OCD

• Define 'OCD'

  Stands for Obsessive-Compulsive Disorder. A condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive i.e. something that is mental, whereas compulsions are behavioural i.e. something that you do.
• Types of OCD


  - The DSM-5 recognises multiple categories of OCD:

  - OCD: characterised by either obsessions and/or compulsions. Most people with a diagnosis of OCD have both obsessions and compulsions.

  - Trichotillomania: compulsive hair pulling.

  - Hoarding disorder: the compulsive gathering of possessions and the inability to part with anything, regardless of its value.

  - Excoriation disorder: compulsive skin-picking.
• Behavioural characteristics of OCD

  - Repetitive compulsions: OCD sufferers typically feel compelled to repeat a behaviour, e.g. handwashing.

  
  

  - Compulsions reduce anxiety: around 10% of people with OCD show only compulsive behaviour - they have no obsessions, just a general sense of irrational anxiety. However, for the large majority, compulsive behaviours are performed to attempt to manage the anxiety produced by obsessions. E.g. compulsive handwashing is a response to an obsessive fear of germs.

  
  

  - Avoidance: OCD can also be characterised by avoidance of situations that may trigger anxiety. However, this avoidance can lead to a disruption in daily life as people may avoid everyday situations such as taking the bins out (for fear of germs).
• Emotional characteristics of OCD

  - Anxiety and distress: OCD is seen as a particularly uncomfortable emotional experience due to the powerful anxiety that accompanies obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and can lead to overwhelming anxiety. The urge to repeat a behaviour, a compulsion, creates anxiety.

  
  

  - Accompanying depression: OCD is often accompanied by depression, so anxiety can come with low mood and a lack of enjoyment of activities. Compulsive behaviour tends to bring some relief to anxiety but this is temporary.

  
  

  - Guilt and disgust: on top of anxiety and depression, OCD can also involve other negative emotions such as irrational guilt, e.g. over minor moral issues, or disgust which could be directed at something external like germs or at the self.
• Cognitive characteristics of OCD

  - Obsessive thoughts: for around 90% of OCD sufferers, the major cognitive feature is obsessive thoughts. These vary between people but are always unpleasant, involving recurring worries of things like germs, certainty that a door has been left unlocked or impulses to hurt someone.

  
  

  - Cognitive coping strategies: some adopt cognitive coping strategies to deal with obsessions. This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.

  
  

  - Insight into excessive anxiety: people with OCD are aware that their obsessive thoughts and compulsions are irrational - this is necessary for a diagnosis. If someone believed an obsessive thought to be reality then it would be a symptom of a very different mental disorder. Despite this, OCD sufferers have catastrophic thoughts about worst-case scenarios that might occur if their anxiety is justified. They also tend to be hypervigilant, maintaining constant alertness and pay attention to potential hazards.
• Biological approach to explaining phobias: Genetic explanations

  - Genes are invovled in individual vulnerability to OCD. Lewis (1936) observed that 37% of his OCD patients had parents with OCD and 21% had siblings with OCD. This suggests that OCD runs in families, although what is probably passed is genetic vulnerability, rather than a 100% certainty of OCD.

  - According to the diathesis-stress model, certain genes leave some people more likely to develop a mental disorder, however this isn't certain. Some environmental stress is necessary to trigger the disorder.
• Candidate genes, different types of OCD and polygenics


  - Candidate genes are specific genes identified by researchers which increase OCD vulnerability. Some of these genes are necessary for the regulation of the development of the serotonin system.

  
  

  - OCD is also polygenic; OCD isn't caused by one single gene, rather, a combination of specific genes increases genetic vulnerability.

  - Taylor (2013) analysed findings of previous studies and found evidence that there are 230 genesthat could potentially cause OCD.

  - Genes related to OCD include any associated with neurotransmitters, specifically dopamine and serotonin as these have a crucial role in mood regulation.

  
  

  - Different combinations of genes can cause OCD, and these vary from person to person; OCD is aetiologically heterogenous.

  - There is also some evidence that implies that different types of OCD may be the result of particular genetic combinations, such as trichotillomania and hoarding disorder.
• Biological approach to explaining OCD: Neural explanations

  - The view that physical and psychological characteristics are determined by the behaviour of the nervous system, particularly the brain and also individual neurons.

  - The genes associated with OCD are likely to affect the levels of vital neurotransmitters as well as brain structures.
• Role of serotonin and decision-making systems


  - Serotonin is a neurotransmitter that helps to regulate mood.

  - Neurotransmitters relay information from one neuron to another via synaptic transmission.

  - If a person has low serotonin levels then abnormal transmission of mood-related information takes place, and can lead to low mood.

  - At least some cases of OCD may be explained by a reduction in how the serotonin system functions in the brain.

  
  

  - Some cases of OCD may also be associated with poor decision-making systems. This impairment could be due to abnormal functioning of the lateral sides of the frontal lobe. The frontal lobes are responsible for logical thinking and decision-making.

  - There is also evidence to suggest that the hippocampal gyrus, an area associated with the processing of negative/unpleasant emotions, functions abnormally in OCD
• Evaluating genetic explanations: Research support


  - A strength of the genetic explanation for OCD is that there is lots of supporting evidence.

  - A source of evidence used for support is twin studies. Nestadt et al. (2010) reviewed twin studies and found that 68% of identical twins shared OCD compared to 31% of non-identical twins.

  - Another source of evidence is family studies. Marini and Stebnicki (2012) found that a person who has a family member with an OCD diagnosis is 4x more likely to develop it.

  - These research studies suggest that there must be some genetic influence to the development of OCD.
• Evaluating genetic explanations: Environmental risk factors


  - A limitation to the model is that environmental risk factors can also affect whether OCD develops.

  - While genetic variations affect OCD vulnerability, environmental risk factors can also trigger or increase the risk of developing OCD.

  - Cromer et al. (2007) found that over half their sample of OCD patients had experienced a traumatic event in the past; OCD was more severe in the patients who had 1+ traumas.

  - This means that genetic explanations only provide a partial explanation for the causation of OCD.
• Evaluating genetic explanations: Animal studies

  - It has proved difficult to find candidate genes.

  - Evidence from animal studies has shown there are particular genes that are associated with repetitive behaviour found in animals such as mice - Ahmari (2016)

  - Although mice and humans have somewhat similar genes, the human mind and brain is much more complex than a mouse's, so it may not be possible to extrapolate findings from animal studies.
• Evaluating neural explanations: Research support


  - A strength is that there is supporting evidence of the neual explanations.

  - Antidepressants that work on serotonin alone are effective at reducing OCD symptoms, suggesting that serotonin has a role in OCD.

  - Moreover, OCD symptoms form a part of disorders proven to be biological in origin, such as Parkinson's disease. If a biological process produces OCD symptoms, then we can assume that biological processes underlie OCD.

  - This suggests that biological factors may also be responsible for OCD.
• Evaluating neural explanations: No unique neural system

  - A limitation is that the serotonin-OCD link may not be exclusive to OCD alone.

  - Co-morbidity can occur; this is where two mental disorders occur simultaneously, e.g. many OCD-sufferers also have depression.

  - This depression most likely involve disruption to serotonin function. It could be that serotonin activity is disrupted in many people with OCD as they are also depressed.

  - This means that serotonin may not be relevant to OCD symptoms.
• Evaluating neural explanations: Correlation and causality

  - There is evidence to show that some neural systems don't work normally in people with OCD. The biological approach states that this is most easily explained by the brain dysfunction causing OCD.

  - But, this is simply a correlation between OCD and neural abnormality, and we cannot assume that neural abnormalities cause OCD directly.

  - It is quite possible that OCD causes brain dysfunction, or that both are influenced by a third unknown factor.
• Biological approach to treating OCD: Drug therapy


  - This is treatment involving drugs - chemicals that have a particular effect on the functioning of the brain or some other system. With regards to psychological orders, drugs commonly alter neurotransmitter levels.

  - Drugs that treat OCD often focus on increasing the level of serotonin in the brain.
• SSRIs

  - Stands for selective serotonin reuptake inhibitors.

  - SSRIs are the standard method for reducing OCD symptoms.

  - During synaptic transmission, serotonin is reabsorbed by the presynaptic neuron when the signal/information has been transmitted and is also broken down so it can be reused.

  - SSRIs work by preventing this reabsorption and breakdown, increasing serotonin levels in the synapse, continuing to stimulate the postsynaptic neuron. This is compensation for whatever is wrong with the serotonin system.

  - Dosage varies depending on the SSRI prescribed and they are available as capsules or liquid.

  - SSRIs must be used daily for 3-4 months to an impact on symptoms.
• Combining SSRIs with other forms of treatment and alternatives

  - SSRIs can be implemented alongside CBT. The subsiding of emotions of anxiety and depression means that OCD sufferers can engage more effectively with CBT.

  - The effects of this vary between people; some respond best to just CBT, whereas others may need to take SSRIs. Alternatively, other drugs may be prescribed alongside SSRIs.

  
  

  - Tricyclics, such as clomipramine are an alternative to SSRIs. These act on different systems, one of which is the serotonin system, where it has te same result as SSRIs. However, clomipramine has more severe side effects than SSRIs, and so it reserved for people who may not respond to SSRIs.

  - SNRIs (serotonin-noradrenaline reuptake inhibitors are another alternative. Like tricyclics, they are a back-up form of treatment for those unresponsive to SSRIs. SNRIs increase levels of serotonin and noradrenaline.
• Evaluating SSRIs: Evidence of effectiveness (with counterpoint)


  - A strength is that using drug treatment generally has good results.

  - Soomro et al. (2009) reviewed 17 studies comparing SSRIs to placebos when treating OCD. All 17 studies showed significantly better outcomes for SSRIs than placebos.

  - Typically, symptoms reduce for around of 70% of patients on SSRIs. The remaining 30% can be treated using alternative drugs, psychotherapies or a combination.

  
  

  - Counterpoint: There is some evidence that SSRIs may not be the most efficient form of treatment. Skapinakis et al. (2016) organised a systematic review of outcome studies and concluded that both behavioural and cognitive therapies were more effective at treating OCD than SSRIs

  - This means that drugs may not be the most effective form of treatment of OCD.
• Evaluating SSRIs: Cost-effective and non-disruptive

  - Another strength of drug therapy is that it is cost-effective and non-disruptive to patients' daily lives.

  - Thousands of tablets/liquid doses can be manufactured in the time it takes to conduct a session of therapy. Therefore, using drugs provides good value for public health systems like the NHS and can also be cost-effective, something that is especially crucial with limited funds.

  - SSRIs arealso non-disruptive to people's lives, and drugs can be taken alone until symptoms decline rather than having to attend therapy sessions which require planning your time around it.

  - This means that drugs are popular with people with OCD and doctors.
• Evaluating SSRIs: Serious side-effects


  - However, a limitation is that SSRIs can have some serious side-effects.

  - While SSRIs do benefit lots of people, a small percentage are unaffected by them. Some also experience negative side-effects such as indigestion, blurred vision and a loss of sex drive. These are temporary but can still be quite distressing.

  - Tricyclics such as clomipramine have more common and serious side effects such as erection problems, weight gain, with 1 in 100 experiencing increased aggression and heart-related problems.

  - This can lead to a lower quality of life as a result of taking these drugs, and patients may stop taking them completely, rendering them useless.
• Evaluating SSRIs: Biased evidence

  - A limitation is that some evidence supporting drug effectiveness may be biased. Goldacre (2013) suggested that some psychologists may selectively publish positive outcomes of drug effectiveness studies as the research is sponsored by these drug companies, biasing the pool of information.

  - On the other hand, there are not many independent studies investigating drug efficacy and research on psychotherapies may be biased. The best evidence available is supportive of drug usage to treat OCD.