Transcript Obsessive Compulsive Disorder

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Obsessive Compulsive Disorder
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Diagnosis
• Obsessions
• intrusive thoughts, impulses or images
• Compulsions
• Distressing, time consuming, interferes
with normal functioning
• Usually recognised as irrational
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• Repetitive/ritualistic behaviours or mental
acts
Diagnosis
• 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)
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• 2.6% lifetime prevalence
Explanations & treatments
• Biological
• Genes, structural brain abnormality,
neurochemical processes
• Drugs, surgery
• Unconscious processes, childhood
experiences
• Psychotherapy (catharsis)
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• Psychodynamic
Explanations & treatments
• Behaviourist
• Classical and operant conditioning
• Desensitisation, deconditioning
• Faulty thinking & ineffective information
processing
• Altering thinking processes (CBT)
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• Cognitive
• 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
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Biological approach
Psychodynamic approach
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• Associated with fixation at anal stage of
development (Freud) or feelings of
inferiority (Adler)
• Clinical case study evidence
• Obsessions are learned anxieties;
compulsions are reinforced through
anxiety reduction
• ‘Superstitious’ behaviour – unrelated to
consequences – easy to observe in
animals and humans
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Behaviourist approach
Cognitive Approach
• Paradoxical effect of trying to suppress
particular thoughts (e.g. the blue rocking
horse)
• Memory failure (‘did I really turn the gas
off?’)
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• Belief that certain thoughts are
unacceptable is a risk factor
Treatments
• 60% patients improve with SSRIs
• moderate gains; frequent relapse
• Flooding (behavioural); forced reality
testing (cognitive)
• Neurosurgery (cingulotomy) may be
effective as a last resort
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• Exposure & response prevention (ERP)
is more effective