OCD Flashcards
The diagnosis of obsessive compulsive disorder:
OCD is an anxiety disorder
It is characterised by the DSM-V as a disorder whereby the patient shows repetitive behaviour (compulsions) and obsessive thinking
The behavioural characteristics of OCD (action)
1) Compulsive behaviours:
Compulsive behaviours are performed to reduce the anxiety created by obsessions. They are repetitive. Patients feel they must perform these actions otherwise something bad might happen, which creates anxiety. Some patients experience compulsions without obsessions. The behaviours are external components that can be seen by others.
2) Hinder everyday functioning:
Having obsessive ideas creates a great deal of anxiety. This could then lead to compulsions and repetitive behaviour that can seriously hinder the ability to perform everyday functions, (for example the person might not be able to have a job).
3) Social impairment:
The anxiety levels created by the obsessions, and the performance of repetitive, compulsive behaviour might become so high that the person might not be able to have meaningful interpersonal relationships
4) Repetitive:
Sufferers feel compelled to repeat behaviours over and over again as a response to their obsessive thoughts, ideas and images.
5) Avoidance:
Some OCD sufferers attempt to reduce their anxiety by avoiding situations that might trigger it which can lead to further problems. (Sufferers who wash their hands continuously avoid coming into contact with germs,)
The emotional characteristics of OCD (feelings)
1) Anxiety and distress:
The obsessions and compulsions are a source of considerable anxiety and distress. Sufferers are aware that their obsessions and compulsive behaviour are excessive and this causes feelings of embarrassment and shame. Sufferers might also be aware that they cannot consciously control their compulsive behaviours which leads to strong feelings of distress.
2) Accompanying depression:
OCD is often accompanied by depression. Anxiety might be accompanied by low mood and a lack of enjoyment of activities. Compulsive behaviour tends to bring some relief from anxiety, but this is temporary.
3) Guilt and disgust:
OCD sometimes involves other negative emotions such as irrational guilt over minor issues, or disgust which may be directed against something external like dirt or the self.
The cognitive characteristics of OCD (thinking)
1) Obsessions:
These are recurrent, intrusive thoughts or impulses. These thoughts, impulses and images are not excessive worries about everyday problems; instead they are uncontrollable and cause anxiety. The person will realise that their obsessions are unreasonable. Obsessions are internal (because they are thoughts that occur internally inside the mind)
2) Recognised as self generated:
Most sufferers understand that their obsessional thoughts, impulses and images are self invented and are not inserted externally by others
3) Realisation of inappropriateness:
Most sufferers understand their obsessive thought and compulsive behaviours are irrational, but they cannot consciously control or stop them.
4) Attention bias:
Perception tends to be focused on anxiety generating stimuli. They tend to be hyper vigilant and tend to look for things that will justify their high anxiety levels.
The biological approach to explaining OCD (introduction)
The biological approach to explaining OCD assumes that OCD is caused by genetics and neural explanations (such as neurotransmitters and abnormal brain circuits).
Genetic causes of OCD: The COMT gene: AO1
OCD might be inherited whereby sufferers have a genetic vulnerability or a genetic predisposition to get the illness
Psychologists often use family or twin studies to investigate genetics
OCD has been classed as polygenic meaning that one single gene is not responsible for the disorder. Instead, many genes might be responsible for causing OCD; and they are known as, candidate genes.
The COMT gene causes OCD. The COMT gene regulates the production of the neurotransmitter dopamine which in high levels is associated with OCD. High levels of dopamine are responsible for drive, motivation and possibly aggression
The COMT gene has been found to be more common in OCD patients than people who do not have the illness.
Genetic causes of OCD: The SERT gene (Serotonin Transport gene): AO1
Individuals have the SERT gene on chromosome 17. It seems a mutation in this gene can cause OCD.
Research conducted by Ozaki found evidence that 6 out of 7 family members who had OCD had a mutation of the SERT gene. The gene mutates which then causes low levels of serotonin to be produced. It seems that there is a link with OCD and depression and this might account for it.
Evaluation of genetics explanations: AO3
Advantages:
1) Nestadt supports the genetic explanation for OCD. He found that people who had a first degree relative who already had OCD were five times more likely to also get the illness. This supports the idea that OCD is transmitted genetically
2) Billett supports the idea that OCD is transmitted genetically. He found from a meta-analysis of 14 twin studies that OCD is twice more likely to be concordant in identical monozygotic twins rather than dizygotic non identical twins. Therefore this supports the idea that OCD is transmitted by genetics
Disadvantages:
1) A criticism of the genetics explanation is that the concordance rate for OCD is not 100%. Therefore OCD cannot be caused entirely by genetic factors. The genetics explanation fails to take into account psychological and environmental factors that might contribute to the cause of OCD
2) A criticism for the genetics explanation for OCD is that it is polygenic and one single gene is not responsible for causing the disorder. OCD has been genetically linked to other illnesses such as Tourettes syndrome, and autism. Therefore it seems that the genetic cause for OCD is very complex and might be related to other illness too. It could be that one specific gene is not responsible for OCD, but could be a predisposing factor.
3) The behavioural approach would contradict the genetic explanation for OCD. The two process model would suggest that OCD can be learnt via classical conditioning, and then rewarded through reinforcement (operant conditioning). The behavioural approach has gained a great deal of support in explaining the cause of OCD, especially as OCD is often treated using behavioural therapies such as exposure (which is similar to systematic desensitisation).
4) The diathesis stress model would argue that OCD can be caused by a combination of genes and a trigger in the environment (stress). Therefore genes alone cannot be the only cause of OCD; genes would need to be combined with other factors in order for the disorder to develop. The diathesis stress model would weaken the genetics argument
Research by Beekman and Cath into genetics and OCD AO1
A meta-analysis was conducted of twin studies into OCD that had occurred over the last 70 years.
MZ twins were compared against DZ twins
The psychologists examined studies between 1929-1965 where OCD patients had been diagnosed using older criteria (before the DSM and ICD)
The psychologists also examined studies after 1965, whereby OCD patients had been diagnosed using DSM criteria
10,034 twin pairs were studied overall (from 28 separate twin studies)
From 1929-1965 there were 37 pairs of twins
From 1965 onwards, there were 9,997 pairs of twins
The results found that in children, OCD is inherited via genes and the genetic influence ranges from 45-65%
The results found that in adults, OCD is inherited via genes and the genetic influence ranges from 27-47%
The conclusion was that OCD is transmitted genetically and this was more apparent when examining children rather than adults.
Evaluation of the research by Beekman and Cath AO3
Disadvantages
1) The research can be criticised because the majority of the twin studies were not performed in controlled conditions. This means that the data is not very objective or scientific and therefore this might affect the validity and the reliability of the results gained from this research. This might question the idea that OCD is genetic
2) The research can be criticised because gene mapping was not taken into consideration when looking at whether OCD is genetic. Gene mapping would look closely at the DNA of the twins that had OCD and compare this with twins that do have OCD. A comparison need to be made in order to make the results more valid and robust.
Neural Explanations of OCD: Dopamine:
Dopamine is a neurotransmitters that affects mood and might be a cause of OCD
The frontal lobes in the brain have been linked to dopamine activity.
OCD sufferers have high levels of dopamine.
Research conducted on animals has found that high doses of drugs that enhance dopamine levels can induce movements that resemble compulsive and repetitive behaviour, which is similar to what OCD sufferers would experience.
High dopamine levels have also been linked to over activity in the basal ganglia area in the brain (motor function and learning).
Neural Explanations of OCD: serotonin:
Serotonin is a neurotransmitters that affects mood and might be a cause of OCD
The frontal lobes in the brain have been linked to serotonin activity.
OCD sufferers tend to have low levels of serotonin and this can cause depressive like symptoms and also obsessive thoughts
Many OCD sufferers are depressed due to the low levels of serotonin
Serotonin plays a key role in operating the caudate nucleus in the brain, and it seems that low levels of serotonin cause the caudate nucleus to malfunction.
The caudate nucleus plays a vital role in how the brain learns, specifically the storing and processing of memories.
It works as a feedback processor, which means it uses information from past experiences to influence future actions and decisions. OCD patients have a malfunctioning caudate nucleus.
Evaluation of neural explanations: AO3
Advantages:
1) There has been a great deal of research support to state that neurotransmitters do cause OCD. Anti-depressant drugs will increase serotonin levels in OCD patients, and this has led to a reduction of OCD symptoms. Therefore there is good evidence to suggest that low levels of serotonin could be a cause for OCD
2) Research conducted by Ciccerone would support the neural explanations of OCD. He found that giving OCD patient’s low doses of the drug Risperidone helped to lower dopamine levels and alleviate some of the symptoms of OCD. Therefore it seems that high levels of dopamine could be a biological cause for OCD
3) Menzies suggested research evidence that would support a genetic link to abnormal levels of neurotransmitters. Menzies studied MRI scans in OCD patients and their immediate family members and compared them with healthy controls. It was found that OCD patients and their families had reduced grey matter in key regions of the brain and they had an unusual neuroanatomy. It was concluded that OCD can be caused by abnormal brain structure which could be inherited via genes
Disadvantages:
1) A disadvantage of the neural explanation is that neurotransmitters such as dopamine and serotonin might not necessarily cause OCD. Instead low levels of serotonin and high levels of dopamine might be the effect of OCD. Therefore we must be cautious when looking at cause and effect of neurotransmitters
2) A problem with the neural explanation is that OCD is co morbid with depression (exists alongside depression). Therefore it is not clear whether low levels of serotonin cause OCD or depression or both. The link between low levels of serotonin causing OCD is not very clear and needs to be investigated further
3) The role of dopamine causing OCD has been questioned. It has been found that high levels of dopamine can also cause other psychological illnesses and not just OCD. For instance high dopamine can cause bipolar depression and schizophrenia. Therefore there is not enough research evidence to suggest the high levels of dopamine can cause OCD to occur. A combination of factors might be responsible for causing the illness.
Neural explanations of OCD – Neuroanatomy by Jenike and Rauch: AO1
There might be a relationship between OCD being caused by some types of brain damage which might be caused by a virus.
The brain damage might then cause a problem in the short term memory that causes a chain reaction of the person doubting whether they have performed a certain action recently. This is a common characteristic of OCD and might then result in repetitive behaviour (compulsions)
OCD patients were studied using PET scans. They were shown an image of something dirty (they had a cleaning obsession). Evidence found that the frontal lobes and the basal ganglia were the most active parts of the brain.
The basal ganglia seems to malfunction in OCD sufferers. The basal ganglia refers to a series of interconnected brain structures that are at the front of the brain. The basal ganglia is responsible for control of voluntary motor movements, procedural learning, habit learning, eye movements, cognition, and emotion. An overactive basal ganglia can lead to repetitive motor functions
Patients who have Tourette’s syndrome also have problems with the basal ganglia, and it seems that many patients who have Tourette’s also have OCD and their symptoms are co-morbid (exist alongside each other).
Further research has found that OCD sufferers might have damage to the frontal cortex of the brain. This part of the brain is involved in selecting, controlling and inhibiting behaviour which OCD patients struggle with.
Evaluation of neural explanations of OCD: AO3:
