Chapter 7 -- Obsessive-Compulsive-Related and Trauma-Related Disorders

I. Obsessive-Compulsive Disorder
A. Characteristics (2% lifetime prevalence)
1. Intrusive, persistent thoughts that are recurrent and senseless (obsessions like contamination)
2. Excessive, ritualistic behaviors to avoid distress  (compulsions like cleaning, counting, checking)
3. More than one hour per day or causes significant distress
4. Develops either before age 10 or during late adolescence/early adulthood
5. 1.5 times more common in women
6. Only 20% have complete recovery
7. Majority have other anxiety disorders or depression
B. Etiology
1. Neurobiological – hyperactive orbitofrontal cortex, caudate nucleus, and anterior cingulate
2. Compulsions reinforced with less anxiety
3. Yadasentience – low sense of I have thought enough about this
4. Attempts to suppress thoughts

II. Body Dysmorphic Disorder
A. Preoccupation with a perceived defect or excessive concern over defect in appearance
B. The person has performed repetitive behaviors or mental acts (e.g., mirror checking, seeking reassurance, or excessive grooming) in response to the appearance concerns (new in DSM-5)
C. Preoccupation is more than about weight or fat
D. Engrossed in small flaws

III. Hoarding Disorder
A. Cannot part with acquired objects
1. Most objects are worthless
2. Extremely attached to objects
3. Resistant to relinquishing objects
B. 66% are unaware of severity of problem
C. Squalid living conditions and negatively affects relationships
D. Poor organizational abilities

IV. Treatment of OCD-related Disorders
A. Medications
1. SSRIs (Serotonin reuptake inhibitors)
2. Tricyclic antidepressants: Anafranil (clomipramine)
B. Exposure plus response prevention (ERP)
1. Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus
2. The exposure results in the extinction of the conditioned response (the anxiety)
C. Cognitive therapy
1. Challenge beliefs about anticipated consequences of not engaging in compulsions
2. Usually includes exposure

V. Post-Traumatic Stress Disorder (PTSD)
A. Characteristics (8.7% lifetime prevalence)
1. Intrusively re-experiencing a truamatic event through nightmares, thoughts, or images
2. Avoidance of stimuli associated with the trauma
3. Other mood and cognitive changes like memory loss, self-blame, or withdrawal
4. Increased arousal and irritability maintained for a month
5. Less than one month is Acute Stress Disorder
B. Etiology
1. Genetic (30% heritability, 60% shared genetic variance with Generalized Anxiety Disorder and Panic Disorder)
2. Biological: overactive amygdala, small hippocampus
3. Childhood exposure to trauma, conditioning
4. Avoidance coping, dissociation, memory suppression

VI. Treatment
A. Exposure to memories and reminders of the original trauma
1. Either direct (in vivo) or imaginal
2. More effective than medication or supportive therapy
3. Treatment can increase symptoms at first
B. Cognitive therapy
1. Enhance beliefs about coping abilities
2. Adding CT to exposure does not improve treatment response
3. Treatment of ASD may prevent PTSD
(Shows benefits even 5 years after the traumatic event)