OCD essay plan – Flashcards

OCD consists of 2 main components - obsessions and compulsions The DSM states that for classification, the obsessions need to consist of persistent thoughts which the individual tries to suppress. The DSM also states that the compulsions need to be repetitive behaviour that aims to reduce distress. In order for a Doctor to diagnose a patient with OCD the obsessions and compulsions have to interfere with everyday life and functioning The mean age of onset is late adolescence in men and early 20s in women.

The two classification systems (ICD and DSM) have different criteria for same disorder - maintained by two different health groups.- reduced reliability of diagnosis. Diagnostic criteria is categorical systems - patient has to meet set criteria, some patients may just miss out on diagnosis - won't get treatment. - validity Co-morbidity of disorders with depression - validity issue Medicalisation of normal behaviour, anxiety considered as healthy response to aid survival, instead anxiety becomes classified as symptom. - reliability and validity.

Suggests we inherit genes from our parents - predisposition to OCD. Twin studies - Mz twins 100% same DNA, 100% concordance rate, Dz twins 50% same DNA, 50% concordance rate.

Research support: Groothest reviewed 70 years twin studies, heritability rate of 45-65% in children and 27-47% in adults. Meta analysis - reliability Doesn't explain why Groothest found differences in heritability rate in children and adults. Also neither results showed a 100% concordance rate meaning that environmental factors are also involved. Not all research supports - Pato - not enough to know genetic mechanisms Reductionist - one single cause, practical applications, e.g. gene screening, counselling. Deterministic

Assumption - there are differences between the brain anatomy and functioning between OCD patients and healthy controls Focus is on orbital region of frontal cortex and caudate nucleus within basal ganglia

Research: Cromer studied OCD patient who shot himself in the orbital region of the brain. Afterwards, dramatic reduction in symptoms. - one patient, not generalisable Soriano Mas tried to categorise OCD patient and healthy controls using info on brain structures, overall accuracy was 77% so some support, but not the same for everyone. Deterministic - no free will in trying to control obsessions. However, practical applications - psychosurgery

Three behavioural explanations - social learning, classical conditioning, operant conditioning Assumption - reinforcement Positive reinforcement - relief felt when compulsion carried out Negative reinforcement - avoidance of anxiety Skinner's superstition hypothesis - bodily actions become associated with reinforcement and thus being repeated. Compulsions are reward.

Operant conditioning: Research: Einstein and Mmenzies gave 60 OCD patients Magical ideation scale, found significant correlation between magical thinking and OCD. Supports Skinner. -Correlation - Well established in other areas of psychology e.g. intelligence. Operant conditioning only shows how OCD is maintained and not how OCD is originated. More appropriate to combine operant and classical - classical explains origin. Previously neutral stimulus associated with unconditioned stimulus leading to conditioned response of fear.

Social learning theory is based on the theory of Bandura. Assumption is that we observe OCD behaviour, then retain it, until we experience a motivation where we imitate it. The observed person is your role model.

Weisman said that anxiety disorders run in families which has been known about for centuries. Explains how OCD originates Doesn't explain how you can have different types of compulsive behaviour within family Some OCD sufferes compulsions and obsessions change throughout their life. Deterministic - if you spend a lot of time with your role model then you'll get OCD.

Sufferers are seen as having impaired, persistent thought processes, and sufferes find it difficult to dismiss intrusive thoughts which lead to self blame, depression and heightened anxiety and inflated sense of personal responsibility.

Practical applications - pie technique, Barret and Healey compared children with OCD with anxious children and non-clinical children finding that ocd children with higher rating of cognitive appraisals such as probability and severity of events, and thought action fusion. - children not adults However, it isn't clear if maladaptive thinking is a cause or an effect of OCD. Not reductionist - considers other factors and not one single cause e.g. environment.

Exposure Response Therapy is a method aimed to stop people carrying out compulsive behaviour. In ERP clients are repeatedly exposed to objects and situations that normally arouse anxiety. They are encouraged to avoid their normal compulsions. But are taught relaxation techniques.

Research: Eddy carried out meta analysis which compared effectiveness of behavioural therapy, cognitive therapy and CBT. ERP is more effective. - meta analysis - reliability - Yale Brown Scale untreated controls had a mean of 22.00, for CBT 14.14, cognitive 13.10 and for ERP 12.48 ERP is effective in the long run - relaxation techniques. However, drop out rates are high - around 25-30% patients drop out. - not appropraite or effective. ERP could be unethical - large amount of distress Combining ERP with cognitive therapies may be more appropriate - cognitive deals with thought processes. Some psychologists say that combining cog and beh will improve effectiveness, - Hill and Blemish claims that integrating components doesn't result in therapeutic gains.

Eddy et al found cognitive therapy moderately effective All OCD patients have obsessional aspects to the disorder and cognitive therapy is very effective at treating this symptom. So if patients have largely obsessional aspect to their OCD then cognitive therapy is an effective treatment. Rachman found evidence that patients who have mostly obsessions are untreated by ERP so cognitive therapies are better. However, patients who have largely compulsive symptoms are not effectively treated by cognitive therapies, and so is not appropriate for all OCD patients.

Drugs are a common method of treating OCD. Different drugs are used that work in similar ways. Anti-depressants such as SSRIs are used as they elevate the levels of serotonin. Anti-psychotic - lowering effect of dopamine. Beta blockers - lower adreanline and noradrenaline.

Picinelli performed a meta analysis of 36 studies which assessed effectiveness of anti-depressants. Effective in short term 61% improved symptoms. - meta analysis - reliability - Berqovist - effects of low doses of anti psychotic drugs risperidone and found it effective. Drugs aren't cure for OCD, as soon as drug taking stops symptoms reappear. Not always appropriate for long term. Drugs only deal with symptoms, not cause of disorder. Drugs are cost effective and user friendly - appropriate.

Used for sever cases of anxiety disorders that don't respond to other treatments, and where there is a greatly reduced quality of life and/or risk of suicide. Psychosurgery involves destroying brain tissue to disrut the corcicostriatal circuit, which affects the orbital frontal cortex, thalamus and caudate nucleus.

Liu followed up 35 OCD patients non-responsive to medication, psychological and behavioural treatments, who underwent stereotactic anterior capsulotomy psycho surgery. PET scans and questionnaires were used to find that 57% were symptoms free, 29% significant improvements, 14% showed no improvements. - medical evidence Psycho surgery should only be used after informed consent is given but it is debatable whether patients with sever OCD can give fully informed consent suggesting ethical issues. - Psychosurgery can't be considered a cure for OCD and patients who undergo surgery will probably continue to need psychiatric support following procedure even if considered a success.