Psychology
OCD
OCD, or Obsessive-Compulsive Disorder, is a mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). These obsessions and compulsions can significantly interfere with daily activities and cause distress. Common compulsions include excessive cleaning, checking, or counting, while obsessions may involve fears of contamination or harm. Treatment often involves therapy and medication.
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11 Key excerpts on "OCD"
eBook - PDF- Kanter, Jonathan W., Woods, Douglas W.(Authors)
- 1(Publication Date)
- Context Press(Publisher)
Obsessive-Compulsive Disorder 117 Chapter 5 A Functional Contextual Account of Obsessive-Compulsive Disorder Michael P. Twohig University of Nevada, Reno Daniel J. Moran Trinity Services, Inc./ MidAmerican Psychological Institute Steven C. Hayes University of Nevada, Reno Obsessive-compulsive disorder (OCD) is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) as an anxiety disorder and is characterized by distressing intrusive thoughts and unwanted repetitive behaviors. Scientific investigation of the possible basis for obsessive-compulsive behavior began to solidify in the 1950’s (Solomon, Kamin, & Wynne, 1953; Solomon & Wynne, 1954), and these seminal studies on traumatic avoidance learning influenced future research investigating the effectiveness of behavior therapy applications (Rachman, Marks, & Hodgson 1973). Empirically supported psychosocial treatments for obsessive-compulsive disorder (Clark, 2004; Steketee & Barlow, 2002) are drawn from a large literature of learning principles and cognitive-behavioral theory, but more recent advances in a behavior analytic approach to language and cognition have not yet been integrated into behavioral and cognitive approaches to OCD. The focus of this chapter is to clarify how these advances might increase our understanding of OCD and possibly our success in treating it. The Nature and Prevalence of OCD OCD is comprised of obsessions and corresponding compulsions. Obsessions are defined in the DSM-IV-TR as “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress; they are not worries about real-life problems; they are accompanied by attempts to ignore, suppress, or neutralize (i.e., subjective resistance); and they are acknowledged as a product of the person’s mind” (APA, 2000, p. 457).
eBook - ePubPsychopathology
History, Diagnosis, and Empirical Foundations
- W. Edward Craighead, David J. Miklowitz, Linda W. Craighead, W. Edward Craighead, David J. Miklowitz, Linda W. Craighead(Authors)
- 2017(Publication Date)
- Wiley(Publisher)
Chapter 5Obsessive‐Compulsive and Related DisordersJonathan S. Abramowitz Shannon M. BlakeyObsessive‐compulsive disorder (OCD) is one of the most devastating psychological disorders. Its symptoms often interfere with work or school, with interpersonal relationships, and with activities of daily living (e.g., watching television, child care). Moreover, the psychopathology of OCD is among the most complex of the psychological disorders. Sufferers appear to struggle against seemingly ubiquitous unwanted thoughts, doubts, and urges that, while senseless on the one hand, are perceived as signs of danger on the other. The wide array of symptoms and intricate associations between behavioral and cognitive symptoms can perplex even the most experienced of clinicians. This chapter describes the nature of OCD symptoms, the leading explanatory theories, and the empirically supported approaches to assessment and treatment.The Nature of OCD: Diagnostic Criteria
Obsessive‐compulsive disorder (OCD) is defined by the presence of obsessions or compulsions that produce significant distress and cause noticeable interference with various aspects of role functioning (e.g., academic or occupational functioning) (American Psychiatric Association [APA], 2013). The DSM‐5 diagnostic criteria appear in Table 5.1 . Obsessions are intrusive thoughts, ideas, images, impulses, or doubts that the person experiences as senseless and that evoke anxiety. Examples include unwanted ideas of germs and contamination, unwanted doubts that one has been negligent, and unacceptable thoughts of a violent, sexual, or blasphemous nature. Compulsions
eBook - PDFCognitive Approaches to Obsessions and Compulsions
Theory, Assessment, and Treatment
- Randy O. Frost, Gail Steketee(Authors)
- 2002(Publication Date)
- Pergamon(Publisher)
Chapter 1 Cognition in Obsessive Compulsive Disorder: An Overview Steven Taylor Introduction Obsessive compulsive disorder (OCD) is among the most common anxiety disorders, with a lifetime prevalence of approximately 2.3 percent (Weissman era/., 1994). It often begins in adolescence or early adulthood, usually with a gradual onset (American Psychiatric Association [APA], 2000). The disorder tends to be chronic if untreated, with symptoms waxing and waning in severity, often in response to stressful life events (Rasmussen & Eisen, 1992). OCD is characterized by clinically significant obsessions, compulsions, or both. Obsessions are intrusive and distressing thoughts, images, or impulses. Common examples of obsessions include intrusive thoughts of being contaminated, recurrent doubts that one has not turned off the stove, and disturbing thoughts of harming loved ones. Compulsions are repetitive, intentional behaviors that the person feels compelled to perform, often with a desire to resist. Compulsions are typically intended to avert some feared event or to reduce distress. They may be performed in response to an obsession, such as repetitive hand-washing in response to obsessions about contamination. Alternatively, compulsions may be performed in accordance to certain rules, such as checking three times that the stove is switched off before leaving the house. Compulsions can be overt (e.g., cleaning) or covert (e.g., thinking a good thought to undo or replace a bad thought). Compulsions are excessive or not rationally connected to what they are intended to prevent. OCD is commonly comorbid with other disorders, such as other anxiety disorders, mood disorders, eating disorders, and substance use disorders (APA, 2000). The degree of insight associated with OCD varies within and between individuals (Kozak & Foa, 1994). Insight refers to the degree that sufferers recognize that their obsessions and compulsions are unreasonable and due to a psychiatric disorder.
- Leonardo F. Fontenelle, Murat Yücel(Authors)
- 2019(Publication Date)
- Cambridge University Press(Publisher)
Chapter 1 1 Section 1 Introduction Obsessive-compulsive disorder (OCD) character- istic symptoms include obsessions (persistent and unwanted thoughts, images or urges) and compulsions (repetitive behaviors that are performed in response to obsessions or according to rigid rules). OCD is both frequent and disabling; it affects up to 3% of the general population and leads to decreased productivity and substantial decreases in quality of life. However, the impact of OCD’s constituent symptoms (obsessions, compulsions and related phenomena) may be greater than the one associated with the disorder per se. For instance, obsessions and compulsions are frequently found in sub-threshold yet impactful forms. They also occur in conditions officially classified by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [1] and the 11th Revision of the International Classification of Diseases (ICD-11) [2] as obsessive-compulsive and related disorders (OCRDs). The fact that obsessive thoughts and compulsive behaviors may occur across a number of neuropsychi- atric conditions has been well known since Kraepelin (for a list of conditions presenting OCD symptoms, see Table 1.1). However, it is only after the end of a strongly hierarchical approach to psychiatric diagnosis that clinicians have been able to officially diagnose OCD in the presence of conditions such as schizophrenia, major depressive disorder or Tourette’s disorder. The recognition that neuropsychiatric disorders could be comorbid with one another has been a major advance in the field. It prompted clinicians not only to iden- tify but also to treat comorbid OCD, thus leading to better outcomes. However, this is not exactly the transdiagnostic approach we deal with in this chapter. Obsessions and compulsions are clinical constructs. Until now, they have proven to be reliable and useful.
eBook - PDF- Mazza, Marisa T.(Authors)
- 2020(Publication Date)
- New Harbinger Publications(Publisher)
This is your first exercise in leaning in and taking a risk. WHAT IS OCD? OCD is a brain and behavioral disorder that is associated with anxiety, fear, doubt or disgust, or any combination of these (Yadin, Foa, and Lichner 2012). The American Psychiatric Association (2013) defines OCD as having recurrent obsessions or compulsions or both that take up at least an hour a day or have a serious negative impact on your life—they cause significant impairment. Obsessions are “recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety and distress.” People with OCD attempt “to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thoughts or action”—that is, with compulsions. Compulsions are “repetitive behaviors or mental acts that the individual feels driven to perform in response to their obsession or by strictly applied rules. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or to preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive” (APA 2013, 237). If the obsessions and compulsions are the result of a substance, medical condition, or another mental health disorder, you should seek professional help and get some clarity as to the best path to take. It is not uncommon for people to have other types of anxiety (panic, general worry, social anxiety) with OCD, and depression can be common. Know that the interventions in this book can be helpful for depression and anxiety as well as OCD. Who Suffers from OCD? One in a hundred people in the United States is diagnosed with OCD (Harvard Medical School 2005), but only about 40 percent will receive some type of treatment (Torres et al. 2007).
eBook - PDF- Pedrick, Cherlene, Parrish, Kathleen M., Landsman, Karen J.(Authors)
- 1(Publication Date)
- New Harbinger Publications(Publisher)
With education, you’ll be more equipped to pro- vide support, help evaluate treatment options, and examine your response to OCD. Knowledge of OCD and improved communication with your loved one will help you put the problems you’re facing in perspective. With increasing knowledge and greater perspective, you’ll be ready to make some important changes. Education and communication will provide a new perspective for understanding OCD symptoms and the ill-fated strategies family members have been using to deal with the symptoms. As you discover how OCD affects your family, you’ll learn to change the way you respond to OCD symptoms. Healthier responses will help you break free from the effects of OCD. As you’ll see, most of your changes will also make an impact on how your loved one handles OCD symptoms. Your gradual withdrawal from participating in rituals and avoidance, for example, will mean big changes in his or her response to obsessions. WHAT IS OCD? Obsessive-compulsive disorder is a neurobiobehavioral disorder characterized by obses- sions and/or compulsions that are distressful, time-consuming, or interfere with routine daily functioning or relationships with others. Saying a disease is a neurobiobehavioral disorder means that it involves both dysregulation of the chemistry and circuitry of the brain and dysfunctional, learned patterns of thought and behavior. Mental-health pro- fessionals rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) to diagnose psychiatric illnesses. It states the following: “The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to be time consuming (i.e., they take more than one hour a day) or cause marked distress or significant impairment. At some point during the course of the dis- order, the person has recognized that the obsessions or compulsions are excessive or unreasonable” (American Psychiatric Association [APA] 2000, 456-457).
eBook - PDF- Pedrick, Cherlene, Hyman, Bruce M.(Authors)
- 1010(Publication Date)
- New Harbinger Publications(Publisher)
On average, it’s likely that one out of forty people surrounding you has OCD. The OCD Workbook 22 The onset of OCD symptoms is usually gradual, although though some children suffer sudden onset in a form of OCD known as PANDAS (see chapter 17). It isn’t uncommon for OCD symptoms to flare up during times of emotional stress at work or at home. Major life transitions such as leaving home for the first time, pregnancy, the birth of a child, the termination of a pregnancy, increased levels of responsibility, health problems, and bereavement may be linked to the onset or worsening of OCD symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association 2000) is the diagnostic bible for mental health professionals. In its criteria for a diagnosis of OCD, it states, “The essential features of obsessive-compulsive disorder are recurrent obsessions or compulsions… that are severe enough to be time-consuming (i.e., they take more than one hour a day) or cause marked distress or significant impairment… At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable” (American Psychiatric Association 2000, 456-457). As explained in chapter 1, obsessions are persistent ideas, images, thoughts, or urges experienced as inappropriate and intrusive, and that cause marked anxiety. People with OCD have the sense that these thoughts aren’t within their control and that they aren’t the kind of thought that they would expect to have. They are also aware that the thoughts are a product of their own minds, versus externally imposed, which would be indicative of a psychotic disorder, not OCD. In OCD, the discomfort of an obsessive thought or urge results in attempts to contain or neutral- ize the discomfort through some repetitive action, performed either covertly with thoughts, or overtly with behaviors.
eBook - PDFClinical Handbook of Psychological Disorders
A Step-by-Step Treatment Manual
- David H. Barlow(Author)
- 2021(Publication Date)
- The Guilford Press(Publisher)
In this chapter we first discuss diagnostic and theoretical issues of OCD and review the available treatments, then describe assess- ment procedures and illustrate in detail how to imple- ment intensive cognitive-behavioral treatment (CBT) involving exposure and ritual prevention (EX/RP) for OCD. Throughout the chapter, we use case material to illustrate interactions that occur between therapist and patient to demonstrate the process that occurs during treatment. DEFINITION According to the 11th edition of the International Clas- sification of Diseases (ICD-11; World Health Organiza- tion, 2021), OCD is characterized by recurrent obses- sions and/or compulsions that interfere substantially with daily functioning (Stein et al., 2016). Common obsessions are repeated thoughts about causing harm to others, contamination, and doubting whether one locked the front door. Common compulsions include handwashing, checking, and counting. OCD is cat- egorized among obsessive–compulsive and related dis- orders (e.g., Stein et al., 2010, 2016), which highlight C H A P T E R 4 Obsessive–Compulsive Disorder Martin E. Franklin Edna B. Foa 134 CLINICAL HANDBOOK OF PSYCHOLOGICAL DISORDERS the formal and functional similarity between OCD and several other disorders that involve intense anxi- ety and associated compulsions (e.g., body dysmorphic disorder [BDD]), as well as those involving repetitive behaviors that appear to be driven by appetitive urges (e.g., trichotillomania [hair pulling], excoriation [skin picking] disorder; Stein et al., 2016). The functional link between obsessions and compul- sions is emphasized: Obsessions are defined as thoughts, images, or impulses that cause marked anxiety or dis- tress, and compulsions are defined as overt (behavioral) or covert (mental) actions that are performed in an at- tempt to reduce the distress brought on by obsessions or according to rigid rules.
- Simon A. Rego(Author)
- 2016(Publication Date)
- The Guilford Press(Publisher)
8 CHAPTER 2 Understanding Obsessive–Compulsive Disorder R ecall from Chapter 1 that OCD consists of recurring obsessions, compulsions, or both. The obsessions in OCD are recurrent thoughts, images, urges, or impulses that a person experi- ences as unwanted, distasteful, inappropriate, intrusive, and distressing, whereas the com- pulsions in OCD are behaviors or mental acts that the person feels driven to perform repeatedly and rigidly in an attempt to “neutralize” an obsessive thought by either preventing the feared con- sequence or relieving the anxiety caused by it. Over the years, researchers have grouped the symp- toms reported by patients into several categories as a way of facilitating assessment and treatment. These categories are described in detail below, followed by the epidemiology, prevalence, and life course of OCD, theories of OCD, and finally, understanding OCD in cognitive-behavioral terms. Obsessions can be grouped into several categories: 1. Fear of contamination. This is the most frequently reported category of obsessions, with the most common examples being an excessive concern with dirt or germs—either in general or from something more specific (e.g., asbestos, household cleaners and solvents, computer radiation). This category can also include less common examples, such as being excessively concerned with impregnating another person. 2. Doubting one’s actions or conversations. This is the second most frequently reported category of obsessions, with the most common examples being an excessive concern about whether a door was left unlocked, an appliance was left plugged in, or a faucet was left running. This category can also include almost any routine activity after which the person wonders whether she wasn’t careful enough, performed it correctly, or, at times, even did it at all—and then typically fears that this in turn could cause something awful or harmful to happen to others, such as an accident or injury.
eBook - PDFObsessive-Compulsive Disorder
Theory, Research and Treatment
- Ross G. Menzies, Padmal de Silva, Ross G. Menzies, Padmal de Silva(Authors)
- 2003(Publication Date)
- Wiley(Publisher)
78 THEORETICAL ACCOUNTS OF OCD respect already. More problematic is the way in which biological theories have become both fragmented and have been built on the assumption that OCD must involve some fundamental disturbance of brain functioning. Paradoxically, then, helping biological researchers to achieve a more so- phisticated view of OCD is probably the greatest challenge facing those working from a CBT perspective (see also Chapter 3). Chapter 5 REPETITIVE AND ITERATIVE THINKING IN PSYCHOPATHOLOGY: ANXIETY-INDUCING CONSEQUENCES AND A MOOD-AS-INPUT MECHANISM Graham C. L. Davey, Andy P. Field and Helen M. Startup A notable feature of many psychopathologies is the tendency of the in- dividual to engage in repetitive types of thought or behaviour. What the disorders have in common is that the individual is seen to persist at an activity, way beyond its utility, be that a cognitive activity, such as catas- trophising in generalised anxiety disorder (GAD; Davey & Levy, 1998a), a behavioural activity, such as compulsions in obsessive-compulsive disor- der (OCD; Turner et al., 1992), or ruminative thoughts in depression (Martin & Tesser, 1989, p. 307). As well as their repetitive nature, what these thought styles and behaviours have in common are their negative emotional conse- quences. Ruminative thoughts typically focus on failed attempts to reach some goal, and so invariably yield negative emotional reactions (Martin & Tesser, 1996); catastrophic worriers report a significant increase in subjec- tive discomfort as catastrophising unfolds (Vasey & Borkovec, 1992) and both the appraisal of obsessive thoughts and the compulsions themselves are associated with increases in negative mood (Frost et al., 1986; Gershuny & Sher, 1995; Steketee et al., 1998a).
eBook - PDF- Gordon L. Flett, Nancy L. Kocovski, Gerald C. Davison, John M. Neale(Authors)
- 2018(Publication Date)
- Wiley(Publisher)
People with OCD tend to procrastinate, fear changes, and be overly concerned about others controlling them—traits that can create special prob- lems for manipulative approaches such as behaviour therapy. In a more recent meta-analytic review of the effectiveness of psychological treatments for OCD, Rosa-Alcazar et al. (2008) concluded that therapist-guided exposure is better than therapist-assisted self-guided exposure and in vivo exposure combined, with exposure via imagination being superior to exposure in vivo alone. Cognitive Approaches to Treatment A combined cognitive behavioural therapy (CBT) approach is clearly required when treating OCD rather than just a cognitive approach because an inherent part of any cognitive therapy is exposure and response prevention. To evaluate whether or not performing a compulsive ritual will have catastrophic conse- quences, the client must stop performing that ritual. Salkovskis and Warwick (1985) provided one of the earliest demonstrations of the usefulness of a CBT approach when they showed that cognitive restructuring helped an OCD client who relapsed following ERP. This client had developed the belief that her hand creams would cause cancer. Salkovskis (1998) has gone on to outline how cognitive procedures can eliminate the dysfunctional beliefs that contribute to the OCD clients’ faulty appraisals. His model focuses on the notion of perceived responsibility, which is defined as “the belief that one has power which is pivotal to bring about or prevent subjectively crucial outcomes” (Salkovskis, 1998, p. 40). Cognitive and behavioural techniques focus on the modification of dysfunctional beliefs involving this sense of personal responsibility. This can involve having the client actually test whether something bad happens as a result of being prevented from performing the ritual (see Van Oppen et al., 1995). Several investigators based in Canada have extended the CBT interventions used to treat OCD.
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