Psychology Column | Psychopathology | Chapter 4 | Anxiety Disorders II: Obsessive Compulsive Disorders, Post Traumatic and Acute Stress Disorders

This is an informative chapter about anxiety-related disorders. None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Obsessive-Compulsive Disorders (OCD)

A disorder that involves recurrent obsessions, compulsions, or both.

Obsession: A persistent idea, thought, image, or impulse that an individual cannot get out of his or her mind and that causes anxiety.

Some common clinical obsessions

• Thoughts of violence (killing or harming someone).
• Thoughts of contamination (becoming infected with germs).
• Thoughts of doubt (wondering one has done it or not).

Compulsion: A behavior that an individual feels driven to perform repeatedly to avoid some negative consequence; often referred to as a ritual.

In obsessive-compulsive disorders; a compulsive act (a ritual) is performed to prevent something terrible to happen (mostly, not knowing what this terrible thing is, causes more anxiety and irrationality).A compulsive act temporarily relieves some anxiety but doesn’t lead to feelings of pleasure (compulsions are not pleasurable).

Obsessive-compulsive disorders explanations

Psychodynamic explanations: unconscious conflict causes anxiety. Irrelevant thoughts and compulsive performance reduce this anxiety.
Learning theory explanations: (operant conditioning). High levels of anxiety. Obsessions and compulsions are used to reduce this anxiety. The reduction in anxiety is rewarding. So, obsessions and compulsions are used again and again.
Cognitive theory explanations: Previous experiences, selective attention. Selective recall leads to incorrect beliefs. Incorrect beliefs (something terrible will happen) leads to compulsive acts.
Physiological explanations: 1. Low levels of serotonin. Reducing serotonin levels increases OCD symptoms in %50 of the patients. Increasing serotonin levels with SSRIs decrease OCD symptoms in %50 of the patients. 2. High levels of brain activity in the orbitofrontal area, cingulate gyrus (A network of connected brain structures is overactive). 3. Damaged brain structures in the orbitofrontal area, soft signs of brain damage (biological traumas, genetic factors).

Obsessive-compulsive disorders treatments

The cognitive approach: Exposure and response prevention. A treatment for compulsions in which the individual is exposed to a situation in which the compulsion would ordinarily be used but is prevented from using it. The notion is that when the compulsion is not used and nothing terrible happens, the individual will change the incorrect belief that the compulsion must be used.
The physiological approach: 1. Drugs to increase levels of serotonin.

1. Surgery on connecting nerve cells (cingulotomy). Making small lesions on the cingulate gyrus which connects the lower brain structures as thalamus and basal ganglia to the orbitofrontal lob.

Trauma and Stressor Related Disorders- Posttraumatic stress disorders (PTSD)

An anxiety disorder in which an individual who has experienced a traumatic event persistently re-experiences the event (has “flash-backs “), avoids the stimuli associated with the event, shows psychological numbing, and shows generally heightened arousal; these symptoms must persist for longer than a month .

Posttraumatic stress disorders (PTSD)

1. The individual must have experienced or witnessed the traumatic event in which physical injury or life was threatened. Traumatic events;

• Natural disasters (floods, earthquakes)
• Accidental disasters (plane crashes, fires)
• Deliberate disasters (wars, torture, rape)

1. The event is persistently re-experienced. The individual frequently recalls the event, has disturbing dreams about it. Experiences “flashbacks” to the event, or feels the intense anxiety that was felt during the original event.

2. The individual avoids stimuli associated with the trauma and shows a general numbing of responsiveness. The individual tries not to think or talk about the traumatic event and avoids activities related to the event.

3. The individual may show a generally heightened arousal that stems from the anxiety problems with sleep, irritability, difficulty in concentrating, exaggerated startle response.

4. The symptoms must last for more than a month.

3 points in diagnosing PTSD

• PTSD can result from many types of stressors.
• Must have strong evidence linking the stressor to the symptoms.
• Must rule out the effects of psychological problems that are associated with the traumatic event.

Posttraumatic stress disorders explanations

Learning and cognitive explanations: (classical conditioning and incorrect beliefs). Classically conditioned fear response. Stimuli associated with the traumatic event activates the PTSD symptoms. The pair of fear with stimuli leads to either conditioning or incorrect beliefs, depending on how you interpret the process.

Posttraumatic stress disorders treatments

Learning and cognitive approaches: (exposure and coping). Exposure to the stimuli that elicit the anxiety and flashbacks. Exposure may take a symbolic form or may involve the actual stimuli.
Physiological approach: Drugs to reduce anxiety and depression. Anxiolytics and antidepressants. combination of drug treatment with psychological interventions.

Acute stress disorders

Same indicators of PTSD. However, the symptoms occur within 4 weeks of the traumatic event and only lasts between 2 days and 4 weeks. Acute stress disorder can be a good predictor of PTSD.

General issues in anxiety disorders

Gender:

Anxiety disorders occur more frequently among women than men.

Women report more stressor;

• In the health or behavior of a relative.
• In an argument with a partner.
• In a change in occupational responsibilities.
• In a problem with colleagues.
• In a change in eating habits.

Men report more stressor;

• In a change in place of residence.
• In a change in working conditions
• In the beginning of an intimate relationship

Age:

Anxiety disorders decline with age.

Socioeconomic class:

Anxiety disorders occur more among;

• Lower-class individuals.
• Lower education.
• More sudden injuries, physical assaults, seeing someone hurt, killed or raped.
• Less financial opportunities.

Ethnicity and culture:

No evidence of difference linked to ethnic or cultural background.

Table of Contents

1. Introduction and Historical Issues
   Normality and abnormality in clinical psychopathology
2. Diagnostic Systems and Techniques
   Interviews, observations and tests
3. Anxiety Disorders I
   Symptoms of anxiety, phobic disorders, generalized anxiety disorders, panic disorder
4. Anxiety Disorders II
   Obsessive-compulsive disorders, post traumatic and acute stress disorders.
5. Mood Disorders I
   Major depressive disorder and dysthymia
6. Mood Disorders II
   Bipolar disorder
7. Schizophrenia I
   Symptoms and issues
8. Schizophrenia II
   Explanations and treatments
9. Disruptive Behavior Disorders-I
   (Attention Deficit/Hyperactivity Disorder)
10. Disruptive Behavior Disorders-II
    (Conduct Disorder and Oppositional Defiant Disorder)
11. Pervasive Development Disorders
    (Autistic Disorder, Asberger`s and other Developmental Disorders)
12. Elimination Disorders and Tic Disorder
13. Mental Retardation
14. Cognitive disorders
    (Amnesia Disorders, Dementia Disorders, Delirium Disorders)
15. Suicide
16. Substance related disorders
17. Sexual Dysfunctions