E-Book, Englisch, 114 Seiten
Abramowitz / Jacoby Obsessive-Compulsive Disorder in Adults
1., 2015
ISBN: 978-1-61334-411-8
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 114 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-411-8
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Cognitive-behavioral therapy using the techniques of exposure and response prevention has helped countless individuals with obsessive-compulsive disorder (OCD) overcome debilitating symptoms and live fuller, more satisfying lives.
This volume opens with an overview of the diagnosis and assessment of OCD in adults and delineates an evidence-based conceptual framework for understanding the development, maintenance, and treatment of obsessions and compulsions.
The core of the book that follows is a highly practical treatment manual, based on decades of scientific research and clinical refinement, packed with helpful clinical pearls, therapist-patient dialogues, illustrative case vignettes, sample forms and handouts. State-of-the-art strategies for enhancing exposure therapy using inhibitory learning, ACT, and couples-based approaches are described. Readers are also equipped with skills for tailoring treatment
to patients with different types of OCD symptoms (e.g., contamination, unacceptable
thoughts, challenging presentations such as mental rituals) and for addressing common
obstacles to treatment. The book is an essential resource for anyone providing
services for individuals with anxiety disorders.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
[1]1 Description 1.1 Terminology Obsessive-compulsive disorder (OCD) (300.3) was previously classified as an anxiety disorder in DSM-IV. In DSM-5 (American Psychiatric Association, 2013), it is the flagship diagnosis of the obsessive-compulsive and related disorders (OCRDs), a category of conditions with putatively overlapping features (see Section 1.5). 1.2 Definition Definition of obsessions and compulsions OCD is defined in the DSM-5 by the presence of obsessions or compulsions (see Table 1). Obsessions are persistent intrusive thoughts, ideas, images, impulses, or doubts that are experienced as unacceptable, senseless, or bizarre and that evoke subjective distress in the form of anxiety or doubt. Although highly specific to the individual, obsessions typically concern the following themes: aggression and violence, responsibility for causing harm (e.g., by mistakes), contamination, sex, religion, the need for exactness or completeness, and serious illnesses (e.g., cancer). Most patients with OCD experience multiple types of obsessions. Examples of common and uncommon obsessions appear in Table 2. Compulsions are urges to perform behavioral or mental rituals to reduce the anxiety or the perceived probability of harm associated with an obsession. Compulsive rituals are deliberate, yet excessive in relation to, and not realistically connected with, the obsessional fear they are performed to neutralize. As with obsessions, rituals are highly individualized. Examples of behavioral (overt) rituals include repetitious hand washing, checking (e.g., locks, the stove), counting, and repeating routine actions (e.g., going through doorways). Examples of mental rituals include excessive prayer and repeating special phrases or numbers to oneself to neutralize obsessional fear. Table 3 presents examples of some common and uncommon compulsive rituals. [2]Table 1
DSM-5 Symptoms of OCD Time-consuming (e.g., 1 hr or more) obsessions or compulsions that cause marked distress and impairment in social, occupational, or other areas of functioning Obsessions: Repetitive and persistent thoughts, images, or impulses that: (a) are experienced as intrusive and unwanted, (b) cause anxiety or distress, and (c) are not worries about real-life problems. The person tries to ignore or suppress the thoughts, images, or impulses, or neutralize them with some other thought or action. Compulsions: Repetitive behaviors or mental acts that are performed in response to an obsession or according to certain rules. Compulsions are aimed at preventing or reducing distress or preventing feared consequences; yet are clearly excessive or are not linked in a realistic way with the obsession. Insight: The person might have varying levels of insight into the validity of her or his obsessions and compulsions, ranging from good or fair insight, to poor insight, to no insight. The level of insight might change with time and vary depending on the particular theme of obsessional fears. Tics: Some people with OCD have tic-like OCD symptoms that are characterized by a distressing sensory (somatic) state such as physical discomfort (e.g., in the neck) which is relieved by motor responses that resemble tics (e.g., stretching, eye blinking). Table 2
Common and Uncommon Obsessions Common obsessions The idea that one is contaminated from dirt, germs, animals, body fluids, bodily waste, or household chemicals Doubts that one is (or may become) responsible for harm, bad luck, or other misfortunes such as fires, burglaries, awful mistakes, and injuries (e.g., car accidents) Unacceptable sexual ideas (e.g., molestation) Unwanted violent impulses (e.g., to attack a helpless person) Unwanted sacrilegious thoughts (e.g., of desecrating a place of worship) Need for order, symmetry, and completeness Fears of certain numbers (e.g., 13, 666), colors (e.g., red), or words (e.g., murder) Uncommon obsessions Fear of having an abortion without realizing it Fear that not being able to remember events means they didn’t occur Fear that one’s mind is contaminated by thoughts of unethical situations Fear of contamination from a geographic region. [3]Table 3
Common and Uncommon Compulsive Rituals Common rituals Washing one’s hands 40 times per day or taking multiple (lengthy) showers Repeatedly cleaning objects or vacuuming the floor Returning several times to check that the door is locked Placing items in the “correct” order to achieve “balance” Retracing one’s steps Rereading or rewriting to prevent mistakes Calling relatives or “experts” to repeatedly ask for reassurance Thinking the word “healthy” to counteract hearing the word “cancer” Repeated and excessive confessing of one’s “sins” Repeating a prayer until it is said perfectly Uncommon rituals Having to touch (with equal force) the right side of one’s body after being touched on the left side Having to look at certain points in space in a specified way Having to mentally rearrange letters in sentences to spell out comforting words 1.2.1 Insight Individuals vary in terms of their insight into the senselessness of their symptoms People with OCD show a range of “insight” into the validity of their obsessions and compulsions – some acknowledge that their obsessions are unrealistic, while others are more firmly convinced (approaching delusional intensity) that the symptoms are rational. To accommodate this parameter of OCD, the DSM-5 includes specifiers to denote whether the person has (a) good or fair, (b) poor, or (c) no insight into the senselessness of their OCD symptoms. Often, the degree of insight varies within a person across time, situations, and across types of obsessions. For example, someone might have good insight into the senselessness of her violent obsessional thoughts, yet have poor insight regarding fears of contamination from chemicals. 1.2.2 Tics DSM-5 also includes a specifier to distinguish between people with OCD with and without tic-like symptoms (or a history of a tic disorder). Whereas in “typical” OCD, obsessions lead to a negative emotional (affective) state such as anxiety or fear, “tic-related OCD” is characterized by a distressing sensory (somatic) state such as physical discomfort in specific body parts (e.g., face) or a diffuse psychological distress or tension (e.g., “in my head”). This sensory discomfort is relieved by motor responses (e.g., head twitching, eye blinking) that can be difficult to distinguish from tics as observed in Tourette’s syndrome. [4]1.2.3 OCD From an Interpersonal Perspective OCD commonly has an interpersonal component The previous description highlights the experience of OCD from an individual perspective. Yet OCD commonly has an interpersonal component that may negatively impact close relationships, such as that with a parent, sibling, spouse, or romantic partner (Abramowitz et al., 2013). This component may be manifested in two ways. First, a partner or spouse (or other close friend or relative) might inadvertently be drawn to “help” or “accommodate” with performing compulsive rituals and avoidance behavior out of the desire to show care or concern for the sufferer (e.g., to help reduce expressions of anxiety). Second, OCD symptoms may lead to arguments and other forms of conflict within the relationships. Symptom Accommodation Accommodation occurs when a loved one (a) participates in the patient’s rituals (e.g., answers reassurance-seeking questions, performs cleaning and checking behaviors for the patient), (b) helps with avoidance strategies (e.g., avoids places deemed “contaminated” by the patient), or (c) helps to resolve or minimize problems that have resulted from the patient’s OCD symptoms (e.g., making excuses for the person’s behavior, supplying money for special extra-strength soaps). Accommodation might occur at the request (or demand) of the individual with OCD, or it might be voluntary and based on the desire to show care and concern by...
