OCD Flashcards
Give the DSM’s 5 criteria for Obsessive Compulsive Disorder (OCD)
A) obsessions or compulsions, B) recognition that the Os/Cs are excessive/unreasonable, C) Os/Cs cause distress, take up 1h+/day & interfere with routines, D) the Os/Cs’ content does not apply to Axis 1 disorders & E) Os/Cs are not due to substances or a general medical condition
Define obsessions & compulsions
Os) recurrent, persistent & intrusive thoughts (not worries about real-life problems) which Pp try to neutralise (reduce their emotional impact). Cs) repetitive behaviours or mental acts which Pp feel driven to perform in response to Os. They reduce distress but are inappropriate or excessive
Are children’s rituals e.g. avoiding cracks in the pavement examples of compulsions?
No
Why have obsessive-compulsive traits evolved? 17% of 26-32 year-olds report either symptom but may not suffer from OCD because…
Because we have evolved an offline psychological immune system to avoid risks. They don’t experience distress as a result
Name 4 noticeable demographic characteristics of OCD patients in comparison to healthy controls and sufferers of other anxiety disorders
1) Less likely to be married, 2) More likely to be unemployed, 3) “ “ have a low income & 4) “ “ have a low social class
Some people believe that OCD encompasses 2 categories or subtypes of disorder e.g….or…
Early-(childhood) vs. late-onset (adulthood) versions. Tic-based, less anxiety-related vs. non-tic-based, more anxiety-related versions
Name 5 characteristics of early onset OCD in comparison to late onset OCD
1) More male patients, 2) More cases of Cs not preceded by Os, 3) Higher comorbidity with tics & TS (more involuntary), 4) worse response to drug treatments & 5) increased familial loading
In contrast to the categorical approach, the dimensional approach claims that OCD suffering lie at different position on a set of - dimensions. These were extracted using FA & include…(factors 1 & 2 only)
3-5. 1) Washers (a strong R between contamination Os & washing Cs) 2) Orderers (a strong R between symmetry obsessions & repeating, counting & ordering Cs)
Factors 3 & 4 of OCD are…
3) checkers (a strong R between aggressive Os & checking Cs), 4) hoarders (a strong R between hoarding Os & hoarding Cs!)
These factors were confirmed by a meta-analysis. Each component study conducted FA on…. The 3-5 factors account for __% of the variance in symptoms
OCD patient responses on a checklist of obsessions & compulsions. 70%
Are the 3-5 factors reliable? Measures in the study were taken after 1), 2) & 3) and were correlated with symptom category at T1 - what are 1, 2 & 3?
Yes, they are stable across time in as much as patients do not switch between symptom categories, though changes in the clinical content of Os & Cs do occur e.g. bleaching to using hot water to washing hands. 6 months, 1 year & 2 years (Mataix-Cols, 2002)
What is the mysterious 5th factor in OCD? Which symptom factor shows the lowest test-retest reliability?
Sexual/ religious. Aggressive/checking
The validity of the 5 factors is supported by…(3 tests of criterion validity)
1) different patterns of response to SSRIs & exposure-based behavioural therapy, 2) different familial loadings & 3) distinct but overlapping neural bases
In particular, patients typical of which 2 symptom factors respond well consistently vs. inconsistently to SSRIs vs. behavioural therapy?
SSRIs consistently: aggressive/checking & symmetry/ordering (both contain S) vs. inconsistently: contamination/washing. Behavioural therapy consistently: orderers, washers vs. inconsistently: checkers
This leaves ___ & ___/___ ___ with no effective treatment avenue
Hoarders & religious/ sexual obsessions sufferers
Which 2 of the 4 main factors were influenced by familial risk and implicated with specific genes? What was the problem with the familial risk study (Alsobrook, 1999)?
Aggressive/checking & symmetry/ordering. Some Pp who scored highly on factor 1 also scored highly on factor 3, meaning that their OCD was more severe i.e. familial risk may simply be more apparent in more severe cases
The fMRI experiment by Mataix-Cols (2004) took OCD patients with mixed symptoms and attempted to provoke symptoms in them e.g….by…. Patients’ & controls’ neural activity in these different conditions was compared
E.g. washing, hoarding, checking, general disgust & neutral symptom conditions. By presenting images & hypothetical scenarios e.g. imagine coming into contact with [this toilet] & not being able to wash your hands afterwards
Through knowledge of what brain area X usually reacts to, Mataix-Cols (2004) was able to infer the sort of mechanisms which are overactive in the OCD mind. ___, ___ & ___ brain areas lit up in the symptom specific conditions & not the normally aversive condition
Emotional, motor & attentional
Name 4 problems with the fMRI study by Mataix-Cols (2004) to which neural activity findings may be attributable
1) severity of OCD was not controlled for, 2) stage of CBT or drug treatment was not controlled for, 3) patients with comorbidity were not excluded & 4) illness duration was not controlled for
What is hoarding?
The acquisition of & failure to discard items that appear (to others) to have little value
Give 3 pieces of evidence which suggest that hoarding should be considered a distinct disorder from OCD
Abramowitz (2008) found that 1) OCD patients had higher scores than OAD (over-anxious disorder) patients & students on all types of OCD symptoms except hoarding, 2) hoarding correlated more weakly with other OCD symptom types than these types correlated with each other & 3) Hoarding items loaded most weakly on a single OCD factor
Some believe that OCD should be removed from the category of anxiety disorders. Give some e.g.s of other anxiety disorders & their definitions
1) Panic disorder (sudden onset of terror associated with physiological symptoms), 2) Generalised Anxiety Disorder (GAD), 3) PTSD (re-experiencing an extremely traumatic event), 4) social phobia (avoidance) & 5) specific phobia (avoidance)
How can it be argued that OCD is not an anxiety disorder?
Lecturer: “the obsessions is primary” vs. me: “compulsions are not always preceded by obsessions”
It may be more appropriate to place OCD with other disorders, given that other disorders are often characterised by obsessive & compulsive symptoms too e.g….
Depression, GAD, hypochondriasis (fear of having a serious disease based on misinterpretation of bodily symptoms), body dysmorphic disorder (preoccupation with a slight bodily anomaly), autism & impulse-control disorders e.g. TS
