Anxiety and

Related
Disorders
How do we identify
and treat anxiety
disorders?

Anxiety Disorders
Affects 25% of the child population.
Affects 2030% 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 childs 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
OCD may include:
Washing, checking, or other
Disorder
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 hadnt
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 doublechecks 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
Involuntary, repetitious, persistent,
nonfunctional acts over which the
Disorders
individual can exert at least some

voluntary control.
Self-stimulation
Self-injury
Tics
Tourettes 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