Discover millions of ebooks, audiobooks, and so much more with a free trial

Only $11.99/month after trial. Cancel anytime.

Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment
Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment
Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment
Ebook365 pages2 hours

Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment

Rating: 0 out of 5 stars

()

Read preview

About this ebook

Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment presents a synthesis of the emerging data across clinical phenomenology, assessment, psychological therapies and biologically-oriented therapies regarding obsessive compulsive disorders, including hoarding, skin picking, body dysmorphic and impulse control disorders. Following the re-classification of such disorders in the DSM-5, the book addresses recent advances in treatment, assessment, treatment augmentation and basic science of OCRDs. The second half of the book focuses on the treatment of OCRDs, covering both psychological therapies (e.g. inhibitory learning informed exposure, tech-based CBT applications) and biologically oriented therapies (e.g. neuromodulation).

  • Includes psychosocial theoretical and intervention approaches
  • Addresses newly proposed clinical entities, such as misophonia and orthorexia
  • Examines neurobiological features of OCRDs across the lifespan
LanguageEnglish
Release dateNov 9, 2019
ISBN9780128165577
Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment

Related to Advanced Casebook of Obsessive-Compulsive and Related Disorders

Related ebooks

Psychology For You

View More

Related articles

Reviews for Advanced Casebook of Obsessive-Compulsive and Related Disorders

Rating: 0 out of 5 stars
0 ratings

0 ratings0 reviews

What did you think?

Tap to rate

Review must be at least 10 words

    Book preview

    Advanced Casebook of Obsessive-Compulsive and Related Disorders - Eric A. Storch

    Advanced Casebook of Obsessive-Compulsive and Related Disorders

    Conceptualizations and Treatment

    Editors

    Eric A. Storch, PhD

    Professor, Vice Chair & Head of Psychology, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States

    Dean McKay, PhD

    Professor, Psychology, Fordham University, Bronx, New York, United States

    Jonathan S. Abramowitz, PhD

    Professor, Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

    Table of Contents

    Cover image

    Title page

    Copyright

    Dedication

    Contributors

    Preface

    Chapter 1. Chew on this: considering misophonia and obsessive-compulsive disorder

    Background

    Case example

    Treatment implementation

    Conclusion

    Chapter 2. Treatment of pathologic healthy eating (orthorexia nervosa)

    Background

    Treatment literature

    Treatment of orthorexia nervosa in the context of obsessive-compulsive disorder

    Terminology relevant to disordered eating

    Assessment

    Case example and treatment

    Conclusions

    Chapter 3. Sensory intolerance

    Background

    Clinical case

    Treatment implementation

    Conclusions

    Chapter 4. Treatment of incompleteness in obsessive-compulsive disorder

    Assessment of incompleteness

    Treatment of incompleteness

    Case illustration

    Conclusions

    Chapter 5. Scrupulosity

    Background

    How is scrupulosity related to OCD?

    Treatment outcome studies

    A conceptual model of scrupulosity

    Case description and conceptualization

    Treatment implementation

    Treatment outcome

    What can be learned from this case

    Chapter 6. Addressing comorbid substance use/abuse in obsessive-compulsive disorder

    Psychologic mechanisms for substance use in obsessive-compulsive disorder

    Treatment strategies for substance use

    Treatment strategy for obsessive-compulsive disorder

    Case illustration

    Chapter 7. Obsessive-compulsive disorder and comorbid posttraumatic stress disorder

    Diagnostic overview

    Age of onset

    Differential diagnosis

    Static versus dynamic comorbidity

    Static comorbidity case example

    Dynamic comorbidity case example

    Treatment

    Treatment case examples

    Chapter 8. Postpartum obsessive-compulsive disorder

    Background

    Phenomenology

    Treatment literature

    Theoretic models

    Case description

    Treatment implementation

    What can be learned from the case

    Chapter 9. Treatment of obsessive-compulsive disorder in a young person with autism spectrum disorder

    Background

    Case description and conceptualization

    Index

    Copyright

    Academic Press is an imprint of Elsevier

    125 London Wall, London EC2Y 5AS, United Kingdom

    525 B Street, Suite 1650, San Diego, CA 92101, United States

    50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States

    The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom

    Copyright © 2020 Elsevier Inc. All rights reserved.

    No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

    This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

    Notices

    Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

    Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

    To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

    Library of Congress Cataloging-in-Publication Data

    A catalog record for this book is available from the Library of Congress

    British Library Cataloguing-in-Publication Data

    A catalogue record for this book is available from the British Library

    ISBN: 978-0-12-816563-8

    For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals

    Publisher: Nikki Levy

    Acquisition Editor: Nikki Levy

    Editorial Project Manager: Barbara Makinster

    Production Project Manager: Poulouse Joseph

    Cover Designer: Alan Studholme

    Typeset by TNQ Technologies

    Dedication

    For Dawn and Rebecca, with love and laughs

    Dean McKay

    To Stacy, Emily, and Miriam, with all my love

    Jonathan S. Abramowitz

    For my cowboy (Noah) and cowgirls (Ellie, Maya, and Jill), with much love

    Eric A. Storch

    Contributors

    Jonathan S. Abramowitz, PhD,     Department of Psychology, University of North Carolina, Chapel Hill, NC, United States

    Kelly N. Banneyer, PhD,     Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States

    Andrea Eugenio Cavanna, MD, PhD, FRCP, FANPA

    Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom

    School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom

    Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom

    Terri L. Fletcher, PhD

    Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States

    Assistant Professor, Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States

    Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX United States

    VA South Central Mental Illness Research, Education and Clinical Center, A Virtual Center, Houston, TX, United States

    Samantha N. Hellberg, BA,     Department of Psychology, University of North Carolina, Chapel Hill, NC, United States

    Natalie Hundt, PhD

    Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States

    Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX United States

    VA South Central Mental Illness Research, Education and Clinical Center, A Virtual Center, Houston, TX, United States

    Amita Jassi, DClinPsy,     National Clinic for Young People with OCD, BDD and related disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom

    Georgina Krebs, DClinPsy

    National Clinic for Young People with OCD, BDD and related disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom

    Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, United Kingdom

    Dean McKay, PhD,     Professor, Department of Psychology, Fordham University, Bronx, NY, United States

    Lucy J. Puryear, MD,     Departments of Obstetrics and Gynecology, and Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States

    Christina A. Treece, MD,     Departments of Obstetrics and Gynecology, and Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States

    Nathaniel Van Kirk, PhD,     Office of Clinical Assessment and Research (OCAR), OCD Institute, McLean Hospital/Harvard Medical School, Boston, MA, United States

    Monica S. Wu, PhD,     UCLA Semel Institute for Neuroscience and Human Behavior, Postdoctoral Scholar & Clinical Instructor, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States

    Hana F. Zickgraf, PhD,     Postdoctoral Fellow, Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, IL, United States

    Preface

    Chiesa (1994) highlights how clinical sciences have often advanced by studying outliers. This stands in contrast to how researchers often treat outliers, which is to consider them noise or errors, something to be deleted from the final dataset. However, sometimes we learn that these outliers are not so out of the ordinary after all. Consider, for example, that it was long believed that obsessive-compulsive disorder (OCD) was extremely rare, in other words, an outlier. Instead, as readers of this book likely are aware, OCD is hardly an outlier, with around 1%–2% of the population suffering from the condition.

    As efficacious treatments have been developed for OCD, the complexity and variety of clinical presentations of the disorder have been well documented. It is in this spirit that we now turn to some potential outlier illustrations of the condition. These are outliers more because investigators have not systematically examined these clinical presentations, such as co-occurring trauma or autism spectrum conditions. Alternatively, in recent conceptualizations of OCD, perceptual features have become better understood, such as the persistent experience of a feeling of incompleteness, other sensory intolerance, and irritability over specific sounds. These specific outlier manifestations, although not well recognized in the broader clinical community, are recognized by specialists in treating OCD and related conditions. Indeed, some might not refer to these presentations as outliers at all. For example, substance use, trauma, and autism spectrum disorders all commonly co-occur with OCD and yet the research literature is comparably silent on how to best address these clinical presentations.

    Into this void, this volume arrives to provide summaries of the extant research and case illustrations of treatment for a variety of presentations of OCD that are likely to present for treatment. The target audience for this volume are any mental health workers routinely treating individuals with OCD or any of the associated conditions described in this book. Much of the treatment depicted in this book is cognitive behavioral in nature, which is to be expected considering that much of the evidence-based treatment for OCD and the associated conditions described herein have efficacious treatments for each derived from cognitive behavior principles.

    Case illustrations frequently stimulate additional research and set the occasion for novel treatment developments. It is our hope that this volume will accomplish that aim, in light of the likelihood that the cases presented are not likely outliers after all.

    References

    Chiesa M. Radical behaviorism: The philosophy and the science. Littleton, MA: Cambridge Center for Behavioral Studies; 1994.

    Chapter 1

    Chew on this: considering misophonia and obsessive-compulsive disorder

    Monica S. Wu, PhD¹, and Kelly N. Banneyer, PhD²     ¹UCLA Semel Institute for Neuroscience and Human Behavior, Postdoctoral Scholar & Clinical Instructor, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, United States     ²Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States

    Abstract

    Misophonia is a unique condition characterized by an extreme sensitivity to selective sounds. Individuals with this condition often display significant emotional distress in response to everyday noises (e.g., chewing, sniffing, tapping). These negative emotions often lead to avoidance and anger outbursts, ultimately resulting in decreased quality of life and increased functional impairment. Although misophonia is largely understudied, treatment literature supporting the use of exposure-based behavior therapy has been emerging. A summary of the extant research is presented, followed by a case report of an adolescent with misophonia, illustrating how to implement exposure and response prevention for this impairing disorder.

    Keywords

    Auditory; Misophonia; Sensitivity; Sensory; Sound

    When listening to nails screech across a chalkboard, most individuals react universally; cringing, grimacing, covering ears, or trying to make the sound stop are all typical reactions. However, there are a subgroup of individuals who display similar visceral reactions to everyday auditory stimuli, irrespective of the frequency bands of the sound (Jastreboff, 2011). Indeed, seemingly innocuous sounds (or even the mere sight) of someone chewing, tapping their foot, or sniffing elicit considerable emotional and physical reactions in these individuals (Johnson et al., 2013). For some, it can become so unbearable that avoidance becomes the primary way of coping with the distress, leading to a limited lifestyle and decreased quality of life. This understudied, yet impairing, condition is called misophonia.

    Background

    What is misophonia?

    Misophonia is a form of decreased sound tolerance that is characterized by a hypersensitivity to selective types of sounds. Common trigger sounds include the sound of people eating, repeated tapping, breathing noises, and throat sounds (Schröder, Vulink, & Denys, 2013; Wu, Lewin, Murphy, & Storch, 2014). When encountering the triggering auditory stimuli, individuals with misophonia often experience considerable emotional and physical arousal. The severity of the emotional reaction is sometimes dependent on the source of the sound (e.g., parent vs. stranger; McGuire, Wu, & Storch, 2015). In other cases, however, it is equally distressing regardless of the source, and individuals with misophonia may just be more effortful in controlling their emotional reactions around strangers in order to comply with social conventions (e.g., refraining from yelling at a stranger for chewing loudly).

    With regard to specific emotions, anxiety, anger, and disgust are common negative reactions to these sounds (Ferreira, Harrison, & Fontenelle, 2013; Wu et al., 2014). Irritation and rage are often observed (Brout et al., 2018), sometimes resulting in verbal or physical aggression (Johnson et al., 2013; Schröder et al., 2013). It is noted, however, that anxiety may play a mediating role in the relationship between misophonia symptoms and rage outbursts (Wu et al., 2014; Zhou, Wu, & Storch, 2017), highlighting the importance of considering the unique role of anxiety in misophonia (Quek et al., 2018). Studies have also highlighted physical arousal in connection with triggering auditory stimuli (Edelstein, Brang, Rouw, & Ramachandran, 2013), specifically demonstrating higher levels of skin conductance responses (SCRs) when compared with a healthy control group. Additionally, a preliminary neuroimaging study revealed aberrant activation and functional connectivity in the anterior insular cortex (Kumar et al., 2017), which are thought to mediate physical responses (i.e., heart rate and SCRs) in the face of misophonia-related triggers.

    Because of the emotional distress and physical arousal induced by the triggering sounds, individuals with misophonia often engage in avoidance behaviors in an attempt to escape from the upsetting auditory stimuli (Schröder et al., 2013; Webber, Johnson, & Storch, 2013). This can manifest as physically removing themselves from the source of the sound (e.g., leaving the room) or doing something to prevent themselves from hearing the sound (e.g., wearing headphones). These avoidance behaviors have immediate effects, such as preventing an individual from eating meals with loved ones for the fear of hearing chewing sounds or missing social events because of the possibility of hearing triggering noises. Avoidance also has deleterious long-term effects, as it is a slippery slope that often leads to more avoidance and decreased functioning in day-to-day life. As such, there is likely to be continued maintenance (and potential exacerbation) of the symptoms, given the negatively reinforcing nature of avoidance (see the section Theoretic models relevant to presentation for a more detailed explanation of this cycle). Other behavioral reactions to misophonia-related triggers include attempting to make the sound go away through their own actions, such as yelling at a person to stop making the noise. This can lead to frequent arguments and strained interpersonal relationships, especially if the sounds are coming from family members and other loved ones (McGuire et al., 2015). Collectively, individuals with misophonia experience a variety of negative emotional states and engage in different maladaptive behaviors in response to specific auditory stimuli, unfortunately resulting in decreased quality of life and functional impairment.

    Who is affected by misophonia?

    Misophonia often begins in childhood or early adolescence, with symptom severity worsening over time (Rouw & Erfanian, 2018). Why certain people develop misophonia and the exact cause of this condition are still unknown, with various putative causes being proposed in the emerging literature (Brout et al., 2018; Palumbo, Alsalman, De Ridder, Song, & Vanneste, 2018). Instead of resulting from damage to or overactivation of the auditory pathway, misophonia is thought to be associated with enhanced connections between the auditory, limbic, and autonomic nervous system (Jastreboff & Hazell, 2004; Jastreboff & Jastreboff, 2013). Additionally, enhanced functional connectivity between various brain regions tied to emotion regulation processes and interoception was observed in individuals with misophonia (Kumar et al., 2017), suggesting potential underlying neurobiological mechanisms.

    Because research on this condition is still burgeoning, definitive incidence rates have been difficult to establish. When considering clinical samples of individuals presenting to audiologic clinics for tinnitus (a condition that is characterized by ringing of the ears, despite the lack of external auditory stimuli), an estimated 10%–60% of these patients are affected by misophonia as well (Hadjipavlou, Baer, Lau, & Howard, 2008; Sztuka, Pospiech, Gawron, & Dudek, 2010). Broader undergraduate samples in the United States and China have reported that 6%–20% of the participating students were affected by elevated, impairing levels of misophonia symptoms (Wu et al., 2014; Zhou et al., 2017). The remainder of studies examining misophonia are typically composed of case reports or use self-selected samples (e.g., from misophonia support groups), making it difficult to infer the true incidence rate. However, these preliminary estimates highlight the potentially high rate of occurrence of misophonia across cultures, suggesting its far-reaching impact.

    With regard to the clinical characteristics of individuals with misophonia, various case reports and cross-sectional studies have highlighted clinical correlates and comorbidities. Higher numbers of misophonia symptoms have been linked with greater sensory sensitivities, with more moderate associations observed with depressive, anxiety, and obsessive-compulsive symptoms (Wu et al., 2014). Diagnostic criteria for misophonia have yet to be established, as it can be unclear whether the symptoms are better accounted for by other psychiatric disorders at times (Ferreira et al., 2013). However, given its moderate relationship with multiple psychiatric symptoms and a potentially unique cluster of symptoms characterizing the disorder, many consider misophonia to be a stand-alone condition that should have its own set of diagnostic criteria (Brout et al., 2018; Schröder et al., 2013).

    Psychiatric comorbidities are often observed in individuals with misophonia. Specifically, the higher numbers of misophonia symptoms have been related to major depressive disorder and posttraumatic stress disorder (Erfanian, Brout, & Keshavarz, 2018; Rouw & Erfanian, 2018). Additionally, a case series suggested the possibility of a link between eating disorders and misophonia (Kluckow, Telfer, & Abraham, 2014), given the shared distress related to food and chewing. Interestingly, a cross-sectional study reported the co-occurrence of obsessive-compulsive personality disorder in approximately half of the sample (Schröder et al., 2013), with the authors suggesting that it may be either a risk factor for developing misophonia or a consequence of having it, but further research is needed to explore these hypotheses. However, perhaps the most researched and reported comorbidity for misophonia has been obsessive-compulsive disorder (OCD) and related conditions, such as Tourette syndrome (Hadjipavlou et al., 2008; Neal & Cavanna, 2013; Schwartz, Leyendecker, & Conlon, 2011). Consequently, clinicians and researchers alike have set forth notable efforts to further examine the similarities in the presentation and treatment of these conditions (Schröder et al., 2013), commonly viewing them within the same theoretic model.

    Theoretic models relevant to the presentation

    In describing the phenomenology and maintenance of the symptoms, misophonia can be viewed through the lens of a cognitive-behavioral model. Within this model, the triad of thoughts, feelings, and behaviors is thought to influence one another in a multidirectional manner (Kendall & Panichelli-Mindel, 1995). When presented with a trigger for misophonia, individuals typically have various thoughts that occur; they can think about how annoying the sound is, how much they want it to stop, and/or how much they dislike the person making the sound. The related feelings can be emotional or physical, including disgust, anger, anxiety (Brout et al., 2018), tenseness, as well as increased heart rate and sweating (Edelstein et al., 2013; Kumar et al., 2017). These thoughts and feelings are thought to contribute to the individual's reactions and behaviors, such as leaving the situation to avoid the trigger or yelling at the person to stop making the sound. Ultimately, all these thoughts, feelings, and behaviors affect one another in the face of the triggering sound. Exposure-based cognitive behavioral therapy (CBT) emphasizes changes in the individual's behaviors in order to break the negative cycle and teach the individual how to react more adaptively.

    Using the cognitive-behavioral model, the maintenance of misophonia symptoms is conceptualized as occurring within a negative reinforcement cycle. Specifically, the individual is presented with a triggering sound (e.g., chewing, sniffing), thereby eliciting a negative emotion (e.g., anger, anxiety, discomfort). Consequently, the individual seeks to engage in a behavior that will help decrease the distress in the moment (short term), such as avoiding the sound or getting the sound to stop. By doing so, this maladaptive behavior is negatively reinforced in the long term, making it more likely for the individual to continue engaging in these behaviors, rather than learning how to handle the distress in a more adaptive manner that will help decrease his/her functional impairment. Given that obsessive-compulsive symptoms follow a very similar negative reinforcement cycle, clinicians and researchers alike have examined the relationship between these two disorders.

    How is misophonia related to obsessive-compulsive disorder?

    Similarities in the respective negative reinforcement cycles in misophonia and OCD have been observed. Specifically, the cycle starts with a trigger (sound, obsession), leads to subsequent distress (discomfort, anxiety), followed by

    Enjoying the preview?
    Page 1 of 1