clinical: OCD

• Obsessive-compulsive disorder (OCD)


  An anxiety disorder, differs from schizophrenia which is a psychotic disorder
• OCD causes considerable distress and can have a major impact on the patient's functioning
• Obsessions


  Persistent, irrational, unwanted thoughts
• Common obsessions


  • Being contaminated, or contaminating someone else
  • Fear of not having done a specific act that could result in harm
  • Hurting themselves or others
  • Unwanted sexual thoughts, images, or urges
• Compulsions


  Tasks that people do to relieve themselves of the obsessions, not realistically connected or extreme beyond reason
• Common compulsions


  • Cleaning and/or washing
  • Checking, praying,
  • Repeated checking behaviors
• People with OCD may also have a tic disorder
• The OCD Cycle


  1. Obsession

  2. Anxiety

  3. Compulsion
• Onset of OCD


  • For most people, the age of onset is late teens and early twenties, although it can start earlier or later
  • Symptoms usually develop gradually, though occasionally there is a sudden, acute onset
• Prevalence of OCD


  • Prevalence rate is between 1.1 and 1.8 percent of the population
  • In adults, OCD is more common in females than in males
  • In children, it is more common in males than females
• Prognosis of OCD


  • Symptoms usually develop gradually but can be extreme from the outset
  • About 70% of people experience a chronic and lifelong course, with worsening and improving symptoms
  • About half have episodic symptoms with partial or complete remission between episodes
  • The content of obsessions does not determine prognosis
• Factors associated with a good prognosis

  • Milder symptoms
  • Brief duration of symptoms
  • Good functioning before full onset
• Risk factors for developing OCD

  • Family history
  • Stressful life events
• Individual differences in OCD: not everyone develops the same symptoms, responds to treatment the same way, and both genetic and environmental factors can affect risk
• Cultural and gender differences in OCD: similar rates across cultures, similar age at onset and comorbidity, but cultural differences in symptom expression
• Biological explanation for OCD

  • Overactive thalamus triggering compulsions
  • Overactive orbitofrontal cortex causing anxiety
  • Basal ganglia malfunction leading to overactive thalamus
• Surgical lesioning of the cingulate gyrus has been used successfully as a treatment for OCD
• Sometimes surgery does not work for OCD, which might mean OCD is more complex than the brain structure/functioning theory suggests
• The functions usually performed by the cingulate gyrus can be taken over by other areas of the brain, so the brain structure/functioning explanation is reductionist and does not fully explain OCD
• It is difficult to show cause and effect using the brain structure/functioning model, as the differences in brain activity may be a symptom rather than the cause of OCD
• Brain activity and thoughts are related, so it is not easy to say whether brain activity altered the thoughts or the thoughts altered the brain activity
• Isolating mental health to biological processes in the brain simplifies a complex behaviour, and it is debated whether this is an appropriate way to view mental disorders and what sort of treatment it leads to
• The genetic link provides support for the biological explanation of OCD, but many people diagnosed with OCD do not have a family history of it
• Cognitive explanation of OCD

  Focuses on the role that thoughts play in the disorder, rather than brain structure or functioning
• Cognitive explanation of OCD

  • False beliefs
  • Memory problems
  • Hypervigilance
• False beliefs


  People with OCD misinterpret their thoughts due to false beliefs learned earlier in life
• Most people have intrusive thoughts similar to those reported by people with OCD, but individuals prone to OCD exaggerate the importance of the thoughts and respond as if they represent an actual threat
• As long as people interpret intrusive thoughts as "catastrophic" and believe the thoughts hold truth, they will continue to be distressed and practice avoidance/ritual behaviours
• People who attach exaggerated danger to their thoughts do so because of false beliefs learned earlier in life
• People who fear their own thoughts usually attempt to neutralize the feelings by avoiding situations that might spark the thoughts or by engaging in rituals
• Memory problems


  People with OCD have poor memories for their actions and low confidence in their memory ability
• Hypervigilance


  People with OCD are overly sensitive to threat, using rapid eye movements to scan the environment and attending selectively to threat-related stimuli
• The cognitive explanation is backed up by evidence, such as Sher et al. (1989) finding that people with OCD had poor memories for their actions
• Cognitive therapy based on the cognitive explanation has been successful as a treatment for OCD, supporting the theory
• The cognitive approach can be easily adapted to individuals' unique OCD symptoms
• The cognitive explanation does not prove a cause and effect link, as the faulty cognitions could be a symptom rather than the cause of OCD
• The cognitive explanation is reductionist as it ignores the role of biology and learning in the development of faulty cognitions
• Drug treatment for OCD

  Antidepressants, anti-anxiety drugs, and beta-blockers are commonly used
• Antidepressants that act on serotonin levels are the most common drug treatment for OCD
• Anti-anxiety drugs like benzodiazepines work by lowering physiological arousal and returning the body to a resting state