Obsessive Compulsive Disorder (OCD)

Anxiety disorders: Obsessive-compulsive disorder (OCD)

OCD involves two components:

• Obsessions – Recurrent, intrusive thoughts that are classed as inappropriate or forbidden. The individual feels unable to control them, which creates intense anxiety.
• Compulsions – They develop as a means of controlling the obsessive thoughts. These compulsions are repetitive behaviours or thoughts, such as repeated hand-washing. Most OCD patients recognise that their compulsions are unreasonable, but they cannot control them. This creates further anxiety. 

The AQA B specification requires that you know about treatments of phobias and OCD. In particular, the AQA B specification mentions drug therapy, psychodynamic therapy (psychoanalysis), systematic desensitisation and flooding, and cognitive therapy.

1. Biological explanations of OCD

Genetic – Individuals may inherit a genetically-determined predisposition to develop OCD. This is supported by family studies, such as Nestadt et al. (2000) who found that people who had a relative with OCD were five times more likely to develop OCD than members of the general population.

Evolutionary – It may be that some aspects of OCD behaviour are adaptive and, therefore, humans are predisposed to develop the disorder. For example, ritualistic behaviours often concern hygiene (e.g. repeated hand-washing) and may be adaptive insofar as extra vigilance over cleanliness might promote survival. Remember that evolutionary explanations for mental disorders are based on the assumption that such disorders are inherited, or a predisposition for the disorder is inherited.

Brain biochemistry – OCD has been linked to low levels of the neurotransmitter serotonin, and high levels of dopamine.

Evaluation:

• Concordance rates in twin studies are quite high for OCD. For example, Rasmussen and Tsuang (1986) found as much as 87% concordance for identical twins. This supports a genetic explanation. However, relatives do not have the same obsessive rituals so this suggests that what is inherited is a tendency to be obsessive.
• One problem with biochemical explanations is that it is not clear whether abnormalities are the cause or the effect.
• The success of drug therapies indicates the involvement of biochemical factors. For example, the use of SSRIs to increase serotonin levels has been shown to be effective. Piggott et al. (1996) found improvement in 42% of patients over a period of two years. Drug therapies do not provide a permanent solution as patients relapse when they stop taking the drugs.

2. Behavioural explanations of OCD

Mowrer’s two-process theory for phobias can be applied to OCD.

Classical conditioning – Some thoughts become associated with an event that creates anxiety, and then take on the associated properties of the event. For example, a mother looks at her baby and thinks ‘I could smother this child’. Such thoughts create intense anxiety and in the future, just looking at the child creates intense anxiety.

Operant conditioning – Distress and compulsive behaviours are maintained because the person learns to avoid the anxiety by escaping (e.g. going to wash their hands).

Evaluation:

• OCD patients are not always able to identify a traumatic event that may have triggered the disorder. Several obsessions can be present within one individual and the obsessions can change without the occurrence of new traumas. This suggests a predisposition to develop the disorder as a response to everyday events.
• The behavioural explanation has led to a successful therapy for OCD patients called exposure and prevention therapy (ERP). Patients are exposed to situations that trigger their obsessions but are prevented from engaging in their usual compulsive response. This enables the person to experience a lack of anxiety following the trigger behaviour. ERP therapy provides opportunities for re-learning. Albucher et al. (1998) reported that 60–90% of OCD patients improve considerably using ERP. ERP is a form of Cognitive Behavioural Therapy because it deals with thoughts and behaviour.

3. Cognitive explanations of OCD

OCD patients suffer from impaired information-processing (faulty thinking). People often have unwanted or intrusive thoughts (such as being infected by germs or harming someone) but these are usually easily dismissed. However, for some people they cannot be ignored. Such individuals think in terms of rigidly defined categories, or believe they should have total control, both of which are examples of maladaptive or faulty thinking. The thoughts create self-blame, depression and anxiety. Neutralising thoughts or acts reduce the obsessive thoughts and these become compulsive, because each time they are performed they reduce the unwanted thoughts and this makes them harder and harder to resist.

Cognitive explanations are similar to behavioural ones but there is greater emphasis on thought processes (faulty thinking). Faulty thinking may be a product of genetic factors.

Evaluation:

• There is some evidence that OCD patients do have more intrusive thoughts than normal people (Clark, 1992).

• There is no evidence to show that faulty thinking is the cause, rather than a consequence of OCD symptoms.

4. Psychodynamic explanations of OCD

OCD develops when the id produces unacceptable impulses that create anxiety for the ego and thus are dealt with by ego defences. The id is the primitive ‘I want’ part of the self, motivated by the pleasure principle. The ego is the realistic part of the self that tries to avoid feelings of anxiety.The three most common ego defences for OCD are:

• Isolation – The ego isolates itself from the unacceptable impulses, but occasionally they intrude as obsessive thoughts.

• Undoing – This takes over when obsessive thoughts intrude, and deals with the anxiety by producing compulsive acts that symbolically undo the unacceptable impulses from the id, for example compulsive hand-washing is a symbolical undoing.

• Reaction formation – Behaviours are performed that are the opposite to the unacceptable impulses, as a means of reducing anxiety. For example, being exceptionally kind when experiencing very aggressive impulses.

Evaluation:

• Psychoanalysis (the therapy related to Freud’s psychodynamic theory) may actually have a negative effect on OCD recovery, which does not support the Freudian explanation.
• Adler (1931) produced a different psychodynamic explanation for OCD, which suggests that OCD develops because of feelings of inferiority. Therefore, the treatment derived from this approach focuses on building confidence.