OCD and Related Disorders Flashcards
(9 cards)
What are the diagnostic criteria of OCD?
A. Presence of obsessions, compulsions or both. B. Time consuming (eg: > 1 hour per day) or cause clinically significant distress or impairment in functioning. C. Not due to a substance or medical condition. D. Not better explained by symptoms of another mental disorder. Specify insight as good or fair, poor, or absent/delusional
The DSM defined obsessions by 2 things:
* Recurrent and persistent thoughts, urges or images that are intrusive and unwanted and cause anxiety or distress. * Individual attempts to ignore or suppress the thoughts, urges or image or neutralise them with some other thought or action (i.e., compulsion)
The DSM defined compulsions by 2 things:
* Repetitive behaviours an individual feels driven to perform in response to an obsession OR according to rules that must be applied rigidly. Can be overt (washing, ordering, checking) or covert (counting, praying) * Behaviours aimed at preventing or reducing anxiety or preventing some dreaded event.
Give examples of the types of obsessions in OCD
* Contamination * Aggressive * Need for exactness * Religious * Somatic * Sexual * Hoarding/saving
Give examples of the types of compulsions in OCD
* Checking * Cleaning/washing * Mental * Repeating * Ordering/arranging * Hoarding/collecting * Counting
What are the differential diagnoses of OCD?
Depression
• Rumination vs obsession
• Rumination = negative review of past events
• Rumination is not alleviated by engagement in
compulsions
Generalised Anxiety Disorder
• Worry = future orientated, changes quickly, varies
greatly
• Worry is not alleviated by engagement in
compulsions, more by safety behaviours – can look
compulsive
Body Dysmorphic Disorder
• In BDD obsessions are limited to appearance
• Clients with BDD do engage in compulsions to alleviate
distress associated with an obsession (eg. skin checking)
Illness anxiety disorder
• IAD: obsessions limited to health concerns rather than
contamination
• Clients with IAD do engage in compulsions to alleviate
distress associated with an obsession (eg. Doctor
shopping, Google, body checking)
Obsessive Compulsive Personality Disorder
• Preoccupation with perfectionism, rigidity, order
• Ego syntonic
• No intrusive thoughts
• Rules about how things must be done as that is the way it
‘should’ be
Many clinicians feel uncomfortable when differentiating
obsessions from:
• Homosexuality
• Paedophilia
• Sociopathy
- Remember, ego syntonic vs ego dystonic
- Satisfaction or distressing?
- Voluntarily fantasize or ‘pop in’?
- Other OCD symptoms?
- Presence of compulsions?
What are the six main belief domains in OCD according to the OCD working group?
- Inflated personal responsibility
- Over importance of thought
- Beliefs about the importance of controlling ones thoughts
- Overestimation of threat
- Intolerance of uncertainty
- Perfectionism
What is Rachman’s model of OCD?
Intrusive thoughts are universal human phenomena
• Obsessions develop when people misinterpret intrusive
thoughts as threatening
• Two cognitive biases increase the likelihood of
misinterpretations of intrusive experiences;
• TAF - thought action fusion - thinking makes an event more likely to occur
• TAF (moral bias) - thinking about something is the moral equivalent of doing it
What is Salkovskis model of OCD? How does this model explain the maintaining role of compulsions in OCD?
- Intrusions develop into obsessions only when the individual appraises the intrusions as posing a threat for which he or she is personally responsible
- Appraisal causes distress and motivate attempts to suppress
- Compulsions are then reinforced by:
- Immediate distress reduction and temporary removal of
the unwanted thought - Prevent learning that appraisals are unrealistic
- Compulsions increase obsessions because they serve as
reminders for the intrusions, thus triggering more
intrusions
- Immediate distress reduction and temporary removal of
