Obsessive Compulsive Disorder

What is OCD?

Obsessive Compulsive Disorder (OCD) is characterised by the presence of persistent obsessions and/or compulsions.

Definitions:

• Obsessions: Recurring, persistent thoughts or images that are intrusive and cause high levels of anxiety.

• Compulsions: Repetitive behaviours or mental acts performed to alleviate anxiety caused by obsessions (e.g., hand washing, checking, counting).

Key Differences:

Examples:

Prevalence of OCD

• 2-3% of the population meets OCD criteria.

• 69% have a comorbid mental disorder.

• 25% chance of OCD in families with a history.

• 6% fully recover; 50% see significant improvement with treatment.

• Females exhibit slightly higher rates, while males have more early-onset cases.

• Most common in older teens and young adults.

Diagnosis of OCD

A diagnosis of OCD requires the individual to:

1. Recognize that obsessions/compulsions are excessive and unreasonable.

2. Experience obsessions/compulsions that take up more than 1 hour per day.

3. Have OCD that interferes with life aspects: job, school, relationships.

Rapoport's (1989) - "Charles"

Aim:

To present a detailed account of an individual with severe OCD and explore the impact on his life.

Procedure:

• Charles, a 14-year-old boy, spent 3 hours a day showering, plus an additional two hours getting dressed.

• His ritual involved meticulous handwashing which intensified over time, leading to school absenteeism.

Findings:

• Initially, Charles could manage his washing obsessive behaviors, but they escalated such that he left school.

• Charles's mother, witnessing his distress, altered her behaviors by cleaning with alcohol and limiting visitors.

• Drug therapy was effective initially; Charles’s OCD lessened but he developed a tolerance and continued to display OCD behaviors in the evenings.

Conclusion:

The case illustrated the debilitating nature of OCD and the challenges in treatment management.

Evaluation:

• Strengths: Provides an individual perspective and detailed behavioral patterns.

• Weaknesses: As a case study, it's not generalizable; this unique case may not represent OCD in the wider population.

Measures of OCD

1. Maudsley Obsessive-Compulsive Inventory (MOCI)

• Description: 30 true/false items assessing symptoms related to checking, washing, slowness, and doubting (score 0-30).

• Strengths: Quick to administer, specific symptom tracking.

• Weaknesses: Simplicity of true/false limits sensitivity to changes; possible biases in responses.

2. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

• Description: Semi-structured interview with 19 items; evaluates time occupied by symptoms and clusters of obsessive thoughts.

• Strengths: Comprehensive assessment of OCD severity; adaptable for different age groups.

• Weaknesses: Time-consuming; requires trained professionals for implementation; possible social desirability biases.

Biological Explanations of OCD

• Dopamine: High levels correlated with compulsive behaviors; increased dopamine in rats led to compulsive movements (Szechtman et al, 1998).

• Serotonin: Low levels observed in individuals with OCD, disrupting decision-making (supported by SSRIs increasing serotonin).

• Oxytocin: Linked with OCD severity; Leckman et al. (1994) explored oxytocin dysfunction related to OCD behavior.

Genetic Influences

• Twin Studies: Concordance rates show genetic influence (Monzani et al., 2014; MZ twins 52% vs. DZ twins 21%). Heritability of OCD estimated at 48%.

• Specific Genes: Research indicates specific genes like SERT linked to serotonin levels; mutations reported in OCD patients (Ozaki et al., 2003).

Evaluation:

• Strengths: Supported by scientific evidence of twin studies and neuroimaging; led to effective treatments.

• Weaknesses: Genetic explanations are reductionist; not all individuals show the same biological patterns.

Psychological Explanations

Cognitive (Rachman, 1977)

• Description: Obsessive thinking is based on faulty reasoning, worsening under stress.

• Strengths: Fits experiences reported by individuals; combines cognitive and behavioral perspectives.

• Weaknesses: Reductionist; oversimplifies cognitive processes, neglecting emotional factors.

Behavioral (Operant Conditioning)

• Description: Compulsive behaviors are learned through reinforcements.

• Key Terms:

  • Negative Reinforcement: Behavior reinforced by removing unpleasant stimuli.

  • Positive Reinforcement: Behavior rewarded, increasing likelihood of occurrence.

• Strengths: Well-aligned with personal experiences of OCD; integrates cognitive and behavioral aspects.

• Weaknesses: Ignores biological components and oversimplifies cognitive function.

Psychodynamic Approach (Freud)

• Description: OCD driven by unconscious desires and conflicts, often linked to traumatic experiences during toilet training.

• Strengths: Provides a comprehensive view of underlying processes; insights on early life trauma.

• Weaknesses: Lack of empirical evidence; overemphasis on childhood experiences.

Issues and Debates

Individual vs. Situational Factors

• Biological and Cognitive Behavioral: Focus on individual factors, potentially reductionist.

• Psychodynamic: Highlights social influences and developmental factors.

Determinism vs. Free Will

• Explanations tend to be deterministic, limiting consideration for free will in OCD behaviors.