Obsessive Compulsive Disorder

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“A MINI PROJECT REPORT”
OF
PAPER-8 “Psychotherapy for Mental Disorders”
ON
TOPIC: OBSESSIVE COMPULSIVE DISORDER
Submitted for the partial fulfilment of the Degree of Masters in Psychotherapy By:
Ms. Roshni Sondhi
Roll No.: IIH/048/PG/PTH/2009J
Second Year

THE GLOBAL OPEN UNIVERSITY NAGALAND

TABLE OF CONTENTS

Title page1
Table of contents2
Introduction4
Features of obsessions and compulsions5
The psychodynamic perspective8
The behavioural perspective9
The cognitive perspective11
The biological perspective12
Diagnosis and phenomenology of OCD15
Symptom subtypes18
Comorbidity, differential diagnosis and the obsessive compulsive spectrum disorders21 Epidemiology25
Biological contributions27
Biochemistry and neuropharmacology28
Neuropsychology31
Neuroanatomy33
A neurodevelopmental model of OCD40
PANDAS42
Cognitive contributions44
Treatment based on cognitive theories52
Conclusion54
References57

INTRODUCTION
The past two decades were characterized by enormous advancement in understanding the nature of mental illness. In particular, findings from basic neuroscience raised the possibility of eventually unravelling the pathophysiology of mental disorders. Similarly, cognitive theories have taken on increasing prominence in explanations for maladaptive psychological functioning. With respect to the anxiety disorders in general, and obsessive compulsive disorder in particular, there has been a virtual explosion of research since the introduction of DSM-III in 1980; much of which is biological and cognitive. Obsessions are persistent thoughts, ideas, impulses, or images that seem to invade a person's consciousness. Compulsions are repetitive and rigid behaviours or mental acts that people feel they must perform in order to prevent or reduce anxiety. Minor obsessions and compulsions are familiar to almost everyone. You may find yourself filled with thoughts about an upcoming performance or exam, or keep wondering whether you forgot to turn off the stove or lock the door. You may feel better when you avoid stepping on cracks, turn away from black cats, or arrange your closet in a particular manner. Minor obsessions and compulsions can play a helpful role in life. Little rituals often calm us during times of stress. A person who repeatedly hums a tune or taps his or her fingers during a test may be releasing tension and thus improving performance. Many people find it comforting to repeat religious or cultural rituals, such as touching a mezuzah, sprinkling holy water, or fingering rosary beads. According to DSM-IV-TR, a diagnosis of obsessive-compulsive disorder is called for when obsessions or compulsions feel excessive or unreasonable, cause great distress, take up much time, or interfere with daily functions. The disorder is classified as an anxiety disorder because the obsessions cause intense anxiety, while the compulsions are aimed at preventing or reducing anxiety. In addition, anxiety rises if individuals try to resist their obsessions or compulsions. Georgia, a woman with this disorder, observed: "I can't get to sleep unless I am sure everything in the house is in its proper place so that when I get up in the morning, the house is organized. I work like mad to set everything straight before I go to bed, but, when I get up in the morning, I can think of a thousand things that I ought to do.... I can't stand to know something needs doing and I haven't done it" (McNeil, 1967, pp. 26-28). Georgia's family was no less affected by her rigid pattern, as these comments by her husband indicate: Sometimes I think she never sleeps. I got up one night at 4 a.m. and there she was doing the laundry downstairs. ... If I forget to leave my dirty shoes outside the back door she gives me a look like I had just...
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