OCD

• OCD:

  • OCD is described as an anxiety disorder
  • OCD involves the frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges
  • a characteristic is a symptom of a psychological disorder, which can be categorised to 3 types; behavioural (how the individual acts and their observable behaviours). emotional (how the individual feels) and cognitive (how the individual thinks and their internal mental processes)
• Behavioural characteristics of OCD:

  • compulsions - repeating a behaviour, such as washing hands repeatedly
  • avoidance - when people with OCD alter their behaviour to avoid places or people because of their obsessions. For example, someone who has a contamination obsession - fear of germs or bodily fluids - may avoid public toilets
• Emotional characteristics of OCD:

  • anxiety and distress - anguish caused by not completing the compulsion
  • comorbid depression - suffering from low mood and feelings of depression as a result of the compulsions
• Cognitive characteristics of OCD:

  • obsessive thoughts - intrusive and repetitive thoughts
  • awareness that behaviour is irrational - the conscious awareness that their obsessive thoughts are not normal
• The biological approach to explaining OCD:

  • the biological approach suggests that behaviour is based on physical/bodily problems

  there are two main biological explanations for OCD;

  • genetic explanations
  • neural explanations
• Genetic explanations:

  • twin studies have shown that there is a role of genetic in OCD
  • for example, Carey and Gottesman conducted a twin study and found that MZ twins have a greater concordance rate of 87% for OCD compared to 47% for DZ twins
  • this suggests that a shared genetic similarity increases the likelihood you will share OCD symptoms
  • OCD is polygenic meaning that multiple genes are involved
  • it is also aetiologically heterogenous, being caused by a combination of multiple genes
  • there genes include candidate genes - COMT and SERT
• SERT gene:

  • the SERT gene appears to be mutated in individuals with OCD, leading to an increase in the reuptake of serotonin in the neuron; leading to a lower level of serotonin
  • serotonin is a mood regulator, therefore low levels of serotonin lead to low mood, linking to the emotional characteristics of comorbid depression and anxiety/distress
• COMT gene:

  • the COMT gene codes for the regulation of dopamine, a neurotransmitter linked to pleasure and rewards
  • if the COMT gene codes for too much dopamine, then the brain will become saturated with dopamine and therefore less responsive to pleasure, so the brain doesn't receive the rewards it should get for completing a task
  • this links to behavioural characteristics of OCD such as compulsions
• Neural explanations:

  there are two neural explanations for OCD;

  • neurotransmitters
  • structure of the brain
• Neurotransmitters:

  • this explanations suggests that OCD is caused by imbalances in these neurotransmitters within the brain
  • it has been linked to low levels of serotonin
  • serotonin is a mood regulating neurotransmitter
  • this has been found by anti-depressant drugs (SSRIs) which work by increasing the amount of serotonin, decrease the symptoms of OCD
  • showing that low levels of serotonin must be linked to causing OCD
• Structure of the brain:

  • PET scans show that a person with OCD have high levels of activity in the orbital frontal cortex (OFC)
  • this part of the brain is linked to carrying out an activity due to an impulse
  • as there is over activity in the OFC in those with OCD it means that even once they carry out the activity the impulse to do so doesn't go away
  • this leads to the cognitive characteristics of obsessions
  • for example, continually thinking they need to wash their hands, resulting in behavioural characteristics of compulsions, such as continually washing their hands
• Evaluation of explanations of OCD:

  S - empirical evidence: Billett's twin study

  S - practical applications

  W - ignores the role of learning

  W - issues establishing causality
• Empirical evidence: Billett's twin study (identify):

  • a strength of the biological explanations of OCD is there is empirical evidence to support
• Empirical evidence: Billett's twin study (explain):

  • Billett (1998) conducted a meta-analysis of twin studies into OCD
  • they found that you are 2x more likely to develop OCD if you have an MZ twin with OCD than if you have a DZ twin with OCD
• Empirical evidence: Billett's twin study (conclusion):

  • this adds to the validity of the biological explanations of OCD because it supports the idea that genetics play a role in OCD as those who are more genetically similar (MZ twins, who share 100% of genetics) are more likely to share the condition than those who are less genetically similar (DZ twins, who share 50% of genetics)
• Empirical evidence: Billett's twin study (counterargument):

  • the research into the genetic explanations of OCS suggests that there is a genetic link, however none of the twin studies have found 100% concordance rate between MZ twins
  • this is an issue because it suggests that there may be other factors such as environmental factors (learning through observation and imitation of role models) or cognitive explanations (faulty thinking)
  • the explanation is too simplistic
• Practical application (identify):

  • a strength of the biological explanations of OCD is that it has led to the development of an effective therapy
• Practical application (explain):

  • the neural explanation of OCD suggests that it is caused by low levels of serotonin
  • SSRIs which address the low levels of serotonin by blocking serotonin reuptake helps to regulate the emotional characteristics of OCD
  • Soomro et al (2008) used a meta-analysis and found that SSRI drugs worked significantly better than placebo in treating OCD
• Practical application (conclusion):

  • this adds to the validity of the biological explanations of OCD because this suggests that there must be biological components to the disorder as the placebo effect had limited success rates compared to the SSRIs which work to increase the neurotransmitters
  • additionally, if the medication works this can help to reduce people's behavioural and emotional symptoms (such as compulsions or comorbid depression) and allow them to return to work, providing positive economic implications for society
• Practical application (counterargument):

  • however, not all patients who take SSRIs for OCD experience significant improvement in their symptoms
  • this is an issue because this questions the population validity of the neural explanation of OCD as evidence from patients suggests that low levels of serotonin is not always the cause of OCD, or the therapy would work for all patients
  • therefore, the theory lacks explanatory power and cannot be generalised to the entire population
• Ignores the role of learning (identify):

  • a weakness of the biological explanation of OCD is that the explanations ignore the role of learning
• Ignores the role of learning (explain):

  • the biological explanation of OCD may be overly simple and ignore other factors
  • for example, the influence of learning in OCD maintenance
  • through operant conditioning, the patient may receive positive and/or negative reinforcement every time they act on a compulsion, encouraging the repetition of the behaviour, suggesting that compulsions could be learnt
• Ignores the role of learning (conclusion):

  • this questions the validity of the biological explanations of OCD because it suggests that abnormal behaviour may not be purely innate and something we are born with (nature) and instead may be developed from our environment through rewards and punishment (nature)
  • therefore, a more complete and holistic explanation of OCD would come from an interactionist approach such as the diathesis stress model
• Ignores the role of learning (counterargument):

  • however, a better explanation of depression considers both biology and environmental factors such as the diathesis stress model
  • this states that, while biology may pre-dispose someone to OCD (through biological factors such as neurotransmitters), environmental stress factors also need to present (such as positive reinforcements) for the symptoms to manifest and present as a disorder
  • it is, therefore, a combination of nature and nurture
• Issues establishing causality (identify):

  • a weakness of the biological explanations of OCD is that there are issues determining a cause and effect relationship
• Issues establishing causality (explain):

  • it is not clear whether OCD is caused by a physical difference or whether the difference occurs as a result of the disorder
  • for example, those who have a difference in the structure of their brain may not have had these difference before getting OCD
  • for example, OCD may cause high activity in the orbitofrontal cortex
  • additionally, it could be a third intervening variable all together that mat be causing the over activity such as neurological conditions or neurodiversity (ADHD)
• Issues establishing causality (conclusion):

  • this questions the validity of the biological explanations of OCD because it may be that OCD causes these, such as high levels of activity in the OFC, due to the obsessions it creates rather than the differences causing OCD themselves
  • this inability to establish casual relationships can therefore impact the quality of diagnosis and treatment for OCD
• The biological approach to treating OCD:

  • biological therapies for OCD work on the assumption that it is caused by low levels of serotonin
  • the aim of the therapy is to increase the level of serotonin transmission
  • the biological therapy is drug therapy: SSRIs (selective serotonin reuptake inhibitor)
  • SSRIs work by blocking the reuptake pump at the presynaptic neuron, ensuring that serotonin transmission increases, addressing the emotional characteristics of OCD. An example is Prozac
• Evaluation of treatments for OCD:

  S - there is evidence to support: Soomro

  W - there are negative side effects

  W - drugs treat the symptoms not the cause

  S - appropriate treatment
• There is evidence to support - Soomro (identify):

  • a strength of the biological treatments of OCD is that there is evidence to show the effectiveness of SSRIs as a treatment for OCD
• There is evidence to support - Soomro (explain):

  • Soomro (2009) reviewed studies who compared patients treated with SSRIs and a placebo for OCD
  • they found that in all studies the SSRI were more effective in treating OCD
• There is evidence to support - Soomro (conclusion):

  • this adds to the effectiveness of SSRIs as a biological treatment for OCD and there is evidence to support its success in treating patients compared to other methods
  • this suggests there must be biological components to the disorder as the placebo effect had limited success rates, compared to the SSRIs which work to increase the neurotransmitters
• There are negative side effects (identify):

  • a weakness of the biological treatments of OCD is that there are negative side effects to taking SSRIs
• There are negative side effects (explain):

  • the SSRIs used in drug therapy have unpleasant physical side effects, such as nausea, weight gain, insomnia, and a loss of libido
  • these side effects will affect the daily routines of patients and make their symptoms of OCD worse
  • they are also likely to lead patients to stop taking their medication and then relapse
• There are negative side effects (conclusion):

  • therefore, this questions the appropriateness of biological treatments of OCD such as drug therapy because side effects such as anxiety, will heighten a patients already high emotional characteristics or additionally could trigger irrational thinking (such as being sick leading to further intrusive thoughts around hygiene and cleanliness)
  • therefore, there may be other treatments which treat OCD without causing these side effects, so are more likely to be used by patients
• Drugs treat the symptoms not the cause (identify):

  • a further weakness of drug treatment for OCD is that they only treat the symptoms not the cause
• Drugs treat the symptoms not the cause (explain):

  • drugs are used only to increase the levels of serotonin to treat OCD, meaning that the drugs just treat the physical symptoms
  • they don't address the faulty thinking that causes the compulsions
  • this means that once the drug therapy finishes, the patient is likely to relapse
• Drugs treat the symptoms not the cause (conclusion):

  • therefore, this questions the appropriateness of drug therapy because without tackling the root cause of a disorder to understand why and when it began, medication will only manage symptoms rather than provide a cure
  • therefore, drug therapy cannot be used as a sustainable treatment for OCD over time and instead a more interactionist approach of dual therapy (medication and counselling) may be the most successful
• Appropriate treatment (identify):

  • a strength of biological treatments of OCD is that they are quick and easy to use
• Appropriate treatment (explain):

  • patients can take drugs easily through swallowing a pill, which isn't as strenuous or cognitively demanding as other treatments such as CBT, which requires the patient to change their thoughts