Psychopathology Lessons 11-13 (OCD)

Question 1

What is OCD?

Answer 1

Obsessive Compulsive Disorder is an anxiety disorder characterised by repetitive behaviour (compulsions) and obsessive thinking.

Question 2

What are 4 behavioural characteristics of OCD?

Answer 2

Compulsive behaviours
Hinder everyday functioning
Social impairment
Avoidance

Question 3

What is Compulsive Behaviour ? (3)

Answer 3

Compulsions are intense, uncontrollable and repetitive actions which sufferers of OCD perform in order to reduce anxiety and distress created by obsessions (recurrent, intrusive thoughts). This person must perform these actions otherwise something dreadful might happen.

For example, an individual may display the compulsive behaviour of repeatedly and excessively washing their hands in an attempt to control the recurrent, intrusive thoughts (obsessions) that they have towards dirt - dirt contains germs which could make me ill and kill me.

Compulsions are external components because they are behaviours.

Question 4

What is Hinder everyday functioning AND Social Impairment?

Answer 4

Obsessions create high levels of anxiety which people with OCD attempt to control through using compulsive behaviours. This can seriously hinder a person’s ability to perform everyday functions and interfere with their ability to make meaningful relationships.

For example, someone with the compulsive behaviour of washing their hands, may always be late to work because they have to wash their hands first or may not be able to go to the cinema with their friends due to them having to always get up to leave to wash their hands.

Question 5

What are 3 emotional characteristics of OCD?

Answer 5

1 Anxiety and distress
2 Accompanying depression
3 Guilt and disgust

Question 6

What is Avoidance?

Answer 6

Some OCD sufferers attempt to reduced their anxiety by avoiding situations which may trigger it. For example, someone who compulsively washes their hands may avoid coming into contact with germs by never emptying their bins.

Question 7

What is anxiety and distress? (3)

Answer 7

Obsessions and Compulsions are a source of considerable anxiety and distress.
Sufferers of OCD are usually aware that their obsessions and compulsions are excessive which causes feelings of embarrassment and shame.
Sufferers are also aware that they cannot consciously control their compulsive behaviours which leads to strong feelings of distress.

Question 8

What is Accompanying depression?

Answer 8

Sufferers of OCD usually are accompanied with depression where anxiety is linked to a low mood and lack of enjoyment of activities.

Question 9

What is guilt and disgust?

Answer 9

OCD sufferers usually experience irrational guilt and disgust over minor issues towards either something external such as dirt, or sometimes even themselves.

Question 10

What are 5 cognitive characteristics of OCD?

Answer 10

1 Obsessions 
2 Recognised as Self Generated
3 Realisation of inappropriateness 
4 Attention bias
5 Uncontrollable urges

Question 11

What are Obsessions? (4)

Answer 11

Obsessions are recurrent, intrusive and uncontrollable thoughts which are perceived as forbidden and inappropriate and usually lead to extreme anxiety.

These thoughts can be frightening or embarrassing for OCD sufferers which is why they might not want to share them with others.

Obsessions can include doubts (did I leave the iron on?), impulses (shouting in public) or images.

Obsessions are internal components because they are thoughts.

Question 12

What is Recognised as Self Generated?

Answer 12

Most OCD sufferers acknowledge that their obsessions are self-invented and are not externally inserted by others.

Question 13

What is Realisation of inappropriateness?

Answer 13

Most OCD sufferers acknowledge that their compulsive behaviours and obsessional thoughts are inappropriate and irrational but they still cannot consciously control or stop them.

Question 14

What is attention bias?

Answer 14

Sufferers of OCD tend to focus more on stimuli which may raise anxiety levels.

Question 15

What are the two main candidates genes responsible for OCD?

Answer 15

The COMT gene

The SERT gene

Question 16

What are uncontrollable urges?

Answer 16

Sufferers of OCD may experience uncontrollable urges to perform acts (compulsions) which they feel will reduce their anxiety.

Question 17

What is the biological explanation for OCD?

Answer 17

The biological explanation for OCD assumes that OCD can be inherited or caused by genetic and neural explanations.

Question 18

How is the COMT gene responsible for OCD?

Answer 18

The COMT gene is responsible for regulating levels of the neurotransmitter dopamine. One variation of the COMT gene results in high levels of dopamine which is associated with many sufferers of OCD.

Question 19

How is the SERT gene responsible for OCD?

Answer 19

The SERT gene regulates the transportation of serotonin. A mutation of this gene involves low levels of serotonin which is often associated with OCD.

Question 20

What is the genetic explanation for OCD?

Answer 20

OCD has been classed as polygenic meaning that there is no single gene responsible for the development of OCD. Instead, many genes may be responsible for causing OCD. These are known as candidate genes.

Question 21

What are two advantages of the genetic explanation of OCD?

Answer 21

+ There is lots of research support the genetic explanation for OCD. Nestadt (2000) discovered how people with a first degree relative who suffers from OCD are 5 times more likely to get the illness too. Therefore, perhaps OCD is genetically inherited/caused by genetic vulnerability.

+ There is lots of research support the genetic explanation for OCD. Billet (1998) supports the idea that OCD is transmitted genetically. He found from a meta-analysis of 14 twin studies that OCD is twice as likely to be concordant / consistent in monozygotic twins, who share the same genes, than dizygotic twins, who do not share the same genes.

Question 22

What are 3 disadvantages of the genetic explanation for OCD?

Answer 22

• A weakness of the genetic explanation for OCD is that the concordance rates for OCD in monozygotic twins is not 100%. Therefore, OCD cannot be entirely caused by genetics and there must be other factors.
• Another weakness of the genetic explanation for OCD is that a the behavioural approach criticises it. The two process model would suggest that OCD is it actually learnt through classical conditioning and maintained through operant conditioning and is not caused by genetics.
• Another weakness of the genetic explanation for OCD is that the Diathesis Stress Model would argue that OCD isn’t caused entirely because of genes, but is instead due to the combination of genes and environment factors such as stress. This weakens the genetic explanation for OCD.

Question 23

What is the neural explanation for OCD?

Answer 23

The neural explanation suggests that it is faults in the nervous system which cause OCD / abnormal levels of neurotransmitters are associated with OCD.

Question 24

What are the two transmitters associated with OCD?

Answer 24

Serotonin and Dopamine

Question 25

How is dopamine associated with OCD?

Answer 25

Dopamine is a neurotransmitter in the brain which affects mood. High levels off dopamine have been associated with OCD.

Research on animals has found that high doses of drugs which enhance dopamine levels can induce compulsive and repetitive behaviour, similarly to that of OCD sufferers.

High levels of dopamine have also been linked to overactivity in the basal ganglia in the brain which can cause repetitive motor functions (compulsions).

Question 26

How is serotonin associated with OCD?

Answer 26

Serotonin is a neurotransmitter in the brain which affects mood. Low levels off serotonin have been associated with OCD as it can cause depressive-like symptoms and also obsessions.

Serotonin also plays a key role in operating the caudate nucleus which plays a vital role in how the brain stores and processes data. However, if serotonin levels are low, this causes the caudate nucleus to malfunction. Therefore, if someone has a malfunctioning caudate nucleus, they may also have OCD.

Question 27

Is high/low levels of dopamine/serotonin associated with OCD?

Answer 27

High levels of dopamine is associated with OCD.

Low levels of serotonin is associated with OCD.

Question 28

What are two advantages of the neural explanation of OCD?

Answer 28

+ Anti-depressant drugs which increase serotonin levels have lead to a reduction in OCD symptoms. This supports the neural explanation that low levels of serotonin could cause OCD.

+ Ciccerone (2000) found that giving patients low doses of the drug Risperidone which helped lower dopamine levels helped alleviate OCD symptoms. This supports the neural explanation that high levels of dopamine could cause OCD.

Question 29

What are two disadvantages of the neural explanation for OCD?

Answer 29

• A weakness of the neural explanation for OCD is that it is unclear whether abnormal levels of serotonin and dopamine cause OCD or OCD causes the abnormal levels.
• Another weakness of the neural explanation of OCD is that it is co-morbid with depression (exists alongside depression) and is unclear whether low levels of serotonin cause OCD or depression or both. Therefore, the link between low levels of serotonin and causing OCD is not very clear and needs to be investigated further.

Question 30

What is the biological approach to treating OCD?

Answer 30

The biological approach utilises medication to increase or decrease neurotransmitter levels in the brain in order to reduce anxiety, lower arousal, decrease heart rate and to generally reduce OCD symptoms.

Question 31

What are two drugs utilised to treat OCD?

Answer 31

SSRI’s (Selective Serotonin Re-Uptake Inhibitors)

BZ’s (Benzodiazepines)

Question 32

What are SSRI’s and how do they help treat OCD?

Answer 32

Selective Serotonin Re-Uptake Inhibitors are anti-depressant drugs which aim to reduce levels of serotonin in the brain. This helps to reduce the anxiety and symptoms in patients with OCD.

Question 33

What are two examples of SSRI’s?

Answer 33

Prozac / Fluoxetine

Question 34

How do SSRI’s work?

Answer 34

SSRI’s aim to prevent the re-uptake and reabsorption of serotonin, which is too fast in people with OCD. This results in higher levels of serotonin where it stays in the synaptic cleft for longer and remains active in influencing the post-synaptic neuron which helps to normalise the ‘worry circuit’. The ‘worry circuit’ is where low levels of serotonin causes damage to the caudate nucleus where it can longer suppress an individual’s minor worry signals. These signals then travel to the orbital frontal cortex which increases anxiety levels. SSRI drugs help to reverse this in order to reduce anxiety levels and help cure OCD.

Question 35

What is an advantage but also a disadvantage of SSRI’s?

Answer 35

An advantage of SSRI drugs is that they are relatively effective and 70% of patients experienced a reduction in OCD symptoms after taking them.
However, the other 30% found that SSRI drugs combined with psychological therapies were more effective which suggests that SSRI drugs cannot alone treat OCD.

Question 36

What are two advantages of SSRI drugs?

Answer 36

+ Soomro (2009) reviewed 17 studies that compared the use of SSRI’s to placebo drugs for treating OCD and found that in all 17 studies, the SSRI drugs were more proven to be more effective than the placebo’s.
+ SSRI’s are very cheap and cost-effective compared to other therapies like CBT, and are good value for money for the NHS.

Question 37

What is a disadvantage of SSRI’s?

Answer 37

A weakness of SSRI drugs is that they have terrible side effects which might mean that the OCD patient may stop taking the medication which prevents their OCD from being cured. Side effects may include a loss of sex drive, blurred vision and indigestion.

Question 38

What are BZ’s and how do they help treat OCD?

Answer 38

Benzodiazepines are anti-anxiety drugs, often used to treat someone with OCD, which work to reduce heart rate and blood pressure to make people feel relaxed and less anxious.

BZ’s also reduce activity in the central nervous system by increasing levels of the neurotransmitter GABA in order to reduce anxiety levels. GABA increases the flow of chloride ions, which reduce the stimulation of neurons, in order to slow down neural activity, making a person feel more relaxed and less anxious.

Question 39

What are two examples of a BZ drug?

Answer 39

Xanax

Valium

Question 40

What are 2 advantages of BZ drugs?

Answer 40

+ BZ drugs are a “quick fix” where they reduce anxiety levels and OCD symptoms in a very short period of time compared to other treatments like CBT. This allows sufferers of OCD to have immediate relief and return to everyday life as quickly as possible.

+ BZ drugs can be used for short periods of time which produce far less side effects compared to SSRI’s.

Question 41

What are 3 disadvantages of BZ drugs?

Answer 41

• When they are used for a long period of time, BZ drugs can produce a lot of serious, long-term side effects such as drowsiness, depression and unpredictable interactions with alcohol. Therefore, BZ drugs cannot and should not be used on a long-term basis.
• Ashton (1997) found that long-term users of BZ became very dependent on the drug where sudden withdrawal of the drug lead to an immediate return of high levels of anxiety and OCD symptoms.
• BZ drugs merely act as a ‘plaster’ and fail to get to the underlying, root causes of the OCD meaning that there is a very high chance that the patient will relapse. Therefore, BZ drugs may not be a very good way to treat OCD.