Obsessive-Compulsive and Related Disorders<\/strong><\/p>\n

\n
• OCD defined by: repetitive thoughts and urges (obsessions) as well as an irresistible need to engage in repetitive behaviours or mental acts (compulsions)<\/li>\n
• Body dysmorphic and hoarding disorder share symptoms of repetitive thoughts and behaviours o BDD \u2013 preoccupation with imagined flaws in one\u2019s appearance & excessive repetitive behaviours or acts regarding appearance\n
  \n
  • HD \u2013 acquisition of an excessive number of objects & inability to part with those objects<\/li>\n<\/ul>\n<\/li>\n
  • These syndromes often co-occur<\/li>\n
  • 1\/3 of those with body dysmorphic disorder meet criteria for OCD<\/li>\n
  • \u00bc of people with hoarding disorder meet criteria for OCD<\/li>\n
  • 1\/3 of people with OCD experience symptoms of hoarding<\/li>\n<\/ul>\n

    Clinical Descriptions of the OC and Related Disorders<\/p>\n

    \n
    • All share repetitive thoughts and irresistible urge to engage repetitively in some behaviour\/mental act<\/li>\n
    • OCD<\/strong>:\n
      \n
      • = Based on the presence of obsessions or compulsions (most experience both) o Obsessions<\/strong> = intrusive and recurring thoughts, images or impulses that are persistent and uncontrollable and that often appear irrational to the person having them<\/li>\n
      • Interfere with normal daily activities<\/li>\n
      • Often involve fear of contamination from germs\/disease<\/li>\n
      • Compulsions<\/strong> = repetitive, clearly excessive behaviours or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring<\/li>\n
      • Feel compelled to repeat a ritual if feel as though did not execute it with precision o DO not regard pleasurable behaviours as compulsions (eating, drinking, gambling) o Tends to begin before age 10, fairly chronic o Pattern of symptoms appears to be similar across cultures o Prone to extreme doubts, procrastination, and indecision<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

        Body Dysmorphic Disorder<\/strong> (BDD):<\/p>\n

        \n
        • = Preoccupied with one or more imagined or exaggerated defects in their appearance<\/li>\n
        • Women focus on their: skin, hair, facial features, breasts, hips, legs o Men focus on their: height, penis size, body hair<\/li>\n
        • Find it very hard to stop thinking about these concerns (3-8 hours\/day)<\/li>\n
        • Compelled to engage in certain behaviours: checking appearance in mirror, comparing their appearance to other people, asking others for reassurance, using strategies to change their appearance\/camouflage<\/li>\n
        • 1\/5 endure plastic surgery<\/li>\n
        • 1\/3 have suicidal ideation, 20% have attempted suicide o Avoid contact with others o Begins in adolescence<\/li>\n
        • Social\/cultural factors play a role in how people decide whether they are attractive o Women are more likely than men to report appearance dissatisfaction o Symptoms\/outcomes are similar across cultures<\/li>\n<\/ul>\n
          \n
          • Hoarding Disorder<\/strong>:\n
            \n
            • = Need to acquire is excessive, abhor parting with their objects even when others cannot say any potential value in them<\/li>\n
            • Extremely attached to possessions, many collections of different categories of objects o Poor hygiene, exposure to dirt, difficulties cooking o \u00be engage in excessive buying and many are unable to work o 10% threatened with eviction o 1\/3 also hoard animals (more often women than men) *view as animal rescuer o Usually begins in childhood or early adolescence<\/li>\n
            • Animal hoarding doesn\u2019t tend to emerge until middle age+<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

              Prevalence and Comorbidity of the OC and Related Disorders<\/p>\n

              \n
              • Lifetime prevalence: 2% for OCD and BDD, 1.5% for hoarding<\/li>\n
              • OCD and BDD slightly more common among women, hoarding is equally common<\/li>\n
              • Very few men seek treatment for hoarding<\/li>\n
              • High rates of comorbidity<\/li>\n
              • Often co-occur with anxiety and depression<\/li>\n
              • OCD and BDD tend to co-occur with substance use disorders<\/li>\n<\/ul>\n

                Etiology of the Obsessive-Compulsive and Related Disorders<\/p>\n

                \n
                • Moderate genetic contribution, heritability estimate of 40-50%<\/li>\n
                • 3 closely related areas of the brain unusually active in people with OCD:\n
                  \n
                  • Orbitofrontal cortex<\/strong> = area of medial prefrontal cortex above the eyes o Caudate nucleus<\/strong> = part of basal ganglia o Anterior cingulate<\/strong> \uf0b7 Etiology of OCD:<\/li>\n
                  • Many of the disruptive thoughts and behaviours have adaptive value o Goal of CBT<\/strong>: understand why the person with OCD continues to show the behaviours\/thoughts used to ward off an initial threat well after that threat is gone\n
                    \n
                    • OCD related to deficit in the intuitive sense of feeling security and closure<\/li>\n
                    • Yedasentience<\/strong> = subjective feeling of knowing that you have thought enough, cleaned enough, or in other ways done what you should to prevent chaos and danger from low-level threats in the environment ***biological deficit for OCD<\/li>\n
                    • Compulsions are reinforcing because they relieve the sensation<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                       <\/p>\n

                      \n
                      • Thought Suppression:\n
                        \n
                        • People with OCD try harder to suppress their obsessions than other people and may actually make the situation worse \uf0a7 Feelings of responsibility for what occurs \uf0b7 Etiology of BDD:<\/li>\n<\/ul>\n<\/li>\n
                        • People with BDD can accurately see and process their physical features<\/li>\n
                        • They are detailed oriented and this influences how they look at facial features, examine one feature at a time instead of examining the whole<\/li>\n
                        • Become engrossed in considering a small flaw<\/li>\n
                        • Consider attractiveness to be more important than others, self-worth is dependent upon it \uf0b7 Etiology of Hoarding Disorder:<\/li>\n
                        • Evolutionary perspective \u2013 would be adaptive to store any resources<\/li>\n
                        • Behavioural model: related to poor organizational abilities, unusual beliefs about possessions, and avoidance behaviours<\/li>\n
                        • Slow at sorting objects into categories, find it anxiety-provoking<\/li>\n
                        • Demonstrate an extreme emotional attachment to possessions *especially to animals<\/li>\n
                        • Avoidance (of anxiety from organizing clutter) helps maintain the clutter Treatment of the OC and Related Disorders \uf0b7 Medications:<\/li>\n
                        • Antidepressants most commonly used<\/li>\n
                        • Clomipramine used for OCD (50% reduction in symptoms) *youth and adults<\/li>\n
                        • Antidepressants more helpful than placebos for BDD *using clomipramine and fluoxetine<\/li>\n<\/ul>\n

                          (continue to experience mild symptoms) o Hoarding symptoms respond less to medication treatment than other OCD symptoms \uf0b7 Psychological Treatment:<\/p>\n

                          \n
                          • Exposure and response prevention<\/strong> (ERP) = exposure treatment to address compulsive rituals people with OCD use to ward off threats o OCD:\n
                            \n
                            • Hold belief that compulsive behaviours will prevent awful things from happening<\/li>\n
                            • ERP \u2013 exposure themselves to situations that elicit the compulsive act and refrain form performing the compulsive ritual<\/li>\n<\/ul>\n<\/li>\n
                            • Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus<\/li>\n
                            • The exposure promotes the extinction of the conditioned response (the anxiety)\n
                              \n
                              • Uses exposure hierarchy, highly effective *more than clomipramine<\/li>\n
                              • 25% of clients refuse ERP treatment<\/li>\n
                              • Cognitive \u2013 challenging beliefs about what will happen if one doesn\u2019t engage in rituals, also use exposure to test beliefs o BDD:<\/li>\n
                              • ERP \u2013 exposure to feared activity e.g. interact with people who could be critical of their looks, response prevention \uf0e0 avoid looking in the mirror<\/li>\n
                              • Supplemented with strategies to address cognitive features o Hoarding Disorder:<\/li>\n
                              • Adaptation of ERP \u2013 focuses on getting rid of objects<\/li>\n
                              • Response prevention \u2013 halting the rituals engage in to reduce anxiety e.g. counting or sorting possession<\/li>\n
                              • Facilitate insight as to why this is a problem<\/li>\n
                              • Build family rapport<\/li>\n<\/ul>\n<\/li>\n
                              • Deep Brain Stimulation: A Treatment in Development for OCD:\n
                                \n
                                • Involves implanting electrodes into the brain for those with chronic OCD that fails to respond after multiple pharmacological treatments<\/li>\n
                                • Implanted into nucleus accumbens or region at the margin of the ventral striatum o 50% attaint significant relief within a couple of month *still experimental<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                  Post-Traumatic Stress Disorder <\/strong>(PTSD) and Acute Stress Disorder <\/strong>(ASD)<\/p>\n

                                  \n
                                  • Diagnosed only when a person develops symptoms after a traumatic event<\/li>\n
                                  • Horrific life experiences can trigger serious psychological symptoms<\/li>\n<\/ul>\n

                                    Clinical Description and Epidemiology of PTSD and ASD<\/p>\n

                                    \n
                                    • PTSD<\/strong> = an extreme response to a severe stressor, including recurrent memories of the trauma, avoidance of stimuli associated with the trauma, negative emotions and thoughts, and symptoms of increased arousal<\/li>\n
                                    • Diagnosis was developed after the Vietnam War<\/li>\n
                                    • Serious trauma<\/strong> = an event that involved actual or threatened death, serious injury, or sexual violation<\/li>\n
                                    • Military trauma is most common for men, rape trauma for women (1\/3 of female rape victims meet criteria)\n
                                      \n
                                      • 70% of rapes are committed by someone known to the woman<\/li>\n<\/ul>\n<\/li>\n
                                      • In addition to exposure to trauma, diagnosis of PTSD requires a set of symptoms be present<\/li>\n<\/ul>\n

                                        1) Intrusively re-experiencing the traumatic event (1<\/strong>) (dreams\/nightmares, memories, flashbacks)<\/p>\n

                                        2) Avoidance of stimuli associated with the event (1<\/strong>) *avoidance usually fails<\/p>\n

                                        Avoid internal or external reminders o 3) Other signs of negative mood and thought that developed after the trauma (2<\/strong>) *feeling detached from friends\/family<\/p>\n

                                        4) Symptoms of increased arousal and reactivity (2<\/strong>) \u2013 continuously on guard, monitoring environment for danger, irritability, sleep disturbance<\/p>\n

                                        5) Symptoms began or worsened after the trauma and continued for at least 1 month o 6) Among children younger than 7, diagnosis requires only 1 symptom from each category<\/p>\n

                                        \n
                                        • Symptoms may develop soon after trauma or not until years after<\/li>\n
                                        • Symptoms are relatively chronic<\/li>\n
                                        • Suicidal thoughts are common, so is non-suicidal self-injury<\/li>\n
                                        • Prolonged exposure to trauma might lead to a broader range of symptoms = complex PTSD<\/strong><\/li>\n
                                        • ASD<\/strong> = diagnosed when symptoms occur after a trauma, symptoms are fairly similar to PTSD but the duration is shorter o Only applicable when symptoms last for 3 days to 1 month\n
                                          \n
                                          • 1) Diagnosis could stigmatize short-term reactions to serious traumas, even though they are quite common<\/li>\n
                                          • 2) Most people who go on to meet diagnostic criteria for PTSD do not experience DSM-IV-TR diagnoses of ASD in the first month after the trauma<\/li>\n
                                          • Elevated risk of developing PTSD within 2 years<\/li>\n<\/ul>\n<\/li>\n
                                          • PTSD is highly comorbid with other conditions: anxiety, depression, substance abuse, conduct disorder<\/li>\n
                                          • Women are 2x as likely to develop PTSD after trauma then men<\/li>\n
                                          • Some cultural groups are exposed to higher rates of trauma (e.g. minority populations in US)<\/li>\n<\/ul>\n

                                            Etiology of PTSD<\/p>\n

                                            \n
                                            • 2\/3 of people with PTSD have a history of an anxiety disorder<\/li>\n
                                            • PTSD related to genetic risk for anxiety disorders *high activity in fear circuit areas (amygdala), childhood trauma, tendencies to attend selectively to cues of threat<\/li>\n
                                            • Neuroticism and negative affectivity predict the onset of PTSD<\/li>\n
                                            • Related to Mowrer\u2019s 2-factor model of conditioning (classical conditioning and operant conditioning) \uf0b7 Nature of the Trauma: Severity and the Type of Trauma Matter:\n
                                              \n
                                              • PTSD rates are doubled with soldiers who have a second tour of duty o More prisoners of war develop PTSD than those only wounded in war o Traumas caused by humans are more likely to cause PTSD than natural disasters \uf0b7 Neurobiology: The Hippocampus:<\/li>\n
                                              • PTSD uniquely related to the function of the hippocampus o Hippocampus volume is smaller in those with PTSD<\/li>\n
                                              • Smaller than average hippocampus volume precedes the onset of the disorder o Plays role in ability to locate autobiographical memories in space, time and context, and in organizing our narratives of those memories<\/li>\n
                                              • Decreased hippocampus volume could explain deficit in verbal memory<\/li>\n<\/ul>\n<\/li>\n
                                              • Coping:\n
                                                \n
                                                • People who cope with trauma by trying to avoid thinking about it are more likely to develop<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                  PTSD o Dissociation<\/strong> = feeling removed from one\u2019s body or emotions or being unable to remember the event *may keep the person from confronting the event<\/p>\n

                                                  \n
                                                  • Symptoms of dissociation after trauma are predictive of development of PTSD o High intelligence and strong social support may help cope with severe trauma more adaptively<\/li>\n<\/ul>\n

                                                    Treatment of PTSD and ASD<\/p>\n

                                                    \n
                                                    • Medication Treatment of PTSD:\n
                                                      \n
                                                      • SSRIs receive strong support as a treatment o Relapse is common if medication is discontinued<\/li>\n<\/ul>\n<\/li>\n
                                                      • Psychological Treatment of PTSD:\n
                                                        \n
                                                        • Exposure treatment<\/li>\n
                                                        • Client is asked to face his worst fears, by working up an exposure hierarchy<\/li>\n
                                                        • Extinguish fear response or help challenge the idea that the person could not cope with anxiety\/fear generated by those stimuli<\/li>\n
                                                        • Exposure focused on memories\/reminders of trauma o In-vivo \u2013 returning to scene of the crime\n
                                                          \n
                                                          • Imaginal exposure<\/strong> = the person deliberately remembers the event o Virtual reality technology sometimes used o More effective that medication<\/li>\n<\/ul>\n<\/li>\n
                                                          • Cognitive processing therapy \uf0e0 designed to help victims of rape and sexual abuse dispute tendencies towards self-blame \uf0b7 Psychological Treatment of ASD:<\/li>\n
                                                          • Short-term CBT include exposure therapy o Decreases chances of ASD developing into PTSD (reduced to 32% compared to 58%) o Exposure more effective than cognitive restructuring in preventing development of PTSD<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                                                            Obsessive-compulsive disorders are defined by repetitive thoughts and behaviours that are so extreme that they interfere with everyday life Trauma-related: PTSD and acute stress disorder Often experience other anxiety… Continue Reading Obsessive-Compulsive Related and Trauma-Related Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4191"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4191"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4191\/revisions"}],"predecessor-version":[{"id":4906,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4191\/revisions\/4906"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4191"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4191"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4191"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}