Lecture 13 - OCD Flashcards
What were the learning outcomes of this lecture?
Learning Outcomes
* Understand what Obsessive Compulsive Disorder (OCD) is
* Understand the underpinning models that help us understand
OCD psychologically
* Understand dominant, evidence based treatment for OCD
* Increased knowledge and awareness of systematic reviews
and meta-analysis
What is OCD?
Presence of obsessions, compulsions, or both:
Obsessions are defined by
1. Recurrent and persistent thoughts, urges or images that are
experienced, at some time during the disturbance, as
intrusive and unwanted, and that in most individuals cause
marked anxiety or distress – (egodystonic)
- The individual attempts to ignore or suppress such thoughts,
urges or images, or to neutralise them with some other
thought or action
What are the different subtypes of OCD?
-Hoarding
-Obsessions without visible compulsions
-Contamination obsessions with cleaning compulsions
-Symmetry obsessions with ordering compulsions
-Harm obsessions with checking compulsions
What are compulsions defined by
Compulsions are defined by
1. Repetitive behaviours (e.g., hand washing, ordering, checking)
or mental acts (e.g., praying, counting, repeating words
silently) that the individual feels driven to perform in
response to an obsession or according to rules that must be
applied rigidly
- The behaviours or mental acts are aimed at preventing or
reducing anxiety, or preventing some dreaded event or
situation; however, these behaviours or mental acts are not
connected in a realistic way with what they are designed to
neutralise or prevent, or are clearly excessive
What are Egodystonic thoughts
Thoughts that conflict with the ego
Thought to have an evolutionary adaptive
function
What are some more features of OCD and its prevalence
Now no longer considered an anxiety disorder in DSM-5 (Abramowitz & Jacoby, 2014)
Life-time prevalence 3-4%
90% of individuals experience obsessions AND compulsions
Similar prevalence in women and men
Up to 50% experience
Major Depressive Disorder at the same time (Torres et al., 2006)
Overlap with Autism? (Postorino et al., 2017)
What does the behavioural perspective to OCD look at?
It looks at classical and operant conditioning.
It says the thoughts come via association and the compulsions happen via negative reinforcement.
Classical: previously neutral objects/thoughts + anxiety-provoking situations = fear
Conditioned stimulus (with repetition) + Unconditioned stimulus =Unconditioned
response
Reinforcement: Neutral object/though = fear
Conditioned stimulus = conditioned response
e.g. touching a doorknob is repeatedly linked with the fear of
contamination => touching any doorknob later = anxiety, even without
actual contamination present
What is the treatment the behavioural perspective uses?
Exposure with Response Prevention = principles based on the behavioural
perspective (Meyer, 1966; Rachman et al., 1973)
Exposure to stimuli that provokes obsessions
Prevention of compulsions
Fairly effective treatment: ~50% of patients recover (Abramowitz, 2006)
So don’t let someone wash their hands, anxiety over time goes down.
What is a limitation of this?
Being exposed to the stimuli that provokes obsessions is not very pleasant. It is only effective if you get somebody in the room to do it in the first place.
Given people think if they don’t do these compulsions they are going to harm someone they love it is going to be very difficult for people to not do the negative reinforcement without some cognitive approach as well.
Also once you might stop one compulsion they might be doing something else as a safety seeking behaviour (they might not wash their hands, but might clean the room after)
What is the cognitive perspective to OCD?
Talk about the role of misinterpretation of intrusive thoughts in the cognitive perspective
- Intrusive thoughts are normal
- OCD characterised by unhelpful misinterpretation of the intrusive
thought - That misinterpretation can have various themes
- Consequence catastrophic -> compulsion required to address
intrusion
Talk about responsibility and the cognitive perspective
Intrusions trigger automatic thoughts so people think they need to do a behaviour to protect. Bad thing, I don’t like, I am a good person truing to protect people from this, I am responsible. He saw how people seem to really place emphasis on how responsible they are for things. Cognitive – this is to do with the way in which we interact with out beliefs.
‘If I do not act on this something awful will happen and I am responsible and I will not be able to bare that’
Talk some more about this
Cognitive Perspective: Responsibility
Schemas
Recurring experiences
* Growing up with rigid rules of conduct
* Being shielded from responsibility (e.g., overprotective
parenting)
* Being raised with a sense of responsibility for avoiding harm
* Increased responsibility for family members’ protection
Isolated experiences
* Incidents in which one actually does cause harm or erroneously
believes that he or she did Salkovskis et al. (1999)
Lots of different things that can create that responsibility schema, but this seems to drive the compulsion
What are some points around misinterpretations of responsibility
Misinterpretations of responsibility
1. Thinking being the same as acting – thought-action fusion.
2. The failure to prevent self or other’s harm is the same as being
responsible for that harm
3. Responsibility is never attenuated by other factors, such as low
probability of a given event occurring
4. Not trying to prevent or neutralize an obsession is the same as
wishing that the event occurs
5. People must (and WE CAN) control their own thoughts
Salkovskis et al. (1999)
Obsessions are not just a mental event, they are misinterpreted as responsibility and that this is dangerous.
What is the Radomsky et al 2022 study around misinterpretation of intrusive thoughts?
This was a checking-based OCD study
- 2 groups (people with OCD, and people without OCD)
- They underwent a variety of conditions with different scenarios that varied the perceived extent they were responsible for an event or the probability an event would happen
[Example -Found if you told people that lightbulb is faulty but it is ok there is a smoke detector to catch up, people did less checking. If told it is broken and going to burn the place down there was more checking]
Findings: Throughout the conditions, there was greater checking in those who had OCD
There was more checking when high responsibility or severity, but this also increased in the control group
The impact of responsibility also seemed to be related to individual obsessions and compulsions
