Obsessive-Compulsive Disorder

Question 1

What is OCD?

Answer 1

disorder characterised by obsessions or compulsions

Question 2

Obsessions

Answer 2

intrusive or recurring thoughts found to be disturbing and uncontrollable
i.e. fear of contamination

Question 3

Compulsions

Answer 3

repetitive/ritualised behaviour patterns that the person feels driven to perform in order to prevent occurrence of negative outcome
i.e. compulsion to check or wash

Question 4

DSM Criteria

Answer 4

recurrent intrusive thoughts, images or impulses
obsessions and compulsions (both always there but one may be less obvious)
person tries to ignore or suppress intrusions
person recognises thoughts, impulses or images as a product of their own mind
clinically significant impairment

Question 5

Prevalence of OCD

Answer 5

onset is usually gradual
often begins to manifest itself in early adolescence or early adulthood
lifetime prevalence is 2.5%
women slightly more affected than men

Question 6

Aetiology:
Biological theory
Brain lesions

Answer 6

mostly biological explanations of OCD but no actual evidence for this
thought that those with traumatic brain injury may be more likely to develop OCD (Jenike, 1986) - areas included are basal ganglia and frontal lobes
but not very well understood

Question 7

Aetiology:
Behavioural theory
Animal model

Answer 7

Solomon, Kamin and Wynne, 1953 - the shuttlebox
OCD is pattern of learned reactions
- between 2 compartments of box is barrier
- light comes on and grid under that portion becomes electrified
- dog learns response to light coming on - dog jumps over barrier to where there is no light
- negative reinforcement
for OCD - certain behaviours reduces aversion experienced

Question 8

Aetiology:

General behavioural theory

Answer 8

Rachman, 1971
everyone has obsessive beliefs but for some these become extreme
obsessions = neutral stimuli which have become associated with anxiety
development of avoidance and escape responses - terminate exposure to stimulus
behaviours are negatively reinforced - so more likely to recur
termination of exposure prevents extinction of anxiety

Question 9

Spontaneous Decay

Answer 9

Rachman, de Silva and Roper, 1976
anxiety increases when rituals not completed but intrusion will recur
gave one condition preparation to see if they could avoid the behaviour - found they eventually learn that the ritual doesn’t stop the thoughts - obsessive behaviours reduces

Question 10

Issues with behavioural theory

Answer 10

obsessions without compulsions - some may experience covert compulsions
the theory is not specifically for OCD but for all anxiety disorders
therapist present effect - someone else present could prevent obsessive behaviours - can link to reassurance - this helps someone get on with daily activity

Question 11

Aetiology:

Cognitive theory

Answer 11

inflated responsibility - intrusions thought to be responsibility of sufferer so belief that they must prevent it - triggers anxiety and compulsive actions to prevent harm to others
thought suppression - intrusions seen as aversive and distressing so suppressed but this might more frequent occurrence (Salkovskis, 1999)
memory deficit - doubting is central to OCD - so memory deficits will give rise to doubt

Question 12

Aetiology:
Cognitive theory
Thought-action fusion

Answer 12

having a thought means a consequence will occur as a direct result of that thought

Question 13

Challenge to cognitive theory

Answer 13

memory deficit perhaps consequence not cause

OCD patients have as good memory as non-clinical patients suggests not a cause of OCD

Question 14

Treatment
Cognitive Therapy
Exposure and Ritual Prevention

Answer 14

explain how OCD works, get others to explain their OCD (shared understanding), formulation of how their problem works, explain their way of thinking about the problem and then therapist provides alternate explanation
most common
2 parts:
1) graded exposure to situation and thoughts that trigger distress - done until distress significantly reduced
2) ritual/response prevention - strategies to modify and prevent rituals

Question 15

Support for exposure and ritual prevention

Answer 15

Foa et al., 2005
double-blind, randomised,
placebo-controlled trial compared ERP, clomipramine, their combination and pill placebo
Clomipramine, ERP, and their combination
are effective treatments
Exposure and ritual prevention superior to clomipramine

Question 16

Treatment
Biological therapy
Medication

Answer 16

short-term
cheap
high relapse
SSRIs sometimes used but dispute over link between serotonin and OCD
Clomipramine is not as effective as ERP

Question 17

Treatment
Cognitive therapy
CBT

Answer 17

targets and modifies dysfunctional beliefs held by those with OCD
targeted are:
- responsibility appraisals
- over-importance of thoughts
- exaggerated perception of threat