Obsessions Pt. 2

Question 1

What are the features of OCD?

Answer 1

• Tends to develop earlier in boys.
• By adulthood, OCD is more
  prevalent in women.
• High co-morbidity with other
  anxiety disorders and depression.
• Tends to follow a chronic course.
• Internally generated thought or
  idea as opposed to external
  factor.

Question 2

What is thought-action fusion?

Answer 2

The thought is as bad as the action,
or the thought can cause an adverse consequence

Question 3

What are the three major causes of OCD?

Answer 3

1. Genetics
2. Learning
3. Unconscious

Question 4

How do we observe the genetics of OCD?

(Relatives and twin studies)

Answer 4

• OCD is more common among
  first-degree relatives of
  individuals with OCD, suggesting
  a heritable component.
• From twin studies, the heritability
  estimates for OCD range from
  45% to 65%

Question 5

What does the learning perspective say about OCD?

Answer 5

These people learn that some thoughts are dangerous

“I hope _____ dies”

Mother: “Don’t ever say that or you’ll be responsible for their death!”

OR

Intake misinformation: Threat value associated with germs is disproportionate

Question 6

Learning perspective cause of OCD:

What is consequence of thought supression?

Answer 6

Avoidance increases the fear of the thing

“Don’t think about the white bear”

Question 7

Psychoanalytic Perspective on OCD?

Anal Stage Fixation

Answer 7

During this stage, children experience conflicts related to control and cleanliness, leading to rigid behavior and anxiety if not resolved

Question 8

Psychoanalytic Perspective on OCD?

Defense Mechanisms

Answer 8

Reaction formation (transforming an unacceptable impulse into its opposite) to cope with anxiety stemming from unconscious conflicts

Question 9

Psychoanalytic Perspective on OCD?

Symbolic Meaning

Answer 9

Symptoms like compulsions and obsessions might carry symbolic meaning, reflecting deeper issues that are not consciously acknowledged

Question 10

Explain how OCD emerges based on the model shown during class?

Answer 10

Type of vulnerability

&

Stressor

Causes OCD

Question 11

Treatment of OCD

Meds

Answer 11

SSRIs appear to yield benefit in approximately 60% of cases but gains are not maintained when medication is
discontinued

Question 12

Treatment of OCD

Exposure and Ritual Prevention

Answer 12

Rituals are actively prevented, and the patient is systematically and gradually exposed to the feared thoughts or situation

Question 13

Treatment of OCD

CBT

Answer 13

Focus on the overestimation of threat, the importance and control of intrusive thoughts, the sense of inflated responsibility and the need for perfectionism and certainty

Question 14

Explain Karen with OCD?

(Freebie)

Answer 14

Thought abt relative dying (and she thinks this thought contributes to death)

• Believes if she washes her hands -> She can stop their death

Family convinced her to get help

ERP was not successful – she
would not agree to refrain from
performing the rituals.

CBT was not successful – she truly
believed she had the power to
prevent deaths

Question 15

How is “Magical Thinking” difficult in OCD treatment?

Answer 15

These people genuinely believe they are magic (so can’t convince them with logic)

• These beliefs are difficult to change (they often refuse to stop the behaviour)

Question 16

What is Body Dysmorphic Disorder

Answer 16

An obsessive focus on perceived flaws or
defects in one’s physical appearance, which may be minor or even nonexistent.

Ex. Men may worry about their receding hairline

Question 17

Diagnostic Criteria for Body Dysmorphic Disorder?

(three things)

Answer 17

1. Perceived or real flaws u are obsessed with
2. repetitive behaviors (e.g., mirror
   checking, skin picking, reassurance seeking,
   grooming) or mental acts (e.g., comparing appearance with others)
3. Causes distress / impairment
   - Ex. grooming takes a lot of time

Question 18

Features of Body Dysmorphic Disorder?

Age

College

Answer 18

Age of onset ranges from early adolescence through the 20s, peaking at the age of 16 to 17. Tends to run a lifelong course.

As 70 percent of college students report at least some dissatisfaction with their bodies,
with 4 to 28 percent of these appearing to meet all the criteria for the disorder

Question 19

Sex Differences in BDD

What do men vs women focus on?

Answer 19

• Men tend to focus on body build, genitals,
  and thinning hair, and tend to have more
  severe BDD.
• Women focus on more varied body areas and are more likely to also have an eating disorder

Question 20

How is Body Dysmorphic Disorder treated?

Answer 20

Usually plastic surgery

Limited evidence SSRIs might alleviate distress of BDD.
* ERP might also be effective for milder cases

Question 21

Hoarding Disorder
* The three major characteristics of this

Answer 21

1. excessive acquisition of things,
2. difficulty discarding anything,
3. and living with excessive clutter under
   conditions best characterized as gross
   disorganization

Question 22

Features of Hoarding Disorder?

Answer 22

Estimates of prevalence range between 2 and 5 percent of the population.

• No notable sex differences.
• Tends to begin in adolescence and
  worsens with age.
• Might collect or shop as a form of
  mood management.
  *** Experience distress at the thought
  of throwing anyway away

Question 23

Treatment of Hoarding Disorder

CBT

Answer 23

Study by Tolin et al (2015) suggested that
CBT might be a promising treatment for
hoarding disorder.

• Aims to teach people to assign different
  values to objects and to reduce anxiety
  about throwing away items that are
  somewhat less valued.
• Preliminary results are promising, but
  results are more modest than those
  achieved with OCD

Question 24

What is trichotillomania?

Answer 24

The urge to pull out one’s own hair from anywhere on the body, including the scalp, eyebrows, and arms, is referred to as trichotillomania.

Question 25

What is Excoriation?

Answer 25

Excoriation (skin-picking disorder) is characterized by repetitive and compulsive picking of the skin, leading to tissue damage.

Question 26

How did Trichotillomania and Excoriation get their own disorder (and not apart of OCD)?

Answer 26

Previously classified under impulse-control disorders. * Reclassified in DSM-5 when it became clear that these disorders often co-occur with OCD and BDD. * Previously assumed that the repetitive behaviours of hair pulling and skin picking functioned to relieve stress or tension. * Not all individuals with these conditions report tension relief. * Tension relief was removed from diagnostic criteria in the DSM- 5

Question 27

Diagnosis - Trichotillomania Three criterion

Answer 27

* Criterion A: The individual must engage in recurrent pulling out of their hair, which leads to noticeable hair loss. * Criterion B: The individual has made repeated attempts to decrease or stop the hair-pulling behavior. * Criterion C: The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 28

Diagnosis – Excoriation Disorder Four Criterion

Answer 28

* Cause visible skin lesions by picking (although some patients try to camouflage lesions with clothing or makeup). * Make repeated attempts to decrease or stop the picking. * Experience significant distress or impairment in functioning from the activity. * The distress can include feelings of embarrassment or shame (eg, due to loss of control of one's behavior or the cosmetic consequences of the skin lesions).

Question 29

How to treat Trichotillomania and Excoriation disorder?

Answer 29

* Habit Reversal Training * has the most evidence for success with these two disorders. * Patients are taught to be more aware of their repetitive behaviour, particularly as it is just about to begin. * Patients are then taught to substitute a different behaviour, such as chewing gum, applying a soothing lotion to the skin, or some other reasonably pleasurable but harmless behaviour. * According to Noch et al (2011), benefits may be evident in as little as four sessions