Anxiety Disorders

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Anxiety Disorders

• Obsessive Compulsive Disorder (OCD)

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Obsession and Compulsions

• Obsession Unwanted repetitive intrusive
  thoughts, images or urges
• Compulsion Repeated thoughts or actions designed
  to provide relief

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Relationship between Compulsion and Obsession

• The most common obsession- germs and dirt is
  related to the most common compulsion handwashing
• Obsessions create considerable anxiety
• Compulsions are an attempt to cope with the
  anxiety.
• Repeating rituals (second most common compulsion)
  is often a way-in their mind-to avoid harm (eg.
  step on the crack game)
• Children recognize that compulsions are
  unreasonable and will attempt to hide the
  behavior with nonfamily members

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Normal Intrusive Thoughts

• Harming
• Impulse to jump out of a high window
• Idea of jumping in front of a car
• Inpulse to push someone in front of train
• Wishing a person would die
• Thought that if I forget to say goodbye to
  someone, they might die
• Thought that thinking about horrible things
  happening to a child might cause it

• Contamination or Disease
• Thought of catching a disease from public pools
  or other public places
• Thoughts I may have caught a disease from
  touching toilet seat
• Idea that dirt is always on my hand

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Normal Intrusive Thoughts (cont).

• Inappropriate or Unacceptable Beh.
• Idea of swearing or yelling at my boss
• Thought of doing something embarrassing in
  public, like forgetting to wear a top
• Hoping someone doesnt succeed
• Thought of blurting out something in church
• Thought of unnatural sexual acts

• Doubts about Safety, Memory Etc.
• Thought that I havent locked the house up
  properly
• Idea of leaving my curling iron on the carpet and
  forgetting to pull out the plug
• Thought that Ive left the heater and stove on
• Idea that Ive left the car unlocked when I know
  Ive loced it
• Idea that objects are not arranged perfectly

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Common Obsessions(Judith Rapoport)

• Dirt and germs (40)
• Something terrible happening ((24)
• Symmetry, order, exactness (17)
• Religious obsessions (13)
• Concern or disgust with bodily waste (8)
• Lucky or unlucky numbers (8)

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Common Compulsions (Raporport)

• Excessive or ritualized handwashing, showering,
  bathing, toothbrushing or grooming (85)
• Repeating rituals (going in or out of a door, up
  or down from a chair (51)
• Checking doors locks, appliances, paper route,
  homework 46)
• Rituals to remove contact with contaminants (23)
• Touching (20)
• Measures to prevent harm to self or others (16)
• Ordering or arranging (17)
• Counting (18)
• Hoarding or collecting rituals (11)

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OCD Diagnostic Criteria

• A. Either obsession or compulsions
• B. Recognition that obsessions or compulsions are
  excessive or unreasonable (does not apply to
  children)\
• C. The obsession or compulsions cause marked
  distress, and are time consuming (take over one
  hour a day) or significantly interfere with the
  persons normal functioning
• D. If another Axis I disorder is present, the
  content of the obsession or compulsion is not
  restricted to it (preoccupation in food in eating
  disorder, concern with drugs in Substance Abuse
  disorder)
• E. The disturbance is not due to the direct
  effects of drugs, medication or a physical
  condition
• Specifier With poor insight if, most of the
  time, the person does not recognize the
  obsessions and compulsions are unreasonable

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OCD Prevalence

• 2.6 (may be a bit of an overestimate)
• 10 to 15 of normal college students engage in
  clinically significant checking behavior
• More common in females (reversed in childhood)
• Age of onset is in teens to young adulthood
• Chronic course

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Etiology OCD Biological Explanations

• Neurotransmitter (low serotonin)
• Brain structures/areas

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Etiology OCD Cognitive Behavioral-Cognitive
Explanations

• Cognitive
• Early life experiences with dangerous or
  unacceptable thoughts
• OCD patients equate thoughts with actions
  (thought action fusion)

• Behavioral-Cognitive
• Random association of compulsion with a reduction
  in anxiety (superstitious behavior gone amuck)
• Any personal examples?
• How did they begin?

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OCD Treatment

• Medication SSRIs (serotonin reuptake inhibitors)
• Average treatment gain with medication is
  moderate and relapse occurs when medication is
  discontinued
• Exposure and ritual prevention (ERP)
• Psychosurgery