8_PSYC_301_OCD psychopatholgy on obessive compulsive disorder.ppt

obsessive compulsive disorder

1. OBSESSIVE-COMPULSIVE
RELATED DISORDERS

Cyprus International University
Department of Psychology
Fall Semester

2. Outline
■OCD: Symptoms and epidemiology
■The commonalities in the etiology of obsessive-compulsive and
related disorders, as well as the factors that shape the expression of
the specific disorders within this cluster.
■The medication and psychological treatments for the obsessive-
compulsive-related disorders

4. 1.Obsessive-compulsive disorder (OCD)
2.Body dysmorphic disorder (BDD)
3.Hoarding disorder (HD)

5. DSM 5 Key Features Placement in DSM-IV-TR
OCD •Repetitive, intrusive,
uncontrollable thoughts or
urges (obsessions)
•Repetitive behaviors or
mental acts that the person
feels compelled to perform
(compulsions)
Anxiety disorder chapter
BDD •Preoccupation with an
imagined flaw in one’s
appearance
•Excessive repetitive
behaviors or acts regarding
appearance (e.g., checking
appearance, seeking
reassurance)
Somatoform disorder chapter
HD •Acquiring an excessive
number of objects
•Inability to part with those
objects
New diagnosis proposed for
DSM-5

6. 
■For all three conditions, the repetitive thoughts and behaviors
are distressing, feel uncontrollable, and require a considerable
amount of time.
■For the person with these conditions, the thoughts and behaviors
feel unstoppable.
■Beyond similarities in the symptoms, these syndromes often co-
occur

7. Clinical Descriptions and Epidemiology of the
Obsessive-Compulsive and Related Disorders
■Obsessions;
Obsessions are intrusive and recurring thoughts, images, or impulses that
are persistent and uncontrollable (i.e., the person cannot stop the
thoughts) and
usually appear irrational to the person experiencing them
have such force and frequency that they interfere with normal activities
oContamination
oSexual or aggressive impulses
oSymmetry
oOrder

8. Compulsions;
■Repetitive, clearly excessive behaviors or mental acts that the person feels
driven to perform to reduce the anxiety caused by obsessive thoughts or
to prevent some calamity from occurring
■Even though rationally understanding that there is no need for this
behavior, the person feels as though something dire will happen if the act
is not performed
o Pursuing cleanliness and orderliness, sometimes through elaborate rituals
o Performing repetitive, magically protective acts, such as counting or
touching a body part
oRepetitive checking to ensure that certain acts are carried out

9. Examples of Compulsive Rituals Repeating routine
activities
■Checking
■Returning home after seeing a fire engine to make sure the
house wasn’t on fire
■Repeating routine activities
■Going through a doorway over and over to prevent bad luck
■Retracing one’s steps to make sure that no mistakes were
made
■Ordering/ arranging
■Saying the word “left” whenever one hears the word “right”
■Mental rituals
■Canceling a bad thought by thinking of a good thought

10. Body Dysmorphic Disorder
DSM-5 CRITERIAS
Preoccupation with a perceived defect or in appearance
The person has performed repetitive behaviors or mental acts (e.g., mirror
checking, seeking reassurance, or excessive grooming) in response to the
appearance concerns
Preoccupation is not restricted to concerns about weight or body fat

11. ■About a third of patients with BDD describe delusions about their appearance,
such as being convinced that others are laughing at them or staring at their
flaws (Phillips, 2006)
■plastic surgery (Phillips, et al., 2001).
■committing suicide
■Occupational and social functioning
■Less than %2 prevelance
■symptoms and outcomes of BDD are similar across cultures (The body part that
becomes a focus of concern sometimes differs by culture, though.
■MDD, SAD, OCD, substance abuse, personality disorders
■Eating disorders vs BDD

12. ■Clinical Case: Joann
■Joann was a 23-year-old woman who sought psychotherapy after
losing her job as a salesclerk for a record store because she had
been taking very long breaks. At the first therapy session, she
seemed extremely uncomfortable; she huddled in her coat and
told her story while looking at the floor.
■She said that she had been taking long breaks at work because
she was uncomfortable when customers were in the store—she
had the feeling they were staring at her. When asked why she
thought that, she said that she knew they were looking at her
skin, which she perceived as being far too dark. She described
feeling compelled to spend hours a day in her home examining
her appearance in the mirror, and she described those hours as
torture. She would spend all morning getting dressed and putting
on makeup, but she never felt satisfied with the results.
Throughout the day, she would think about how her skin, nose,
and lips were “repulsively ugly.” She often avoided leaving home,
and when in public, she was paralyzed by extreme anxiety when
others looked at her. She said that these symptoms had come and
gone since adolescence but had become much worse over the last
2 years.

13. Hoarding Disorder

14. Animal Hoarding...

15. HD DSM-5
CRITERIA
Persistent difficulty discarding or parting with possessions, regardless of the
value others may attribute to these possessions
Strong urges to save items and/or distress associated with discarding
The symptoms result in the accumulation of a large number of possessions that
clutter key areas the home or workplace to the extent that their intended use is
no longer possible unless others intervene

16. ■Personal hygiene and general health issues
■Interpersonal issues
■Excessive shopping
■Economic loss
■Eviction
■Animal protection agencies sometimes become involved
■Can also occur among those who do not have OCD symptoms
■MDD, GAD, SAD, Schizophrenia, Demantia...

17. Etiology of the Obsessive-Compulsive
and Related Disorders
■All 3 of them share some overlap in etiology
■Might be due to genetic and neurobiological risk factors
BDB and HD often have a family history of OCD (Gustad,
2003; Taylor, Jang, & Asmundson, 2010).
Brain-imaging studies: Orbitofrontal cortex, caudate nucleus, the
anterior cingulate

19. Etiology of OCD
■Genetic contribution: 30 to 50 percent (Taylor et al., 2010).
■Cognitive factors: why do intrusive thoughts persist?
■Deficit in yedasentience? An anxious internal sense that things are not
complete?
Yedasentience: Subjective feeling of knowing (Woody & Szechtman,
2011).
Behavioral models: Operant conditioning of compulsions
Models focusing on compulsions: Mistrust their memory
Models focusing on obsessions: Thought suppression and perceived
responsibility (Salkovskis, 1996).

20. ■Yedasentience: Subjective feeling of
knowing (Woody & Szechtman, 2011).
■Just like you have a signal that you have eaten
enough food, yedasentience is an intuitive signal
that you have thought enough, cleaned enough,
or in other ways done what you should to
prevent chaos and danger.
■One theory suggests that people with OCD
suffer from a deficit in yedasentience. Because
they fail to gain the internal sense of
completion, they have a hard time stopping
their thoughts and behaviors. Objectively, they
seem to know that there is no need to check the
stove or wash their hands again, but they suffer
from an anxious internal sense that things are
not complete.

21. Learning Model
■Mowrer’s two-stage theory of fear acquisition and maintenance
■First stage: Classical conditioning
■Neutral stimulus, aka. the conditioned stimulus (CS), paired with
aversive stimulus, aka. the unconditioned stimulus (UCS)
■The CS comes to elicit a conditioned fear response, or CR
■Second stage: Operant conditioning
■Avoidance behaviors reduce anxiety; avoidance is negatively
reinforced by the immediate reduction in distress.
■Compulsive rituals develop as an escape behavior from
obsessional fear when avoidance is impossible

22. Cognitive Behaviour Models
■Based on Beck’s cognitive theory
■Emotional disturbance is brought about by how one makes
sense of situations or stimuli
■Unwanted intrusive thoughts (i.e., thoughts, images, and
impulses that intrude into consciousness) are a normal
experience
■Intrusions develop into a clinical obsession if the person
believes they have serious consequences
■Compulsive rituals and avoidance represent efforts to
remove intrusions and prevent feared consequences

23. ■According to the cognitive model of OCD, everyone
experiences intrusive thoughts from time-to-time.
However, people with OCD often have an inflated sense of
responsibility and misinterpret these thoughts as being
very important and significant which could lead to
catastrophic consequences.
■The repeated misinterpretation of intrusive thoughts leads
to the development of the obsessions and because the
thoughts are so distressing, the individual engages in
compulsive behaviour to try to resist, block, or neutralise
the obsessive thoughts.

24. Paul Salkovskis
■The cognitive theory of OCD developed by psychologist Paul
Salkovskis has been fundamental in the understanding and
treatment of this disorder.
■Salkovskis proposed that OCD arises from the interaction
between intrusive thoughts and dysfunctional beliefs about
these thoughts. According to his theory, obsessions cause
anxiety due to the catastrophic interpretation that people with
OCD give them, which in turn triggers compulsions as a way to
reduce anxiety and prevent feared consequences.
■For example, a person without OCD may occasionally think
about the possibility of contracting an illness from seeing
someone sneeze. On the other hand, someone with OCD
could interpret this thought as constant threat, which would
trigger a high level of anxiety.

25. ■This model suggests that people with OCD may try harder
to suppress their obsessions than other people and, in
doing so, may actually make the situation worse.
■Several researchers have shown that people with OCD
tend to believe that thinking about something can make it
more likely to occur (Rachman, 1977). People with OCD
are also likely to describe especially deep feelings of
responsibility for what occurs (Ladoceur, Dugas, Freeston,
et al., 2000).
■As a consequence of these two factors, they are more
likely to attempt thought suppression (Salkovskis, 1996).

26. ■Consider the findings of one study of what happens when
people are asked to suppress a thought (Wegner, 1987).
Two groups of college students were asked either to think
about a white bear or not to think about one; they were
also told to ring a bell every time they thought about a
white bear. The findings indicated that attempts to avoid
thinking about the white bear did not work—students
thought about the bear more than once a minute when
trying not to do so.
■Beyond that, there was a rebound effect—after students
tried to suppress thoughts about the bear for 5 minutes,
they thought about the bear much more often during the
next 5 minutes. Trying to suppress a thought may have the
paradoxical effect of inducing preoccupation with it.

27. Serotonin Hypothesis
■Obsessions and compulsions arise from a hypersensitivity
of the postsynaptic serotonergic receptors
■Three potential lines of evidence:
■Medication outcome studies supportive
■Studies of biological markers—such as blood and
cerebrospinal fluid levels of serotonin metabolites—are
inconclusive
■Results from the pharmacological challenge paradigm
largely incompatible

28. Etiology of Body Dysmorphic
Disorder
■Cognitive models of BDD focus on what happens when a person with this
syndrome looks at his or her body.
■the problem does not appear to be one of distortion of the physical features.
■Rather, those with BDD are more attuned to features that are important to
attractiveness, such as facial symmetry, than are those without BDD
(Lambrou, Veale, & Wilson, 2011).
■They appear to focus on details more than on the whole (Deckersbach,
Savage, Phillips, et al., 2000).
■Consider attractiveness to be vastly more important than do control
participants
■The exclusion of focusing on more positive stimuli

29. Etiology of Hoarding Disorder
■An evolutionary perspective (Zohar & Felz, 2001).
■Poor organizational abilities,
■Unusual beliefs about possessions,
■Avoidance behaviors (Steketee & Frost, 2003).
■Difficulties with attention (Hartl, Duffany, Allen, et al., 2005).
■Decision making (Samuels et al., 2009).
■Extreme emotional attachment to their possessions.

30. ■1. Sam, a 15-year-old male, reports that he has had a really bad
song stuck in his head for days. He is frustrated that he cannot
seem to rid himself of the song, no matter what he does.
■2. Jan, a 41-year-old woman, was referred by her husband. He was
worried because she spent hours and hours in the bathroom each
day, crying while looking in the mirror at her hairline. She was
convinced that her face and hairline were horribly asymmetrical and
that others would dislike her as a result. She had visited two
doctors to inquire about getting hair implants along her forehead,
but both doctors felt that this was not advisable, as they saw no
evidence that her hairline was in anyway atypical.

31. ■June, a 60-year-old woman, needs to sell her
house for financial reasons. The realtor has told
her she must get rid of her stuff for the house to
sell. At this point, there is no place in the house
to sit, as so many different collections fill every
possible spot. Her children have stopped visiting
as they became so frustrated by her excessive
spending behavior and her all-consuming focus
on her possessions. Although June understands
that she must purge her house of these
collections, she is unable to do so. Every time
she tries to sort through what to keep or not,
she is paralyzed with overwhelming anxiety.

32. Treatment of the Obsessive-Compulsive
and Related Disorders
Medication:
■Antidepressants
Clomipramine (SRI)
SSRI’s
Psychological Treatment:
Exposure and response prevention (ERP).(Victor Meyer, 1966)

33. Exposure in Obsessive-
Compulsive Disorder
■Expose themselves to situations that elicit the compulsive act and
then refrain from performing the compulsive ritual
1. Not performing the ritual exposes the person to the full force of the
anxiety provoked by the stimulus.
2. The exposure results in the extinction of the conditioned response
(the anxiety).
■Involves refraining from performing rituals during sessions lasting
upwards of 90 minutes, with 15 to 20 sessions within a 3-week
period
■25 percent of clients refuse ERP treatment (Foa & Franklin, 2001).

34. Exposure in BDD and HD
BDD
■Might be asked to interact with people who could be critical of their looks
■Asked to avoid the activities they use to reassure themselves about their
appearance, such as looking in mirrors and other reflective surfaces
HD
■Based on the ERP therapy that is employed with OCD (Steketee & Frost,
2003).
■Exposure - getting rid of their objects
■RP- halting the rituals that they engage in to reduce their anxiety, such as
counting or sorting their possessions.

35. Questions
■1. List three reasons to consider OCD, BDD, and hoarding
as related conditions.
■2. What type of medication has been most carefully tested
for the treatment of obsessive-compulsive and related
disorders?
■3. What is the most commonly used psychological
treatment for obsessive compulsive and related disorders?