OCD

Question 1

Outline the use of the drugs in the treatment of obsessive-compulsive disorder (OCD). (4m)

Answer 1

• the aim of the drugs are to attempt to increase or decrease levels of neurotransmitters or the activity of neurotransmitters in the brain
• the general purpose is to decrease anxiety, lower arousal, lower blood pressure or heart rate
• antidepressants – like the SSRIs – prevent the reuptake of serotonin and prolong its activity in the synapse in order to reduce anxiety / normalise the ‘worry circuit’
• tricyclics – block the transporter mechanism that re-absorbs both serotonin and
  noradrenaline, again prolonging their activity
• anti-anxiety drugs – such as benzodiazepines – enhance the activity of GABA and
  therefore slow down the CNS causing relaxation
• SNRIs – more recent drugs which also increase levels of serotonin and nor-adrenaline and are tolerated by those for whom SSRIs are not effective.

Question 2

Distinguish between obsessions and compulsion

Answer 2

• obsessions are internal components because they are thoughts
• compulsions are external components because they are behaviours.

Question 3

“Researchers analysed the behaviour of over 4000 pairs of twins. The results showed that the degree to which obsessive-compulsive disorder
(OCD) is inherited is between 45% and 65%.”

what do the results seem to show about possible influences on the development of OCD?

Answer 3

• results indicate development of OCD is at least partly genetic
• the findings suggest that heritability is high (between 45% and 65%)
• this means that there must also be other explanations (inherited influence is not 100%)
• so other factors (eg environment or other bio factors) may also partly account for OCD.

Question 4

Outline characteristics of obsessive-compulsive disorder

Answer 4

A cognitive characteristic would be an irrational belief or persistent recurring thoughts – catastrophic thinking such as: ‘My family is in danger and might get trapped in a house fire’.

An emotional characteristic would be feeling anxiety or the reduction of anxiety

Question 5

define obsessions

Answer 5

repetitive and persistent thoughts and images

Question 6

define compulsions

Answer 6

repetitive acts or behaviours, physical (touching/tapping things a certain way), or mental (counting to a certain number in your head)

Question 7

what are thought-event fusions, as stated in the ICD-11?

Answer 7

• ICD-11 states that compulsions are often carried out in response to an obsession, possibly to neutralise negative thoughts.
• a person may imagine something bad like someone getting in a car accident and become anxious believing the thought will make it happen.
• they may feel compelled or driven to carry out certain behaviours in order to stop the accident from happening, to neutralise the negative thought, even if the compulsion is not rationally linked

Question 8

when would OCD be diagnosed?

Answer 8

• only if the obsessions and compulsions are time-consuming, and take up more than one hour a day.
• only if the symptoms cause significant distress and/or negative impact on a person’s life in any way.

Question 9

what are specifiers when diagnosing OCD?

Answer 9

• gives information but whether the person has
  1. poor-absent insight into their condition
  2. fair-good insight into their condition

Question 10

what differs between people who lack insight into their condition and those who do?

Answer 10

people who lack insight into their condition may be convinced that their obsessional thoughts are true and that their compulsions are necessary to control events in the world.

Question 11

list some types of obsession

Answer 11

contamination
harm/safety
symmetry/order
taboo thoughts

Question 12

list some types of compulsions

Answer 12

cleaning
checking
counting
ritualistic physical or mental acts in an attempt to neutralise.

Question 13

what are the two types of measurements for OCD?

Answer 13

Maudsley Obsessive-compulsive Inventory (MOCI)

Yale-Brown Obsessive-compulsive scale (Y-BOCS)

Question 14

describe to MOCI

Answer 14

• consists of 30 items
• scored either truth or false
• to assess symptoms relating to checking, washing, slowness, and doubting
• takes 5 minutes to complete
• score ranges from 0 to 30
• developed by Hodgson and Rachman (1977)

Question 15

what is a strength of the MOCI

Answer 15

one strength is that it has a high-rest reliability.
- Hodgson and Rachman (1977) asked 50 students to complete the test and then reassessed them one month later.
- 89% of the 1500 pairs of scores generated were the same, showing the test to be highly consistent.
- important because a test that is not accurate can lead to inaccurate diagnoses, OCD could become worse due to lack of appropriate treatment

Question 16

what is a weakness of the MOCI

Answer 16

weakness is that it uses fixed-choice questions.
- between true or false
- may not know how to respond if a statement is only true some of the time or they do not understand the question
- ex: “I use only an average amount of soap” The definition of average differs and is subjective.
- if the available options do not reflect what the respondent really thinks or feels, the data will lack validity, meaning they may not receive correct treatment

Question 17

describe the Y-BOCS

Answer 17

• described by Goodman et al. (1989)
• designed to measure the nature and severity of an individual’s symptoms
• semi-structured interview
• 30 mins
• a checklist of different obsessions and compulsions with a 10-item severity scale
• scale used to help plan treatment or to assess how treatment is progressing
• score from 0-40
• above 16 is considered in the clinical range for OCD

Question 18

what is a strength of the Y-BOCS?

Answer 18

a strength of this psychometric test is it has strong inter-rater reliability.
- means two or more interviewers use the scale to assess the same person, there is a high level of agreement between them regarding the severity of the person’s symptoms.
- goodman et al. (1989) tested this using 40 people with OCD, each of whom were assessed by 4 different interviewers.
- found it reliable measure of OCD symptom severity

Question 19

What is a weakness of the Y-BOCS?

Answer 19

it asks people to consider the severity of their symptoms in the last week.
- can be a problem if symptoms are different throughout the week.
- some days may be worse than others if the person were, example, under stress
- important because without qualitative data to put the scores into context it may be difficult for a clinician to get an accurate impression of the impact that the symptoms are having on a person’s overall functioning

Question 20

what is the difference between the MOCI and the Y-BOCS?

Answer 20

the MOCI is self-reported while the Y-BOCS is completed by a clinician as part of a semi-structured interview.

both tests are weakly correlated (goodman et al., 1989), thought to be related to the way data is collected

Question 21

what are some possible genes that may be linked to OCD? explain.

Answer 21

5-HTT which codes for serotonin

DRD4 and COMT linked to dopamine

SLITRK5 linked to BDNF

oxytocin - higher levels, more severe symptoms

Question 22

what are some psychological explanations of OCD?

Answer 22

thinking error - Having the thought itself is just as bad as carrying it out.

operant conditioning - engaging in behaviour may alleviate the obsession temporarily. rewarded by having the obsession satisfied,can shape into learned behaviour

psychodynamic - explains OCD by looking at unconscious beliefs and desires. obsessive thoughts that come from the id disturb the rational part of the self (the ego) to the extent that it may lead to compulsive cleaning and tidying rituals later in life, to deal with the earlier childhood trauma.

Question 23

what are some psychological therapies for treating OCD?

Answer 23

exposure and response prevention
- people are asked to identify obsessional thoughts that trigger compulsive behaviours and then identify environmental triggers that cue these thoughts. These cues are given
Subjective Units of Distress Scale (SUDS) ratings
- only effective if exposures last long enough for the person to habituate to the stimulus, meaning that arousal levels reduce to the point where the person is no longer anxious.