OCD

• obsession and compulsions severe enough to be time consuming and cause distress
• ritualizing and avoidance also present in OCD and can significantly impair social functioning

recurrent and persisten thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety and distress

repetitive behaviors or mental acts that are engaged in to prevent or reduce anxiety or distress

• equally common in males and females
• lifetime prevalence of dsm-iv-tr is 1.6% (kessler et al, 2005)

Evidence from patient and epidemiological samples indicates that 55-60% are female

• Research shows that in over 25% of patients, overt compulsions are not evident
• Foa and Kozak, 1995

• between adolescence and the mid 20's
• males earlier onset (13-15) women (20-24)
• acute onset noted in some cases, but most px recall gradual or insidious onset (Rasmussen et al, 1990)

• usually continuous with waxing and waning
• exaccerbations in symptoms related to life stress
• 10-15% show a progressively deteriorating course
• 2-5% report episodic course with minimal or no symptoms between episodes (Rasmussen & Eisen, 1988)

• in clinical samples, at least 50% of patients with a principal diagnosis of OCD have additional anxiety and mood disorders at the time of evaluation (Brown & Barlow, 1992)
• Most often MDD, dysthymia, panic disorder, social phobia.
• Roughly 2/3 OCD have a lifetime history of clinical depression and 30-40% have co-occurring mood disorder at time of eval.
• depression typically follows onset of OCD

• contamination (about 40%)
• fear of harming self or others (about 25%)
• and somatic (about 10%)

80%

• checking
• cleaning
• counting

• mixed support for the validity of OCD
• several twin studies produced findings attesting to genetic aggregation in OCD
• concordance rates higher among MZ than DZ (65% vs 15%)
• argued that genetic factor predispose general influence on development of anxiety, not OCD specifically (Andrews et al. 1990)

• Salkovskis 1999
• Negative automatic thoughts, avoidant behavior, and neutralizing behavior are responsible for the maintenance of obsessions.
• individual differences regarding cognitive appraisal of normal intrusions are key to determining whether these events develop into clinical disorder (intrusive thoughts occur in 90% of nonclinical samples)
• OCD px prone to interpret intrusive thoughts in highly negative and threatening manner
• thought-action fusion (shafran et al, 1996)
• excessive responsibility for preventing harm to self or others
• failing to prevent harm is same as causing harm
• inflated sense of responsibility and self-blame
• neutralization in the form of compulsions or reassurance seeking
• occurs primarily in the context of negative automatic thoughts pertaining to strong feelings of responsibility or guilt

• most studies using nonclinical samples
• rachman et al, 1995
• most focused on diminishing sense of responsibility
• OCD symptoms, diminished urge to check, discomfort, and perceived probability and severity of anticipated harm... diminished when experimenter said they would accept blame if patient failed to check

• although salkovskis 1996 is good, it doesn't account for what vulnerability dimensions take a person from normative intrusions to OCD
• biopsychosocial model integrates: similar to models of GAD, current conceptualizations of the etiology and maintenance of OCD are becoming increrasingly integrative. Barlow, 2002.
• Evidence from Kendler et al., 1992 that the biological vulnerability for OCD may be shared with all anxiety and mood disorders.
• Although no specific genetic or biological markers have yet been identified, Barlow considers this general anxiety vulnerability to be best characterized as an overactive neurobilological response to life stress.
• As suggested by Salkovskis, one type of psychological vulnerability may be learning in childhood to regard some thoughts as dangerous or unacceptable. Like persons raised in devoutly religious families may think thoughts about sex and abortion are inappropriate. Then anxiety about those intrusive thoughts. Coupled with trying to suppress them, have them more.
• This is a positive feedback loop and is OCD