Obsessive compulsive disorder

Question 1

OCD cycle`

Answer 1

-Intruding thoughts (obsessions) - Repetitive, ritualistic behaviour (compulsions) - brings short-term relief for anxiety (Recurring, time consuming, disturbing obsessions, resistant to reason)

Question 2

Types of compulsion

Answer 2

-Compulsive checking and washing, superstitious ritualized movements or thoughts, systematic arranging of objects and compulsive hording

Question 3

DSM-5 diagnostic criteria

Answer 3

• Presence of obsessions, compulsions, or both:
• Obsessions: Recurrent, persistent, intrusive, unwanted thoughts, urges, or images that cause anxiety or distress. Individual attempts relieve anxiety by ignoring/supressing thoughts or performing compulsions
• Compulsions: Repetitive behaviour, mental acts or rigorous rules applied to relieve anxiety or prevent a dreaded event or situation (unrealistic connection)
• The obsessions or compulsions are time-consuming e.g. more than 1 hour a day, cause significant distress or impair functioning
• Not attributed to the effects of a substance or other medical or mental condition

Question 4

OCD-related disorders

Answer 4

• Body dysmorphic disorder: preoccupation with perceived physical defects
• Hoarding disorder: difficulty parting with possessions leading to congested clutter
• Trichotillomania: Compulsively pulling out hair in leading to significant hair loss
• Skin picking disorder: Recurrent picking of the skin resulting in skin-lesions

Question 5

Aetiology

Answer 5

• Biological factors
• Psychological factors
• Inflated responsibility
• Mental contamination
• Though action fusion

Question 6

Biological factors

Answer 6

• Higher concordance in monozygotic twins (80-87%) that dizygotic twins (47-50%)
• Family relatives of individuals with OCD are likely to have a diagnosis of OCD
• Onset can be associated with traumatic head injury (Frontal lobes and basal ganglia)
• Compulsions may result from inability to inhibit genetically stored behaviours

Question 7

Psychological factors

Answer 7

• OCD patients have similar thoughts, beliefs and cognitive processes
• Objective measurement through interviews and questionnaires produced clinical constructs: Inflated responsibility, thought-action fusion, Mental contamination

Question 8

Inflated responsibility

Answer 8

-The belief that one possesses power to provoke or prevent negative outcomes. Which are essential to prevent due to their consequences or moral implication

Question 9

Mental contamination

Answer 9

-Extreme feeling of dirtiness without physical contact with contaminant. Often caused by a violation by another person e.g. humiliation or abuse or by thinking of contamination e.g. thoughts or memories which creates anxiety

Question 10

Thought action fusion

Answer 10

-Belief that simply having unpleasant, unacceptable thoughts can influence events in the world which generates distress and anxiety

Question 11

Treatment

Answer 11

• Thought suppression
• Preservation and role of model
• Exposure and ritual prevention
• CBT
• Pharmacological and neurological

Question 12

Thought suppression

Answer 12

• Attempts to suppress obsessive thoughts can atually increase their frequency
• Ppts asked NOT to think about white bears were unable to suppress the thought. After suppression they were asked to think about polar bears. Those asked to suppress thoughts in the first condition had more thoughts about the bears
• Cognitive-behavioral models suggest that this distress arises due to negative interpretations of intrusive thoughts as personally significant and dangerous
• Connectivity between the PFC and medial temporal lobe structures (hippocampus, amygdala) may contribute to ineffective control and individual differences in vulnerability to this negative cycle of suppression

Question 13

Prevention and role of model

Answer 13

-Mood-as-input hypothesis: Suggests people use their concurrent mood to determine whether or not they have successfully completed a task. Individuals with OCD often have negative moods making their behaviour more repetitive as it doesn’t feel complete

Question 14

Exposure and ritual prevention

Answer 14

• Exposure treatment: exposes individuals to a hierarchy of least to most anxiety inducing situations and response prevention treatment - eliminates anxiety as link between obsession and distress becomes habituated.
• Ritualistic behavior: Negative reinforcement of anxiety is eliminated by confronting dysfunctional beliefs when client encounters feared situation

Question 15

Cognitive behaviour therapy

Answer 15

-Targets and modifies dysfunctional beliefs: responsibility appraisals, belief they are responsible for preventing any harmful outcomes, over-importance of thoughts, targets thought fusion and exaggerated perception of threat

Question 16

Pharmacological and neurological

Answer 16

• Short term effects as relapse is common when drug is discontinued
• SSRIs are commonly prescribed if symptoms are comorbid with depression
• Cheapest option, psychological therapies are more effective
• Cingulotomy (destroying cells in cingulum) is a last resort