OCD

Question 1

Give the DSM’s 5 criteria for Obsessive Compulsive Disorder (OCD)

Answer 1

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

Question 2

Define obsessions & compulsions

Answer 2

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

Question 3

Are children’s rituals e.g. avoiding cracks in the pavement examples of compulsions?

Answer 3

No

Question 4

Why have obsessive-compulsive traits evolved? 17% of 26-32 year-olds report either symptom but may not suffer from OCD because…

Answer 4

Because we have evolved an offline psychological immune system to avoid risks. They don’t experience distress as a result

Question 5

Name 4 noticeable demographic characteristics of OCD patients in comparison to healthy controls and sufferers of other anxiety disorders

Answer 5

1) Less likely to be married, 2) More likely to be unemployed, 3) “ “ have a low income & 4) “ “ have a low social class

Question 6

Some people believe that OCD encompasses 2 categories or subtypes of disorder e.g….or…

Answer 6

Early-(childhood) vs. late-onset (adulthood) versions. Tic-based, less anxiety-related vs. non-tic-based, more anxiety-related versions

Question 7

Name 5 characteristics of early onset OCD in comparison to late onset OCD

Answer 7

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

Question 8

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)

Answer 8

3-5. 1) Washers (a strong R between contamination Os & washing Cs) 2) Orderers (a strong R between symmetry obsessions & repeating, counting & ordering Cs)

Question 9

Factors 3 & 4 of OCD are…

Answer 9

3) checkers (a strong R between aggressive Os & checking Cs), 4) hoarders (a strong R between hoarding Os & hoarding Cs!)

Question 10

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

Answer 10

OCD patient responses on a checklist of obsessions & compulsions. 70%

Question 11

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?

Answer 11

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)

Question 12

What is the mysterious 5th factor in OCD? Which symptom factor shows the lowest test-retest reliability?

Answer 12

Sexual/ religious. Aggressive/checking

Question 13

The validity of the 5 factors is supported by…(3 tests of criterion validity)

Answer 13

1) different patterns of response to SSRIs & exposure-based behavioural therapy, 2) different familial loadings & 3) distinct but overlapping neural bases

Question 14

In particular, patients typical of which 2 symptom factors respond well consistently vs. inconsistently to SSRIs vs. behavioural therapy?

Answer 14

SSRIs consistently: aggressive/checking & symmetry/ordering (both contain S) vs. inconsistently: contamination/washing. Behavioural therapy consistently: orderers, washers vs. inconsistently: checkers

Question 15

This leaves ___ & ___/___ ___ with no effective treatment avenue

Answer 15

Hoarders & religious/ sexual obsessions sufferers

Question 16

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)?

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

Emotional, motor & attentional

Question 19

Name 4 problems with the fMRI study by Mataix-Cols (2004) to which neural activity findings may be attributable

Answer 19

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

Question 20

What is hoarding?

Answer 20

The acquisition of & failure to discard items that appear (to others) to have little value

Question 21

Give 3 pieces of evidence which suggest that hoarding should be considered a distinct disorder from OCD

Answer 21

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

Question 22

Some believe that OCD should be removed from the category of anxiety disorders. Give some e.g.s of other anxiety disorders & their definitions

Answer 22

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)

Question 23

How can it be argued that OCD is not an anxiety disorder?

Answer 23

Lecturer: “the obsessions is primary” vs. me: “compulsions are not always preceded by obsessions”

Question 24

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….

Answer 24

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

Question 25

In sum, there are 2 overriding conceptual issues with OCD. What are they and how might they be solved? (Covered in previous Qs)

Answer 25

1) There is heterogeneity in the phenotype (categorical vs. dimensional solutions), 2) There are boundary issues with other disorders (broaden the OCD phenotype to encompass 2 independent but overlapping categories relating to other disorders)

Question 26

What characterises the two proposed OCD categories?

Answer 26

1) anxiety-related OCD (late onset, lower familial loading), 2) tic related OCD (early onset, higher familial loading)

Question 27

OCD has been explained in terms of deficits to information processing, in particular to…(2 things). There is much evidence to support this view.

Answer 27

Cognitive & behavioural inhibition

Question 28

At the neural level OCD patients’ failure to inhibit has be explained in terms of dysfunctional…

Answer 28

frontal striatal loops, including the basal ganglia (motor inhibition) & orbitofrontal cortex (updates changes in reward contingencies) = unable to inhibit previously reinforced actions

Question 29

The frontal striatal loop begins at the thalamus, runs up to cortex and then back down to the thalamus via the ___, ___ ___ (& ___ nucleus)

Answer 29

striatum, globus pallidus (internal vs. external), subthalamic nucleus (external GP route only)

Question 30

Whiteside’s (2004) meta-analysis of PET & SPECT studies found the largest effect sizes for resting state & symptom provocation activity levels in…

Answer 30

the left & right orbital gyri & the left & right heads of the caudate

Question 31

Generally the pattern of cognitive deficits in OCD corresponds to the brain sites which show the greatest abnormality in activity in OCD except that…(2 things)

Answer 31

OCD patients are impaired on EF tasks which engage other PFC regions (i.e. not orbital gyri) e.g. the Tower of London planning task & are intact at some decision making tasks which require the OFC e.g. the Iowa gambling task (Menzies, 2008)

Question 32

Rachman’s (1997) cognitive model of OCD attributes the disorder to faulty cognitive appraisals. The series of events begin with a normal intrusive thought, followed by…

Answer 32

Misinterpretation of the thought as important or threatening, leading to obsessional anxiety, efforts to remove obsessional fear e.g. rituals or thought suppression, anxiety reduction & reinforcement of maladaptive core beliefs

Question 33

Abramowitz (2006) provides support for the cognitive appraisal view, finding that the greater the no. of intrusive, obsessive thoughts which expectant mothers…

Answer 33

experience before their babies’ birth, the greater the likelihood that postpartum the mothers will experience distressing intrusive thoughts about their infants & will report the use of “neutralising” strategies

Question 34

Name 2 examples of treatment for a) the pharmacological approach & b) the behavioural approach

Answer 34

a) SSRIs & antipsychotics, b) (imaginal) exposure: systematic, repeated & prolonged confrontation with anxiety-promoting stimuli & response prevention (refrain from performing compulsions to demonstrate no adverse consequences)

Question 35

Give one advantage & disadvantage of SSRIs as a treatment for OCD

Answer 35

They work well in the short-term, as shown by large effect sizes but there are residual symptoms which the SSRIs don’t target & relapse is common because they don’t target the cause of OCD - notice the treatment/explanation discrepancy

Question 36

Order to the following OCD treatments in terms of their effectiveness, as found by Foa (2005): combination of drug & therapy, behavioural therapy, placebo & medication

Answer 36

Least to most effective: placebo, drug (chlomipramine), behavioural therapy (exposure & ritual prevention) & the combination (which was only a little more effective than just behavioural therapy)

Question 37

What does cognitive therapy involve doing? It is usually combined with ___ therapy and is effective in such cases

Answer 37

Identifying & modifying maladaptive cognitions & core beliefs on an individual-by-individual basis. Behavioural

Question 38

Smaller effect sizes are found when CBT is compared with ___ treatments rather than doing a __- vs. __- treatment comparison. The first study in the table presented used patient ratings as the outcome V, whereas the 2nd study used…

Answer 38

Control. Pre, post. Assessor ratings