diagnostic features of OCD
- obsessions
- compulsions
examples of obsessions
- contamination
- responsibility for harm/mistakes
- symmetry/order
- unacceptable thoughts w immoral, sexual, or violent content
obsessions
recurrent, persistent thoughts/urges/images that are intrusive/unwanted, which person tries to ignore, suppress or neutralize
compulsions
- repetitive behaviours/mental acts that intended to prevent or reduce anxiety/distress or to prevent a dreaded event that person is driven to do
- to neutralize an obsession or prevent an event even though the behaviour/mental acts are not reasonably related to obsession or are excessive
examples of common compulsions
- decontamination
- checking
- repetitive routine activities
- ordering and arranging
- mental rituals
OCPD
- high on perfectionism
- personality traits ex excessive perfectionism, inflexibility, and need for control
- negatively impact relationship and functioning
OCD vs OCPD
- ODC: ego-dystonic (against ego), OCPD: ego-syntonic (w ego)
- OCD: not grounded in reality, OCPD: focus on everyday rules
- OCD=more distressing
OCD canada prevalence, onset and sex ratio
- prevalence: 1-2%
- onset: early 20s
- sex ratio: 1:1
t or f: women w OCD have higher prevalence w tic and substance abuse and higher sexual/religion obsesseions
- false, above is true for men
- for women, greater comorbidity w depression and higher contamination/cleaning
response to intrusive thought for ppl w out OCD
stimulus>intrusive thought>distraction
cognitive model of OCD
stimulus/trigger>hyper vigilance/scanning>intrusive thought>perceived threat (intolerance of uncertainty, thought action fusion, overestimation of threat)> neutralization/compulsion (neg reinforcement)>rebound effect (starts back at intrusive thought)
dysfunctional beliefs of OCD
- inflated responsibility: actions have stronger affect on world than they actually do/one has power to cause/duty to prevent neg outcomes
- overestimation of threat: neg events are likely and unmanageable
- exaggeration of importance of thoughts: thought action fusion, mere presence of thought indicates that it has occurred
- need to control thoughts: belief that complete control over thoughts is needed and possible
- perfectionism: belief that mistakes and imperfection
- uncertainty: belief that its needed and possible to be 100%v certain that neg outcomes will not occur/intolerence for anything below 100%
consequences of neutralization/compulsion
- paradoxical increase in thought frequency
- hyper vigilance to thought triggers
- terminates exposure to thought (prevent new learning)
- negative mood>increases salience and accessibility of thought
- spread activation
ERP
- exposure and response prevention
- exposure to obsessive stim and prevent compulsive response
- helps to habituate to the obsessed distressed
- learn that fear outcomes are less likely/less severe than anticipated
- eventual extinction of obsessed anxiety
erp exercises ex
- contamination/washing: touch a fear and withhold washing ex hold dog poop
hoarding
- distinct OCD subtype
- extreme fear of throwing things away (houses have been threatened to be condemned in many cases)
Medication treatment of OCD
- SSRIs and SRI (doesn’t always minimize symptoms)
- in ppl that have partial response, low dose anti psychotic medication (risperidone, aripiprazole)
In a study with OCD patients, what was the outcome of some getting risperidone and some erp
- both decreased the severity of OCD symptoms, with erp having a more significant drop
