Psychopathology:

1

• Psychopathology
• Biological explanations of OCD

2
What are the characteristics of someone with
Obsessive-compulsive disorder (OCD)?

• Obsessions recurrent, intrusive thoughts or
  impulses that are perceived as inappropriate,
  grotesque or forbidden (DSM-IVR).
• The obsessions generally cause anxiety as they
  are unlike the sufferers typical thoughts. These
  thoughts are believed to be uncontrollable, the
  sufferer feels as though they may lose control
  and act upon these obsessions. The most common
  obsessions take the form of
• DOUBTS IMPULSES IMAGES.
• Compulsions Repetitive acts that work to reduce
  anxiety of the sufferer by preventing some
  dreaded event happening (DSM-IVR).
• These behaviours can be hidden i.e. mental acts
  or overt i.e. hand washing.
• The vast majority of sufferers realise their
  behaviour is irrational but feel compelled to
  perform the given behaviour for fear of
  something terrible occurring, thus the behaviour
  also create anxiety.

• OCD is an anxiety disorder. The behaviours are
  ritualistic, (hand washing, constant checking)
  and is therefore is the source of great anxiety.
• Interestingly the disorder is equally common in
  both men and women and the onset of the behaviour
  is usually in young adult life.
• Again you could think of the disorder as having
  two components
• Obsessions.
• Compulsions.

3
What are the characteristics of someone with
Obsessive-compulsive disorder (OCD)?

• A diagnosis is given if the sufferer fits the
  following criteria
• Recurrent persistent thoughts, impulses or images
  that feel intrusive and inappropriate, and cause
  excessive anxiety or distress.
• The sufferer partakes in regular repetitive
  behaviour
• (hand washing). The behaviour must not be related
  in anyway to what they are designed to prevent.
• The individual recognises the behaviour is
  excessive and product of their own mind.

4
Biological explanations of OCD.

• Genetic Factors (A01)
• Family/Twin Studies- Nestadt et al (2000) 80
  patients with OCD 343 of their near relatives
  compared with 73 control patients without mental
  illness 300 of their relatives. Strong link
  with near family (5x greater risk if had first
  degree relative).
• Meta-analysis of 14 twin studies found on average
  MZ twins 2x more likely to develop the disorder
  if their co-twin had it than DZ twins.
• COMT gene COMT helps to reduce the action of
  dopamine. The variation in the COMT gene
  decreases the amount of COMT available and
  therefore dopamine is not controlled and there is
  probably too much. Researchers collected DNA
  samples from 73 people with OCD and 148 who did
  not have a mental disorder. The variation in the
  gene occurred in nearly half of the men with OCD
  but only 10 of women with OCD. It was found in
  about 17 of those with good mental health.

• .

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Evaluation of genetic factors (AO2)

• Concordance rates for twin studies generally
  high compared with other disorders (e.g.. 87)
• The OCD symptoms of parents and their children
  are often different which suggests the disorder
  is not learned.
• -However, concordance rates are never 100 which
  means that OCD is not entirely genetic.
• COMT gene- study by Schindler confirmed
  association but didnt find gender differences
  found previously.
• -Research rarely replicated as this is a new area
• /-Other genes being discovered all the time
  unlikely to be just one gene.
• - Studies before 1990 difficult to interpret due
  to differences in diagnostic criteria.
• -Problems with twin studies they may not be
  truly identical. Problems with bias in diagnosis.
• -Difficulties in separating effects of
  environment and genetics.

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Biochemical Factors(AO1)

• Serotonin Lower levels of serotonin found in
  OCD sufferers .
• Dopamine levels are thought to be abnormally high
  in people with OCD- thus suggesting other
  neurotransmitters are involved in OCD.

7
Evaluation of biochemical factors

• Studies using drugs have shown a reduction in
  dopamine levels is positively correlated with a
  reduction in OCD symptoms.
• Experiments which inject animals with drugs that
  increased levels of dopamine have caused the
  animals to demonstrate OCD type behaviours.
• Drugs that increase serotonin (anti depressants
  have been shown to reduce OCD symptoms.
• - But research results relating to serotonin are
  varied sometimes symptoms have been made worse.
  There is a great deal of contradictory research.
• - Drugs seem to show only partial alleviation of
  the symptoms so the process is not fully
  understood. The exact function of
  neurotransmitters in the development of OCD is
  far from understood.
• -Cause or effect- it may be that neurotransmitter
  levels fluctuate as a result of OCD rather than
  as a cause of it.

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Neuroanatomy

• Brain Dysfunction
• Basal Ganglia abnormalities in prefrontal cortex
  where thinking and judgement takes place is often
  present in OCD sufferers.
• OCD is often found in cases of Tourettes and
  Parkinsons disease which are all disorders in
  which the basal ganglia is implicated.
• Basal ganglia damage resulting from head injuries
  can also cause OCD.
• Surgery which disconnects the basal ganglia from
  the frontal cortex can reduce symptoms of severe
  OCD

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Neuroanatomy

• Brain Dysfunction
• Another area implicated is the OFC circuit. The
  OFC sends worry signals. These signals are
  normally suppressed by the caudate nucleus. In
  OCD the caudate nucleus is thought to be damaged
  so it cannot suppress the signals which become
  increasingly excited increasing compulsive
  behaviour and anxiety.

10
Evaluation of neuroanatomy explanation

• Basal ganglia and OFC
• Neuro imaging studies have shown increased
  activity in basal ganglia in OCD sufferers.
• - However results of neuro imaging studies have
  been inconclusive and basal ganglia impairment
  has not been found in all OCD patients.
• Scans show increased activity in OFC in OCD
  patients.
• It has been demonstrated that OFC damage caused
  by head injury, viruses and tumours can give rise
  to OCD.
• Menzies (2007) supported both neuroanatomical
  and genetic explanations make notes on the
  study (207)

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Evaluation of biological explanations

• Promising research but cannot yet offer a
  complete explanation.
• One of most powerful challenges to this view is
  that PSYCHOLOGICAL interventions show a strong
  therapeutic effect and yet do not rely on drugs
  or make any physical intervention.

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Examination questions on biological explanations

• January 2010
• Outline one biological and one psychological
  explanation for obsessive compulsive disorder (9)
• Evaluate explanations for obsessive compulsive
  disorder (16)
• June 2010
• Not examined -Psychological therapies and
  clinical characteristics
• January 2011

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Psychological explanations of OCD

• Psychodynamic
• Freud OCD arises when unacceptable wishes and
  impulses from the ID are only partially repressed
  and so provoke anxiety. The use of ego defence
  mechanisms reduce the anxiety. The 3 most common
  defences in terms of OCD are
• isolation ( people attempt to isolate
  themselves, or disown undesirable thoughts and
  impulses. When the forces of the ID dominate, the
  impulses intrude as obsessional thoughts.
• undoing ( when isolation fails the second
  defence of undoing produces compulsive
  acts-washing away unacceptable impulses)
• reaction formation (taking on traits that are
  opposite to the unacceptable impulses-such as
  compulsive kindness may be a way of countering
  unacceptable aggressive impulses.)

14
Psychodynamic-Adler

• Inferiority complex explanation-
• Some parents dominate their children and prevent
  them from developing a sense of their own
  competence. When this happens an inferiority
  complex may result so that later, as adults,
  these people may adopt compulsive rituals such as
  tidying out drawers, in order to carve out an
  area in which they exert control of something and
  can feel competent.

15
Psychological explanations of OCD

• Freud used the evidence of Rat Man to support
  his explanations
• Some researchers have suggested that the therapy
  developed by Freud (Psychoanalysis) may have a
  negative effect on OCD recovery.
• -Difficult to test the idea of unconscious
  motivations. No convincing evidence to support
  the PD view of OCD and psychoanalysis has been of
  little help in helping people to overcome OCD.

16
Psychological explanations of OCD.

• Behavioural
• Mowrer suggested that the learning of fears is a
  two step process
• Classical conditioning A neutral stimulus becomes
  associated with anxiety through Classical
  Conditioning.
• Operant conditioning Any action that enables the
  individual to avoid a negative event is negative
  reinforcement. Avoidance of the fear leads to
  positive outcomes and is therefore reinforced.
• Thus the compulsive behaviour becomes a way of
  establishing control and reducing anxiety- and
  as a result the behaviour is reinforced and the
  behaviour may become compulsive whenever the
  individuals face thoughts that provoke anxiety.

17
Psychological explanations of OCD.

• Behavioural evaluation AO2
• Researchers thought that if Mowrer was right,
  that OCD patients are predisposed to more rapid
  conditioning. Research did support this finding,
  OCD patients were conditioned more rapidly.
• Further research (Rachman) has shown that
  compulsions do relieve the anxiety of obsessional
  thoughts. In a series of experiments OCD
  patients were asked to carry out some
  prohibited activity such as touching something
  dirty. Patients were then allowed to carry out
  their compulsion (showed reduction in anxiety).
  If however they were asked to delay carrying out
  their compulsive activity their anxiety levels
  were found to persist for a while then gradually
  decline. Compulsions therefore provide a quicker
  relief from anxiety.
• This theory has led to development of a
  reasonably effective therapy ERP.
• - Theory does not explain the CAUSE of the
  obsessive thoughts, it explains how they are
  maintained. (e.g. aspirins might cure headaches
  but headaches are not due to lack of aspirin in
  the body!)

18
Cognitive explanations of OCD

• Cognitive
• Everyone has unwanted or intrusive thoughts from
  time to time but these thoughts can be ignored or
  dismissed fairly easily.
• For some people irrational thoughts cannot be
  ignored and feel overwhelming leading to the
  expectation that terrible things will happen.
• The thoughts continue because the person cannot
  ignore them.
• This is also because they often have depression.
• In order to avoid the consequences of these
  thoughts the sufferer must neutralise them.
  This only provides temporary relief and then the
  anxiety builds up again.
• Over time people become more convinced that
  these thoughts are dangerous and they become
  obsessions.
• The need to reduce the anxiety they cause becomes
  a compulsion.

19
Evaluation of cognitive explanations of OCD

• Research has supported the idea that people
  with OCD have different patterns of thinking,
  such as believing that they should have total
  control over their world.
• Research has also shown that people with OCD
  have more intrusive thoughts than normal
  people.
• The Rachman research also supports the cognitive
  explanation as well as the behavioural
  explanation.
• CBT therapies have been shown to be reasonably
  effective in treating OCD.
• -the theory is more descriptive than explanatory
  why do people develop OCD in the first place?
  We all have intrusive thoughts but dont all get
  OCD.

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Conclusion

• No single explanation can account for a complex
  disorder like OCD
• Likely to be an interaction between biological,
  psychological and social factors.
• Diathesis stress model- certain individuals have
  an underlying biological predisposition to OCD.
  This may develop fully in response to
  environmental triggers.