DSM-IV: symptoms that cause distress, are time consuming and/or markedly interfere with daily live
Recurrent, persistent thoughts, impulses or images that are experienced, as intrusive and inappropriate and that cause marked anxiety or distress
-NOT simply excessive worries about real life problems, but repetitive unwanted and involuntary intrusive thoughts
-person attempts to ignore or suppress it, or to neutralize it w/ some other thought or action
-recognizes that they are product of own mind.
Repetitive behaviours or mental acts that feel driven to perform in response to an obsession, or according to rules that must be applied rigidly.
-Aim to prevent or reduce distress or some dreaded event, but are not connected in a realistic way to what they are designed to neutralize, or are very excessive.
1.2.3 superstitious ritualized movements or mental acts
1.2.4 systematic arranging of objects
1.2.5 (hoarding)- but new Dx
Graham doesn't feel they're central
2.1.2 traumatic head inj
2.1.3 frontal lobes and
when compulsion performed, blood flow increases in both the frontal lobes and the basal ganglia suggesting some role in OCD (Rauch et al, 1994)
2.1.4 neuro deficit that
gives rise to 'doubting'
2.2.1 Behaviour theory
126.96.36.199 OCD maintained by the behaviour/compulsion
1.obsessions cause anxiety
2. compulsions temporarily relieve anxiety
3.thus compulsions prevent extinction of anxiety on it's own
4. Compulsions are negatively reinforced (by temp relieve of anx) and so get more frequent and severe
2.2.2 Cognitive theory
188.8.131.52 OCD maintained by the beliefs about intrusive thoughts
2.2.3 memory deficits theory (now not accepted as a causal role)
20 years ago thought ppl with OCD had mem deficits because of the 'doubting' seen in OCD
-however, doubting seems to be a result of compulsive behaviour rather than a cause (Van den Hout & Kindt, 2003)
-no obvious mem deficits found in these ppl
2.2.4 metacognitive model
184.108.40.206 examining the role of ‘metacognitive’
processes and beliefs (attempts to regulate
thoughts and beliefs about thoughts and
thought processes) (Purdon & Clark 1991)
3.1 Behavioural Rx (ERP)
-develop shared understanding of the behavioural account of difficulties
-draw up graded hierarchy of ERP tasks
-Engage in graded exposure at least once per day
3.1.1 exposure and...
3.1.2 ...response prevention
3.2 Cognitive Therapy
dysfunctional beliefs challenged:
-normalising intrusive thoughts
-responsibility appraisals-the over-importance of thoughts-exaggerated perception of threat
3.4 Neurosurgical (cingulotomy)
-often manifest in early childhood
-lifetime prev = 2.5%
-cognitive processes v. well established by time of Dx
5 IN CHILDHOOD
-Common way for anx to be expressed
-common themes = contamination, aggression, symmetry, & exactness (Geller et al. 2001)
-Compulsions often tactile
-onset can be as early as 3-4 but more likely around 10 yrs
To control intrusive thoughts, need lot of top down control. Requires efficient WM, large capacity.
-Get rid of them by throwing them out of WM.
-kids prone to intrusive thoughts because WM capacity still developing. They have difficulty with top down control of those thoughts.
-also why more common in ppl with learning disabilities
5.2 Tic disorders: 60%
kids with OCD have