Topic #6 – Anxiety Disorders (OCD)
Reviewed by : …………………………. / JC2
a) Definitions, Measures, Examples of Obsessions and Compulsions DEFINITION OF OBSESSIONS & COMPULSIONS
Obsessions involve recurring and persistent thoughts, images, or impulses that are experienced as inappropriate, intrusive, and anxiety provoking, and are not just excessive worries about real-life problems. Compulsions involve repetitive and rule following behaviour or mental acts that the sufferer feels driven to perform (often in response to an obsession) to reduce distress or to avoid an imagined catastrophe. Obsessive-Compulsive Disorder

is an anxiety disorder characterised by persistent obsessional thoughts and/or compulsive acts. CASE STUDIES OF/EXAMPLES (e.g. ‘Charles’ by Rappaport, 1989, or others) Charles was a boy who was unable to rid himself of a feeling of ‘stickiness’, despite 3 hours a day in the shower. His obsession is over the feeling of stickiness and his compulsive act is showering for hours. MEASURES

Maudsley Obsessive Compulsive Inventory (MOCI)
Form
4 subscales
30 items – True or False – self report questionnaire
Washing/Cleaning
Checking
Slowness
Doubting
+ : reliable, the 2 subscales (washing & checking) were proven to be valid, quantitative measure: easy to calculate. : the response is limited to true or false, can not detect the severity of one’s OCD; only 2 compulsions are involved (not generalisable to other compulsive acts).

b) Explanations & Treatments of OCD
APPROACH
EXPLANATIONS
TREATMENTS
EVALUATIONS
Biomedical
a) Genetic

b) Neurotransmitter

c) Brain functions

Family of OCD patients are 10x more likely to have OCD.

Serotonin deficiency
(OCD can be treated with SSRI and SSRI can increase serotonin. So, OCD is caused by lack of serotonin). High level of dopamine (there is a similar increase in metabolic activity with those who have Tourette’s syndrome and TS is known to have high level of dopamine).

Increased metabolic activity in the left frontal lobe which is responsible for uncontrolled repetitive behaviour.

Drug Therapy
SSRI and SRI : prozac, etc.

Ignoring the environmental factors, e.g. observational learning (modelling) instead of genetics. Drugs can be addictive because they don’t eliminate the causes eventhough they relieve symptoms. Cognitive-Behavioural

Cognitive:
Worrying that their thoughts will lead to harmful acts or terrible consequences.

Behaviour:
Operant conditioning (getting negative reinforcement by doing the compulsive act which is a temporary relief from the anxiety caused by obsessional thoughts, thus encourage the person to repeat his/her compulsion).

CBT
ERP (Exposure and Response Prevention Therapy) :
Challenging the obsessive thoughts.
Giving insight that the compulsions don’t help.
BE (Behavioural Experiments) through homework, etc.
Combined with flooding or SD.
Habituation (“nothing bad happens when I don’t perform my compulsions”). +
No side effects
Most effective
Combined with medicine to reduce anxiety if needed.

It needs commitment
Psychodynamic
Fixation at the anal stage of development, which is a toilet training period.

If the parents are harsh during this period, then the child would show a reaction formation which is converting his urge to soil into compulsive cleanliness.

Psychoanalytic Therapy
Psychotherapy to uncover hidden trauma from the past (through dream analysis, etc.)

+
May uncover past traumatic experiences

–
Subjective interpretation;
Only uncover trauma, what about the treatment?