DiscoverCounselor Toolbox PodcastObsessive Compulsive Disorder and Addiction Awareness
Obsessive Compulsive Disorder and Addiction Awareness

Obsessive Compulsive Disorder and Addiction Awareness

Update: 2020-10-15
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Obsessive Compulsive Disorder and Addiction Awareness

#ocdawareness #obsessivecompulsivedisorder


Cheap CEUs are available for this presentation at

https://www.allceus.com/member/cart/index/product/id/1352/c/


Objectives

~ Define obsessions and compulsions

~ Define obsessive compulsive personality disorder

~ Define addiction

~ Explore common obsessions and compulsions and their function

~ Explore why addiction often co-occurs with OCD

~ Identify interventions appropriate to assist people with OCD, OCPD and Addiction.

Introduction

~ “Obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on different levels, including phenomenology, co-morbidity, neurocircuitry, neurocognition, neurochemistry and family history” Obsessive-Compulsive Disorder, Impulse Control Disorders and Drug Addiction

~ Activity in the orbitofrontal cortex is associated with cocaine and alcohol craving and obsessive–compulsive disorder

~ Obsessions and compulsions are central characteristics of OCD and addiction

~ Proposed that impulse control and obsessive- compulsive disorders may acquire qualities of the other with time

Introduction

~ Compulsivity in OCD and addictions is related to impaired dopamine and serotonin release

~ Treatment of these disorders must address alterations in the underlying motivations (experiential learning) and neurobiology

Obsessions

~ Obsession

~ Disturbing recurrent and persistent thoughts (if I don’t…) or impulses (I must…) that are intrusive

~ Fears of germs, taboo thoughts, aggressive thoughts, need to do particular behaviors to prevent harm

~ Thoughts do not focus exclusively on real problems (generalized anxiety, eating disorders, addiction, PTSD, postpartum depression)

~ The person attempts to ignore or suppress the thoughts or impulses

~ The person is aware that the obsessional thoughts, impulses, or images are a product of his or her own mind

Common Obsessions

~ Relationship

~ “If I enjoy when my partner is away, maybe I don't really love them.”

~ “Sometimes I look at other people and think about cheating. Maybe I secretly want someone else.“

~ “Sometimes my partner looks at other people. Maybe they want someone else.”

~ “My partner hasn’t texted me all day. They must be cheating on me or not want me anymore.”

~ Harm OCD

~ “If I drive on a bridge I might drive off and kill everyone”

~ “If the doors aren’t locked someone will break in and kill us.”

~ If I didn’t turn off the stove…

~ If I am around other people…


Common Obsessions

~ Health

~ What if this pain is cancer?


Compulsions

~ Repetitive behaviors or thoughts that the person feels driven to perform to prevent or reduce distress or keep something bad form happening

~ The symptoms of OCD are not the result of another psychiatric disorder present or caused by a medical condition or substance abuse (i.e. cravings, diabetes, Chron’s disease).


Common Compulsions

~ Relationship

~ Comparing partner to others

~ Comparing self to others

~ Frequent breakups

~ Needing frequent reassurance

~ Harm

~ Checking

~ Washing

~ Isolating

~ Prayer

~ Health

~ Nutrition

~ Detoxification (Exercise, diet, sauna)

~ General

~ Magical thinking (rituals, mantras)


Obsessive Compulsive Personality Disorder

~ A pervasive pattern of preoccupation with orderliness, perfectionism, and control in a variety of contexts beginning by early adulthood as indicated by 4+ of the following:

~ Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

~ Shows perfectionism that interferes with task completion

~ Is excessively and unnecessarily devoted to productivity to the exclusion of recreation

~ Is overconscientious and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

~ Is unable to discard worn-out or worthless objects even when they have no sentimental value. (Hoarding)

~ Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

~ Adopts a miserly spending style

~ Shows rigidity and stubbornness


Interventions

~ Medications for addiction which modulate dopamine system through

~ Opioid (e.g. Buprenorphine and naltrexone)

~ Glutamate (e.g. Topiramate)

~ Serotonin/ 5HT3 (e.g. Ondansetron)

~ GABA (e.g. baclofen and topiramate)

~ Treatment of these disorders must account for alterations in the underlying neurobiology of the condition. For example

~ Naltrexone for people with co-morbid SUD and ICD

~ Topiramate for people with co-morbid ICD and eating disorders

Interventions–Cognitive

~ Explore when the OCD or OCPD began

~ Explore when the addiction began

~ In what ways does the OCD or OCPD

~ Address feelings of unsafeness?

~ Develop a checklist

~ Journaling and exploring probability that something bad will happen

~ Reaching out to a support person (i.e. feel overpowered by emotions or thoughts)

~ Protect from rejection or failure?

~ Explore the beliefs surrounding rejection and failure

~ Enhance hardiness

~ Improve self-esteem

~ Explore where those messages came from and their validity

Interventions–Cognitive

~ How does the addiction help the person?

~ Use chaining to explore how the addiction relates to the obsessive thoughts to trigger cravings and compulsions (using)

~ Fears of germs anxiety  cravings to rebalance neurotransmitters  use

~ Discussion: What is your thought/or the situation  what are your feelings  what are your urges and what is the function of those urges

~ Learn about distress intolerant thoughts (Draw from the hat)

~ Develop alternative self statements

~ Learn about urges and riding the wave

~ Learn about unhooking

~ Develop distress tolerance skills


Interventions

~ Identify and develop a plan to mitigate triggers or vulnerabilities for the OCD or OCPD (logs, plans)

~ Beach Ball Activity: Common triggers for OCs / OCPD behavior intensification

~ Address cognitive distortions that contribute to distress

~ Mindreading, personalization, all or nothing, catastrophizing, availability heuristic (likelihood)

~ Facts, exceptions, probability

~ Mindful awareness activities to improve self-awareness of increasing anxiety or anger levels and promote early intervention

~ Psychological flexibility

~ 4 Stations: For and against behaviors and thoughts

Interventions

~ Exposure and Response Prevention (ERP w/biofeedback)

~ Think the thought or about the situation describe how you feel in session

~ If I don’t clean the kitchen, my husband will die.

~ If I am around people I will get sick and die.

~ Practice re-regulation/distress tolerance activities when prevented from engaging in the compulsive behavior (breathing, talking to a support)


Summary

~ There is significant overlap between OCD and addictive behaviors.

~ Treatment involves

~ Identifying the underlying thoughts

~ Exploring what is contributing to fears of unsafeness (harm, rejection) and powerlessness

~ Identifying the function of the thoughts and behaviors

~ Practice Exposure and Response Prevention to decondition the compulsive behaviors

~ Potentially medicating the neurotransmitter imbalance until the brain can adapt (reroute)

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Obsessive Compulsive Disorder and Addiction Awareness

Obsessive Compulsive Disorder and Addiction Awareness

Charles Snipes