OCD

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what is OCD?

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

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
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issues with using ICD-10/ DSM-V

  • 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
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Assessing severity of OCD

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)
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evaluation of Y-BOCS

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 
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psychological explanations of OCD

  • 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 
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evaluation psychodynamic approach

  • 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 
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cognitive explanation of OCD

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
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evaluation of cognitive explanation

  • 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 
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behavioural explanation of OCD

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 
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evaluation of Behavioural theory

  • 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 
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Biological explanation of OCD

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)
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A02

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
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Biological explanation of OCD

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 
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evaluation of biological explanations

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)
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Biological therapies of OCD

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 
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evaluation of drugs

  • 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)
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Biological therapies of OCD

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 
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case study

Mary Lou Zimmerman 

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

  • 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 
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deep brain stimulation (A02)

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

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 
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evaluation of psychological therapy

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 
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evaluation of psychological therapy

  • 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 
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psychological therapies for OCD

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 
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evaluation of psychological therapy

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 
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