Lecture 6

Question 1

What is OCD?

Answer 1

classified as an anxiety disorder
the occurrence of unwanted and intrusive obsessive thought usually accompanied by compulsive behaviours used to neutralise the obsessive thoughts

Question 2

prevalence onset

Answer 2

2% lifetime prevalence
1% one year prevalence
98% show obsession and compulsion
equal across gender
equal across culture
socio-economic drift noticeable

Question 3

age onset

Answer 3

late adolescence, early adulthood
childhood onset more common in males

Question 4

Features of OCD

Answer 4

obsession
- recurrent intrusive thoughts
- images
- experienced as disturbing or inappropriate

compulsion
- used to get rid of or deal with obsessions, prevent distress
- repetitive behaviours
- covert mental acts

Question 5

DSM - 5 criteria for obsessions

Answer 5

recurrent and persistent thoughts, urges or images that are experienced at some post during the disturbance as intrusive and unwanted and cause marked anxiety and distress
the person attempts to suppress or ignore such thoughts, impulses or images or neutralise them with some other thoughts or actions

Question 6

DSM - 5 criteria for compulsions

Answer 6

repetitive behaviours or mental acts 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 distress or preventing some dreaded event or situation. these behaviours either are not connected in a way that could neutralise or pre-empt what they are meant to address or are clearly obsessive

Question 7

co - morbidity

Answer 7

80% experience depressive symptoms
30% experience major depression
co - occurs with other anxiety disorder such as panic, social phobia, PTSD
high co-occurence with body dysmorphic disorder

Question 8

intrusive thoughts

Answer 8

when the occur regularly and impact our daily life
repetitive behaviour may join intrusive thoughts

Question 9

types of compulsions

Answer 9

cleaning
checking
repeating
ordering
counting

Question 10

pathological doubt

Answer 10

linked to a cognitive deficit in memory
failure to do a task, as a result an individual believes something terrible will happen as a result

Question 11

unrealistic risk assessment

Answer 11

lack of understanding of how unlikely such an event is

Question 12

behavioural explanation - Mowrer

Answer 12

touching door handle causes contamination which causes anxiety
waking hands reduces anxiety reinforcing behaviour
any thought of door handle leads to anxiety
excessive hand washing if anything causes anxiety

a cycle of OCD

Question 13

evolutionary explanation

Answer 13

biological preparedness - some obsessions are more common
animals show displacement activities when stressed. rather than focusing on a stressful/threatening situation, they focus on something else

Question 14

thought suppression increases intrusive thoughts

Answer 14

non-OCD can forget about intrusive thoughts
OCD patients asked to suppress them, report more intrusive thoughts - a rebound effect

Question 15

cognitive explanation

Answer 15

increased sense of personal responsibility
- appraisal of intrusive thoughts
- negative automatic thoughts

inability to distinguish between thoughts and actions
- thinking about something becomes the same as doing it

Question 16

biological explanation

Answer 16

brain abnormalities
an increased glucose metabolism in the frontal brain regions

Question 17

Baxter et al 2000

Answer 17

primitive urges arise in the ortitofrontal cortex
- sex, aggression, hygiene and danger

urges usually filtered by basal ganglia before reaching the thalamus and rest of the cortex

Question 18

chemical imbalances

Answer 18

drugs that increase levels of serotonin alleviate symptoms
50-70% show improvement but relapse rates are high if discontinued

Question 19

psychosurgery

Answer 19

bilateral cingulotomy

Question 20

drug treatment

Answer 20

SSRI
if treatment effective and 12 month continuous supply to prevent relapse and then review

Question 21

CBT

Answer 21

shown to be most effective
patients exposed many times to situations that cause obsessive thoughts and they learn to tolerate the anxiety and so reduce the need for compulsive behaviour

• reduces stress
• reduces anxiety
• resolves inner conflict

low intensity treatments can be offered if symptoms are mild such as group CBT

Question 22

effectiveness of CBT

Answer 22

CBT vs medication - CBT more effective
combined CBT and drug therapy - interactionism
SSRIS and CBT combined are most effective