Obsessions
Thoughts, images, ideas or impulses that are persistent & uncontrollably intrude on consciousness
-cause significant anxiety or distress
Compulsions
Repetitive behaviors or mental acts that an individual feels he or she must perform
OCD DMS criteria
A. Either Obsessions (1-4) or Compulsions (1-2)
B. Realization that obsessions or compulsions are excessive or unreasonable during course of disorder
C. Obsessions/compulsions cause marked distress
D. Not restricted to other present Axis I disorder
E. not due to effects of substance or medical condition
OCD characteristics
Begins at young age: males: 6-15, females 20-29
- 66% are also depressed
- prevalence: 1-3% (2.5)
Common OCD symptoms
- obsessive thoughts about dirt and contamination across cultures
- aggressive impulses
- sexual thoughts
- impulses going against one’s moral code
- repeated doubts
- > patients cannot dismiss or ignore thoughts
- > tied to impulsive behaviors (seem purposeful but aren’t functional)
Biological Circuit Theory of OCD
Brain circuit involved in executing primitive patterns of behavior dysfunctional
-> no longer able to turn off primitive impulses that normally wouldn’t reach threshold
(-> basal ganglia)
Genetic Theoriy
Evidence: OCD runs in families, genetic component in obsessive and compulsive behaviors found:
-80-87% in twins, up to 50% in siblings
Cognitive-Behavioral Theories
- thought-action fusion
- mood as input hypothesis
- mental contamination
- thought suppression
- compulsions as developing through operant conditioning: anxiety reduced if engaged in certain behaviors
- > behaviors reinforced as result leading to compulsions
Mood as input hypothesis
Suggests people use mood to judge about whether they have successfully completed a task
OCD Treatments
Biological Treatments
Behavioral Treatments
Biological OCD treatments
Antianxiety drugs (e.g. benzos); no useful mostly
- Antidepressants affecting serotonin levels helped relieve symptoms (e.g. SSRIs)
- 50-80% experience decrease in obsessions and compulsions
- Side effects (constipation, drowsiness, sexual dysfunction)
- Cingulotomy
Behavioral OCD treatments
Exposure and response prevention (ERP) therapies combined with drug treatments
- client exposed to content of obsession and prevented from engaging in intrusive thoughts
- > cognitive dissonance: thought or behavior has to be changed
- significant improvements in 60-90%, most effective
Inhibitory Learning
Original CS-US association not erased during extinction but left intact as secondary inhibitory learning about CS-US
- amygdala inhibited by cortical influences as result of extinction learning
- > CS has two meanings afterwards
Therapeutic Strategies for enhancing inhibitory learning:
- expectancy violation
- deepened extinction
- occasional reinforced extinction
- removal of safety signals
- variability
- retrieval cues
- multiple contexts
- reconsolidation
Differences between clinical and non-clinical obsessions
Clinical obsessions:
- last longer
- more discomforting
- more intense & frequent
- lower acceptability
- threshold of acceptability higher
- harder to dismiss
Effect of repeated checking on memory distrust
Repeated relevant checking leads to memory distrust
Forms of Thought-Action fusion
Likelihood TAF: self & other
Moral TAF
Likelihood TAF
Belief that having intrusive thoughts increases likelihood of occurence of a specific adverse event
- > self: TAF related to oneself
- > other: TAF related to someone else
Moral TAF
Belief that having an unnacceptable intrusive thought is almost moral equivalent of carrying it out
