Obsessive Compulsive Disorder

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Obsessive Compulsive Disorder
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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

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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)

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Explanations treatments

• Biological
• Genes, structural brain abnormality,
  neurochemical processes
• Drugs, surgery
• Psychodynamic
• Unconscious processes, childhood experiences
• Psychotherapy (catharsis)

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Explanations treatments

• Behaviourist
• Classical and operant conditioning
• Desensitisation, deconditioning
• Cognitive
• Faulty thinking ineffective information
  processing
• Altering thinking processes (CBT)

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Biological approach

• Tends to run in families
• Often accompanies other brain insult (e.g.
  encephalitis) or neurological problem (e.g.
  Tourettes syndrome)
• Responds to serotoninergic drug treatment

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Psychodynamic approach

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

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Behaviourist approach

• 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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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?)

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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

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