NSCI 1001 Exam 4

OCD

Obsessive-compulsive disorder

Obsessions

Recurrent and persistent thoughts, urges, or images

Compulsions

Repetitive behaviors or mental acts

Disorder

Time‐consuming or clinically significant distress or functional impairment

Doidge's outline for error correction

1) Detect error (mistake feeling)

2) Anxiety [fix the mistake]

3) “Gearshift” (move on)

Doidge’s error correction mishaps

1. See things as problems that might not be a problem (or misidentifying the problem)

Sometimes a person is aware that the “problem” isn’t a problem,

but it FEELS like a problem. Something “isn’t right”.

2. Not moving on. Doidge calls this a sticky gearshift.

Ex) Checking and rechecking a door to make sure it is locked

Lifetime prevalence for OCD US adults

2.3%

Risk Factor : Genetics

Studies have shown that having a first-degree relative (parent or sibling)

with OCD is associated with an increased chance of developing the disorder.

Risk Factor : Biology

Brain imaging studies have shown that people with OCD often have differences

in the frontal cortex and subcortical structures of the brain,

areas of the brain that impact the ability to control behavior and emotional responses.

Risk Factor : Temperament

Some research has found that people who exhibit more reserved behaviors, experience negative emotions, and show symptoms of anxiety and depression as children are more likely to develop OCD.

Risk Fator : Childhood trauma

Some studies have reported an association between childhood trauma

and obsessive-compulsive symptoms.

OCD Risk Factors

Genetics

Biology

Temperament

Childhood Trauma

OCD Treatment : Cognitive Behavioral Therapy

• Brain lock unlocked method

• Exposure and response prevention (ERP)

OCD Treatment : Drugs

SSRIs

OCD Treatment : Other methods

DBS, surgical removal

Detect error brain region

Frontal cortex

In particular: Orbital frontal cortex

Anxiety brain region

Cingulate Cortex

Cingulate cortex activation causes

Trigger of heart, gut, etc.

Gearshift brain region

Striatum

In particular, caudate

Psychotherapy OCD treatments

Cognitive behavioral therapy (CBT)

Exposure & response prevention therapy (ERP)

Cognitive behavioral therapy (CBT)

A type of talk therapy that helps people recognize harmful or untrue ways of thinking so they can more clearly view and respond to challenging situations.

Exposure and response prevention therapy (ERP)

Spend time in a safe environment that gradually exposes them to

situations that trigger their obsession (such as touching dirty objects)

and prevent them from engaging in their typical compulsive behavior

(such as handwashing).

Key Corrective Steps

1) Relabel.

There is a problem. But that problem is my OCD.

2) Refocus.

Manual gearshift. Do something else rewarding.

How to check biologically if therapy is working?

Changes in blood level in specific brain regions

(Preferably lower for OCD)

Insight

Self-knowledge that the you are having obsessions and that something is off

SSRI

Selective Serotonin Reuptake Inhibitor

Effects of SSRIs

Acutely increased serotonin levels in synapse

Reduces symptoms of OCD

Flaws of OCD drug treatment

1. Only treating the symptoms, not the underlying disorder

2. The drugs may produce compensatory changes in the brain (ie more serotonin receptors on post-synaptic cells), which account for effectiveness, but will likely make getting off the drug difficult