Week 5: Obsessive-Compulsive and related disorders Flashcards
(61 cards)
1
Q
Outline the criteria for OCD
A
- Presence of obsessions, compulsions or both (must meet this!)
- Obsessions and compulsions are time consuming
- Disturbance not due to substance abuse
- Disturbance not better explained by another mental health disorder
2
Q
What are obsessions?
A
Intrusive, nonsensical, lasting thoughts which cause distress
3
Q
What are compulsions?
A
Things done to try and ensure obsessions don’t come true
4
Q
Do you need obsessions AND compulsions to be diagnosed with OCD
A
No, but they often cooccur
5
Q
Are compulsions always physical behaviours
A
No, compulsions can be mental
6
Q
What counts as “time consuming” obsessions/ compulsions
A
- at least one hour a day
- If not, then need to identify clinically significant distress and impairment
7
Q
What are the specifiers for OCD?
A
Insight: do they recognise that their obsessions are nonsensical? (good/ fair, poor, absent/delusional)
Tic related (i.e. tourettic ocd)
8
Q
What may help us differentiate between OCD with delusional insight specifier and a psychotic disorder?
A
Compulsions
9
Q
What are tics?
A
Sudden, repetitive movements or sounds, often preceded by sensory urges.
Sudden, involuntary, frequent
10
Q
What are compulsions linked to in tourettic OCD as opposed to standard OCD?
A
Linked to sensory or psychological discomfort rather than anxiety.
11
Q
Compulsions in tourettic OCD reduce…
A
Discomfort, rather than preventing catastrophe
12
Q
What are the different themes of common obsessions?
A
- Contamination
- Responsibility for harm (e.g. what if I hit a pedestrian with my car by mistake?)
- Sex and morality
- Violence
- Religion
- Symmetry and order (e.g. odd numbers are bad, need to arrange books “just right”) –> **need for this to a greater degree than they would like. **
13
Q
What are common compulsive rituals?
A
- Often tied to obsessions, but sometimes don’t make sense
- Decontamination
- Checking
- Repeating routine activities
- Ordering/ arranging
- Mental rituals
14
Q
What are some examples of mental rituals?
A
- Replacing bad with good thoughts
- rehearsing
- Counting
- Trying to get rid of an obsession
15
Q
Are there links between obsessions and compulsions?
A
Yes. Often there is a focus of obsession where an individual fears something, and performs the compulsion to be rid of anxiety/ prevent disaster
16
Q
What are some compulsions loaded with incompleteness obsessions?
A
Ordering, arranging, counting
17
Q
What are some compulsions associated with religion, sex and violence obsessions?
A
Mental rituals, checking, reassurance seeking
18
Q
What is the prevalence of OCD (per year and per lifetime)
A
- Lifetime: 2%, Year: 1%
19
Q
What is the gender ratio of OCD?
A
Female: Male = 1:1
20
Q
What is the onset of OCD like?
A
- Often gradual, but can be sudden.
- Begins in childhood to mid twenties generally
21
Q
What are some situations where OCD onset can be sudden?
A
- Pregnancy and childbirth (even more than MDD). Could be due to the responsibility and being afraid of not taking care of the child enough, etc. –> core beliefs can trigger onset of OCD
- PANDAS-streptococcal infection: inflames basal ganglia –> can trigger onset
22
Q
Is OCD acute or chronic?
A
Chronic. However, symptoms can wax and wane.
23
Q
How much does biology (i.e. genes) contribute to OCD?
A
50%
24
Q
What are psychological vulnerabilities to develop OCD?
A
- Early life experiences/ learning
- Maladaptive beliefs (e.g. intolerance to uncertainty, perfectionism, thhhink thoughts can’t be controlled, inflated responsibility, etc.)
- Avoidance (e.g. ritual like behaviour or avoidance –> “give in” to thoughts)
25
How do we disrupt the model of OCD by Abramowitz et al. (2009)
* Prevent the compulsions
* Challenge core beliefs (e.g. realise thoughts dont equal reality)
26
What is the treatment for OCD?
* SSRIs
* CBT
* Exposure therapy
27
Do SSRIs have long term benefit on OCD?
No. There is a large effect size, but relapse starts soon after meds are discontinued (24-89% relapse)
28
What is CBT- ERP
CBT emphasising exposure and response prevention. It has multiple lengthy sessions with gradual confrontation in it.
29
What is the only empirically supported psychological treatment for OCD?
CBT
30
Is the effect size for CBT or Meds greater for OCD?
CBT has double the effect size
31
Should you add CBT to meds (i.e. start meds than CBT) or the other way around?
You should start with meds --> then start CBT
32
What is BDD criteria
* Preoccupation with perceived flaws in appearance, unnoticeable or slight to others
* Repetitive behaviours or mental acts performed in response to appearance concerns
* Preoccupation = clin sig distress
* Appearance preoccupation is NOT DUE TO BODY FAT OR WEIGHT CONCERNS IN SOMEONE MEETING EATING DISORDER CRITERIA
* Specify with muscle dysmorphia if appropriate
33
If Jenny was starving herself because she was constantly obsessing over her weight, would we diagnose her with an ED or OCD?
ED.
34
Prevalence of BDD?
2% life
35
Which groups of people have higher prevalence of BDD
* Dermatology, cosmetic surgery, adult orthodontia, and oral/maxillofacial surgery patients
36
When does BDD start?
Often in teenage years, and is chronic.
37
What is the treatment like for BDD?
Similar to OCD treatment.
38
What is the criteria for hoarding disorder?
Im paraphrasing here but
* Persist difficulty in discarding or parting w possessions regardless of actual value
* perceived need to save items, distress with discarding
* Accumulate possessions which compromise their living spaces substantially. ACTIVE LIVING AREAS.
* Clinically sig distress or impairment
* Not attributable to another mental condition/ disorder
39
Henry collects lots of things. He loves them. Every lolly wrapper, coin, antique piece of fine china he will keep in his attic. You can barely move around in there. Can we diagnose Henry with hoarding disorder?
No because it must be in active living spaces. Attics and garages currently don't count in the DSM
40
What often drives hoarding?
* Emotional attachment or sentimental attachment with objects
* Objects bring comfort and emotional security
* Social desireability (ready for ppl to borrow)
41
Risk factors of HD
* Inattention problems and memory deficits
* Indecision: difficutlies in categorising and organising
* Perfectionism: can lead to procrastination (e.g. i cant organise perfectly so i wont do it at all
* Negative emotions and low self efficacy in coping with them
42
What does the research say about inattention and memory deficits being a risk factor of HD?
* Mixed results
* Hoarding is a **perceived issue**. Most people will be OK on neuropsycholigcal exams of attention and memory but PERCEIVE it as worse than others
43
What is the prevalence of HD?
* About 2.5%
44
What is the gender ratio of HD?
Equal men to women. However, women seek treatment more
45
What is the trajectory of HD?
* Average age of onset at 17, but worsens with each decade of life (time to accumulate possessions)
46
What is the treatment for HD?
* CBT
47
What does CBT for HD focus on?
* Motivation for change
* Loosen beliefs that they need objects to do things that they want
* Skills training (e.g. discard bit each day, space out time, build up tolerance for emotional distress, ignoring unhelpful thoughts, exposure/ discarding sessions)
48
Outline the criteria for trichotillomania
* Recurrent hair pulling, resulting in hair loss
* Repeated attempts to stop
* Clin sig distress/ impairment
* Not attributable by another medical condition
* Not better explained by another dx
49
What does the urge to pull hair often get precipitated by?
sense of tension --> pleasure from doing it --> relief from pulling (short term)
50
Prevalence of trichotillomania
* 1-2%
51
What is the gender ratio of trichotillomania
FEMALE: male : 10:1
52
What is the trajectory of trichotillomania
Chronic, but waxes and wanes
Sites of hair pulling can vary over time
53
What is the main treatment for trichotillomania?
* Habit reversal training (Awareness training for sensations, focused on their actions, mimicking the motions without actually doing it, practicing stopping the behaviour using a competing response (e.g. hold something or sit on your hands)
54
What is excoriation disorder?
Skin picking disorder
55
What are the criteria for excoriation disorder?
* Recurrent skin picking resulting in lesions
* Repeated attempts to decrease or stop
* Clin sig distress or impair
* Not attributable to substance or med
* Not better acc for by other disorder
56
What is the prevalence of excoriation disorders and its trajectory
* Low prevalence (1%)
* Female: Male (4:1)
* Age of onset w puberty
* Chronic, waxes and wanes (skin pick sites may vary over time)
57
Treatment for excoriation disorder?
Habit reversal training
58
What are the shared features of OCRD and anxiety disorders
* Fear evoking stimuli
* Underlying belieffs
* Safety behaviours maintain the disorders
59
Why does melissa say that rationale 1 of having OCD and OCRD together (i.e. including repetitive thoughts and bhvrs and a failure of bhvr inhibition) is flawed?
* HD has no real compulsions
* Function of these behaviours may be markedly different (eg. pleasure from skin picking and HD vs OCD ritual never being pleasusable)
* No repetitive thoughts assoc with skin pick, trichotillomania and hoarding
60
Why does melissa say rationale 2 (OCD AND OCRD HAVE SIMILAR TX RESPONSE PROFILES) are flawed?
* SSRI function on HD, trich or skin pick as well as OCD and BDD= inconsistent
* SSRIs work for other dxs not part of OCRD chapter
* ERP works for OCD and BDD, but not for trich and skin
* ERP does not work for HD
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