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1. Obsessive Compulsive and
Related Disorders
Psychology and Abnormality
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2. Obsessive Compulsive Disorder (OCD) is a
mental health disorder that affects people of
all ages and walks of life, and occurs when a
person gets caught in a cycle of obsessions and
compulsions. Obsessions are unwanted,
intrusive thoughts, images or urges that trigger
intensely distressing feelings. Compulsions are
behaviors an individual engages in to attempt
to get rid of the obsessions and/or decrease
his or her distress.Prepared by Tooba Qaiser

3. Most people have obsessive thoughts
and/or compulsive behaviors at some
point in their lives, but that does not
mean that we all have “some OCD.” In
order for a diagnosis of obsessive
compulsive disorder to be made, this
cycle of obsessions and compulsions
becomes so extreme that it consumes a
lot of time and gets in the way of
important activities that the person
values.
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4. What exactly are obsessions and compulsions?
Obsessions are thoughts, images or impulses
that occur over and over again and feel outside
of the person’s control.
Individuals with OCD do not want to have
these thoughts and find them disturbing. In
most cases, people with OCD realize that these
thoughts don’t make any sense.
Obsessions are typically accompanied by
intense and uncomfortable feelings such as
fear, disgust, doubt, or a feeling that things
have to be done in a way that is “just right.” In
the context of OCD, obsessions are time
consuming and get in the way of important
activities the person values. This last part is
extremely important to keep in mind as it, in
part, determines whether someone has OCD
— a psychological disorder — rather than an
obsessive personality trait.
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7. Compulsions are the second part of
obsessive compulsive disorder. These are
repetitive behaviors or thoughts that a
person uses with the intention of
neutralizing, counteracting, or making
their obsessions go away.
People with OCD realize this is only a
temporary solution but without a better
way to cope they rely on the compulsion
as a temporary escape. Compulsions can
also include avoiding situations that
trigger obsessions.
Compulsions are time consuming and get
in the way of important activities the
person values.
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8. Similar to obsessions, not all repetitive behaviors or
“rituals” are compulsions. You have to look at the
function and the context of the behavior. For
example, bedtime routines, religious practices, and
learning a new skill all involve some level of
repeating an activity over and over again, but are
usually a positive and functional part of daily life.
Behaviors depend on the context.
Arranging and ordering books for eight hours a day
isn’t a compulsion if the person works in a library.
Similarly, you may have “compulsive” behaviors that
wouldn’t fall under OCD, if you are just a stickler for
details or like to have things neatly arranged. In this
case, “compulsive” refers to a personality trait or
something about yourself that you actually prefer or
like. In most cases, individuals with OCD feel driven
to engage in compulsive behavior and would rather
not have to do these time consuming and many
times torturous acts. In OCD, compulsive behavior is
done with the intention of trying to escape or
reduce anxiety or the presence of obsessionsPrepared by Tooba Qaiser

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10. CASE STUDY
Charles, Rapoport, 1989
Page # 153
Study the case study and write down
all the symptoms.
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11. Measures: Maudsley Obsessive-
Compulsive Inventory (MOCI)
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13. Biomedical Explanations for OCD
Genetic causes
OCD runs in families and can be considered a
"familial disorder." The disease may span
generations with close relatives of people with
OCD significantly more likely to develop OCD
themselves.
• Mattheisen et al. (2015) Page 154
• Taj et al., 2013, Page 154
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14. Biochemical Causes:
Leckman et al, 1994, found that
some forms of OCD were related
to oxytocin dysfunction. This
could mean that OCD type
behaviors may be at extreme end
of a normal range of behaviors
moderated by the hormone.
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15. Neurological causes
Brain imaging techniques have allowed
researchers to study the activity of specific
areas of the brain, leading to the discovery
that some parts of the brain are different in
people with OCD when compared to those
without.
Despite this finding, it is not known exactly
how these differences relate to the
development of OCD.
Imbalances in the brain chemicals serotonin
and glutamate may play a part in OCD.
Brain scans have shown abnormal activity in
people with OCD.
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16. Behavioral causes
The behavioral theory suggests that people
with OCD associate certain objects or
situations with fear. They learn to avoid those
things or learn to perform "rituals" to help
reduce the fear. This fear and avoidance or
ritual cycle may begin during a period of
intense stress, such as when starting a new job
or just after an important relationship comes
to an end.
Once the connection between an object and
the feeling of fear becomes established,
people with OCD begin to avoid that object
and the fear it generates, rather than
confronting or tolerating the fear.
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17. Cognitive causes
The behavioral theory outlined on how people with OCD make an association
between an object and fear. The cognitive theory, however, focuses on how
people with OCD misinterpret their thoughts.
Most people have unwelcome or intrusive thoughts at certain times, but for
individuals with OCD, the importance of those thoughts are exaggerated.
For example, a person who is caring for an infant and who is under intense
pressure may have an intrusive thought of harming the infant either deliberately
or accidentally.
Most people can shrug off and disregard the thought, but a person with OCD may
exaggerate the importance of the thought and respond as though it signifies a
threat. As long as the individual with OCD interprets these intrusive thoughts as
cataclysmic and true, they will continue the avoidance and ritual behaviors
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21. Class Assignment
Search about
Can traumatic toilet training really
cause OCD?
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22. Treatment
OCD usually develops into a chronic condition if left
untreated, with episodes where symptoms seem to
improve. Without treatment, remission rates are low,
at around 20 percent.
However, around 40 percent of people who develop
OCD in childhood or adolescence experience remission
by early adulthood. Treatment for OCD will depend on
how much the condition affects the person's ability to
function.
First-line treatments for OCD will often include:
• cognitive behavioral therapy (CBT)
• selective serotonin reuptake inhibitors (SSRI)
• a combination of SSRI and CBT
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23. Cognitive behavioral therapy
CBT is an effective method of treating
OCD. CBT is a type of psychotherapy
(talking therapy) that aims to help the
individual change the way they think, feel,
and behave. It refers to three distinct
treatments:
• exposure and response prevention
(ERP) (Lehmkuhl et al., 2008)
• modeling
• cognitive therapy (Lovell et al., 2006)
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24. Research has shown that 75 percent of people with
OCD are significantly helped by cognitive behavioral
therapy. Treatment techniques include exposure and
response prevention (ERP), this involves the following:
• Exposure: This involves exposure to situations and
objects that trigger fear and anxiety. Over time, the
anxiety generated by these obsessional cues
decreases and, eventually, the obsessional cues
cause little or no anxiety. This is called habituation.
• Response: Response prevention refers to the ritual
behaviors that people with OCD engage in to reduce
anxiety. This treatment helps people learn to resist
the compulsion to perform these rituals.
Other techniques focus solely on cognitive therapy. People who
participate in this type of therapy work toward eliminating the
compulsive behavior. This is done by identifying and re-evaluating
their beliefs about the consequences of engaging, or not engaging,
in the compulsive behavior.
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26. Biomedical
Selective serotonin reuptake inhibitor (SSRIs)
There are a number of drugs available for treating OCD, with the
development of SSRIs expanding the range of treatment options.
SSRIs that may be prescribed to help people manage OCD
include:
• clomipramine
• fluoxetine
• fluvoxamine
• paroxetine hydrochloride
• sertraline
• citalopram
SSRIs are generally used in higher doses for OCD than for
depression. It might take up to 3 months for results to be
noticed.
About half of all people with OCD do not respond to SSRI
treatment alone, with atypical antipsychotic medications often
added to the treatment. Prepared by Tooba Qaiser

27. Video
https://www.youtube.com/watch?v=G
4r3qCkLUDQ
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28. Overview of the chapter
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29. OCD Case Examples
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30. CASE 1
A 13-year-old boy learns in health class that vomiting is an
involuntary response to illness. While watching the news
with his family one evening, he hears a story about a young
man who aspirates vomit during his sleep and dies. He
becomes obsessed about getting ill and vomiting. The boy
shuns anyone who appears to be sick at school. His friends
wonder why he isn’t talking to them. This boy carries hand
sanitizer everywhere he goes, and avoids public
restrooms. He won’t touch food that he thinks might be
contaminated by germs. He avoids all the restaurants that he
used to enjoy with his family. The boy’s parents worry about
him.
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32. CASE 2
A thirty-year old school teacher without previous treatment. She
described having a book collection that she dusted daily and would
not let anyone else, including her husband, touch. She insisted that
her husband get into bed at night before her so that she could make
sure that nothing in the house had been moved after she went to
bed. If they were late for an engagement, she was unable to modify
her routine of getting ready. Both at work and at home, she refused
to allow others to do any tasks that might be helpful to her, as she
felt that only she could perform these tasks correctly. When leaving
the house, she insisted on driving or walking a predetermined route
despite any obstacles, such as traffic, that presented themselves
along the way. She was critical and outspoken about "shortcuts" that
she thought other teachers took in their work. These patterns of
behavior and attitudes caused major marital conflict and conflict
with other teachers.
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34. Case 3:
A 26 year old engineer who has become increasingly “stressed” by the need to
check and double check items at home and work. Before leaving home for work, he
will spend 30 minutes or even longer ensuring that all switches and taps are turned
off. He has developed a time-consuming ritual of turning on and off a tap several
times, then staring at it for 1 minute to ensure that it is properly turned off. On
many occasions as he starts to drive to work, he will suddenly return home to
repeat all the checks as he is doubtful if the checks are properly done previously.
As a result he is frequently late for work. Besides chiding him for lateness, his boss
also complains that he has not been submitting his work on time. Indeed, his
compulsive checking and rechecking of all documents and papers because of his
fears that he might make careless mistakes has delayed his work significantly and
his colleagues has started to brand him as “slow”.
There is also a group of OCD sufferers who predominantly has repetitive and
intrusive thoughts and mental images that keep replaying in their minds, for
example of violence, silly or senseless things that is abhorrent and has no
relevance at all to the sufferer.
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36. Case 4
A 31 years old secretary who has always been a clean and tidy person.
For the past 3 months, however, she has been excessively fearful of
getting contaminated by “germs”. She spends a several minutes each
time washing her hands with soap whenever she touched a surface
which she deemed as “contaminated” eg. An office document, a chair
and most other surfaces. She is starting to develop redness and
peeling of her hands because of excessive washing. At home, she can
only sleep very late as she has to spend many hours cleaning her
house. Her relationship with her partner effected as well. She
becomes depressed as a result.
In obsessive doubt, a sufferer may have a persistent fear of having
missed various things (such as not properly switching off lights or gas
stove, not closing doors or windows properly, making a careless
mistake in work or misplacing a wallet). He or she then compulsively
checks for these “mistakes”. Hence the sufferer may spend a long time
checking these things.
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38. Documentaries
• https://www.youtube.com/watch?v=4Vixj8lSE
ws
• https://www.youtube.com/watch?v=x4sadYeL
HKU
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41. Paper 3: AO1 and AO3