Obsessive-Compulsive and Related Disorders

What are the most common obsessions?

Instrusive and persistant thoughts
Soubts
Worries
Images

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Give three examples of common obsessions

Worrying about contamination
Worrying about bad things happening if they don't do something
Worrying they will catch a disease

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What are compulsions?

Repetitive physical behaviours, mental repetitions and actions that are performed over and over again

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What are some common compulsions?

Excessive hand washing
Checking light switches & plug sockets
Checking items are displayed in a 'correct' order
Mentally counting to a certain number

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What is hoarding disorder?

People acquire an excessive amount of items in their home and store them unsystematically, getting in the way of their everyday life.

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What is body dysmorphic disorder (BDD)?

An anxiety disorder that causes people to have a distorted view of their body and appearance. They spend a lot of time worrying about their appearance and believe minor flaws are major issues.

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What are some of the symptoms of BDD?

Comparing appearances with others
Spend long periods in front of mirrors, then at times avoiding mirrors entirely
Feel anxious in social situations
Become distressed by a particular area of their body

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Describe a case study into OCD and name the researcher.

Rapoport 1989. 12 y/o Charles began washing obsessively. He eventually washed so often he had to leave school, and had a washing ritual. He had drug therapy and his symptoms disappeared until he developed a tolerance for the drug.

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What does MOCI stand for?

Maudsley Obsessive-Compulsive Inventory

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What is the MOCI?

30-item scale used to measure OCD. It uses two major (Checking and Cleaning) and two minor subscales (Slowness and Doubting) with only true or false answers. Practitioners use the overall score to pinpoint main features of the patient's OCD.

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What are the strengths and weaknesses of MOCI?

Strength: Was rigorously tested to ensure it is consistent over time
Weakness: Questionnaire relies on patient honesty, so may not truly represent OCD symptoms

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What does Y-BOCS stand for?

Yale-Brown Obsessive-Compulsive Scale

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What is the Y-BOCS measure of OCD?

Semi-structured interview; interviewer goes through a 67-item symptom list and notes whether each symptom is current, past or absent. There is also a 19-item measure of symptom severity.

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What is the biological explanation of OCD?

The activity circuits in our brain that prompt us to do certain actions e.g wash hands after using the toilet doesn't die down after doing the action when it should, stimulating the person to continue doing the action.

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What is the behavioural explanation for OCD?

Performing compulsions is a learned behaviour that is reinforced by the consequences of performing them. E.g hand washing makes them less anxious (negative reinforcement) and they have less germs (positive reinforcement)

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What is the cognitive explanation for OCD? 1/2

Obsessive thoughts increase with stress, and people with OCD have had childhood experiences that have taught them that some thoughts are unacceptable, which has effected their information-processing networks.

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What is the cognitive explanation for OCD? 2/2

When new info is processed, it is affected by these processing networks and generates anxiety that can only be alleviated by compulsive behaviours

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What is the psychodynamic explanation for OCD? 1/2

OCD is caused by instinctual forces that are not under full control due to traumatic experiences in the anal stage of psychosexual development, the person therefore is fixated in the anal stage. Obsessive thoughts generated by the ID

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What is the psychodynamic explanation for OCD? 2/2

but the ego counteracts this by making the person behave in a way that is the complete opposite. E.g ID: be messy and out of control, EGO: being neat and orderly

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What is the biomedical treatment for OCD?

SSRIs

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What did Askari et al do?

Examined the use of granisetron in conjunction with an SSRI. Ptps randomly assigned granisetron or placebo. Assessed using Y-BOCS every two weeks for 8 weeks.

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How were the outcomes measured by Askari et al?

Partial response = min. 25% reduction in Y-BOCS score
Complete response = min. 35% reduction in Y-BOCS score
Remission = score 16 or less on Y-BOCS.

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What were the results of Askari et al?

By week 8, 100% of granisetron group had a complete response and 90% had met the remission criterion. Only 35% of placebo managed the same.

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Who investigated the cognitive treatments of OCD and what was their aim?

Lovell et al
Test the effectiveness of telephone-administered CBT for the treatment of OCD

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What was the sample used by Lovell et al and what were the groups used?

72 patients who had a primary diagnosis of OCD that could not be caused by biological causes. Randomly assigned to two groups;
G1; participated in telephone-administered CBT
G2; participated in the same CBT programme but face to face

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What was the method used by Lovell et al?

Each group had one face to face session with therapist, G1 continued this for 10 one-hour sessions. G1 then had 8 weekly 30min sessions, with a final face to face session.

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How were the outcomes measured by Lovell et al?

Y-BOCS scores, Beck Depression Inventory scores and client satisfaction taken at baseline, immediately after treatment and at specified times after treatment

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What were the results of the study by Lovell et al?

Scores on both measures reduced significantly immediately after the prom and continued at 6months post-treatment. Clients in both groups equally satisfied with their experiences, so telephone CBT is equivalent to in person in outcome and satisfaction

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What are the strengths and weaknesses of the study by Lovell et al?

Strength: Strong application as it was successful
Weakness: Outcome measures were self-reports, could have social desirability bias and therefore be less valid.

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Who reported on a case study for exposure and response prevention (ERP) as a treatment for OCD and who was the case study on?

Lehmkuhl et al
12 y/o boy with autism also diagnosed with OCD.

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What is the method for ERP programmes for OCD?

Three components;
1. Information gathering on symptoms
2. ERP begins lead by a therapist
3. Generalisation and relapse training

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What did Lehmkuhl et al report on the case study? 1/

At 11y/o Jason developed ritualistic behaviours around his fear of contamination. His symptoms began to interfere with everyday functioning. He went through ten 50-min therapy sessions over 16 weeks. First session was an introduction.

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What did Lehmkuhl et al report on the case study? 1/

Section session Jason was exposed to situations he feared, such as touching elevator buttons, until he habituated to the anxiety. Each session started with a review of any homework set, which would be using contaminated items.

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What was the results of Jason's ERP?

His parents felt there had been a significant decrease in his distress levels and symptoms. He was participating more in classroom activities. His children's Y-BOCS score went from 18 to 3 immediately after treatment, which was maintained at 3months post

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What are the strengths and weaknesses of the case study reported by Lehmkuhl et al?

Strength: Case study means in-depth information which should be valid
Weakness: Generalisation is difficult in case studies as he may be a unique case.

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Obsessive-Compulsive and Related Disorders

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