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Anxiety Disorders continued.docx

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Mark Coates

Obsessive-Compulsive Disorder • A. Obsessions as defined by (1), (2), (3), and (4): • (1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress • (2) the thoughts, impulses, or images are not simply excessive worries about real-life problems • (3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action • (4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) • OR Compulsions as defined by (1) and (2): • (1) 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 rules that must be applied rigidly • (2) 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 • Either obsessions or cumplusions, you can have both or one or the other • Rare not to have both • Compulsions are behaviours- can be cognitive thoughts • Need to wash hands • Need to check door is locked • obsessions – cognitive thoughts • Have to make sure its not a real life worry – worrying about financial situation and you are in a bad place or worrying about school when your grades are low • Person wishes they didnt have these thoughts • If i dont wash my hands i will get sick • 4 is important for distinguishing from other disorders • Recognizes that these are their thoughts, they put them there, its there fault they have them • Someone else didnt put those thoughts there • Causes alot of stress and anxiety • Complusions reduce the anxiety • B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. • C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. • B. At some point the person recognizes they are excessive or unreasonable • Dont need to check the door for 20 mins in the morning • In kids they think they are actually doing something that protects them • C. Takes up alot of time/ imparing functioning • Cant go to work until 4 blue cars pass my house • Touch all 4 walls when entering a room • Washing hand so much layers of skin come out • Prevalence is estimated at 1.5-2.5% • Excessive belief in personal responsibility and guilt • Feel they must perform compulsive behaviour or bad things will happen to other people • Feel that negative unwanted thoughts can cause those negative events to happen (Thought-Action Fusion) • A lot of people have some ocd – some weird ritual thats not distressing so its not ocd • Though action fusion • Believe that if i think something it will cause it to happen • If i think something it means something aboout me • I have to wait for 4 blue cars to pass or else i will get in a car accident or my family members • Think there complusions benefit other people – prevents things from happening to other people • Feeel they have a responsibility/ weight on their shoulders • “knock on wood”, play-off beards – scared to shave it off bc if they do they will lose • We all believe in this a bit but not at ocd level • Unwanted thoughts are extremely common! • % female / % male in a non-clinical population: • Running car off road (64/56) • Hurting family member (42/50) • Scratching car paint (26/43) • Sex with unacceptable person (48/63) • Thinking of a stranger naked (51/80) • Jumping off high place (39/46) • Most people quickly dismiss these thoughts and don't act on them • Patients with OCD feel that their behaviour and thoughts are fused, therefore an immoral thought is the same as an immoral behaviour • It is exceptionally and paradoxically difficult to block specific thoughts • Every now and then we all have thoughts that pop in our head we shouldnt be thinking of • People with ocd cant control there thoughts as much, if they randomly think of hurting a stranger they think they will hurt them or the stranger will be hurt, cant stop thinking about it, need to do a complusion to stop it • They think if they have an inappropriate thought they are an inappropriate person • Neurological differences might account for some OCD symptoms • The basal-ganglia are involved in motor planning and movement, reward, and instrumental learning • The frontal lobes are involved in inhibition and behavioural control • Low memory confidence • Cognitive theories emphasize catastrophic thinking about intrusive thoughts, and reinforcement of compulsions (because the feared events don't happen!) • Basal-ganglia: • Memory and memory from movement – ocd has less activity in that part of brain, if they think back to whether they locked the door or not its not there • Low memory confidence – less able to remember if they locked the door or turned off stove • Frontal lobes have trouble stopping compulsive disorders • Exposure with response pervention – stop them from doing the complusion and observe what actually happens • Bring in a tray of dirt and have them put there hands in the dirt, show them nothing bad happens • Compulsions a lot less specific in kids • Adults have very specific routine they have to do • A kid will wash there hands for 15 mins • Adults will wash only with a certain kind of shop, only new bars, have to open the soap a certain way, etc • Learn specific compulsions from family, society, etc • Subtypes of OCD: • Contamination • Checking • Hoarding • Ordering/Symmetry • In DSM5, OCD may be moved to a separate category with other related disorders (trichotillomania, hoarding disorder, body dysmorphic disorder) • Checking: fear ive left door unlocked, stove on, etc • Ordering: things lined up in certain way, need to stand in middle of room, touch all four corners • Hoarding: trouble throwing things away, strong emotional attachments to things that dont have a purpose • Trichotillomania : complusive hair pulling • Connection between ocd and eating disorders • Resticting eatings • Compulsive exercising • Considered a separate disorder though cause everyone has to eat to survive Post Traumatic Stress Disorder • Exposure to a traumatic event, leading to persistent re-experiencing, avoidance of stimuli associated with the trauma, and increased arousal • PTSD is interesting because it is one of only three psychiatric illness in the DSM-IV-TR where the etiology is part of the diagnostic criteria • Very common • Requires serveral different parts • Have to have been exposed to traumatic event for it to be PTSD • A. The person has been exposed to a traumatic event in which both of the following were present: • (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others • (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior • B. The traumatic event is persistently reexperienced in one (or more) of the following ways: • (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are • expressed. • (2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. • (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In
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