OCD

• OCD

  condition characterised by obsessions and compulsive behaviour
• behavioural characteristics of OCD

  • compulsions are repetitive
  • compulsions reduce anxiety
  • avoidance
• compulsions are repetitive

  people with OCD feel compelled to repeat behaviour

  e.g. handwashing, cleaning
• compulsions reduce anxiety

  compulsive behaviours are performed in an attempt to manage anxiety produced by obsessions

  e.g. compulsive handwashing is in response to an obsessive fear of germs
• avoidance

  people with OCD try to avoid situations which may trigger their anxiety.

  this can cause them to avoid everyday things such as emptying their rubbish bins
• emotional characteristics of OCD

  • anxiety and distress
  • accompanying depression
  • guilt and disgust
• anxiety and distress

  obsessive thoughts are unpleasant + frightening which causes anxiety

  the urge to repeat behaviour will also cause anxiety
• accompanying depression

  OCD is often accompanied by depression.

  anxiety can be accompanied by low mood and energy levels
• guilt and disgust

  OCD sometimes involves irrational guilt and disgust
• cognitive characteristics of OCD

  • obsessive thoughts
  • cognitive coping strategies
  • insight into excessive anxiety
• obsessive thoughts

  main cognitive feature of OCD is obsessive thoughts for 90% of people.

  they are always unpleasant and recur over and over again

  e.g. certainty the door has been left unlocked.
• cognitive coping strategies

  people respond to obsessive thoughts by adopting cognitive coping strategies to deal with obsessions.

  e.g. a religious person may pray.

  they may help anxiety but make the person with OCD seem abnormal to others and distract them from everyday tasks.
• insight into excessive anxiety

  people with OCD are aware that their compulsions and obsessions are irrational.

  however, they still have catastrophic thoughts about worst case scenarios despite this insight.
• which approach explains OCD?

  the biological approach
• genetic explanation

  genetic vulnerability to OCD is passed down generations

  candidate genes involved in regulating the development of the serotonin system. e.g. 5HT1-D beta is implicated in the transport of serotonin across synapses.

  OCD is polygenic as it is caused by a combination of genetic variations which increase vulnerability. They could cause different types of OCD.
• strength of genetic explanation - research support

  twin study by Nestadt et al

  -> found 68% of MZ twins shared OCD opposed to 31% of DZ twins sharing OCD.

  family studies

  -> have found that someone with a family member diagnosed with OCD are four times more likely to develop it compared to someone without.
• limitation of genetic explanation - environmental risk factors

  OCD isn't entirely genetic, only genetic vulnerability.

  environmental risk factors trigger or increase the risk of developing OCD.

  Diathesis-stress model.

  Cromer et al

  -> found that over half the OCD clients in their sample had experienced a traumatic event in their past.
• neural explanation

  low levels of serotonin means normal transmission of mood-relevant information does not take place

  impaired decision-making is associated with impaired lateral frontal lobes which are responsible for logical thinking.

  the left Parahippocampal gyrus is associated with processing unpleasant emotions and functions abnormally in OCD.
• strength of the neural explanation - research support

  Antidepressants that work purely on serotonin are effective in reducing OCD symptoms which suggests serotonin may be involved in OCD.

  Suggests biological factors may be responsible
• limitation of neural explanation - co-morbidity

  the link between serotonin and OCD may not be unique to OCD.

  many people with OCD also experience clinical depression -> co-morbidity of having 2 disorders.

  this depression involves disruption of serotonin which means that serotonin may not be a basis for OCD but people with OCD have just had serotonin activity disrupted
• SSRIs

  antidepressant drug - selective serotonin reuptake inhibitor

  SSRIs work on the serotonin system in the brain

  -> prevent reabsorption + breakdown which increases levels of serotonin in the synapse and continues to stimulate the postsynaptic neuron.

  compensates for whatever is wrong with the serotonin system in OCD
• combining SSRIs with other treatments

  drugs often used alongside CBT to treat OCD.

  The drugs reduce the emotional symptoms so the person with OCD can engage more effectively with the CBT.

  Occasionally, other drugs are prescribed alongside SSRIs
• strength of SSRIs - evidence for effectiveness

  Clear evidence showing SSRIs reduce symptom severity and improve the quality of life for people with OCD.

  Soomro et al

  -> reviewed 17 studies comparing SSRIs to placebos.

  -> all 17 studies showed better outcomes for SSRIs

  typically, symptoms of OCD can be reduced for 70% of people who take SSRIs. the other 30% can be helped by alternatie drugs or a combination of drugs + therapy.
• strength of SSRIs - cost-effective + non-disruptive

  drugs are cheap compared to psychological treatments as thousands can be produced in the time it takes one therapy session.

  therefore drugs are good for the NHS.

  drugs also are non-disruptive to people's everyday lives whereas therapy sessions are time-consuming.
• limitation of SSRIs - side effects

  indigestion, blurred vision.

  side effects are usually temporary but can be distressing

  long-lasting for the minority.

  can be more serious for different drugs.

  means there is a reduced quality of life.