Which anxiety disorders exist? - Chapter 4 (Abnormal Psychology)

General fear anxiety

Due to evolution, humans and animals have an automatic reaction to danger: the fight or flight response (fight or flight). The psychological changes that arise during this response are due to the activation of two systems: the autonomic nervous system and the adrenal cortical system.

The hypothalamus activates the sympathetic part of the autonomic nervous system, which prepares to fight or flight by releasing energy. The hypothalamus also activates the adrenal cortical system by releasing CRF (corticotrophin-releasing hormone), which releases the adrenocorticotropic hormone (ACTH). This hormone causes the cortisol level to rise. Cortisol in the blood and urine is an indicator of stress. We then experience the emotions that come with danger, after which we either confront the danger (fight) or run from it(flight).

People with anxiety disorders follow the same pattern, but with them there is no actual objective danger but rather a more subjective, psychological one.

We refer to anxiety disorder when people are continuously living with fear and normal functioning is thereby impeded. When this happens, people tend to realize the unreal nature of the disorder and suffers from it.

Fear consists of four different types of symptoms.

1. somatic symptoms: physical responses such as sweating and increased blood pressure

2. emotional symptoms: feelings of anxiety and vigilance

3. cognitive symptoms: unrealistic worries such as the feeling that something bad is going to happen

4. behavioral symptoms: such as avoidant or flight behaviours.

Posttraumatic stress disorder

Posttraumatic stress disorder and acute stress disorder both occur as a result of an experience of extreme stress. For example, many people developed a stress disorder in America as a result of the 11^th of September attacks. Furthermore, it is estimated that 7% of the people experience stress during their lifetime as a result of a traumatic experience.

For a diagnosis of PTSD, from all the symptoms in the DSM, at least the following four are necessary:

1. Relive the traumatic experience: including flashbacks, thoughts.
2. Avoiding situations, thoughts or memories associated with the trauma.
3. Negative changes in thoughts and state of mind associated with the event. For example, they may feel guilty about the fact that they are still alive. They can also feel stressed or emotionally stunned.
4. Hyper vigilance and chronic arousal: people are always alert and feel anxious that there will be another traumatic event.

Many people with PTSD experience symptoms of dissociation, a process in which parts of the identity, memories or consciousness lose contact with each other. These people can be diagnosed with the subtype PTSD with prominent dissociative symptoms.

An acute stress disorder occurs in traumas that resemble PTSD, only the symptoms of acute stress disorder develop within a month. Dissociative symptoms are common in ASD: stiffening, less awareness of the environment, experiencing the world as a dream. People with ASD have an increased risk of developing PTSD.

Another trauma- and stress-related disorder is adjustment disorder, in which emotional and behavioral symptoms arise within 3 months after the experience of the trauma. The stressors can also be weaker, while those of PTSD are extreme.

The DSM-IV does not provide a clear definition of a traumatic event, in the DSM-V: the individual must experience the event, see that others experienced it, or be a close friend or family of someone who experienced the event, or should be regularly exposed to the negative details of the event. According to the DSM-V, the traumas can be divided into events in which someone is exposed to death or threat to death, serious injuries, or sexual violence. Children have other symptoms of PTSD: they express it in play and play after what they have seen.

Traumas that can lead to PTSD

The traumas that lead to PTSD are often: natural disasters, war, terrorist attacks, torture and abuse. In the case of a war, about 42% of the soldiers get PTSD from both sides of the conflict, and in the country of the war about 72% of the population have an anxiety disorder.

Explanations for greater susceptibility to PTSD

1. Environment and social factors

Strong predictors for PTSD are the severity and duration of the traumatic event and the proximity of the individual to the event itself. So the longer you experience the event and the more serious it is, the greater the chance to develop PTSD. Furthermore, the closer you are to the event, such as when you are hit, the greater the chance of PTSD.

Another predictor is social support. People who receive emotional support recover faster and get PTSD less often.

2. Psychological factors

People who already have symptoms of stress disorder before a traumatic event occurs, are more likely to have PTSD after the traumatic event. The way people deal with trauma is also a predictor of the risk of PTSD. The risk of developing the disorder is greater if you apply self-destruction and avoidance behavior (drinking, isolating). Some people feel like they are in another body. This is called dissociation and aims to distance yourself from the trauma by looking at it through someone else's eyes.

3. Gender and cultural differences

Women are more likely to be diagnosed with PTSD (and all other anxiety disorders in general). Some triggers experience women more / more often than men, especially sexual abuse. Men, on the other hand, have PTSD more often because of war, for example.

Culture also influences the development of PTSD. In Latin American cultures, 'ataque de nervios' often occurs. People feel more warmth, a faster heart rhythm, pinpricks in the body, dizziness, etc. The person then starts to scold, shout or attack others and then falls down, after which he gets a kind of chance or stops as if he is dead . This often occurs after a recent trauma.

Culture and gender can influence sensitivity: women are more likely to have anxiety disorders everywhere, but more in one culture than in another. Differences in gender sometimes play a major role: in one culture man and woman are almost equal, in the other culture the woman is very submissive.

4. Biological factors

Findings by neuroimaging (

PET) scans and MRI show differences between people with PTSD and people without PTSD, especially in areas of the brain that regulate emotion, memory and the fight / flight response. The amygdala reacts more violently to emotional stimuli in people with PTSD. The medial prefrontal cortex (modulates the activity of the amygdala) is less active. So, people with PTSD respond more strongly to emotional stimuli.

The hippocampus is getting smaller, probably as a result of too much exposure to neurotransmitters and hormones, such as cortisol, that are released in response to stressors.

Biochemical findings

In case of a fight or flight reaction cortisol is released, which is an indicator of a high stress level. People with PTSD have a low level of cortisol as long as they are not reminded of the trauma, but the level increases enormously when they are reminded of the trauma or have to deal with other stressors.

A lower level may indicate longer-lasting activity of the sympathetic nervous system as a result of stress. In people who are sensitive to PTSD not all stress receptors work well together (heart rhythm, adrenaline): the brain gets too much epinephrine, norepinephrine and other neurotransmitters.

Traumas in childhood cause a change in the biological stress response, and therefore a higher sensitivity to PTSD and other anxiety disorders.

Genes

Sensitivity to PTSD can be inherited. Progeny of people with very serious trauma (such as the Holocaust) are more sensitive to PTSD than others.

Treatment of PTSD

Goals:

1. Exposing patients to what they are afraid of.
2. Tackling twisted cognitions that contribute to the symptoms.
3. Helping patients reduce stress in their lives.

Cognitive behavioral therapy and stress management

Cognitive behavioral therapy is effective in both children and adults. An important element is systematic desensitization (systematic desensitization). The client identifies thoughts and situations that cause anxiety and sets them in order from most anxiety-provoking to least anxiety-provoking. Then the therapist takes the client through this list and uses relaxation techniques to reduce anxiety.

The person must retrieve the event in the memory (imaging). Because the recovery takes place in a safe environment, the patient gets used to the thoughts.

There is another method for people who can not bear to think back to the event: stress management interventions.

Therapists also teach the client skills that ensure that he or she can deal effectively with problems in life.

Biological therapies

Medications: selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. These are especially effective for sleep problems, nightmares, etc. People who take SSRIs often have no symptoms within five months.

Disorder

Panic attacks are short, intense attacks of anxiety, where the person experiences many different symptoms of anxiety. Panic attacks can come from nowhere, but there is usually something in the environment that provokes a panic attack. The attack usually occurs in a specific situation. Panic attacks occur occasionally in many people. No less than 28% of adults have a panic attack, especially during periods of stress. For most people, these attacks are annoying, but they do not affect the way people do not live. However, one speaks of a panic disorder when the attacks are more common in the same kind of situation and the person is going to worry about this and change his behavior to prevent a panic attack. Approximately 3 to 5 percent of the population develops panic disorder in his or her lifetime, often between late adolescence and mid-30. It is more common in women, and is often chronic.

Some people with this disorder have episodes with many attacks, alternating with periods when there are few seizures. Others have the attacks more regularly, such as once a week. In the interval, people often fear a new panic attack.

Patients often think that they have a life-threatening illness, or have a heart attack or stroke, even if research has ruled out. Three to five percent of people develop a panic disorder somewhere in their lives and this usually occurs between late adolescence and mid-thirties.

Agoraphobia

A third to half of people with panic disorder have agoraphobia (literally: fear of the marketplace). They are afraid of places that are difficult to leave or where they can hardly get help in the event of a panic attack. They are also afraid to embarrass themselves. Agoraphobia can also occur in people who do not have panic attacks, but they seek help less quickly.

Agoraphobia can become so bad that the patient no longer dares to leave his or her home.

Theories about panic disorders

Role of genes

10% of people who are directly related to someone with a panic disorder get the disorder themselves. This is in contrast to the 2% chance you have of getting a panic disorder if you do not have a direct family with such a disorder. The chance of passing on the disorder is the largest of parents on children.

Twins studies show that 30-40% is passed on by the genes, so the rest comes from environmental factors.

Neurobiological contributors

Panic attacks can easily be triggered by hyperventilating, inhaling carbon dioxide, ingesting a lot of caffeine or breathing in a paper bag. These activities trigger a fight or flight response.

People without a history of a panic attack feel some physical discomfort at these events, but never an attack.

Difference between people with and without panic disorder can be seen in the limbic system, which is responsible for the stress response and consists of the amygdala, hypothalamus and hippocampus. People with the disorder have a dysregulation of the norepinephrine system in the locus coeruleus. Poor regulation in the locus coeruleus can cause panic attacks, which then stimulate the limbic system, lowering the threshold for the activation of diffuse and chronic anxiety. The anticipatory fear can then increase the likelihood of dysregulation of the locus coeruleus, and thus the chance of a subsequent panic attack.

The hormone progesterone affects serotonin and GABA, which makes menstruating women suffer more from anxiety.

Psychological Theories

The cognitive model states that panic arises from the fact that patients pay too much attention to what they feel in their bodies and subsequently misinterpret these feelings. A snowball effect arises in catastrophic thinking, resulting in panic reactions. Between panic attacks, a person is hyper vigilant for body reactions and often thinks about his health. The view that physical symptoms are associated with harmful consequences is called anxiety sensitivity . This is also because these people are more aware of body reactions that may indicate a panic attack.

The Vulnerability stress model combines the biological and cognitive theories into one theory. According to this theory, people with panic disorder suffer from a hypersensitive fight or flight response. In small things they react quite anxiously. This fear alone does not cause a panic attack. Because people are afraid that something is wrong, because they suddenly start to sweat, the fight or flight response becomes even stronger, causing a panic attack.

Treatment methods

The most effective medicines for panic attacks are the antidepressants. The frequency of panic attacks is reduced in more than half of the people taking antidepressants. The tricyclic antidepressants are likely to improve the functioning of the norepinephrine system. The disadvantages of these drugs are the side effects and the fact that the drug does not offer a real solution: after stopping taking it, the symptoms reappear.

SSRIs cause an increase in the release of the neurotransmitter serotonin, and this increase appears to have a positive effect on the panic disorder

Benzodiazepines depress the central nervous system and affect the levels of serotonin, norepinephrine and GABA. These drugs work for many people, but have many disadvantages. Benzodiazepines are addictive, slow down the motor skills and cognitive performance of the patient and do not help people in the long run from their panic attacks, if the medication is stopped.

Cognitive behavioral therapy tries to help patients get rid of their panic attacks by showing them that they have irrational thoughts about the panic attacks, and by ensuring that the anxiety reactions are reduced. Cognitive behavioral therapy consists of five components. First of all, a patient is taught how to relax. Thereafter, the therapist helps the patient to identify the wrong thoughts. Then the patient must learn to control himself while being exposed to symptoms of a panic attack. Then the patient learns that the thoughts he had are wrong. Finally, the therapist applies systematic desensitisation to help the patient get rid of his fears. This cognitive behavior therapy works just as well as medication, but is more effective in preventing a relapse.

Phobias

The DSM-V divides phobias into two categories: specific phobias, aimed at a specific object, and agoraphobia, a generalized fear of situations in which the person can not flee or receive help when needed. Agoraphobia was previously described in panic disorders.

Specific phobias are fears that relate to specific objects or situations. Many people are afraid of certain things, but it is only called a phobia if someone is going to change their lives differently to avoid confrontation with frightening stimuli. There are four different types of specific phobias:

1. animal type phobias, fears for certain animals such as snakes and spiders;
2. natural environment type phobias, focus on situations or events in the natural environment, such as flooding;
3. situational type phobias, fears for example for lifts or flying;
4. blood-injection-injury type phobias, afraid of seeing blood, getting an injection or being injured. The difference with other phobias is that with this phobia the heartbeat and blood pressure does not go up but just goes down, so that these people faint quickly.

Most people develop their phobia in childhood, often only the parents have it.

Psychological Theories

Freud's theory of phobias is the best-known theory in psychodynamics. This theory states that a phobia arises when an unconscious fear is projected onto a certain object.

Freud used as illustration to this theory the story of Little Hans, who was afraid of horses. Freud said that this was because Hans moved the tensions of his Oedipus conflict into the fear of horses. This story is not really easy to accept, just like the theory in general. The Oedipus complex generally means that boys have a sexual desire for their mother and are jealous of or fearful of their father.

The behaviourist theories state that fears simply arise from classical conditioning, after which the fears persist by operant conditioning. The best-known example is that of Little Albert who was scared of rats. That was done every time Albert saw a rat, making a loud noise with an iron bar. After a while, Albert got the same fear response in the rat, without hearing the sound itself. If Albert, however, would see the rat very often without hearing the sound, there would be extinction, with his fear response to the rat slowly decreasing.

In people with phobias, the same anxiety lasts for a long time. The behaviourist explanation for this is that operant conditioning takes place. Because people will avoid the object they are afraid of or run away from, they unconsciously learn that if they avoid the object, there is less fear. Because of this 'negative reinforcement' the fear remains equally strong.

According to the safety signal hypothesis , people remember the places where they had a panic attack very well, even if the environment had nothing to do with the panic attack. Because people are afraid to get another attack in the same environment, they will avoid that place from now on. By avoiding this, the symptoms become less, and the avoiding behavior is strengthened. If a man in a cinema gets a panic attack, he will not go to the cinema anymore. If a man then feels safe in his home, staying at home will continue to be associated with not having an attack, and the man will stay at home in the future.

As an extension of behaviourist theory, it is stated that fears can also arise through learning through observation. If a child sees that her father is afraid of thunder, the child will also be afraid of it, because it has learned that fear is the appropriate response.

Another extension of behaviourist theory is that of Prepared Classical Conditioning. This theory answers the question of why phobias arise with certain objects, but not with others. The similarity between a large proportion of objects that often arouse fear among people is that the avoidance of these objects has always been beneficial for man in evolutionary history. Although these objects are now much less dangerous than they were before, it is still in man to be afraid of it.

Biological theories

It seems that phobias are slightly heritable transferable. Probably a certain temperament is transmitted through the genes. This temperament makes it easier to be conditioned for phobias. For example, children who are very timid and shy are more likely to develop a phobia.

Treatment methods for phobias

Behavioral treatments use systematic desensitization, modelling and flooding.

With systematic desensitisation , a list is made of the situations or objects that the patient is afraid of, from least to the most scary stimuli. The patient learns to relax during the confrontation with frightening stimuli. When the patient is no longer afraid of the scariest stimuli, the therapy is successful. Often exercises are also taught there to relax, in particular through breathing exercises.

For the blood-injury-injection type phobia, there is another method, because in this phobia the blood pressure goes down instead of up. If someone who suffers from this phobia has to relax when he is afraid, he will faint even sooner. Therefore, with this phobia, it is necessary to learn how to raise blood pressure by tightening muscles.

Modelling is often used in combination with systematic desensitization. First, the therapist asks the client why he / she is afraid of the object. The therapist then shows how the patient must act, after which the patient must imitate the therapist. This technique works on the basis of the idea of ​​learning through observation.

The idea behind flooding is to let the patient intensify the fear, just as long as the fear goes away (extinction).

Cognitive behavioral therapies often use the methods described above in combination with techniques to identify and change wrong ways of thinking. The therapist allows the patient to see that he is wrong while they are working together to overcome the patient's fear. In social phobias, for example, group therapy is also used. The group works as a factor for desensitization, modelling and flooding, and can also help to change the wrong thoughts of the individuals.

Many therapists combine both cognitive and behavioral therapy. This is especially useful for social phobias. People who all have a social phobia are brought together to communicate, while the therapist coaches them to relax during the conversation.

Medications are not effective to remedy phobias. Some people use benzodiazepines to reduce their fears when they have to face the object they are afraid of. Antidepressants are sometimes used in a social phobia. The problem with these methods is that people fall back into their fears when the medication is stopped. Medications then give a temporary relief, but the phobia remains.

Social anxiety disorder

People with social anxiety disorders become so afraid of social situations, and are so afraid of being rejected, judged or humiliated in public, that they are seriously concerned about such events. They worry so much that their lives become focused on avoiding social events. A social anxiety disorder more often causes a serious disturbance in someone's daily life than a specific phobia. People with a social anxiety disorder often experience tremors and sweating, confusion and dizziness, palpitations and sometimes even a complete panic attack in a social situation. Women are slightly more likely to have this disorder than men. It often occurs at a young age, for example during adolescence when many people become aware of themselves. Also, adolescents often worry about the opinions of others about them. More than 90% of people with a social anxiety disorder experienced degrading experiences that contributed to their symptoms. It often goes hand in hand with mood disorders and other anxiety disorders.

Theories about social anxiety disorder

Social anxiety occurs in families, and twin studies suggest that there is a genetic basis. Genetic factors do not specifically lead to fear of social situations, but rather to a general sensitivity to anxiety disorders.

According to cognitive perspectives, people with a social anxiety disorder have extremely high standards for their social performance. They also focus on the negative aspects of social interactions and evaluate their own behavior negatively. They misinterpret potentially threatening social cues. They show 'safety behaviours’ to reduce their fear. For example, they avoid eye contact or social interactions and practice what they want to say in social interactions. After a social interaction they ponder very much about their performance and the reactions of other people.

Treatments

SSRIs and SNRIs can be effective in reducing symptoms of social anxiety. When people stop taking these drugs, however, symptoms often return. Cognitive behavioral therapy is effective in treating social anxiety. The behavioral component means that clients are exposed to social situations that make them anxious. Relaxation techniques can also be taught to control fear in social situations. Skills can also be learned to deal effectively with others. Therapists also help clients to recognize and eliminate safety behaviours. The cognitive component includes identifying negative cognitions and changing these cognitions. Cognitive behavioral therapy can also be applied in a group in which the group members form each other's audience.

Generalized Anxiety Disorder

It happens that people are not afraid of a specific object or situation, but that they have a constant sense of anxiety. These people are diagnosed with Generalized Anxiety Disorder (GAD, Generalized Anxiety Disorder). People with GAD are worried about many things in their lives, such as their health, their children or coming too late for an appointment. Often the one concern goes away, but another comes in its place. Worry is accompanied by a number of physical symptoms such as fatigue and tension in the muscles. The disorder often starts in childhood and the people who suffer from this often remain anxious for life. GAD is relatively common, about 14% of individuals are confronted with a generalized anxiety disorder once in their life. Almost 90% of people with GAD also have a different mental disorder. This is often another anxiety disorder, but mood disorders and substance abuse are common. There is also a greater chance of physical illnesses due to GAD, such as cardiovascular disease.

Theories about GAD

Cognitive theories state that people with GAD are consciously and unconsciously focused on threats. At the conscious level people with GAD constantly think things like "I have to make sure everyone loves me" and "I must always be prepared for danger". On the unconscious level people have negative automatic thoughts that are wrong. They are also constantly trying to discover possible threats at an unconscious level. People with GAD always expect bad things, but never fully anticipate their expectations. That is why these expectations are often unrealistic. It is not yet known why people with GAD are so sensitive to threats. One theory is that people with GAD were made so sensitive by traumatic experiences that they themselves could not do anything about and that were unpredictable. Through these experiences a chronic fear could arise. People with GAD also experience more intense negative emotions, which they can not control.

Within the biological theories GAD is thought to be related to a deficiency of GABA or to malfunctioning GABA receptors, as it has been shown that the use of, for example, benzodiazepines shows a recovery of generalized anxiety disorder. Probably the problem is mainly in the limbic system, which takes care of the emotional responses. It is not yet clear whether GAD is hereditary.

Treatments of GAD

Cognitive behavioral therapies appear to be more effective than drug therapies, placebo therapies and other forms of treatment. Cognitive behavioral therapy works for a long time, whereas with medication, the big problem is that the fears return when the medication stops. In cognitive behavioral therapies, people learn strategies to deal with the negative, catastrophic thoughts.

Separation Anxiety Disorder

A separation anxiety disorder often occurs in childhood. Many children get upset when they are separated from their primary caregiver. As they get older, however, they learn that their caregiver comes back. Some children remain extremely anxious when separated from their caregiver, even in childhood and adolescence. They can be very shy, sensitive and demanding to their caretakers. They may refuse to go to school because they are afraid of divorce, and may suffer from abdominal pain, headaches, nausea and vomiting if they have to leave their caregivers. It is more common in girls than in boys.

Theories of separation

anxiety disorder Children with a separation anxiety disorder often have a family history of anxiety and depression. The tendency to develop anxiety is hereditary. Probably the tendency to behavioral inhibition is hereditary. Children who score high on behavioral inhibition are shy, anxious, and easily irritated. They are also quiet and introverted when they go to school. They avoid new situations and stick to their parents. This characteristic is a risk factor for the development of an anxiety disorder in childhood.

Parents of children with separation anxiety are controlling, critical and negative in their communication with their children. This can be a reaction to the anxious behavior of the child, but many parents of anxious children are themselves anxious or depressed. Children can learn to be anxious from their parents, or in response to their environment.

Treatments for separation

anxiety disorder Cognitive behavioral therapy is often used to treat a separation anxiety disorder. Children are taught new coping strategies and learn to challenge their cognitions. They can also learn relaxation exercises for when they are separated from their parents. Their fears are challenged. The parents must also be involved in the treatment. Sometimes antidepressants, anti-anxiety medication, stimulants or antihistamines are prescribed. SSRIs are the most effective in reducing anxiety symptoms.

Obsessive Compulsive Disorder (OCD)

Obsessions are stubborn, recurring thoughts or images that someone can not get rid of. These thoughts or images give the person fear and stress.

Compulsive actions (compulsions) are compulsions that someone has to perform because he feels that something bad is going to happen.

OCD (Obsessive-compulsive disorder) is an anxiety disorder in which people experience anxiety through obsessive thoughts and when they can not perform the compulsive actions. People with OCD sometimes seem psychotic, but they are not. They know exactly what they are doing and realize that it is irrational, but can not control or control the actions.

OCD usually starts at a young age. In men usually between 6 and 15 years, in women usually between 20 and 29 years. If OCD is not treated, it usually becomes chronic. Between one and three percent of people, OCD develops in his or her life. Some of these people are also depressed.

Symptoms

The themes of an obsession are generally the same in different cultures. Especially the obsession about dirt occurs all over the world. This mainly concerns the fear of becoming infected. Other obsessions that often occur are obsessions about aggressive impulses (for example, being afraid to hurt your child), sexual thoughts, impulses to do something that goes against the norms of a culture (for example, cursing in the church), and obsessions about doubts (for example, whether the gas or light is turned off). People with OCD do not carry out these obsessions, but they are very disturbed by the fact that they think these things. When people have a lot of persevering thoughts about something like that, they often do compulsive actions in the hope of making the thoughts and fear of those thoughts disappear.

Sometimes the compulsive actions can logically be explained by the obsession (if someone is afraid that he has forgotten to turn out the light, he will check it very often). Often the link between obsession and compulsion is the result of magical thinking: people think it will be okay if they perform a certain action with a certain frequency, but otherwise something really bad happens (for example, they do five times the light switch on and off). With some compulsions there is no direct link to the obsession. It may be that even the patient does not know why he is doing something, except because he feels that he has to.

Hoarding is a compulsion that is strongly related to OCD, but stands as a separate disorder in the DSM-V because it has separate characteristics and separate biological causes. Hoarding means that people can not throw away their possessions. This applies to everything, including waste such as old newspapers. Hoarding differs from OCD because people with this disorder do not perceive their possessions as unwanted or stressful, but more as part of their natural stream of thoughts. They experience no fear about their behavior.

The hair-pulling disorder is also included in the DSM-V as a separate category. These people repeatedly pull their hair out, leading to hair loss. People with the skin-picking disorder pick their skin, causing them damage in their skin that can ignite and cause scarring. People with these two disorders often experience tension prior to the impulse, and pleasure or relief when they give in to the impulse. However, it often happens automatically, without people knowing it. To get the diagnosis, the behavior must result in significant stress or limitations.

People with body-dysmorphic disorder are extremely concerned with a part of their body that they think are ugly, but seen by others as normal or only slightly deviant. People spend a lot of time looking in the mirror, trying to hide or change the body part. They spend an average of three to eight hours a day on their preoccupation and check behavior. Sometimes they even undergo surgery to have the body part corrected. Women with this disorder are often more concerned with their breasts, legs, hips and weight, while men are more concerned with their physique, genitalia, body hair and thinning hair. The disorder often begins in the teen years and becomes chronic if it is not treated. The average age at which the disorder develops is sixteen years, and the average number of body parts with which one is dissatisfied is four. It often occurs with anxiety and depression, personality disorders and substance abuse. OCD is also often associated with this disorder.

OCD statements

In recent years, particular  biological explanations regarding OCD became popular. One theory states that in people with OCD something is wrong with the circuit that ensures the processing of primitive impulses. When a certain impulse occurs, the information goes from the orbital frontal cortex, via the basal ganglia to the thalamus where the impulse is devised to be performed. Normally the impulse is then handled. It is thought that in people with OCD this impulse does not stop when the action is done, or that the action does not stop if the momentum is gone.

There are a number of indications for this theory. With PET scans it can be seen that in people with OCD the area discussed is indeed more active than with other people. People also suffer less from OCD if they take medicines that improve the effect of serotonin. In the area discussed there is a serotonin deficiency in people with OCD. Moreover, it appears that OCD is hereditary.

Psychodynamic theories state that the obsessions and compulsions of a patient are symbols for unconscious conflicts within that person. These conflicts are so heavily loaded that the patient can only indirectly address them by moving the tension to other thoughts or behaviours. The reason many obsessions and compulsions are about sex and aggression would be because most unconscious conflicts are about this. People can be helped by giving them insight into the conflicts that occur unconsciously.

Everyone has negative thoughts that he or she can not control. Especially when people are under stress, they tend to have this kind of thoughts and are also inclined to think very rigidly. According to the cognitive explanation , people with OCD can not eliminate these negative thoughts. There are several reasons:

1. Because people with OCD are often depressed or anxious and therefore think negatively very quickly, they can not switch off their thoughts.
2. It is also possible that people with OCD tend to think rigidly and morally. As a result, they view the thoughts as unacceptable and feel guilty about it.
3. The third reason is that people with OCD have the idea that they should be able to control their thoughts. They can not do that, which makes them feel bad about it. According to this theory, the compulsions arise through operant conditioning. If people have a certain thought and they try to remove the thought by performing a certain action, then that thought will probably go away. The patient then associates the departure of the thought with the performance of that action. If that happens every time, you quickly have a compulsion. If, for example, every time you think you want to hit someone, you cough very hard, you cough the thought away.

OCD treatments

It has been discovered that drugs (benzodiazepines and antidepressants), which cause an increase in serotonin, help to reduce OCD. However, these drugs do not work sufficiently. In the people who respond to the medication, only half of the obsessions and compulsions is usually removed. There is also a relapse when the medication is stopped and there are side effects that are sometimes difficult to tolerate.

Medications are often combined with cognitive behavioral therapy. This therapy focuses on exposing patients to obsessions while they can not perform those compulsions. By exposing the obsessions, the patient gets used to the stimuli, which means less and less arousal is generated. Because the patient can not perform the compulsions, habituation (or habituation) can be brought about.

The therapist can use ‘modelling’ to teach the patient the desired behavior (or rather: not performing the unwanted behavior). The therapist can, for example, fumigate his or her hands and not let the patient do the same. The therapist can also give the patient a kind of homework. For example, someone with a fear of friction may only clean his home twice a week. This form of therapy works in a small proportion of patients, and if it works, it usually does not work completely.