Obsessive compulsive disorder Flashcards
difference between impulsive and compulsive
impulsive has little forethought, reflection, consideration of consequences, involve unplanned actions, arise with perceived immediate benefit
compulsive has repeated actions, arise with perceived threat
criteria of diagnosis for ocd
- Obsession: intrusive recurrent thoughts, unwanted urges
- Compulsion: repetitive actions, impairs normal function
reasoning for behaviour
suppress excessive unrealistic obsession, temporary relief due to reduced anxiety
types of ocd
hoarding: distress getting rid of possessions regardless of use, which negatively affects social life
body dysmorphic disorder: obsessive thoughts on faults in appearance, anxiety causes repetitive behaviour, excessive grooming, extensive time looking in mirror
what is MOCI
Maudsley obsessive compulsive inventory, 30 items true/false, subscales for washing slowness checking doubting, score 0-30, 5 min
what is Y-Bocs
yale brown obsessive compulsive scale, semi-structured interview and questionnaire, 30 min, ten item severity scale determined by time resistance distress (0-4), score 0-40, clinical range above 16, checklist of different compulsions+obsessions
evaluate MOCI and y-bocs
good concurrent validity, good test-retest reliability, subjective, response bias, reductionist as symptoms can be unique to individuals, MOCI has no qualitative data, “distress” can also relate to depression anxiety
genetic explanation + Mattheisen et al.
inherit specific genes, study analysed 1406 people with and without ocd, PTPRD and SLITRK3 genes regulate particular synapses in brain, DRD4 relates to dopamine uptake
biochemical explanations + Leckman et al.
oxytocin dysfunction causes increase in fear of certain stimuli with belief of threat to survival, analysing spinal fluid, found oxytocin levels higher
neurological explanation
abnormality of brain structure, basal ganglia and orbifrontal cortex and cingulate gyrus work to send warning messages about threatening stimuli, malfunction leads to patient continuously receiving message to do survival activities, case studies
cognitive and behavioural explanation
- cognitive obsession: faulty reasoning, increased stress and anxiety
- behavioural compulsion: operant conditioning, negative reinforcer relieves unpleasant, positive reinforcer rewards with clean hands, learned behaviour
psychodynamic explanation
anal stage of psychosexual development, difficulty between child and parent during defecation and urination, anally expulsive or anally retentive, fixated at this stage, compulsive ritual soothe trauma, id and superego conflict has obsessive cleaning act as defense mechanism
evaluate explanations
biomedical is objective, reliable, but does not explain presence of genes in people without ocd
biochemical, neurological, psychodynamic unestablished cause and effect
all applicable to everyday life for treatment
cognitive requires self-report so response bias
psychodynamic unsupported by empirical research
cognitive and biomedical focus on individual while psychodynamic has the unconscious, personality, psychosexual stages of development, experiences during potty training
nature vs nurture
determinism (learning process, genetics)
biomedical treatment + Soomro et al.
SSRIs increase serotonin levels, improve ocd symptoms, lessen anxiety, no need to engage in repetitive behaviour to relieve anxiety
effective 6-13 weeks, ybocs, 3097 participants
cognitive therapy + Lovell et al
compare effectiveness of CBT face to face or telephone, 72 patients with score above 16, 10 weekly sessions, first sessions always in person and explain ERP, 8 sessions on phone and homework sheet, ybocs bdi and client satisfaction questionnaire, after 6 months significant improvement
exposure and response prevention + Lehmkuhl et al.
case study on jason, 12 old, has ASD, contamination fear, excessive hadn-washing, counting, checking, significant anxiety, 10 sessions, 50 min, 16 weeks, not imagine pretend situations, identify feelings of distress, exposed to stimuli until habituated, practice out of therapy, ybocs dropped (18-3), three month follow up shows significant improvement
ERP consists of gathering info on symptoms, therapist-initiated erp, generalisation and relapse training
exposure: touching contaminated objects like doorhandles
response prevention: reducing anxiety through coping statements
evaluation of treatments
lovell et al: reseracher bias as random allocation, control group to compare, outcomes measured the same valid scales so reliable and valid
lehmkuhl et al: less generalisable, quantitative and qualitative data, ethics due to being child, longitudinal so valid, communication problems adjusted so increases validity, response to demand characteristics
all applicable to real life, biomedical is reductionist and individual while erp is situation because jason practiced outside of therapy
obsessions
aggressive, sexual, contamination, hoarding, religious, symmetry, body focused, other
compulsions
counting, checking, washing, repeating, cleaning, ordering, hoarding, other
