PSY240H1 Lecture 4: Lecture 4 pt 1
Wednesday, October 4, 2017
OCD and related Disorders:
OCD at a Glance
Occurs in all cultures, worldwide (although subtypes vary)
Rates are equal in men and women (although again subtypes vary)
Can start at any age, but typical age of onset is adolescence or early adulthood (childhood onset
is not rare, however). Although childhood onset isn’t rare, onset after 30 is rare. Most people do
not get an accurate diagnosis until much later.
Tends to be lifelong if left untreated
High degree of comorbidity (~90% of people of OCD will have one or more other disorder)
Commonly misdiagnosed (because in order to accurately asses OCD you have to have a good
rapport with the person because of embarrassment and sometimes part of the OCD is not telling
anyone about your OCD).
One of the top ten conditions causing impairment, according to World Health Organization
About 10 to 25% of people with OCD will attempt suicide.
Estimate by DSM that suicidal thoughts (not necessarily with intent) will be present in up to 50%
of OCD sufferers.
It often effects entire families (both in terms of feeling bad for the person with OCD and in terms
of the person suffering from OCD putting their compulsions/obss onto the families.
Why OCD was Formerly an Anxiety Disorder
Up until the DSM 5 it was considered an anxiety disorder.
OCD symptoms appear to overlap to a great degree with the main features of anxiety disorders !
– Excessive and Irrational fears
-Anxious Apprehension!
– Avoidance behaviour
OCD is highly commorbid with many of the anxiety disorders
>75% of people with OCD have been found to meet criteria for an anxiety disorder
Another difficulties with diagnosis: because often ppl just diagnose the anxiety disorder but not
the other parts.
OCD and anxiety disorders are maintained by the same psychological mechanisms, involving
cognitive distortions and negative reinforcement.
Anxiety disorders and OCD all respond well to exposure therapy.
36
Wednesday, October 4, 2017
Arguments for Moving OCD out of the Anxiety Disorders and Creating the OCRDs
Cardinal symptoms of OCD and the OCRDs are repetitive thoughts and behaviours, and a failure
of behaviour inhibitions.
In anxiety disorders it is not necessarily the same thought but the same theme (within social
anxiety for example) of thoughts but with OCRDs its more specific its the same thoughts.
OCD also has the compulsion aspect which distinguishes OCD from anxiety disorders.
However, the function of the repetitive behaviours in OCD and BDD is different from the body-
focused receptive behaviours (BFRBs).!
In OCD and BDD, behaviours are performed to reduce distress
In BFRBs, behaviours are often triggered by general tension, boredom, or habit. (There are
sometimes reasons of distress for performing these behaviours but not always).
Overlap between OCD and OCRDs in their age of onset, comorbidity, and family loading
hare brain circuitry and neurotransmitter abnormalities
Share similar treatment response profiles
OCD
Obsessive-compulsive related disorders:
– Body dysmorphic disorder
– Hoarding disorder!
– Trichollomania (hair-pulling disorder)
– Excoriaon (skin-picking) disorder
Body-focused receptive behaviours
Other specified obsessive-compulsive and related disorder
Unspecified obsessive-compulsive and related disorder
(Same thing as with anxiety)
Disorders characterized by etiology: !
– Substance/medication-induced obsessive-compulsive and related disorder !
– Obsessive-compulsive and related disorder due to another medical condition
!
(NEXT SLIDE HAS REVIEW CHART)
OCD
Prevalence estimate for OCD in a population is about 2.5%
37
Wednesday, October 4, 2017
One reason why its so important to know about OCD is because people always say “I’m so
OCD.” Which downplays people suffering greatly. So we should learn what it actually means to
be so OCD.
To be OCD you need:
Presence of obsessions:
Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and
unwanted, and cause marked anxiety or distress.
Attempts to ignore or suppress thoughts, urges, or images, or to neutralize (this term means:
sometimes people with OCD have this idea that when they have a thought they have to do
something to make that thought okay, so for example if you have a thought u will die alone u tap
your chair twice and then its okay). them with some other thought or action.
AND/OR
Presence of compulsions:
Repetitive behaviours or mental acts that the individual feels driven to perform in response to an
obsession or according to rules that must be applied rigidly.
Behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing
some dreaded event or situation; however, compulsions are excessive or are not realistically
connected to what they are designed to prevent. (So like the neutralization example above).
Symptoms are time-consuming or cause clinically significant distress or impairment
Not attributable to the physiological effects of a substance or another medical condition.
Not better explained by the symptoms of another mental disorder
So neutralizations can be small and like sayings where as compulsions are forms of
neutralizations which are more overt. In this vein, there are people who are diagnosed (or in
prof’s opinion) misdiagnosed with obsessional only OCD because they only have small
neutralizations and not overt compulsions. So thats why they have the AND/OR so those people
who essentially also have OCD (because their neutralizations serve the same purposes as
compulsions) wouldn’t meet criteria.
OCD Time-Consuming Criterion.
Only disorder in the DSM-5 that lists “time consuming” as a diagnostic criteria, in addition to
distress and impairment.
Helps to distinguish the disorder from occasional intrusive thoughts or receptive behaviours that
are common in the general population (e.g. double-checking that a door is locked).
A common bench-mark for OCD is that your obsessions and compulsions have to take up at least
one hour of your time every day.
38
1
PSY240H1 Full Course Notes
Verified Note
1 document
Document Summary
Occurs in all cultures, worldwide (although subtypes vary) Rates are equal in men and women (although again subtypes vary) Can start at any age, but typical age of onset is adolescence or early adulthood (childhood onset is not rare, however). Although childhood onset isn"t rare, onset after 30 is rare. Most people do not get an accurate diagnosis until much later. High degree of comorbidity (~90% of people of ocd will have one or more other disorder) Commonly misdiagnosed (because in order to accurately asses ocd you have to have a good rapport with the person because of embarrassment and sometimes part of the ocd is not telling anyone about your ocd). One of the top ten conditions causing impairment, according to world health organization. About 10 to 25% of people with ocd will attempt suicide. Estimate by dsm that suicidal thoughts (not necessarily with intent) will be present in up to 50% of ocd sufferers.
