Obsessive-Compulsive Disorder (OCD)

1. 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.

2. 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.

3. 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

4. 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.

5. 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).

6. 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

7. 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.

8. 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)

9. 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.

10. 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.

11. 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 audience’s behavior. • Exposure to social situations. • Attentional control training.

12. 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).

13. 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.

14. 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).

15. 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).

16. 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).

17. 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.

18. 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