- Characterised by presence of obsessions and compulsions.
- Obessions = persistent and uncontrollable thoughts or urges
- Compulsions = the need to repeat certain actions to reduce anxiety.
- Minor OCD can sometimes be helpful at calming us when stressed.
- Becomes a disorder when so intrusive it interferes with life/normal functioning.
- Person is aware thoughts are unreasonable and are from own mind.
- Common themes/compulsions:
- contamination/dirt --> compulsive cleaning/need for order.
- Checking (e.g. switches, door locked etc.)
- Counting/touching objects a certain number of times.
- Measured by the Maudsley Obsessive Compulsive Inventory (MOCI)
- Approx 1-3% of population are sufferers but secretive so could be higher.
- Male onset younger, typically 6-15 years.
- Female onset typically 20-29 years.
- Males more likely to be checkers.
- Females more likely to be washers.
- Mower (1960)
- Classical Conditioning - Certain words, thoughts and images have become associated with anxiety causing stimuli.
- Operant Conditioning - carry out an act (compulsion) which reduces anxiety = reinforced behaviour!
- Not all obsessions have compulsions!
- How are obsessions maintained without the presence of compulsions?
- Rachman & deSilva (1978)
- 90% have intrusive thoughts, only 1-3% develop disorder.
- OCD sufferers must interpret thoughts differently as opposed to simply learning the behaviour.
- If behavioural model was correct, the 90% would all develop the disorder easily.
- Cognitive Biases - OCD sufferers have a number of faulty cognitions:
- RESPONSIBILITY - high sense - if don't do something people will be harmed.
- GUILT - excessive moral value on cleanliness etc, if fall short of standards then guilt.
- THOUGHT = ACTION - believe if think something they will do it/it will happen.
- OVERESTIMATE DANGER - and exaggerate likelihood of averse consequences.
- CONTROL - feel should have control over thoughts.
- MEMORY - memory problems may explain compulsive checking/worry.
- Greisberg & McKay (2003) - deficits in organisational strategies = trying to recall disorgaised info = doubting.
- Kirkby (2003) - frontal lobe dysfunction.
- Purcell et al (1998) - Errors in executive and visual memory
- Veale et al (1996) - planning and accuracy errors.
Medical / Biological Model
1) Brain Deficits / Activity
- Baxter et al (2001) - Basic impulses from frontal cortex can't be switched off.
- Chamberlain et al (2005) - frontal cortex more active than controls.
- Baxter et al (1990) - Caudate nuclei & thalamus too active? = constant troublesome thoughts and actions.
2) Genetics / Vulnerability
- Lambert & Kinsley (2005) - higher concordance for MZ than DZ.
- Pauls et al (1995) - 6% of sufferers' parents also suffered.
- Chromosome 9 potentially implicated.
- Menzies (2007) - OCD patients and relatives showed behavioural impairment linked to reduced grey matter in frontal cortex.
- Some have linked OCD to low levels of serotonin --> SSRIs effective for OCD!
1) Harsh toilet training
- = child rage which in turns leads to parents bad mood.
- child wants to be 'dirty' but also wants to keep parents happy.
- This conflict leads to OCD.
- Would explain cleanliness OCD but not other forms?
- Usually sexual or aggressive in nature battled out in conscious instead of unconscious.
- Id Impulses = obsessions.
- Ego defences = compulsions.
Social Model & Integration Model
- Parents may have placed great emphasis on unreasonably high standards.
- If these standards not met = anxiety.
- Genetic predisposition / Brain structure / chemistry.
- Experience high arousal to cognitions due to this = anxiety.
- Judgements and assumptions distorted.
- Try to stop the thoughts but makes them more frequent.
- Various cognitive / behavioural acts give temporary relief.
Cognitive-Behavioural Treatment (ERP)
- Rationale = always perform compulsions to reduce anxiety, never risk not doing them --> need to stop doing something to see its effect.
Exposure and Response Prevention (ERP)
1) Expose person to stimulus causing anxiety.
2) Block compulsive behaviour.
3) Reappraise the fear - person sees that nothing bad happens when compulsions not carried out.
- Has to be done in a very controlled setting occasionally (e.g. hospital).
- VERY STRESSFUL!!
- Mant won't even try ERP and drop out rates are high.
Efficacy of ERP
- Hallon et al (2006) - 55-85% improvement
- Works best for cleaning and checking OCD.
- Foa & Kozak (1996) - Benefits lost over 29 months.
- Foa (2008) - 25% failed to benefit.
- 22-30% drop out or don't comply.
- Some relapse has been seen - likely down to non-compliance.
Pure Cognitive Therapies
- Try to correct overestimates of danger and negative consequences.
- Identify, challenge and change distorted cognitions.
1) NORMALISING - show clients how intrusive thoughts are normal part of everyday life.
2) THOUGHT-ACTION FUSION - help clients realise that thoughts don't always lead to action.
3) MEMORY - Randomsky et al (2006) - show that reportedly checking is counterproductive as makes memory worse and fuels checking ritual.
- Anti-depressants used successfully - SSRIs now most widely used.
- SSRIs increase functional level of serotonin in frontal lobe = increased activity.
- Bareggi et al (2004); Lenike (1993) - Positive effects seen in 50-80% of people.
- Bridge et al (2007) - Meta-analysis effect size of 0.48.
- Maina et al (2001) - not complete recovery & relapse if treatment stops.
- Prefrontal lobotomy as a last resort - 50% improve.