OCDs Flashcards
What are obsessions
Obsessions are repetitive and persistent thoughts that are discordant with ones personality and extremely distressful
What are compulsions
these are repetitive rituals that individuals engage in to minimise the distress caused by the obsessions
What is the ICD-11 criteria for OCD
1)For diagnosis to happen there needs to be persistent obsessions and or compulsions for more than 1 hour a day.
2)The obsessions/compulsions are extremely time consuming and result in significant impairment in the core areas of functioning
3)The symptoms are not a manifestation of another medical condition e.g basal ganglia stroke.
Describe the study by Rapoport
Case study
Sample - 12 year old boy named Charles
Case history;
from age 12, Charles became obsessed that there was something sticky on his skin. This led to him spending three hours in the shower everyday. After months of behavioral therapy and various medications, he began seeing Rapoport at the age of 14.
. Before the onset of his disorder, he had been doing well at school, especially in biology. Gradually, his symptoms worsened and he was unable to go to school.
Washing took up too much of his day and he was unable to concentrate on schoolwork.
Charles mother tried to help him by rigorously cleaning everything in his room and the rest of the house. Visitors were asked to wash their hands to avoid contamination but eventually she stopped asking people to the house at all.
Symptoms;
- Charles was obsessed with stickiness and called it terrible, some kind of disease’
- The worst thing he could think of was touching honey.
He washed for three hours at a time - for example, passing the soap from one hand to the other after a certain amount of time had passed.
He showed general slowness with dally routines, e,g dressing could take two hours.
When Rapoport did an EEG on Charles he stayed up washing all night following the day of the EEG.
Charles was sad because his sisters and other children would call him crazy
Treatment;
Charles was given clomipramine (a tricyclic antidepressant). This helped in the short term.
Within a month, Charles was able to pour and touch honey, but one year later he relapsed.
He had become tolerant to the drug, meaning he needed increasingly large doses to produce the same effect. His symptoms returned, although in a more manageable way.
What are the two measures of OCD
Maudsley obsessive compulsive inventory (MOCI)
Yale brown obsessive compulsive scale (Y-BOCS)
Describe the Maudsley Obsessive Compulsive inventory (MOCI) as a mesure of OCD
-It is a 30 item short assessment tool for OCD. the items measure 4 different subscales of compulsions i.e washing , checking , slowness , doubting
-Each item is scored either true or false. True =1 , False =0
-MOCI produces scores ranging from 0-30
-The person completing the questionnaire is asked to circle either true or false for each of the 30 items
Give 3 examples of items in MOCI
items that measure checking;
- spending a lot of time everyday checking things over and over again (true or false)
items that measure slowness
-Im often late because i can’t seem to get through everything on time (true or false)
Items that measure washing
-I’m not excessively concerned about cleanliness
Describe the Yale Brown obsessive compulsive scale (Y-BOCS) by Goodman et al as a measure of OCD
-It comprises a semi-structured interview that obtains data about the patients OCD from both the patients and the patients relatives
-The two sets of data from the patient and the patients relatives are compared for reliability.
-It is a checklist of 10 different obsessions and compulsions.
-it has two subscales ; the obsession subscale and the compulsion subscale each comprising of 5 items
-Each item on the Y-BOCS is rated on a 5 point scale from 0-4
4= extreme/disabling , 0=none
-The individual completing the questionnaire is asked to circle an appropriate number relating to the severity of their symptoms.
-Scores range from 0-40 , the higher the scores the more disabling the symptoms.
-Individuals with scores above 16 are considered in the clinical range for OCD.
How is the severity of the symptoms operationalised in Y-BOCS
- The durations spent in the obsessions and compulsions
-How hard the obsessions and compulsions are to resist
-How much distress the obsessions cause the individual
Give examples of items in the Y-BOCS that measures obsessions
-How much of an effort do you make to resist the compulsions
0=always try to resist , 4= completely and willing to yield all compulsions
-How would you feel if prevented from performing your compulsions ? How anxious would you become ?
0= none , 4= incapacitating anxiety
Evaluate MOCI and Y-BOCS
1)Concurrent validity
2)Social desirability bias
3)Low validity
4)Useful application to everyday life
5)Holism vs reductionism
Describe the biological explanation of OCD
1)Dopamine
- Research has shown that those with OCD tend to have abnormally high levels of dopamine . For example research by Szechtman et al shows that if you increase dopamine levels in rats they will show repetitive movement that reflect the compulsive behaviours in people with OCD.
2)Serotonin
-Research has shown that patients with OCD have lower than normal levels of serotonin in their brains. There is evidence that supports this claim , . Strong anti-depressants have shown to be effective treatments for OCD as they increase the brain serotonin levels.
3)Oxytocin
Often described as the love hormone because it is involved in enhancing trust and attachment . However oxytocin is also known to process other behaviours in the extreme ends of the spectrum of behaviours , such as distrust and fear.
Therefore OCD could be considered one of the behaviours in the spectrum of behaviours processed by oxytocin
Describe the genetic explanations of OCD
According to numerous research evidence , OCDs are thought to have a genetic basis , i.e that genetic markers are passed down to offsprings by parents that cause the disorder to develop
-Monzani et al
-Ozaki
-Matthiessen
Describe Monzani et al’s research as a genetic explanation of OCD
-Carried out a large scale twin study , data from the study found a 52% concordance for OCD trait in MZ twins compared to 21% in DZ twins
Describe Ozaki et al (2003) research as a genetic explanation of OCD
-Research implicates SERT gene (serotonin ) in trait OCD. variants of the SERT gene were found in 6 members of two unrelated families who had OCD.
Describe Matthessian et al’s (2015) research as a genetic explanation of OCD
Matthessian conducted a large scale study involving 1406 patients with OCD and other members of the general population to analyse and identify genes that will be linked to OCD symptoms.
-Data from this study revealed that the gene PTPRD was implicated along with the gene SLITRK3 in the development of OCD.
Evaluate the biological explanation of OCDS
-Reductionism vs holism
The biological explanation is reductionist as it only focuses on the biological aspect of OCD
Behavior. It disregards the psychological explanation. For example it only focuses on the role of neurotransmitters such as the excess amounts of dopamine and below average levels of serotonin in the brain which lead to the development of OCD.
However a holistic view would require the psychologist to look at the interconnectedness between biological factors e.g low serotonin levels and the psychological triggers e.g thought action fusion which is an error of thinking found in individuals with OCD.
-Useful application to everyday life
The biological explanation has useful application to everyday life as it has led to the discovery that SSRIs can be used to treat individuals with OCD. This has useful application as it significantly reduces the distress caused be the obsession.
-Nature vs Nurture
What are the 3 psychological explanations of OCD
1)Cognitive explanations
2))Behavioural explanation
3)Psychodynamic
Describe the cognitive explanation (thinking errors) (as a psychological explanation of OCDS)
-According to cognitive psychologists OCD is a form of catastrophic misinterpretation of the significance of the intrusive thoughts , impulses and images
-Rachman claims that OCD results from a thinking error such as thought action fusion (TAF)
-According to Rachman people with OCD equate the thoughts to the actions , for them thinking about an event is morally equivalent to acting on the event , or thinking about the event increases the likelihood of the event happening.
Describe the Behavioural explanation (as an psychological explanation of OCDS)
-Negative reinforcement is a principle of operant conditioning.
-According to behaviourists OCDs are learnt responses through negative reinforcement.The compulsions negatively reinforce the OCD by relieving the individual from the distress caused by the obsessions
Describe the psychodynamic explanation (psychosexual development) (as an psychological explanation of OCDS)
(Traumatic toilet training in the anal stage of psychosexual development)
-According to psychodynamic psychologists like Freud , OCD is a manifestation of fixation at the anal stage of psychosexual development 1-3 years.
-Toilet training is the main activity at this stage , however when it is traumatic e.g when parents are strict it creates tension between the caregiver and the child
-To regain control the child can either soil themselves (anal expulsive personality) or retain the feces (anal retentive personality) both anal retentive and anal expulsive are a manic fixation.
-OCDS are a consequence of under gratification or over gratification of the anal impuloses.
Evaluation of the Psychological explanations
Useful application to everyday life
Operant conditioning theory and the cognitive explanations have led to the development of CBT techniques such as ERP exposure and response prevention of ocd.
Patients leave ERP with skills that allow them to survive in the outside world without the therapist e.g visualization skills , response prevention skills.
Subjective
Explanations such as the psychodynamic theory of ocd are subjective because ideas such as fixation at the anal stage of psychosexual development cannot be subjected to objective scientific testing and therefore they are just opinions of the scientists.
Determinism vs free will
- the explanations such as negative reinforcement support the determinism side of the determinism vs free will debate. Because the theory claims that we are products of operant conditioning which we have no control over. Also the psychodynamic explanation of fixation at the anal stage of development is deterministic it claims that we are products of early childhood experiences such as traumatic toilet training which leads to fixation that we have no control over.
However since humans are intelligent and rational beings a more optimistic view would be to look at the ability of humans to overcome the predicament by finding solutions for their situations. Hence humans have the freedom of choice.
The explanation supports the nurture side of the debate as we learn from events e.g traumatic toilet training. Which lead to the development of OCD.
What are the two types of treatment/management of OCDS
biological
psychological
Describe the biological treatment of OCDS
-Obsessions are particularly distressful images , thoughts and impulses
-SSRIS’s help to avert the distress by inhibiting the reabsorption of serotonin across the presynaptic membrane , hence increasing synaptic serotonin levels.
-This helps to minimize the distress by boosting the mood of the patient
