OCD Flashcards
OCD
● OCD is characterized by the presence of obsessions and compulsions
● Obsessions and compulsions are time consuming and can take up to 1-5 hours a day or be pervasive – throughout the entire day
obsessions
● Obsessions: recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted
● Not pleasurable
● Not perceived as voluntary
● Often the individual attempts to ignore or suppress it
● Children become fixed on a thought & it negatively impacts their ability to progress through a task or transition to another one
● Center around disease, danger, contamination, doubts, numbers, sexual thoughts
compulsions
● Compulsions or rituals: repetitive behaviors or mental acts that an individual feels driven to performance in response to an obsession or according to rules that must be applied rigidly
● Compulsions are typically performed as a response to an obsession to reduce the distress triggered by the obsessions
common themes
● Individuals often have symptoms in more than one dimension
● Cleaning / Contamination
● Symmetry / ordering or counting
● Forbidden or taboo thoughts / related compulsions
DSM-5
● Presence of obsessions, compulsions, or both
● The obsessions and compulsions are time-consuming (take more than 1 hour a day), or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
● The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
● OCD is no longer considered an anxiety disorder.
● It is grouped with other disorders including
○ Body dysmorphic disorder
○ Hoarding disorder
○ Trichtillomania (hair pulling)
○ Exoriation (skin picking)
Prevalence
US = 1.2%
International = 1.1-1.8%
0.3%–3% of the pediatric population
Females affected at a slightly higher rate than males in adulthood
Males higher rates in childhood
Similarity across cultures in gender, age at onset, co-morbidity, & content of obsession/compulsion, but differences regionally in symptom expression
Development & Course
Mean age of onset 19.5 years of age; 25% of cases start by age 14
Onset can be gradual; few cases of acute onset
Untreated; chronic with waxing and waning symptoms
Childhood onset can lead to life time OCD; although 40% may go into remission in early adulthood
Course can be complicated by other disorders
Manifestation of OCD in Children
Frequent presence of comorbid conditions, traumatic event, or significant change
Peak age of symptoms – 5-8 years of age or 10-15 years of age
Males earlier onset than females
Average/above average intelligence levels
Etiology: OCD
The etiologies of these disorders are unknown.
Genetic Factors
20% of children with OCD had a family member with the disorder, tics, Tourette’s
Type of obsessions & rituals are not inherited
Physiological:
Dysfunction in the orbito-frontal cortex, anterior cingulate cortex, and striatum
Risk & Prognostic Factors
Risk factors
Temperament: behavior inhibition, negative emotionality, greater internalizing symptoms
Environment: physical/sexual abuse, stressful or traumatic events related to increased risk; infectious agents, and post-infectious autoimmune syndrome
Comorbidy
Comorbid Conditions: Tourettes Schizophrenia Major depression Anxiety Depressive disorder OCPD Other problems: peer isolation, absenteeism, substance use, suicide
Assessment
Thorough assessment lays foundation for treatment
Goal of Biopsychosocial Assessment
Complete & sensitive understanding of OCD symptoms
Consider child’s attributes (physical health, family, social, & school functioning)
Collaboration with physician, therapist, parent, child, school, & other relevant players
Assess child’s motivation
Initial evaluation & Diagnosis
Assess baseline severity & impairment
Identify potentially difficult areas of treatment
Target current & past fears
Target rituals & triggers
Events surrounding the onset of symptoms
Frequency & context of symptoms
Degree of distress, impairment, comorbid conditions, medical/developmental histories, family history, social relationships
Assessment: Methods
Methods:
Clinical interviews:
self-report, parent ratings, & clinician ratings:
Broadband: E.g., CBCL
Specific: E.g., MASC
Functional impairment: COIS
Clinician ratings: NIMH Clinical Global Improvement Scale
OCD symptom analysis
Examination of symptoms (obsessions, compulsions, triggers)
Nature & severity of symptoms
Children’s Yale Brown Obsessive-Compulsive Scale (CY: BOS)
Behavioral observations:
Treatment: Exposure and Response
Exposure
Purposeful confrontation of objects or situations that trigger obsessive fears
With children exposure should be graded
Progressing in small sequential steps from the least feared to the most feared
Create a graded exposure fear hierarchy
Symptom monitoring- tracking diary for parents
Fear Temperature- analogous to SUDS
60% to 100% response rates
Mean symptom reduction rate 50 to 67%
Maintenance of 18 months
Treatment: Cognitive Strategies
Prepare child’s belief system in anticipation of anxiety Perspective taking Reframing Externalizing / distancing from OCD Coping statements: take back control
