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OCD (Comorbidites (Anxiety disorder(panic,social, PTSD), mood disorder,…

- - - - Obsession
        
        intrusive recurring thoughts or images
        
        which the patient finds extremely disturbing and distressful
        
        Types
        
        Aggressive
        
        monitoring violent crimes, asking if being a good person
        
        Contamination
        
        Washing or cleaning ritual
        
        Pathological doubt, completeness
        
        checking excessively, actions in a particular order
        
        Religious
        
        Asking forgiveness, praying, reassurance seeking
        
        Self-control
        
        avoiding being around others
        
        Sexual
        
        avoiding triggering situations, mental rituals to conteract
        
        Superstition
        
        counting excessively
        
        Symmetry and Exactness
        
        ordering and arranging
      - compulsion
        
        repetitive ritual behaviors
        
        which are performed to reduce anxiety caused by distressful thoughts
        
        prevent negative outcomes from happening
        
        strongly compelled to perform these actions and become automatic over time
      - these are time consuming or cause impairment of functioning or distress
  - - - patients perceive defects in physical appearences
        
        leads to compulsions in response to concerns
    - - recurrently pick the skin causing skin lesions
        
        often multiple attempts to stop
    - - trouble discarding
        
        accumulate items to a degree that living space cannot be used
    - - keep pulling their hair resulting hair loss
        
        often multiple attempts to stop
- - - - can modify gene expression with neurotransmitter
        
        changing brain's network
    - - glutamate dopamine and others too
    - - frontal lobes and basal ganglia
        
        inability of the brain to inhibit
  - - - doubt is the result of a problem with Executive Function
        
        repeated checking really does cause memory distrust
        
        vividness and detail declined
    - - OCD find their obsessions distressing so they suppress it
        
        when a negative thought is suppressed, it comes back more frequently than before
        
        rebound effect
    - - OCD use the current mood as feedback to understand if they met their stop rule criteria
        
        a rule that states that they must stop the compulsive behavior only when they are sure they completed the task
        
        perseveration is the consequence of perseveration of bad feelings
  - - - Inflated responsibility
        
        feeling responsible for the content of their thought
      - Thought-action fusion (TAF)
        
        believing that having a thought about an action is equal to doing it
        
        Likelihood TAF
        
        belief that having a thought increases the likelihood that the event will happen
        
        Moral TAF
        
        belief that having an intrusive thought is the moral equivalent of doing that act
        
        assessing TAF
        
        self-report
        
        TAF is the example of how people give significance on the unwanted intrusive thoughts
        
        Likelihood TAF more connected to exaggerated sense of responsibility than Moral TAF
        
        TAF in anxiety too and to some degree in normals
        
        A two-factor solution with likelihood and Moral is supported for components of TAF
        
        TAF can be positive
      - Mental contamination
        
        feelings of contamination that appear even thought there was no contact like the thought of dirtiness leading to washing
- - - - CBT sub and most effective for OCD
        
        exposing to the stimuli that provokes the obsession and asked not to do compulsive response
        
        have to practice competing behaviour or modify the compulsion
        
        self, group, family, computer
        
        long term lasting effect for 75%
    - - alternative if ERP does not work
        
        try to modify dysfunctions beliefs about fears and thoughts
        
        aims to change the significance of rituals
    - - show them that responsibility is not only theirs
        
        using a pie graph showing the responsibility is spread among different variables
  - - - so Selective Serotonin Reuptake Inhibitors (SSRI)
        
        if this alone does not help combine and antidepressant
  - - - destroying cells in cingulum close to corpus callosum