Week 5 - Trauma and OCD Flashcards
(23 cards)
Post-traumatic stress disorder
DSM
- Exposure to actual/threatened death/injury/violence (necessary)
- Intrusion symptoms
- Persistent avoidance
- Negative alterations in cog. and mood
- Alterations in arousal and activity associated with trauma
- 1+ month, cause distress/impairment
Acute stress disorder
DSM
- Exposure to actual/threatened death/injury/violence
- Presence of 9 or more sxs from intrusion, mood, dissociation, avoidance, arousal
- Minimum 3 days, maximum 4 weeks
PTSD and Acute stress disorder differences
Length - PTSD is more than 1 month, acute stress is less
Symptoms - ASD must meet 9+, PTSD only 6 (1 intrusion, 1 avoidance, 2 physiological, 2 cognition/mood)
PTSD/ASD prevalence and risk factors
Prevalence
- 7% (life), 4% (year) - many people exposed to trauma, but PTSD is rare
Risk factors
- Vocations with traumatic exposure
- Highest after rape, military, imprisonment, genocide
- Closer to trauma, more frequent trauma
Ehlers & Clark cognitive model
Trauma alters beliefs about world, self, others
Memory - poorly elaborated and integrated (here and now quality)
Perceived threat > avoidant coping
Evidence - PTSD trauma narratives have more sensory detail and negative emotion, disorganised trauma narratives associated with symptom severity
Research shows people with autobiographical memory qualities associated with PTSD, not trauma itself
PTSD and ASD treatment
Immediate - psychological first aid (compassion, safety, calm, support)
Later - trauma-focused therapy (prolonged exposure, cognitive processing therapy, CBT), SSRIs
- Teach emotion regulation first, then psychoeducation, exposure, cognitive restructuring
EMDR
Recounting trauma + visual stimulus
Not more effective than exposure, could lead to dangerous therapies (overestimating visual stimulus importance)
Adjustment disorder
DSM
- Emotion/behaviour symptoms in response to stressor within 3 months
- Clinically significant, not normal bereavement
- Not another disorder
- Once stressor is terminated, sxs gone within 6 months
Prevalence
- 5-20% outpatients, 50% hospital
- May be misdiagnosis (possibly MDD instead)
Reactive attachment disorder
DSM
- Inhibited behaviour toward caregivers (rarely seeks comfort when stressed)
- Persistent social/emotional disturbance
- Child has had extreme insufficient care (likely cause)
- Not autism, must be 9 months and occur before 5 years
Disinhibited social engagement disorder
DSM
- Child actively approaches unfamiliar adults
- Not limited to ADHD impulsivity
- Child has had extreme insufficient care (likely cause)
- Must be 9 months
RAD/DSED prevalence
Unknown but seems rare (less than 1%, 10% in neglected children)
Prolonged grief disorder
DSM
- Death more than 12 months ago (6 months in children)
- Persistent grief, 3+ of: identity disruption, disbelief, avoidance, pain, poor reintegration, numbness, loneliness, meaninglessness
- More days than not for 1 month
- Clinically sig. distress, not another disorder
Demographics and prevalence unknown (new disorder in DSM)
Obsessive compulsive disorder
DSM
- Presence of obsessions, compulsions, or both (almost always both, compulsions can be mental)
- O/Cs are time consuming (at least an hour/day)
- Not due to substance or other disorder
- Specifiers: insight (good, poor, delusional), tic-related
Tic-related (Tourettic OCD)
- Sudden repetitive movements/sounds (w/sensory urges)
- Compulsions linked to sensory discomfort (not anxiety) and work to reduce discomfort
OCD obsessions and rituals
Obsessions - contamination, responsibility for harm, sex, morality, violence, religion, symmetry, order
Rituals (compulsions) - decontamination, checking, repetition, arranging, mental
Obsessions and compulsions link - compulsions performed to get rid of anxiety/prevent disaster (avoidance is maintenance mechanism)
OCD prevalence and treatment
Prevalence
- 2% (life), 1% (year)
- 1F:1M
Generally gradual onset (can be sudden)
- Begins in childhood/mid 20s (chronic but wax/wane)
Possible cause - pregnancy/birth, PANDAS-strep infection
Vulnerability - 50% biological, psychological (early life learning - uncertainty intolerance, responsibility, thoughts as bad as actions)
Abramowitz model of OCD
Normal intrusive thought > misinterpret as something threatening > obsessional anxiety > effort to remove obsession > anxiety reduction > maladaptive core belief (that maintains threat interpretation)
Cycle must be prevented - challenge core beliefs, show obsessions don’t influence > show thought is unimportant
OCD treatment
Treatment
- Selective SSRIs - large effect, relapse after drugs are stopped though (24-89%)
- CBT and exposure - only empirical treatment, double effect size of medication, 12% relapse
- Adding meds to CBT has no improvement (vice versa does though)
Body dysmorphic disorder
DSM
- Preoccupation with perceived appearance flaws
- Repetitive behaviours in response
- Clinically sig. distress
- Isn’t due to ED
- Specify - muscle dysmorphia
Prevalence
- 2% (life) - higher for dermatology, cosmetic surgery, adult orthodontia,
- Starts in teens (chronic)
Treatment
- Same as OCD
Hoarding disorder
DSM
- Difficulty discarding or parting with possessions (emotional attachment)
- Perceived need to save items (creative belief, non-intrusive thoughts but part of patient)
- Accumulation of possessions that compromises living space
- Clinically sig. distress, not caused by something
Risk factors
- People that perceive themselves as having attention/memory problems
- Indecisive people (struggle to categorise/organise)
- Perfectionistic, leading to procrastination
Hoarding disorder prevalence and treatment
Prevalence
- 2.5% (1M:1F, but more women seek treatment)
- Onset - 17 YO (worsens every decade of life)
Treatment
- CBT - motivation to change, skills training
Trichotillomania
DSM
- Recurrent hair pulling (leading to hair loss)
- Repeated attempts to stop
- Clinically sig. distress, not due to something else
Prevalence
- 1-2% (10F:1M)
- Onset - puberty (chronic but waxes and wanes)
Treatment
- Habit reversal training - awareness, mimicking, competing responses
Excoriation disorder
DSM
- Recurrent skin picking
- Repeated attempts to stop
- Clinically sig. distress, not due to something else
Prevalence
- 1% (4F:1M)
- Onset - puberty (chronic, but waxes and wanes)
Treatment
- Habit reversal training
Evidence for OCRD chapter
OCD and PTSD overlaps with many other anxiety disorders (fear stimuli, underlying beliefs)
Should it have separate chapter?
- Rationale 1 - OCRD have repetitive behaviours/thoughts (function is overlooked, skin picking/hoarding have no repetitive thoughts and have pleasure components)
- Rationale 2 - OCRDs have similar treatments (SSRIs inconsistent + also used for anxiety and MDD, exposure used for some but others)
- Rationale 3 - more emotions in PTSD than just fear, anxiety (disgust, shame and anger also relevant to other disorders
Overall, mixed evidence these disorders should have separate section
