OCDs

Question 1

What are obsessions

Answer 1

Obsessions are repetitive and persistent thoughts that are discordant with ones personality and extremely distressful

Question 2

What are compulsions

Answer 2

these are repetitive rituals that individuals engage in to minimise the distress caused by the obsessions

Question 3

What is the ICD-11 criteria for OCD

Answer 3

1)For diagnosis to happen there needs to be persistent obsessions and or compulsions for more than 1 hour a day.

2)The obsessions/compulsions are extremely time consuming and result in significant impairment in the core areas of functioning

3)The symptoms are not a manifestation of another medical condition e.g basal ganglia stroke.

Question 4

What are the two measures of OCD

Answer 4

Maudsley obsessive compulsive inventory (MOCI)
Yale brown obsessive compulsive scale (Y-BOCS)

Question 5

Describe the Maudsley Obsessive Compulsive inventory (MOCI) as a mesure of OCD

Answer 5

-It is a 30 item short assessment tool for OCD. the items measure 4 different subscales of compulsions i.e washing , checking , slowness , doubting

-Each item is scored either true or false. True =1 , False =0

-MOCI produces scores ranging from 0-30

-The person completing the questionnaire is asked to circle either true or false for each of the 30 items

Question 6

Give 3 examples of items in MOCI

Answer 6

items that measure checking;
- spending a lot of time everyday checking things over and over again (true or false)

items that measure slowness
-Im often late because i can’t seem to get through everything on time (true or false)

Items that measure washing
-I’m not excessively concerned about cleanliness

Question 7

Describe the Yale Brown obsessive compulsive scale (Y-BOCS) by Goodman et al as a measure of OCD

Answer 7

-It comprises a semi-structured interview that obtains data about the patients OCD from both the patients and the patients relatives

-The two sets of data from the patient and the patients relatives are compared for reliability.

-It is a checklist of 10 different obsessions and compulsions.
-it has two subscales ; the obsession subscale and the compulsion subscale each comprising of 5 items

-Each item on the Y-BOCS is rated on a 5 point scale from 0-4
4= extreme/disabling , 0=none

-The individual completing the questionnaire is asked to circle an appropriate number relating to the severity of their symptoms.
-Scores range from 0-40 , the higher the scores the more disabling the symptoms.

-Individuals with scores above 16 are considered in the clinical range for OCD.

Question 8

How is the severity of the symptoms operationalised in Y-BOCS

Answer 8

• The durations spent in the obsessions and compulsions
  -How hard the obsessions and compulsions are to resist
  -How much distress the obsessions cause the individual

Question 9

Give examples of items in the Y-BOCS that measures obsessions

Answer 9

-How much of an effort do you make to resist the compulsions
0=always try to resist , 4= completely and willing to yield all compulsions
-How would you feel if prevented from performing your compulsions ? How anxious would you become ?
0= none , 4= incapacitating anxiety

Question 10

Evaluate MOCI and Y-BOCS

Answer 10

1)Concurrent validity
2)Social desirability bias
3)Low validity
4)Useful application to everyday life
5)Holism vs reductionism

Question 11

Describe the biological explanation of OCD

Answer 11

1)Dopamine
- Research has shown that those with OCD tend to have abnormally high levels of dopamine . For example research by Szechtman et al shows that if you increase dopamine levels in rats they will show repetitive movement that reflect the compulsive behaviours in people with OCD.

2)Serotonin
-Research has shown that patients with OCD have lower than normal levels of serotonin in their brains. There is evidence that supports this claim , when patients use antidepressants in the treatment of depression. Strong anti-depressants have shown to be effective treatments for OCD as they increase the brain serotonin levels.

3)Oxytocin
Often described as the love hormone because it is involved in enhancing trust and attachment . However oxytocin is also known to process other behaviours in the extreme ends of the spectrum of behaviours , such as distrust and fear.
Therefore OCD could be considered one of the behaviours in the spectrum of behaviours processed by oxytocin

Question 12

Describe the genetic explanations of OCD

Answer 12

According to numerous research evidence , OCDs are thought to have a genetic basis , i.e that genetic markers are passed down to offsprings by parents that cause the disorder to develop
-Monzani et al
-Ozaki
-Matthiessen

Question 13

Describe Monzani et al’s research as a genetic explanation of OCD

Answer 13

-Carried out a large scale twin study , data from the study found a 52% concordance for OCD trait in MZ twins compared to 21% in DZ twins

Question 14

Describe Ozaki et al (2003) research as a genetic explanation of OCD

Answer 14

-Research implicates SERT gene (serotonin ) in trait OCD. variants of the SERT gene were found in 6 members of two unrelated families who had OCD.

Question 15

Describe Matthessian et al’s (2015) research as a genetic explanation of OCD

Answer 15

Matthessian conducted a large scale study involving 1406 patients with OCD and other members of the general population to analyse and identify genes that will be linked to OCD symptoms.

-Data from this study revealed that the gene PTPRD was implicated along with the gene SLITRK3 in the development of OCD.

Question 16

Evaluate the biological explanation of OCDS

Answer 16

-Reductionism vs holism
-Useful application to everyday life
-Nature vs Nurture

Question 17

What are the 3 psychological explanations of OCD

Answer 17

1)Cognitive explanations
2))Behavioural explanation
3)Psychodynamic

Question 18

Describe the cognitive explanation (thinking errors) (as a psychological explanation of OCDS)

Answer 18

-According to cognitive psychologists OCD is a form of catastrophic misinterpretation of the significance of the intrusive thoughts , impulses and images

-Rachman claims that OCD results from a thinking error such as thought action fusion (TAF)

-According to Rachman people with OCD equate the thoughts to the actions , for them thinking about an event is morally equivalent to acting on the event , or thinking about the event increases the likelihood of the event happening.

Question 19

Describe the Behavioural explanation (as an psychological explanation of OCDS)

Answer 19

-Negative reinforcement is a principle of operant conditioning.

-According to behaviourists OCDs are learnt responses through negative reinforcement.The compulsions negatively reinforce the OCD by relieving the individual from the distress caused by the obsessions

Question 20

Describe the psychodynamic explanation (psychosexual development) (as an psychological explanation of OCDS)

Answer 20

(Traumatic toilet training in the anal stage of psychosexual development)
-According to psychodynamic psychologists like Freud , OCD is a manifestation of fixation at the anal stage of psychosexual development 1-3 years.

-Toilet training is the main activity at this stage , however when it is traumatic e.g when parents are strict it creates tension between the caregiver and the child

-To regain control the child can either soil themselves (anal expulsive personality) or retain the feces (anal retentive personality) both anal retentive and anal expulsive are a manic fixation.

-OCDS are a consequence of under gratification or over gratification of the anal impuloses.

Question 21

Evaluation of the Psychological explanations

Question 22

What are the two types of treatment/management of OCDS

Answer 22

biological
psychological

Question 23

Describe the biological treatment of OCDS

Answer 23

-Obsessions are particularly distressful images , thoughts and impulses
-SSRIS’s help to avert the distress by inhibiting the reabsorption of serotonin across the presynaptic membrane , hence increasing synaptic serotonin levels.

-This helps to minimize the distress by boosting the mood of the patient

Question 24

Describe the psychological treatment of OCDS

Answer 24

-ERP is made up of two components ;
1)Exposure component
2)Response prevention

1) Exposure component
-Here the patient is repeatedly exposed to the situation or object of obsession. The goal of repeated exposure is habituation. (this is when the patient discovers that the object of obsession or fear is in fact not harmful) .

-Exposure is done in a graded way using a hierarchy of fears , exposure begins from least stressful to most distressful which means exposure can be done in vitro and progress to in vivo.

-The hierarchy of feared objects is chosen through collaboration between the patient and the practitioners in one domain of obsessions e.g in the domain of contamination.

2)Response prevention ,
-This is when the patient is stopped from simultaneously engaging in the compulsions while being exposed to the situation/object of obsession
-The goal of response prevention is to weaken the compulsive response to the obsessions
for example , a patient with intrusive thoughts of contamination is prevented from engaging in compulsive washing /cleaning during the exposure sessions until the compulsive behaviour is extinguished

Question 25

What is the sample in Lehmkuhl et Al (2008)

Answer 25

• a case study of a 12 year old boy known as Jason.
• He had both OCD and autism spectrum disorder (ASD)
• He had been diagnosed with high functioning autism (normal iq score) and experienced contamination fear , excessive hand washing, counting and checking.
• He would spend several hours each day engaged in compulsive behavior and reported significant anxiety when prevented from completing his rituals

Question 26

What type of study is Lehmkuhl et Al

Answer 26

A case study

Question 27

Describe the procedure in Lehmkuhl et Al

Answer 27

• Jason attended 10 50 minute CBT sessions over 16 weeks. Some of the ERP techniques were modified to meet Jason’s specific ASD needs ; he was not asked to do visualisation exercises as he would find it impossible to imagine pretend situations.
• step 1 - Jason first identified feelings of distress and with the help of the therapist. learned coping statements for when he felt anxious (e.g. ‘I know that nothing bad will happen…’).
• Step 2 - this step involved exposing Jason to stimuli which he felt were contaminated and produced feelings of anxiety or disgust. These include common objects such as door handles and elevator buttons.
• The exposure involved Jason being asked to touch these items, and repeatedly to do so until he became habituated, and his anxiety levels dropped.
• Exposures became increasingly difficult, so that Jason was engaging in behaviours that held increasing anxiety for him.
• In between sessions, he practised this exposure through specific tasks in his normal environment, handing out papers in a classroom or using contaminated’ items at home.

Question 28

What are the results in the study by Lehmkuhl et Al

Answer 28

• After completing his therapy, Jason’s score on the Y-BOCS had dropped from a severely high pre-therapy score of 18 to just 3, well within the normal range.
• At a three-month follow-up his score remained low, and both he and his parents reported a significant improvement in both his OCD symptoms and his participation in school and social activities.