Chapter 7 Obsessive Compulsive related disorders and trauma related disorders Obsessive compulsive disorder o Symptoms of OCD Body Dysmorphic disorder o Symptoms Obsessions repetitive thoughts and urges Intrusive persistent and uncontrollable thoughts irrational most common contamination sexual and aggressive impulses body problems Compulsions actions behaviors Impulse to repeat certain behaviors mental acts to avoid distress ex cleaning counting touching checking extremely difficult to resist the impulses may involve elaborate behavioral rituals o Characteristics of OCD more common in women 75 have comorbid anxiety disorder only 20 completely recover can develop before 10 or during adolescence early adulthood Preoccupied with an imagined or exaggerated defect in appearance perceive self to be ugly or monstrous women focus on skin hips breasts legs men focus on height penis size body hair muscularity Engage in compulsive behaviors checking appearance in mirror often camouflage appearance tanning makeup plastic surgery High levels of shame anxiety depression occurs slightly more often in women 2 prevalence nearly all have another comorbid disorder o DSM criteria o Etiology o Red flags Preoccupation with perceived defect markedly excessive concern over a slight defect in appearance Person has performed repetitive behaviors mental acts in response to concerns Preoccupations are not just about weight Behavioral and cognitive focus on details of appearance attend to physical attractiveness miss the whole picture and focus on small flaws believe in an exaggerated importance of appearance Appearance concerns that are difficult for others to see unrealistic expectations of treatment outcomes worrying about appearance repeatedly throughout the day for long periods of time more than 1 hours using cover up strategies reassurance seeking mirror checking or avoidance of mirrors disruption of daily activities Hoarding disorder o Symptoms Cannot part with an acquired object most objects are worthless but they re extremely attached 66 are unaware of severity of problem 33 engage in animal hoarding animals often receive inadequate care Sever consequences repulsive living conditions negatively impacts relationships o Etiology Evolutionary perspective adaptive to stockpile vital resources Cognitive behavioral poor organizational abilities unusual beliefs about Etiology of Obsessive Compulsive and related disorders possessions avoidance behaviors o Hyperactivity of regions of the brain orbitofrontal cortex caudate nucleus anterior cingulate reduction of anxiety o Operant reinforcement maintains fears compulsions are negatively reinforced by the o Behavioral and cognitive factors lack of a satiety signal yadasentience subjective feeling of completion knowing you ve cleaned thought about something enough individuals with OCD have a deficit Attempts to suppress intrusive thoughts can actually make it worse Treatment of obsessive compulsive and related disorders o Medications Tricyclic antidepressant anafranil clomipramine SSRI s serotonin reuptake inhibitors o Exposure plus response prevention ERP Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus Exposure results in the extinction of the conditioned response anxiety o Cognitive therapy Challenge beliefs about anticipated consequences of not engaging in compulsions usually also involves exposure o OCD treatment strategies 76 of patients were very much much improved Exposure and ritual prevention are effective components Posttraumatic Stress Disorder PTSD o Symptoms o Clusters Extreme response to sever stressor anxiety avoidance of stimuli associated with trauma emotional numbing Exposure to traumatic event that involves actual or threatened death or injury war rape natural disaster etc that leads to intense fear helplessness A trauma stressor B re experiencing intrusions recollections or dreams intense distress at exposure to cues that resemble an aspect physiologic activity C avoidance numbing inability to recall aspects of the trauma reduced interest in significant activities feelings of attachment restricted range of affect sense of foreshortened future D increased arousal difficulty falling staying asleep irritability difficulty concentrating hyper vigilance exaggerated startle response E F more than a month of symptoms and causes functional problems could go on for years must be clinically significant impairment o Risk factors strength and severity of stressor characteristics of the stressor greater perceived threat feeling helpless unpredictable uncontrollable o Treatment Exposure to memories and reminders of original trauma could be in vivo or imagined more effective than medication difficult at first Cognitive therapy enhance beliefs about coping abilities doesn t improve treatment response Prolonged exposure most effective 9 12 weeks focused on discussing fears recalling event relaxation training and confronting safe situations involving memories of trauma Acute Stress disorder trauma o Similar to PTSD but shorter duration symptoms occur between 3 days and 1 month after Chapter 10 Substance Use Disorders Categorized by specific substance o Alcohol amphetamines cannabis cocaine hallucinogen inhalant opioid phyencyclidine sedative hypnotic anxiolytic tobacco DSM criteria o Failure to meet obligations repeated use in situations where it s dangerous repeated relationship problems continued use despite problems caused by the substance tolerance withdrawal substance taken for longer time more amount than intended efforts to reduce control use doesn t work much time spent trying to obtain it social hobbies or work activities given up reduced continued use despite knowing consequences craving is strong Addiction symptoms o Severe substance use disorder has far more severe symptoms Tolerance larger doses needed lower dosage doesn t produce typical effect Withdrawal negative physical psychological effects from stopping usage Using more than intended trying unsuccessfully to stop physical psychological problems made worse by drug experience problematic relationships Alcohol use disorder o Alcoholic physiologically dependent or heavy user o Delirium tremens DT can occur when blood alcohol level quickly drops deliriousness tremulousness hallucinations mostly visual o Poly drug abuse abusing multiple substances 85 of drinkers are also smokers o Abuse 17 prevalence dependence 12 prevalence Fetal alcohol
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