Chapter 7. Obsessive-Compulsive-Related And Trauma-Related Disorders

Front 1

Obsessions

Back 1

Intrusive and unwanted thoughts, urges, or images that persist or recur and usually cause distress or anxiety.

Front 2

Compulsions

Back 2

Repetitive behaviors or mental acts that a person feels driven to carry out and that usually must be performed according to rigid “rules” or correspond thematically to an obsession.

Front 3

Obsessive-compulsive disorder (OCD)

Back 3

A disorder characterized by one or more obsessions or compulsions.

Front 4

types

Back 4

contamination --washing

order -- ordering

fear of losing control -- counting backwards if you feel like screaming 'penis' at a funeral

doubts about whether the patient performed an action. -- Checking if the stove was turned off

Front 5

Comorbidity

Back 5

over 90% of those with OCD have another disorder, with the most frequent categories of comorbid disorders being mood disorders (63%) and anxiety disorders (76%).

Front 6

Body dysmorphic disorder

Back 6

A disorder characterized by excessive preoccupation with a perceived defect or defects in appearance and repetitive behaviors to hide the perceived defect.

Front 7

Gender Differences of Body dysmorphic disorder

Back 7

body dysmorphic disorder affects both genders with approximately equal frequency, but men and women tend to differ with regard to the specific body parts they view as defective (Phillips, Menard, & Fay, 2006): Women are preoccupied with body weight, hips, breasts, and legs and are more likely to pick their skin compulsively. In contrast, men are preoccupied with body build, genitals, height, excessive body hair, and thinning scalp hair.

Front 8

explain

Back 8

when the frontal lobes trigger an action, there is feedback from the basal ganglia, in part via the thalamus (a brain structure involved in attention). Sometimes this feedback sets up a loop of repetitive activity, as shown inFigure 7.1

Front 9

OCD appears to arise in large part because brain circuits don’t operate normally, but why don’t they do so?

Back 9

One reason may be that people with OCD have too little of the neurotransmitter serotonin, which allows unusual brain activity to occur (Mundo, Richter, et al., 2000). And, in fact, medications that increase the effects of serotonin (such as Prozac), often by preventing reuptake of this neurotransmitter at the synapse (see Chapter 5), can help to treat OCD symptoms

Front 10

Behavioral Explanations: Operant Conditioning and Compulsions

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Operant conditioning occurs when the behavior is negatively reinforced: Because the behavior (temporarily) relieves the anxiety, the behavior is more likely to recur when the thoughts arise again

Front 11

Cognitive Explanations: Obsessional Thinking

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One theory about how a normal obsession becomes part of OCD is that the person decides that his or her thoughts refer to something unacceptable, such as killing someone or, as was the case with Howard Hughes, catching someone else’s illness

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Social Factors

Two types of social factors can contribute to OCD:

Back 12

Stress--one study found that people with more severe OCD tend to have more kinds of family stress and are more likely to be rejected by their families (Calvocoressi et al., 1995). Note, however, that thedirection of causation is not clear:

Culture--culture and religion can help determine the particular content of some obsessions or compulsions

Front 13

Medication

Back 13

An SSRI is usually the type of medication used first to treat OCD:

OCD can also be treated effectively with the TCA--clomipramine (Anafranil), although a higher dose is required than that prescribed for depression or other anxiety disorders

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Behavioral Methods: Exposure With Response Prevention

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A behavioral technique in which a patient is carefully prevented from engaging in his or her usual maladaptive response after being exposed to a stimulus that usually elicits the response.

Front 15

According to DSM-5 (American Psychiatric Association, 2013), a trauma-related disorder is marked by four general types of persistent symptoms after exposure to the traumatic event:

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Intrusive re-experiencing of the traumatic event. Intrusion may involve flashbacks that can include illusions, hallucinations, or a sense of reliving the experience, as well as intrusive and distressing memories, dreams, or nightmares of the event.

Avoidance. The person avoids anything related to the trauma.

Negative thoughts and mood, and dissociation.Symptoms include persistent negative thoughts about oneself or others (“no one can be trusted”), persistent negative mood (fear, for instance, and difficulty experiencing positive emotions), and dissociation (a sense of feeling disconnected or detached from experiences).

Increased arousal and reactivity. Arousal and reactivity symptoms include difficulty sleeping, hypervigilance, irritable behavior, angry outbursts, and a tendency to be easily startled (referred to as a heightened startle response).

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Among the trauma-related disorders in DSM-5 are:

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acute stress disorder, which is the diagnosis when some of the above symptoms emerge immediately after a traumatic event and last between 3 days and 1 month;

posttraumatic stress disorder (PTSD), which requires a certain number of symptoms from each of the four groups mentioned above, and the symptoms last more than 1 month.

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what constitutes a traumatic event? The answer, according to DSM-5, is an event that involves:
***study

Back 17

directly experiencing actual or threatened serious injury, sexual violation, or death;

witnessing (in person) actual or threatened serious injury, sexual violation, or death;

learning of a violent or accidental death or threatened death of a close family member or friend; or

experiencing extreme exposure to aversive details about the traumatic event (as might occur for first responders).

Note that according to the DSM-5 definition, emotional abuse is not a traumatic event because it does not involve actual or threatened physical injury or death.

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Several factors can affect whether a traumatic event will turn into a disorder

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The kind of trauma. Trauma involving violence—particularly intended personal violence—is more likely to lead to a stress disorder than are natural disasters

The severity of the traumatic event, its duration, and its proximity. Depending on the specifics of the traumatic event, those physically closer to it—nearer to the primary area struck by a tornado, for example—are more likely to develop a stress disorder (

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Posttraumatic stress disorder (PTSD)

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is diagnosed when people who have experienced a trauma persistently

(a) have intrusive re-experiences the traumatic event,

(b) avoid stimuli related to the event,

(c) have negative changes in thoughts and mood associated with the traumatic event, and

(d) have symptoms of reactivity and hyperarousal; all of these symptoms must persist for at least a month

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Gender Differences

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Women who have been exposed to trauma develop PTSD more often than do men, although males are more likely be victims of trauma (Tolin & Foa, 2006).

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Acute stress disorder

Back 21

A traumatic stress disorder that involves

(a) intrusive re-experiencing of the traumatic event,

(b) avoidance of stimuli related to the event,

(c) negative changes in thought and mood,

(d) dissociation, and (e) hyperarousal and reactivity, with these symptoms lasting for less than a month.

Front 22

how many asd --> ptsd

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three-quarters of people with acute stress disorder go on to develop PTSD

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The neurological factors that contribute to PTSD include:

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include overly strong sympathetic nervous system reactions and abnormal hippocampi.

In addition, the neurotransmitters norepinephrine and serotonin have been implicated in the disorder, and there is evidence that genes contribute to (but by no means determine) the likelihood that experiencing trauma will result in PTSD.

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hippocampi? watsup

soldier gene study
***important

Back 24

the hippocampus apparently must work harder than normal in PTSD patients when they try to remember information, as shown by the fact that this brain structure is more strongly activated in these patients during memory tasks than in control participants

PTSD patients have trouble recalling autobiographical memories

this study, researchers compared the sizes of the hippocampi in veterans who had served in combat and had PTSD with the sizes of hippocampi in their identical twins who had not served in combat and did not have PTSD.

In both twins, the hippocampi were smaller than normal (Gilbertson et al., 2002). This finding implies that the trauma did not cause the hippocampi to become smaller, but rather the smaller size is a risk factor

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Two specific beliefs that can make a person vulnerable to developing PTSD are ...

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considering yourself unable to control stressors (Heinrichs et al., 2005; Joseph et al., 1995) and the conviction that the world is a dangerous place (Keane, Zimering, & Caddell, 1985; Kushner et al., 1992).

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Hurricane Paulina in Mexico and Hurricane Andrew in the United States were about equal in force, but the people who developed PTSD afterward did so in different ways (

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Mexicans were more likely to have intrusive symptoms, such as flashbacks about the hurricane and its devastation, whereas Americans were more likely to have arousal symptoms, such as an exaggerated startle response or hypervigilance (Norris et al., 2001).

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first-line medications for treating the symptoms of PTSD (

Back 27

The SSRIs sertraline (Zoloft) and paroxetine (Paxil)

can also help reduce comorbid symptoms of depression (Hidalgo & Davidson, 2000)—which is important because many people with PTSD also have depression.

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Eye Movement Desensitization and Reprocessing (EMDR)

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The phase of the treatment most similar to exposure therapy has the client think about the disturbing visual images or beliefs about the trauma while “moving the eyes from side to side for 15 or more seconds” as the therapist moves his or her fingers back and forth (

Randomized trials comparing EMDR to exposure therapies have found little to no differences in outcomes for the two treatments (