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    11 views7 pages

    2019 FONTENELLEYUCEL Chap1

    Uploaded by

    helena ribeiro

    Copyright:

    © All Rights Reserved
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    of 7
    [ESEEEEE Theoretical Foundations of Obsessive-Compulsive and Related Disorders waa A Transdiagnostic Approach to Obsessions, Compulsions and Related Phenomena Leonardo F Fontenelle and Murat Ycel Introduction Posie Ses ee eng Obsesvecompulive dioder (OCD) cancer. Su inte symptoms include obsessions (persistent and” predominantsite of Disorder ‘unwanted thoughts, imagescrurges) and compulsions regan (tepettive behavior that are performed in response to ttvesions or acordng to gd ul). OCD i both Noma} Teves aoe frequent and dling tacts to ofthe general Spat tr that population and leas to deeaed productivity snd ra Substantial decreases in quality of lie. However, the rtegtnieee fmpact of OCD’ consituert symptoms (obsessions, compulsions and related phenomena) may be greater ‘than the one associated with the disorder per se. For Fesiv sian pay instance, obsessions and compulsions are frequently optic vit caicton Sound in sub-theeshold yet Impact forme. They (tram) also occur in conditions ofically classed by the rea Diagnose and ttitical Manual of Mental Disorders, ‘th edition (DSM-5) [1] andthe 1Ith Revision ofthe Caen rion International Classification of Disease (ICD-11) [2] a8 Woe veram ‘obsesive-compulsive and reed disorders(OCRDS)._Feralatoercgutie. Sve “Te fact that obsessive thoughts and compulsive srst@npoalicbe behaviors may occur arossa number af newropeychi- sain conten atric conditions has been wall known since Kraepelin (foralistof conditions presenting OCD symptoms, sce Rooeawon ei et, Table 11), However itisonlyafter the end ofastrongly Etec herarchical approach to pychitric diagnosis that Gewolmdton uve malay clinicians have been abe o offically diagnose OCD ostunton inthe presence of conditions such ae schizoph isjor depressive disorder or Tourette’ disorder. The en ‘ecogiton that neuropsychiatric disorders could be 7 omorbid with one another hasbeen a major advance P#CwECHI Seton in the field. 1 prompted clinicians not only to iden Dapeng tpl) Ly but also to teat comorbid OCD, this leading to better outcomes. However, this is not exactly the teanadignostic approach we del with inthis chapter, Obsesions and compulsions are linia! anstructs, Unt ove they have proven tobe reliable And useful. They are reliable for being consistent over being remediate by a series of strategie that, des- "ime and between dierent clinicians, and useful for Pit Rot being efectve in some cases can alleviate Section 1-Theortical Foundations of CROs symptoms in many. However, rather than existing as “natural kinds" obsessions and compulsions may be the final products of multiple intrelting dysfune: tional cognitive affective proceses and corresponding neurobiological systems. Faure to recognize these The RDOC svgges the newophysoiogcl underpinning of cnet detection to be ERN, lead adresse in tht hapter ander cognitive contol L the caper f xine na dtd uo he a Gohang need bi ermtonn OCRDS ss ech duced more depth ner sos boa eg. Chapter 8 Hove lee Mend neal et brn et 1 Pet comple deter we ought Aerob apyopt aden ersoe es tethering ehh could lp ‘petiecanplvy or ke Ti insane bounce stone ave been ceased angstrom drag SESS has tat eden by poste ence seas The me migit At for ther atl dons aches anling order Macrae tes gunes tmigntnt em cay ee che OGD wih he ab formaton model ne OCD Stave denser aden by pte, Soran ponte ehecomen Yr ple ‘eb teadedoped gee avian haba San onl ins shock Since ok died fo Induce hatte through wertraing (0) Al ple of 72 patents ith OCD: ve hve ound fan thie Saloon Hat Indes SRE) ones tried poate wh nds of OCD seve {Goer Comp ment sr eon td {co tnd the le Bown Obese Compue Sas conplaons ioc) ee ie etna Siu tems ere eed [the tater Say there wr sh craton tetven duton of es tric acting promt and ntsc of other pons 1)" atom between has tnd ching hs been ihe tone ‘aly th nine cn and deere fret tmengton The bi sem may alo be involved in nathr tere deem cv rte irl dares {Oc and SAD, mandy te nese eh lr compety alae nh mot OCRD eta Ing wang cen nd odsing behave Although the ttn earch amin ‘ton bs cmpbaded ie semen he ly {prom eompler mot sore (Le eton ‘ora In coptive driers Sapper Peg he pouty at compen OCD ra ‘ress: mie phemnenan at nan xe ecto «soe copes mee et es behavioral roatnes tha a enaplatd in chun United by ston ound, epg en sigs om the rain athe rental core) Ua Smith and Geni [6] edt ta hse behaviors could results from chunking-rlted activity In the dorsolateral striatum or infralimbic cortex oss ‘of erorcorrectve signaling in the dorsolteral sti ‘zum or inflexibily in the infalimblc related ha promoting process Synthesis of the Transdiagnostic Approach to Obsessions and Compulsions We baleve that an indepth dicasion on the tranlagnovcaspetsofobsssonsand compulsions {eather than one tht focuses on al Blown DSM 3 ‘OCD) poses sigan challenges For stance, we Scknowedge tht as advocated by the RDWC mate dine and vbtieshold forms of pyhopatology actly to share the sane undeing newrbilogy tia tie sce Chapter 13). However cles Sil speciy wit iscsiiable or dogronble and ‘ha oe ot eed ny spect spec ern Son. Although diagnostic contact ean be dimen sonal and obcsonliy and compalsy are dear trample of thee sorts uf symptoms te sion of eating or nt tetng a patent remains ‘gore ne Ta dentin! approach poet Prete and ethical question, sch ahee tenes Should be dawn an the aneciated ris of over oF {mderteniment hs denna bs ben faced by pre vows prychiatrc csifeatory schemes and should tbe ignored Yeu it one wants to discus the impliations cf the trnuiaraatc aspects of obsetons and Compulsion ont shuld operational the concepts Of obvesionaty and comput. In ly tere, tuendonality cold be simply dvribed a he ten dency to think excniven while compuly cou be dine at popeatytvard sibling beter ‘aces Hower thee wommon sen non dnt sce to have much clin tty as they cncopse several elated opie. depee ‘ination and behavior eg, pychomotr og on syptoms. Also, thy cannot gue trestnen a theresnotherapetcapronchthatsablet remediate Al anormally perstentcopns and exesive Behaviors indisinintl Howevertes we propose lesional and compas arecostaedas ls that paral ove wth wht has been techy in a cbssons and compulon, we believe that a few advance an be mae at est he et ial component ofthe ater conivut ae ented Section 1: Theoretical Foundations of OCRDs and described. Thus, there may be different type and Aefnitions of obsessionality and compulsivty This ‘was our approach in this chapter, where we refer to diferent RDoC dimensions. Symptoms that could be subsumed under obsesionality and compulsvty are listed in Tables 1.2 and 1.3, respectively. Deconstructing obsessions and compulsions into their key components has theoretical (pathophysio- logical) and practical (diagnostic and therapetic) ‘nmpications. First, DSM-5 OCD may have diferent neurobiological ystems implicated in is pathopays- ‘logy depending on whetheraspecifisetofeympioms (eg, obsessions, compulsions or bath) predominates, For instance, obsessive images may be more trauma Felted 36}, whereas compulsive behaviors may be ‘more neurodevelopmentlly based [73]. Notably, this ‘pproach mighthave implications for other conditions that share features with OCD; for example, OCD obsessive images and PTSD intrusive images may both eslt fom dysfunction in similar brain ercuits (able 1.2) (74), Second, atransdiagnostic approach io ‘obsessions and compulsions may also have diagnostic consequences, a the diferential diagnosis of OCD ‘may be more precisely performed if cognitions (eg thought alienation) or behaviors (eg. stereotypes) that characterize other disorders (eg, schizophrenia) are disentangledfeom obsessional thoughts or com- pulsve ritual that are core to OCD. Most critically, however, a transdiagnostic approach to obsessions and compulsions could help ‘0 illuminate the neurobiology of diferent psychi atric disorders, thus leading to beter treatment in line with RDOC guidelines. For instance, patients with OCD recognize obsessions, along with several other cognitive symptoms that share the feature of being persistent and distressing as their own exper ence, and not as someone else as in thought alien ation. Thus, it makes sense to conttast OCD with Schizophrenia samples to clarify the biology thet ‘underlies abnormal agency. Similar, compared with delusions, which are prereflexive phenomens (delusional patents express conviction and cer {ainty about certain statements rather than admit that these statements may be subject to discussion and inquiry” (75), obsessions involve an Intense Internal dialog, thus suggesting that patients with OCD can be contrasted with psychotic patient to iluminate the biology ofinsight and sel-knowlecge. Further, like many obsessions, the preoccupations ‘of GAD include doubt, elements that are lacking in J auditory hallucinations and parapilic fantasies and ‘ould be studied under the construct of cognitive control and suitaned threat Al behaviors listed in Table 1.3 can be executed with a certain degree of automaticity but compul sive, avoidant and addictive behaviors are the only ‘ones more clearly performed to decrease fear and dis tees. Thus, it seems reasonable to contrast patents with the later conditions to samples with other sulomatic behaviors to daify the biological bass of sustained threat and to develop ant-fear treatment, tis also interesting that behaviors associated with the so-called sensory phenomena, such as OCD compulsions, Tourettes tes and tichotillomania grooming behaviors have been shown to be genet. ically linked [76]. Further, thas been demonstrated ‘that impulsivity isa risk factor fr addiction, and both ray be related to poor cognitive contol and lack of foresight. Finally, while additive, grooming and unding behaviors are all well known tobe associated with reward valuation expectancy and responsive- nes, it has been increasingly recognized that OCD ‘compulsions and ansety disorder avoidance can also be associated with reward processing abnormalities, “Thus, It seems sensible to tet approaches targeting anticipatory (dopaminergic) and/or consummatory (opioidergc) transmission in the later conditions ‘We must acknowledge that, instead of resulting from the combination of multiple dysfunctional neurobiological systems, OCD may be ascribed to 8 tll unrecognized and broad obsessionality and! ‘or compulsivity RDOCconstruct/sub-construct However, there is yet no fll consensus on how these ‘concepts should be understood: that a symptom phenomena, as personality traits or a8 neue. peychological constructs [77]. Although the RDoC ‘spproach is particulary interested in addressing the abnormal biology underlying symptoms (rather than on obsessions or compulsions per se), it it conceptually difficult to disentangle absessionality and compulsvity from the concept sith which i 1s intcnsicaly intermingled (ke. & symptom com: plex). In other words, searching for the biology ‘of obsessionality and. compulsivity and not for ‘obsesionsand compulsions could beamere semantic exercise that does not capture the underlying biology ‘of OCRDs. However, only future therapeutic studies willbe able to clarify whether concentrating on dys functional RDO systems underlying absessionalty and compulsivity will prove more beneficial 10 Table 1.2 Overiewf penn and ening cave rms shang eee hese Preaccputons Ruminatons Obseine Obsesve Fentalee shu alucaond Pte asstin! ererioed ocCamters Symotm —Thowght hoogeager ferere er racy i Ee A somos 8 Sure RDO. esetch Domain (0b bey mmc cer GAS geese oe te than concentrating on obsesions and 13, Sing GE, Tantomor dela concen pate In Recard M, eur general y pea Madrid tori Gres 19567282 14. Denys. Obeesonaty and compulviys Pempulsions Pe behaviors behaviors Compulsive Avoidant References ‘Phenomenology of obsesive-compulsive disorder, ' / + ¢ 8 «mein Peis socio, Dagon hice nant Med 21183 ‘4 feral Mana of Mel Dore, thd 1s mate te pean type 8 | ‘Washington,DC: APA: 2013 7 Spat Poop 20¢24329-25. 5 4 Wold Heath Organization Iran 16, Marko IS, Jair Berios GE Insight and ie : etseatono Dies th Revision rere ern ied ' + 1 4 4 Sie 5 Geer WHO; 2018 chp 208425):277- 28, Bee i 4. Arwmagham SS, Reddy JY. Augmentation strategies in Fontenelle JM, Harrison Bf, Santana L, Concecao ‘Aeaeecompulsive diordr Exper Rev Neurtier. ‘do Rosario M, erin! M, Fontenalle LE Corzlate g -2013413(2):187-202. of insight into different symptom dimensions in eet : eter have Mea Resa eee rd on lyr ‘ . & domain criteria (RDC): toward a new classification 2013:25(I)11-16. i eke okra yeh. 201017} 788-751. Addictive Punding Impulsive Complex behaviors des : ‘eperince in chrome compel dre eng 5 $ : 5. Cather BN. Reseach Domain Cotes toward theless, suey senate and diese ‘. i Graphic esl Disses ln Nero. trance: Cl Pye er. 201483) 286-27 ae: isan 9-97 19, Alina JM, Teal NA Hakeem AY a The vou 4 Mj Nantowing te gp tween ICDIDSM and Tonome nos nthe otinae sd reo 5 MBuccontrcs pose eprand cnet Wo Spe corer A NY Aen So 20112559 § ; ' Be Pye 201615095 19-194 20. Som EM, Th yh of Sopa: Renata Tre ee t fo §Rs 2. Yager feinstin RE, Pletal plication of the {ftaman Percy, Crnbary. NI Paeigh ang NSichitoatce fea! afte Resrch Domin——Bknsn Unerty Pre 207 aR teri (RDAC cnc pci practie how 9), Yond, tbl G, ChamblesD Relaty and [RDoC might eased in assent, agnostic process cate formulition, treatment planing and Utne notes J Cln Phir. 217,423 1 Fa Clinical oehopatolgy Sigs and Symptoms InPsych, 2nd Haron Myo Brit fn ‘ality ofthe Yale-Brown Obesive-Compalsive Shale Behav Ret Ther 19953(59397-60, | 22, Rosario Campos MC, Miguel EC Qutrano St “The Dimensonal Yale: Brown Obese Compulsive ‘Grooming behavion Sele DY-BOCS) an nstrment or asessng ‘Wright; 1985, _obsessive-compulsive symptom dimensions, Mol Be 9. Synfek, Vou. Disbunesf he sense pct noel) 04 : hi Tagen in hn nn i tant + +o 23, Abramomt J Deson Bln 80,

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