OCD Revision Cards

• Characterised by presence of obsessions and compulsions.
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    • Obessions = persistent and uncontrollable thoughts or urges
    • Compulsions = the need to repeat certain actions to reduce anxiety.

• Minor OCD can sometimes be helpful at calming us when stressed.
• Becomes a disorder when so intrusive it interferes with life/normal functioning.
• Person is aware thoughts are unreasonable and are from own mind.

• Common themes/compulsions:
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    • contamination/dirt --> compulsive cleaning/need for order.
    • Checking (e.g. switches, door locked etc.)
    • Counting/touching objects a certain number of times.

• Measured by the Maudsley Obsessive Compulsive Inventory (MOCI)

• Approx 1-3% of population are sufferers but secretive so could be higher.

• Male onset younger, typically 6-15 years.

• Female onset typically 20-29 years.

• Males more likely to be checkers.

• Females more likely to be washers.

• Mower (1960)

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    • Classical Conditioning - Certain words, thoughts and images have become associated with anxiety causing stimuli.
    • Operant Conditioning - carry out an act (compulsion) which reduces anxiety = reinforced behaviour!

BUT!

• Not all obsessions have compulsions!
• How are obsessions maintained without the presence of compulsions?

• Rachman & deSilva (1978)
  •  
    • 90% have intrusive thoughts, only 1-3% develop disorder.
    • OCD sufferers must interpret thoughts differently as opposed to simply learning the behaviour.
    • If behavioural model was correct, the 90% would all develop the disorder easily.

• Cognitive Biases - OCD sufferers have a number of faulty cognitions:

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    • RESPONSIBILITY - high sense - if don't do something people will be harmed.
    • GUILT - excessive moral value on cleanliness etc, if fall short of standards then guilt.
    • THOUGHT = ACTION - believe if think something they will do it/it will happen.
    • OVERESTIMATE DANGER - and exaggerate likelihood of averse consequences.
    • CONTROL - feel should have control over thoughts. 
    • MEMORY -  memory problems may explain compulsive checking/worry.

Cognitive Deficits

• Greisberg & McKay (2003) - deficits in organisational strategies = trying to recall disorgaised info = doubting. 

• Kirkby (2003) - frontal lobe dysfunction.

• Purcell et al (1998) - Errors in executive and visual memory

• Veale et al (1996) - planning and accuracy errors.

1) Brain Deficits / Activity

• Baxter et al (2001) - Basic impulses from frontal cortex can't be switched off. 

• Chamberlain et al (2005) - frontal cortex more active than controls. 

• Baxter et al (1990) - Caudate nuclei & thalamus too active? = constant troublesome thoughts and actions.

2) Genetics / Vulnerability

• Lambert & Kinsley (2005) - higher concordance for MZ than DZ.
• Pauls et al (1995) - 6% of sufferers' parents also suffered.
• Chromosome 9 potentially implicated. 
• Menzies (2007) - OCD patients and relatives showed behavioural impairment linked to reduced grey matter in frontal cortex.

3) Neurochemicals

• Some have linked OCD to low levels of serotonin --> SSRIs effective for OCD!

1) Harsh toilet training

• = child rage which in turns leads to parents bad mood. 
• child wants to be 'dirty' but also wants to keep parents happy.
• This conflict leads to OCD.
• Would explain cleanliness OCD but not other forms?

2) Impulses

• Usually sexual  or aggressive in nature battled out in conscious instead of unconscious. 
• Id Impulses = obsessions. 
• Ego defences = compulsions. 

Social Model

• Parents may have placed great emphasis on unreasonably high standards. 
• If these standards not met = anxiety. 

Integration Model

• Genetic predisposition / Brain structure / chemistry.
• Experience high arousal to cognitions due to this = anxiety.
• Judgements and assumptions distorted.
• Try to stop the thoughts but makes them more frequent.
• Various cognitive / behavioural acts give temporary relief.

• Rationale = always perform compulsions to reduce anxiety, never risk not doing them --> need to stop doing something to see its effect. 

Exposure and Response Prevention (ERP)

1) Expose person to stimulus causing anxiety.

2) Block compulsive behaviour.

3) Reappraise the fear - person sees that nothing bad happens when compulsions not carried out. 

BUT!

• Has to be done in a very controlled setting occasionally (e.g. hospital).
• VERY STRESSFUL!!
• Mant won't even try ERP and drop out rates are high. 

• Hallon et al (2006) - 55-85% improvement

• Works best for cleaning and checking OCD. 

• Foa & Kozak (1996) - Benefits lost over 29 months. 

• Foa (2008) - 25% failed to benefit. 

• 22-30% drop out or don't comply.

• Some relapse has been seen - likely down to non-compliance.

• Try to correct overestimates of danger and negative consequences.
• Identify, challenge and change distorted cognitions. 

1) NORMALISING - show clients how intrusive thoughts are normal part of everyday    life. 

2) THOUGHT-ACTION FUSION -  help clients realise that thoughts don't always lead    to action.

3) MEMORY - Randomsky et al (2006) - show that reportedly checking is  counterproductive as makes memory worse and fuels checking ritual.

• Anti-depressants used successfully - SSRIs now most widely used.

• SSRIs increase functional level of serotonin in frontal lobe = increased activity. 

• Bareggi et al (2004); Lenike (1993) - Positive effects seen in 50-80% of people. 

• Bridge et al (2007) - Meta-analysis effect size of 0.48.

BUT!

• Maina et al (2001) - not complete recovery & relapse if treatment stops. 

• Prefrontal lobotomy as a last resort - 50% improve.