): 60,1% with BDD: no lifetime treatment, only 22% received medication or CBT * Only 13% of patients with CBT had received all components * Marques (2011): medication (SSRI or clomipramine): 40% * Individual-level treatment barriers: shame and stigma

Answer 38

* 6 patients with BDD + severe depression * Same protocol as in OCD and depression (same target area) No sham control condition results: * 4 of 6 patients did improve and were really happy with results --> rtms study * 5 of 6 really improved in depressive symptoms

Answer 39

rTMS in combination with medication: * 47% decrease in BDD symptoms * 62% decrease of depressive symptoms peak-effect after 10 sessions 2 non-responders: low insight, increased suicidality, no FU, not continuing with rTMS for long could lead to high relapse rates -> maybe DBS is better

Answer 40

* Positive results also with DBS * 1 patient treated, something to look for in the future

Answer 41

1. major depression 2. social anxiety disorder 3. **obsessive-compulsive disorder (OCD),** 4. **eating disorders.**

Answer 42

Risk assessment is important because BDD is associated with high rates of suicidality. Assessing for suicidal ideation and behavior is crucial for safety.

Answer 43

exposing individuals to situations that trigger their appearance concerns or repetitive behaviors and preventing them from engaging in their usual avoidance or ritualistic responses. This helps to habituate them to the distress and experience distress habituation.

Answer 44

help patients view themselves more objectively and globally, focusing on their whole body rather than obsessing over perceived flaws. It aims to reduce self-critical judgment.

Answer 45

similarities: * compulsive checking behavior and compulsive drug use * biases in selective attention * memory deficits differences: * CBT for BDD focuses on body image and SSRIs * CBT for SUDs focuses on MI and medication assisted treatment

Module 10: OCD-related disorders Flashcards

1. Module background 1-9, 2. Lecture 10-64 3. Jassi & Krebs 65-69 (69 cards)