OCD

Question 1

Obsession and compulsions explanations

Answer 1

Obsessions:
intrusive, repetitive and distressing thoughts/images/urges.
Ego-dystonic in nature (at odds with ego or self-image).
Known to be product of own mind.

Compulsions:
repetitive behaviours or mental rituals (neutralisations).
Performed to decrease distress caused by obsessions.

Question 2

Subtypes & sub dimensions

Answer 2

Most common:
Checking
Doubting
Cleaning/ Contamination
Symmetry/ Ordering
Hoarding
Religious

All relate to fear of being responsible for harm.

Question 3

Salkovskis (1985) cognitive model of obsessions

Answer 3

Obsessions = misinterpretation of intrusive thoughts.

e.g. a disaster might happen, impulse to harm someone.

Question 4

Intrusive thoughts

Answer 4

99% population experience negative intrusive thoughts.

Differ from obsessions in frequency and intensity, but not in content.

Majority of us can dismiss negative thoughts, obsessive individuals misinterpret them.

Think thoughts reveal hidden aspects of their character.

Question 5

Inflated responsibility

Answer 5

Checking subtype strongly related to responsibility.

Reeves, Reynolds and Wilson (2010)
81 children (8-12 yrs) 3 groups: Inflated/Moderate/Reduced.
Sort sweets according to whether they contained nuts.
More responsibility = hesitation/slower and increased checking.

Question 6

Salkovskis (1985) 5 ‘dysfunctional assumptions’:

Answer 6

1. Having thoughts about action is like performing action.
2. Failing to prevent harm is the same as having caused harm.
3. Responsibility not reduced by other factors e.g. low probability of occurrence.
4. Not neutralising intrusions = wanting intrusion to happen.
5. One should (and can) exercise control over their thoughts.

Question 7

Thought Action Fusion

Answer 7

(Shafran et al, 1996): The belief that thoughts and actions are inextricably linked:

Moral: Unacceptable thoughts are moral equivalent of actions.
Likelihood: Thinking of event increases likelihood of event occurring.

Both forms linked to OCD, Likelihood-TAF more so.
Found in most subtypes more often in checking.

Misinterpretations lead to feelings of anxiety, guilt, compulsive and neutralising behaviours.

Neutralisations & performing compulsions strengthened by their partial success - event doesn’t occur.

Question 8

Prevalence

Answer 8

1-3% population.

One of the most debilitating mental health disorders (WHO)

Profound effect on sufferer’s quality of life – sometimes more so than schizophrenia (Moritz et al., 2008)

Rarely emerges before puberty

Question 9

Thought suppression

Answer 9

Obsessional thoughts cause distress so resisted.

Resistance takes form of thought suppression - attempting to stop thinking that thought.

Wegner et al’s (1987) White Bear Experiment (suppression led to increase in thoughts even afterwards).

Question 10

Orbitofrontal-Striatal Model

Answer 10

Most widely accepted model of brain dysfunction in OCD.

Imbalance of circuits between the prefrontal cortex and the striatum.

Evidence that different symptom dimensions have different biological substrates.

Question 11

Twin studies

Answer 11

Genetics account for 37-41% variance in symptoms.

OCD is heritable.

Question 12

Treatment

Answer 12

SSRIs and benzodiazepines

Exposure and Response Prevention (ERP)
Patient is exposed to compulsion-eliciting stimulus and prevented from performing compulsions.

CBT
Patient’s faulty cognitions are addressed, e.g. appraisals of risk and responsibility.