Practise diagnosing OCD with obsessions, compulsions and Y-BOCS or MOCI evidence, comparing explanations and evaluating SSRIs, ERP and CBT treatment.
Sarah is always thinking about germs. At work she eats lunch alone as she believes this will protect her colleagues. She always washes her hands for 15 minutes in very hot water. She feels better after this, but after 45 minutes she wants to wash again. When Sarah gets home, she washes her clothing, shoes and coat. One day, when Sarah had sat next to a colleague, she could not sleep that night as she was convinced that he would get ill.
Explain how Sarah meets the diagnostic criteria for obsessive-compulsive disorder (OCD).
Award 3-4 marks for a detailed answer with clear understanding of how Sarah fits the diagnostic criteria for OCD.
Award 1-2 marks for a basic answer with some understanding of how Sarah fits the diagnostic criteria for OCD.
Diagnostic criteria ICD-11
- Presence of persistent obsessions/compulsions
- Obsessions are repetitive and persistent that are intrusive/unwanted
- Compulsions are repetitive behaviour or rituals
- Obsessions and compulsions are time-consuming or result in significant distress/impairment in personal, family, social, educational, occupational, or other important areas of functioning.
4
1 max for reference to Sarah's obsession/belief = germs, protect colleagues, colleague gets ill.
1 max for reference to Sarah compulsion - washing hands for 15 mins /very hot water, washing clothing, shoes, coat.
1 max for reference to persistence/time-consuming = always thinking about, takes up to at least an hour a day ( 15 min every 45).
1 max for explain why obsession is irrational.
1 mark for explain that the compulsion acts to reduce the anxiety created by the obsession.
2 max for reference to impairment in life (couldn't sleep, sitting alone at lunch).
Allow reference to both ICD and DSM guides.
Do not credit 'obsessions and compulsions' on its own as in the question.
The response must identify both obsessions and compulsions from the stem to be awarded full marks.
1
Example:
Sarah fits the diagnostic criteria for OCD as she is experiencing obsessions and compulsions. One of her obsessions is thinking about germs. (1) This is something Sarah thinks about frequently, so it is persistent. (1) In addition, Sarah engages in compulsions which include washing her hands for 15 minutes in very hot water. (1) Sarah's behaviour is repetitive and/or ritualistic (e.g. 15 minutes of hand washing and/or washing her clothing, shoes and coat).
When she washes her hands, she does feel better, however her anxiety returns, and she has to wash her hands again which is time-consuming and excessive. (1) Her obsessions and compulsions are having a negative effect on her job as she is spending time washing her hands as well as feeling distressed with her thoughts about germs. (1) She is also missing out on socialising with her colleagues at lunchtime as she has to sit alone. (1) The other negative effect she is experiencing is not being able to sleep at night if she accidentally touches someone. (1)
Other appropriate responses should also be credited.
DSM-5 is creditworthy
Presence of obsessions and/or compulsions.
Obsessions are recurrent/persistent thoughts that are intrusive/unwanted - thoughts are neutralised with some other thought/action.
Compulsions are repetitive behaviours/mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The compulsion is aimed at preventing/reducing anxiety; however, these behaviours are excessive. Obsessions and/or compulsions are time-consuming or cause significant distress or impairment in social, occupational, or other important areas of functioning.
Outline what is meant by a situational explanation of obsessive-compulsive disorder (OCD), including an example from the behavioural explanation of OCD.
Award 1 mark for an outline of the term/concept.
Award 1 mark for an example.
Example:
Situational explanation is the view that behaviour is caused by the environment the person is in.(1) AND
For example, the person with OCD learns that by washing their hands this provides temporary relief (negative reinforcement) from anxiety and so repeats this behaviour. (1)
Other appropriate responses should also be credited.
2
Context = explanation of obsessive-
compulsive disorder
Allow 1 mark for behavioural explanation of
OCD if doesn't mention environment.
Explain one weakness of the situational explanation of OCD, including an example from the behavioural explanation of OCD.
Award 2 marks for a detailed explanation of the weakness in context. Award 1 mark for a basic outline/identification of weakness.
Problems might include:
- Deterministic explanation - suggests that there is no free-will in the development of the obsessive-compulsive disorder as it has developed from situational factors outside of the control of the individual.
- Reductionist explanation - suggests obsessive-compulsive disorder is caused by psychological factors (e.g. negative reinforcement) and ignores other possible causes such as biochemical, genetic or individual causes.
- Difficult to determine if it is the situational factor that is the only cause of obsessive-compulsive disorder.
- Poor practical applications - as the explanation is based on situational factors and it is not possible for the patient with obsessive-compulsive disorder or a therapist to prevent the situational factor from occurring.
- Individual differences - not everyone who has a negative thought/anxiety about their environment (e.g. dirty surfaces) and then engages in cleaning will develop OCD even though they have experienced negative reinforcement.
Example:
One weakness of the situational explanation is that it is difficult to determine if the situational factor is the only cause of OCD.(1) For example, some people develop OCD due to genetic and/or biochemical causes rather than just the experience of doing the compulsion (interacting with their environment/ situation) and then experiencing negative reinforcement.
Other appropriate responses should also be credited.
2
Context = behavioural explanation of obsessive-compulsive disorder
From the key study by Lovell et al. (2006) on the treatment of obsessive-compulsive disorder:
Identify two criteria that were necessary for participants to meet to be included in the study.
Syllabus: 1.5.3 Key study on treatment of obsessive-compulsive disorder using telephone administered cognitive- behavioural therapy (CBT): Lovell et al. (2006).
Award 1 mark for each appropriate reason.
Definitive answer:
- diagnosis of obsessive-compulsive disorder
- score of 16 or more on YBOCS (Yale-Brown scale)
- age 16-65.
Outline two reasons why some participants were excluded from the study.
Outline two reasons why some participants were excluded from the study.
Award 1 mark for each appropriate reason.
Definitive answer: patients with:
- obsessional slowness
- organic brain disease
- a diagnosis of substance misuse
- severe depression or with suicidal intent
- patients who had been on anti-depressants or anxiolytics for less than 3 months.
NOTE: 0 marks for 'withdrawing from study'; 0 marks for 'mixing/doubling up' with Q1(a)(i)
Suggest why Lovell et al. did not include a control group in their study.
Suggest why Lovell et al. did not include a control group in their study.
Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied.
Answers may include:
- a control group was not needed ( 1 ) the aim was to see if CBT by telephone was as good as face-to-face; both groups receiving CBT (2)
- a control group would receive no treatment (1) and if they were to be an appropriate control group they would have to meet the same inclusion criteria as the experimental groups (2).
Other appropriate responses to be credited.