OCD

Question 1

what is OCD?

Answer 1

is is characterised by either obsessions (recurring thoughts, images etc..) and/or compulsions (repetitive behaviours such as handwashing)
most people with a diagnosis of OCD have both obsessions and compulsions

Question 2

what are the different kinds of OCD the DSM-5 recognises?

Answer 2

• OCD
• trichotillomania (compulsive hair pulling)
• hoarding disorder (compulsive gathering of possessions and the inability to part with anything, regardless of its value)
• dermatillomania/excoriation disorder (compulsive skin picking)

Question 3

what is the behavioural component of OCD?

Answer 3

compulsive behaviour

Question 4

what are the 3 behavioural characteristics of OCD?

Answer 4

• compulsions are repetitive
• compulsions reduce anxiety
• avoidance

Question 5

what is the behavioural characteristic ‘compulsions are repetitive’?

Answer 5

typically people with OCD feel compelled repeat a behaviour
some examples: handwashing, counting, praying, tidying/ordering groups of collections of objects, organise food containers in a food cupboard

Question 6

what is the behavioural characteristic ‘compulsions reduce anxiety’?

Answer 6

around 10% of people with OCD show compulsive behaviour alone (no obsessions just a general sense or irrational anxiety)
however for most of the people with OCD, compulsive behaviours are performed in attempt to manage the anxiety produced by obsessions
(e.g. compulsive checking a door is locked is a response to the obsessive thought that it might’ve been left unsecured)

Question 7

what is the behavioural characteristic ‘avoidance’?

Answer 7

the behaviour of people with OCD may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it. People with OCD tend to try manage the OCD by avoiding anxiety triggering situations. However this avoidance can lead to people avoiding everyday life situations, this then interferes with everyday life.
(e.g. someone who compulsively wash they may avoid coming into contact with germs, they may also avoid emptying a rubbish bin)

Question 8

what are the 3 emotional characteristics of OCD?

Answer 8

anxiety and distress
accompanying depression
guilt and disgust

Question 9

what is the emotional characteristic ‘anxiety and distress’?

Answer 9

OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxieties that accompanies both obsessions and compulsions.
obsessive thoughts are unpleasant and can be frightening, and the anxiety that goes with these can be overwhelming. The urge to repeat a behaviour creates anxiety

Question 10

what is the emotional characteristic ‘accompanying depression’?

Answer 10

OCD is often accompanied by depression, so anxiety can be accompanied by low self esteem/mood and lack of enjoyment in activities
Compulsive behaviour tends to bring some relief from anxiety but this is temporary

Question 11

what is the emotional characteristic ‘guilt and disgust’?

Answer 11

as well as anxiety and depression, OCD sometimes involve other negative emotions such as irrational guilt.
(e.g. over minor moral issues, or disgust, which may be directed against something external like dirt or at the self)

Question 12

what are the 3 cognitive characteristics for OCD?

Answer 12

obsessive thoughts
cognitive coping strategies
insight into excessive anxiety

Question 13

what is the cognitive characteristic ‘obsessive thoughts’?

Answer 13

for around 90% of people with OCD the major cognitive factor of their condition is obsessive thoughts i.e. thoughts that recur over and over again. these vary considerably from person to person but are always unpleasant.
(examples: certainty that a door has been left unlocked and that intruders will enter through it, recursing thoughts of worries of being contaminated by dirt and germs, impulses to hurt someone)

Question 14

what is the cognitive characteristic ‘cognitive coping strategies’?

Answer 14

obsessions are the major cognitive aspect of OCD, but people also respond by adopting cognitive coping strategies to deal with the obsessions. these may help to manage the anxiety but can make that person appear abnormal to others and can distract them from everyday tasks.

Question 15

what is the cognitive characteristic ‘insight into excessive anxiety’?

Answer 15

people with OCD are aware that their obsessions are not rational. in fact this is necessary for a diagnosis for OCD. if someone really believed that their obsessive thoughts were based on reality that would be a symptom of a quite different form of mental illness. however in spite of the insight, people with OCD experience catastrophic thoughts about the worse case scenarios that might result if there anxieties were justified. they also tend to be hyper vigilant (they maintain constant alertness and keep attention focused on potential hazards)

Question 16

what is the OCD cycle?

Answer 16

↗️ obsessive thoughts ⤵️
temporary relief anxiety
↖️ compulsive behaviour ↩️

Question 17

what is predispositional vulnerability?

Answer 17

a genetic tendency to suffer from OCD

Question 18

how can OCD be understood as biological?

Answer 18

someone’s genes can make them prone to OCD

Question 19

what were Lewis’ findings for the percentage of immediate family of his OCD patients having OCD?

Answer 19

37% of their parents had OCD
21% of siblings had OCD

Question 20

what were Nestadt et al. (2010) foundings on OCD in twin studies?

Answer 20

68% of identical twins experienced OCD
31% of non identical twins experience OCD
this suggests that OCD has a strong genetic component

Question 21

what is the diathesis-stress model?

Answer 21

predispositional vulnerability + stress from life experiences
this model says genes don’t make OCD certain, but certain life experiences may trigger the condition

Question 22

what is a candidate gene?

Answer 22

are responsible for vulnerability to OCD.

Question 23

what do candidate genes do?

Answer 23

some of them regulate the seretonin system
(e.g. the gene SHT1-D beta is involved in the transport of serotonin across synapses)

Question 24

how is OCD polygenic?

Answer 24

OCd isn’t caused by a single gene but several are involved
(e.g. OCD genes are linked to dopamine and serotonin (these are the neurostransmitters linked to mood))

Question 25

how is OCD aetiologically heterogeneous?

Answer 25

one group of genes may cause OCD in one person, but a different group causing it in someone else (OCD has different genetic causes)

Question 26

what does the neural explanation to OCD focus on?

Answer 26

neurotransmitters as well as brain structures

Question 27

how can OCD be explained by a reduction in the serotonin system in the brain?

Answer 27

serotonin is the chemical that regulates mood. someone with low levels of serotonin may not have normal transmission of mood-relevant information, and therefore other mental functions may be affected.

Question 28

how can abnormal functioning of the lateral of the front lobes lead to OCD?

Answer 28

the frontal lobes (behind your forehead) are responsible for logical thinking and making decisions
(e.g. hoarders syndrome is associated with this)

Question 29

what is the evidence that links the parahippocampal gyrus and OCD?

Answer 29

the parahippocampal gyrus (a bit of the brain) associated with processing unpleasant emotions functions abnormally in OCD

Question 30

how is ‘good supporting evidence’ a strength to the genetic explanation to OCD?

Answer 30

there is good supporting evidence from a variety of sources for the idea that some people are vulnerable to OCD as a result of their genetic makeup-up. one of the best sources of evidence for the importance of genes is twin studies. Nestadt et al (2010) reviewed previous twin studies and found that 60% of identical twins and 31% of non-identical twins share OCD. this therefore strongly suggests that there is a genetic component involved in the development in OCD.

Question 31

how is ‘a genetic explanation is unlikely to ever be very useful’ a limitation to the genetic explanation to OCD?

Answer 31

it is unlikely to be very useful as it provides little predictive value. although twin-studies strongly suggest that OCD is largely under genetic control, psychologists have been much less successful at pinning down all the genes involved. one reason for this is because it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction

Question 32

how is ‘OCD cannot be entirely genetic in origin in all cases’ a limitation to the genetic explanation to OCD?

Answer 32

it is likely that environmental factors can also trigger or increase the risk of developing OCD (the diathesis-stress model). for example Cromer et al. (2007) found that over half the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma. therefore, it may be more helpful to focus on the environmental causes because we are more able to do something about these.

Question 33

how is ‘evidence to support the role of some neural mechanisms in OCD’ a strength to the neural explanation to OCD?

Answer 33

for example some antidepressants work purely on the serotonin system, increasing the level of the neurotransmitter. such drugs are effective in reducing OCD symptoms and this suggests that the serotonin system is involved in OCD.
OCD symptoms also form part of a number of other conditions that are biological in origin (for example: parkinson’s disease (Nestadt et al. 2010)). this suggests that the biological processes that cause the symptoms in those conditions may also b e responsible for OCD.

Question 34

how is ‘twin studies’ a limitation to the neural explanation to OCD?

Answer 34

twin studies make the assumption that identical twins are only more similar than non-identical twins in terms of their genes, but overlook the fact that identical may also be more similar in terms of shared environment. (for example: non-identical twins might be a boy and a girl who have quite different experiences)

Question 35

how is ‘we can’t really claim to understand the neural mechanisms involved in OCD’ a limitation to the neural explanation to OCD?

Answer 35

studies of decision making have shown these neural systems are the same systems that function abnormally in OCD (Cavedini et al. 2002). However, research has also identified other brain. systems that may be involved sometimes but no system has been found that always plays a role in OCD.

Question 36

how is ‘we should not assume the neural mechanisms cause OCD’ a limitation to the neural explanation to OCD?

Answer 36

there is evidence to suggest that various neurotransmitters and structures of the brain do not function normally in patients with OCD. however, this is not the same as saying that this abnormal functioning causes the OCD. these biological abnormalities could be a result of OCD rather than its cause.

Question 37

what is the biological approach to treating OCD?

Answer 37

1. drug therapy is used to treat OCD
2. drug therapy for OCD aims to increase or decrease levels of serotonin in the brain.
3. the anti depressant drug used to treat OCD is called a ‘selective serotonin reuptake inhibitors’ or ‘SSRIs’ for short. Serotonin is released by presynaptic neurons in the brain and travel across a synapse (a small gap separating neurons). the neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then its reabsorbed by the presynaptic neuron where it is reused
4. SSRI’s increase levels of serotonin in the synapse and this corrects the faulty serotonin system in OCD sufferers
5. dosages of SSRI’s varies
6. fluoxetine is an SSRI and a typical dose is 20mg a day. it can take 3-4 months for SSRI’s to have an impact.
7. drugs are often used with CBT to treat OCD. the drug reduces the symptoms like anxiety or depression, thus allowing the CBT to be affective. some people are helped by CBT alone whilst others benefit from drugs.
8. doses of drugs can be increased, it can be combined with other drugs for effectiveness or a completely new antidepressants can be tried.:
   - tricylics may be used (such as clomipramine). these have the same effects as SSRI’s, but have more severe side-effects than SSRI’s
   - SNRI’s or ‘serotonin noradrenaline reuptake inhibitors’. these are quite a recent et of antidepressant drugs. SNRI’s increase levels of serotonin and another neurotransmitter called ‘noradrenaline’.

Question 38

how is ‘ drug therapy is effective at tackling OCD symptoms’ a strength to the biological approach to treating OCD?

Answer 38

there is evidence for the effectiveness of SSRI’s in reducing the severity of OCD symptoms so this improves the quality of life for OCD patients. Soomro et al (2009) reviewed studies comparing SSRI’s to placebos in the treatment of OCD and concluded that all 17 studies reviewed showed significantly better results for the SSRI’s than for placebo conditions. Effectiveness is greatest when SSRI’s are paired with psychological treatment, usually CBT. Typically symptoms decline significantly for 70% of the patients taking SSRI’s, the remaining 305 usually get alternate drug treatment or combination of drug and psychological treatment, these are only effective for some, so drugs are helpful for most patients with OCD.

Question 39

how is ‘drugs are cost effective and non-disruptive’ a strength to the biological approach to treating OCD?

Answer 39

an advantage of drug treatments is that in general they are cheep compared to psychological treatment. using drugs to treat OCD is therefore good value for a public health system like the NHS. as compared to psychological therapies, SSRI’s are also non-disruptive to patients lives. if you wish you can simply take drugs until your symptoms decline and you don’t have to engage in the hardworking of psychological therapy. many patients and doctors like drug treatments for these reasons

Question 40

how is ‘drugs can. have side-effects’ a limitation to the biological approach to treating OCD?

Answer 40

although drugs like SSRI’s are often helpful for OCD sufferers , a significant minority will get no benefit. some patients will also suffer from side effects such has : indigenisation, blurred vision, loss of sex drive. these side effects are usually temporary. for those taking ciomipramine, side effects are more common and more serious. more than 1/10 patients suffer from: erection problems, tremors, weight gain. more than 1/100 people become aggressive and suffer disruption to blood pressure and heart rhythm. sucfacotrs reduce the effectiveness because people stop taking the medication.

Question 41

how is ‘some cases of OCD follow trauma’ a limitation to the biological approach to treating OCD?

Answer 41

OCD is widely believed to be biological in origin. it makes sense, therefore, that standard treatment should be biological. however, it is acknowledged that OCD can have another range of other causes, and that in some cases it could be a response to a traumatic event. this means drug treatments may not be appropriate for all sufferers