OCD

OCD biological explanation → genetic explanation

• higher concordance rate in MZ twins than DZ → OCD’s hereditary

genes prevalent in OCDs

• 5-HTT → codes for SERT (mutation of SERT found on people with OCD)

• DRD4 → codes for dopamine

• COMT → codes for an enzyme breaking down dopamine → low levels of this enzyme could increase dopamine

• SLITRK-5

OCD biological explanation → biochemical explanation

role of serotonin and dopamine

• OCD = high dopamine (when rats given dopamine, repetitive behaviour)

• OCD = low serotonin (SSRIs work on them)

role of oxytocin

• oxytocin could reduce repetitive behaviour in those with autism

  • could affect OCD patients with similar symptoms

• however, it has also been found that high levels of oxytocin could make symptoms more severe

OCD psychological explanation → cognitive

• thinking error

• ppl with OCD have a harder time ignoring passive thoughts → think that every thought has a meaning → thoughts turn into obsessions

1. overestimation of personal responsibility

2. errors in thought-action and thought-event fusion

• thought-action → if you imagine doing something you’re more likely to do it

• thought-event → if you imagine something happening it’s more likely to happen

diagnostic criteria

• peristent obsessions/compulsions or both

• obsessions: obtrusive thoughts, images, or urges

• compulsions: repetitive behaviours → eg hand washing

  • responses to obsessions

• obsessions & compulsions must take up more than an hour per day and result in significant distress

Example study → Rapoport

• ‘Charles’ case study → 14yr old boy with OCD

• obsessed with the thought of something sticky on his skin

• took an antidepressant → worked: was able to pour honey etc.

• however, he developed a tolerance to medication → relapsed

measures for OCDs

Maudsley Obsessive-Compulsive Inventory (MOCI)

Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

Maudsley Obsessive-Compulsive Inventory (MOCI)

• 30 items → score 0-30

• answer true or false

• assesses symptoms such as slowness → “I do not take a long time to dress in the morning”

• takes about 5min

Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

• semi-structured interview (30min) and a checklist

• checklist = 10 items → different obsessions and compulsions

• patients rate obsessions and compulsions on severity → how much time they spend on obsessions, how much distress they cause

• 0(no symptoms)-40(severe)

evaluate measures for OCDs

applications to everyday life → MOCI is quick to complete and gives an indication of OCD symptoms. Y-BOCS rates symptoms on severity → help plan treatment and see severity of OCD. also use them before and after treatment to see if it works.

reductionism vs holism → MOCI reductionistic: answer only true/false. receive a score 0-30. Y-BOCS holistic: interview and checklist → qualitative and quantitative data, better understanding

validity → MOCI and Y-BOCS are self reports and rely on the person’s ability to assess symptoms

OCD psychological explanation → behavioural

• OCD explained via operant conditioning

• compulsions alleviate obsessions temporarily → reduced anxiety → negative reinforcement

• also positive reinforcement as the person is ‘rewarded’ (eg feeling clean after washing hands)

OCD psychological explanation → psychodynamic

• looks at unconscious beliefs & desires

• symptoms come from a conflict between id and ego

• obsessive thoughts that come from the id disturb the ego → compulsions

evaluate biological explanations for OCDs

reductionistic → only looks at genes. doesn’t look at childhood, thinking error, or operant conditioning.

deterministic → assumes we have no free will and are determined to develop OCD if we have certain genes.

applications to everyday life → knowing that a patient has low serotonin for example can help in treatment → use SSRIs → Rapoport

evaluate psychological explanations for OCDs

applications to everyday life → get an understanding of the cause of OCD. eg if the patient has thinking error, these can be improved in treatment so symptoms reduce.

deterministic → assumes we have no free will to influence our early experiences or thinking patterns that may lead to OCDs.

reductionistic → studies show that OCD is highly hereditary. ignoring role of genes and neurotransmitter is reductionistic.

treatment - biological

• SSRIs most used

• block serotonin reuptake → more of it

• reduce obsessive-compulsive symptoms and lessen anxiety

• Rapoport showed that antidepressants can work on OCDs

treatment - psychological → exposure and response prevention (ERP)

• form of CBT

• exposed to stimuli that provoke their obsessions, at the same time helped to prevent their compulsive behaviour

• taught to tolerate anxiety → it’s not lowered with meds

• aim: prevent compulsions as a response to obsessions

• learn that the uncomfortable feeling will go away on its own

Example study - Lehmkuhl et al.

• ERP on a 12 year old with OCD and autism

• therapy adjusted to meed boy’s needs: not asked to do visualisation (not able to imagine fake scenarios)

• Y-BOCS score dropped from severely high to low after therapy

• at a check up, score remained low

• conclusion: ERP effective on those with OCD and autism

treatment - CBT

works by understanding and challenging irrational thoughts held by the individual to bring out positive change in their emotional and behavioural responses