OCD
What is OCD?
• obsession: a persistent thought, idea, impulse or image that experienced repeatedly, feels intrusive and causes anxiety
• compulsion: a repetitive and riding behaviour or mental act that a person feels driven to perform in order to prevent or reduce anxiety
• OCD is found in about 2% of the population, around 1 in every 50 people will experience it in their lifetime
DSM-5 categories of OCD:
• OCD: characterised by obsessions and compulsions
eg. Trichotillomania: compulsive hair pulling
eg. Hoarding Disorder: compulsion of gathering possessions and the inability to part with anything regardless of its value
eg. Excoriation Disorder: compulsive skin picking
DSM-5 Criteria of OCD:
• recurrent obsessions and compulsions
• recognition by the individual that their obsessions and compulsions are excessive/unreasonable
• the person is usually distressed or impaired, daily life is disrupted
Characteristics of OCD- Emotional:
• anxiety/distress: unpleasant and frightening
• depression: compulsions may reduce anxiety but they’re only short term fixes
• guilt/disgust: these can be about the self or external factors and the guilt is often irrational
Characteristics of OCD- Behavioural:
• compulsions: repetitive (habitual)
eg. hand washing, counting
• compulsions (anxiety reduction): only 10% of OCD show compulsions without obsessions, for most of these compulsion serve the sole purpose to reduce anxiety
• avoidance: individuals may attempt to avoid anxiety by avoiding situations
eg. germ avoiders may avoid putting bins out
Characteristics of OCD- Cognitive:
• Obsessive thoughts: 90% of individuals with OCD have recurring thoughts and are unpleasant
• Cognitive coping strategies: they devise their own ways of coping
eg. obsessive thoughts of family dying may choose to pray to interfere with everyday life etc
• awareness of excessive anxiety: they are aware their behaviours are not rational. They are hyper vigilant and alert of potential hazards.
OCD cycle:
1. obsessive thought
2. anxiety
3. compulsive behaviour
4. temporary relief
Biological Treatment for OCD
SSRI- Selective Serotonin Reuptake Inhibitors:
• work on increasing certain neurotransmitters in brain by preventing the reabsorption of serotonin
• by preventing this reabsorption, SSRIs increase the levels in the synapse and thus continue to stimulate the postsynaptic neuron
Therapy: drugs are often used alongside cognitive behavioural therapy
• the drugs reduce the sufferer’s emotional symptoms such as anxiety or depression
• means that the patient can then engage more effectively with CBT
• some sufferers may respond more effectively to CBT alone without the need for medication
Alternatives for SSRI:
• if not effective after 3 months is can be increased or combined with other drugs
• patients may react better to different drugs but not for all
• tricyclics
• SNRIs
Research by Soomro (2009) suggests that SSRIs are effective in reducing the severity of OCD
Drug treatments are cheaper and less disruptive than psychotherapy.
Drug companies do not always disclose all the side effects of their products in research.
Side effects may include:
weight gain
sexual dysfunction
loss of memory
Trauma related OCD may not respond well to SSRI drugs
SSRI —> reduce OCD severity
Drug therapy —> cost effective and non-disruptive
trauma related OCD —> may not respond to SSRI
Neural Explanations of OCD
• the genes associated with OCD are likely to affect the levels of key neurotransmitters and structures of the brain
• Neuroimaging (brain scans) enabled researchers to study the brain in detail
• Brain scans shows trending patterns, highlighting what’s normal and compare this to abnormal brains who don’t have these patterns
• brain is known as basal ganglia
• Basal ganglia is responsible for innate psychomotor functions
• Rapport and Wise said basal ganglia have a hypersensitivity which rises repetitive motor behaviours
• eg. cleaning/counting
• the orbitofrontal cortex is also involved in OCD and the thalamus
• the thalamus is a brain area whose functions include cleaning, checking and other safety behaviours
• Orbitofrontal cortex is responsible for decision making/risk taking/worry about social behaviours
• in OCD, the orbitofrontal cortex and the thalamus are believed to be overactive
• the overactive thalamus increases motivation to clean/check for safety etc
• overactive orbitofrontal cortex leads to increased anxiety and plans to avoid anxiety
Evaluation:
Support:
• evidence from a variety of sources that people are more vulnerable to OCD due to their genetic makeup
• best study showing this evidence is twin studies
• Nestadt et al (2010) reviewed twins studies and found 68% of identical twins shared OCD as opposed to 31% of non-identical twins
• this suggests a genetic influence of OCD
Support:
• research support for impact of environmental factors that can trigger or increase risk of OCD
• Cromer et al 2007 found over half his OCD patients had a traumatic event in the past, and that the OCD was moore severe in patients with more than one trauma
• suggests OCD may not be entirely genetic
• it may be beneficial to focus on possible environmental factors and we are more able to change them.
Limitation:
• there is an issue when understanding neural mechanisms involved in OCD
• evidence suggests certain neural systems do not function normally in patients suffering from OCD, such as orbitofrontal cortex, research also identified other areas of brain are also involved
• This shows no consistent brain system playing a role in OCD
• There is evidence of the neurotransmitters and brain structures and implicated, there is a cause and effect relationship since the biological abnormalities are hard to tell as a cause of OCD or the result of the disorder.
Biological Explanation for OCD
Genetics:
• OCD has numbers of explanations but the most useful is the biological approach suggestions
• It has proposed there is a genetic component to OCD which predisposes into some individuals with illness
• genetic explanation suggests if a person with OCD is due to genes. This often explains why some people have family members also have OCD
Bellodi et Al (2001):
• claim genes play a factor into the disorder
• use evidence from twins studies and family studies
• show the closer relatives are more likely to have the disorder
Mckeon and Murray
• patients with OCD are more likely to have first degree relatives who also suffer
Pauls et al:
• there are a higher percentage of people with OCD that have relative with the disorder
• a lower percentage of people with OCD that don’t have family members with the disorder