Obsessive-Compulsive Disorder And Comorbidity
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For the typical OCD patient, this behavior would be a ritual performed to ward off some impending disaster or protect against perceived external threats. Any pleasure they get from the action comes from a temporary relief from the anxiety they experience at the thought of what could happen if they did not perform the ritual. In contrast, an ASD patient might turn a light switch on and off because they experience self-soothing pleasure from the act itself, not because it shields them from some obsessional fear.
Typically, ASD patients have no interest in changing their behaviors because their compulsions are pleasurable. They may even feel that their compulsive actions are positive and helpful. Similarly, using only behavioral methods on an OCD sufferer without working on the underlying fears would be just as ineffective. Each disorder requires its own particular treatment program.
Typical treatment for OCD compulsions involves controlling antecedent events, meaning controlling the thought processes and fears that cause the compulsive actions. A therapist might use repeated prolonged exposure response prevention interventions to lower levels of anxiety for OCD patients; however, in an individual diagnosed with ASD, anxiety arises from a different source, e. Instead, the treatment approach will have to be more about consequential control of behaviors, i.
This can be done with behavioral techniques such as anger management or desensitization techniques, and reinforcing these replacement behaviors with a reward system. Social issues can make it difficult for such patients to successfully work with a cognitive therapist.
Basic social skills training are essential for successful cognitive therapy and should be used to treat both OCD and ASD. With this training, patients are able to understand their behaviors are atypical and caused by neurological irregularities, and also learn to socially connect. Basic social skills training may take longer with ASD patients because of their general lack of insight, but with perseverance, these skills will eventually take hold. By beginning with basic social skills training, the effectiveness of the therapy that follows will be greatly enhanced.
Another issue that may arise in treatment of individuals with ASD is they often show intense and sudden bursts of anger and frustration. They often take far longer to regain peaceful composure than the general population. The sudden burst of anger and difficulty regaining calm make mindfulness training for OCD patients very difficult. Since mindfulness is one of the core parts of many treatment models, finding ways to work around this problem is essential. Then, therapy should begin with anger management and basic social skills training.
The therapist must overcome obstacles in these two areas before successful OCD treatment can happen. While treating patients with both OCD and ASD may take longer and present more challenges, research studies suggest that patients with both disorders tend to retain their improvement better than other patients. For example, Dr. Michael Strober and Dr.
In my own professional experience, I have found this also to be true with ASD adults. Usually patients suffering from OCD-BD comorbidity show a peculiar clinical course, characterized by a larger number of concomitant depressive episodes and episodic course.
In these cases, the treatment with antidepressants is more likely to elicit hypomanic or manic switches, while mood stabilizers significantly improve the overall clinical picture. Moreover, OCD-BD patients are frequently comorbid with a number of other psychiatric disorders, in particular anxiety disorders, social phobia, and different substance abuses, such as alcohol, nicotine, caffeine and sedatives.
Conclusions: BD-OCD comorbidity needs further investigations in order to provide more solid evidences to give patients a more precise clinical diagnosis and a more targeted therapeutic approach. Keywords: Obsessive-compulsive disorder, bipolar disorder, psychiatric comorbidity, antidepressants, mood stabilizers, atypical antipsychotics. Abstract: Background: Obsessive-compulsive disorder OCD symptoms within the context of a bipolar disorder BD have been described since the 19th century. The first category of executive dysfunction is based on the observed structural and functional abnormalities in the dlPFC, striatum, and thalamus.
One proposed model suggests that dysfunction in the OFC leads to improper valuation of behaviors and decreased behavioral control, while the observed alterations in amygdala activations leads to exaggerated fears and representations of negative stimuli. Due to the heterogeneity of OCD symptoms, studies differentiating between symptoms have been performed.
Comorbidity between obsessive-compulsive disorder and body dysmorphic | NDT
Symptom specific neuroimaging abnormalities include the hyperactivity of caudate and ACC in checking rituals, while finding increased activity of cortical and cerebellar regions in contamination related symptoms. Another model proposes that affective dysregulation links excessive reliance on habit based action selection  with compulsions. This is supported by the observation that those with OCD demonstrate decreased activation of the ventral striatum when anticipating monetary reward, as well as increase functional connectivity between the VS and the OFC.
Furthermore, those with OCD demonstrate reduced performance in pavlovian fear extinction tasks, hyper responsiveness in the amygdala to fearful stimuli, and hypo-responsiveness in the amygdala when exposed to positively valanced stimuli. Stimulation of the nucleus accumbens has also been observed to effectively alleviate both obsessions and compulsions, supporting the role of affective dysregulation in generating both.
Studies of peripheral markers of serotonin, as well as challenges with proserotonergic compounds have yielded inconsistent results, including evidence pointing towards basal hyperactivity of serotonergic systems. Despite inconsistencies in the types of abnormalities found, evidence points towards dysfunction of serotonergic systems in OCD.
Although antipsychotics, which act by antagonizing dopamine receptors may improve some cases of OCD, they frequently exacerbate others. Antipsychotics, in the low doses used to treat OCD, may actually increased the release of dopamine in the prefrontal cortex, through inhibiting autoreceptors.
Further complicating things is the efficacy of amphetamines, decreased dopamine transporter activity observed in OCD,  and low levels of D2 binding in the striatum. Abnormalities in glutaminergic neurotransmission have implicated in OCD. Findings such as increased cerebrospinal glutamate, less consistent abnormalities observed in neuroimaging studies, and the efficacy of some glutaminergic drugs such as riluzole have implicated glutamate in OCD.
Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. The Quick Reference to the edition of the DSM states that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and that cause marked anxiety or distress.
These thoughts, impulses or images are of a degree or type that lies outside the normal range of worries about conventional problems. Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress.
Comorbidity and OCD
Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD such as ordering items in a pantry by height , the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions, otherwise they will experience significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive.
In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming taking up more than one hour per day or cause impairment in social, occupational or scholastic functioning. With measurements like these, psychiatric consultation can be more appropriately determined because it has been standardized. OCD is sometimes placed in a group of disorders called the obsessive—compulsive spectrum. OCD is egodystonic , meaning that the disorder is incompatible with the sufferer's self-concept.
OCPD, on the other hand, is egosyntonic —marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image , or are otherwise appropriate, correct or reasonable. As a result, people with OCD are often aware that their behavior is not rational, are unhappy about their obsessions but nevertheless feel compelled by them.
From the Community
A form of psychotherapy called " cognitive behavioral therapy " CBT and psychotropic medications are first-line treatments for OCD. The specific technique used in CBT is called exposure and response prevention ERP which involves teaching the person to deliberately come into contact with the situations that trigger the obsessive thoughts and fears "exposure" , without carrying out the usual compulsive acts associated with the obsession "response prevention" , thus gradually learning to tolerate the discomfort and anxiety associated with not performing the ritualistic behavior.
At first, for example, someone might touch something only very mildly "contaminated" such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school. That is the "exposure". The "ritual prevention" is not washing.
Another example might be leaving the house and checking the lock only once exposure without going back and checking again ritual prevention. The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level drops considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
It has generally been accepted that psychotherapy in combination with psychiatric medication is more effective than either option alone. The medications most frequently used are the selective serotonin reuptake inhibitors SSRIs.