OCD

Question 1

OCD Criteria

Answer 1

A. Either Obsessions OR compulsions
B. Symptoms are time-consuming (more than an hour a day) or cause distress or functional impairment
C. Symptoms not due to a substance or medical condition
D. Not due to another mental disorder (such as GAD, ED trichotillomania, BDD, etc)

Specifier: insight or tic-related (current or past)

Question 2

What are obsessions

Answer 2

Intrusive and persistent thoughts, images or urges that cause marked anxiety or distress. They are ignored or suppressed or neutralized by a compulsion.

Question 3

What are compulsions

Answer 3

Compulsive and repetitive behaviours or mental acts that aim to reduce or prevent the anxiety/distress caused by an obsession. They are applied according to rigid rules.

They are not logically connected and are excessive

Question 4

Epidemiology facts

Answer 4

• Females slightly higher
• More males affected in childhood
• Onset usually teen to early adult
• Onset over 35 is rare
• Common to be comorbid with other anxiety and mood disorders
• 30% have tic related disorder
• 85% have both obsessions and compulsions
• 15% no behaviour rituals but instead mental rituals

Question 5

Types of Obsessions

Answer 5

• more than one theme common

H- harm to self and others (contamination)
B - blasphemy (thoughts about religious figures)
S - inappropriate sexual themes

Thoughts are ego-dystonic and distressing

Question 6

Types of compulsions

Answer 6

• checking (responsibility for harm)
• washing (contamination)
• repeating numbers, words, actions (magical thinking)
• Ordering (perfection)
• Slowness (meticulous planning)

Question 7

Neurological/bio theories of etiology

Answer 7

1. Deficits in inhibition in dismissing extraneous stimuli especially negative material and material related to their fears).

Physiological:
Dysfunction in the orbito-frontal cortex, anterior cingulate cortex, and striatum

Question 8

CBT Psychological model of etiology (Beck)

Answer 8

Becks 1976 theory

1. Symptoms due to meaning-making not the situations themselves. For example, everyone has strange intrusive thoughts, but most know they are irrational. People with OCD misinterpret intrusive thoughts as harmful or significant and experience anxiety and attempts to suppress it.
2. Symptoms (obsessions and compulsions) are caused by dysfunctional beliefs
3. Strength of belief leading to the degree of persons insight

Question 9

Risk

Answer 9

Temperament: behavioral inhibition, neuroticism, greater internalizing symptoms

Environment: physical/sexual abuse in childhood, stressful or traumatic events related to increased risk; infectious agents, and post-infectious autoimmune (strep)

Genetic

• 1st degree relative with disorder doubles risk
• If family member had onset in childhood or teen years rate 10x risk

Question 10

Course of OCD

Answer 10

• Usually onset before 25 years-
• Average onset age males 21 years
• Average onset age females 22-24 years
• Lifetime prevalence approx 1-3%
• Chronic condition
• Symptoms fluctuate with stress
• Slightly more females > men, but males more commonly affected in childhood

Question 11

Thought-action fusion

Answer 11

Believing that a ‘thought’ is the same as an ‘action’. Feeling remorse after the thought.

Question 12

Dysfunctional Beliefs PICOT

Answer 12

PICOT

Perfectionism/intolerance of uncertainty
Inflated sense of responsibility for harm
Control thoughts (should )
Over-estimates of danger and severity
Thought action fusion

Question 13

Maintaining Factors

Answer 13

• Avoidance - prevent fears occurring (eg contamination by avoiding restrooms does not learn unlikely
• Negative reinforcement
• Accommodation by family members - stops them learning that feared event unlikely to occur and can handle it.
• Mowrers 1960 2 stage theory - classical and operant conditioning. Operant explains the maintenance of symptoms by relieving distress and anxiety.
• Relationship stress