Psychology Theories of Obsessive Compulsive Disorder (OCD)

Psychological perspectives and behaviour.

Psychological perspective

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Key characteristics of the perspective used to explain the cause of OCD

Analysis of the perspective to effectively explain the cause of OCD

Psychodynamic approach

This perspective explains that OCD is a result of fixation of the anal stage of development. Trauma during this stage leads to the individual being anally retentive in later life which can result in the person developing OCD.

The perspective uses the concept of development stages and issues relating to the anal stage of development to explain the cause of OCD.

The theory suggests the compulsions experienced with OCD are the signs of an unconscious conflict which the individual is attempting to suppress. The conflict stems from an unconscious wish which would be deemed as socially unacceptable behaviour. The conflict is transferred to a behaviour which seems more manageable in an attempt to help a person deal with it, this can be hand washing, counting, checking and other obsessive compulsions.

This theory explains the source or cause of OCD as being linked to the unconscious and childhood development, however despite showing an association it does not effectively provide scientific evidence to fully explain the cause of OCD.

Cognitive perspective

OCD is a result of faulty thought processes, these are the obsessive thoughts. The theory explains that individuals with OCD have a cognitive bias which may cause hypervigilance and possible memory problems.

It focuses on a singular explanation for the cause of OCD and explains that the key characteristic of the cause of OCD is faulty thinking.

The cognitive explanation for OCD is reductionist, it offers a single explanation. Individuals with OCD have faulty thought processes and are unable to ignore invasive thoughts. Their faulty thinking and obsessive thoughts lead them to believe something bad or negative will occur if they do not carry out a certain behaviour, this then results in their compulsive actions. Another factor of the cognitive explanation suggests that those who develop OCD are extremely aware of their surroundings (hyper vigilant) and focus on things which they perceive as a threat, and that they also have issues with their memory processes. These factors in conjunction with faulty thinking are what causes OCD.

Biological perspective

The biological perspective consists of 3 assumptions which offer explanations for the cause of OCD, these are; genetic explanation, biochemical explanation and brain structural explanation. Each assumption states key characteristics such as genetic predisposition, how levels of certain neurotransmitters cause OCD and brain activity in certain areas of the brain linked with OCD.

The genetic assumption explains that OCD is genetically passed on, that it runs in families. It uses twin studies to analyse the concordance rates of OCD in twins to assess the probability of those with the same genes having the same characteristics.

The biochemical explanation suggests that OCD is caused by low levels of serotonin, this is supported by Zohar et al (2004).

The brain structural explanation does not definitively offer an explanation for the cause of OCD however it does state that there appears to be increased activity in the orbital frontal cortex and caudate nucleus within the brain in those who have OCD.

Behaviourist perspective

OCD is a learned behaviour, and is a form of avoidance from the feeling of fear or anxiety. Behaviour becomes ritualistic because the individual has learned that by carrying out these behaviours their fear or anxiety of a specific situation is alleviated.

The individual associates an event or a situation with fear and anxiety and so they create a response or behaviour which reduces their fear. In relation to OCD this may be obsessive hand washing, counting etc. this then becomes their conditioned response, again in relation to explaining OCD this suggests that the ritualistic nature of behaviours is a conditioned response to reduce anxiety.

TAQ 1 part b

Psychological perspective

Brief description of study (ies) offered to support the perspective’s explanation for obsessive compulsive disorder.

Evaluation of the methods of data gathering used by each perspective.

Cognitive perspective

Rachman (2004) is a case study of woman with OCD and provides a detailed account of hypervigilance. The patient had a fear of diseases and attempted to seek out anything which may be perceived as blood, for example dark spots.

The patient could recall past items that she had encountered and had related to blood, this was a result of her hyper vigilant observations. (1)

The cognitive perspective uses both qualitative and quantitative methods of data gathering.

Lab experiments are often used which provide quantitative data. These experiments are easily replicated and extraneous and independent variables are easily controlled. However they have low ecological validity as they are set in artificial environments, participants may also display demand characteristics.

Case studies and interviews provide qualitative data and allow for an in depth investigation. They provide insight for further study and the information provided is rich and detailed. Despite these strengths these methods are difficult to replicate and the results are difficult to generalise.

As the data gathering methods are varied this perspective offers a broad spectrum of evidence which provides strong support for their explanations.

Biological perspective

Carey and Gottesman 1981 studied obsessive symptoms in identical twins. The findings suggested that there was an 87% concordance rate for obsessive symptoms in identical twins. This shows that genetics are of some significance.(2)

Hoaker and Schnurr (1980) study of MZ twins showed a 50-60% concordance rate of OCD in MZ twins.(3)

Zohar et al (1996) studied the effect of SSRI’s on OCD. 60% of those tested reported that SSRI’s were effective in reducing symptoms of OCD. (4)

Biological perspective uses quantitative data gathering methods such as lab experiments, CAT and Pet scans, correlational studies and clinical studies.

Laboratory experiments are easily replicated because they are carried out using a regulated procedure. They enable the researcher to control independent and extraneous variables, this means that a clear cause and effect relationship may be established. They do however have low ecological validity and are difficult to generalise due to the artificial environment and possible unnatural behaviour.

Correlational studies allow a clear statistical analysis, showing the relationship between variables. Despite being quick and easy and showing a clear relationship, this method does not offer an explanation of the cause of behaviours. It is also impossible to determine whether one outcome causes the other.

In conclusion the data gathering methods are limited and are difficult interpret and investigate from a range of perspectives.

References

psych tutor. ().Anxiety Disorders (obsessions and compulsions).Available: http://psychtutor.weebly.com/anxiety-disorders-ocd.html. Last accessed 18/06/2015.
Michael Eysenck. (2015). psychopathology. In: Eysenck, Michael W. Flanagan, C.AQA psychology. 6th ed. East Sussex: Psychology Press. p306.
Katie R Bradford. (2012).biological explanations for OCD.Available: https://katierbradford.wordpress.com/2012/02/18/biological-explanations-for-ocd/. Last accessed 22/06/2015.
AQA B psychology. (2010).Obsessive Compulsive Disorder: Introduction, Explanations and Treatments.Available: http://aqabpsychology.co.uk/2010/07/obsessive-compulsive-disorder-introduction-explanations-and-treatments/. Last accessed 22/06/2015

Evaluate the contribution of psychological perspectives in the treatment of specific behaviours, states of consciousness and emotional states that are associated with OCD.

I am going to be writing about how different psychological perspectives contribute to the treatment of OCD and associated factors. By evaluating the strengths and limitations and including evidence to support or dispute these points from each perspective, I will be able to explore the effectiveness of their treatment in cases of OCD.

The key treatment contributed by the psychodynamic perspective is psychoanalysis, methods within psychoanalysis include dream analysis and free association. There is little evidence to support Psychoanalysis as an effective treatment for OCD. The perspective assumes that the root cause for OCD is trauma in anal stage of development, however this is supported by only one case study of a child ‘little Hans’ Freud (1909) (1). Further evidence to support Psychoanalysis is the case of Anna O. Although this evidence has been dismissed as being falsified, for example by Dr Vincent Berger (2005) (2). Psychoanalysis is time consuming and expensive, it is also very subjective and as a consequence results cannot be compared to a control group. It has also been stated that psychoanalysis increases symptoms of OCD-Jean-Marc Lawton (2012) (3). Dream analysis developed by Freud (1900) is another method of psychoanalysis, it focuses on the patients dream state of consciousness. Despite the evidence which dismisses the contribution of Psychoanalysis it is an empathetic and non-judgemental form of therapy. However it is subjective and difficult to test scientifically as it focuses on unconscious thoughts, and it cannot be generalised.

Behavioural perspective contributes therapies such as systematic desensitisation, flooding and aversion therapy. There is little evidence for a long term success rate in aversion therapy due to the behaviours often reappearing after the removal of the deterrent (4). Flooding involves exposing the patient to their worst fears, it can be dangerous and could be regarded as abusive. It is difficult to apply flooding to cases of OCD where there are obsessive thoughts which cannot be physically seen i.e. thoughts of harming others. There has been success in treating phobias using this method of treatment which could suggest that it may be effective in some cases OCD. Systematic desensitisation is a significant contribution to OCD treatment from this perspective and there is supporting evidence that it is effective. It was successfully used to treat an 18 year old with a severe hand washing compulsion, after a follow up 4 years later it was revealed that he had a complete remission of compulsive behaviours (Wolpe 1964) (5) The basis for behaviourist therapies is that OCD is a learned avoidance response, this concept is supported by studies which have produced evidence to support the theory of classical and operant conditioning such as Watson and Rayner (1920), Pavlov (1902) and B.F Skinner (1948). Behaviourist treatments only appear to address the symptoms of OCD and not the underlying cause. The perspective does offer a variation of methods to alter behaviour in OCD, thus treating the compulsive behaviour, however its contribution is limited as it does not work to challenge the irrational or obsessive thoughts.

The cognitive perspective’s principle contribution to treatment of OCD is cognitive behavioural therapy (CBT). It is remarked as being an effective treatment for OCD and evidence suggests that the success rates are significant. ’Research has shown that 75% of people with OCD are significantly helped by Cognitive Behavioural Therapy’ (6) Ellis ABC model (1957) is based upon the assumption that it is peoples interpretations of things that causes psychological distress. This therapy encourages patients to identify that it is their own illogical thoughts causing them distress which then enables them to work towards changing these thoughts. Created alongside REBT (Rational Emotive and Cognitive Behaviour Therapy) Ellis (1955) the aim is to help people to change their irrational beliefs (7). Exposure and response therapy deliberately exposes individuals to anxiety inducing situations and requires them to resist compulsive behaviours. There is support for this treatment being successful ‘’Research which has followed by clients after ERP therapy has shown that between 55%and 75% show improvement and that the improvement lasts for 5 or 6 years’’ Franklin et al (2005) (8) Beck (1967) developed the cognitive triad, it identifies 3 forms of negative thinking and describes how they induce irrational thinking when they interact. It is beneficial as it targets irrational thoughts and enables patients to address these, there is evidence to support Becks’ cognitive triad – A study of meta-analysis which investigated Becks cognitive triad concluded that around 80% of clients benefited from the treatment (Butler and Beck 2000) (9) Conclusively this perspective contributes very effective and successful treatment for OCD, within CBT there is a varied approach to identifying, challenging and changing faulty thoughts which cause OCD. However this is a very reductionist perspective as it focuses only on thought processes and it is argued that there are other factors which need to be explored and so treatment approach needs to be broadened.

The biological perspective contributes several forms of treatment for OCD relevant to the different assumptions within the perspective (genetic, biochemistry, brain structure). The medical model consists of drug therapy, ECT and psycho surgery. Drug therapy is a cheap, quick and easy solution to treat the patient’s symptoms but does not treat the underlying cause. There is also I high relapse rate when medication is discontinued (10) There is evidence to support drug therapy as treatment for disorders such as OCD ‘’60% of OCD sufferers experience a significant reduction in OCD symptoms when receiving medication SSRI’s’’ (Zohar et al 1996) (11). Drug therapy does include side effects and high dependency. ECT also has side effects such as memory loss and it how it works is presently unknown. The treatments contributed by the biological perspective are largely perceived as unethical and methods such as psychosurgery are often perceived as outdated. The most effective contribution from this perspective is drug therapy as it fast acting and inexpensive but ideally has no long term value.

From the discussed information there appears to be a vast contribution of treatments from each perspective. OCD affects individuals in different ways and factors attributed with the disorder can vary, and so it is helpful to have a range of treatments available. There is evidence to support or refute the effectiveness of treatments contributed by each perspective. In conclusion medication is successful in treating severe symptoms as a short term solution, providing quick relief of symptoms. As a long term treatment CBT is the most successful in treating OCD and offers the greatest contribution in treating specific associated behaviours and emotional states.

References

McLeod, S. A. (2008). Little Hans – Freud (1909). Retrieved from www.simplypsychology.org/little-hans.html
Dr Vincent Berger. (2005).Famous psychologists: Sigmund Freud.Available: http://www.psychologistanywhereanytime.com/famous_psychologist_and_psychologists/psychologist_famous_sigmund_freud.htm. Last accessed 10/06/2015.
Jean-Marc Lawton (2012).AQA(A) A2 Psychology student union guide new edition. Oxfordshire: Philip Allan. Unit 4 section A
psychologist world. (2015).aversion therapy.Available: http://www.psychologistworld.com/behavior/aversiontherapy.php. Last accessed 09/06/2015.
) McLeod, S. A. (2008). Systematic Desensitization. Retrieved from www.simplypsychology.org/Systematic-Desensitisation.html
OCD-UK. (2013).cognitive behavioural therapy (CBT) .Available: http://www.ocduk.org/cognitive-behavioural-therapy. Last accessed 09/06/2015.
Kendra Cherry. (2015).rational emotive behaviour therapy.Available: http://psychology.about.com/od/typesofpsychotherapy/a/rational-emotive-behavior-therapy.htm. Last accessed 09/06/2015
(Franklin et al2005).(9) psych tutor. ().anxiety disorder obsessions and compulsions.Available: http://psychtutor.weebly.com/anxiety-disorders-ocd.html. Last accessed 10/06/2015.
McLeod, S. A. (2015). Cognitive Behavioral Therapy. Retrieved from www.simplypsychology.org/cognitive-therapy.html
AQA B psychology. (2010).Obsessive Compulsive Disorder: Introduction, Explanations and Treatments.Available: http://aqabpsychology.co.uk/2010/07/obsessive-compulsive-disorder-introduction-explanations-and-treatments/. Last accessed 10/06/2015
) Psych Teacher UK. ().Biological treatments of abnormality and mental illness.Available: http://www.psychteacher.co.uk/abnormality/biological-treatments.html. Last accessed 10/06/2015.

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