Psychology Exam 2: OCD

Definitions: Obsessions

• Recurrent and persistent- thoughts, urges, images

• That are experienced as: intrusive and unwanted

• That in most individuals cause: anxiety and distress

Definitions: Compulsions

• Repetitive behaviors OR mental acts the individual feels driven to perform: in response to an obsession or according to rules that must be applied rigidly

• The behaviors OR mental acts are aimed at: preventing or reducing anxiety or distress or, preventing some dreaded situation

• However, these behaviors and mental acts: are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

What are some common themes of OCD?

• Cleaning- contamination obsession, cleaning compulsions

• Symmetry- symmetry obsessions; repeating, ordering, and counting compulsions

• Harm- obsessive fears of harm to oneself or others; related checking compulsions

What is the DSM-5 criteria for Obsessive- Compulsive Disorder?

• Prescence of obsession, or compulsion, or both (for most people with OCD they have both)

• Obsessions and compulsion are time consuming (1+ hr per day) or cause clinically significant distress or impairment

• Not attributable to physiological effects of a substance or medical condition

• Not better explained by symptoms of another mental disorder

• Specifiers: with good or fair insight, with poor insight, with absent insight/delusional beliefs

What is some additional information about OCD?

• 12 month prevalence (US): 1.2%

• Lifetime prevalence (US): 2.3%

• Gender: No differences

• Race/ethnicity: No differences

• Age of onset (US): Median age= 20 yo, 25% of cases start by 14 yo, males have an earlier age of onset

• Course: Chronic with waxing and waning symptoms, when not treated 20% experience complete remission

• Genetics: MZ Twins: 53%, DZ Twins: 23%

What are causes of OCD in the biological perspective?

• Low serotonin activity

• Abnormal brain functioning in areas that convert sensory information into thoughts and actions

  • Orbitofrontal cortex: too active

  • Caudate nuclei: too active

What are treatments for OCD in the biological perspective?

• Antidepressants that specifically increase serotonin activity

  • 50%-60% improve

  • Obsessions/compulsions cut in half in 8 weeks

• Long term benefit?

  • Tend to relapse if medication stopped

• Best practice?

  • combination of medication and therapy

  • Higher symptoms reduction, improvements last longer

What are causes of OCD from the behavioral perspective?

• People “happen upon” their compulsions randomly

  • Fearful situation → do something → threat goes away

  • Link improvement with the action

  • When repeated becomes a method of reducing anxiety

• Research supports idea that compulsions are “rewarded” by reduction in anxiety

  • operant conditioning- Negative reinforcement

What are treatments for OCD from the behavioral perspective?

• Exposure and response prevention

  • Repeatedly exposed to objects/situations that produce: anxiety, obsessive fears, compulsive behaviors

  • Told to resist performing the behaviors

• Does it work?

  • 55-70% improve considerably

  • Improvement often long lasting

  • Does not work as well for obsessions only

What are causes of OCD from the Cognitive perspective?

• Everyone at some point has repetitive, unwanted, or intrusive thought

• People who developed OCD: blame themselves for the thoughts, expect terrible things to happen, try to neutralize the thoughts to avoid negative outcomes

• Neutralizing:

  • Think or behave in a way that is meant to put matters right or make amends

  • Leads to temporary reduction in discomfort→ reinforced!

  • Used so often that it becomes an obsession or compulsion

What is treatment for OCD from the cognitive perspective?

• (1) Educate about symptoms and how maintained: misinterpretations, excessive sense of responsibility, neutralizing acts

• (2) Identify, challenge and change harmful thought

• What does research say?

  • Reduce number and impact of obsessions and compulsions

  • Combination of cognitive and behavioral is better than either on their own

What are some additional obsessive- compulsive related disorders?

• Hoarding disorder: difficulty discarding/ parting with possessions, perceived need to save things, distress associated with discarding, and congested an cluttered living areas

• Trichotillomania: recurrent pulling out of one’s hair resulting in hair loss, repeated attempts to decrease or stop behavior

• Excoriation disorder: recurrent skin picking resulting in skin lesions, repeated attempts to stop skin picking