OCD

Notes for OCD from AQA A A2 Level.

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Obsessive-Compulsive Disorder
Classification and Diagnosis of OCD
Most forms of mental disorder are categorised into groups according to their common symptoms,
in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders (DSM). The
DSM is produced in the USA and used in the UK; the most recent version is the DSM-IV-TR.
The Characteristics of OCD
The main characteristic is anxiety, which can arise from obsessions and compulsions.
Obsessions ­ recurrent, intrusive thoughts or impulses that are perceived as inappropriate. These
cause anxiety because their content is unlike the thoughts the person usually has. Obsessions are
perceived as uncontrollable, and the sufferer fears they will act on them. Common themes are ideas
(germs everywhere), doubts, impulses (to shout out obscenities) or images.
Compulsions ­ repetitive behaviours or mental acts that reduce anxiety or prevent something bad
from happening. Includes overt behaviours, like hand washing or checking, and mental acts, like counting
or praying. Most OCD sufferers recognise their compulsions as unreasonable, but believe something
bad will happen if they don't perform that behaviour. These can also create anxiety.
Diagnostic Criteria
A clinical diagnosis is only given if there can be no other physiological cause or if the symptoms
can be better accounted for by another disorder. The OCD sufferer recognises that their behaviour
is unreasonable, otherwise they could have schizophrenia. A diagnosis is given if:
1. A person has persistent thoughts etc that are experienced as intrusive and inappropriate and they cause
anxiety, and they are not excessive worries about real life problems
2. A person displays repetitive behaviours or mental acts in response to an obsession. They are not
connected in any realistic way to what they are designed to prevent, they are excessive.
3. The person recognises that these obsessions or compulsions are excessive or unreasonable.
Reliability
This is the consistency of a measuring instrument. It can be measured in terms of whether two
independent assessors give similar scores (inter-rater reliability measures external reliability) or
whether the test items are consistent (internal reliability).
Goodman devised the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ­ It is a semi structured
interview used to assess symptom severity and also to monitor response to treatment. The first two sections
ask patients to identify obsessions or compulsions that have been experienced now or in the past; and the third
section has 10 questions which ask about the extent to which these obsessions and compulsions interfere with
everyday life.
This scale has good reliability; Woody assessed 54 patients with it and found good internal
consistency. Inter-rater reliability was good but test-retest results after an average of 48.5 days
were bad. Kim found good test-retest reliability after two weeks. Self report and computerised
versions of Y-BOCS appear to have similar reliability to interviewer administered versions. Scahill
has found good reliability for the children's version of the scale (CY-BOCS).
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Obsessive-Compulsive Disorder
Validity
The extent to which a classification system, like the DSM, measures what it claims to measure.
Discriminant validity ­ the ability of a diagnosis to distinguish between OCD and other conditions. Rosenfeld
found that patients diagnosed with Y-BOCS had higher scores than those with other anxiety disorders and
controls. However, Woody found that many OCD patients were also diagnose with depression. Brown said that
most experienced clinicians can distinguish between simple worries and obsessions.…read more

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Obsessive-Compulsive Disorder
Genetic Factors
Nestadt looked at 80 patients with OCD and 343 first degree relatives and 73 control patients and
300 of their relatives. They found that people with a first degree relative with OCD had a five
times greater risk of having the illness, compared with the general population. A meta-analysis of
14 twin studies found that MZ twins were more than twice as likely to develop OCD if their twin
had the disorder, than if the twin were DZ.…read more

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Obsessive-Compulsive Disorder
Ritual behaviours associated with this anxiety disorder could be considered an exaggeration of
adaptive behaviour. Marks and Nesse suggest the following examples of adaptive behaviours that
may lead to obsessive compulsive behaviours:
1. Grooming Behaviour ­ parasitism is reduced by grooming, OCD sufferers groom endlessly
2. Concern for others ­ ignoring the needs of others in the group increases the likelihood of ostracism
from the group, many obsessive-compulsives are overly concerned with harming or embarrassing
others
3.…read more

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Obsessive-Compulsive Disorder
Soomro reviewed 17 studies of the use of SSRIs with OCD and they were found to be more effective
than placebos in reducing symptoms as measured with Y-BOCS up to 3 months after treatment. Koran
said little long term data existed
Koran said that tricyclics are more effective than SSRIs, however, they tend to have more side effects,
like hallucinations and irregular heartbeat. So they are more likely to be used only when SSRIs are not
effective.…read more

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Obsessive-Compulsive Disorder
Greenburg used TMS to treat 12 OCD patients, 20 minutes of treatment was effective for at least 8
hours. However, when patients were given sham TMS or TMS there was no measurable difference
afterwards as assessed by the Y-BOCS. So earlier success may have been due to the placebo effect.
Appropriateness:
Ablative psychosurgery, where permanent changes are made to the brain, has severe side effects
ranging from personality change to seizures. However, research has shown that these side effects are
not long lasting.…read more

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Obsessive-Compulsive Disorder
Compulsions ­ compulsive rituals are learnt because of the association between the anxiety-associated
obsessions and the reduction in anxiety. So ritualistic behaviour is reinforced and is carried out when the
individual is faced with obsessive thoughts or situations that provoke anxiety.
Evidence:
Tracy said that Mowrer's theory would predict that OCD patients are predisposed to rapid conditioning.
Students were divided into two groups, and OCD-like group and a control group.…read more

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Obsessive-Compulsive Disorder
pregnancy. This suggests that obsessive-compulsive disorders have different triggers in men and
women.
Psychological therapies for OCD
Psychoanalysis
Koran reported that there were no controlled studies that demonstrate the effectiveness of
psychoanalysis in dealing with OCD. However, the therapeutic approach may help patients who
resist treatment for obsessions and compulsions.
Behavioural Therapy ­ Exposure and Response Prevention therapy
Both obsessions and compulsions are acquired through conditioning so to recover patients must
unlearn these behaviours. However, they are maintained by avoidance.…read more

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Obsessive-Compulsive Disorder
Success of ERP depends on the effort made by the patient. This leads to a substantial refusal rate which
may increase the success of this therapy as only those who are willing to be helped may agree to
participate.
Cognitive Therapy
This therapy focuses on changing thoughts, rather than behaviour. CT aims to challenge and
modify dysfunctional beliefs.
Obsessions ­ the therapist questions how patients interpret beliefs, why they think they are true and why they
think the obsessions developed.…read more

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