Psychopathology Lessons 11 - 13 (OCD) Flashcards
Behavioural characteristics of OCD
COMPULSIVE BEHAVIOURS: repetitive, unconcealed, patients feel they must do these otherwise something bad might happen and this creates anxiety. The behaviours are external components that can be seen by others
HINDER EVERYDAY FUNCTIONING: obsessive thoughts = great anxiety = compulsions and repetitive behaviour = inability to perform everyday functions
SOCIAL IMPAIRMENT: high anxiety levels = inability to conduct meaningful interpersonal relationships
REPETITIVE: compulsion to repeat behaviours (e.g. washing hands)
AVOIDANCE: avoiding situations that might trigger OCD (e.g. avoiding situations with germs, so never emptying bins)
Emotional characteristics of OCD
ANXIETY AND DISTRESS: sufferers are aware that their behaviour is excessive and this causes feelings of embarrassment and shame
ACCOMPANYING DEPRESSION: anxiety might be accompanied by low mood. Compulsive behaviour brings relief but only temporarily
GUILT AND DISGUST: sufferers feel negative emotions (such as guilt) over minor issues
Cognitive characteristics of OCD
OBSESSIONS: recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden. May be frightening or embarrassing. Internal (because they are thoughts that occur internally inside the mind)
RECOGNISED AS SELF GENERATED: sufferers understand that thoughts, impulses and images are self invented
REALISATION OF INAPPROPRIATENESS: sufferers understand that thoughts and behaviours are irrational but they cannot consciously control them
ATTENTION BIAS: sufferers pay more attention to stimuli that create anxiety, tend to be hyper vigilant, tend to look for things that justify their high anxiety levels
UNCONTROLLABLE URGES: to perform acts that they feel will reduce anxiety
The biological approach to explaining OCD
OCD is caused by genetics and neural explanations
May be inherited whereby sufferers have a genetic vulnerability or genetic disposition to get the illness
OCD has been classed as polygenic (multiple genes responsible, known as candidate genes)
Psychologists use family or twin studies to investigate genetics
COMT
Regulates the production of the neurotransmitter dopamine, which in high levels is associated with OCD
The gene is more common in OCD patients than patients without OCD
High levels of dopamine are responsible for drive, motivation and possibly aggression
SERT gene (Serotonin Transport gene)
Affects the transportation of serotonin which results in low levels of serotonin (resulting in low mood and depressive symptoms)
Found on chromosome 17
Osaki (2003) found evidence that 6/7 family members who had OCD had a mutation of the SERT gene
Evaluation of genetics explanations
+ Nestadt (2000) found that people who had a first degree relative with OCD were 5x more likely to get it (transmitted genetically)
+ Billett (1998) found from a meta-analysis of 14 twin studies that OCD is 2x times likely to be concordant in identical monozygotic twins than in dizygotic non identical twins (transmitted genetically)
- The concordance rate is not 100%, so genetics cannot be the only factor - fails to take into account psychological and environmental factors
- OCD is polygenic. Has been linked to autism and Tourettes syndrome. The genetic cause for OCD is very complex (might be a predisposing factor) and might be related to other illnesses
- Behavioural approach (two process - OCD is learnt) contradicts the genetic explanation
- Diathesis model argues that OCD is caused by a combination of genes and a trigger in the environment (stress) - genes need to be combined with other factors for OCD to develop
Beekman and Cath research into genetics (2005)
A meta-analysis was conducted of twin studies over the last 70 years. Monozygotic twins are compared to dizygotic twins. Studies were examined before the DSM and ICD and after.
10,034 twin pairs were studied overall (from 28 separate twin studies)
From 1929 - 1965 there were 37 pairs of twins
From 1965 onwards there were 9,997 pairs of twins
The results showed that in children, OCD is inherited via genes and the genetic influence ranges from 45 - 65 %
The results showed that in adults, OCD is inherited via genes and the genetic influence ranges from 27 - 47 %
Conclusion: OCD is transmitted genetically and this was more apparent in children than adults
Evaluation of the research by Beekman and Cath
(-) Can be criticised as the majority of studies were not performed in controlled conditions - not very objective or scientific - affects the validity and reliability of results
(-) Gene mapping was not taken into consideration - would have looked at the DNA of twins with OCD and twins without and compared
Dopamine
Is a neurotransmitter that affects mood and might be a cause of OCD (sufferers have high levels).
The frontal lobes in the brain have been linked to dopamine activity.
Research conducted on animals has found high doses of drugs that enhance dopamine levels can induce movement that resemble compulsive and repetitive behaviour, similar to OCD sufferers.
High dopamine levels have been linked to over activity in the basal ganglia area of the brain (motor function and learning)
Serotonin
A neurotransmitter that affects mood and might be a cause of OCD (sufferers have low levels that cause depressive like symptoms and obsessive thoughts).
The frontal lobes in the brain have been linked to serotonin activity.
Serotonin plays a key role in operating the caudate nucleus in the brain - low levels of serotonin cause the caudate nucleus to malfunction
The caudate nucleus plays a vital role in how the brain learns, specifically the storing and processing of memories. Works as a feedback processor, uses information from past experiences to influence future actions and decisions
Evaluation of neural explanations
+ Research support. Anti-depressant drugs increase serotonin levels, reducing OCD symptoms (low levels of serotonin could be a cause for OCD)
- Neurotransmitters might not be the cause - low levels of serotonin and high levels of dopamine might be the effect
- OCD exists alongside depression - not clear whether low levels of serotonin cause OCD or depression or both (link between low levels of serotonin and OCD needs to be investigated further)
+ Ciccerone (2000) found that giving OCD patients low doses of the drug Risperidone helped lower dopamine levels and alleviate some symptoms (high levels of dopamine could be the cause)
+ Menzies (2007) studied MRI scans and found that OCD patients and their families had reduced grey matter in key regions of the brain (compared to healthy controls) and they had an unusual neuroanatomy - abnormal brain structure could be the cause
- High levels of dopamine can also cause other psychological illnesses (e.g. bipolar depression and schizophrenia) - not enough research evidence to suggest that high levels of dopamine cause OCD - could be a combination of factors
Neuroanatomy by Jenike and Rauch
Might be a relationship between OCD being caused by some types of brain damage which might be caused by a virus.
Brain damage causes a problem in the STM that causes a chain reaction of the person doubting whether they performed a specific action (e.g. did I lock the front door?) - may result in repetitive behaviour.
OCD patients were studied using PET scans; they were shown an image of something dirty (they had a cleaning obsession), and evidence showed that their frontal lobes and the basal ganglia were the most active parts of the brain.
The basal ganglia might be overactive (leading to repetitive motor functions), and seems to malfunction in OCD sufferers. It is responsible for control of voluntary motor movements, procedural learning, habit learning, eye-movement, cognition and emotion
Further research has found that OCD sufferers might have damaged the frontal cortex of the brain
Anti-depressants: SSRI drugs
Selective Serotonin Re-uptake Inhibitors
Examples include Prozac and Fluoxetine
SSRI drugs aim to prevent the reuptake of serotonin and prolong its activity - patient feels less anxious
Low levels of serotonin are implicated in the “worry circuit” whereby damage to the caudate nucleus in the brain fails to suppress minor worry signals. The messages then sent to the orbital frontal cortex and the worrying and anxiety get worse.
High levels of serotonin (provided by SSRI drugs) helps the orbital frontal cortex to function at normal levels. The orbital frontal cortex has extensive connections with sensory areas and the limbic system which is involved in memory and emotion. SSRI drugs help stabilise moods and emotions and improve memory.
Drugs are prescribed for 12-16 weeks
Anti-depressants: SSRI’s Evaluation
+ Soomro (2009) reviewed 17 studies comparing SSRI to placebo drugs and found that all studies showed that SSRI drugs are more effective, especially when combined with CBT
+ Relatively effective and 70% of patients experienced a decline in OCD symptoms
- The remaining 30% opted for psychological therapies (maybe SSRI drugs are most effective if combined with other treatments)
+ Relatively cheap and cost effective when compared to psychological therapies (good value for money and economical)
- Does not work for all OCD patients. Alternative drugs may need to be taken
- Terrible side-effects (e.g. indigestion, blurred vision, loss of sex drive)
- Koran (2007) stated that drug therapy might be a popular treatment, but psychotherapies such as CBT should be tried first. Drugs may be effective short-term but are not a long lasting cure and many patients relapse within a few weeks if medication is stopped
