OCD
- Created by: millietronnolone
- Created on: 11-01-16 21:10
what is OCD?
- obessions,ideas,thoughts images or impulses
- repeatly enter mind
- unwelcome & distressing
- compulsions-acts driven to perform
- compulsions remove anxiety
diagnosing OCD
ICD 10 or DSM-V
- obesessions/compulsions present on most days for 2 weeks
- accpeted by patient coming from own mind
- recognised as excessive/umpleasant
- resisted by patients
- not pleasurable
- cause distress
- arent caused by another disorder or drug use
issues with using ICD-10/ DSM-V
- different wording of classifcation (reduces inter observer diagnosis
- developed in west (cultural variations)
- within defintions there are overlaps between other disorders
- 1-3% have OCD
- OCD charity estimated 7%
- may not go to doctors due to self fulfiling prophecy
- stigma attached mental illness seen as a negative lable
Assessing severity of OCD
Yale Brown obsessive complusive scale (Y-BOCS)
- semi structured interview indentify severity of OCD
- patients given score after completing scale
- final judgment given by clinician
- ranges from subclinical to extreme
advantages of semi structured interview
- builds repor with interviewer,sensitive subject (increase validity)
- elaborates (answer prompts)
- all answer same questions (increased reliability)
- can reword Q's for children
disadvantages
- forcing their answer,limited responses (decrease validity)
- social desirability bias (dont want to appear severe)
evaluation of Y-BOCS
Reliability
- 54 patients with OCD using Y-BOC's & found good internal consistency
- inter rater reliability was reported as excellent
- (woody et al)
Test re-test
- not reliable after delays
- due to subjectivity of illness as it changes (good days/bad days)
Validity
- Is Y-BOCS assessing OCD or other disorders?
- shares similar characteristics with schizophrenia & depression
- social desirability
- should we catagorise all compulsions as the same
psychological explanations of OCD
- ID- irrational pleasure seeking part of our unconscious mind
- SuperEgo- moral part of personality helps controls urges from ID
- Ego- rational conscious part of our personality
freud
- childs natural behaviour repressd
- children dont cope well will suffer from OCD later in life
adler (1931)
- inferiority complex
- children rearing practices are too controlling
- unable to develop sense of autonomy
- individual adopts compulsive rituals to control and achieve autonomy
evaluation psychodynamic approach
- cannot test the theory- no empirical evidence (shouldnt disregard)
- retrospective data- majority of evidence unreliable (may not remember,memory influcenced by children & current situations)
- objectivity
- ignore current factors- e.g. relationship breakdown/unemployment to explain abnormality
- androcentric research- sexist only studied men
cognitive explanation of OCD
Salkovskis et al (2003)
- people with OCD believe that they can & should be in control of their thoughts
- when experience an intrusive thought they act
- neutralising the intrusive thought
support the cognitive explanation
Salkovski (1997)
- asked patients to record intrusive thoughts in diary
- try and repress thought on certain days
- patients recorded x2 many thoughts on repression days
evaluation of cognitive explanation
- vauge and don't know where thought processes come from (does it explain how OCD develops)
Reductionist
- ignoring environmental & subconscious factors
A02 conclusion (diathesis-stress model)
- mixture of both biological explanation & psychological
behavioural explanation of OCD
Mowrer(1977)
- classical conditioning = obessions (associations)
- operant conditioning= complusive rituals maintained positive/negative reinforcement
Rachman & Hodgson (1980) support
- people who engage in compulsive behaviour rewarded in a reduction of anxiety
evaluation of Behavioural theory
- effective therapy (ERP) based on the explanations of the behavioural approach
- good explanation of how OCD is maintained & not just focusing on cause
Marks (1981)
- ERP only effective at treating compulsions not thoughts
- where do they come from?
Treatment aetiology fallacy
- treatment doesnt equal an explanation
- doesnt mean if treatment works thats the explanation
Biological explanation of OCD
Neuroanatomical abnormalities
- orbital frontal cortext plays a role in sensory processing
- linking value to reinforcing stimuli & decision making (obessions)
- Basal Ganglia where movements controlled (compulsions)
PET scan
- patients with OCD have heightened activity in OFC
Basal Ganglia
- problems with BG linked to OCD (wise & rapoport)
- surgery discontecting BG from OFC can help OCD sufferers (Aylward)
A02
Comer (1998)
- OCD sufferers low levels of serotonin- vital for frontal lobes and OFC
- cause & effect
- low levels of serotonin?
- PFC not working?
sukel (2002)
- high dopamine levels
- over activity in BG
Biological explanation of OCD
Antidepressants
Pigott et al (1990)
- serotonin/dopamine reduce OCD symtoms others don't
- SSRS procedure
- treatment aetiology fallacy
Genetic factors Nestadt et al(2000)
- 80 OCD & 343 1st degree family members
- 1st degree relative with OCD X5 more likely to get OCD
- something genetically will be past down
Billet et al (1998)
- MZ X2 likely to get OCD if co-twin had disorder
- maybe prone to vicarious learning
evaluation of biological explanations
advantages
- scientific- empirical evidence
- objective measures
- removes blame
Disadvantages
- reductionist-ignores current factors/environmental
- deterministic- removal of free will (acting as pupets and their biology is the master)
Biological therapies of OCD
serotonin
- linked with emotion & mood
- research suggests neurotransmitter flucates then depression/mood disorder flucates
- 10-20% used in brain
- cannot be articially created or placed in brain
Soomaro et al (2008)
- 17 studies of SSRI's give to OCD patients
- more effective than placebos
evaluation of drugs
- severe side effects
- short term solution
- takes away persons sense of responsibility/control
- addiction
- relapse when stop taking the drug
- cheap & quick
- alternative to psychological treatments (prescribre more freely)
Biological therapies of OCD
Psychosurgery
- surgial intervention aims to treat behaviour
- no cause has been established
- only used for severe cases if patient doesnt respond to other forms of treatment
Cingulotomy
- heated probes the cingulated gurus tissue destroyed
- links OFC & lympic system (emotion and behaviour)
Dougherty (2002)
- 45% patients unsuccessfully treated with drugs
- showed improvement cingulotomy
case study
Mary Lou Zimmerman
- suffered from OCD
- drugs ineffective
- performed cingulotomy
- she was paralysed from the opperation
deep brain stimulation
- MRI scan to pin point area
- firing electordes into the brain
- implanting tiny electrical wire and emits signors to cure brains abnoral brain waves/rhythm
- fine tune pace maker to suit individual
- rewires brain
- MRI scans locate parts of brain
- microscopic robots used target parts of brain
- experience mood swings
deep brain stimulation (A02)
- tailor fine tuning to the individual needs
- scienfic
- turn pace maker off
- change settings
- long term
- expensive
- danger/risk
psychological therapies for OCD
Exposure And Response Prevention Therapy (ERP)
Meyer (1966)
- obessions and compulsions learned ths patient must unlearn
- Modelling (exposure)- exposed to feared stimulus
- Response prevention- learns to realise there are other ways to remove anxiety caused by obession
- taught relaxation techniques
- relatives and partners often advised to join
- verbal persuasion,encouragement of alternative behaviour and contiouous monitoring help
- forceful intervention is counter productive
evaluation of psychological therapy
albucher et al (1998)
- 60-90% adults with OCD improved using ERP
Huppert & Franklin (2005)
- ERP works best along side cognitive behavioural therapy
Salkovski & Kirk (1997)
- ERP has moderate success rate
- complete removal of OCD symptoms occured in less than 1/2 of patients
EmmelKamp(1982)
- gave women obessed with cleaning exposure homewoek in between therapy sessions
- can treat yourself at home using BTsteps
evaluation of psychological therapy
- high in validity
- long term (patient power)
- time consuming
- expensive
- shortage of counsellors- computer guided may not be successfull
- positive effects on the brain e.g OFC may have improved
psychological therapies for OCD
Cognitive Therapy
- changing thoughts
- obessesions and compulsions challenged
- asked why they believe what they believe
- not logical
- patients record any unwanted thoughts and actions for later discussion
evaluation of psychological therapy
Ellis (2001)
- some patients rejcect therapist and ifnore their help
Koran et al (2007)
- CT and ERP very similar combine the two to produce best results
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