OCD

 I thought an interesting point in the Barlow reading was the procedural problems a clinician may encounter when assessing for OCRD. I think an important one, especially taking culture into consideration, is the lack of awareness or minimization of symptoms. There may be obsessions or compulsions being reported that seem worrisome to the clinician, but actually have a cultural value. Gaining additional information from outside sources can be incredibly useful in determining the cultural or even personal reasons for the area of concern. taking this into account does not have to rule out OCD diagnosis, but it may help to inform the development and maintenance factors that the individual may not be aware of. Maybe someone grew up in a very chaotic household and now prefers things in order and very clean. The client may not make this connection, but a sibling may. You could also see if the cleaning and ordering behaviors are similar across the siblings- is this at a disordered level or a result of parenting styles? It is also interesting to consider assessment time with OCRD. This is a new factor I had not considered. Overexplaining, perfectionism, and the need for reassurance would be important in-session behaviors to be aware of. This would also be important to point out after assessment during treatment. In addition, the distinction between OCRD compulsions and compulsive behaviors that are often pleasurable (overeating, stealing, shopping) was interesting. I remember discussing this in previous classes- if overeating, stealing, shopping, and "sex addiction" should be considered as obsessive behaviors? The distinction makes sense, but do we treat these "pleasurable" obsessions the same as other obsessions? 

I liked the breakdown of CBT for OCRD. Specifically, I liked the four "Ps" idea to conceptualize the patient's presenting problem. I think this can expand beyond OCRD. This can also help inform assessment procedures by opening doors to other useful assessments. If we understand precipitating factors, perpetuating, and protective factors we may need to add assessments for anxiety, PTSD, depression, etc., that can help inform diagnostic considerations. 

 Grade: 12/15