OCD Revision Cards

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OCD Description/Diagnosis

  • Characterised by presence of obsessions and compulsions.
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      • 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:
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      • 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)
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Epidemiology

  • 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.
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Behavioural Model

  • Mower (1960)
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      • 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!

BUT!

  • 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.
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Cognitive Model

  • Cognitive Biases - OCD sufferers have a number of faulty cognitions:
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      • 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.

Cognitive Deficits

  • 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.
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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.

3) Neurochemicals

  • Some have linked OCD to low levels of serotonin --> SSRIs effective for OCD!
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Psychoanalytic Model

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?

2) Impulses

  • Usually sexual  or aggressive in nature battled out in conscious instead of unconscious. 
  • Id Impulses = obsessions. 
  • Ego defences = compulsions. 
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Social Model & Integration Model

Social Model

  • Parents may have placed great emphasis on unreasonably high standards. 
  • If these standards not met = anxiety. 

Integration Model

  • 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.
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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. 

BUT!

  • 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. 
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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.
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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.

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Drug Treatments

  • 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.

BUT!

  • Maina et al (2001) - not complete recovery & relapse if treatment stops. 
  • Prefrontal lobotomy as a last resort - 50% improve.
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