Obsessive Compulsive Disorder

psyc

hlot

ron.

org.

uk

psyc

hlot

ron.

org.

uk

Diagnosis

• Obsessions• intrusive thoughts, impulses or images

• Compulsions• Repetitive/ritualistic behaviours or

mental acts• Distressing, time consuming,

interferes with normal functioning• Usually recognised as irrational

psyc

hlot

ron.

org.

uk

Diagnosis

• 2.6% lifetime prevalence• Obsessions often contamination,

illness, aggression, sex, symmetry• Compulsions often washing, ritualistic

behaviour• Multiple obsessions in 60% of cases

• Continuous with normal behaviour (degree rather than kind)

psyc

hlot

ron.

org.

uk

Explanations & treatments

• Biological• Genes, structural brain abnormality,

neurochemical processes• Drugs, surgery

• Psychodynamic• Unconscious processes, childhood

experiences• Psychotherapy (catharsis)

psyc

hlot

ron.

org.

uk

Explanations & treatments

• Behaviourist• Classical and operant conditioning• Desensitisation, deconditioning

• Cognitive• Faulty thinking & ineffective

information processing• Altering thinking processes (CBT)

psyc

hlot

ron.

org.

uk

Biological approach

• Tends to run in families• Often accompanies other brain

insult (e.g. encephalitis) or neurological problem (e.g. Tourette’s syndrome)

• Responds to serotoninergic drug treatment

psyc

hlot

ron.

org.

uk

Psychodynamic approach

• Associated with fixation at anal stage of development (Freud) or feelings of inferiority (Adler)

• Clinical case study evidence

psyc

hlot

ron.

org.

uk

Behaviourist approach

• Obsessions are learned anxieties; compulsions are reinforced through anxiety reduction

• ‘Superstitious’ behaviour – unrelated to consequences – easy to observe in animals and humans

psyc

hlot

ron.

org.

uk

Cognitive Approach

• Paradoxical effect of trying to suppress particular thoughts (e.g. the blue rocking horse)• Belief that certain thoughts are

unacceptable is a risk factor

• Memory failure (‘did I really turn the gas off?’)

psyc

hlot

ron.

org.

uk

Treatments

• 60% patients improve with SSRIs• moderate gains; frequent relapse

• Exposure & response prevention (ERP) is more effective• Flooding (behavioural); forced reality

testing (cognitive)• Neurosurgery (cingulotomy) may

be effective as a last resort

psyc

hlot

ron.

org.

uk