Psychopathology of

OCD

Obsessions
Obsessions are intrusive, distressing thoughts and mental images which repeat over and over. They are ego-dystonic (experienced as unpleasant). Common obsessions:
Dirt and contamination Need for symmetry Hoarding Sexual content Scrupulosity Aggressive content Superstitious fears

Compulsions
Compulsions are behaviors people perform in order to try and reduce or remove the fear and anxiety caused by obsessions. Common compulsions:
Cleaning and washing Arranging until things are just right Hoarding Checking Mental rituals (prayers, counting etc.)

OCPD
Preoccupation with details, orderliness, perfectionism rules and lists, so that the point of the activity is lost

Perfectionism that interferes with task completion

Excessively devoted to work so that leisure activities and friendships suffer

OCD vs. OCPD

OCD is ego dystonic ((symptoms distress patient )) OCPD are ego syntonic ((symptoms distress others)) OCPD lacks true obsessions or compulsions OCPD go to med school OCD patients are found in clinics

Biological theory
Serotonin Hypothesis
key chemical involved in OCD is called serotonin. key gene for this process is hSERT (hSERT works too fast )
improvement with SSRI (fluoxetin )

Genetics 1st degree relatives 35%, Monozygotes 80-87%

NEUROIMMUNOLOGY Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)

Biological theory
Neuroimaging
circuit >>regulates primitive aspects of our behavior such as aggression, sexuality, and bodily excretions. circuit >>>> relays information from orbitofrontal cortex to the thalamus and the caudate nucleus of the basal ganglia. if circuit is activated, impulses brought to your attention perform a particular behavior that appropriately addresses the impulses

IN OCD

abnormal activity in this brain circuit >>difficulty turning off or ignoring impulses from this circuit Increased activity of the orbitofrontal cortex Increased activity of the cingulate cortex Increased activity in the caudate nucleus Increased activity in the thalamus Dysfunction of cortical/basal ganglia loop

Overactivity of prefrontal-basal ganglia loops

Increased activity in the thalamus

Psychodynamic Theories
obsessions and compulsions >> signs of unconscious conflict (usually related to a sexual or aggressive urge). that you trying to suppress, resolve or cope with

if conflict >>repulsive or distressing>> deal with them indirectly by transferring the conflict to something more manageable such as hand-washing, checking or

ordering.

Psychodynamic Theories
Stress and parenting styles are environmental factors

that have been blamed for causing OCD

Psychodynamic therapy
making the person aware of these conflicts can reduce symptoms of OCD Usually patient refractory to this therapy:

Psychoanalytic theory
Freud fixation in the anal stage

Child accepts will of parents being neat and clean when their natural preference may be messy.
If preference is too strong and parents are too strict child becomes anally fixated Occurs at an unconscious level sufferer believes there really concerned with keeping clean and tidy. Psychoanalysts believe OCD is most likely to be found in people who show anal personality characteristics e.g. being excessively neat, orderly and punctual. Obsessions can be defence mechanisms which occupy the mind so as to displace more disturbing thoughts. There is conflict between the Id and defence mechanisms

Cognitive Behavioral theory

Learning Theory>>
OCD symptoms are a result of a person developing learned negative thoughts and behaviour patterns, towards previously neutral situations which can result from life experiences.

cognitive model >>

everyone experiences intrusive thoughts from time-to-time misinterpret these thoughts as being very important and significant which could lead to catastrophic consequences repeated misinterpretation of intrusive thoughts >> obsessions and because the thoughts are so distressing>> compulsive behaviour to >> resist, block, or neutralise the obsessive thoughts.

Why patient resist treatment.

Secondary gain ( symptoms had special meaning to the patient )

Power and control over family members (interpersonal meaning )