OCD Flashcards
OCD
anxiety disorder
- characterised by the DSM-V
- repetitive behaviour (compulsions) and obsessive thinking
behavioural characteristics of OCD (5)
COMPULSIVE BEHAVIOUR
HINDER EVERYDAY FUNCTIONING
- obsessive/forbidden ideas creates lots of anxiety
- could lead to compulsions & repetitive behaviour
- seriously hunger ability to perform everyday functions, like having a job
SOCIAL IMPAIRMENT
- anxiety levels and compulsive behaviour might become so high they cannot conduct meaningful interpersonal relationships
REPETITIVE
- repeat behaviours over and over again
- response to obsessive thoughts, ideas, images
AVOIDANCE
- some reduce anxiety by avoiding situations that might trigger it
- can lead to further problems
compulsive behaviours: behavioural characteristic of OCD
performed to reduce anxiety created by obsessions
- repetitive & unconcealed
- eg hand washing or checking things
- could include mental acts, like praying/counting
- feel they must do these things otherwise smthn dreadful might happen
- external components - can be seen by others
emotional characteristics of OCD (3)
ANXIETY & DISTRESS
- obsessions + compulsions = source
- aware that compulsive behaviours are excessive
— causes embarrassment and shame
- cannot consciously control their compulsive behaviour
— distress
ACCOMPANYING DEPRESSION
- low mood
GUILT & DISGUST
- irrational guilt over minor issues
- disgust directed either externally (eg dirt) or internally
cognitive characteristics of OCD (4)
OBSESSIONS
RECOGNISED AS SELF GENERATED
- understand obsessive thoughts, impulses, images are self invented
REALISATION OF INAPPROPRIATENESS
- cannot consciously control or stop thoughts
- know they’re inappropriate / irrational
ATTENTION BIAS
- perception tends to be focused on anxiety generating stimuli
- eg focussing on dust on the table that has just been cleaned
- tend to be hyper vigilant & look for things to justify their anxiety
obsessions: cognitive characteristic of OCD
recurrent, intrusive thoughts/impulses
- perceived as inappropriate or forbidden
- may be frightening or embarrassing
- common themes include ideas, doubts (cooker is off?), impulses (shout/swear in public), or images (sexual)
- uncontrollable and cause anxiety
- internal - occur in the mind
biological approach to explaining OCD
assumes OCD is caused by genetics and neural explanations
genetic causes of OCD
COMT and SERT gene
- may be inherited whereby sufferers have a genetic vuln. or predisposition to get the illness
- polygenic = one single gene is NOT responsible, many genes = responsible (candidate genes)
COMT gene
regulates production of dopamine (neurotransmitter)
- HIGH levels of dopamine associated w OCD
- dopamine responsible for drive, motivation, aggression
- gene found to be more common in OCD patients
SERT gene
effects transportation of serotonin
- results in LOW levels of serotonin
- low mood and depressive symptoms
- this gene on chromosome 17, it seems a mutation in this gene can cause OCD
- Ozaki (2003) found that 6/7 family members who had OCD has a mutation of the SERT gene
- link w OCD and depression
strength of genetic explanations - OCD
Nestadt (2000) supports the genetic explanation for OCD
- found that ppl who had a FIRST DEGREE RELATIVE who alr had OCD were 5X MORE LIKELY to also get the illness
- supports the idea that OCD is transmitted genetically
strength of genetic explanations for OCD
Billett (1998) supports the idea that it’s transmitted genetically
- did a META-ANALYSIS of 14 twin studies
- found OCD is 2X more likely to be concordat in IDENTICAL monozygotic twins (rather than dizygotic identical twins)
- supports the idea that it’s transmitted by genetics
criticism of genetic explanation
the CONCORDANCE RATE for OCD is NOT 100%
- so, it cannot be caused entirely by genetic factors
- explanation fails to take into account PSYCHOLOGICAL & environmental factors (that might contribute to cause of OCD)
criticism of genetic explanation
it’s POLYGENIC
- one single gene is not responsible for causing it
- it’s been genetically linked to other illnesses, eg tourette’s syndrome & autism
- therefore, it seems that genetic cause is very COMPLEX
- and might be related to other illnesses too
- could be that one specific gene is not responsible for it, but it could be a predisposing factor
weakness of genetic explanation (behavioural approach)
behavioural approach would CONTRADICT the genetic explanation
- two process model would suggest that OCD can be LEARNT via classical conditioning
— rewarded through reinforcement (operant conditioning)
- behavioural approach gained a great deal of support in explaining cause of OCD
- often treated using behavioural therapies (eg exposure, similar to SD)
weakness of genetic explanation (model)
the diathesis model would argue 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 it
- genes would need to be COMBINED w other factors in order for the disorder to develop
- the diathesis stress model would WEAKEN the genetic argument
Beekman and Cath twin studies
META ANALYSIS
- MZ twins compared w DZ twins
- 10034 twin pairs studied overall
- results in CHILDREN : ocd is inherited via GENES
— (genetic influence ranges from 45%-65%)
- results in ADULTS : ocd is inherited via GENES
— (genetic influence is 27%-47%)
- conclusion = ocd transmitted genetically, this is more apparent in children)
weakness of Beekman and Cath’s research
majority of the twin studies were NOT performed in CONTROLLED CONDITIONS
- means that the data is NOT very OBJECTIVE, or scientific
- might affect the validity and reliability of the results gained
- might question the idea that ocd is genetic
criticism of Beekman and Cath’s research 🗺
GENE MAPPING was NOT taken into consideration
- when looking at whether ocd = genetic
- gene mapping would look closely at the DNA of the twins that had ocd
— compare w twins that don’t have ocd
- COMPARISON needs to be made in order to make the results more valid
strength of Beekman and Cath’s research
META ANALYSIS = strong
- multiple diff. studied and combining them
- results = more accurate
neural explanations of OCD
neurotransmitters : dopamine and serotonin
dopamine (neural explanation)
- neurotransmitter that affects mood, might be a cause
- FRONTAL LOBES in the brain have been linked to dopamine activity
- ocd - high levels
- high levels have also been linked to over activity in the BASAL GANGLIA (in the brain)
- research found that high does of dopamine enhancing drugs can induce movements that resemble compulsive and repetitive behaviour, similar to OCD symptoms
serotonin (neural explanation)
- FRONTAL LOBES in the brain have been linked to serotonin activity
- ocd = low levels, can cause depressive like symptoms + obsessive thoughts
- serotonin plays key role in operating the CAUDATE NUCLEUS in the brain
— low levels cause it to malfunction
strength of neural explanations
great deal of RESEARCH SUPPORT
- state that neurotransmitters do cause OCD
- anti-depressant drugs will inc. serotonin levels in ocd patients
— had led to a reduction of ocd symptoms
- therefore, there is good evidence to suggest that low levels of serotonin could be a cause of ocd
disadvantage of neural explanations
CAUSE and EFFECT
- neurotransmitters might not necessarily CAUSE ocd
- instead, low serotonin + high dopamine might be the EFFECT of ocd
- so, we must be cautious when looking at cause & effect of neurotransmitters
disadvantage of neural explanations 🪦
ocd is co morbid w DEPRESSION (exists alongside it)
- therefore, it’s NOT CLEAR whether low levels of serotonin cause ocd, depression or both
- so, the link between low levels of serotonin causing ocd is not very clear and needs to be INVESTIGATED FURTHER
strength of neural explanations
research conducted by Ciccerone (2000)
- found that giving ocd patients low does of the drug Risperidone helped to LOWER DOPAMINE levels
— and alleviate some of the ocd symptoms
- so, high levels of dopamine could be a biological cause for ocd
strength of neural explanations
Menzies (2007) suggested research evidence
- that would support a genetic link to abnormal levels of neurotransmitters
- studied MRI scans in ocd patients AND their immediate family members
— compared them w healthy controls
- found that ocd patients & their families had REDUCED grey matters in key regions of the brain
— &they had an UNUSUAL neuroanatomy
- concluded that ocd CAN be caused by ABNORMAL brain structure
— which could be inherited via genes
weakness of neural explanations (??)
role of DOPAMINE causing ocd has been QUESTIONED
- it’s been found that high levels of dopamine can also cause OTHER psychological illnesses (not just ocd)
— eg bipolar depression + schizophrenia
- so, not enough research evidence to suggest high dopamine can cause ocd to occur
- a COMBINATION of factors might be responsible
Jenike and Rauch - research : neural explanations ocd
might be a relationship between ocd being caused by some types of brain damage which might be caused by a virus
- brain damage may cause a problem in STM that causes a chain reaction
— person doubting whether they have performed certain actions
- might then result in repetitive behaviour
how were OCD patients studies - Jenike and Rauch
PET scans
- patients w cleaning obsession were shown something dirty
- evidence found that the frontal lobes and basal ganglia were the most active parts of the brain
— basal ganglia might be overactive & seems to malfunction in ocd sufferers
what is the basal ganglia?
series of interconnected brain structures at the front of the brain
- near the orbital frontal cortex
— which also seems to be overactive in ocd patients
- BG is responsible for control of voluntary motor movements, procedural learning, habit learning, eye movements, cognition, and emotion
— overactive BG can lead to repetitive motor functions
anti depressants : SSRI drugs
- selective serotonin reuptake inhibitors
- eg Prozac and Fluoxetine
- drug aims to PREVENT REUPTAKE of serotonin and PROLONG its ACTIVITY in the synapse
- person will feel less anxious and have HIGHER serotonin levels
- prescribed for 12-16 weeks
low levels of serotonin are also implicated in the …
‘worry circuit’, whereby damage to the CAUDATE NUCLEUS in the brain fails to suppress minor worry signals
— message then sent to orbital frontal cortex, worrying gets worse
why does increasing serotonin levels help OCD patients?
helps regulate mood & reduce anxiety levels
- inc. serotonin via SSRI drugs will also help to normalise and reduce the ‘worry circuit’
- high serotonin helps the orbital frontal cortex to function at normal levels
- helps stabilise moods and emotions and improve memory
— so, it will reduce compulsive behaviour and checking
SNRI drugs (not on spec i don’t think)
selective norepinephrine reuptake inhibitors
- new type of drug
- inc. serotonin and noradrenaline / norepinephrine
- suitable for ocd patients that can’t tolerate ssri drugs
strength of SSRIs (study)
SUPPORTING EVIDENCE that they’re an effective treatment
- soomro (2009) reviewed 17 studies that compared SSRIs to placebo drugs
- found that all studies showed SSRIs were more effective than placebos
- especially when combines w CBT
evaluation of SSRI drugs (%)
RELATIVELY EFFECTIVE
- 70% of patients have experienced a DECLINE in ocd SYMPTOMS when taking them
- however, remaining 30% tend to opt or psychological therapies
— or a combination of SSRIS and therapy
- might mean that the drugs are most effective if COMBINED w other treatments
benefit of SSRIs
relatively CHEAP and COST EFFECTIVE
- in comparison to psychological therapies (cbt)
- good value for money for the NHS, and is economical (compared to other treatments)
criticism of SSRIs
they DON’T WORK for ALL patients
- for some patients, the drug will not alleviate their ocd symptoms
- they’ll have to take another drug instead which might be more effective (eg tricyclics)
problem w SSRIs
terrible SIDE EFFECTS
- might mean that the patient stops taking them
- effects are temporary
- include indigestion, blurred vision, loss of sex drive
criticism of drugs for treating OCD
Koran (2007) stated that drug therapy might be common/popular BUT PSYCHOTHERAPIES should be tried FIRST
- eg CBT
- drug therapy requires little effort
— might be effective short term
- but it doesn’t provide a LASTING CURE
- many patients relapse within a few weeks if the medication is stopped
BZ drugs
- Benzodiazepines
- eg valium and xanax
- help reduce anxiety
- aim to control the action of neurotransmitters
- reduce activity in the CNS and reduce brain arousal
- reduce blood pressure and reduce heart rate
GABA
GABA = neurotransmitter in the brain
- slows down the firing of neurons
- makes the person less anxious & calmer
- helps reduce psychological activity in the body
GABA & BZs
- BZ drugs BIND to the GABA RECEPTOR SITE of the post synaptic neuron
- this increases the flow of CHLORIDE IONS into the POST SYNAPTIC NEURON
— makes it more difficult for the neuron to be stimulated by other neurotransmitters
— thus SLOWING down its activity & making the person feel more RELAXED - neurons in the brain become LESS ACTIVE - feels calmer
what is a post synaptic neuron?
neuron that receives the signal (from a synapse)
however, BZs decrease …
SEROTONIN
- means that the person has lower arousal and reduces anxiety
- BUT = less happy
- more likely to get depressed
strength of BZs
very EFFECTIVE at reducing anxiety & ocd symptoms
- used by millions of people worldwide
- so they’re very good at reducing anxiety & ocd on a GLOBAL BASIS
advantage of BZs
work very QUICKLY & effectively to cure ocd symptoms
- compared to other psychological treatments
- BZs can begin to reduce anxiety levels and ocd symptoms in a short period of time
- person will see some IMMEDIATE BENEFITS f relief
strength of BZs
can be used for a SHORT PERIOD of time with HARDLY ANY serious SIDE EFFECTS
- unlike other types of drugs
- so, side effects are kept to a minimum in the short ter,
- good for the patient
problem w BZs
if they are used LONG TERM, then several unwanted SIDE EFFECTS can begin to appear
- eg drowsiness, depression, unpredictable interactions w alcohol
- patients have high chance of being involved in accidents
- so, BZs should NOT be used as a long term treatment
weakness of BZs (Ashton)
Ashton (1997) found that long term users become very DEPENDANT on the drug
- sudden withdrawal can lead to a return of high anxiety & ocd symptoms
- problem of DRUG ESCALATION
— whereby patients need to take very large doses of the drug in order to reduce ocd symptoms (if they take the drug for a long period)
criticism of BZs
Stewart (2005) criticised LONG TERM use of BZs
- bcs they cause IMPAIRMENT in speed & processing of VERBAL LEARNING
- effects = temporary (but are still -ve)
- carried out a meta analysis
— found clear evidence that long term use leads to COGNITIVE IMPAIRMENTS
- (cognitive ability seems to improve one BZs are withdrawn, but it’s still below that of control patients who have never taken them)
