Chapter 7 Obsessive-Compulsive related disorders and trauma related disorders- Obsessive compulsive disordero Symptoms of OCD 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 ritualso 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- Body Dysmorphic disordero Symptoms 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 disordero DSM criteria 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 weighto Etiology 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 appearanceo Red flags Appearance concerns that are difficult for others to see; unrealistic expectations of treatment outcomes; worrying about appearance repeatedly throughout the dayfor long periods of time (more than 1 hours); using cover-up strategies; reassurance seeking; mirror checking or avoidance of mirrors; disruption of dailyactivities - Hoarding disordero 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 relationshipso Etiology Evolutionary perspective- adaptive to stockpile vital resources Cognitive-behavioral- poor organizational abilities, unusual beliefs about possessions, avoidance behaviors- Etiology of Obsessive-Compulsive and related disorderso Hyperactivity of regions of the brain: orbitofrontal cortex, caudate nucleus, anterior cingulateo Operant reinforcement maintains fears: compulsions are negatively reinforced by the reduction of anxietyo 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 disorderso Medications SSRI’s: serotonin reuptake inhibitors Tricyclic antidepressant: anafranil (clomipramine)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 exposureo OCD treatment strategies 76% of patients were “very much”/”much” improved Exposure and ritual prevention are effective components- Posttraumatic Stress Disorder (PTSD)o Symptoms 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/helplessnesso Clusters 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 offoreshortened 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” impairmento Risk factors: strength and severity of stressor; characteristics of the stressor: greater perceived threat, feeling helpless, unpredictable, uncontrollableo 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 disordero Similar to PTSD but shorter duration (symptoms occur between 3 days and 1 month after trauma)Chapter 10 Substance Use Disorders- Categorized by specific substance:o Alcohol, amphetamines, cannabis, cocaine, hallucinogen, inhalant, opioid, phyencyclidine, sedative/hypnotic/anxiolytic, tobacco- DSM criteriao 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 symptomso 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-
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