anxiety and related disorders how do we identify and treat anxiety disorders?
TRANSCRIPT
Anxiety and Related Disorders
How do we identify and treat anxiety disorders?
Anxiety Disorders• Affects 2–5% of the child population.• Affects 20–30% of students referred to
clinics for behavior problems.• Equal prevalence in boys and girls.• Have both social and biological causes.• Appear amenable to social learning
approaches.
Interventions for School Phobia• Desensitize the child’s fear by role
playing.• Reinforce school attendance, even for
brief periods.• Include matter-of-fact parental
statements that child will go back to school.
• Remove reinforcers for staying home.
Obsessive Compulsive
Disorder
Dr. Aubrey H. Fine
Obsessive Compulsive Disorder• OCD may include:
– Washing, checking, or other repetitive motor behavior
– Cognitive compulsions consisting of words, phrases, prayers, or sequences of numbers
– Obsessional slowness– Doubts and questions that elevate
anxiety
Facts and Figures• Prevalence
– Originally believed to be rare• >0.1%
– Recent evidence suggests 1-3% Onset / Characteristics:
– Males:, high prevalence of checking– Females:, high prevalence of washing
OCD Diagnosis (1): DSM IV• Obsessions defined by all of the following:
– Recurrent and persistent thoughts, impulses or images experience at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
– The thoughts/impulses/images are not simply excessive worries about real life problems.
– The person attempts to ignore or suppress such thoughts/impulses/images, or neutralize them with some other thought or action.
– The person recognizes that the obsessional thoughts/impulses/images are a product of their own mind (not imposed from without).
OCD Diagnosis (2): DSM IV• Compulsions defined by:
– Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules which must be applied rigidly
– The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
• Not better accounted for by other diagnosis
What is an Obsession?
• Involuntary intrusive cognition
• Types
• Doubts (74%)
• Thinking (34%)
• Fears (26%)
• Impulses (17%)
• Images (7%)
• Other (2%)
Examples of Obsessions• Doubt “Did I lock the door”• Thought that he had cancer• Thought / Image that he had
knocked someone down in his car• Impulse + thought to shout
obscenities in church• Image of corpse rotting away• Impulse to drink from inkpot and to
strangle son
Themes in Obsessions• Obsessions often have common themes
– Contamination, dirt, disease, illness (46%)– Violence and aggression (29%)– Moral and religious topics (11%)– Symmetry and sequence (27%)– Sex (10%)– Other (22%)
• The themes often reflect contemporary concerns (the devil, germs, AIDS)
Examples of Compulsions• Scanning text for “life” having read
“death”
• Touching the ground after swallowing saliva
• Driving back to check he hadn’t knocked someone down in his car
• Counting 6,5,8,3,7,4 in your head
• Hand washing
Linking Obsessions and Compulsions
OCD and “Normal” Experience• Obsessional thoughts found in 90% of
people– It is well replicated that 80%+ of normal people
have intrusive thoughts– There thoughts are similar in content and form
to OCD patients
• Compulsions– Many people have compulsions such as
stereotyped or superstitious behaviors– 66% of normal people report some form of
checking behavior
• Is OCD qualitatively distinct?
OCD Experiences OCD Not OCD
A man who washes his hands 100 times a day until they are
red and raw
A woman who unfailingly washer her hands before
every meal
A women who locks and relocks her door before going to work every day – for half an hour
A woman who double-checks that her apartment
door and windows are locked each night before
she goes to bed.
A college student who must tap on the door frame of every classroom 14 times before
entering
A musician who practices a difficult passage over and over again until its perfect
A man who stores 19 years of newspapers “just in case” – with no system for filling or retrieving
A woman who dedicates all her spare time and money
to building her record collection
Cognitive Aspects of OCD• Responsibility for harm to self/others
– Any influence over outcome = responsibility for outcome
– Omission: “I will omit to do something that leads to myself/others being hurt”
– Magical thinking• Thought Action Fusion
– Thought = action “I will harm my child”• Obsessions = “going crazy”• Control: “Trying to hard”
– Suppression: “white bears”– Pre-Occupation: “Looking for trouble”
OCD: Therapy • Exposure and Response Prevention (ERP)• Responsibility
– Am I a murderer or just worried about being one?
– Normalizing / Other explanations
• Thought = action– Can I think myself to death?
• Neutralizing– Experiment to show how thought suppression
increases thought frequency
• Exposure: Cued Intrusions
Key Issues• What are the strengths and limitations of
behavioral models of OCD?– Think about the empirical findings of current
psychological models such as Salkovskis’
• Have cognitive models of obsessions and compulsions helped us understand OCD and how it should be treated?
• How are intrusive thoughts in OCD different from “normal” intrusive thoughts?– Are they different at all?
Posttraumatic Stress Disorder• Repeatedly perceived memories of the
trauma.• Repetitive behaviors that may be
similar to obsessions or compulsions.• Fears linked to the traumatic event.• Altered attitudes toward people, life, or
the future, reflecting feelings of vulnerability.
Stereotyped Movement Disorders• Involuntary, repetitious, persistent,
nonfunctional acts over which the individual can exert at least some voluntary control.
• Self-stimulation• Self-injury• Tics• Tourette’s syndrome
Selective Mutism• Children who are reluctant to speak although
they know how to converse normally.• May be a response to:
– Trauma – Abuse– Social Anxiety
• Most effective interventions incorporate social learning principles.
Eating Disorders
• Anorexia
• Bulimia
• Pica
• Rumination
• Highly exclusive food preferences
• Obesity
Elimination Disorders
• Enuresis
• Encopresis