OCD

What is an obsession

- a persistant thought, idea, impulse/image that is experienced repeatedly, feels intrusive and causes anxiety

What type of disorder is OCD

- anxiety

What is a compulsion

- a repetitive and rigid behaviour/mental act that a person feels driven to perform

- in order to prevent/reduce anxiety

Differences between obsessions and compulsions

- obsession is an unwanted thought and compulsion is a repetitive act that one is driven to perform in order to reduce anxiety associated with the obsession

What is an obsessive compulsive disorder

- a mental health condition where a person had obsessive thoughts and compulsive activity

What percentage of the general population has OCD

2%

Men:women with OCD

Equal

Age of onset of OCD

- late adolescence to early adulthood

Behavioural characteristics of OCD

- compulsive behaviours: repetitive (hand washing/counting) & mainly to reduce anxiety produced by the obsessions

- avoidance: may keep away from situations that trigger anxiety & can interfere with leading a normal life

Emotional aspects of OCD

- Anxiety / distress - due to obsession being unpleasant & frightening = urge to repeat a behaviour

- Depression - often accompanies OCD, compulsions may reduce anxiety but they're only short term fixes

- Irrational guilt / Disgust - these can be about the self or external factors (e.g. dirt) and guilt is often irrational.

Cognitive aspects of OCD

- Obsessive thoughts - 90% of sufferers have recurring thoughts and are unpleasant

- Awareness of excessive anxiety - they are aware their thoughts / behaviours are not rational. They are hypervigilant and alert of potential hazards

- Cognitive coping strategies -They devise their own ways to cope with obsessive thoughts e.g. those with obsessive thoughts of family members dying will choose to pray (making them seem abnormal to others) and can interfere with everyday life.

symptoms of OCD defined by DSM

- Recurrent obsessions and compulsions

- Recognition by the individual that obsessions and compulsions are excessive and unreasonable

- That the person is distressed and daily life is disrupted by obsessions and compulsions

outline the biological approach

- The biological approach assumes that abnormality is caused by physiological factors such as brain biochemistry, neuroanatomy (brain structural abnormalities) and genetics. Treatments that alter physiology such as drugs are used to address the disorder.

state the biological explanations for OCD

- genetic explanation

- neural explanations

- neurophysiological-decision making systems

Outline the genetic explanation for OCD.

- Genes consists of DNA that codes the physical features and and psychological characteristics. They are inherited from parents.

- Due to this some people may be genetically predisposed to inherit a mental disorder such as OCD. This means that OCD may run in families and is inherited from a family member.

- Evidence for this comes from twin studies and family studies. This is because families share similar genes. Then if your likelihood of developing the disorder increases if your family member has the disorder it would imply that there is a genetic link.

- Candidate genes have been identified as the genes that create vulnerability to OCD. Some of these are responsible for regulating the development of the serotonin system.

E.g 5HT1-D is involved in how efficiently serotonin is transported across the synapse. Or Gene 9 which is inherited. OCD seems to be polygenic

outline research support as strength for genetic explanation

P: research support

E: Study 1: Nestadt et al ( 2010) reviewed previous twin studies and found the concordance rate for OCD to be 68% for MZ twins and 31% for DZ twins. Since the concordance rate increases as genetic similarity increases between the twins, it suggests that there is a strong genetic influence on OCD.

OCD. eg = born with the disposition to develop OCD but may need an environmental stressor to trigger it =

the Diathesis stress model and seems like a more plausible explanation.

P: There has been evidence that over half the OCD patients in a sample had a traumatic event in their past supporting this viewpoint.

E: Study 2: Lewis observed that in his OCD patients 37% had parents in OCD and 21% had siblings with compared to 2% in general population.

Outline research support as a weakness for genetic explanation

E: Nestadt study however assumes that MZ twins are more similar than DZ twins because they have greater similarity in genes but overlooks the fact that MZ twins may be more similar because they have a more similar shared environment- they are treated more similarly. This reduces the value of the support provided by twin studies for the genetic explanation of OCD.

- If OCD was purely genetic then the concordance rate between MZ twins should have been 100% and not 68% since they share 100% of their genes. This implies that there must be environmental factors that increase the risk of developing

- However this finding could also be explained by other factors. Close family members also share the same environment and this could explain the higher concordance rates, rather than genetics.

- reductionist explanation

outline weakness of genetic explanation: reductionist

- findings could also be explained by other factors. Close family members also share the same environment and this could explain the higher concordance rates, rather than genetics.

- Social learning theory could argue that OCD runs in families because people may observe obsessive compulsive behaviour in family members and then imitate the behaviour instead of a genetic predisposition.

strength of research support for candidate genes

Taylor (2013) analysed findings of previous studies and found evidence of up to 230 genes involved in the development of OCD. Genes associated with both the action of dopamine and serotonin has been implicated in the development of OCD.

- This implies that the origin of OCD has different causes - it is aetiologically heterogenous since one group of genes may cause OCD in one person and another group of genes may cause it in another person.

evaluate candidate genes as genetic explanation

However Psychologists have not been able to identify all the genes involved and because it is aetiologically heterogenous, the genetic explanation is unlikely to be very useful because it is difficult to predict if someone will have the disorder based on it + limited treatment (treat symptoms not cause)

E: social sensitivity- could cause parents to feel guilty

state evaluative points of genetic explanation

- research support: but diathesis stress model is better

- reductionist

- social sensistivity

outline neural explanation

- Neural explanation -the view that physical and psychological characteristics are determined by the nervous system - brain and neurotransmitters.

- Neurotransmitters are important in maintaining communication between neurons. An imbalance can affect behaviour. OCD may be because of low levels of the neurotransmitter serotonin may be associated with anxiety (low levels of serotonin means that normal transmission of mood related information does not take place) and high levels of dopamine are linked to compulsive behaviour.

state evaluative points of neural explanation

- used for treatments

Evaluate neural explanation of OCD

- Drugs e.g. SSRI anti-depressants that increase the amount of neurotransmitter Serotonin in the brain also reduce obsessive compulsive symptoms.

E: supports for the theory that the serotonin system is involved in OCD + successful treatments gives biological explanation predictive validity

P: diathesis model is better explanation

E: However Serotonin may be responsible for OCD. Drugs such as SSRI's which increase the levels of serotonin in the brain only report a 50% improvement. This suggests that there are other explanations of OCD. It may be that one is born with a genetic predisposition to develop OCD but only develops it if there are environmental stressors. = diathesis stress model

- There is a time delay - the drugs affect levels of serotonin within hours but the effect on serotonin takes weeks so other factors must be involved.

- Also it is very difficult to establish cause and effect. Low levels of serotonin may cause OCD or it may be that OCD caused the low levels of serotonin.

outline neurophysiological-decision making systems

- Results from PET scans have shown that people with OCD have very abnormal functioning of the lateral ( sides) part of the frontal lobes of the brain. The frontal lobe is responsible for logical thinking and making decisions.

- This may explain hoarding disorder that seems to be due to impaired decision making.

- Brain scans have also linked a part of the brain called the basal ganglia to OCD. This brain area controls psychomotor functions and it is suggested that hypersensitivity of the basal ganglia explains the repetitive actions seen in OCD sufferers.

evaluate neurophysiological-decision making systems

- However this theory is not supported in a meta analysis by Aylward who found no significant differences in basal ganglia structures between OCD patients and controls.

- Also this theory only accounts for the repetitive behaviours in OCD and does not explain the obsessional thoughts that are thought to give rise to the behaviours in the first place.

overall evaluation of biological explanation

This explanation is biologically deterministic. It suggests that biological factors outside of the individual's control are responsible for OCD. This will limit the treatment options for OCD.

biological approach to treating OCD

- drug therapy

What is drug therapy?

- treatment involving drugs - chemicals that have a particular effect on the functioning of the brain- in psychological disorders they usually affect neurotransmitter levels.

- Drug therapy involves attempting to change the level of implicated neurotransmitters in the brain.

state drugs used to treat OCD

- antidepressants

- SSRI's: fluoxetine

- tricyclics

- SNRI's

role of antidepressants in treating OCD

- Antidepressants are the main medications

prescribed for OCD because it is frequently accompanied by depression.

- These are not given in an attempt to change the behaviours exhibited, but to reduce the anxiety experienced.

how do SSRI's treat OCD

- They prevent the reuptake or reabsorption of serotonin by the pre- synaptic neuron, where it is broken down and re-used.

- This prevention of reabsorption and breakdown of serotonin increases its levels in the synapse and allows it to continue stimulating the post synaptic neuron.

- This compensates for whatever is wrong with the serotonin system in OCD. These drugs also cause the frontal cortex to operate more normally.

outline dosage of fluoxetine

typical daily dose is 20mg ( liquid or capsule) - but advice and dosage varies. It takes 3-4 months of daily use to have much impact on the symptoms.

why might alternatives to SSRI's be used

-sometimes different antidepressants are tried since patients respond differently to different drugs and alternatives might work better for some OCD patients.

How do tricyclics work?

prevent the reuptake and breakdown of serotonin at the presynaptic neuron.

issues with tricyclics

- They have more common and sometimes severe side effects than SSRIs

- Example: 1/10 suffer from tremors and weight gain (common) or 1/100 can become aggressive or have disruption to their heart rhythm.( serious).

How do SNRIs work?

They prevent the reuptake of serotonin and noradrenaline and are also used as second line of defence if the patients do not respond to SSRIs.

evaluate drug therapy as being more effective than psychological treatments for severe cases of OCD

P: more effective than psychological treatments for severe cases who lack insight or motivation.

E: not dependent on a client therapist relationship for it to be effective unlike psycho therapy. C: However a patient is passive in the treatment unlike psycho therapy in which they are active. + takes 4-12 weeks before any benefit is noticed and this together with the side effects might cause people to stop using them causing a relapse.

state strengths of drug therapy

- research support

- improves quality of life

- requires little effort from patient

- more effective than psychological treatments

Evaluate research support for drug therapy

P: research support

E: symptoms. Soomro reviewed 17 studies comparing SSRIs and placebos in the treatment of OCD and found significantly better results for SSRIs than placebos.

evaluate improved quality of life because of drug therapy

P: improved quality of life

E: Symptoms reduce significantly in 70% of the patients taking SSRIs. less disruption since the obsessive thoughts and compulsive behaviours do not dominate ( do not have to be homebound or hospitalised and can socialise, be in employment, go to school).

evaluate drug therapy as requiring less effort for patient

P: less time consuming and non-disruptive to the patient's lives than cognitive therapy in which the patient has to attend regular meetings with a therapist and be active in tackling their problems

E: Using drugs is therefore good value for a public health service like the NHS.

C: is expensive to produce

state weakness of drug therapy

- treats symptoms not cause

- biased evidence

evaluate the fact that drug therapy treating symptom not the cause

P: Drug therapy treats the symptoms and not the cause.

E: It also does not teach any skills to deal with the disorder, so the effectiveness is short term. It lasts as long as the treatment lasts (causes dependency). Patients may relapse once the treatment stops, leading to a revolving door syndrome.

E: Due to this the best line of treatment for long term effectiveness is the combination of drug therapy and cognitive therapy. Drug therapy will help reduce the emotional symptoms such as anxiety and depression and cognitive therapy will try and get to the root cause as well as teach the patient long term coping skills. This is even more beneficial if the OCD has been triggered by some trauma.

what is the revolving door syndrome

- never ending cycle

- taking drug, stop, relapse, taking drug etc

evaluate the biased evidence of drug therapy

P: some psychologists feel that the evidence favouring drug therapy is biased.

E: because most research into their effectiveness is sponsored by drug companies who do not report all the evidence.

E: file drawer effect

file drawer effect

- Studies that do not support drug therapy are less likely to get published than studies that do

- because funding is from pharmaceutical companies