Obsessive Compulsive Disorder

Question 1

For a diagnosis to be made:

Answer 1

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.

Question 2

Thought Event Fusion

Answer 2

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.

Question 3

Types of Obsessions and Compulsions

Answer 3

contamination - cleaning
safety - checking
symmetry/order - arranging, counting, ordering
forbidden thoughts/taboos - ritualistic physical or mental acts

Question 4

A short assessment tool for OCD

Answer 4

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.

Question 5

a semi structured interview schedule…

Answer 5

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.

Question 6

Genetic Explanations of Obsessive-Compulsive Disorder

Answer 6

5-HTT and Serotonin
DRD4, COMT, and Dopamine
SLITRK5 and BDNF

Question 7

5-HTT, Serotonin

GENETIC

Answer 7

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.

Question 8

DRD4, COMT, and Dopamine

GENETIC

Answer 8

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.

Question 9

SLITRK5 and BDNF

GENETIC

Answer 9

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.

Question 10

Biochemical Explanations

Answer 10

Serotonin, Dopamine, BDNF
The Role of Oxytocin

Question 11

Serotonin, Dopamine, AND BDNF

Biochemical Explanation

Answer 11

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

Question 12

The Role of Oxytocin

Biochemical Explanation

Answer 12

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

Question 13

Psychological Explanations

Answer 13

Cognitive (thinking error):
Thought-Action Fusion (TAF)
Thought-event fusion
Over-estimation of Personal Responsibility

Behavioural (Operant Conditioning)

Psychodynamic

Question 14

Cognitive (thinking error):

Psychological Explanations

Answer 14

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

Question 15

Behavioural (Operant Conditioning)

Psychological Explanations

Answer 15

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.

Question 16

Psychodynamic

Psychological Explanations

Answer 16

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.

Question 17

Tricyclics

Biological Treatment and Management

Answer 17

Increases serotonin, dopamine, and noradrenaline

Question 18

SSRIs

Biological Treatment and Management

Answer 18

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

Question 19

Exposure and Response Prevention (ERP)

Psychological Treatment

Answer 19

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

Question 20

Aim and hypothesis of Lovell et al

Answer 20

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)

Question 21

Lovell et al methodology and procedure

Answer 21

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.

Question 22

sample - Lovell et al

Answer 22

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.

Question 23

results - Lovell et al

Answer 23

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

Question 24

conclusions - lovell et al

Answer 24

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