ObsessiveCompulsive Disorder OCD

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Obsessive-Compulsive Disorder (OCD)

• Characterized by obsessive thoughts and
  compulsive behaviors that arise as a consequence
  of those thoughts.
• Thoughts may appear delusional or have a
  psychotic quality however, unlike individuals
  with a psychotic disorder, individuals with OCD
  are aware of how irrational their thoughts are.

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OCD

• Begins at a young age (for men, 6 to 15, and for
  women, 20 to 29).
• Usually a gradual onset.
• 1 to 3 of people will develop OCD in their
  lifetime.
• Chronic course and often very debilitating.

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OCD diagnostic criteria

• Either obsessions or compulsions
• Obsessions as defined by all of the following
• Recurrent and persistent thoughts, impulses, or
  images that are experienced as intrusive and
  inappropriate and that cause distress and
  anxiety.
• Thoughts, impulses, or images are not simply
  excessive worries about real life problems.
• The person attempts to ignore or suppress such
  thoughts, impulses, or images, or to neutralize
  them with some other thought or action.
• The person recognizes that the obsessional
  thoughts, impulses, or images are a product of
  his or her own mind.
• Contamination, aggression, sexual, blasphemy,
  doubts

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OCD diagnostic criteria

• Compulsions as defined by all of the following
• Repetitive behaviors (e.g., hand washing,
  ordering, checking) or mental acts (e.g.,
  praying, counting, repeating words silently) that
  the person feels driven to perform in response to
  an obsession or according to particular rules.
• The behaviors or mental acts are aimed at
  preventing or reducing distress or preventing
  some dreaded event or situation however, these
  behaviors or mental acts either are not connected
  in a realistic way with what they are designed to
  neutralize or prevent or are clearly excessive.
• Obsessions and Compulsions are viewed as
  unreasonable.

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Theories of OCD

• Most prominent psychological theory of OCD is
  cognitive-behavioral in nature.
• Obsessions are caused by catastrophic
  misinterpretation of the significance of
  intrusive thoughts/images/impulses.
• Through this catastrophic misinterpretation,
  neutral cues in the environment or internally are
  turned into threatening ones, leading to
  avoidance (compulsions).

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Theories of OCD

• As a result of this avoidance, catastrophic
  misinterpretations are never challenged and thus
  persist. However, relief is achieved in the short
  term (compulsions negatively reinforced).
• Attempts are made to avoid, neutralize, or
  suppress obsessions, leading to a vicious cycle.
• Obsession ? Neutralization ? Relief ?
  Confirmation of belief ? Obsession

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Treatment

• Cognitive Restructuring and Exposure
• Response prevention ? prevent the use of
  compulsions to manage obsessive thoughts. In
  doing so, individual may habituate to anxiety as
  a result of obsessions and obsessions can be
  disconfirmed.

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Social Anxiety Disorder

• Persistent fears of situations involving social
  interaction or social performance or situations
  in which there is the potential for scrutiny by
  others.
• More than 13 of the population meet criteria for
  SAD at some point in their lives.
• More than just shyness.
• Generalized (most social situations),
  Non-generalized (limited to specific situations)

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Model of SAD

• Underlying beliefs that people are critical.
• Poor mental representation of the self,
  especially in social situations.
• Misinterpretation of internal (blushing) and
  external cues that negatively influence the
  mental representation of the self.

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A Model of SAD

• Attentional bias for negative cues (e.g.,
  frowning, yawning) that confirm maladaptive
  beliefs about the self and performance.
• All of this information is used to create a
  prediction of what the audience expects and how
  the individual is performing. With SAD, there is
  a huge discrepancy between these two evaluations.

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Treatment

• Again, cognitive-behavioral treatment has been
  found to be highly effective for SAD.
• Cognitive restructuring for maladaptive beliefs
  about the self, performance expectations, and
  interpretations of audiences behavior.
• Exposure to social situations.
• Attentional control training.

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Generalized Anxiety Disorder (GAD)

• Newest anxiety disorder diagnosis to be
  studied.
• Until recently (1994), little was known about the
  disorder or how it can be separated from other
  anxiety disorders.
• May be considered the basic anxiety disorder.
• At any point in time, 1.6 of the population have
  GAD. Lifetime prevalence of 5.1.
• Higher rates among African-American females (3.5
  current and 14.5 lifetime).

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GAD

• More common among women.
• Earlier age of onset than most anxiety disorders.
• Although some studies find it to be more
  prevalent among older populations.
• Persists for a long period of time low
  remission rate left on its own or following
  treatment.

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GAD Symptoms

• Excessive anxiety and worry for at least 6 months
  (realistic worry).
• Difficulty controlling the worry.
• Associated with at least 3 symptoms (e.g.,
  restlessness, fatigue, difficulty concentrating,
  irritability, muscle tension, sleep disturbance).

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Worry

• Defining feature of GAD.
• Individuals with GAD worry about many of the same
  topics as those without an anxiety disorder it
  is just more frequent, excessive, and
  uncontrollable.
• May serve to avoid anxiety (worry is associated
  with decreased physiological arousal).

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Theories of GAD

• Psychodynamic Theories Occurs when our defense
  mechanisms can no longer contain our id impulses
  or neurotic anxiety.
• Cognitive Theories
• Maladaptive beliefs (e.g., I must always be
  prepared I must be liked by everyone, etc.).
  Tendency to misinterpret ambiguous situations as
  threatening.
• Intolerance of uncertainty ? GAD individuals
  believe that worry will help them prepare for
  future negative events. Worry is an attempt at
  control.
• Meta-worry Worry about worry (negative
  appraisals of worry).

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Theories of GAD

• Behavioral
• Worry as avoidance of anxiety and thus negatively
  reinforced (however, anxiety is never fully
  approached and habituation does not occur).
• Worry also may function to avoid other, more
  emotionally distressing topics.
• Emotion-Regulation Model of GAD (Mennin et al.,
  2005)
• Individuals with GAD experience emotions more
  intensely (vulnerability) and have a poor
  understanding of their emotions, making them
  frightening and aversive.
• This perception of emotions as aversive leads to
  attempts to avoid them through worry.

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Treatment

• Cognitive-behavioral treatment
• Cognitive restructuring
• Designating a time for worry
• Progressive muscle relaxation
• Mindfulness- and acceptance-based treatments
• GAD is future-focused increase present moment
  living through mindfulness
• Decrease avoidance through acceptance
• Increase value-driven living