OCD

Define obsessions

Recurrent, persistent, intrusive, and unwanted thoughts, urges, or images that cause anxiety and are resisted or neutralised

Define compulsions

Repetitive behaviours or mental acts done to reduce distress or prevent a feared event, even when unrealistic or excessive

What distinguishes OCD from ordinary intrusive thoughts

In OCD, intrusions are frequent, distressing, resisted, and produce rituals or avoidance

Relationship between obsessions and compulsions?

Compulsions are negatively reinforced by brief anxiety relief, which strengthens the behaviour

How do people with OCD view their symptoms

They recognise obsessions/compulsions as irrational or excessive (insight usually good).

Lifetime prevalence of OCD? Typical age of onset?Gender pattern?

Roughly 2–3 %; 17/ late adolescense, often gradual; more in men in childhood and more in female in adults 

4 common replicable sympytom dimensions

• obsessions abt contamination and washing compulsion 

• obsessions abt causing harm/ making mistake and checking compulsions

• obsessions abt summetry and ordering complsions

• repugnant obsessiona and mental complusions/ other covert neutralising

Which circuit shows higher activity in OCD on the biological model slide? Related functio? 

Cortico-striato-thalamo-cortical circuitry: prefrontal cortex, thalamus, basal ganglia - Filtering out irrelevant information and perseveration of behaviour

What happens after SSRI discontinuation and what is advised

Majority relapse; add behaviour therapy.

For OCD, what behavioural treatment is most empirically supported? Evidence?

Exposure and Response Prevention (ERP); Moderate symptom reduction in 55–67 % of patients; about 19 % dropout

what 3 key learning outcomes does ERP aim to teach

1 - anxiety + emotional responses decrease over repeated exposures,
2 - feared events do not occur,

3 - it is safe and acceptable to allow intrusive thoughts without performing compulsions

What does the combination of pharmacological treatment and ERP demonstrate?

Greater symptom reduction than medication alone, showing additive benefit when behavioural therapy is included.

What is the key principle underlying cognitive therapy for OCD?

Most people experience intrusive thoughts; it is the interpretation of these thoughts as threatening that drives anxiety and compulsive behaviour

How does cognitive therapy address intrusive thoughts?

By challenging the meaning and importance attributed to the thoughts and re-evaluating them as benign mental events rather than indicators of danger or immorality.

What maladaptive beliefs maintain OCD?

• Over-importance of thoughts (“This thought means I am violent”).

• Overestimation of threat (“I am more likely to cause harm”).

• Perfectionism (“Even small mistakes cause serious harm”).

• Intolerance of uncertainty (“I must be completely sure no harm will occur”).

What strategies are used to normalise intrusive thoughts?

• Presenting intrusive thoughts as common in the general population.

• Using surveys or examples from non-clinical samples.

• Metaphors such as treating thoughts like internet pop-up ads or sushi-train dishes—acknowledging them without engagement

What is thought–action fusion? 2 forms? 

The belief that having a thought is equivalent to performing the act or increases its likelihood.Likelihood TAF: Thinking about an event makes it more likely to happen. Moral TAF: Having the thought is as morally bad as committing the act

Why was hoarding separated from OCD in DSM-5?

Research demonstrated it is distinct from other OCD subtypes (Grisham et al., 2005), leading to classification as an independent disorder. Still a sub-type of OCD

What are the core features of hoarding disorder?

Persistent difficulty discarding possessions, perceived need to save items, distress when discarding, and clutter that obstructs living areas. Compulsive acquisition may also occur.

What is the prevalence and course of hoarding disorder?

Twice as common as OCD. Affects approximately 2–5 percent of the population. Onset is early, chronic, and tends to worsen over time. It runs in families and may have genetic influences; stressful or traumatic events can contribute

What factors are thought to contribute to hoarding?

Genetic predisposition, life events, and executive-functioning difficulties affecting decision-making and organisation

How effective are standard OCD treatments for hoarding, and what approaches show promise?

Hoarding responds poorly to typical behavioural and pharmacological OCD treatments. CBT shown better