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FSU CLP 4143 - Chapter 7 Obsessive-Compulsive

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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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