7.4 SUMMING UP

Obsessive-Compulsive Disorder and Related Disorders

• OCD is marked by persistent and intrusive obsessions or repetitive compulsions that usually correspond to the obsessions. People with OCD feel driven to engage in the compulsive behaviors, which provide only brief respite from the obsessions.
• Common obsessions include anxiety about contamination, order, losing control, and doubts. Common compulsions include washing, ordering, counting, and checking.
• Body dysmorphic disorder is characterized by an excessive preoccupation with a perceived defect in appearance that is either imagined or slight, and mental acts or behaviors related to the preoccupation. Body dysmorphic disorder shares features with OCD: preoccupations that arise from beliefs that are disproportional to the situation and time-consuming corresponding compulsive behaviors.
• Neurological factors associated with OCD include disruptions in the normal activity of the frontal lobes, the thalamus, and the basal ganglia; the frontal lobes do not turn off activity in the neural loop among these three brain areas, which may lead to the persistent obsessions. Lower-than-normal levels of serotonin also appear to play a role. And genes appear to make some people more vulnerable to anxiety-related disorders in general—not necessarily to OCD specifically.
• Psychological factors that may underlie OCD include negative reinforcement of the compulsive behavior. In addition, normal preoccupying thoughts may become obsessions when the thoughts are deemed “unacceptable” and hence require controlling. In turn, the thoughts lead to anxiety, which is then relieved by a mental or behavioral ritual. People with OCD have cognitive biases related to their feared stimuli—in this case, regarding the theme of their obsessions.
• Social factors related to OCD include socially induced stress, which can influence the onset and course of the disorder, and culture, which can influence the particular content of obsessions and compulsions.
• Medication (such as an SSRI or clomipramine) directly targets neurological factors that underlie OCD. The primary treatment for OCD—exposure with response prevention—directly targets psychological factors. Family education or therapy, targeting social factors, may be used as an additional treatment.

Trauma-Related Disorders

• Trauma-related disorders are characterized by four types of persistent symptoms: intrusive re-experiencing of the trauma, avoidance of stimuli related to the event, negative thoughts and mood and dissociation, and increased arousal and reactivity.
• DSM-5 includes two types of trauma-related disorders: acute stress disorder and posttraumatic stress disorder (PTSD). Acute stress disorder is diagnosed when symptoms arise soon after the traumatic event and have lasted for at least 3 days but not more than 1 month; when symptoms last more than 1 month, the diagnosis can shift to PTSD. The diagnostic criteria for acute stress disorder also include symptoms of dissociation.
• An event is considered traumatic if the person experienced or witnessed an actual or threatened death, serious injury, or sexual violation. Types of traumatic events are large-scale events with multiple victims, unintended acts involving smaller numbers of people, and interpersonal violence.
• An unusually small hippocampus is a risk factor for PTSD. Patients with PTSD respond to high levels of norepinephrine by having panic attacks or flashbacks; they also have abnormal serotonin function. Although genes—through their influence on temperament—may affect a person’s tendency to enter risky situations, characteristics of a traumatic event itself are more important in determining whether the person will develop PTSD.
• Psychological factors that exist before a traumatic event contribute to PTSD; these factors include a history of depression or other psychological disorders, a belief in being unable to control stressors, and the conviction that the world is a dangerous place. After a traumatic event, classical and operant conditioning contribute to the avoidance symptoms.
• Social factors that contribute to PTSD include the stress of low socioeconomic status and a relative lack of social support for the trauma victim. Culture can influence the ways that people cope with traumatic stress.
• Medication, specifically an SSRI, is the treatment that directly targets neurological factors. Treatments that target psychological factors include EMDR and CBT, specifically psychoeducation, exposure, relaxation, breathing retraining, and cognitive restructuring. Treatments that target social factors are designed to ensure that the person is as safe as possible from future trauma and to increase social support through group therapy or family therapy.