Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

OCD

may include:

Washing, checking, or other repetitive motor behavior Cognitive compulsions consisting of words, phrases, prayers, or sequences of numbers Obsessional slowness Doubts and questions that elevate anxiety

Facts and Figures

Prevalence

Originally believed to be rare

>0.1%

Recent evidence suggests 1-3% Onset / Characteristics: Males:, high prevalence of checking Females:, high prevalence of washing

OCD Diagnosis (1): DSM IV

Obsessions
Recurrent

defined by all of the following:

and persistent thoughts, impulses or images experience at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. The thoughts/impulses/images are not simply excessive worries about real life problems. The person attempts to ignore or suppress such thoughts/impulses/images, or neutralize them with some other thought or action. The person recognizes that the obsessional thoughts/impulses/images are a product of their own mind (not imposed from without).

OCD Diagnosis (2): DSM IV

Compulsions
Repetitive

defined by:

behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules which must be applied rigidly The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
Not

better accounted for by other diagnosis

What is an Obsession?
Involuntary intrusive cognition

Types
Doubts (74%) Thinking (34%) Fears (26%) Impulses (17%)

Images (7%)
Other (2%)

Examples of Obsessions
Doubt

Did I lock the door Thought that he had cancer Thought / Image that he had knocked someone down in his car Impulse + thought to shout obscenities in church Image of corpse rotting away Impulse to drink from inkpot and to strangle son

Themes in Obsessions
Obsessions

often have common themes

Contamination,

dirt, disease, illness (46%) Violence and aggression (29%) Moral and religious topics (11%) Symmetry and sequence (27%) Sex (10%) Other (22%)
The

themes often reflect contemporary concerns (the devil, germs, AIDS)

Examples of Compulsions
Scanning

text for life having read death Touching the ground after swallowing saliva Driving back to check he hadnt knocked someone down in his car Counting 6,5,8,3,7,4 in your head Hand washing

Linking Obsessions and Compulsions

OCD and Normal Experience

Obsessional

thoughts found in 90% of

people
It

is well replicated that 80%+ of normal people have intrusive thoughts There thoughts are similar in content and form to OCD patients
Compulsions
Many

people have compulsions such as stereotyped or superstitious behaviors 66% of normal people report some form of checking behavior
Is

OCD qualitatively distinct?

OCD Experiences

OCD
A man who washes his hands 100 times a day until they are red and raw A women who locks and relocks her door before going to work every day for half an hour

Not OCD
A woman who unfailingly washer her hands before every meal A woman who doublechecks that her apartment door and windows are locked each night before she goes to bed. A musician who practices a difficult passage over and over again until its perfect A woman who dedicates all her spare time and money to building her record collection

A college student who must tap on the door frame of every classroom 14 times before entering A man who stores 19 years of newspapers just in case with no system for filling or retrieving

Cognitive Aspects of OCD

Responsibility
Any

for harm to self/others

influence over outcome = responsibility for outcome Omission: I will omit to do something that leads to myself/others being hurt Magical thinking
Thought

Action Fusion
= action I will harm my child

Thought

Obsessions

= going crazy Control: Trying to hard

Suppression:

white bears Pre-Occupation: Looking for trouble

OCD: Therapy
Exposure
Am

and Response Prevention (ERP) Responsibility

I a murderer or just worried about being one? Normalizing / Other explanations
Thought
Can

= action

I think myself to death?

Neutralizing
Experiment

to show how thought suppression increases thought frequency

Exposure:

Cued Intrusions

Key Issues
What

are the strengths and limitations of behavioral models of OCD?

Think

about the empirical findings of current psychological models such as Salkovskis

Have

cognitive models of obsessions and compulsions helped us understand OCD and how it should be treated? How are intrusive thoughts in OCD different from normal intrusive thoughts?
Are

they different at all?

Posttraumatic Stress Disorder

Repeatedly

perceived memories of the

trauma. Repetitive behaviors that may be similar to obsessions or compulsions. Fears linked to the traumatic event. Altered attitudes toward people, life, or the future, reflecting feelings of vulnerability.

Stereotyped Movement Disorders

Involuntary,

repetitious, persistent, nonfunctional acts over which the individual can exert at least some voluntary control. Self-stimulation Self-injury Tics Tourettes syndrome

Selective Mutism
Children

who are reluctant to speak although they know how to converse normally. May be a response to: Trauma Abuse Social Anxiety Most effective interventions incorporate social learning principles.

Eating Disorders
Anorexia Bulimia Pica Rumination Highly

exclusive food preferences Obesity

Elimination Disorders
Enuresis Encopresis