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Hussein Makled

Dr. Birkhill

Abnormal Psychology

March 9, 2017

Obsessive-Compulsive Disorder (OCD)

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Obsessive-Compulsive Disorder involves unwanted and disturbing thoughts, images, or

urges (obsessions) that intrude into a child/teens mind and cause a great deal of anxiety or

discomfort, which the child/teen then tries to reduce by engaging in repetitive behaviors or

mental acts (compulsions) (Anxiety BC). The DSM-5 is a manual that mental health

professionals use determine if an individual has a mental diagnosis; such as OCD. The mental

health professional conducts a psychological exam to see if one meets the OCD criteria listed in

the DMS-5. Some criteria include: having obsessions, and compulsions, you may or may not

realize that your obsessions and compulsions are excessive or unreasonable; you perform

physical rituals or mental acts to reduce the severe anxiety caused by obsessive thoughts.

Patients who are diagnosed with OCD show symptoms for both compulsions and obsessions.

Obsessions are repeated thoughts that cause anxiety, these symptoms include: fear of

contamination, aggressive thoughts towards self and others, having things in a perfect order,

individual unsuccessfully tries to suppress or ignore disturbing thoughts, images, or urges. And

finally, compulsions are repeated behaviors in response to obsessive thoughts; these symptoms

include: excessive cleaning/ hand washing, ordering things in a specific way, and repeatedly

checking on things and compulsive counting (Gluck 2013).

The causes of OCD are unknown but there have been some discovered risk factors. One

of the risk factors involves genetics; twin studies and family studies have shown that people with

first degree relatives who have OCD are at higher risk for developing OCD, some research

indicated that if one twin out of identical twins has OCD the other is more likely to have OCD.

A study founded by the National Institute of Health examined DNA, and the results suggested

that OCD may be associated with a mutation of the human serotonin transporter gene. Many

cognitive theorists believe that individuals with OCD have dysfunctional beliefs and their
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misinterpretation of intrusive thoughts leads to the creation of obsessions and compulsions. Also,

Environmental exposures, is another influence that may contribute to OCD. Although some

research suggests that there is no link between negative life events and OCD, there are reports in

which childhood OCD has been triggered by; traumatic events, death of a loved one, divorces,

and changes in schools (What Causes OCD). .

In a study called A Family Study of Obsessive- Compulsive Disorder, (Pauls, Alsobrook,

Goodman, Rasmussen, Leckman. 1995) the researchers set out to find whether OCD is familial

(occurring in family). This family study was unlike others, because most did not directly

interview the families, and failed to include a comparison group. The researchers interviewed

100 subjects with OCD to see if they fit the DSM-5 criteria. After a diagnosis of OCD had been

established the researchers then retrieved a history of each first- degree relative, and those

relatives were later interviewed. The interviews included a series of screenings designed to

cover all the DSM-5 diagnosis criteria of OCD. After completion of the interviews, the data was

collected. The total sample included 679 individuals: 100 obsessive-compulsive disorder

subjects, 466 first-degree biological relatives, and 113 comparison subjects who were relatives of

unaffected individuals. The findings of this study are consistent with those of the majority of

studies suggesting that obsessive-compulsive disorder is familial, (Pauls, Alsobrook, Goodman,

Rasmussen, Leckman. 1995).

A study called, Neuroimaging Studies of Obsesive- Compulsive Disorder in Adults and

Children was conducted to understand the pathophysiology of OCD in both pediatric and adult

patients. This is a very detailed study, which analyzed the frontal cortex, basal ganglia, striatum,

and the thalamus through use of CT, MRI, PET, and SPECT images. evidence in children

neuroimaging show that another brain structure may be implicated in the onset and maintenance
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of OCD symptoms: the corpus callosum. There is an age related increase in the corpus callosum

in healthy children however this was not found in that of OCD patients (Friedlander, Desrocher).

According to a study called, Volumetric MRI Assessment of Brain Regions in Patients

with Refractory OCD at the Firat University School of Medicine Department of Psychology,

these researchers performed and MRI study in patients with OCD, to see the structures that have

been implicated in this disorder. What they saw at the conclusion of the study was that OCD

patients had a significantly smaller left & right orbito- frontal cortex volumes compared with

treatment responded patients. Another conclusion that the researchers came to was, reductions in

orbito- frontal cortex and an increase in thalamic volumes may be associated with refractoriness

of OCD. In a case report called Obsessions Appear After the Removal of a Brain Tumor in the

Right Frontal Lobe (M.S Liu, Zhang, Liu M.D. 2014), the doctors reported a case where a

patient developed OCD after resection of meningioma of the right frontal lobe. They suggested

that the onset of secondary OCD is associated with the right frontal lobe; by this they proposed

that, the origin of obsessions and compulsions is located in the right frontal lobe. Neuroimaging

studies have identified high activities through out the frontal cortex of OCD patients. The doctors

found that their case report provides evidence that OCD is associated with the frontal lobe

(Atmaca, Yildirim, Ozdemir, Aydin, Tezcan, Ozler. 2006).

In a research study called the Meta-Analysis of the Symptom Structure of Obsessive-

Compulsive Disorder, the authors conducted a meta- analysis to determine the factor structure of

the OCD symptom checklist. In the study involving 5,124 participants the factors that were

observed were: repeating, ordering, counting, forbidden thoughts, cleaning, and hoarding. The

findings of this study saw concluded that the DSM-5 should include specification of the four

symptoms. In a research conducted by Dr. Abramowitz, he discusses the psychological treatment

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of OCD, with Exposure & Response Prevention (ERP) and how this development shows that the

prognosis for individuals with OCD has changed from poor to very good (Bloch, Weisenberger,

Rosario, Pittenger, Leckman. 2008).

The strategies that have been seen to be the most effective in patients with OCD include,

Psychotherapy, Pharmacotherapy, and ERP. According to the National Institute of Mental Health

medications that have been seen to work well for OCD consist of SRIs (Serotonin Reuptake

Inhibitors) and SSRIs (Selective Serotonin Reuptake Inhibitors). These SRIs and SSRIs include:

Fluoxetine, Fluvoxamine, Sertraline, Paroxetine, etc. Psychotherapy like Cognitive Behavior

Therapy is effective in habit reversal training and reducing compulsive behaviors. Exposure &

Response prevention is a therapist guided, systematic, repeated and prolonged exposure to

situations that provoke obsessional fear. The treatment involved having OCD clients develop

upsetting stimuli then clients are asked to expose themselves repeatedly to stimuli that will

provoke their obsession following each exposure theyre asked to not engage in rituals that they

ordinarily would. According to Dr. Abramowitzs research, Intensive ERP has been found more

effective than the antidepressant clomipramine, which is believed to be most effective form of

pharmacotherapy for OCD.

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Works Cited

Abramowitz, Jonathan S., PhD. The Psychological Treatment of Obsessive-Compulsive Disorder. N.p.:

Canadian Journal of Psychiatry, June 2006. PDF. Vol 51, No. 7

Atmaca, Murad, Hanefi Yildirim, Huseyin Ozdemir, Aye Aydin, Ertan Tezcan, and Sinan Ozler.

"Volumetric MRI Assessment of Brain Regions in Patients with Refractory Obsessive

compulsive Disorder." Progress in Neuro-Psychopharmacology and Biological Psychiatry 30.6

(2006): 1051-057. Science Direct. 9 May 2006. Web. 08 Mar. 2017.

Bloch, Michael H., Angeli Landeros-Weisenberger, Maria C. Rosario, Christopher Pittenger, and James F.

Leckman. "Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder.:

American Journal of Psychiatry: Vol 165, No 12. The American Journal of Psychiatry, Dec. 2008.

Web. 08 Mar. 2017.

Friedlander, Laura, and Mary Desrocher. "Neuroimaging Studies of ObsessiveCompulsive Disorder in

Adults and Children." Vol. 26, No. 1 ScienceDirect. Jan. 2006. Web. 08 Mar. 2017.

Gluck, Samantha. "OCD Diagnosis: OCD Criteria and Characteristics in DSM 5 - HealthyPlace."

HealthyPlace. 19 May 2013. Web. 08 Mar. 2017.

Jenike, Michael, MD. "Medications for OCD." International OCD Foundation. N.p., 09 May 2014. Web.

08 Mar. 2017. <https://iocdf.org/about-ocd/treatment/meds/>.

Liu, Jie, M.S, Xinhua Zhang, M.D, and Jihua Liu, M.D. "Obsessions Appear after the Removal a Brain

Tumor in the Right Frontal Lobe." General Hospital Psychiatry 36.4 (2014): n. pag. Mardigian

Library. Web. 8 Mar. 2017.

National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 08 Mar. 2017 .

"Obsessive Compulsive Disorder." AnxietyBC. N.p., 17 July 2015. Web. 08 Mar. 2017.

"OCD Facts: What Causes OCD." OCD Education Station. Web. 08 Mar. 2017.
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Pauls David, Alsobrook John, Goodman Wayne, Rasmussen Steve, and Leckman James. "A Family Study

of Obsessive-Compulsive Disorder." The American Journal of Psychiatry 152.1 (1995): 76-84.

ProQuest. Web. 8 Mar. 2017.