W3: Obsessive-compulsive disorder (OCD)

What is obsessive-compulsive disorder (OCD)?

Presence of obsessions, compulsions, or both

What are obsessions?

Recurrent and persistent thoughts, urges, or images that are intrusive and unwantedand cause marked anxiety

What are the 3 typical content of obessions?

1. Repugnant (“i am going to stand up and scream something racist in public”)

2. Contamination (“this chicken is undercooked and i’m gonna fall sick”)

3. Doubting (“the stove may still be on and the house might burn down”)

What are 4 cases which are NOT obsessions?

1. Worries about real-life issues (e.g. work)

2. Recurrent sexual fantasies

3. Preoccupation with a new car, boyfriend etc

4. Desires to gamble, steal, drink etc

How do individuals try to ignore/suppress/neutralise these thoughts, urges or images?

By performing a compulsion

What are compulsions?

Repetitive behaviours or mental acts that the individual performs in response to an obsession or according to rules

What is the 3 aim of compulsions?

1. “Undo” obsessions

2. Prevent harm associated with an obsession

3. Alleviate anxiety

What makes it pathological?

Their behaviours/mental acts are not connected in a realistic way with what they want to prevent or are clearly excessive

What is OCD’s lifetime prevalence and gender difference?

• 2-3% lifetime prevalence

• F=M

When does OCD start to develop on average?

17 y/o (mean age), but a significant portion starts from childhood

What are 4 commonly replicable symptom dimensions of OCD?

1. Obsessions about contamination and washing compulsions

2. Obsessions about responsibility for causing harm/making mistakes and checking compulsions

3. Obsessions about symmetry and arranging compulsions

4. Repugnant obsessional thoughts about sex, religion and violence and mental compulsions and other covert neutralising

Which part of the brain is higher activity detected?

The “cortical-striatal-thalamic” circuit (prefrontal cortex, thalamus, basal ganglia)

What is this area associated with?

Filtering out irrelevant information and preservation of behaviour

What is a pharmacological treatment of OCD?

Selective serotonin reuptake inhibitors (SSRIs)

What is a limitation of pure usage of SSRIs?

Majority of patients relapse after discontinuation of SSRIs → adding behaviour therapy is important

What is a psychological treatment for OCD?

Exposure and response prevention (ERP)

How does ERP work?

Through repeated exposure to feared situations and thoughts without performing compulsions

What 3 lessons does the individual learn?

1. Emotional response subsides

2. The feared event does not happen

3. It is safe and moral to let the thought go without responding with a compulsion (“its ok if i don’t wash my hands another time”)

What is a cognitive strategy?

Normalising intrusive thoughts

What belief is this based on?

Almost all people experience intrusive thoughts and the negative appraisal of the thought (“i’m bad/mad/dangerous”) causes anxiety which promote compulsive behaviour

What are 4 OCD-relevant beliefs related to intrusive thoughts?

1. Over-importance of thoughts - this must mean i’m a violent person

2. Overestimation of threat - i am more likely to cause harm

3. Perfectionism - even minor mistakes will cause harm

4. Intolerance of uncertainty - i need to be absolutely sure i wont hurt others

What are the 4 methods to challenge the meaning and importance of intrusive thoughts?

1. Report intrusive thoughts by a non-clinical sample (normal population)

2. Survey friends

3. Treating thoughts like pop up ads on the internet/sushi train (no meaning, pass and go)

What is thought-action fusion (TAF)?

A cognitive distortion where a person with OCD believes their thoughts have a direct, real-world connection to actions and having those thoughts increase the likelihood of the event occurring

What type of disorder used to be an OCD dimension but is no longer now?

Hoarding disorder

What are the 3 factors that place an individual at risk?

1. Genetics

2. Life events

3. Executive functioning difficulties

What is hoarding a consequence of?

Poor treatment response to behavioural and medication treatment for OCD