Chapter 7 Obsessive Compulsive Related Disorders and Trauma Related Disorders What are the symptoms of OCD the combination of having repetitive unwanted thoughts and urges obsessions repetitive behaviors and mental acts that a person is compelled to perform to prevent distress or a dreaded event compulsions What is the difference between Obsessions and Compulsions Obsessions the thoughts and urges in a person s head usually unwanted intrusive persistent and uncontrollable thoughts experienced as irrational ex My hands are dirty Compulsions the behaviors and actions associated with the compulsions ex Washing hands constantly extremely difficult to resist the impulse may involve elaborate behavioral rituals experienced as non enjoyable What are Characteristics of OCD Develops either before age 10 or during late adolescent early childhood more common in women 1 5 times more common than inn men 75 of people have comorbid anxiety disorder resistant to treatment substance abuse is common usually leads to having a lot of anxiety the people affected tend to realize there is an issue Body Dysmorphic Disorder define symptoms Preoccupied with an imagined or exaggerated defect in appearance repetitive thoughts and urges about personal appearance negative thoughts perceive themselves to be ugly or monstrous engage in compulsive behaviors check appearance in mirrors often camouflage their appearance tanning makeup plastic surgery preoccupation is not restricted to concerns about weight or fat Women focus on skin hips breast legs Men focus on height penis size body hair muscularity high levels of shame anxiety and depression often leads to plastic surgery Hoarding Disorder define symptoms repetitive thoughts about possessions cannot part with acquired objects most objects are worthless extreme attachment to objects resistant to relinquishing objects 66 are unaware of severity of problem do not realize there is something wrong with these behaviors in denial 33 engage in animal hoarding animals often receive inadequate care severe consequences squalid living conditions negatively impacts relationships Etiology of Obsessive Compulsive Disorder Operant reinforcement compulsions negatively reinforced by the reduction of anxiety Cognitive factors lack of satiety signal disgust caused by overindulgence or excess attempts to suppress intrusive thoughts makes the problem stronger worse Yadasentience subjective feeling of completion knowing that you ve thought enough or cleaned enough individuals with OCD have a yadasentience deficit Etiology of Hoarding Disorder evolutionary perspective adaptive to stockpile vital resources poor organizational abilities unusual beliefs about possessions avoidance behaviors key aspect does not want to deal w problem b c anxiety levels rise greatly when faced w issue Etiology of BDD focus on details of appearance no actual distortion of physical features attend to physical attractiveness features e g facial symmetry miss the gestalt or the whole picture focus attention on small pieces become engrossed in small flaws believe in an exaggerated importance of appearance Treatment of Obsessive Compulsive and Related Disorders Medications SSRIs serotonin reuptake inhibitors Tricyclic antidepressants Anafranil clomipramine Exposure Response Prevention ERP not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus the exposure results in the extinction of the conditioned response the anxiety extremely difficult on patient Cognitive Therapy challenge beliefs about anticipated consequences of not engaging in compulsions usually also involves exposure Posttraumatic Stress Disorder PTSD extreme response to severe stressor anxiety avoidance of stimuli associated with trauma emotional numbing exposure to an actual event that involves actual or threatened death or injury e g war rape natural disaster trauma leads to intense fear or helplessness symptoms present for more than a month came to light back in the times of the Vietnam war most common stressors war rape or physical abuse sometimes can happen even from witnessing traumatic events first responders Symptoms of PTSD Four categories Trauma the stressor Intrusively re experiencing the traumatic event nightmares intrusive thoughts or images Avoidance of stimuli e g refuse to walk on street where rape occurred other signs of mood and cognitive changes memory loss negative thoughts and emotions self blaming blaming others withdrawal drinking and drug abuse Increased arousal and reactivity irritability aggressiveness recklessness or self destructiveness insomnia difficulty concentrating hypervigilance exaggerated startle response keeping guns checking locks constantly more than one month of symptoms but may go on for years causes functional problems tends to be chronic higher risk for suicide and self injuries Define Acute Stress Disorder ASD characterized by the development of severe anxiety dissociative and other symptoms after a traumatic event symptoms similar to PTSD duration is shorter symptoms occur between 3 days and 1 month after trauma as many as 90 of rape victims experience ASD ASD predicts higher risk of PTSD with 2 years exposure best way to get over trauma Psychological Treatment of PTSD Exposure to memories and reminders of the original trauma either direct in vivo or imaginable virtual reality effective more effective than medication or supportive therapy treatment can be difficult at first possible increase in symptomology prolonged exposure absolute best type of treatment typically involves 9 12 weeks sessions that last at least 90 120 minutes treatment is focused upon discussing fears recalling the traumatic event relaxation training and confronting unsafe situations that involve memories of the trauma Cognitive therapy some effect enhance beliefs about coping abilities adding CT to exposure does not improve treatment response treatment of ASD may prevent PTSD shows benefits even 5 years after the traumatic event Iatrogenic Caused Symptoms certain forms of post disaster psychological debriefing treatment techniques in which survivors are strongly suggested to discuss the details of their traumatic experience often in groups and shortly after the disaster are not only likely to be ineffective but can be iatrogenic meaning the symptoms are induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures DSM IV TR pathological use of
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