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A-LEVEL PSYCHOLOGY > Obsessive compulsive and related disorders > Flashcards

Obsessive compulsive and related disorders Flashcards

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1
Q

Define obsessive-compulsive and related disorders

A

disorders that are unified by the presence of obsessive thinking and compulsive behaviour

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2
Q

Obsessions

A

intrusive, recurrent thoughts and unwanted urges

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3
Q

Compulsions

A

repetitive actions that impair normal functioning

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4
Q

Define OCD

A

is classified as an anxiety disorder and has two main components: obsessions and compulsions and that’s the criteria that has to be met in DSM-5

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5
Q

Why do individuals perform repetitive behaviours and how do they help

A

So they can suppress unwanted obsessive thoughts as way to reduce anxiety and give temporary relief

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6
Q

List of common obsessions

A

-Fear of deliberately harming oneself
-Fear of illness or infection
-Fear about harming or killing other people
-Fear of accidentally injuring oneself or others
-Strong desire for order and symmetry

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7
Q

List of common compulsions

A

-Frequent and excessive hand-washing
-Putting things in order (e.g. all labels on food in cupboard facing the same way)
-Checking things repeatedly (e.g. checking oven 20 times to ensure it is ‘off’ before leaving home)
-Repeating words to oneself or repetitive counting

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8
Q

Body dysmorphic disorder (BDD)

A

Involves obsessive thoughts regarding perceived faults in one’s physical appearance. These obsessions are often focused on imagined flaws or defects on the skin around the face and head.

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9
Q

Compulsive behaviour caused by BDD

A

In general, behaviours are intensely time-consuming with individuals with BDD spending several hours a day performing rituals such as
-frequent mirror-checking
-excessive grooming (hair-washing, shaving, tooth-brushing)
-constantly comparing one’s appearance with others

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10
Q

Hoarding

A

-an obsessive-compulsive disorder in which individuals experience great difficulty getting rid of possessions
-this means they collect so many possessions their homes may be unsafe, due to access or hygiene issues
-individuals experience distress associated with discarding possessions, which can then impact their ability to live with their families, have visitors and so on.

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11
Q

Frequently hoarded items

A

clothes and newspapers

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12
Q

A case study of OCD was performed on who by whom in what year?

A

Charles (a 14 years old boy) by Rappaport, 1989

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13
Q

OCD compulsions that Charles had

A

-spent three hours or more each day showering
-another two hours getting dressed
-had elaborate, repetitive routines for holding soap in one hand, putting it under water, switching hands and so on

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14
Q

OCD obsessions that Charles had

A

utterly obsessed with the thought that he had something sticky on his skin that had to be washed off causing him to leave school

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15
Q

Case study of Charles

A

-His mother contacted Rappaport after the child exhibited this behaviour for around 2 years
-In an attempt to help her son overcome this worrying thought, his mother had helped him clean his room and kept things he touched clean with rubbing alcohol
-He had had trips to the hospital, where he received standard treatments of medication, behavioural therapy and psychotherapy
-He was socially isolated (only one friend) because his rituals left him little time to leave the house
-He underwent a drug trial for clomipramine (antidepressant), which effectively relieved his symptoms (he was able to pour honey); however, he developed tolerance to it and relapsed (returned to ritualistic washing and dressing)

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16
Q

Tests used to assess obsessive-compulsive disorders

A

Maudsley Obsessive-Compulsive Inventory (MOCI)
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

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17
Q

MOCI

A

-a short assessment tool that contains 30 items that are scored either ‘true’ or ‘false’
-assesses symptoms relating to checking, washing, slowness and doubting
-takes around 5 mins to complete and is scored between 0-30

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18
Q

Example of items in MOCI

A

~I frequently have to check things (Checking)
~I am excessively concerned about germs and diseases (Washing)
~I don’t take a long time to dress (Slowness)
~Despite doing something carefully, I often feel it is not quite right (Doubting)

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19
Q

Who was MOCI designed for

A

as a quick assessment tool for clinicians and researchers, rather than a formal diagnostic tool

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20
Q

Who developed the Y-BOCS in what year

A

Goodman et al. (1989)

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21
Q

Y-BOCS

A

-a widely used test designed to measure the nature and severity of an individual’s symptoms
-a 30-minute semi-structured interview and a checklist of different obsessions and compulsions
-checklist includes a 10-item severity scale allowing individuals to rate (between 0-4) time spent on obsessions and compulsions, how hard they resist, and how much distress they cause
-total scores range from 0-40, where >16 is in the range for OCD

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22
Q

Y-BOCS obsessions categories

A

Aggressive, Contamination, Sexual, Hoarding, Religious, Symmetry, Body focus, Other

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23
Q

Y-BOCS compulsions categories

A

Cleaning, Washing, Checking, Repeating, Counting, Ordering/arranging, Hoarding, Other

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24
Q

3 explanations of OCD

A

– biomedical (genetic, biochemical and neurological)
– cognitive and behavioural
– psychodynamic

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25
Q

Genetic explanation of OCD

A

suggests that patients with OCD inherit specific genes that cause OCD

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26
Q

Studies that conducted research into explaining OCD using genes

A

Mattheisen et al., 2015
Taj et al., 2013

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27
Q

Brief procedure of Mattheisen et al.

A

-large-scale study on 1406 people
-both people with and without OCD
-analysed and identified genes that may be linked to OCD symptoms

28
Q

genes that Mattheisen et al. implicated

A

PTPRD and SLITRK3

29
Q

How genes PTPRD and SLITRK3 might cause OCD

A

they interact to regulate particular synapses in the brain; the irregularity of these synapses leads to neurological disorders like OCD

30
Q

The gene that Taj et al. implicated

A

DRD4 (dopamine receptor D4)

31
Q

role of DRD4 in OCD

A

DRD4 is related to the uptake of dopamine (its abnormal levels are implicated in OCD e.g. high levels of dopamine associated with compulsive behaviour)

32
Q

Biochemical explanation of OCD

A

-‘oxytocin’ or love hormone, is known to enhance trust and attachment, but can also increase distrust and fear of certain stimuli, especially those that pose a threat to survival
-OCD behaviours could be at the extreme end of a normal range of behaviours moderated by oxytocin

33
Q

A study that explained OCD using biochemicals

A

Leckman et al., 1994

34
Q

brief procedure and results of Leckman et al.

A

-analysed cerebral spinal fluid and patient behaviour
-found that oxytocin levels are higher in patients with OCD
-found a positive correlation with a higher frequency of repetitive behaviour

35
Q

Neurological explanation of OCD

A

-Abnormalities of brain structure and function offer a third possible biomedical explanation for OCD
-The basal ganglia and two associated regions (orbitofrontal cortex and cingulate gyrus) work together to send and check warning messages about threatening stimuli
-In brain-damaged (case study) patients, the checking ‘loop’ doesn’t work as it should, so the basal ganglia continues receiving worrying messages, relating to the obsessive thinking symptom of OCD

36
Q

Researcher that investigated the cognitive explanation of OCD

A

Rachman, 1977

37
Q

Cognitive and behavioural explanation of OCD

A

-OCD consists of cognitive obsessions and behavioural compulsions
-Obsessive thinking is based on faulty reasoning e.g. belief that hands covered in germs could kill
-Compulsive behaviours are outcomes of erroneous thinking, attempts to alleviate obsessions and the associated anxiety
-Such behaviours are learnt can be explained via operant conditioning, for example:
*Hand washing is the negative reinforcement as it has relieved something unpleasant (obsessive thoughts)
*It is also a positive reinforcement as the person is rewarded by knowing they have cleaner hands

38
Q

Psychodynamic explanation of OCD

A

-OCD symptoms result from an internal conflict between the id and the ego
-Freud suggests that conflicts arise in the anal stage of psychosexual development (around the time most children begin toilet training)
-There’s tension between parents and children, as the parent may want to control when the child defecates/urinates against the child’s wishes.
-Children may soil themselves to regain control, upsetting their parents (leads to anally expulsive behaviour: being messy and careless)
-Alternatively, they may fear harsh responses from parents and retain faeces/urine to regain control (leads to anally retentive behaviour: compulsive need for order and tidiness)
-Anally retentive/expulsive behaviours can lead to behavioural disturbances as the individual has become ‘fixated’ in this stage. (Fixation: when conflict at the psychosexual stage remains unresolved and the person is unable to move on to the next stage)
-Obsessive thoughts coming from the id disturb the rational part of the self, ego, to the extent that it leads to compulsive cleaning and tidying rituals later in life, to deal with childhood trauma

39
Q

Evaluation of genetic explanation of OCD

A

-objective and usually controlled under lab conditions, making it highly replicable.
-doesn’t explain why some individuals may carry genes that are implicated in OCD but never develop symptoms

40
Q

Evaluation of biochemical explanation of OCD

A

-oxytocin hypothesis is supported by lab-based studies
-it is difficult to establish a causal relationship between hormones and OCD symptoms

41
Q

Evaluation of neurological explanation of OCD

A

-supported by case studies on brain-damaged individuals
-lacks generalisability to other OCD patients

42
Q

Evaluation of cognitive and behavioural explanation of OCD

A

-fit well with the experience of OCD symptoms reported by individuals with the disorder
-research in this area relies on self-report, including measures such as the Y-BOCS or MOCI; introduces bias as individuals may deliberately or inadvertently mislead researchers

43
Q

Evaluation of psychodynamic explanation of OCD

A

not supported by empirical research as you can’t mention or control variables involved, so no causal relationship found e.g. between harsh toilet training and later compulsive washing

44
Q

Issues and Debates of OCD explanations: Applicable to everyday life

A

-Biomedical explanations for OCD can indicate potential areas for research on treating and management of the disorder. For example, understanding the role of the basal ganglia, orbitofrontal cortex and anterior cingulate gyrus has led to innovations in neurosurgery which may offer symptom relief
-cognitive-behavioural and psychodynamic accounts have also led to treatment options for OCD, including psychoanalysis and CBT

45
Q

Issues and Debates of OCD explanations:
Individual vs Situational explanations

A

-biomedical, cognitive and behavioural explanations focus on the individual e.g. hormonal abnormalities and faulty thought processes, making it reductionist
-psychodynamic explanation emphasises the effect of early social relationships on an individual’s development

46
Q

Issues and Debates of OCD explanations:
Nature vs Nurture

A

-Nature side: biomedical explanation (rely on physiological factors such as genes, hormones, and brain structure)
-Nurture side: behavioural (learnt behaviours) making individuals with OCD a product of their environment
-Both biomedical and behavioural explanations are considered to be deterministic; we have no freewill to influence our genetic makeup or the automatic learning processes that may lead to developing OCD
-Both nature and nurture: psychodynamic (natural urges we are born with vs childhood experiences)

47
Q

Issues and Debates of OCD explanations:
Determinism

A

Both biomedical and behavioural explanations are considered to be deterministic; we have no freewill to influence our genetic makeup or the automatic learning processes that may lead to developing OCD

48
Q

Ways to treat and manage OCD

A

-Biomedical (SSRIs)
-Cognitive
-Exposure and response prevention (ERP)

49
Q

Treating OCD using SSRIs

A

-acts on the serotonin transporter, increasing its level and acting as a treatment
-reduce the severity of OCD as they seem to lessen the anxiety associated with it

50
Q

Who investigated using SSRIs to treat OCD

A

Soomro et al. (2008)

51
Q

brief procedure and results of Soomro et al. study

A

-reviewed the results of 17 studies comparing the effectiveness of SSRIs with placebo
-In all studies, totalling 3097 participants, the SSRIs group was more effective at reducing OCD symptoms shown using Y-BOCS 6-13 weeks after treatment

52
Q

Who conducted the study on treating OCD using cognitive methods

A

Lovell et al., 2006

53
Q

Aim of Lovell et al.’s study

A

to compare the effectiveness of CBT delivered by telephone vs the same therapy offered face-to-face

54
Q

Sample of Lovell et al.’s study

A

72 patients from 2 different hospitals

55
Q

The procedure of Lovell et al.’s study

A

-used RCT wherein participants underwent 10 weekly sessions of therapy either by telephone or face-to-face
-Changes in well-being were measured via Y-BOCS, BDI, and a client satisfaction questionnaire

56
Q

Results of Lovell et al.’s study

A

6 months after treatment, Y-BOCS scores significantly improved in both groups, along with high participant satisfaction, suggesting patients may benefit equally from both forms of CBT

57
Q

Who conducted the research on ERP to treat OCD

A

Lehmkuhl et al., 2008

58
Q

Sample of Lehmkuhl et al.’s study

A

a 12-year-old boy Jason who had both OCD and autism spectrum disorder (ASD)

59
Q

OCD symptoms that Jason had

A

-experienced contamination fear, excessive hand-washing, counting and checking
-spent several hours daily in compulsive behaviour, having anxiety when prevented from his rituals

60
Q

ERP consists of

A

-Exposure and response prevention is a form of CBT that involves:
1)gathering information about existing symptoms
2)therapist-initiated ERP
3)generalisation and relapse training

61
Q

The procedure of Lehmkuhl et al.’s study

A

-Jason attended ten 50-minute CBT sessions over 16 weeks and ERP techniques were modified to fit Jason’s needs
-Identification and coping: Jason first identified feelings of distress and with the help of the therapist, learned coping statements when he felt anxious
-Some ERP techniques were modified to fit Jason’s needs; he was not asked to do visualisation exercises as he would find it impossible to imagine pretend situations
-Exposure: he was exposed to stimuli which he felt were contaminated and produced feelings of anxiety/disgust (door handles, elevator buttons)
-He was asked to touch them repeatedly until he became habituated and his anxiety levels dropped.
-Mid-sessions, he was exposed to specific tasks in his normal environment – handing out papers in classes or using ‘contaminated’ items at home

62
Q

Results of Lehmkuhl et al.’s study

A

-Jason’s score on Y-BOCS dropped from a severely high pre-therapy score of 18 to just 3 (normal)
-At a 3-month follow-up, his score remained low, and he showed improvement in both OCD symptoms and participation in social activities

63
Q

Evaluation of cognitive therapy (Lovell et al)

A

-used independent measures design where participants were randomly allocated to two conditions, removing researcher bias
-Face-to-face CBT group acted as a control group, so researchers could compare the results and effectiveness of telephone therapy
-Validity and reliability: duration of therapy in both groups was the same, and outcomes were measured using the same validated scales

64
Q

Evaluation of ERP (Lehmkuhl et al.)

A

-Limited generalisability: case study was used and the participant had ASD too, thus unrepresentative of the general OCD population
-Ethical issues: Jason was a child with additional needs, and issues regarding briefing, consent and risk of psychological harm
Qualitative and quantitative: in-depth qualitative data through ERP and interviews, along with quantitative data via Y-BOCS scores

65
Q

Issues and debates of OCD treatments:
Use of children in psychology

A

-SSRIs are generally considered safe, but sometimes restricted in the case of children with OCD due to risks of harmful side effects
-Ethics: Jason’s parents would have had to give consent on his behalf; some procedures of ERP were altered to accommodate his age and ASD needs

66
Q

Issues and debates of OCD treatments:
Application to everyday life

A

CBT and SSRIs are frequently used OCD treatments meaning research in this area applies to real life

67
Q

Issues and debates of OCD treatments:
Individual vs Situational explanations

A

-SSRIs only treat one aspect: the individual’s serotonin uptake, ignoring what may have caused the OCD symptoms to emerge, thus also being a reductionist approach to treatment
-cognitive-behavioural therapies consider the environment in which the compulsive behaviour takes place e.g. Jason’s therapy addressed triggers in the home and school environment in order to help prevent relapse

A-LEVEL PSYCHOLOGY (10 decks)

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