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Lecture 6

Lecture 6-OCD and Social Phobia Feb 26

Course Code
Neil Rector

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Lecture 6: obsessive compulsive disorder and social phobia (February 26th 2008)
Obsessive compulsive disorder (OCD)
Î Obsessions: recurrent and intrusive thoughts, images or urges causing marked anxiety
o E.g. contamination fears, doubting, disturbing sexual thoughts.
Î Compulsions: repetitive behaviors or mental acts to reduce anxiety
o E.g. washing, checking, and ordering
o Purpose is to turn off the anxiety caused by the obsessions
Î Common obsessions
o Contamination
E.g. excessive concern with dirt or germs. Fear of dirty parts of towns, kisses,
germs, blood, saliva
o Doubting
E.g. fear of responsibility for fire, burglar. Like fear of not locking the doors,
appliances, interpersonal themes (did I say the right thing?)
o Aggressive
E.g. thoughts of strangling children. Violent or horrific images, fear of harming
o Sexual
E.g. sexual themes around children or incest
o It has to be ego distonic it has to be inconsistent with who the person seems to be.
o ^}uµv^/l]oo}u}vUµv[uu_Uo]P]}µ}vUZ}]vP}vX
Î Common compulsions
o Cleaning/washing
E.g. excessive or ritualized handwashing
Avoiding shaking hands
o Checking
E.g. checking locks, stoves appliances. Always checks to see if they actual locked
the door. About 4-8 times
o Avoidance
Overt: avoidant behavior
x E.g. avoiding contact with knives
Covert neutralizing thoughts
x E.g. undoing bad thoughts with good thoughts
Î Majority of patients have more one type of OCD obsession. The most common ones in
contamination and washing
Î Repeating is rereading until understanding something perfectly.
Î Subgroups of OCD
o Contamination
o Doubt
o Order
o Pure obsessions (sexual
Î Epidemiological research: OCD
o Life time prevalence: 2.6 %
o Gender differences: 55-60% women
o Age of onset:
Early adolescene to mid-twenties

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Earlier in men (13-15 years) than women (20-24 years)
Î Course of OCD
o Continuous and unchanging (27.4%)
o Continuous with deterioration (9.2%)
o Continuous with improvement (24.4%)
o Episodic with partial remission (24.4%)vit can come and go
o Episodic with full remission (11.3%)vexperience OCD and then turn off completely
Î Behavioral Model for OCD
Neutral event----------------traumatic event
--------------- Media information
Vicarious experience
Anxiety increases
Rituals, avoidance negative reinforcement strengthens obsessions
Anxiety decreases
Provocation of anxiety and compulsive cleaning urges (n=11)
Î Anxiety rating very low, start and then obsession increases anxiety and then ritual came down. If
lK}o}µZv]v]Çµlv}v[oZy then watch the urge to wash
and act in the ritualvwithin an hour anxiety decreased. This lead to the development of OCD
treatment is to expose them gradually to obsession. E.g. get them to leave the house without
checking. The goal is to get the client to know the triggers and then get them to overcome it.
Expose them and prevent them from acting out their compulsion.
Treatment efficacy of ERP as intensive inpatient treatment
Î High % of symptom reduction symptom free 40% moderately improved and about 10% is non
Time to relapse by treatment modality following successful treatment of OCD
Î The lowest rate of survival 12 weeks is the CMI ERP and CMI or ERP alone is better than the drug
Exposure and response prevention
Î 75% of patients experience clinical improvement during the active phase of intervention an
about 75% show long-term improvements in their OCD symptoms
Î Long term effects of exposure in vivo with OCD have been demonstrated in follow up studies of
two year and three year duration
Î But
o 25% refuse treatment option
o 25% show only partial response
o Not as effective for pure obsessions (sexual, religious, somatic)
o 17-ðð9Z}Á^µ_}]}v
o ^µuuÇW^ïì9Çu}uµ]}vuÇ}voÇñì9_
Limitations of behavioral theory of OCD
Î Fails to differentiate OCD from other anxiety disorders
Î Does not explain why some people become obsessionals and other phobic
Î Although may account for compulsions, does not adequately explain the cause of obsessions.
Î There are individuals who show increase in anxiety after rituals
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