Obsessive Compulsive Disorder

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Obsessive Compulsive Disorder. Features of OCD. Obsessions Recurrent and persistent thoughts; impulses; or images of violence, contamination, and the like intrusive and distressing Individual tries to ignore, suppress, or neutralize Compulsions - PowerPoint PPT Presentation

Transcript of Obsessive Compulsive Disorder

  • Obsessive Compulsive Disorder

  • Features of OCDObsessionsRecurrent and persistent thoughts; impulses; or images of violence, contamination, and the likeintrusive and distressingIndividual tries to ignore, suppress, or neutralizeCompulsionsRepetitive behaviors individual feels driven to performRitualistic/need to follow a set of rulesIntended to prevent or reduce distress or some dreaded event

  • DSM-IV CriteriaSee webpage

  • OCD FeaturesData from the Epidemiological Catchment Area (ECA) survey found a 6-month point prevalence of 1.6% and a lifetime prevalence of 2.5% in the general populationSex ratio is 1:1.1 (men to women)Mean age of onset is 20.9 years (SD=9.6) Males is 19.5 years (SD = 9.2) Females is 22.0 years (SD = 9.8) Most develop their illness before the age of 25 Symptoms can be remembered as far back as the onset of puberty.

  • ComorbidityMajor depression is the most common comorbid disorder 1/3 have concurrent MDD 2/3 have a lifetime history of MDD Other Axis I disorders include panic disorder with agoraphobia, social phobia, generalized anxiety disorder, Tourettes syndrome, trichotillomania, schizophreniaAxis I comorbid disorders can effect the severity and treatment of OCD.

  • ComorbidityObsessive-compulsive personality disorder (OCPD) is an Axis II disorder. OCPD differs from OCD by the lack of true obsessions and compulsions. OCPD behaviors are ego-syntonic, whereas OCD is ego-dystonic

  • More featuresTypes of ObsessionsAggressive obsessions Contamination obsessions Sexual obsessions Hoarding/saving obsessions Religious obsessions Symmetry/exactness Somatic obsessions

  • Types of compulsionsCleaning/washing compulsions Checking compulsions Repeating rituals Counting compulsions Ordering/arranging Hoarding/collecting Mental rituals

  • Most people experience intrusive thoughts throughout their lifeIndividuals who develop OCD may react more negatively to their intrusions

  • Neurobiology/physiologyNo chronic hyperarousalOver activation of the orbitofrontal cortex (thought generation) and under activation of the caudate nuclei (thought suppression)

  • PsychosocialLearningAnimal modelsHigh stress or repeated frustration leads to increase in ritualistic-like behaviorsFixed action pattern- innate and adaptive behavioral sequences to specific stimuliBiological preparednessWashing and checking may have once promoted survival

  • Cognitive deficitsIncreased attention allocated to fear related stimuliTend to encode negative stimuli more indepth than neutral and positive stimuli, leading to better memory for negative stimuliOverattention to detailh

  • Cognitive theory of OCD Obsessional thoughts:If obsessions occur frequently in normal populations, why dont most people suffer from OCD?Its not the thought itself that is disturbing, but rather the interpretation of the thought. Example: having an unacceptable sexual thought leads to beliefs that the person is depraved, perverted, abnormal, evil, etc., which leads to affective states such as anxiety and depression.The issue of responsibility is believed to be a core belief or cognitive distortion of people with OCD.

  • Compulsive behaviors:Neutralizing, either through compulsive behaviors or mental strategies, is aimed at preventing terrible consequences, or averts the possibility of being responsible Seeking reassurance is another form of neutralizing, as it can serve to spread responsibility to others, thus diluting that of the individual Avoidance, though not an overt neutralizing behavior, is often used to prevent contact with particular stimuli

  • Model:Stimuli in the form of unpleasant intrusive thoughts, of either external or internal origins are experiencedThe thought is ego-dystonic, that is, it is inconsistent with the individuals belief systemThe NAT usually involves an element of blame, responsibility, or control, which interacts with the content of the intrusive thoughtDisturbances in mood and anxiety follow, which in turn lead to neutralizing behavior

  • There are three main consequences of neutralizing behaviorIt results in reduced discomfort, which leads to the development of compulsive behavior as a tool for dealing with stress. This reinforcing behavior may result in a generalization of this strategyNeutralizing will be followed by non-punishment, and can lead to an effect on the perceived validity of the beliefs (NAT)The neutralizing behavior itself becomes a powerful and unavoidable triggering stimulus. The neutralizing behavior serves to reinforce the belief that something bad may happen

  • TreatmentCBTExposure and response prevention was first used by Meyer in 1966The principle behind EX/RP is to expose the individual to the triggering stimuli (obsession) and block the neutralizing behaviorAs a result, the individual learns:Anxiety is temporary The feared catastrophic consequence never transpiresTheir interpretation of the obsession weakensObsessional thoughts are harmless Imaginal exposure is also used when in-vivo is not possible

  • Components of EX/RPGroup treatment is comprised of 2 individual sessions and 12 group sessionsIndividual treatment is also time limited and comprises approximately 12 to 14 sessionsPsychoeducationPre-treatment assessment of severity of OCD and depressionHierarchy construction and explanation of SUDS

  • Treatment session:Homework reviewIn-vivo exposure and response prevention, including monitoring SUDS levelReview of exposureHomework assigned and next sessions exposure discussedTermination sessionFollowing a time limited (12-weeks) CBT approach, symptom reduction is maintained

  • Problems with CBT25% of people refuse to engage in CBTCBT alone is ineffective when there is a severe comorbid major depression, over valued ideation, tic disorder, schizoid personality disorderThere is limited availability of therapists trained in CBT for OCD

  • PharmacotherapySerotonin (5-HT) neurotransmission abnormalities have been implicated in the pathophysiology and treatmentAntidepressant medications of the Serotonin Reuptake Inhibitor classification and specific tryciclic antidepressants (Clomipramine) have been proven to be effective in the treatment of OCD

  • Currently there are 6 SRIs that are FDA approved for the treatment of OCDClomipramine (Anafranil)Fluoxetine (Prozac)Fluvoxamine (Luvox)Paroxetine (Paxil)Sertraline (Zoloft)Citalopran (Celexa)The goal of a SRI is to increase the level of 5-HT transmission within the synapse