OCD

• Obsessive-compulsive disorder (OCD)


  A mental health disorder characterized by intrusive thoughts, obsessions, and repetitive behaviours or compulsions
• Symptoms of obsessive-compulsive disorder (OCD) include:
• Obsessions


  • Recurrent, persistent thoughts, images, and/or impulses that are ego-dystonic (ie, thoughts, impulses, and behaviours that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept), intrusive and senseless
  • Accompanied by negative affect, fear, disgust, doubt, distress, etc
• Compulsions


  • Repetitive, purposeful behaviours done in responses to an obsession, often according to specific rules or in a stereotyped fashion
  • Purpose is to ignore, neutralise, or suppress the obsessive thoughts
  • Can be observable (eg, washing, tapping) or covert/mental (eg, counting/thinking)
• For a diagnosis, these obsessions and compulsions must take up at least an hour per day and symptoms must cause distress/dysfunction
• Common obsessive thoughts in OCD

  • Fear of being contaminated by germs or dirt or contaminating others
  • Fear of losing control and harming yourself or others
  • Intrusive sexually explicit or violent thoughts and images
  • Excessive focus on religious or moral ideas
  • Fear of losing or not having things you might need
  • Order and symmetry: the idea that everything must line up "just right"
  • Superstitions; excessive attention to something considered lucky or unlucky
• Common Compulsive behaviors


  • Excessive double-checking of things, such as locks, appliances, and switches
  • Repeatedly checking in on loved ones to make sure they're safe
  • Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
  • Spending a lot of time washing or cleaning
  • Ordering or arranging things "just so"
  • Praying excessively or engaging in rituals triggered by religious fear
• Body dysmorphic disorder (BDD)


  A type of OCD where patients believe they look ugly or deformed, when in reality they look normal
• As a result of their appearance concerns, they may stop working and socializing, become housebound, and even commit suicide
• To qualify for a diagnosis of BDD, at some point during the course of the disorder, the individual must perform repetitive, compulsive behaviours in response to the appearance concerns
• BDD compulsions


  • Behavioural (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking, clothes changing)
  • Mental acts (e.g. comparing one's appearance with that of other people)
• Other Specified Obsessive-Compulsive and Related Disorder


  Diagnosis for individuals who meet all diagnostic criteria for BDD except for the compulsive behaviours
• Charles developed an obsession with sticky substances at the age of 12
• He spent three hours at a time in the shower due to his obsession
• After months of behavioral therapy and medications, he began seeing Rapoport at age 14
• Gradually, his symptoms worsened, and he became unable to attend school
• His excessive washing rituals consumed his day and hindered his concentration
• Charles's mother


  Attempted to help him by cleaning rigorously, both in his room and the entire house. Visitors were asked to wash their hands to avoid contamination, but eventually, visitors were discouraged from coming to the house
• Charles's father


  Coped with the situation by working longer hours
• Charles's symptoms


  • Preoccupation with stickiness, describing it as "terrible" and like "some kind of disease"
  • Prolonged washing rituals, spending three hours in the shower
  • Daily routines, such as dressing, took an extended amount of time, up to two hours
  • Extreme distress when an EEG was suggested, involving sticky paste on his scalp
  • Staying up all night washing following the EEG appointment
  • Feeling sad because his sisters and other children called him "crazy"
• Charles was prescribed clomipramine, a tricyclic antidepressant, which helped initially
• Within a month, he could touch and pour honey
• However, after one year, he relapsed because he had developed tolerance to the drug. His symptoms returned, although they were more manageable
• Strengths of the case study

  • It can highlight the idiosyncratic nature of OCD, eg. Charles's obsessive thoughts of 'stickiness'
  • It gathers a lot of rich, in-depth detailed information, such as his rituals and the exact obsessive thoughts, helping researchers to learn how exactly OCD affects individuals
  • It is high in applicability, as the findings can be used to inform the use of the same drug Rappaport studied, as it gave empirical evidence that it is useful and effective
• Weaknesses of the case study

  • It is about just one boy, so it could be unique to him and his experience, especially that his mother was supporting him- other people with OCD may not have the same thoughts or symptoms, making it lower in generalizability
  • It is low in ethics, as the boy didn't know he has the right to withdraw and he was psychologically harmed and had to have an EEG attached to his scalp
• Maudsley Obsessive-Compulsive Inventory (MOCI)

  • A 30-item true/false questionnaire developed through interviews with 30 people with OCD, categorizing respondents into four types: cleaning, checking, slowness and doubting
  • It is a screening tool, not diagnostic, and usually takes 5 minutes to complete
• Strengths of the MOCI

  • Reliable: The MOCI demonstrates good test-retest reliability, indicating consistent results over time
  • Valid: The MOCI has been extensively validated as a measure for assessing OCD symptoms
  • Easy Administration: The MOCI is a self-report questionnaire, making it easy to administer and score
  • Comprehensive Assessment: The MOCI covers a wide range of OCD symptoms, including both obsessions and compulsions
  • Quantitative measure: provides numerical data- so we can see the improvements during sessions
  • It asks about obsessive thoughts- only through self-report can we know those thoughts
• Weaknesses of the MOCI

  • Limited Scope: The MOCI focuses primarily on obsessions and compulsions and may not capture the full range of OCD symptoms, such as other subtypes or related features
  • Self-Report Bias: Like all self-report measures, the MOCI is susceptible to self-report bias, where participants may provide responses that are influenced by social desirability or personal interpretation
  • Ethnocentric: The MOCI was developed and validated in Western cultural contexts, and its applicability to other cultural groups may be limited
• Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)


  • A semi-structured interview schedule with ten items measuring symptom severity (mild to extreme) on a five-point scale (0-4)
  • An accompanying checklist can be used to diagnose OCD type
  • Interview duration = 30 minutes
  • 50 obsessions and compulsions, categorized into 15 groups, may be used for reference during interviews
• Severity Levels of Y-BOCS

  • Mild: Scores between 8-15
  • Moderate: Scores between 16-23
  • Severe: Scores between 24-31
  • Extreme: Scores between 32-40
• Strengths of the Y-BOCS

  • Comprehensive Assessment: The Y-BOCS assesses a broad range of OCD symptoms, including obsessions, compulsions, and the subjective distress associated with these symptoms
  • Reliable and Objective: The Y-BOCS provides a structured interview format, which reduces subjective interpretation and enhances the reliability and objectivity of the ratings
  • Longitudinal Assessment: The Y-BOCS can be used to track changes in OCD symptoms over time, making it valuable for treatment evaluation and monitoring progress
• Weaknesses of the Y-BOCS

  • Time-consuming: due to its structured interview format, which may limit its feasibility in certain settings
  • Ethnocentric: Y-BOCS was developed and validated in Western cultural contexts, potentially limiting its cross-cultural validity
  • Subjective and people may lie due to social desirability bias
• Genetic factors in OCD

  • 37 per cent of people with OCD have a parent with OCD
  • Concordance rates: MZ twins = 87 per cent; DZ twins = 47 per cent
  • OCD is polygenic and frequency of certain alleles is more/less common in people with OCD (e.g. Allele 2 of the DRD4 gene is less common, under-expression of the SLITRK3 gene is linked to OCD)
• Biochemical factors in OCD

  • Serotonin and/or dopamine imbalance may increase OCD risk, caused by abnormalities relating to presynaptic serotonin reuptake, postsynaptic receptors (e.g. D4 dopamine), or enzymes (e.g. MAO-A)
  • Oxytocin dysfunction may cause OCD—high or low levels may contribute to the obsessive thoughts and compulsive behaviors
• Strengths of biological explanations

  • Backed up by empirical evidence - silencing the SLITRK5 gene caused compulsive grooming and hoarding behaviour in mice
  • High in applicability - led to the development of drug treatments, such as clomipramine
• Weaknesses of biological explanations

  • Validity - exercise caution when extrapolating data from mice to humans. Mice can only display compulsions; this does not explain the origin of obsessions
  • Reductionist - high concordance rates in family studies can also be explained by nurture (e.g. modelling). Both twins especially MZ twins can be treated identically, causing OCD to impact both
  • Deterministic- does not give room for freewill- an individual's fate is determined by the genetic inheritance and has to keep taking medications
• Cognitive (thinking error) explanations of OCD

  • People with OCD find it impossible to ignore passing thoughts
  • They make a thinking error; all thoughts must be meaningful and significant
  • The thoughts themselves are not problematic; the meaning attached to them causes distress (e.g. shame, disgust)
  • Compulsions are seen as a way of neutralising obsessive/negative thoughts
  • Personal responsibility for negative outcomes may be overestimated, leading to anxiety
  • Thought-action fusion- People with OCD believe that merely thinking about a certain behavior increases the likelihood of engaging in that behavior
• Strengths of cognitive explanations

  • Holistic- the different thought processes- it both explains obsessions as well as compulsions
  • Individual approach because each individual has their own meaning out of the thoughts
  • Free will because you gave the thought meaning – you can change it – and challenge it
  • High in applicability - CBT
• Weaknesses of cognitive explanations

  • Nurture doesn't take into account the role of nature
  • Low in validity- in order to test the meaning of thoughts for each individual self reports must be used- those require people to be honest, this may be compromised due to social desirability bias
• Behavioural (operant conditioning) explanations of OCD

  • Compulsive behaviors develop as they help to reduce negative feelings
  • Actions are repeated as they are negatively reinforced (removed dirt) as well as positively reinforced (clean hands)