What is OCD characterized by?
- recurrent obsessions/compulsions
- causing significant distress/impairment
Terminology
- obsessions
- compulsions
- recurrent and unwanted intrusive thoughts (ilness, contamination, security etc)
- repetitive behaviors or mental acts performed to reduce anxiety caused by obsessions. Rigid rules in application of compulsion
Outline the biological aetiology of OCD
Biological:
- 48% heritability
- molecular mechanism (dopaminergic/glutaminergic genes)
- neurobio abnormalities
- neurotransmitter networks (SRIs)
Outline the Psychological aetiology of OCD
- CBT model: -
- maladaptive beliefs ->compulsions to cope with anx - Functional relation btwn obsession and compulsion:
- C reduces stress, avoidance which reinforces fear via negative reinforcement (instant relief)
- C limits opportunity to become accustomed to feared objects and events - Overestimation of threat
- Intolerance of uncertainty
Outline the environmental aetiology of OCD
- stressful and traumatic life events (trigger symptoms
- infections
Outline the social aetiology of OCD
- early childhood exposure to fear/anx
- family/parental dynamics (excessive control, rigidity, restriction of autonomy)
What are the broad diagnostic criteria?
- Obs and Comps that cause distress and discomfort
- time consuming or impairment in other area of functions
- not attributable to physiological causes
- disturbance not better explained by another MD
Outline the Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5)
- designed to diagnose anxiety disorder (ocd included)
- useful in differentiating OCD from other anxiety disorders
- structured interviews with modules for various anxiety disorders
What is the rough course of treatment for OCD
- build therapeutic relationship
- psychoeducation
- psychological or pharmacological approaches
Outline the psychoeducation, psychotherapy and pharmacotherapy treatment for OCD
- Psychoeducation
- explain/normalize
- coping strategies
- treatments
- stigma and family maintenance
- involved family - Psychotherapy
- CBT with Exposed and response prevention (ERP) - Pharmacotherapy
- SSRIs
50% of OCD sufferers….
fail to respond to first line pharmacotherapy treatment.
- need a combination of psychological and pharmacological approaches
What are some of the controversial factors in OCD?
- Overlap of symptoms
- GAD, BDD, Dep Ds., Anx Ds with ritualistic behaviour - Alternative treatments
- psilocybin, cannabis, nicotine, morphine - Environmental vs biological role
- overemphasis of genetic
- quantifying environmental factors - Stigma and Misunderstanding
- confusion with perfectionism
- misunderstanding of comps and obs
What are some of the cognitive distortions associated with OCD?
- catastrophic thinking
- overestimating risks and probabilities
- black and white thinking
- excessive importance placed on thoughts
What are some self-help strategies for OCD?
- mindfulness and relaxation techniques
- challenging and reframing thoughts
- setting achievable goals, gradual exposure
- creating structured daily routine
