Obsessive compulsive disorder
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Obsessive Compulsive Disorder. Features of OCD. Obsessions Recurrent and persistent thoughts; impulses; or images of violence, contamination, and the like intrusive and distressing Individual tries to ignore, suppress, or neutralize Compulsions

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Features of ocd
Features of OCD

  • Obsessions

    • Recurrent and persistent thoughts; impulses; or images of violence, contamination, and the like

    • intrusive and distressing

    • Individual tries to ignore, suppress, or neutralize

  • Compulsions

    • Repetitive behaviors individual feels driven to perform

    • Ritualistic/need to follow a set of rules

    • Intended to prevent or reduce distress or some dreaded event


Dsmiv
DSMIV

  • See webpage:

  • http://anxiety.psy.ohio-state.edu/ocd1.htm


Ocd features
OCD Features

  • Data from the Epidemiological Catchment Area (ECA) survey found a 6-month point prevalence of 1.6% and a lifetime prevalence of 2.5% in the general population

  • Sex ratio is 1:1.1 (men to women)

  • Mean age of onset is 20.9 years (SD=9.6)

    • Males is 19.5 years (SD = 9.2)

    • Females is 22.0 years (SD = 9.8)

  • Most develop their illness before the age of 25

  • Symptoms can be remembered as far back as the onset of puberty.


Comorbidity
Comorbidity

  • Major depression is the most common comorbid disorder

    • 1/3 have concurrent MDD

    • 2/3 have a lifetime history of MDD

  • Other Axis I disorders include panic disorder with agoraphobia, social phobia, generalized anxiety disorder, Tourette’s syndrome, trichotillomania, schizophrenia

  • Axis I comorbid disorders can effect the severity and treatment of OCD.


Comorbidity1
Comorbidity

  • Obsessive-compulsive personality disorder (OCPD) is an Axis II disorder. OCPD differs from OCD by the lack of true obsessions and compulsions.


More features
More features

  • Types of Obsessions

    • Aggressive obsessions

    • Contamination obsessions

    • Sexual obsessions

    • Hoarding/saving obsessions

    • Religious obsessions

    • Symmetry/exactness

    • Somatic obsessions


Obsessive compulsive disorder

  • Types of compulsions

    • Cleaning/washing compulsions

    • Checking compulsions

    • Repeating rituals

    • Counting compulsions

    • Ordering/arranging

    • Hoarding/collecting

    • Mental rituals


Is ocd experienced by the normal population
IS OCD Experienced by the Normal Population??

  • Most people experience intrusive thoughts throughout their life

  • Individuals who develop OCD may react more negatively to their intrusions


Neurobiology physiology
Neurobiology/physiology

  • No chronic hyperarousal

  • Over activation of the orbitofrontal cortex (thought generation) and under activation of the caudate nuclei (thought suppression)


Psychosocial
Psychosocial

  • Learning

    • Animal models

      • High stress or repeated frustration leads to increase in ritualistic-like behaviors

      • Fixed action pattern- innate and adaptive behavioral sequences to specific stimuli

    • Biological preparedness

      • Washing and checking may have once promoted survival


Obsessive compulsive disorder

  • Cognitive deficits

    • Increased attention allocated to fear related stimuli

    • Tend to encode negative stimuli more indepth than neutral and positive stimuli, leading to better memory for negative stimuli

    • Overattention to detail


Cognitive theory of ocd
Cognitive theory of OCD

  • Obsessional thoughts:

    • If obsessions occur frequently in normal populations, why don’t most people suffer from OCD?

    • It’s not the thought itself that is disturbing, but rather the interpretation of the thought.

      • Example: having an unacceptable sexual thought leads to beliefs that the person is depraved, perverted, abnormal, evil, etc…., which leads to affective states such as anxiety and depression.

    • The issue of responsibility is believed to be a core belief or cognitive distortion of people with OCD.


Obsessive compulsive disorder

  • There are three main consequences of neutralizing behavior

    • It results in reduced discomfort, which leads to the development of compulsive behavior as a tool for dealing with stress. This reinforcing behavior may result in a generalization of this strategy

    • Neutralizing will be followed by non-punishment, and can lead to an effect on the perceived validity of the beliefs (NAT)

    • The neutralizing behavior itself becomes a powerful and unavoidable triggering stimulus. The neutralizing behavior serves to reinforce the belief that something bad may happen


Pharmacotherapy
Pharmacotherapy

  • Serotonin (5-HT) neurotransmission abnormalities have been implicated in the pathophysiology and treatment

  • Antidepressant medications of the Serotonin Reuptake Inhibitor classification and specific tricyclic antidepressants (Clomipramine) have been proven to be effective in the treatment of OCD


Obsessive compulsive disorder