ObsessiveCompulsive Disorder

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Obsessive-Compulsive Disorder

• MBB NOH Hope Park

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• My compulsions are caused by fears of hurting
  someone through my negligence. Its always the
  same mental rigmarole. Making sure the doors are
  latched and the gas jets are off. Making sure I
  switch off the light with just the right amount
  of pressure, so I dont cause an electrical
  problem. Making sure I shift the cars gears
  cleanly, so I dont damage the machinery..
• I fantasize about finding an island in the South
  Pacific and living alone. That would take the
  pressure off if I would harm anyone it would
  just be me. Yet even if I were alone, Id still
  have my worries because even insects can be a
  problem. Sometimes when I take the garbage out,
  Im afraid that Ive stepped on an ant. I stare
  down to see if there is an ant kicking and
  writhing in agony. I took a walk last week by a
  pond, but I couldnt enjoy it because I
  remembered it was spawning season, and I worried
  that I might be stepping on the eggs of bass or
  bluegill.
• I realise that other people dont do these
  things. Mainly, its that I dont want to go
  through the guilt of having hurt anything. Its
  selfish in that sense. I dont care about them
  as much as I do about not feeling the guilt.
• From Nevis, Rathus and Green, 2006.

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Definition of OCD

• Obsessions
• Recurrent, persistent and irrational impulses,
  thoughts or images that cause anxiety or distress
  and are not just excessive worries of real life
  (DSMIV)
• Compulsions
• Ritualistic, repetitive, purposeful behaviours or
  mental acts that an individual feels compelled to
  perform in response to an obsession (DSMIV)

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How does it work

• The person attempts to ignore or suppress those
  impulses/thoughts/images or neutralise them with
  some other thought or action
• Interference with Normal Functioning
• Personal Distress
• Deviance from Social Norms
• The person recognizes that those are a product of
  their own mind

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Examples of obsessions and compulsions

• Type of compulsions
• Excessive or ritualistic handwashing, bathing,
  showering, grooming (85)
• Repeating rituals, e.g., going in or out of a
  door (51)
• checking compulsions (46) gas, locks
• Ordering or arranging (17)
• Counting (18)
• Hoarding or collecting (6) old newspapers, empty
  boxes

• Type of obsessions
• dirt and germs (40)
• Worries about something terrible happening (24)
• Worries about symmetry, order and exactness (17)
• Males high prevalence of checking
• Females high prevalence of washing

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OCD and Not OCD
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Who is affected?

• Develops in childhood/adolescence
• 80 present before age 18
• Mean age of onset 10.3 years
• Average lifetime prevalence of 1-3 in adults
• More males than females in childhood
• 21 to 32 ratios
• Earlier age of onset for males
• Males have more severe symptoms
• More females than males in adults
• Cultural variations of OCD

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Related disorders

• Hypochondriasis - disorder characterized by an
  unwarranted preoccupation with ones physical
  health
• Tourettes syndrome nervous ticks and/or
  repeating words, often swearing
• Anorexia Nervosa obsession with ones appearance

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OCD links.

• Family (genetic?) association with Tourettes.
• Depression anxiety common - 50 is
  psychological response to OCD.
• Anorexia Epilepsy.
• Sydenhams chorea ( 30 have OCD)
• Post-encephalitic Parkinsonism.
• Post-partum mothers.

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What Causes Obsessive-Compulsive Disorder

• Behavioural View
• The compulsions act to reduce the anxiety
  experienced as a consequence of the obsessions,
  and are thus reinforcing.
• Biological (Medical) View
• Genetic component
• The frontal lobe (responsible for thinking and
  planning), and the basal ganglia (responsible
  partly for motor movement) are affected in OCD
  patients.

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Impulse control malfunction

• Impulse control malfunction?
• Dorsolateral regions of prefrontal cortex
• And basal ganglia and thalamus
• Via frontostriatal circuits
• Increased activity of frontal sub-cortical
  circuits
• Circuits are involved in gating and inhibition of
  limbic system activity
• Patients may therefore be unable to inhibit
  repetitive and ritualistic thoughts and actions
  even in the absence of emotional problem
• ? perseverate on a single thought or action

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OCD Serotonin - Basal Ganglia Hypothesis.

• OCD result of malfunctioning, instinct-related
  system.
• Basal Ganglia, especially Caudate nucleus.
• Serotonin key transmitter (in this system,
  Serotonin seems to balance Dopamine).
• OCD helped by raising 5-HT levels.

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OCD Serotonin.

• Only effective drugs SSRIs.
• Clomipramine first (still seems best), Prozac
  (fluoxetine) still being tried.
• 5-HT antagonists worsten OCD.
• BUT SSRIs take 2-3 weeks for clinical effect, gt
  adaptation key.
• Da 5-HT seem to balance in Caudate.

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Modulatory control

• Problems in modulating socially appropriate
  behaviours
• Orbitofrontal cortex has a role in social
  appropriateness
• Damage ? tactless, impulsive, disinhibited
  behaviour
• Themes of danger, sexuality or cleanliness
• Cyngulate gyrus and amygdala (involved in
  processing threatening information)

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OCD evolution

• Key, ancient, species specific, fixed action
  patterns (eg grooming) being triggered?
• Checking, washing, counting, needing to confess,
  hoarding and requiring precision all carry the
  potential to benefit society
• Hormonal cycles in adult females influence
  severity. Post-partum cases. (Fits FAPs)
• 5-HT influences FAPs, etc, in mammals.
• Basal Ganglia mediate FAPs, etc, in many
  mammals.
• Just exaggerated normal behaviour?
• Fixed-action patterns gone mad? (grooming,
  preening etc)
• A little amount might be adaptive

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OCD Conclusion

• Biological basis plausible.
• Behaviour therapy shows learning crucial. Could
  work on links between FAPs environmental
  triggers?
• Psychodynamic approaches take a deeper view of
  individual causal factors
• Shows value of multiple perspectives.