Tiêu đề 06 AbPsy - Obsessive Compulsive and Related Disorders.pdf ✅

06 – Obsessive Compulsive and Related Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Obsessive-Compulsive Disorder 2. Body Dysmorphic Disorder 3. Hoarding Disorder 4. Trichotillomania 5. Excoriation Disorder OBSESSIVE-COMPULSIVE DISORDER DEFINING OBSESSIVE-COMPULSIVE DISORDER Obsessive-Compulsive Disorder – characterized by the presence of obsessions and/or compulsions ● Obsessions are lasting and unwanted thoughts that keeping coming back or urges or images that are intrusive and cause distress or anxiety ● Culmination of the anxiety disorders ● Obsessions: intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate ● Compulsions: thoughts or actions used to suppress the obsessions and provide relief ● The dangerous event is a thought, image, or impulse ● Mean age at onset of OCD is 19.5 years ● 25% of cases start by age 14 years ● The onset of symptoms is typically gradual; however, acute onset has also been reported ● Presence of comorbid major depressive disorder increases the suicide risk DIAGNOSTIC CRITERIA A. Presence of obsessions, compulsions, or both B. The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition. D. The disturbance is not better explained by the symptoms of another mental disorder Specify if: With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. Specify if: Tic-related: The individual has a current or past history of a tic disorder. CAUSES / RISK FACTORS ● Early experiences taught them that some thoughts are dangerous and unacceptable because terrible things that they are thinking might happen ● Early experiences would result in a specific psychological vulnerability to develop OCD ● Thought-Action Fusion: when patients with OCD equate specific actions represented by thoughts ○ Bad thoughts = bad person ● Several studies showed that the strength of religious belief was associated with thought-action fusion and severity of OCD ● Generalized biological and psychological vulnerabilities must be present ● Believing some thoughts are unacceptable and therefore must be suppressed put people at greater risk 1 | @studywithky
DIAGNOSTIC ISSUES Gender ● Females are affected at a slightly higher rate than males in adulthood ● Males are more commonly affected in childhood DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Obsessive Compulsive Personality Disorder ● OCPD: excessive perfectionism, rigid control, no distress ● OCD: true obsessions and/or compulsions, w/ distress ● If both criteria are met, both can be diagnosed Generalized Anxiety Disorder ● GAD: real-life concerns ● OCD: irrational, odd obsessions Body Dysmorphic Disorder ● BDD: limited to physical appearance Trichotillomania ● Trichotillomania: hair-pulling (compulsion), no obsession ● OCD: obsession precedes compulsion (ex. Symmetry obsession - plucking compulsion) Psychotic Disorders ● Psychotic: presence of positive psychotic symptoms (eg., delusions, hallucinations) ● OCD: no other psychotic symptoms (eg., Hallucinations, formal thought disorder), may have poor insight/delusional OCD beliefs Comorbidity ● Many adults tend to have a lifetime diagnosis of an anxiety disorder or a depressive or bipolar disorder ● Up to 30% of individuals with OCD also have a lifetime tic disorder ● A comorbid tic disorder is most common in males with onset of OCD in childhood ● Disorders that occur more frequently in individuals with OCD include body dysmorphic disorder, trichotillomania, and excoriation TREATMENT Medications ● Clomipramine (aka Anafranil) ○ Relapse occurs when discontinued Psychological Treatments ● Exposure and Ritual Prevention (ERP) ○ Most effective approach ○ Process in which the rituals are actively prevented ○ Patient is systematically and gradually exposed to feared thoughts / situations ○ Procedure seems to facilitate reality testing ● Cognitive Treatments ○ Focus: overestimation of threat, importance and control of intrusive thoughts, sense of inflated responsibility, need for perfectionism and certainty ● Psychosurgery ○ A misnomer that refers to neurosurgery for a psychological disorder BODY DYSMORPHIC DISORDER DEFINING BODY DYSMORPHIC DISORDER Body Dysmorphic Disorder – persistent, intrusive, and horrible thoughts about appearance ● Imagined Ugliness: imagined defect in appearance by someone who actually looks reasonably normal ○ 61% adolescents focused on their skin and 55% on their hair ○ Considered a somatoform disorder ○ Previously known as dysmorphophobia ● Often co-occurs with OCD ● Found among family members of BDD patients ● Engage in such compulsive behaviors as repeatedly looking in mirrors to check their physical features ● Excessive grooming and skin picking are also common ● Suicidal ideation, suicide attempts, and suicide itself are typical consequences of this disorder 2 | @studywithky
● Ideas of Reference: they think everything that goes on in their world somehow is related to them ● Most common procedures are rhinoplasties (nose jobs), facelifts, eyebrow elevations, liposuction, breast augmentation, and surgery to alter the jawline DIAGNOSTIC CRITERIA A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to the appearance concerns. C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Specify if: With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case. Prevalence ● Seen equally in men and women ● Women focus on more varied body areas and are more likely to develop eating disorder ● Age of onset ranges from early adolescence through the 20s, peaking at the age of 16-17 ● Among the more serious of psychological disorders; depression and substance-abuse are common consequences TREATMENT Biomedical ● Drugs (SSRIs) ○ Clomipramine (aka Anafranil) ○ Fluvoxamine ● Dermatology (skin) Treatment ○ Most often received ● Plastic Surgery ○ Most common procedures: rhinoplasties (nose jobs), facelifts, eyeshadow elevations, liposuction, breast augmentation, surgery to alter the jawline Psychological Treatments ● Cognitive-Behavioral Therapy (CBT) ○ Exposure and response prevention ○ Produce better and longer lasting outcomes than medication alone HOARDING DISORDER DIAGNOSTIC CRITERIA A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties. D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). F. The hoarding is not better explained by the symptoms of another mental disorder. Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. Development and Course ● Can begin early in life and get worse with each passing decade TREATMENT Psychological Treatments ● Teaching people to assign different values to objects ● Reducing anxiety about throwing away items that are somewhat less valued TRICHOTILLOMANIA DEFINING TRICHOTILLOMANIA AND EXCORIATION DISORDER Trichotillomania – urge to pull out one’s own hair from anywhere on the body ● Results in noticeable hair loss, distress, and significant social impairments ● Commonly reported among females 3 | @studywithky
Excoriation – repetitive and compulsive picking of the skin, leading to tissue damage ● Noticeable damage to skin occurs, sometimes requiring medical attention ● Both disorders were classified under impulse control disorders ● Diagnostic criteria referring to tension relief, present in DSM-IV, have been removed in DSM-5 DIAGNOSTIC CRITERIA A. Recurrent pulling out of one’s hair, resulting in hair loss. B. Repeated attempts to decrease or stop hair pulling. C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The hair pulling or hair loss is not attributable to another medical condition. E. The hair pulling is not better explained by the symptoms of another mental disorder Prevalence ● More common in women than men ● Some genetic influence may explain the disorder TREATMENT Medications ● SSRIs Psychological Treatments ● Habit Reversal Training: patients are carefully taught to be more aware of their repetitive behavior, particularly EXCORIATION DISORDER DIAGNOSTIC CRITERIA A. Recurrent skin picking resulting in skin lesions. B. Repeated attempts to decrease or stop skin picking. C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). E. The skin picking is not better explained by symptoms of another mental disorder TREATMENT Psychological Treatments ● Habit Reversal Training: patients are carefully taught to be more aware of their repetitive behavior, particularly REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Barlow, D., Durand, V., Lalumiere, M., & Hofmann, S. (2018). Abnormal psychology: An integrative approach (8th ed.). Cengage Learning. Hooley, J., Nock, M., & Butcher, J. (2021). Abnormal psychology (18th ed.). Pearson. 4 | @studywithky