Obsessive-Compulsive and Hoarding Disorders

Question 1

Compulsivity and Impulsivity differences and similarities

Answer 1

Similarities
-inability to delay repetitive behaviors

Differences

• driving mechanism in compulsivity is reduction of discomfort (negative reinforcement)
• driving mechanism in impulsivity is obtaining arousal or satisfaction (positive reinforcement)

Question 2

Obsessions or Compulsions causes

Answer 2

• distress
• time consumption> 1h/day
• interference with daily activities/relationships

Question 3

OCD

Answer 3

characterized by compulsivity- obsessive preoccupation and repetitive behaviors

Obsession–>Anxiety–>Compulsion

• repetitive
• undesired/unwilled
• compelled

Question 4

OCD Obsession

Answer 4

intrusive, unwelcome distressing thoughts and mental images

Question 5

OCD Compulsions

Answer 5

the behavior the people with OCD perform in a vain attempt to relieve the fears and anxieties caused by their obsessions

Question 6

OCD Types of obsessions

Answer 6

• contamination
• fear of harm
• symmetry/perfection
• somatic
• religious
• sexual
• hoarding
• unacceptable urges
• miscellaneous

Question 7

OCD Manifestation of obsessions

Answer 7

• checking
• cleaning/washing
• miscellaneous
• repeating
• mental rituals
• ordering
• hoarding/collecting
• counting

Question 8

OCD Course

Answer 8

• chronic, waxing and waning
• stress sensitivity
• considerable variability
• shifting symptoms and clusters

Question 9

OCD comorbidities

Answer 9

• panic, phobias

- major depression

Question 10

OCD DSM Diagnostic

Answer 10

A. Obsessions or Compulsions defined by:

1. recurrent and persistent thoughts
   - intrusive and inappropriate and that cause marked anxiety of distress
2. not simply excessive worries about real-life problems
3. person attempts to ignore
4. product of his or her own mind

C. marked distress, are time consuming ( more than 1 hour a day), or significantly interfere with person’s day-to-day functioning

Question 11

OCD Neurobiological Substrates- Cortico-striatal-thalamic-cortical loop dysfunction

Answer 11

• Cortical: Orbitofrontal and anterior cingulate cortices
• Striatal: Basal Ganglia (caudate nucleus, putamen)
• Thalamic: Thalamus

Question 12

OCD Neurobiological Substrates- Cortico-striatal over-activation

Answer 12

• These structures activated during symptom provocation

- Returns to normal with treatment

Question 13

OCD Treatment- Pharmacotherapy

Answer 13

Medications- selective serotonin reuptake inhibitors, glutamate receptor antagonist

Question 14

OCD Treatment- Psychotherapy

Answer 14

Cognitive Behavioral Therapy 
-Mindfulness
Four Steps: 
1. Relabel 
2. Reattribute 
3. Refocus  
4. Revalue

Exposure and Response Prevention (ERP)

• Exposure to fear
• Refrain from ritual

Question 15

OCD Treatment- Surgical interventions

Answer 15

• last resort

- Cut fibers btw ant. cingulate and caudate nucleus

Question 16

Hoarding

Answer 16

-excessive collection and failure to discard objects of apparently little value, leading to clutter distress and disability

1. Excessive collection
2. Storing, keeping and not discarding
3. Neglect of living space

Question 17

Hoarding-Neurobiological Substrates

Answer 17

• Fronto-limbic
• Anterior Ventromedial Cortex
• Cingulate cortex
• These structures activated during symptom provocation
  1. Ventromedial prefrontal cortex activated during simulated discarding
  2. Anterior cingulate activated during simulated “keeping”

Question 18

Hoarding- Characteristics

Answer 18

• difficulty discarding or letting go of possessions
• fear of losing important information, emotional attachments, or useful items
• Nature of the items
  
  • clothes
  • newspapers, mail, books
  • containers
  • art/craft supplies
• Severe clutter impedes use of living spaces
• appear to lack an awareness of the disorder - poor insight

Question 19

Hoarding- Under regulation: Inadequate strength

Answer 19

• Chronic: guilt and stress can weaken resolve
• Temporary: physiological/psychological
• Externally-mediated or prompted- saving of objects in hoarders often associated with pleasure (Positive reinforcement)
• exposure / availability

Question 20

Hoarding- Misregulation

Answer 20

• Distorted belief system with regard to possessions
• Distorted Self-Knowledge
• Poor insight: People who hoard appear to lack an awareness of the severity of the problem

Question 21

Hoarding- Spiraling Distress

Answer 21

• Lapse
• Temporary positive mood
• Consequences
• Saving allows the hoarder to avoid the decision required to throw something away and the worry that accompanies that decision (procrastination of action)
• Subjects react with panic to discarding of items

Question 22

Hoarding- Reinforcement patterns

Answer 22

• Compulsive behavior in OCD is negatively reinforced via avoidance conditioning (avoiding distress, feared consequences, etc.), but there is no positive reinforcement of OCD symptoms
• In hoarding, there is both avoidance conditioning (avoiding loss, etc.) and positive reinforcement

Question 23

Hoarding- Under regulation: Reduced monitoring behavior

Answer 23

Renegade attention

Managing attention towards trigger

       - Preoccupation: as if hypnotized
      - One is surrounded by possessions and clutter, “possession myopia”

Question 24

Hoarding- Under regulation: General

Answer 24

• Acquiescence

- Loss of control over attention–>transcendence failure