OCD Flashcards
Give the DSM’s 5 criteria for Obsessive Compulsive Disorder (OCD)
A) obsessions or compulsions, B) recognition that the Os/Cs are excessive/unreasonable, C) Os/Cs cause distress, take up 1h+/day & interfere with routines, D) the Os/Cs’ content does not apply to Axis 1 disorders & E) Os/Cs are not due to substances or a general medical condition
Define obsessions & compulsions
Os) recurrent, persistent & intrusive thoughts (not worries about real-life problems) which Pp try to neutralise (reduce their emotional impact). Cs) repetitive behaviours or mental acts which Pp feel driven to perform in response to Os. They reduce distress but are inappropriate or excessive
Are children’s rituals e.g. avoiding cracks in the pavement examples of compulsions?
No
Why have obsessive-compulsive traits evolved? 17% of 26-32 year-olds report either symptom but may not suffer from OCD because…
Because we have evolved an offline psychological immune system to avoid risks. They don’t experience distress as a result
Name 4 noticeable demographic characteristics of OCD patients in comparison to healthy controls and sufferers of other anxiety disorders
1) Less likely to be married, 2) More likely to be unemployed, 3) “ “ have a low income & 4) “ “ have a low social class
Some people believe that OCD encompasses 2 categories or subtypes of disorder e.g….or…
Early-(childhood) vs. late-onset (adulthood) versions. Tic-based, less anxiety-related vs. non-tic-based, more anxiety-related versions
Name 5 characteristics of early onset OCD in comparison to late onset OCD
1) More male patients, 2) More cases of Cs not preceded by Os, 3) Higher comorbidity with tics & TS (more involuntary), 4) worse response to drug treatments & 5) increased familial loading
In contrast to the categorical approach, the dimensional approach claims that OCD suffering lie at different position on a set of - dimensions. These were extracted using FA & include…(factors 1 & 2 only)
3-5. 1) Washers (a strong R between contamination Os & washing Cs) 2) Orderers (a strong R between symmetry obsessions & repeating, counting & ordering Cs)
Factors 3 & 4 of OCD are…
3) checkers (a strong R between aggressive Os & checking Cs), 4) hoarders (a strong R between hoarding Os & hoarding Cs!)
These factors were confirmed by a meta-analysis. Each component study conducted FA on…. The 3-5 factors account for __% of the variance in symptoms
OCD patient responses on a checklist of obsessions & compulsions. 70%
Are the 3-5 factors reliable? Measures in the study were taken after 1), 2) & 3) and were correlated with symptom category at T1 - what are 1, 2 & 3?
Yes, they are stable across time in as much as patients do not switch between symptom categories, though changes in the clinical content of Os & Cs do occur e.g. bleaching to using hot water to washing hands. 6 months, 1 year & 2 years (Mataix-Cols, 2002)
What is the mysterious 5th factor in OCD? Which symptom factor shows the lowest test-retest reliability?
Sexual/ religious. Aggressive/checking
The validity of the 5 factors is supported by…(3 tests of criterion validity)
1) different patterns of response to SSRIs & exposure-based behavioural therapy, 2) different familial loadings & 3) distinct but overlapping neural bases
In particular, patients typical of which 2 symptom factors respond well consistently vs. inconsistently to SSRIs vs. behavioural therapy?
SSRIs consistently: aggressive/checking & symmetry/ordering (both contain S) vs. inconsistently: contamination/washing. Behavioural therapy consistently: orderers, washers vs. inconsistently: checkers
This leaves ___ & ___/___ ___ with no effective treatment avenue
Hoarders & religious/ sexual obsessions sufferers
Which 2 of the 4 main factors were influenced by familial risk and implicated with specific genes? What was the problem with the familial risk study (Alsobrook, 1999)?
Aggressive/checking & symmetry/ordering. Some Pp who scored highly on factor 1 also scored highly on factor 3, meaning that their OCD was more severe i.e. familial risk may simply be more apparent in more severe cases
The fMRI experiment by Mataix-Cols (2004) took OCD patients with mixed symptoms and attempted to provoke symptoms in them e.g….by…. Patients’ & controls’ neural activity in these different conditions was compared
E.g. washing, hoarding, checking, general disgust & neutral symptom conditions. By presenting images & hypothetical scenarios e.g. imagine coming into contact with [this toilet] & not being able to wash your hands afterwards
Through knowledge of what brain area X usually reacts to, Mataix-Cols (2004) was able to infer the sort of mechanisms which are overactive in the OCD mind. ___, ___ & ___ brain areas lit up in the symptom specific conditions & not the normally aversive condition
Emotional, motor & attentional
Name 4 problems with the fMRI study by Mataix-Cols (2004) to which neural activity findings may be attributable
1) severity of OCD was not controlled for, 2) stage of CBT or drug treatment was not controlled for, 3) patients with comorbidity were not excluded & 4) illness duration was not controlled for
What is hoarding?
The acquisition of & failure to discard items that appear (to others) to have little value
Give 3 pieces of evidence which suggest that hoarding should be considered a distinct disorder from OCD
Abramowitz (2008) found that 1) OCD patients had higher scores than OAD (over-anxious disorder) patients & students on all types of OCD symptoms except hoarding, 2) hoarding correlated more weakly with other OCD symptom types than these types correlated with each other & 3) Hoarding items loaded most weakly on a single OCD factor
Some believe that OCD should be removed from the category of anxiety disorders. Give some e.g.s of other anxiety disorders & their definitions
1) Panic disorder (sudden onset of terror associated with physiological symptoms), 2) Generalised Anxiety Disorder (GAD), 3) PTSD (re-experiencing an extremely traumatic event), 4) social phobia (avoidance) & 5) specific phobia (avoidance)
How can it be argued that OCD is not an anxiety disorder?
Lecturer: “the obsessions is primary” vs. me: “compulsions are not always preceded by obsessions”
It may be more appropriate to place OCD with other disorders, given that other disorders are often characterised by obsessive & compulsive symptoms too e.g….
Depression, GAD, hypochondriasis (fear of having a serious disease based on misinterpretation of bodily symptoms), body dysmorphic disorder (preoccupation with a slight bodily anomaly), autism & impulse-control disorders e.g. TS
In sum, there are 2 overriding conceptual issues with OCD. What are they and how might they be solved? (Covered in previous Qs)
1) There is heterogeneity in the phenotype (categorical vs. dimensional solutions), 2) There are boundary issues with other disorders (broaden the OCD phenotype to encompass 2 independent but overlapping categories relating to other disorders)
What characterises the two proposed OCD categories?
1) anxiety-related OCD (late onset, lower familial loading), 2) tic related OCD (early onset, higher familial loading)
OCD has been explained in terms of deficits to information processing, in particular to…(2 things). There is much evidence to support this view.
Cognitive & behavioural inhibition
At the neural level OCD patients’ failure to inhibit has be explained in terms of dysfunctional…
frontal striatal loops, including the basal ganglia (motor inhibition) & orbitofrontal cortex (updates changes in reward contingencies) = unable to inhibit previously reinforced actions
The frontal striatal loop begins at the thalamus, runs up to cortex and then back down to the thalamus via the ___, ___ ___ (& ___ nucleus)
striatum, globus pallidus (internal vs. external), subthalamic nucleus (external GP route only)
Whiteside’s (2004) meta-analysis of PET & SPECT studies found the largest effect sizes for resting state & symptom provocation activity levels in…
the left & right orbital gyri & the left & right heads of the caudate
Generally the pattern of cognitive deficits in OCD corresponds to the brain sites which show the greatest abnormality in activity in OCD except that…(2 things)
OCD patients are impaired on EF tasks which engage other PFC regions (i.e. not orbital gyri) e.g. the Tower of London planning task & are intact at some decision making tasks which require the OFC e.g. the Iowa gambling task (Menzies, 2008)
Rachman’s (1997) cognitive model of OCD attributes the disorder to faulty cognitive appraisals. The series of events begin with a normal intrusive thought, followed by…
Misinterpretation of the thought as important or threatening, leading to obsessional anxiety, efforts to remove obsessional fear e.g. rituals or thought suppression, anxiety reduction & reinforcement of maladaptive core beliefs
Abramowitz (2006) provides support for the cognitive appraisal view, finding that the greater the no. of intrusive, obsessive thoughts which expectant mothers…
experience before their babies’ birth, the greater the likelihood that postpartum the mothers will experience distressing intrusive thoughts about their infants & will report the use of “neutralising” strategies
Name 2 examples of treatment for a) the pharmacological approach & b) the behavioural approach
a) SSRIs & antipsychotics, b) (imaginal) exposure: systematic, repeated & prolonged confrontation with anxiety-promoting stimuli & response prevention (refrain from performing compulsions to demonstrate no adverse consequences)
Give one advantage & disadvantage of SSRIs as a treatment for OCD
They work well in the short-term, as shown by large effect sizes but there are residual symptoms which the SSRIs don’t target & relapse is common because they don’t target the cause of OCD - notice the treatment/explanation discrepancy
Order to the following OCD treatments in terms of their effectiveness, as found by Foa (2005): combination of drug & therapy, behavioural therapy, placebo & medication
Least to most effective: placebo, drug (chlomipramine), behavioural therapy (exposure & ritual prevention) & the combination (which was only a little more effective than just behavioural therapy)
What does cognitive therapy involve doing? It is usually combined with ___ therapy and is effective in such cases
Identifying & modifying maladaptive cognitions & core beliefs on an individual-by-individual basis. Behavioural
Smaller effect sizes are found when CBT is compared with ___ treatments rather than doing a __- vs. __- treatment comparison. The first study in the table presented used patient ratings as the outcome V, whereas the 2nd study used…
Control. Pre, post. Assessor ratings
