OCD Flashcards
1
Q
prevalence of OCD
A
~2%
2
Q
what are obsessions
A
recurrent and persistent thoughts, urges, images which are unwanted or intrusive, and often provoke anxiety and distress
3
Q
what can obsessions sometimes consist of
A
contamination
mistakes
impulses
order
4
Q
what are compulsions
A
repetitive behaviours or mental acts that the individual does in response to an obsession or rigid rule
5
Q
examples of compulsions
A
checking
cleaning
repeating
counting
ordering
6
Q
what is ego-dystonia
A
people with OCD know that the behaviours are unnecessary but, abnormal excess cannot resist the urge
7
Q
how does ego-dystonia occur
A
loss of connection between conscious belief/common sense, and unconscious (urge to perform actions)
8
Q
obsessional criteria for OCD
A
- recurrent and persistent thoughts, urges, images that are unwanted/intrusive and provoke anxiety/distress
- individual attempts to ignore, suppress, or neutralise
9
Q
compulsion criteria for OCD
A
- repetitive behaviours or mental acts that individual does in response to obsession or rigid rule
- aimed at preventing or relieving anxiety/distress, or preventing some feared consequence
- not realist or clearly excessive
10
Q
general criteria for OCD
A
time consuming (>1 hr per day) or cause clinically significant distress/impairment of fucnctioning
not attributable to substance
or another disorder/medical condition
11
Q
concordance of OCD is higher in which set of twin
A
monozygotic (identical)
12
Q
prevalence of OCD among 1st degree relatives is …
A
increased
13
Q
early onset OCD symptoms
A
tics
requires medication which act on dopamine system
more heritable
14
Q
late onset OCD symptoms
A
tend to be more anxious
less dopaminergic agents needed
different neurobiological mechanism
appears adolescent - 20/30s
15
Q
environmental factors of OCD
A
head trauma (damage to basal ganglia)
16
Q
treatment of OCD - SSRI and results
A
higher dose required than in depression
up to 65% achieve 20-40% reduction in symptoms but often see relapse
17
Q
what % of OCD achieve remission
A
less than or equal to 25%
18
Q
treatment for OCD - CBT
A
incorporate exposure and response prevention
and cognitive therapy
19
Q
what is exposure and response prevention therapy
A
reduce extent to which need to perform rituals
20
Q
results of EXRP therpy
A
62-80% of patients respond
fewer relapses
but higher attrition (25%)
21
Q
OCD in DSM-4
A
considered type of anxiety disorder
22
Q
OCD in DSM-5
A
conceptualised under obsessive-compulsive and related disorder
due to different neural circuitry
23
Q
DSM 5 - all OC and related disorders
A
OCD
body dysmorphic disorder (BDD)
hoarding disorder
trichotillomania (hair pulling)
excoriation (skin picking)
24
Q
what is BDD
A
preoccupation with imagined or exaggerated flaws in physical appearance
25
DSM 5 criteria for BDD
appearance preoccupation
repetititve behaviours, or mental acts
clinical significance and not better explained by another disorder/condition
26
examples of BDD repetitive acts
mirror checking
excessive grooming
skin picking
reassurance seeking
disguising/covering areas
comparing appearance to others
27
BDD and sex differences
women - 2.5%
men - 2.2%
28
examples of skin defects (BDD)
acne
wrinkles
scars/lines
29
examples of facial deformities (BDD)
large nose
prominent chin
asymmetry
30
examples of hair (BDD)
thinning
balding
excessive facial/body hair
31
examples of body parts (BDD)
muscle dysphoria
portruding belly
32
heritability of BDD
44%
33
environmental factors of BDD
history of child abuse or neglect
history of teasing/bullying in school - appearance related
cultural specificity
early childhood temperament (shyness, perfectionism, anxiety/depression)
34
SSRIs treatment for BDD
up to 63% achieve clinically significant improvement
but often relapse when drug discontinued
35
CBT for BDD
cognitive - identify and question the meaning of defectiveness
- collect info discontinuous with beliefs and challenge values placed on appearance
behavioural - ExRP, exposure to avoided situation
- reduce compulsive behaviours
psycho-education - creating hierarchy to build up to challenges to get rid of behaviours
36
hoarding disorder - criteria
- persistent difficulty discarding/parting with possessions, regardless of value
- due to perceived need to save items, and distress associated with discarding items
- results in accumulation of possession which clusters living areas and compromises the intended use
- clinical significance and no other explanation
37
CBT for hoarding disorders
re-evalaute the value put on items
handle the desire to get more stuff
38
medications for hoarding disorder
SSRIs
stimulants
-> reduced efficacy
39
services for hoarding disorders
cleaning/removal services
professional organiser
case management
court appointed guardian
40
trichotillomania and excoriation
repetitive pulling out of hair from head, eyelashes etc
imbalance between behaviour that occurs when stressed and ability to control it
41
habit reversal training for trichotillomania
- monitor pulling to identify situational antecedents
- increase awareness of behaviour and high risk situations
- identify competing response incompatible with hair pulling
- decrease opportunities to pull hair, or interfering/preventing pulling
42
is medication or HRT better for trichotilomania
HRT
43
which brain areas are associated with BDD, hoarding and OCD
hyperactivity in orbitofrontal cortex
caudate
thalamus
44
what is dissociation
lack of normal integration of thoughts, feelings, experiences into consciousness and memory
45
features of dissociation
disruption of
- sense of self
- sense of body and surroundings
- memory (amnesia)
- self identification
46
what is depersonalisation
separation of thoughts, emotions, sense of self, feel like outside of own body
47
what is derealisation
surroundings appear surreal and dreamlike, detachment
48
dissociative amnesia
inability to recall autobiographical information
not attributable to substance use, brain injury, psych condition
symptoms are distressing/impairing
49
what events is retrograde concerned with
past
50
what is dissociative fugue
situation where one takes off and engages with purposeful travel before they are reminded and brought back home
51
what events are anterograde concerned with
future events
52
albert dadas
12 year who ran away
dissociative fugue
53
what is dissociative identity disorder
characterised by experience of at least 2 distinct personality traits (alters)
discontinuity in identity
54
who was billy mulligan
committed violent sexual acts and claimed to be embodied by another alter at time
not tried as a criminal due to guilty by insanity defence
55
who was shirley mason
began treatment for anxiety and memory loss, and 12 alters emerged over 2 decades of treatment
hypnosis, psychodynamic treatment, medications
admitted to lying during therapy about alters, and Dr dismissed claim, continued treatment
56
when was DID added to DSM
1980
57
what is malingering
pretending to have symptoms because it benefits them
58
what are iatrogenic symptoms
symptoms that are caused by treatment
59
prevalence of DID
1.5%
60
prevalence of depersonalisation/derealisation
2.5%
61
prevalence of dissociative amnesia
7.5%
62
which disorders are dissociative disorders most comorbid with
borderline personality disorder
somatic symptom disorder
depression
ptsd
history of suicide attempts
63
what causes dissociation
sleep deprivation
stress
drugs
64
what is the post traumatic model for dissociation
syndrome may arise after attempts to restore balance and stability, cope with life following trauma
65
what is the primary risk factor for dissociative disorders
trauma
66
childhood trauma prevalence and dissociative disorders
sexual - 57-90%
emotional - 57%
physical - 63-82%
neglect - 63%
67
68
what is the socio cognitive model for dissociative disorders
treatments may be causing symptoms
people seek explanations and suggestions from therapists, or media may cause symptoms to appear/elaborated
69
what are the treatment options for DID
psychotherapy and psychodynamic approaches
70
psychotherapy for DID
to help client form more adaptive coping techniques are manage stressors
convince individual they do not need alters to be safe
reintegration of identity
71
psychodynamic approaches for dissociative disorders
focus on repressed memories by reactivating them and working through them
can be detrimental - false memories inductions later proven wrong
72
somatic symptom disorder - features
- used to be called hypochondriac
- excessive concerns about physical health symptoms
- having significant focus on physical symptoms (pain, weakness, shortness of breath) leads to major distress and problems functioning
- make frequent doctor visits, request lots of tests
- obsessing over symptoms online
73
categories in DSM - somatic
somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
74
criteria for somatic symptom disorder
one or more somatic symptoms distressing and disrupt daily life
should last at least 6 months
75
what is illness anxiety disorder
preoccupation and high anxiety around having or acquiring serious illness
76
criteria for illness anxiety disorder
excessive illness behaviour (checking, reassurance seeking, avoidance of medical care)
somatic symptoms are not present or mild
last at least 6 months
77
functional neurological disorder
first described as hysteria (conversion disorder)
condition where individual experience an alteration in neural functioning
incompatibility between symptom and recognised neuro/medical condition
78
side effects of FND
sensation or motor movements
seizures
paralysis
blindness
79
what is the crucial aspect of FND
no identified medical cause of neurological symptoms
80
factitious disorder
falsification of physical or psych signs of symptoms, or induction if injury or disease
81
what do people with factitious disorder do
extreme behaviours
lengthy hospital stays
painful tests
take drugs which damage self
fake tests
undergo surgeries, treatments
82
reasons which may explain factitious disorder
some think it may be a need to be cared for/attention
possibly related to personality disorders
83
prevalence for somatisation disorder
<1%
84
prevalence of illness anxiety disorder
1.3 - 10%
85
prevalence of FND
2-5/100,000
86
prevalence of factitious disorder
1% in hospital settings
87
risk factors for somatic disorders
environmental and psychological
88
environmental risk factors for somatic disorders
childhood abuse or adversity
physical trauma
insecure attachment
89
psychological risk factors for somatic disorders
excessive anxiety about ones health
increased attention to and experience of somatic symptoms
behaviours they engage with reinforces the anxiety
90
which parts of the brain react to unpleasant senations
insula
anterior cingular cortex
91
which part of the brain processes bodily sensations
somatosensory cortex
92
cognitive behavioural models of somatic symptoms
anxiety/stress/depression amplify attention to/experience of pain, catastrophize consequences of pain, causes somatic symptoms
vicious cycles can maintain chronic pain
93
what is the biopsychosocial model of chronic pain
brains interact with world through perception
- do not all perceive in same way, attend to information differently
94
what might someone be more anxious about health
acute stress exposure may start cycle
excessive concern over health and symptoms may be learnt in childhood
people may receive sympathy, and reinforcement of behaviour from health professionals
95
freud explaining FND
medically unexplained physical symptoms can be caused by unconscious conflict
96
CBT for SSD - thoughts
change beliefs
pay less attention to bodily sensations
teach coping mechanisms
97
CBT for SSD - feelings
reduce stress and anxiety which may trigger concerns
treat depression
teach recognition between links of body and brain
98
CBT for SSD - behaviours
stop taking tests
stop googling
find strategies to get reinforcement elsewhere
family to stop reinforcing behaviour
