Obsessive-Compulsive and Hoarding Disorders Flashcards Preview

Impulse Control > Obsessive-Compulsive and Hoarding Disorders > Flashcards

Flashcards in Obsessive-Compulsive and Hoarding Disorders Deck (24)
Loading flashcards...
1

Compulsivity and Impulsivity differences and similarities

Similarities
-inability to delay repetitive behaviors

Differences
-driving mechanism in compulsivity is reduction of discomfort (negative reinforcement)
-driving mechanism in impulsivity is obtaining arousal or satisfaction (positive reinforcement)

2

Obsessions or Compulsions causes

-distress
-time consumption> 1h/day
-interference with daily activities/relationships

3

OCD

characterized by compulsivity- obsessive preoccupation and repetitive behaviors

Obsession-->Anxiety-->Compulsion

-repetitive
-undesired/unwilled
-compelled

4

OCD Obsession

intrusive, unwelcome distressing thoughts and mental images

5

OCD Compulsions

the behavior the people with OCD perform in a vain attempt to relieve the fears and anxieties caused by their obsessions

6

OCD Types of obsessions

-contamination
-fear of harm
-symmetry/perfection
-somatic
-religious
-sexual
-hoarding
-unacceptable urges
-miscellaneous

7

OCD Manifestation of obsessions

-checking
-cleaning/washing
-miscellaneous
-repeating
-mental rituals
-ordering
-hoarding/collecting
-counting

8

OCD Course

-chronic, waxing and waning
-stress sensitivity
-considerable variability
-shifting symptoms and clusters

9

OCD comorbidities

-panic, phobias
-major depression

10

OCD DSM Diagnostic

A. Obsessions or Compulsions defined by:
1. recurrent and persistent thoughts
- intrusive and inappropriate and that cause marked anxiety of distress
2. not simply excessive worries about real-life problems
3. person attempts to ignore
4. product of his or her own mind

C. marked distress, are time consuming ( more than 1 hour a day), or significantly interfere with person's day-to-day functioning

11

OCD Neurobiological Substrates- Cortico-striatal-thalamic-cortical loop dysfunction

-Cortical: Orbitofrontal and anterior cingulate cortices
-Striatal: Basal Ganglia (caudate nucleus, putamen)
-Thalamic: Thalamus

12

OCD Neurobiological Substrates- Cortico-striatal over-activation

-These structures activated during symptom provocation
-Returns to normal with treatment

13

OCD Treatment- Pharmacotherapy

Medications- selective serotonin reuptake inhibitors, glutamate receptor antagonist

14

OCD Treatment- Psychotherapy

Cognitive Behavioral Therapy
-Mindfulness
Four Steps:
1. Relabel
2. Reattribute
3. Refocus
4. Revalue

Exposure and Response Prevention (ERP)
-Exposure to fear
-Refrain from ritual

15

OCD Treatment- Surgical interventions

-last resort
-Cut fibers btw ant. cingulate and caudate nucleus

16

Hoarding

-excessive collection and failure to discard objects of apparently little value, leading to clutter distress and disability

1. Excessive collection
2. Storing, keeping and not discarding
3. Neglect of living space

17

Hoarding-Neurobiological Substrates

-Fronto-limbic
-Anterior Ventromedial Cortex
-Cingulate cortex

-These structures activated during symptom provocation
1. Ventromedial prefrontal cortex activated during simulated discarding
2. Anterior cingulate activated during simulated “keeping”

18

Hoarding- Characteristics

-difficulty discarding or letting go of possessions
-fear of losing important information, emotional attachments, or useful items
-Nature of the items
-clothes
-newspapers, mail, books
-containers
-art/craft supplies
-Severe clutter impedes use of living spaces
-appear to lack an awareness of the disorder - poor insight

19

Hoarding- Under regulation: Inadequate strength

-Chronic: guilt and stress can weaken resolve
-Temporary: physiological/psychological
-Externally-mediated or prompted- saving of objects in hoarders often associated with pleasure (Positive reinforcement)
-exposure / availability

20

Hoarding- Misregulation

-Distorted belief system with regard to possessions
-Distorted Self-Knowledge
-Poor insight: People who hoard appear to lack an awareness of the severity of the problem

21

Hoarding- Spiraling Distress

- Lapse
- Temporary positive mood
- Consequences
- Saving allows the hoarder to avoid the decision required to throw something away and the worry that accompanies that decision (procrastination of action)
- Subjects react with panic to discarding of items

22

Hoarding- Reinforcement patterns

-Compulsive behavior in OCD is negatively reinforced via avoidance conditioning (avoiding distress, feared consequences, etc.), but there is no positive reinforcement of OCD symptoms
-In hoarding, there is both avoidance conditioning (avoiding loss, etc.) and positive reinforcement

23

Hoarding- Under regulation: Reduced monitoring behavior

Renegade attention

Managing attention towards trigger
-Preoccupation: as if hypnotized
-One is surrounded by possessions and clutter, “possession myopia”

24

Hoarding- Under regulation: General

-Acquiescence

-Loss of control over attention-->transcendence failure