OCD☑️ (obsessive compulsive disorder)

OCD

-defined by DSM-5 as ‘a condition characterised by obsession 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

-repetitive compulsions: repeating certain behaviours to reduce anxiety (eg handwashing, counting, tidying) as compulsive handwashing is carried out as a response to an obsessive fear of germs.

-avoidance: avoiding situations of events that may trigger anxiety

emotional characteristics of OCD

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

-accompanying depression; anxiety can be accompanied by low mood + lack of enjoyment in activities

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

cognitive characteristics of OCD

-obsessive thoughts (recurring unpleasant thoughts, extreme worrying, uncertainty or compulsion to hurt others)

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

-insight to excessive anxiety; hyper vigilance, maintaining high levels it alertness + focus on potential hazard due to them being aware of their irrational thoughts

the diathesis stress model - meehl (1960)

-suggests having a genetic vulnerability doesn’t necessarily mean you’ll develop the disorder, but rather 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, however a 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

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

biological approach to explaining OCD: genetic explanation

research support

-strong evidence base: gerald nestsdt et al(2010) twin study reviewed twins and found that 68% of identical 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: kiara 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

role of serotonin: helps to regulate mood and responsible for replaying information from one neuron to another. 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 OCD. hyperactivity for this causes repetitive actions (conpulsions)

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

-parahippocampal gyrus: associated with processing unpleasant emotions, which functions abnormally in OCD

the biological approach to explaining OCD

evaluation

-research support: antidepressants that work solely on serotonin 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 increase or decrease levels or activity of neurotransmitters in the brain, therefore drugs to treat OCD work in various ways to increase the levels of serotonin in the brain.

SSRI’s

-selective serotonin reuptake inhibitor (SSRI) 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 and other advice varies according to which SSRI is prescribed, typically 20mg of prozac, although may be 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 a persons emotional symptoms meaning people with OCD can engage more effectively with the CBT

alternative to SSRI’s

-if it’s 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) have more recently been used to treat OCD as a second line if SSRIs don’t work. they work by increasing serotonin levels and noradrenaline (another neurotransmitter)

biological approach to treating OCD

evaluation: strengths

-evidence of effectiveness; shows SSRIs reduce symptom severity and improve the quality of life for people with OCD. mustafa 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 than for other placebo conditions. typically symptoms reduce for around 70%. for the remaining 30% most can be helped by either alternative drugs or combinations of drugs and psychological therapies. meaning drugs appear to be helpful for most OCD patients.

counterpoint: even if drug treatments are helpful, it’s not the most effective; petros skapinakis et al (2016) carried a systematic review of outcome studies and concluded that both cognitive and behavioural therapies were more effective than SSRIs, meaning the drug may not be the optimum treatment.

-cost effective and not disruptive to people’s lives; good for public health systems (NHS) and a good use of limited funds. compared to psychological therapies, SSRIs are also non-disruptive to people’s lives meaning it’s a 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 for people

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

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