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Obsessive Compulsive Disorder: Introduction, Explanations and Treatments

Obsessive Compulsive Disorder

  • Everyone has a fear or routine for something
  • But, someone with an OCD → becomes so invasive and is accompanied by severe anxiety → cant function effectively in daily life
  • Is the most severe anxiety disorders and is the most difficult to treat
  • Obsession – persistent and recurrent, thoughts and images which enter the mind and cannot be removed
  • Compulsive – the element of OCD which is the irresistible urge to carry out repetitive/ritualistically in order to avoid some form of danger or consequence
  • A third who report it say it started in childhood, however, in many cases it goes undetected
  • Can last a few years to decades
  • Sufferers can go through intermittent periods  of depression
  • Affects around 1-3% of population (Source: National Institute of Mental Health)
  • Affects both men and women equally – women more likely to suffer from compulsions of cleanliness

Characteristics

  • Sufferers acknowledge their problem – but are powerless to overcome them
  • Will suffer from severe anxiety (leading to symptoms)
  • O & C do not alleviate the anxiety → they make it worse
  • Suffer from severe depression (i.e. a symptom)
  • Onset → late teens/early 20’s
  • Either obsession or compulsion have to be experienced
  • Obsession or compulsion have to be time consuming in the daily routine

Its not how much time it takes, it’s about how they react to the stimulus. 

Cobb (1978) – 78% of a sample of OCD patients viewed their rituals as “rather silly” or ‘absurd’

Types

  • Obsessional Cleanliness – obsession with dirt/contamination → leads to compulsive behaviours e.g. hand-washing
  • Compulsive Rituals – specific ways/order of doing things, yet have the urge to stop, but cant
  • Obsessional Doubts – usually related to health and safety concerns e.g. locking the house door
  • Compulsive Checking – follows on from obsessional doubts, will have to keep checking, double-checking things e.g. the house door…….and never end up leaving
  • Obsessional Ruminations – internal debates with self, will present themselves with an issue and debate for and against it, even over simple things
  • Obsessional Impulses – strong urge to perform an embarrassing, dangerous or violent act.

BIOLOGICAL APPROACH

  • No specific gene has yet been identified
  • Studies have shown it runs in families (could be due to shared environment)

Genetics

Family Studies

  • Carey & Gottesman (1981) – reported a prevalence of up to 10% in 1st degree relatives.
  • Lenane (1990) – 30% of 1st degree relatives in their study also had an OCD

Twin Studies

  • Hoaker & Schnurr (1980) – Found concordance rate of 50-60%
  • When OCD’s run in families they inherit the general nature of it, but not exactly the same symptoms (again, suggests that it could be partly genetic and environment
  • Dr. Dennis Murphy (2003) – DNA from 170 people, 30 had OCD and 80 healthy people. They were looking for variations of the human serotonin transporter gene which controls the movement of the chemical between nerve cells in the brain. Found that 6 out of 7 people in 2 separate families who had 1 gene mutation had an OCD. Whilst the 4 people with the most severe symptoms also had a 2nd mutation in the same gene

Biochemical

  • OCD may result from a deficiency of serotonin (neurotransmitter) or a malfunction of its metabolism like blocked serotonin receptors.
  • Research support from studies using drugs
  • Zohar et al (1996) – Found that some tricyclic drugs inhibit the re-uptake of serotonin → beneficial for around 60% of the OCD sufferers tested.
  • However, Lydiard et al (1996) – Found that drugs only provided partial alleviation from the symptoms (therefore, drugs are not a cure
  • SSRI (Selective Serotonin Reuptake Inhibitor) reduces symptoms of OCD

Brain Structure

  • Rapoport & Wise (1998) – Suggest OCD results from a dysfunction in the C.N.S (specifically the basal ganglia), this theory is supported by disorders such as Huntington’s, Parkinson’s and Tourette’s
  • Rapoport (1994) – People who had surgery to disconnect the basal ganglia from frontal cortex brought relief in severe cases of OCD.

Evaluation of biological explanations of OCD’s

  • Difficult to identify whether its genetics or the effect of the shared environment
  • Inconsistency in findings regarding serotonin.
  • Psychological therapy is very good, due to its success rates and contradicts the serotonin theory
  • Inconsistency with results regarding basal ganglia e.g. Aylward (1996) – found no difference between OCD and non-OCD sufferers.
  • Whether OCD is a consequence of increased activity, a cause of it or merely a correlate is still unclear
  • Head injuries and brain tumours have been associated with the development of OCD
  • Research into brain structures are still in their infancy due to the technological advancements
  • Rappoport (1989) – About 20% of OCD patients display nervous tics, implying that there is a link with the anatomy of the nervous system
  • What causes abnormal brain functions? Answer may lie in the diathesis-stress model which links the biological basis with the findings that the OCD occurs after a stressful event
  • Seems contradictory that OCD’s have genetic basis yet behavioural therapies are most widely used.

PSYCHODYNAMIC APPROACH

  • Freud → fixation in the anal stage
  • Child accepts will of parents being neat and clean → when their natural preference may be messy.
  • If preference is too strong and parents are too strict → child becomes anally fixated
  • Occurs at an unconscious level → sufferer believes there really concerned with keeping clean and tidy.
  • Psychoanalysts believe OCD is most likely to be found in people who show anal personality characteristics e.g. being excessively neat, orderly and punctual.
  • Obsessions can be defence mechanisms which occupy the mind so as to displace more disturbing thoughts.
  • There is conflict between the Id and defence mechanisms
  • Adler (1930) – Disagrees with Freud.
  • Believes OCD results from when children are kept from developing a sense of competence (especially if parents are too strict).
  • If preference is too strong and parents are too strict → child becomes anally fixated
  • Occurs at an unconscious level → sufferer believes there really concerned with keeping clean and tidy. The child establishes a domain where they can actually exert control
  • Psychoanalysts believe OCD is most likely to be found in people who show anal personality characteristics e.g. being excessively neat, orderly and punctual.

Evaluation of psychodynamic

  • Hard to experimentally test the idea of the unconscious motivation
  • Gross (1996) – Reports that studies that examine the potty training of anal personality types (who are not as severe as OCD) find no difference from the potty training of other personality types.

BEHAVIOURAL APPROACH

  • Suggest that OCD is an extreme form of ‘learned avoidance’ behaviour:
    • At first, an event is associated with an anxiety or fear
    • As a result → avoidance behaviour initially alleviates the fear
    • BUT consequently, it becomes a conditioned response
  • Meyer & Cheeser (1970) – Compulsions are learnt responses which are ways of reducing the anxiety brought on by the obsession.
  • If the behaviour reduces anxiety it becomes reinforced
  • Superstition Hypothesis (Skinner, 1948) – Found that people who develop OCD’s make by chance associations between behaviours and reinforces. This leads them to repeat the behaviours.

Evaluation of behavioural

  • Symptoms of OCD e.g. avoidance behaviour themselves create anxiety; is hard to argue that people learn these responses in order to reduce their fear
  • Behavioural therapies are very effective → Baxter et al (1992) and Schwartz et al (1996) both found that behavioural therapies not only  reduces the symptoms but also brings about changes in biochemical activity
  • E.g. athletes ‘psych themselves up’ before an event, to suppress self-defeating thoughts.
  • An OCD patient will use strategies to reduce the negative thought, but the effort they put in to trying to inhibit the thoughts ends up inducing a preoccupation with it.

COGNITIVE APPROACH

OCD’s are the result of faulty and irrational ways of thinking at an extreme level

  • Suggests that specific environmental stimuli  are paired at some point with an anxiety-provoking thought = a conditioned response
  • E.g. if I don’t clean, I’ll get AIDS, so to avoid the possible threat they undertake the compulsive behaviour
  • This triggers the obsessional thoughts BUT the compulsive rituals try to counter-balance and neutralise them.
  • Rachman & Hodges (1987) – Argue that some people are more susceptible to obsessional thoughts due to vulnerability factors e.g. genetically determined hyper-arousability, depressed mood or poor socialisation experience
  • Research by the National Institute of Mental Health have found that OCD patients perform poorly in tasks involving the recall of events

Evaluation of cognitive

  • Lack of evidence supporting the view that OCD’s are a result of poor socialisation experiences.
  • Sher et al (1983) – Patients who scored highly on a measure of compulsive behaviour also showed a memory deficit for actions recently performed.
  • Davison & Neale (1994) – Suggest that OCD patients are unable to distinguish between reality and imagination.

Neither biological (specifically medication) nor psychological therapies provide a long term solution to OCD’s. Suggests that it is a very complex disorder to understand and treat.

Treatment

  • Biological/Medical – usually in the form of tricyclic drugs or SSRI drugs, which inhibit the serotonin
  • Behavioural – Systematic Desensitisation, a process where the patient is gradually exposed more and more directly to their obsession or compulsion. If that’s impractical
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