OCD (+ Explanation & Treatment)

Outline OCD

Characterised by either obsessions (recurring thoughts, images etc) and/or compulsions (repetitive behaviours such as hand washing). Most people diagnosed have both obsessions and compulsions.

Name 3 disorders related to OCD

• Trichotillomania - Compulsive Hair Pulling.

• Hoarding disorder - Compulsive gathering of possessions and the inability to part with anything, regardless of value.

• Excoriation disorder - Compulsive skin picking.

Outline the behavioural characteristic of OCD

Compulsive behaviour.

E.g: Handwashing Checking things Counting Arranging Objects Compulsions are repetitive and people feel compelled to do so.

This repetitive behaviour reduces the person's anxiety produced by obsessions.

E.g: Compulsive Hand Washing is a compulsion due to an obsessive fear of germs therefore performing this reduces their anxiety of getting ill.

Outline the emotional characteristics of OCD (1/3)

Anxiety and Distress: OCD is an unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts can be unpleasant and frightening, and the anxiety that goes with these thoughts can be overwhelming. The urge to repeat a behaviour creates anxiety.

Outline the emotional characteristics of OCD (2/3)

Accompanying Depression: OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities.

Outline the emotional characteristics of OCD (3/3)

Guilt and Disgust: Sufferers of OCD may experience irrational guilt or disgust E.g: feeling disgusted about dirt or disgusted about themselves for feeling guilty.

Define Comorbidity

More than one condition is present at the same time in an individual.

Outline the cognitive characteristic of OCD

Obsessive Thoughts: Thoughts that recur over and over again, these vary from person to person. 90% of people with OCD have the major component of Obsessive thoughts. Individuals experience catastrophic thoughts about the worst case scenario. This causes people with OCD to be hypervigilant (maintaining constant alertness)

Outline Cognitive Coping Strategies

• People with OCD can respond to obsessive thoughts by adopting cognitive coping strategies.

• Someone may meditate to help manage their anxiety.

• However, these strategies in day to day life may make an individual look abnormal and distract them from everyday tasks. People with OCD are aware that their obsessions and compulsions are irrational. This is necessary for the diagnosis. If an individual was not aware that their thoughts were irrational, this would require an alternative diagnosis.

Outline the genetic explanation of OCD

Candidate Genes: Mental disorders are inherited - individuals inherit certain genes from their parents that cause OCD. 3 Genes involved with OCD: COMT Gene SERT Gene 5Ht1-D Beta Gene

Outline/Describe the COMT Gene

• Regulates the production of neurotransmitter dopamine. One allele of the COMT gene has been found to be more common in those with OCD.

• This variation leads to lower activity of the COMT gene - therefore higher concentrations of dopamine, which is common in people with OCD.

Outline/Describe the SERT Gene

Affects the transport of serotonin (neurotransmitter) - lower levels of serotonin. Lower levels of serotonin are associated with OCD.

Outline Ozaki et al's findings of the SERT Gene

Found a mutation of the SERT gene in 2 separate families where 6/7 members had OCD.

Outline/Describe the 5Ht1-D Beta Gene

Linked to OCD - implicated in the transport of serotonin across synapses.

Using Taylor's findings, explain why is OCD considered polygenic

Polygenic - when a condition is caused by a combination of genes that increase predisposition to the disorder. Taylor (2013) - 230 different genes may be involved in OCD.

Define aetiologically heterogeneous using OCD

Origins of OCD vary from person to person. One set of genes may cause OCD in one person but a different set of genes may cause it in another individual.

Outline the diathesis stress model

• Unlikely that one gene on its own would be responsible for causing OCD.

• Also shown that genes like SERT are involved in other disorders like depression and PTSD

• Therefore suggests that an individual allele only creates a genetic disposition, as the person may develop a different disorder.

• Other factors determine whether a person develops OCD, not the allele itself.

Outline Cromer et al's findings of OCD

Cromer et al - found that over half of his sample with OCD had experienced a traumatic event in their past. OCD was more severe in those with more traumatic experiences.

Strength - Genetic basis of OCD - Evidence from twin studies and first degree relatives

E.g: Nestadt et al found that out of 14 twin studies, 68% of monozygotic twins shared the disorder compared to only 31% of dizygotic twins.

CP: On the other hand, this evidence shows that concordance rates are not always 100%. From Nestadts research, this shows that 32% of monozygotic twins are not accounted for in the genetic explanation.

Exp: This matters as it means that there are other environmental factors that play a part in developing the disorder.

Critcism - biological approach for explaining OCD - faces strong competition from psychological explanations.

E.g: The Two Process model, commonly used in the explanation of phobias, can also be applied to OCD. Initial learning (classical conditioning) occurs when a stimulus (e.g. dirt) is associated with anxiety. This is maintained through operant conditioning as the anxiety inducing stimulus is avoided. Therefore an obsession is formed and compulsive behaviours are performed to reduce the anxiety.

Exp: This matters because it suggests that OCD may have psychological causes as well as/instead of biological causes.

Strength - Genetic basis of OCD - can identify specific genes that link to mental health disorders.

E.g: eggs can be screened to give parents the choice to abort the eggs with a faulty allele. Future therapy may also involve repressing characteristics of certain genes so that the disorder is not expressed.

CP: On the other hand, applying biological therapies like gene therapy are complex and can be seen as controversial and unethical as individuals are 'picking and choosing' their babies based on their disorders, in addition to the fact that possessing the gene does not 100% guarantee that the child will have the disorder.

Exp: This matters as the explanation of OCD can be used in real life treatments.

Outline the role that dopamine plays in the neural explanation of OCD

Dopamine levels are a lot higher in individuals with OCD This is based on animal studies (Szechtman et al. 1988) High doses of drugs that enhance levels of dopamine induced stereotypical movements in the animals which were consistent with the compulsive behaviours found in OCD patients.

Outline the role that serotonin plays in the neural explanation of OCD

Serotonin levels are a lot lower in people with OCD. This is based on the fact that antidepressant drugs that increase the levels of serotonin have been shown to reduce the symptoms of OCD (Piggot et al. 1990) Antidepressant drugs that have less of an effect on serotonin levels have been found to be less effective at reducing OCD symptoms (Jenicke. 1992)

Outline the role that worry circuits play in the neural explanation of OCD

This theory is supported by PET scans of patients with OCD, taken whilst symptoms are active. These scans show heightened activity in the OFC.

Outline the role that abnormal brain circuits play in the neural explanation of OCD

Several areas of the frontal lobe are thought to be abnormal in individuals with OCD.

The caudate nucleus (found in the basal ganglia) normally suppresses signals from the orbitofrontal cortex (OFC).

The OFC then sends a signal to the thalamus about things that are worrying (e.g. potential germ hazard).

The caudate nucleus is damaged, like in people in OCD, it fails to suppress minor worries - the thalamus is alerted which sends further signals back to the OFC.

This acts as a worry circuit.

Limitation - neural basis of OCD - link to serotonin to the symptoms of OCD may just be comorbidity with depression

E.g: Many people with OCD may become depressed. Having two disorders present at the same time is called comorbidity. This depression involves disruption to the serotonin system, leaving us with a logical problem as to whether depression is a symptom or a separate disorder in the individuals themselves.

Exp: This matters because it is hard to distinguish whether the serotonin system is disrupted due to a separate disorder or due to the fact that its a common symptom.

A limitation of the neural basis of OCD - we should not assume that the neural mechanisms are the cause of OCD.

E.g: There is evidence to suggest that various neurotransmitters and structures of the brain do not function normally in patients with OCD. However, this is not the same as saying that abnormal functioning causes OCD.

Exp: This matters because these biological abnormalities could be a result of OCD rather than its cause.

Define action potential

Stimulation from a neuron - causes vesicles to fuse with the presynaptic membrane and release the neurotransmitters.

What role do antidepressants play in treating OCD

Antidepressants (like anti-anxiety drugs) improve mood and reduce anxiety which is experienced by patients with OCD.

What are SSRIs and what role do they play in treating OCD

One type of antidepressant drug, which help reduce the symptoms of depression which are often found in patients with OCD, due to low serotonin levels. This includes drugs like Prozac.

SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the presynaptic neuron. This increases the level of serotonin in the synapse and results in more serotonin being received by the postsynaptic neuron.

Outline combination of therapies alongside OCD

Antidepressant drugs are often used alongside therapies like CBT (cognitive behavioural therapy). The drugs reduce a person's emotional symptoms which means the individual can engage more effectively with the therapy. Sometimes the individual can benefit from CBT without additional drugs.

Outline Alternatives to SSRIs

When an SSRI is not effective in the first 3-4 months the dose can be increased or can be combined with other drugs. Sometimes other antidepressants are tried.

What are tricyclics?

An older type of antidepressant, e.g. clomipramine.

Acts on various systems such as the serotonin system where it has the same effect as SSRIs.

They often have more severe side effects than SSRIs so are kept for people who don't respond to SSRIs.

What are SNRIs?

SNRIs: (N- Noradrenaline) Recently used to treat OCD. They are a different class of antidepressant drugs, and like Tricyclics are a second line of defence for people who don't respond to SSRIs. They increase levels of serotonin as well as noradrenaline.

Strength - Drug treatment for OCD - Cost effective and non-disruptive to people’s lives

E.g: Drug treatments for psychological disorders in general are cheaper than psychological therapies. This is because many thousands of tablets or liquids can be produced in the same time it takes to conduct a session of psychological therapy. Therefore, drugs treating OCD are good value for public health systems like the NHS. Also, taking medication does not disrupt one’s daily life, unlike other therapy choices.

Exp: This matters because it means that drug therapy appears to be helpful for the majority of people with OCD.

Weakness - Drug treatment for OCD - Potentially serious side-effects

E.g: For example, some individuals who take SSRIs to help with their OCD may experience indigestion, blurred vision, and loss of sex drive. Although these side effects are usually temporary, for some they can be long-lasting. For all individuals experiencing side effects, this is a distressing process.

Weakness - Drug treatment for OCD - Controversy over the evidence for the effectiveness of drugs

E.g. Goldacre (2013) suggested that some researchers who are sponsored by drug companies may publish positive outcomes of drugs that their sponsors are selling.

Exp: This matters because it is difficult to know whether we can trust research that informs us of the effectiveness of drug treatments for OCD.