OCD☑️ (obsessive compulsive disorder)

OCD

-defined by DSM-5 as ‘a condition characterised by obsessive and/or compulsive behaviour. obsessions are cognitive and compulsions and behavioural’.

three main compulsions:

-trichotillomania; hair pulling

-hoarding disorder

-excoriation disorder; compulsive skin picking

behavioural characteristics of OCD

compulsions: repeating certain behaviours to reduce anxiety (eg handwashing for obsessive germ fear, tidying)

-avoidance: avoiding situations or events that may trigger anxiety

emotional characteristics of OCD

-anxiety and distress; unpleasant and overwhelming thoughts + feelings, behaviour repetition urges creates anxiety

-depression; anxiety accompanied by low mood + anhedonia

-guilt and disgust; irrational guilt over minor issues (lack of communication during OCD spike)

cognitive characteristics of OCD

-obsessive thoughts: recurring unpleasant thoughts, extreme worrying

-cognitive coping strategies; turning to religion (praying or meditating to deal with guilt and anxiety)

-excessive anxiety; hyper vigilance and high levels of alertness

the diathesis stress model - meehl (1960)

-suggests having a genetic vulnerability doesn’t necessarily mean you’ll develop the disorder, but that you’re at a higher risk, where environmental stressors could trigger it

diathesis (a predisposition) + stress (environmental factors; prenatal trauma, physical or sexual abuse, family conflict etc) leads to development of the psychological disorder; stronger diathesis means less stress is necessary to produce the disorder

the biological approach to explaining OCD

-OCD is a neurological condition that has a stronger biological component than most other mental disorders (a genetic explanation)

-the genetic explanation: suggests OCD is hereditary + inherited

-the neural explanation: focus on neurotransmitters and brain structures

genetic explanation for OCD

-candidate genes: genes that create a genetic vulnerability for OCD, some of which are involved in the serotonin regulation system

-its aetiologically heterogeneous meaning the origins of OCD vary from one person to another

biological approach to explaining OCD: genetic explanation

research support

-strong evidence base: nestsdt et al (2010) twin study found that 68% of MZ twins shared OCD as oppose to 31% of non-identical twins

-marini and stebnicki (2012) research found that a person with a family member diagnosed with OCD is around 4x as likely to develop it as someone without.

-environmental risk factors: cromer et al (2007) found that over half of OCD clients in her sample has experienced a traumatic event in their past, and was more severe in the ones with trauma, meaning genetic vulnerability only provided a partial explanation for OCD

biological approach to explaining OCD

neural explanations

role of serotonin

serotonin helps regulate mood and is responsible for relaying information between neurons. if a person has low serotonin levels, their transmission of mood relevant information doesn’t take place and they may experience low moods.

decision making systems

-basal ganglia distributes serotonin and controls emotional and cognitive functions; damage causes hyperactivity and repetitive actions (compulsions) OCD.

-lateral and frontal lobes for logical and rational thinking + decision making. the ‘worry circuit’ causes inability to filter small worries in OCD, which is overactive

-parahippocampal gyrus which processes unpleasant emotions; functions abnormally in OCD

the biological approach to explaining OCD

evaluation

-research support: antidepressants that work solely on serotonin (SSRIs) are effective in reducing OCD symptoms, suggesting serotonin may be involved in OCD

-the serotonin-OCD link may not be unique/specific to OCD as many people suffering from it experience clinical depression (co-morbidity).

the biological approach to treating OCD

drug therapy: aims to alter levels or activity of neurotransmitters in the brain; drugs to treat OCD work to increase the levels of serotonin in the brain.

SSRI’s

-selective serotonin reuptake inhibitors (SSRIs) work on the serotonin system in the brain. when the serotonin is released by the presynaptic neurons and travels across a synapse, the neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then is reabsorber by the presynaptic neuron where it is broken down and used. By preventing the reabsorption and breakdown, the SSRI’s effectively increase serotonin levels in the synapse and thus continue to stimulate the postsynaptic neuron, compensating for whatever is wrong with the system in OCD

SSRIs dosage

-dosage varies with which SSRI is prescribed, typically 20mg of prozac, although increased if effect is minimal; takes 3-4 months of daily use to have impact on the symptoms.

combining SSRI’s with other treatment

-drugs are often used alongside CBT to treat OCD; the drugs reduce emotional symptoms so people with OCD can engage more effectively with CBT

alternative to SSRI’s

-if not effective after 3-4 months, the dose can be increased or it can be combined with other drugs; different antidepressants

-tricyclics; acts on various systems, including the serotonin system where it has the same effect as SSRI’s, more severe side effects so usually a reserve

-SNRIs (serotonin-noradrenaline reuptake inhibitors) more recently used to treat OCD as a second if SSRIs don’t work. work by increasing serotonin and noradrenaline levels

biological approach to treating OCD

evaluation: strengths

shows SSRIs reduce symptom severity and improve the quality of life for OCD patients. soomro et al (2009) meta-analysed 17 studies that compared SSRIs to placebos in OCD treatment and all studies showed significantly better outcomes for SSRIs conditions; typically symptoms reduce around 70%. for the remaining 30% can mostly be helped with alternative or combination of drugs and psychological therapies (drugs appear to be helpful for most OCD patients)

counterpoint: durg treatments are not the most effective; skapinakis et al (2016) carried a systematic review of outcome studies and concluded that cognitive and behavioural therapies were more effective than SSRIs, meaning the drug may not be the most effective treatment.

good for public health systems (NHS) and a good use of limited funds. compared to psychological therapies, not disruptive with lives so popular options with OCD patients and their doctors.

biological approach to treating OCD

evaluation: limitations

-serious potential side-effects; a small minority get no benefit or experience side effects such as indigestion, blurred vision and decreased libido. although they’re usually temporary, they can be quite distressing

-side effects for tricyclic clomipramine are more common and more serious; erection problems, weight gain, aggression and heart related problems; reduced quality of life due to drugs.

-biased evidence as some researchers may be sponsored by drug companies and selectively publish positive outcomes for the drugs their sponsors are selling (goldacre 2013).