{"id":418,"date":"2020-07-27T14:41:06","date_gmt":"2020-07-27T14:41:06","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=418"},"modified":"2022-07-26T20:05:57","modified_gmt":"2022-07-26T20:05:57","slug":"psychological-perspectives-on-ocd-and-trauma-related-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/psychological-perspectives-on-ocd-and-trauma-related-disorders\/","title":{"raw":"Psychological Perspectives on OCD and Trauma-Related Disorders","rendered":"Psychological Perspectives on OCD and Trauma-Related Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning ObjectiveS<\/h3>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\">Describe views on OCD from the major psychological perspectives<\/li>\r\n \t<li style=\"font-weight: 400;\">Describe views on stress-related disorders from the major psychological perspectives<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>The Biological Perspective<\/h2>\r\nPast research of family and\u00a0<span class=\"search-highlight first text last focus\">twin studies<\/span>\u00a0suggest that OCD has a moderate genetic component. OCD is five times more frequent in the first-degree relatives of people with\u00a0<span class=\"search-highlight first text last\">OCD<\/span>\u00a0than in people without the disorder (Nestadt et al., 2000); the concordance rate of\u00a0<span class=\"search-highlight first text last\">OCD<\/span>\u00a0among identical twins is around 57% and 22% for fraternal twins (Bolton, Rijsdijk, O\u2019Connor, Perrin, &amp; Eley, 2007).\u00a0<span class=\"search-highlight first text last\">Studies<\/span>\u00a0have implicated about two dozen potential genes that may be involved in\u00a0<span class=\"search-highlight first text last\">OCD<\/span>; these genes regulate the function of three neurotransmitters: serotonin, dopamine, and glutamate (Pauls, 2010).\r\n\r\nFurthermore, research also suggests that there may be differences in the brain structures of those with OCD versus those without. The orbitofrontal cortex is part of a series of brain regions that, collectively, is called the OCD circuit; this circuit consists of several interconnected regions that influence the perceived emotional value of stimuli and the selection of both behavioral and cognitive responses (Graybiel &amp; Rauch, 2000). People with OCD show more brain activity in these areas when asked to do things that provoke symptoms, such as looking at crookedly hung pictures or touching a dirty counter; because of this, it is believed that abnormalities in these regions may be the cause for OCD symptoms.\r\n\r\nFor PTSD, and other stress-related disorders, researchers have found that genetics\u00a0<em>and<\/em> environment play an important role in one's risk for developing PTSD due to trauma; estimates for the genetic influences for PTSD account for 30\u201373% of vulnerability for the disorder.\u00a0Some of the hereditary traits or genes that affect the increased risk for developing PTSD are common to those linked to a higher rate of susceptibility to major depression, anxiety, and panic disorder. One study actually identified 17 gene variants that were associated with PTSD.[footnote]Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., Milad, M. R., &amp; Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. <em>Nature reviews<\/em>. Neuroscience, 13(11), 769\u2013787. https:\/\/doi.org\/10.1038\/nrn3339[\/footnote]\r\n\r\n[caption id=\"attachment_3549\" align=\"aligncenter\" width=\"604\"]<img class=\"wp-image-3549 \" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/22131743\/Hippocampus_and_PTSD.jpg\" alt=\"Infographic about the effect of ptsd on hippocampal size. The hippocampus has been known for its role in how memories are made. Patients with PTSD have a smaller hippocampus, alchoholism exaggerates the reduction in hippocampal volume, the severity and duration of trauma may also exacerbate it. MRI scans could be helpful in diagnosing PTSD.\" width=\"604\" height=\"781\" \/> <strong>Figure 1<\/strong>. Recent studies have shown that smaller hippocampal volume has been correlated with PTSD.[\/caption]\r\n\r\nGenes may not be the only thing affecting the risk factor for PTSD. In fact, the very structures of a person's brain, like in the case of OCD, may have something to do with this. Recent studies have shown that smaller hippocampal volume has been correlated with PTSD\u2014the relationship between PTSD and smaller volume in this region of the brain is associated with negative effects of stress hormones; what's interesting is that smaller hippocampal volume was found not only in the brains of combat veterans diagnosed with PTSD but\u00a0<em>also\u00a0<\/em>in their twins who hadn't experienced combat, and thus never developed the disorder. This biological factor implies that someone could be predisposed to developing this disorder should they experience a traumatic event.[footnote]Kremen, W. S., Koenen, K. C., Afari, N., &amp; Lyons, M. J. (2012). Twin studies of posttraumatic stress disorder: differentiating vulnerability factors from sequelae. <em>Neuropharmacology<\/em>, 62(2), 647\u2013653. https:\/\/doi.org\/10.1016\/j.neuropharm.2011.03.012[\/footnote]\r\n<h2>The Sociocultural Perspective<\/h2>\r\nThe sociocultural perspective looks at a person's behaviors and symptoms in the context of their culture and background.\r\n\r\nSome cultures in which religion and customs are held to a very high standard may be connected to OCD; these factors are so ingrained and so varied that they can influence the onset, outcome, and response to treatment for OCD. Among Egyptians, for example, there is an emphasis on religious rituals that involve repeated phrases\u2014it appears that the prevalence of religious obsessions and compulsions are hard to distinguish between those with OCD and those simply practicing their religion. Types of obsessions among study participants in Egypt and Jerusalem were similar, mostly associated with religion and cleanliness or purity, whereas themes among Indian and British participants related more to being orderly and avoiding aggressiveness.[footnote]Okasha, Ahmed. OCD in Egyptian Adolescents: The Effect of Culture and Religion. <em>Psychiatric Times<\/em>. https:\/\/www.psychiatrictimes.com\/view\/ocd-egyptian-adolescents-effect-culture-and-religion.[\/footnote] Understanding social influences on behavior is important; for example, how might you tell the difference between someone who is working hard to \"purify\" themselves via the strict adherence of religious rituals\u2014possibly washing their hands frequently, praying, or performing specific tasks several times a day\u2014and someone who has a diagnosis of OCD?\r\n<p id=\"__p76\" class=\"p p-first\">In regards to PTSD, different cultures and belief systems may help or hinder the prevalence of the disorder. Cultural beliefs may influence an individual's personal meanings of trauma and their attempts to come to terms with trauma memories in helpful and unhelpful ways. The meanings linked to PTSD show cultural variations: in individualistic cultures appraisals about a vulnerable or inadequate self are common; in collectivistic cultures appraisals about social functioning or evaluation by others. Cultural beliefs may also influence the reactions of significant others and the community and can thus facilitate or impede recovery from trauma.[footnote]Schnyder, U., Bryant, R. A., Ehlers, A., Foa, E. B., Hasan, A., Mwiti, G., Kristensen, C. H., Neuner, F., Oe, M., &amp; Yule, W. (2016). Culture-sensitive psychotraumatology. <em>European journal of psychotraumatology<\/em>, 7, 31179. https:\/\/doi.org\/10.3402\/ejpt.v7.31179[\/footnote]<\/p>\r\n<p class=\"p p-first\">In a 2013 study that examined the prevalence and determinants of PTSD and post-traumatic stress symptoms following the 2004 tsunami in Indonesia and India, Rajkumar et al. credited the absence of avoidance symptoms among tsunami survivors to the cohesive social bonds and religious rituals that facilitated talking about the event and collective mourning in the community. Religious and spiritual beliefs may also influence trauma susceptibility.[footnote]Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities. Rajkumar AP, Mohan TS, Tharyan P. <em>International Journal of Social Psychiatry<\/em>. 2013 Mar; 59(2):123-9.[\/footnote] Research has indicated that locus of control plays a role in susceptibility to PTSD. While an <strong>internal locus of control<\/strong>\u2014the belief that the outcomes of events in your life are in your own control\u2014seems to provide a protective role in people subjected to traumatic experiences, an external locus, in which events in one\u2019s life are believed to be controlled by outside forces, tends to instill a sense of helplessness and lack of control in victims of trauma. In India, where the role of religion and strong beliefs in karma are highly predominant, society is generally characterized by an external locus of control.[footnote]Gilmoor, A. R., Adithy, A., &amp; Regeer, B. (2019). The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. <em>Frontiers in psychiatry<\/em>, 10, 439. https:\/\/doi.org\/10.3389\/fpsyt.2019.00439[\/footnote]<\/p>\r\n\r\n<h2>The Psychodynamic Perspective<\/h2>\r\n[caption id=\"attachment_1438\" align=\"alignleft\" width=\"200\"]<img class=\"wp-image-1438 size-medium\" title=\"https:\/\/pixabay.com\/photos\/sigmund-freud-portrait-1926-1153858\/\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/01040921\/sigmund-freud-1153858_1920-200x300.jpg\" alt=\"Photo of Sigmund Freud\" width=\"200\" height=\"300\" \/> <strong>Figure 2<\/strong>. According to Freud, our personality develops from a conflict between two forces: our biological aggressive and pleasure-seeking drives versus our internal (socialized) control over these drives.[\/caption]\r\n\r\nPsychodynamic theory suggests that there are three areas at work in determining a person's personality and behavior: the id, superego, and ego. The id represents our unconscious, primitive drives or urges. The superego is what we learn as we grow\u2014societal rules, what is or isn't acceptable\u2014our \"moral compass\" essentially, and when we fail to live up to the standards of the superego, we may experience shame or guilt. The ego is the most rational part of our personality that balances the two by satisfying the desires of the id in a realistic way.\r\n\r\nWhen there is an imbalance of these three interacting parts of our personality, the psychodynamic approach says that we are likely suffering from\u00a0neurosis\u00a0(a tendency to experience negative emotions), anxiety disorders, or unhealthy behaviors. For example, a person who is dominated by their id might be narcissistic and impulsive. A person with a dominant superego might be controlled by feelings of guilt and deny themselves even socially acceptable pleasures; conversely, if the superego is weak or absent, a person might become a psychopath. An overly dominant superego might be seen in an over-controlled individual whose rational grasp on reality is so strong that they are unaware of their emotional needs, or, in a neurotic who is overly defensive (overusing ego defense mechanisms).\r\n\r\nTo view OCD in light of this perspective, obsessions and compulsions are, in actuality \"unconscious conflict\" that you may be trying to stop or cope with, and this conflict comes from a clash between the id (usually a sexual or aggressive urge) and the superego (the desire to do the right thing and follow socially\r\n\r\n[caption id=\"attachment_1483\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-1483 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/01163533\/Triangle_Of_Conflict-300x300.png\" alt=\"Triangle of Conflict.\" width=\"300\" height=\"300\" \/> <strong>Figure 3<\/strong>. Researcher David Malan proposed the triangle of conflict, which holds that true feelings can be blocked by defenses and anxieties.[\/caption]\r\n\r\nacceptable behavior). A good way to illustrate this would be to picture in your mind's eye that common image of a devil and an angel on each shoulder, whispering in each ear. A person with OCD is stuck between \"right\" and \"wrong,\" no longer able to function within normal limits. When these two (id and superego) are at odds, especially in extreme circumstances, a person is forced to manage them via repeated task(s), such as hand-washing or frequent checking.[footnote]Owen Kelly, P. D. (2020, July 26). Do they know what causes obsessive-compulsive disorder? <em>Verywell Mind<\/em>. https:\/\/www.verywellmind.com\/causes-of-ocd-2510476.[\/footnote]\r\n\r\nThe psychodynamic perspective attempts to bring repressed traumatic experiences out of the unconscious, where they are perceived as more toxic, and address them by helping patients to understand the relationship between hidden impulses, anxiety, and defense mechanisms.[footnote]Spermon, D., Darlington, Y., &amp; Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes. <em>Psychology research and behavior management<\/em>, 3, 119\u2013127. https:\/\/doi.org\/10.2147\/PRBM.S10215[\/footnote]\r\n<h2>The Humanistic Perspective<\/h2>\r\nFrom the humanistic perspective, with its emphasis on the potential for good and self-actualization in all people, those suffering OCD and PTSD are likely undergoing an existential crisis. People with these disorders are attempting to work toward self-actualization but finding themselves \"stuck\" and unable to move forward. For those with OCD, it manifests in obsessions and compulsions, they are trapped in a vicious, never-ending cycle, unable to move higher on Maslow's hierarchy. These obsessions and complusions could stem from a basic need that wasn't met in the early years, or from a feeling of insecurity. Similarly, those with PTSD have had a traumatic experience, one in which a basic need was severely threatened (i.e., their life), and therefore, they may feel helpless to move forward because of the difficulty with never truly feeling safe.\r\n<h2>The Cognitive Perspective<\/h2>\r\nCognitive psychology focuses on studying our thoughts and their relationship to our experiences and our actions. The cognitive model of OCD, as proposed by Paul Salkovskis, proposes that everyone will experience intrusive thoughts from time to time, but those with OCD falsely assume that \"(i) thinking about an action is the same as doing it; (ii) failing to prevent harm is morally equivalent to causing harm; (iii) responsibility for harm is not diminished by extenuating circumstances; (iv) failing to ritualize in response to a thought about harm is the same as an intention to harm; and (v) one should exercise control over one's thoughts.[footnote]Salkovskis, Paul (1985) Obsessional-compulsive problems: a cognitive-behavioural analysis. <em>Behaviour Research and Therapy.<\/em>\u00a023(5):571-83.[\/footnote]\u00a0The idea that thinking about an action is the same as doing it, is known as thought-action fusion. If someone with OCD has the sudden thought of robbing a bank, their mind acts as if they've already done it\u2014the thought, in turn, is just as bad as the action itself.[footnote]Jerry Kennard, P. D. (2010, October 25). Explaining OCD: A cognitive approach - obsessive compulsive disorder - Anxiety. <em>HealthCentral<\/em>. https:\/\/www.healthcentral.com\/article\/explaining-ocd-a-cognitive-approach.[\/footnote] Cognitive behavioral therapy (CBT) attempts to address and end the patterns of thinking that connect a thought with a compulsion.\r\n\r\nIn regards to PTSD, cognitive theory takes the following approach: traumatic events disrupt a person's perspective on life and the world around them, which ultimately creates a negative viewpoint that has lasting damage, resulting in chronic stress symptoms seen in PTSD. When you can't help but view the world as an unpredictable, dangerous place, it's hard to move forward without high levels of stress. People with PTSD may have a hard time believing that anyone or anything can be trusted, to the point where they may even struggle with their own self-worth.[footnote]Park, C. L., Mills, M. A., &amp; Edmondson, D. (2012). PTSD as Meaning Violation: Testing a Cognitive Worldview Perspective. <em>Psychological trauma: theory, research, practice and policy<\/em>, 4(1), 66\u201373. https:\/\/doi.org\/10.1037\/a0018792[\/footnote]\r\n<h2>The Behavioral Perspective<\/h2>\r\nAccording to the behavioral approach, for someone with OCD, a\u00a0neutral event comes to elicit fear or stress when it is paired with a stressful event (an unconditioned stimulus, or UCS). The conditioned stimulus (CS) could be a thought or something physical, such as a doorknob or a bathroom, and for someone with OCD, the stress caused by the conditioned stimulus is only reduced through compulsions.[footnote]Foa E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. <em>Dialogues in clinical neuroscience<\/em>, 12(2), 199\u2013207.[\/footnote]\u00a0Unfortunately, these rituals a person with OCD uses to neutralize the problem actually reinforce this notion that the obsession\u00a0<em>is<\/em> bad and they must do something to stop it, which results in becoming \"stuck\" in the constant cycle of obsession compulsion.\r\n<div>\r\n\r\n[caption id=\"attachment_1523\" align=\"alignleft\" width=\"300\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/02142611\/d8hob6asra2sn4czvfar.jpe\"><img class=\"wp-image-1523 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/02142611\/d8hob6asra2sn4czvfar-300x194.jpe\" alt=\"Photo of Little Albert and John Watson\" width=\"300\" height=\"194\" \/><\/a> <strong>Figure 4<\/strong>. The Little Albert Experiment: Through classical conditioning, Little Albert came to fear furry things, including Watson (the researcher) in a Santa Claus mask.[\/caption]\r\n\r\nPTSD learning models suggest that some symptoms are developed and maintained through classical conditioning. The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety. Cognitive, emotional, physiological, and environmental cues accompanying or related to the event are conditioned stimuli. These traumatic reminders evoke conditioned responses (extreme fear and anxiety) similar to those caused by the event itself (Nader, 2001). Differences in how conditionable individuals are help to explain differences in the development and maintenance of PTSD symptoms (Pittman, 1988).\r\n\r\n<\/div>\r\n<div>For example, if a combat veteran witnessed the death of a fellow soldier due to a roadside bomb, he may have fear of even benign objects on the side of the road upon return home (where there is little danger of being exposed to roadside bombs); though this initial response may be a normal reaction to extreme stress\/trauma, if the fear continues, (i.e., he swerves around trash in the road or avoids driving altogether) and\/or if it remains heightened (every time he passes by objects in the road\u2014a trash bag on the curb, a discarded box\u2014he experiences flashbacks), then this persistent conditioned stimulus that is no longer part of a true environmental danger becomes PTSD symptoms.<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/a3693c45-b0fc-401a-b514-7d06268dd280\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/a13e26b0-d51d-4643-a788-2b2d13258b6c\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning ObjectiveS<\/h3>\n<ul>\n<li style=\"font-weight: 400;\">Describe views on OCD from the major psychological perspectives<\/li>\n<li style=\"font-weight: 400;\">Describe views on stress-related disorders from the major psychological perspectives<\/li>\n<\/ul>\n<\/div>\n<h2>The Biological Perspective<\/h2>\n<p>Past research of family and\u00a0<span class=\"search-highlight first text last focus\">twin studies<\/span>\u00a0suggest that OCD has a moderate genetic component. OCD is five times more frequent in the first-degree relatives of people with\u00a0<span class=\"search-highlight first text last\">OCD<\/span>\u00a0than in people without the disorder (Nestadt et al., 2000); the concordance rate of\u00a0<span class=\"search-highlight first text last\">OCD<\/span>\u00a0among identical twins is around 57% and 22% for fraternal twins (Bolton, Rijsdijk, O\u2019Connor, Perrin, &amp; Eley, 2007).\u00a0<span class=\"search-highlight first text last\">Studies<\/span>\u00a0have implicated about two dozen potential genes that may be involved in\u00a0<span class=\"search-highlight first text last\">OCD<\/span>; these genes regulate the function of three neurotransmitters: serotonin, dopamine, and glutamate (Pauls, 2010).<\/p>\n<p>Furthermore, research also suggests that there may be differences in the brain structures of those with OCD versus those without. The orbitofrontal cortex is part of a series of brain regions that, collectively, is called the OCD circuit; this circuit consists of several interconnected regions that influence the perceived emotional value of stimuli and the selection of both behavioral and cognitive responses (Graybiel &amp; Rauch, 2000). People with OCD show more brain activity in these areas when asked to do things that provoke symptoms, such as looking at crookedly hung pictures or touching a dirty counter; because of this, it is believed that abnormalities in these regions may be the cause for OCD symptoms.<\/p>\n<p>For PTSD, and other stress-related disorders, researchers have found that genetics\u00a0<em>and<\/em> environment play an important role in one&#8217;s risk for developing PTSD due to trauma; estimates for the genetic influences for PTSD account for 30\u201373% of vulnerability for the disorder.\u00a0Some of the hereditary traits or genes that affect the increased risk for developing PTSD are common to those linked to a higher rate of susceptibility to major depression, anxiety, and panic disorder. One study actually identified 17 gene variants that were associated with PTSD.<a class=\"footnote\" title=\"Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., Milad, M. R., &amp; Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. Nature reviews. Neuroscience, 13(11), 769\u2013787. https:\/\/doi.org\/10.1038\/nrn3339\" id=\"return-footnote-418-1\" href=\"#footnote-418-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div id=\"attachment_3549\" style=\"width: 614px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3549\" class=\"wp-image-3549\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/22131743\/Hippocampus_and_PTSD.jpg\" alt=\"Infographic about the effect of ptsd on hippocampal size. The hippocampus has been known for its role in how memories are made. Patients with PTSD have a smaller hippocampus, alchoholism exaggerates the reduction in hippocampal volume, the severity and duration of trauma may also exacerbate it. MRI scans could be helpful in diagnosing PTSD.\" width=\"604\" height=\"781\" \/><\/p>\n<p id=\"caption-attachment-3549\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Recent studies have shown that smaller hippocampal volume has been correlated with PTSD.<\/p>\n<\/div>\n<p>Genes may not be the only thing affecting the risk factor for PTSD. In fact, the very structures of a person&#8217;s brain, like in the case of OCD, may have something to do with this. Recent studies have shown that smaller hippocampal volume has been correlated with PTSD\u2014the relationship between PTSD and smaller volume in this region of the brain is associated with negative effects of stress hormones; what&#8217;s interesting is that smaller hippocampal volume was found not only in the brains of combat veterans diagnosed with PTSD but\u00a0<em>also\u00a0<\/em>in their twins who hadn&#8217;t experienced combat, and thus never developed the disorder. This biological factor implies that someone could be predisposed to developing this disorder should they experience a traumatic event.<a class=\"footnote\" title=\"Kremen, W. S., Koenen, K. C., Afari, N., &amp; Lyons, M. J. (2012). Twin studies of posttraumatic stress disorder: differentiating vulnerability factors from sequelae. Neuropharmacology, 62(2), 647\u2013653. https:\/\/doi.org\/10.1016\/j.neuropharm.2011.03.012\" id=\"return-footnote-418-2\" href=\"#footnote-418-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h2>The Sociocultural Perspective<\/h2>\n<p>The sociocultural perspective looks at a person&#8217;s behaviors and symptoms in the context of their culture and background.<\/p>\n<p>Some cultures in which religion and customs are held to a very high standard may be connected to OCD; these factors are so ingrained and so varied that they can influence the onset, outcome, and response to treatment for OCD. Among Egyptians, for example, there is an emphasis on religious rituals that involve repeated phrases\u2014it appears that the prevalence of religious obsessions and compulsions are hard to distinguish between those with OCD and those simply practicing their religion. Types of obsessions among study participants in Egypt and Jerusalem were similar, mostly associated with religion and cleanliness or purity, whereas themes among Indian and British participants related more to being orderly and avoiding aggressiveness.<a class=\"footnote\" title=\"Okasha, Ahmed. OCD in Egyptian Adolescents: The Effect of Culture and Religion. Psychiatric Times. https:\/\/www.psychiatrictimes.com\/view\/ocd-egyptian-adolescents-effect-culture-and-religion.\" id=\"return-footnote-418-3\" href=\"#footnote-418-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> Understanding social influences on behavior is important; for example, how might you tell the difference between someone who is working hard to &#8220;purify&#8221; themselves via the strict adherence of religious rituals\u2014possibly washing their hands frequently, praying, or performing specific tasks several times a day\u2014and someone who has a diagnosis of OCD?<\/p>\n<p id=\"__p76\" class=\"p p-first\">In regards to PTSD, different cultures and belief systems may help or hinder the prevalence of the disorder. Cultural beliefs may influence an individual&#8217;s personal meanings of trauma and their attempts to come to terms with trauma memories in helpful and unhelpful ways. The meanings linked to PTSD show cultural variations: in individualistic cultures appraisals about a vulnerable or inadequate self are common; in collectivistic cultures appraisals about social functioning or evaluation by others. Cultural beliefs may also influence the reactions of significant others and the community and can thus facilitate or impede recovery from trauma.<a class=\"footnote\" title=\"Schnyder, U., Bryant, R. A., Ehlers, A., Foa, E. B., Hasan, A., Mwiti, G., Kristensen, C. H., Neuner, F., Oe, M., &amp; Yule, W. (2016). Culture-sensitive psychotraumatology. European journal of psychotraumatology, 7, 31179. https:\/\/doi.org\/10.3402\/ejpt.v7.31179\" id=\"return-footnote-418-4\" href=\"#footnote-418-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<p class=\"p p-first\">In a 2013 study that examined the prevalence and determinants of PTSD and post-traumatic stress symptoms following the 2004 tsunami in Indonesia and India, Rajkumar et al. credited the absence of avoidance symptoms among tsunami survivors to the cohesive social bonds and religious rituals that facilitated talking about the event and collective mourning in the community. Religious and spiritual beliefs may also influence trauma susceptibility.<a class=\"footnote\" title=\"Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities. Rajkumar AP, Mohan TS, Tharyan P. International Journal of Social Psychiatry. 2013 Mar; 59(2):123-9.\" id=\"return-footnote-418-5\" href=\"#footnote-418-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> Research has indicated that locus of control plays a role in susceptibility to PTSD. While an <strong>internal locus of control<\/strong>\u2014the belief that the outcomes of events in your life are in your own control\u2014seems to provide a protective role in people subjected to traumatic experiences, an external locus, in which events in one\u2019s life are believed to be controlled by outside forces, tends to instill a sense of helplessness and lack of control in victims of trauma. In India, where the role of religion and strong beliefs in karma are highly predominant, society is generally characterized by an external locus of control.<a class=\"footnote\" title=\"Gilmoor, A. R., Adithy, A., &amp; Regeer, B. (2019). The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. Frontiers in psychiatry, 10, 439. https:\/\/doi.org\/10.3389\/fpsyt.2019.00439\" id=\"return-footnote-418-6\" href=\"#footnote-418-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<h2>The Psychodynamic Perspective<\/h2>\n<div id=\"attachment_1438\" style=\"width: 210px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1438\" class=\"wp-image-1438 size-medium\" title=\"https:\/\/pixabay.com\/photos\/sigmund-freud-portrait-1926-1153858\/\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/01040921\/sigmund-freud-1153858_1920-200x300.jpg\" alt=\"Photo of Sigmund Freud\" width=\"200\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-1438\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. According to Freud, our personality develops from a conflict between two forces: our biological aggressive and pleasure-seeking drives versus our internal (socialized) control over these drives.<\/p>\n<\/div>\n<p>Psychodynamic theory suggests that there are three areas at work in determining a person&#8217;s personality and behavior: the id, superego, and ego. The id represents our unconscious, primitive drives or urges. The superego is what we learn as we grow\u2014societal rules, what is or isn&#8217;t acceptable\u2014our &#8220;moral compass&#8221; essentially, and when we fail to live up to the standards of the superego, we may experience shame or guilt. The ego is the most rational part of our personality that balances the two by satisfying the desires of the id in a realistic way.<\/p>\n<p>When there is an imbalance of these three interacting parts of our personality, the psychodynamic approach says that we are likely suffering from\u00a0neurosis\u00a0(a tendency to experience negative emotions), anxiety disorders, or unhealthy behaviors. For example, a person who is dominated by their id might be narcissistic and impulsive. A person with a dominant superego might be controlled by feelings of guilt and deny themselves even socially acceptable pleasures; conversely, if the superego is weak or absent, a person might become a psychopath. An overly dominant superego might be seen in an over-controlled individual whose rational grasp on reality is so strong that they are unaware of their emotional needs, or, in a neurotic who is overly defensive (overusing ego defense mechanisms).<\/p>\n<p>To view OCD in light of this perspective, obsessions and compulsions are, in actuality &#8220;unconscious conflict&#8221; that you may be trying to stop or cope with, and this conflict comes from a clash between the id (usually a sexual or aggressive urge) and the superego (the desire to do the right thing and follow socially<\/p>\n<div id=\"attachment_1483\" style=\"width: 310px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1483\" class=\"wp-image-1483 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/01163533\/Triangle_Of_Conflict-300x300.png\" alt=\"Triangle of Conflict.\" width=\"300\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-1483\" class=\"wp-caption-text\"><strong>Figure 3<\/strong>. Researcher David Malan proposed the triangle of conflict, which holds that true feelings can be blocked by defenses and anxieties.<\/p>\n<\/div>\n<p>acceptable behavior). A good way to illustrate this would be to picture in your mind&#8217;s eye that common image of a devil and an angel on each shoulder, whispering in each ear. A person with OCD is stuck between &#8220;right&#8221; and &#8220;wrong,&#8221; no longer able to function within normal limits. When these two (id and superego) are at odds, especially in extreme circumstances, a person is forced to manage them via repeated task(s), such as hand-washing or frequent checking.<a class=\"footnote\" title=\"Owen Kelly, P. D. (2020, July 26). Do they know what causes obsessive-compulsive disorder? Verywell Mind. https:\/\/www.verywellmind.com\/causes-of-ocd-2510476.\" id=\"return-footnote-418-7\" href=\"#footnote-418-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<p>The psychodynamic perspective attempts to bring repressed traumatic experiences out of the unconscious, where they are perceived as more toxic, and address them by helping patients to understand the relationship between hidden impulses, anxiety, and defense mechanisms.<a class=\"footnote\" title=\"Spermon, D., Darlington, Y., &amp; Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes. Psychology research and behavior management, 3, 119\u2013127. https:\/\/doi.org\/10.2147\/PRBM.S10215\" id=\"return-footnote-418-8\" href=\"#footnote-418-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/p>\n<h2>The Humanistic Perspective<\/h2>\n<p>From the humanistic perspective, with its emphasis on the potential for good and self-actualization in all people, those suffering OCD and PTSD are likely undergoing an existential crisis. People with these disorders are attempting to work toward self-actualization but finding themselves &#8220;stuck&#8221; and unable to move forward. For those with OCD, it manifests in obsessions and compulsions, they are trapped in a vicious, never-ending cycle, unable to move higher on Maslow&#8217;s hierarchy. These obsessions and complusions could stem from a basic need that wasn&#8217;t met in the early years, or from a feeling of insecurity. Similarly, those with PTSD have had a traumatic experience, one in which a basic need was severely threatened (i.e., their life), and therefore, they may feel helpless to move forward because of the difficulty with never truly feeling safe.<\/p>\n<h2>The Cognitive Perspective<\/h2>\n<p>Cognitive psychology focuses on studying our thoughts and their relationship to our experiences and our actions. The cognitive model of OCD, as proposed by Paul Salkovskis, proposes that everyone will experience intrusive thoughts from time to time, but those with OCD falsely assume that &#8220;(i) thinking about an action is the same as doing it; (ii) failing to prevent harm is morally equivalent to causing harm; (iii) responsibility for harm is not diminished by extenuating circumstances; (iv) failing to ritualize in response to a thought about harm is the same as an intention to harm; and (v) one should exercise control over one&#8217;s thoughts.<a class=\"footnote\" title=\"Salkovskis, Paul (1985) Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy.\u00a023(5):571-83.\" id=\"return-footnote-418-9\" href=\"#footnote-418-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a>\u00a0The idea that thinking about an action is the same as doing it, is known as thought-action fusion. If someone with OCD has the sudden thought of robbing a bank, their mind acts as if they&#8217;ve already done it\u2014the thought, in turn, is just as bad as the action itself.<a class=\"footnote\" title=\"Jerry Kennard, P. D. (2010, October 25). Explaining OCD: A cognitive approach - obsessive compulsive disorder - Anxiety. HealthCentral. https:\/\/www.healthcentral.com\/article\/explaining-ocd-a-cognitive-approach.\" id=\"return-footnote-418-10\" href=\"#footnote-418-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a> Cognitive behavioral therapy (CBT) attempts to address and end the patterns of thinking that connect a thought with a compulsion.<\/p>\n<p>In regards to PTSD, cognitive theory takes the following approach: traumatic events disrupt a person&#8217;s perspective on life and the world around them, which ultimately creates a negative viewpoint that has lasting damage, resulting in chronic stress symptoms seen in PTSD. When you can&#8217;t help but view the world as an unpredictable, dangerous place, it&#8217;s hard to move forward without high levels of stress. People with PTSD may have a hard time believing that anyone or anything can be trusted, to the point where they may even struggle with their own self-worth.<a class=\"footnote\" title=\"Park, C. L., Mills, M. A., &amp; Edmondson, D. (2012). PTSD as Meaning Violation: Testing a Cognitive Worldview Perspective. Psychological trauma: theory, research, practice and policy, 4(1), 66\u201373. https:\/\/doi.org\/10.1037\/a0018792\" id=\"return-footnote-418-11\" href=\"#footnote-418-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/p>\n<h2>The Behavioral Perspective<\/h2>\n<p>According to the behavioral approach, for someone with OCD, a\u00a0neutral event comes to elicit fear or stress when it is paired with a stressful event (an unconditioned stimulus, or UCS). The conditioned stimulus (CS) could be a thought or something physical, such as a doorknob or a bathroom, and for someone with OCD, the stress caused by the conditioned stimulus is only reduced through compulsions.<a class=\"footnote\" title=\"Foa E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in clinical neuroscience, 12(2), 199\u2013207.\" id=\"return-footnote-418-12\" href=\"#footnote-418-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a>\u00a0Unfortunately, these rituals a person with OCD uses to neutralize the problem actually reinforce this notion that the obsession\u00a0<em>is<\/em> bad and they must do something to stop it, which results in becoming &#8220;stuck&#8221; in the constant cycle of obsession compulsion.<\/p>\n<div>\n<div id=\"attachment_1523\" style=\"width: 310px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/02142611\/d8hob6asra2sn4czvfar.jpe\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1523\" class=\"wp-image-1523 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/02142611\/d8hob6asra2sn4czvfar-300x194.jpe\" alt=\"Photo of Little Albert and John Watson\" width=\"300\" height=\"194\" \/><\/a><\/p>\n<p id=\"caption-attachment-1523\" class=\"wp-caption-text\"><strong>Figure 4<\/strong>. The Little Albert Experiment: Through classical conditioning, Little Albert came to fear furry things, including Watson (the researcher) in a Santa Claus mask.<\/p>\n<\/div>\n<p>PTSD learning models suggest that some symptoms are developed and maintained through classical conditioning. The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety. Cognitive, emotional, physiological, and environmental cues accompanying or related to the event are conditioned stimuli. These traumatic reminders evoke conditioned responses (extreme fear and anxiety) similar to those caused by the event itself (Nader, 2001). Differences in how conditionable individuals are help to explain differences in the development and maintenance of PTSD symptoms (Pittman, 1988).<\/p>\n<\/div>\n<div>For example, if a combat veteran witnessed the death of a fellow soldier due to a roadside bomb, he may have fear of even benign objects on the side of the road upon return home (where there is little danger of being exposed to roadside bombs); though this initial response may be a normal reaction to extreme stress\/trauma, if the fear continues, (i.e., he swerves around trash in the road or avoids driving altogether) and\/or if it remains heightened (every time he passes by objects in the road\u2014a trash bag on the curb, a discarded box\u2014he experiences flashbacks), then this persistent conditioned stimulus that is no longer part of a true environmental danger becomes PTSD symptoms.<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_a3693c45-b0fc-401a-b514-7d06268dd280\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/a3693c45-b0fc-401a-b514-7d06268dd280?iframe_resize_id=assessment_practice_id_a3693c45-b0fc-401a-b514-7d06268dd280\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_a13e26b0-d51d-4643-a788-2b2d13258b6c\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/a13e26b0-d51d-4643-a788-2b2d13258b6c?iframe_resize_id=assessment_practice_id_a13e26b0-d51d-4643-a788-2b2d13258b6c\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-418\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Christina Hicks for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Obsessive-Compulsive and Related Disorders. <strong>Provided by<\/strong>: OpenStax . <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/15-5-obsessive-compulsive-and-related-disorders\">https:\/\/openstax.org\/books\/psychology-2e\/pages\/15-5-obsessive-compulsive-and-related-disorders<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Access for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction<\/li><li>Culture-sensitive psychotraumatology. <strong>Authored by<\/strong>: Ulrich Schnyder, Richard A. Bryant, Anke Ehlers, Edna B. Foa, Aram Hasan, Gladys Mwiti, Christian H. Kristensen, Frank Neuner, Misari Oe, and William Yule. <strong>Provided by<\/strong>: European Journal of Psychotraumatology. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055610\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055610\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. <strong>Authored by<\/strong>: Andrew Roderick Gilmoor, Adithy Adithy, and Barbara Regeer . <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6620607\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6620607\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Hippocampus and PTSD. <strong>Provided by<\/strong>: Wikimedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hippocampus_and_PTSD.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Hippocampus_and_PTSD.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Freud and the Psychodynamic Perspective. <strong>Provided by<\/strong>: OpenStax. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/11-2-freud-and-the-psychodynamic-perspective\">https:\/\/openstax.org\/books\/psychology-2e\/pages\/11-2-freud-and-the-psychodynamic-perspective<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction<\/li><li>Freud Image. <strong>Provided by<\/strong>: Pixabay. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/photos\/sigmund-freud-portrait-1926-1153858\/\">https:\/\/pixabay.com\/photos\/sigmund-freud-portrait-1926-1153858\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><li>Post traumatic stress disorder. <strong>Provided by<\/strong>: OpenStax. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/cnx.org\/contents\/Sr8Ev5Og@13.1:unjXeB6F@12\/15-6-Posttraumatic-Stress-Disorder\">https:\/\/cnx.org\/contents\/Sr8Ev5Og@13.1:unjXeB6F@12\/15-6-Posttraumatic-Stress-Disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@13.1<\/li><li>Triangle of Conflict. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/David_H._Malan#\/media\/File:Triangle_Of_Conflict.png\">https:\/\/en.wikipedia.org\/wiki\/David_H._Malan#\/media\/File:Triangle_Of_Conflict.png<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-418-1\">Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., Milad, M. R., &amp; Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. <em>Nature reviews<\/em>. Neuroscience, 13(11), 769\u2013787. https:\/\/doi.org\/10.1038\/nrn3339 <a href=\"#return-footnote-418-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-418-2\">Kremen, W. S., Koenen, K. C., Afari, N., &amp; Lyons, M. J. (2012). Twin studies of posttraumatic stress disorder: differentiating vulnerability factors from sequelae. <em>Neuropharmacology<\/em>, 62(2), 647\u2013653. https:\/\/doi.org\/10.1016\/j.neuropharm.2011.03.012 <a href=\"#return-footnote-418-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-418-3\">Okasha, Ahmed. OCD in Egyptian Adolescents: The Effect of Culture and Religion. <em>Psychiatric Times<\/em>. https:\/\/www.psychiatrictimes.com\/view\/ocd-egyptian-adolescents-effect-culture-and-religion. <a href=\"#return-footnote-418-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-418-4\">Schnyder, U., Bryant, R. A., Ehlers, A., Foa, E. B., Hasan, A., Mwiti, G., Kristensen, C. H., Neuner, F., Oe, M., &amp; Yule, W. (2016). Culture-sensitive psychotraumatology. <em>European journal of psychotraumatology<\/em>, 7, 31179. https:\/\/doi.org\/10.3402\/ejpt.v7.31179 <a href=\"#return-footnote-418-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-418-5\">Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities. Rajkumar AP, Mohan TS, Tharyan P. <em>International Journal of Social Psychiatry<\/em>. 2013 Mar; 59(2):123-9. <a href=\"#return-footnote-418-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-418-6\">Gilmoor, A. R., Adithy, A., &amp; Regeer, B. (2019). The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. <em>Frontiers in psychiatry<\/em>, 10, 439. https:\/\/doi.org\/10.3389\/fpsyt.2019.00439 <a href=\"#return-footnote-418-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-418-7\">Owen Kelly, P. D. (2020, July 26). Do they know what causes obsessive-compulsive disorder? <em>Verywell Mind<\/em>. https:\/\/www.verywellmind.com\/causes-of-ocd-2510476. <a href=\"#return-footnote-418-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-418-8\">Spermon, D., Darlington, Y., &amp; Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes. <em>Psychology research and behavior management<\/em>, 3, 119\u2013127. https:\/\/doi.org\/10.2147\/PRBM.S10215 <a href=\"#return-footnote-418-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-418-9\">Salkovskis, Paul (1985) Obsessional-compulsive problems: a cognitive-behavioural analysis. <em>Behaviour Research and Therapy.<\/em>\u00a023(5):571-83. <a href=\"#return-footnote-418-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-418-10\">Jerry Kennard, P. D. (2010, October 25). Explaining OCD: A cognitive approach - obsessive compulsive disorder - Anxiety. <em>HealthCentral<\/em>. https:\/\/www.healthcentral.com\/article\/explaining-ocd-a-cognitive-approach. <a href=\"#return-footnote-418-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-418-11\">Park, C. L., Mills, M. A., &amp; Edmondson, D. (2012). PTSD as Meaning Violation: Testing a Cognitive Worldview Perspective. <em>Psychological trauma: theory, research, practice and policy<\/em>, 4(1), 66\u201373. https:\/\/doi.org\/10.1037\/a0018792 <a href=\"#return-footnote-418-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-418-12\">Foa E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. <em>Dialogues in clinical neuroscience<\/em>, 12(2), 199\u2013207. <a href=\"#return-footnote-418-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":14,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Obsessive-Compulsive and Related Disorders\",\"author\":\"\",\"organization\":\"OpenStax \",\"url\":\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/15-5-obsessive-compulsive-and-related-disorders\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Access for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction\"},{\"type\":\"cc\",\"description\":\"Culture-sensitive psychotraumatology\",\"author\":\"Ulrich Schnyder, Richard A. Bryant, Anke Ehlers, Edna B. Foa, Aram Hasan, Gladys Mwiti, Christian H. 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