Obsessive Compulsive Disorder Flashcards
For a diagnosis to be made:
the obsessions and compulsions must take up more than an hour per day
must result in significant distress or significant impairment to one or more important areas of functioning such as family, social or occupational.
Thought Event Fusion
One type of obsession
The ICD-11 states that compulsions are often carried out in response to an obsession, possibly to neutralise negative thoughts.
A person may imagine a loved one being involved in an accident and become anxious believing that their thoughts will make an accident more likely to happen in real life.
They may then feel compelled or driven to carry out certain behaviours to stop the accident from happening, neutralising the power of the negative thought.
Types of Obsessions and Compulsions
contamination - cleaning
safety - checking
symmetry/order - arranging, counting, ordering
forbidden thoughts/taboos - ritualistic physical or mental acts
A short assessment tool for OCD
The Maudsley Obsessive-Compulsive Inventory - MOCI
Contains 30 items that are scored either ‘true’ or ‘false’.
It assesses symptoms relating to checking, washing, slowness, and doubting.
It takes around 5 minutes to complete and produces scores that range between 0 and 30.
a semi structured interview schedule…
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
a semi-structured interview schedule
5 items relating to obsessions
5 items on compulsions
Respondents are asked to rate each item on a 0-4 scale in relation to the severity of their symptoms in the last week.
Y-BOCS is a reliable measure of OCD symptom severity. it has strong inter-rater reliability.
Genetic Explanations of Obsessive-Compulsive Disorder
5-HTT and Serotonin
DRD4, COMT, and Dopamine
SLITRK5 and BDNF
5-HTT, Serotonin
GENETIC
Carriers of a mutation of the 5-HTT - imbalance of serotonin = OCD
Vulnerability to OCD has been linked to various genes, including those that code for serotonin receptors and transporter molecules, as well as MAO-A, an enzyme that breaks down serotonin.
DRD4, COMT, and Dopamine
GENETIC
no allele of DRD4 gene - imbalance of dopamine = OCD
no COMT gene - too much dopamine = OCD
A specific allele of the gene DRD4 (a gene that codes for D4 dopamine receptors) is less common in OCD people –> suggesting that an imbalance of dopamine may also be involved in vulnerability to OCD
The COMT gene codes for an enzyme that breaks down dopamine. Decreased levels of this enzyme could cause an excess of dopamine and this may increase vulnerability to OCD.
SLITRK5 and BDNF
GENETIC
absence of SLITRK5 gene - decreased BDNF protein = OCD
SLITRK5 - a gene involved in developing new synapses and thus our ability to learn from new experiences.
absence of SLITRK5 may affect an important protein called BDNF.
This protein maintains our neural networks and keeps them working effectively.
Anything that decreases BDNF is likely to result in abnormal cognition and behaviour.
Biochemical Explanations
Serotonin, Dopamine, BDNF
The Role of Oxytocin
Serotonin, Dopamine, AND BDNF
Biochemical Explanation
5-HTT gene - an imbalance of serotonin = vulnerability to OCD.
This may be linked to:
- irregularities in the transport of serotonin from the synapse back into the presynaptic cell
- abnormalities relating to the receptors on the postsynaptic cell
- problems with enzymes (such as MAO-A) that break down serotonin.
Abnormalities relating to D4 dopamine receptors = OCD
Anything that affects the production of BDNF protein = OCD
The Role of Oxytocin
Biochemical Explanation
Oxytocin is involved in enhancing trust and attachment.
Oxytocin has also been shown to increase distrust and fear of certain stimuli, particularly those that might pose a threat to survival
Higher levels of oxytocin are associated with more severe OCD symptoms, particularly in people who develop the condition at a young age and are resistant to drug treatments.
This could be explained by upregulation, whereby a lower number of receptors on the postsynaptic cell causes a greater amount of oxytocin to be released
Psychological Explanations
Cognitive (thinking error):
Thought-Action Fusion (TAF)
Thought-event fusion
Over-estimation of Personal Responsibility
Behavioural (Operant Conditioning)
Psychodynamic
Cognitive (thinking error):
Psychological Explanations
Thinking error: imagining behaving a certain way increases the probability that you will actually behave this way
Thought-event fusion - the belief that imagining a certain event will make it more likely
for example, imagining your friend dropping their laptop will make it more likely to happen.
Thought-Action Fusion (TAF)
Over-estimation of Personal Responsibility
Behavioural (Operant Conditioning)
Psychological Explanations
Avoiding the feared stimulus is negatively reinforcing, as it removes unpleasant feelings of anxiety.
Any actions the person takes that reduce these negative emotions are reinforced, as they make the person feel better, meaning the behaviours become more likely.
Psychodynamic
Psychological Explanations
unconscious beliefs and desires.
Freud suggested that such conflict arises in the anal stage of psychosexual development, around the time most children begin toilet training.
Both these behaviours (anally expulsive/retentive) can lead to later behavioural disturbances, as the individual has become ‘fixated’ in this stage.
obsessive thoughts that come from the id disturb the rational part of the self (the ego) to the extent that it may lead to compulsive cleaning and tidying rituals later in life, to deal with the earlier childhood trauma.
Tricyclics
Biological Treatment and Management
Increases serotonin, dopamine, and noradrenaline
SSRIs
Biological Treatment and Management
Increase serotonin in the synapse by blocking presynaptic transporter molecules.
Although synaptic serotonin is immediately increased, improvement in symptoms is often not observed for some considerable time.
This suggests that when symptoms do improve, this possibly results from down regulation
for example, the brain compensates for the increased serotonin by reducing the amount that is released from the presynaptic cell.
It is possible to enhance the effects of SSRIs in people who have previously been treatment-resistant by offering additional drugs: antipsychotics
Exposure and Response Prevention (ERP)
Psychological Treatment
a type of CBT
Involves experiencing high levels of anxiety through exposure, Then habituating to the stimuli without being allowed to carry out compulsions like handwashing or counting.
Triggering situations are arranged into a hierarchy from the lowest to highest SUDS( Subjective Units of Distress Scale) rating
In ERP the therapist’s role is to ensure that the person is prevented from carrying out these maladaptive behaviours
practise every day (homework) and keep records of their progress to share during the next session.
ERP does not include any training in relaxation strategies
Aim and hypothesis of Lovell et al
To compare two modes of delivery for one-to-one ERP as a treatment for obsessive-compulsive disorder: telephone treatment versus face- to-face treatment.
the study aimed to test the hypothesis that the experimental treatment (telephone ERP) is not less effective than the control treatment (face-to-face ERP)
Lovell et al methodology and procedure
an experiment with independent measures and a longitudinal design.
randomised control trial with quantitative data
self-report questionnaires:
- a ten-item checklist to assess compulsive behaviour from the Yale-Brown Obsessive-Compulsive Disorder Scale
- the Beck Depression Inventory
- a questionnaire designed specifically to measure client satisfaction
The participants were randomly allocated to the two groups: face-to-face (n = 36) or telephone treatment (n = 36).
Researchers who were unaware of each participant’s mode of delivery (i.e. blind) assessed the participants twice, four weeks apart, to establish a baseline and again at three follow-up sessions - at one, three and six months later.
Therapy manuals and twice monthly supervision (including reviewing the therapists’ notes) ensured the therapy was faithful to the principles of ERP.
sample - Lovell et al
aged 16-65
opportunity sample
72 people with obsessive-compulsive disorder were selected from two outpatient departments in Manchester, UK.
All participants scored at least 16 on the Y-BOCS and were already diagnosed with OCD as their main problem.
Some people were excluded, including people who had comorbid substance misuse or suicidality; Anyone who had taken medication for depression or anxiety in the last three months was also excluded.
results - Lovell et al
77 per cent of the telephone group and 67 per cent of the face-to-face group were treated successfully using exposure and response prevention.
Overall, both OCD and depression symptoms dropped twice as much as would have been necessary to accept the hypothesis that telephone therapy was no less effective than face-to-face therapy, despite the reduced contact time
conclusions - lovell et al
Telephone-delivered exposure and response prevention therapy for OCD is as effective as face-to-face therapy despite the majority of sessions being 50 per cent shorter.
This equates to a saving of 40 per cent of the therapists’ time, allowing more people to gain access to therapy
