Psychopathology of ocd and bdd

it contains most of the psychosocial formulation theories that explain the OCD and BDD.

1. PSYCHOPATHOLOGY OF Mr. VARUN MUTHUCHAMY Ms. RASHI Dr. NITIN ANAND OCD BDD &

2. OCD

3. Obsessive-Compulsive Disorder OBSESSION : Obsessions are an unwanted intrusive thought, doubt, image or impulse/urge that repeatedly enters a person’s mind.. COMPULSION : Repetitive behaviours or mental rituals, governed by specific rules that the individual feels compelled to perform.

4. Obsessive-Compulsive Disorder Compulsive act could be attributed to neutralize the distress caused by obsessions. Compulsive act must be non-pleasure and it is characterised by tension relief. Ego-Dystonic

5. Diagnostic Guidelines Obsessional Sx or Compulsive acts or both must be present on most days for at least 2 successive weeks and be a source of distress. The obsessional Sx should have the below characteristics (a) Recognized as own thought. (b) At least one thought or act that is still resisted unsuccessfully. (c) The thought of carrying out the act must not itself be pleasurable. (release of tension and not a pleasure) (d) The thoughts, images or impulses must be unpleasantly repetitive.

6. Psychopathology of OCD: Psychodynamic Perspective Learning theory ( Mowrer’s two factor, 1939) Clark, 2004 Salkovskis et al, 1996 Rachman,1997 Manchin , 2004

7. Psychodynamic Theory Obsessional thought= I ntrapsychic conflicts Obsessional thought= Defensive responses to unconscious impulses Mother-Infant interaction during anal phase is the critical phase. Early and extreme toilet training are perceived as hostility and child experiences lack of autonomy and aggression. To deal with those experiences child utilises defences like reaction formation, isolation and undoing.

8. Psychodynamic Theory ( Cont …) Adler: OCD as compensation for feeling’s of inferiority and incompetence. Denied chance to develop sense of competence leads to the devp of inferiority. Unconscious adoption of rituals happens to deal with the inferior feeling. Rituals in form of excessive cleaning, checking or other forms. These rituals will later develops as compulsions.

9. Learning Theory (Mowrer’s,1939) Mowrer’s theory Combination of Classical and Operant Conditioning. Dollard and Miller adopted Mowrer’s theory to explain OCD. 1) Neutral stimuli attains quality of distress stimuli through the association with pain/fear. 2) Behaviour are learnt to reduce distress. (Escape and Avoidance) In OCD these escape and avoidance takes a form of rituals and compulsions.

10. Clark’s Theory Levels in processing. -Vulnerable -Primary appraisal -Secondary appraisal. Focuses on cognitive control of thoughts. Efforts to control the intrusive thoughts gone vain and greater efforts are exerted to resolve dystonicity.

11. Salkovskis Theory Healthy Indi. feels responsible for their thought and action but Pt. with OCD will have Inflated sense of responsibility. “feeling that one has the power to cause or prevent negative outcomes that are perceived as highly probable to the patient” Psychological risk factors are the basis for the development of the belief of inflated responsibility. This belief has to interact with life events, prolonged stress and depressed moods to cause a OCD

12. Contd … Salkovskis proposed that intrusions develop into obsessions only when the individual appraises the intrusions as posing a threat for which he or she is personally responsible.

13. Rachman’s Theory This theory extends further from the inflated sense of responsibility and also addresses other factors also. Obsessions can also be a resultant of any misinterpretation that the intrusive thought is personally significant, revealing, threatening, or even catastrophic.

14. Mancini’s Theory The obsessed subject is more concerned about the correctness of his performance than of the result ; he concerns about preventing the possibility of feeling guilty of not having doing his duty . For this reason he focuses on the obsessive repetition of a particular activity .

15. Mancini’s Theory

16. BDD

17. Body Dysmorphic Disorder Dysmorphophobia , derived from dysmorfia ( greek word= facial ugliness). Prevalance : 1.9-2.5% in female 1.4-2.2% in male Condition which ppl believe they are physically deformed or ugly in a socially noticeable fashion, despite normal appearance. (Phillips, 1991) Initially was categorized under somatoform and later to OCDS in DSM

18. Body Dysmorphic Disorder DIAGNOSITIC CRITERIA: (DSM-5) Preoccupation with one or more alleged deformities or imperfections in appearance that are not perceivable by others, or are considered insignificant by them. At a certain moment during the course of the disorder, the person concerned performed repetitive actions in response to the anxiety about appearance (such as checking himself in the mirror, taking care of excessive appearance, tapping the skin, or asking for peace) or psychological activities. performed (such as comparing one's own appearance with that of others). The preoccupation causes clinically significant suffering or limitations in social or occupational functioning or in functioning in other important areas. The preoccupation with the appearance can not be explained better by the worries about body fat or weight in someone whose symptoms meet the criteria for an eating disorder . + ICD-10

19. Comparing OCD and BDD Obsessions and compulsions . (Focus) Level of insight. OCD (66-85%), Delusional Level (2-3%). BDD (Delusional Level Insight=32-39 %). Delusion of reference (others are noticing defective part) in nearly two-third of the patient. Suicide OCD= 36% ideation with 11% attempt BDD= 80% ideation with 28% attempt

20. Neziroglu’s model, 2004 1. Childhood operant conditioning: Early experiences which positively reinforce an individual for physical appearance may play an important role in BDD development. “Physical appearance were highlighted than performance” “abused or trauma produced marks” 2 . Social learning: Vicarious learning occurs by observing others being reinforced positively or negatively for a particular belief or behaviour. “Physical attractiveness leads to rewards”

21. Neziroglu’s model, 2004 3 . Symptom development through classical and evaluative conditioning: UCS (Teasing)  UCR (anxiety, depression) + CS (normal commenting about nose)  CR (anxiety, depression )

22. CBT model of BDD (David Veale, 2003) -Initiates in front of reflection. -Process of selective attention begins results in heightened awareness and exaggeration of certain features . -Distorted Mental Image about own body. -Appraisal by comparing 3 diff. images. -Uncertain and leads to increased behv .

23. CBT model of BDD (David Veale, 2003) -Longer the person faces mirror, worse he feels and belief of ugliness and defect is reinforced. -Not facing the mirror= focus on internal body image and starts ruminate. -Discrepancy among 3 diff images leads to depressed mood and negative thoughts.

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