OCD

• obessions,ideas,thoughts images or impulses
•  repeatly enter mind 
• unwelcome & distressing
• compulsions-acts driven to perform
• compulsions remove anxiety 

ICD 10 or DSM-V

• obesessions/compulsions present on most days for 2 weeks
• accpeted by patient coming from own mind 
• recognised as excessive/umpleasant 
• resisted by patients 
• not pleasurable 
• cause distress 
• arent caused by another disorder or drug use

• different wording of classifcation (reduces inter observer diagnosis 
• developed in west (cultural variations)
• within defintions there are overlaps between other disorders 
• 1-3% have OCD 
• OCD charity estimated 7% 
• may not go to doctors due to self fulfiling prophecy 
• stigma attached mental illness seen as a negative lable

Yale Brown obsessive complusive scale (Y-BOCS)

• semi structured interview indentify severity of OCD
• patients given score after completing scale
• final judgment given by clinician
• ranges from subclinical to extreme

advantages of semi structured interview 

• builds repor with interviewer,sensitive subject (increase validity)
• elaborates (answer prompts)
• all answer same questions (increased reliability)
• can reword Q's for children 

disadvantages 

• forcing their answer,limited responses (decrease validity)
• social desirability bias (dont want to appear severe)

Reliability 

• 54 patients with OCD using Y-BOC's & found good internal consistency 
• inter rater reliability was reported as excellent 
• (woody et al)

Test re-test 

• not reliable after delays 
• due to subjectivity of illness as it changes (good days/bad days)

Validity

• Is Y-BOCS assessing OCD or other disorders?
• shares similar characteristics with schizophrenia & depression 
• social desirability
• should we catagorise all compulsions as the same 

• ID- irrational pleasure seeking part of our unconscious mind 
• SuperEgo- moral part of personality helps controls urges from ID
• Ego- rational conscious part of our personality

freud

• childs natural behaviour repressd 
• children dont cope well will suffer from OCD later in life 

adler (1931)

• inferiority complex
• children rearing practices are too controlling 
• unable to develop sense of autonomy 
• individual adopts compulsive rituals to control and achieve autonomy 

• cannot test the theory- no empirical evidence (shouldnt disregard)
• retrospective data- majority of evidence unreliable (may not remember,memory influcenced by children & current situations)
• objectivity
• ignore current factors- e.g. relationship breakdown/unemployment to explain abnormality
• androcentric research- sexist only studied men 

Salkovskis et al (2003)

• people with OCD believe that they can & should be in control of their thoughts 
• when experience an intrusive thought they act
• neutralising the intrusive thought 

support the cognitive explanation 

Salkovski (1997)

• asked patients to record intrusive thoughts in diary 
• try and repress thought on certain days 
• patients recorded x2 many thoughts on repression days

• vauge and don't know where thought processes come from (does it explain how OCD develops)

Reductionist 

• ignoring environmental & subconscious factors

A02 conclusion (diathesis-stress model)

• mixture of both biological explanation & psychological 

Mowrer(1977)

• classical conditioning = obessions (associations)
• operant conditioning= complusive rituals maintained positive/negative reinforcement 

Rachman & Hodgson (1980) support

• people who engage in compulsive behaviour rewarded in a reduction of anxiety 

• effective therapy (ERP) based on the explanations of the behavioural approach 
• good explanation of how OCD is maintained & not just focusing on cause 

Marks (1981)

• ERP only effective at treating compulsions  not thoughts 
• where do they come from?

Treatment aetiology fallacy

• treatment doesnt equal an explanation 
• doesnt mean if treatment works thats the explanation 

Neuroanatomical abnormalities 

• orbital frontal cortext plays a role in sensory processing 
• linking value to reinforcing stimuli & decision making (obessions)
• Basal Ganglia where movements controlled (compulsions)

PET scan 

• patients with OCD have heightened activity in OFC 

Basal Ganglia 

• problems with BG linked to OCD (wise & rapoport)
• surgery discontecting BG from OFC can help OCD sufferers (Aylward)

Comer (1998)

• OCD sufferers low levels of serotonin- vital for frontal lobes and OFC
• cause & effect 
• low levels of serotonin?
• PFC not working?

sukel (2002)

• high dopamine levels 
• over activity in BG

Antidepressants

Pigott et al (1990) 

• serotonin/dopamine reduce OCD symtoms others don't 
• SSRS procedure 
• treatment aetiology fallacy 

Genetic factors  Nestadt et al(2000)

• 80 OCD & 343 1st degree family members 
• 1st degree relative with OCD X5 more likely to get OCD 
• something genetically will be past down

Billet et al (1998)

• MZ X2 likely to get OCD if co-twin had disorder 
• maybe prone to vicarious learning 

advantages 

• scientific- empirical evidence 
• objective measures
• removes blame 

Disadvantages 

• reductionist-ignores current factors/environmental 
• deterministic- removal of free will (acting as pupets and their biology is the master)

serotonin

• linked with emotion & mood 
• research suggests neurotransmitter flucates then depression/mood disorder flucates
• 10-20% used in brain 
• cannot be articially created or placed in brain 

Soomaro et al (2008)

• 17 studies of SSRI's give to OCD patients 
• more effective than placebos 

• severe side effects
• short term solution 
• takes away persons sense of responsibility/control
• addiction
• relapse when stop taking the drug 
• cheap & quick 
• alternative to psychological treatments (prescribre more freely)

Psychosurgery 

• surgial intervention aims to treat behaviour 
• no cause has been established 
• only used for severe cases if patient doesnt respond to other forms of treatment 

Cingulotomy

• heated probes the cingulated gurus tissue destroyed
• links OFC & lympic system (emotion and behaviour)

Dougherty (2002)

• 45% patients unsuccessfully treated with drugs
• showed improvement cingulotomy 

Mary Lou Zimmerman 

• suffered from OCD 
• drugs ineffective 
• performed cingulotomy 
• she was paralysed from the opperation 

• MRI scan to pin point area
• firing electordes into the brain 
• implanting tiny electrical wire and emits signors to cure brains abnoral brain waves/rhythm 
• fine tune pace maker to suit individual 
• rewires brain 
• MRI scans locate parts of brain 
• microscopic robots used target parts of brain 
• experience mood swings 

• tailor fine tuning to the individual needs
• scienfic 
• turn pace maker off 
• change settings
• long term 
• expensive 
• danger/risk 

Exposure And Response Prevention Therapy (ERP)

Meyer (1966)

• obessions and compulsions learned ths patient must unlearn 
• Modelling (exposure)- exposed to feared stimulus 
• Response prevention- learns to realise there are other ways to remove anxiety caused by obession 
• taught relaxation techniques 
• relatives and partners often advised to join 
• verbal persuasion,encouragement of alternative behaviour and contiouous monitoring help 
• forceful intervention is counter productive 

albucher et al (1998)

• 60-90% adults with OCD improved using ERP 

Huppert & Franklin (2005)

• ERP works best along side cognitive behavioural therapy

Salkovski & Kirk (1997)

• ERP has moderate success rate 
• complete removal of OCD symptoms occured in less than 1/2 of patients 

EmmelKamp(1982)

• gave women obessed with cleaning exposure homewoek in between therapy sessions 

• can treat yourself at home using BTsteps 

• high in validity 
• long term (patient power)
• time consuming 
• expensive
• shortage of counsellors- computer guided may not be successfull
• positive effects on the brain e.g OFC may have improved 

Cognitive Therapy 

• changing thoughts
• obessesions and compulsions challenged 
• asked why they believe what they believe 
• not logical 
• patients record any unwanted thoughts and actions for later discussion 

Ellis (2001)

• some patients rejcect therapist and ifnore their help

Koran et al (2007) 

• CT and ERP very similar combine the two to produce best results