Etiology of OCD

Etiology of ocd

1. Obsessive Compulsive and Related Disorders

2. Group members : Mahum Azhaar Anum Suhail Shahtaj Shakir Sidra Javed Wajeeha Ghani Pakeeza Arif Soofia Hussain S. Amna Burhan

3. Obsessive Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder Excoriation Trichotillomania

4. It is defined as occurring of unwanted and intrusive thoughts or distressing images which are accompanied by compulsive behaviors to neutralize the obsessive thoughts.

5. Obsessive: Repetitive Thoughts which are distressing, inappropriate and uncontrollable. Order and exactness Doubting Religious Contamination Aggressive Sexual Violence

6. Compulsions: Repetitive overt behaviors or it can be covert mental rituals. There are five main primary types of compulsive rituals. Cleaning Repeated checking, Ordering Arranging Counting

7. The distressing thoughts are usually unacceptable or taboo in nature ( sexual ,  harming ,  religious thoughts ). Rather than perform an overt ritual, such people will engage in covert rituals and mental neutralizing. 

8. OCD CYCLE

9. One recent study found that more than 25% of people in NCS-R co-morbidity study reported experiencing obsessions or compulsions at some time of their lives. The average lifetime prevalence was 2.3 %. British Epidemiology found a gender ratio of 1.4 to 1 (women to men; Torres et al., 2006)

10. Co-morbidity with Other Disorders Depression Social phobia, panic disorder, GAD and PTSD BDD

11. CELEBS WITH OCD

12. PSYCHOLOGICAL CAUSAL FACTORS

13. Learning Theory (OCD AS LEARNED BEHAVIOR) Evolutionary Theory (OCD AND PREPAREDNESS)

14. Mowrer’s two process theory of avoidance learning(1947) : According to this theory, neutral stimuli become associated with frightening thoughts or experience through classical conditioning and come to elicit anxiety. EXAMPLE OCD AS LEARNED BEHAVIOR

15. This model predicts, then, that exposure to feared objects or situations should be useful in treating OCD if the exposure is followed prevention of the rituals, enabling the person to see that the anxiety will subside naturally in time without the ritual. This indeed the cure of the most effective form of Behavioral therapy for OCD.

16. CLASSICAL EXPERIMENTS CONDUCTED BY RACHMAN AND HODGSON They found that for most people with OCD, exposure to a situation that provoked their obsession did indeed produce distress, which would continue for a moderate amount of time and then gradually dissipate.

17. OCD AND PREPAREDNESS We have also enlarged our understanding of Obsessive Compulsive Disorder by looking at in an evolutionary context. Example

18. In addition, some theorists have argued that the displacement activities that many species of animal engage in under situations of conflict or high arousal resemble the compulsive rituals seen in Obsessive-Compulsive Disorder.

19. Cognitive Causal Factors

20. The Effects of Attempting to Suppress Obsessive thoughts

21. People with normal and abnormal obsessions differ primarily in the degree to which the resist their own thoughts. The factor contributing to the frequency of obsessive thoughts and negative moods is the attempt to suppress them.

22. OCD patients were asked to record their intrusive thoughts in a diary, both on days when they were told to suppress their thoughts and on days without instructions to suppress their thoughts. They reported twice as many intrusive thoughts when they tried to suppress them.

23. Researches suggest that thought suppressions leads to more general increase in obsessive compulsive symptoms just beyond the frequency of obsessions. Naturalistic study of people with OCD.

24. Appraisal of Responsibility for intrusive Thoughts Salkovskis , Rachman and other cognitive theorists have distinguished between intrusive thoughts and negative automatic thoughts and catastrophic appraisal that people have about experiencing such thoughts.

25. Inflated sense of Responsibility People with OCD often seems to have an inflated sense of responsibility. This sense of inflated responsibility for the harm they may cause adds to the “perceived awe fullness of any harmful consequences and may motivate compulsive behaviors like washing and checking to reduce the likelihood of the event. Differentiate them from normal people with obsessions and from the people who have OCD.

26. Thought Action Fusion? The irrational assumption that just because a “bad” thought presents itself to your mind, then it is undeniably followed or accompanied by a specific “bad” action.  In other words, thinking something makes it so.  For some, this fusion is so strong that they believe that their thoughts actually cause actions to occur.

27. Attention is drawn to disturbing materials like in anxiety disorder. Suppression of thoughts. Have difficulty in blocking out negative and irrelevant information. Cognitive Biases and Distortions

28. Have low confidence in their memory.

29. BIOLOGICAL CAUSAL FACTORS

30. Genetics: OCD often seems to "run in the family." In fact, almost half of all cases show a familial pattern. Research studies report that parents, siblings and children of a person with OCD have a greater chance of developing OCD than does someone with no family history of the disorder.

31. Question? If OCD is "taught" by one family member to another. If this were the case, though, why do individual family members often have very different symptoms of OCD?

32. What causes OCD? OCD is caused by damage to a specific part of the brain called the “basal ganglia”

33. Basal ganglia Basal ganglia are strongly inter linked at amygdal e to the limbic system. The basal ganglia are associated with a variety of functions including: control of voluntary motor movements, procedural  learning, routine behaviors or "habits" such as, eye movements,  cognition  and emotion

34. Damage in basal ganglia Scientists proposed that any damage to the basal ganglia might result in the OCD symptoms. The significance of identifying the basal ganglia is that it shows that physical damage to a brain structure results in a neuropsychological (mental/emotional) condition.

35.  Researchers learned that two brain structures that communicate with the basal ganglia are more active in patients with OCD. These two structures are known as the orbitofrontal cortex (OFC) and the anterior cingulate gyrus (ACG). Specifically,  people with OCD  show abnormal activity in different parts of this circuit including the orbital frontal cortex, cingulated cortex and caudate nucleus of the basal ganglia.

36. Changes in Brain Activity Modern brain imaging techniques have allowed researchers to study the activity of specific areas of the brain. Such studies have shown that people with OCD have more than usual activity in three areas of the brain. These are:

37. 1.The caudate nucleus, specific brain cells in the basal ganglia This area of the brain acts as a filter for thoughts coming in from other areas. The caudate nucleus is also considered to be important in managing habitual and repetitive behaviors.

38. 2.The prefrontal orbital cortex, located in the front area of the brain The level of activity in the prefrontal orbital cortex is believed to affect appropriate social behavior. Lowered activity or damage in this region is linked to feeling uninhibited, making bad judgments and feeling a lack of guilt. More activity may therefore cause more worry about social concerns.

39. 3.The cingulate gyrus, in the centre of the brain The cingulate gyrus is believed to contribute the emotional response to obsessive thoughts. This area of the brain tells you to perform compulsions to relieve anxiety. This region is highly interconnected to the prefrontal orbital cortex and the basal ganglia via a number of brain cell pathways.

40. Examples: After using the washroom, you may begin to wash your hands to remove any harmful germs you may have encountered. While having a lunch Writing something repeatedly,

41. There are certain cortical and subcortical structures that are involved in behavior patterns forming a circuit have abnormally high levels of activity. The cortico -basal ganglionic thalamic circuit is normally involved in the preparation of complex sets of interrelated behavioral responses used in specific situations like social concerns.

42. Theories regarding dysfunction in cortico basal ganglionic thalamus circuit BAXTER AND COLLEGUES: When this circuit is not functioning properly, inappropriate behavioral responses may occur, including repeated sets of behavior e.g. checking and cleaning. -Over activation of the orbital frontal cortex that combines with a dysfunctional interaction among the Orbital frontal cortex Corpus striatum or caudate nucleus thalamus The Cortico -striatal- thalamo -cortical loop is a major site of synaptic dysfunction

43. Prevents people with OCD from showing normal inhibition of sensations, behaviors and thoughts that would occur if the circuits were functioning properly. The impulses towards aggression sex hygiene and danger leak through as obsessions and distract people with OCD from goal oriented behavior White matter abnormality Fear of contamination (hygiene) Checking

44. Increased activity of serotonin and increased sensitivity of certain brain structures are involved in OCD symptoms. The drugs that causes a down regulation of certain serotonin receptors further causing functional decrease in the availability of serotonin. Anafranil (clomipramine) : a tricyclic drug effective in OCD treatment. Research shows this is because clomipramine has greater effects on the neurotransmitter SEROTONIN which is strongly implicated in OCD. FLUXOERINE (Prozac): an antidepressant drug that has relatively selective effects on serotonin. Other neurotransmitters that effect the activity of brain structures related to OCD are GABA ,GLUTAMATE, dopamine but their role is not yet understood. Neurotransmitter Abnormality

45. A behavioral treatment that combines exposure and response preventions seems to be the most effective approach to treat OCD. Expose themselves repeatedly to the stimuli that will provoke their obsessions. Following each exposure they are asked not to engage in the rituals that they ordinarily would engage to reduce anxiety or distress provoked by their obsession. Behavioral And Cognitive-Behavioral Treatments

46. BODY DYSMORPHIC DISORDER

47. BODY DYSMORPHIC DISORDER (BDD), also known as body dysmorphia or dysmorphic syndrome (originally dysmorphophobia), is mental illness that involves belief that one's own appearance is unusually defective (worthy of hiding or fixing), while one's thoughts about it are pervasive and intrusive (at least one hour per day)

48. Severe, the distress of BDD worsens  quality of life  by impairing social, occupational, and academic functioning, and yields  social isolation . BDD usually involves suicidal ideation and often involves suicide attempts. BDD is common among psychiatric patients, whose BDD often remains unrecognized. 

49. People experiencing BDD wish to change or improve some aspect of their physical appearance—usually hair, nose, skin, or, particularly in men,  body size or musculature Relatively common, found in about 1% to 2% of the general population, BDD is about equally prevalent in women and men.

50. Often misdiagnosed, BDD is often thought to be merely major depressive disorder or social phobia.  BDD might involve  delusions of reference , whereby one believes, for instance, that passersby are pointing at the flaw.

51. Epidemiology Population studies suggest a point prevalence rate of 0.72-2.4%.International studies suggest that 6-15% of patients attending cosmetic surgery and dermatology clinics are estimated to have body dysmorphic disorder (BDD)

52. RESEARCH: Neuroimaging suggest weaker connection between the  amygdala  and the  orbitofrontal cortex  (involved in regulation of emotional arousal).In a cognitive-behavioral model, BDD arises through interaction of personality factors, such as introversion and self-consciousness, with early childhood experiences and social learning. As a group, BDD cases report high incidence of emotional abuse during childhood

53. Relationship of OCD and BDD People with BDD have prominent obsession such as reassurance seeking, mirror checking, compare themselves to others . The same neurotransmitter (Serotonin) and the same set of brain structures are implicated in the two disorders, and the same kinds of treatment that work for OCD are also the treatment of choice for BDD.

54. Western culture has become increasingly focused on “Looks as every thing” with billions of dollars spent each year on enhancing appearance through makeup,clothes,plastic surgery and other means. A second reason BDD has been understudied is the most people with this condition never speak psychological or psychiatrist treatment.

55. Part of the reason why people are now seeking treatment is that starting in the past 15 years the disorder has received a good deal of media attention. It has even been discussed on some daily talk shows, where it is sometime called “ imaginary defect disorder ”

56. Recent Twin Study by Monzani et al(2012) Finding: Physical appearance as a heritable trait Secondly Body Dysmorphic Disorder occurring in sociocultural context Self Schemas: MY APPEARANCE IS DEFECTIVE CAUSAL FACTORS: A BIOPSYCHOSOCIAL APPROACH

57. POSSIBILITIES: Reinforcement V/S Criticism for appearance( Neziroglu et al 2004) Empirical evidence tells that BDD patients show baised attention and interpretation of information relating to attractiveness( Buhlmann and Wilhelm 2004)

58. They attend to words like ugly or beautiful more as compared to other emotional words which are not related to appearance Secondly, BDD patients interpret facial expressions as contemptuous or angry.

59. STUDY DONE ON BDD INDIVIDUALS BY DIDIE ET AL, 2006 RESULTS:

60. Studies done by using fmri technology One more study by Feusner et al., 2010, 2011 BDD patients show deficits on task which measures executive functioning for e.g. manipulating information, planning and organization which are monitored by prefrontal brain regions.

61. TREATMENT OF BDD SSRI anti depressants like paroxetine and sertraline. Cognitive behavioral therapy

62. HOARDING DISORDER BURRIED ALIVE

63. Acquired as Well Inherited Acquired A Relative With Hoarding In Surroundings Suffered A Trauma Or Loss Inherited Genetic Researches Indicate Of A Unique Pattern Of Chromosome 14 Within Families Of Hoarding Vs Non-hoarding Relatives Of OCD

64. NEUROPSYCHOLOGICAL FINDINGS Decreased Cognitive Process Effecting Psychological Thought Process Lack In Attention Lack In Memory Lack In Decision Making Lack In Categorizing Possessions ,

65. NEUROIMAGING FINDINGS Researchers Brain Regions Activation Function Sanjaya Saxena Anterior Cingulate Cortex (ACC) Increased Activation Linked To Risk Assessment , Importance Of Stimuli And Emotional Decisions. David Mataix-cols Left Precentral Gyrus And Right Orbitofrontal Cortex Increased Activation Decision-making , Reward Processing, And Inhibition Ann Et Al. Ventromedial Prefrontal Cortex (VMPFC) Increased Activation Decision Making Tolin And Kiehl Left Lateral Orbitofrontal Cortex (OFC) Increased Activation Decision-making And Expectation

66. EXCORIATION AND TRICHOTILLOMANIA

67. PSYCHOLOGICAL FACTORS To Reduce Attractiveness Because Of Psychosexual Conflicts A Maladaptive Coping Mechanism SOCIAL FACTORS : Repressed Rage Of Children Against Authoritarian Parents. EXCORIATION AND TRICHOTILLOMANIA NEUROIMAGING FINDINGS Impaired Motor Inhibitory Control-Frontostriatal Circuit. Circuit Is Involved In The Suppression Of Inappropriate Behaviors

68. SELF HELP COPING STRATEGIES WITHIN DAILY LIVING

69. STEP 1:UNDERSTANDING AND IDENTYFIYING ANXIETY Fact #1 Normal and adaptive system of body indicating danger Fact #2 Considered a problem if indicating danger when there is none. Learn that worries, fear and physical feelings have a name anxiety.

70. STEP 2:UNDERSTANDING OCD Unhelpful meaning to Obsessions Thought-action fusion Inflated responsibility. Mental control failure. Perfectionism. Intolerance of uncertainty.

71. Build a fear ladder Climbing The Fear Ladder – Exposure & Response Prevention

72. TO THE OCD’S TAKE THAT FIRST STEP!