Psychology Essay

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Figure 13.10 (a) Repetitive hand washing and (b) checking (e.g., that a door

is locked) are com m on com pulsions am ong those with obsessive-

com pulsive disorder. (credit a: m odiﬁcation of work by the USDA; credit b:

m odiﬁcation of work by Bradley Gordon)

M o d u le 1 3 .5 : O b s e s s iv e - C o m p u ls iv e a n d R e la t e d D is o r d e r s

O bsessive-com pulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and

repetitive behaviors. M any of us experience unw anted thoughts from tim e to tim e (e.g., craving double cheeseburgers w hen dieting), and m any

of us engage in repetitive behaviors on occasion (e.g., pacing w hen nervous). H ow ever, obsessive-com pulsive and related disorders elevate the

unw anted thoughts and repetitive behaviors to a status so intense that they disrupt daily life. Included in this category are obsessive-

com pulsive disorder (O CD ), body dysm orphic disorder, and hoarding disorder.

O b s e s s iv e -C o m p u ls iv e D is o rd e r

People w ith obsessive-com pulsive disorder (O CD ) experience thoughts and urges that are intrusive and unw anted (obsessions) and/or the need

to engage in repetitive behaviors or m ental acts (com pulsions). A person w ith this disorder m ight, for exam ple, spend hours each day w ashing

his hands or constantly checking and rechecking to m ake sure that a stove, faucet, or light has been turned off.

O bsessions are m ore than just unw anted thoughts that seem to random ly

jum p into our head from tim e to tim e, such as recalling an insensitive

rem ark a cow orker m ade recently, and they are m ore signiﬁcant than day-to-

day w orries w e m ight have, such as justiﬁable concerns about being laid off

from a job. Rather, obsessions are characterized as persistent, unintentional,

and unw anted thoughts and urges that are highly intrusive, unpleasant, and

distressing. Com m on obsessions include concerns about germ s and

contam ination, doubts ("D id I turn the w ater off?"), order and sym m etry, and

urges that are aggressive or lustful. U sually, the person know s that such

thoughts and urges are irrational and thus tries to suppress or ignore them ,

but has an extrem ely diﬃ cult tim e doing so. These obsessive sym ptom s

som etim es overlap, such that som eone m ight have both contam ination and

aggressive obsessions.

Com pulsions are repetitive and ritualistic acts that are typically carried out

prim arily as a m eans to m inim ize the distress that obsessions trigger or to reduce the likelihood of a feared event. Com pulsions often include

such behaviors as repeated and extensive hand w ashing, cleaning, checking (e.g., that a door is locked), and ordering (e.g., lining up all the

pencils in a particular w ay), and they also include such m ental acts as counting, praying, or reciting som ething to oneself (Figure 13.10).

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Figure 13.11 Those who suffer from hoarding disorder

have great diﬃ culty in discarding possessions, usually

resulting in an accum ulation of item s that clutter living or

work areas. (credit: "puuikibeach"/Flickr)

Com pulsions characteristic of O CD are not perform ed out of pleasure, nor are they connected in a realistic w ay to the source of the distress or

feared event. Approxim ately 2.3% of the U .S. population w ill experience O CD in their lifetim e and, if left untreated, O CD tends to be a chronic

condition creating lifelong interpersonal and psychological problem s.

B o d y D y s m o rp h ic D is o rd e r

An individual w ith body dysm orphic disorder is preoccupied w ith a perceived ﬂaw in her physical appearance that is either nonexistent or

barely noticeable to other people. These perceived physical defects cause the person to think she is unattractive, ugly, hideous, or deform ed.

These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation w ith im agined physical

ﬂaw s drives the person to engage in repetitive and ritualistic behavioral and m ental acts, such as constantly looking in the m irror, trying to hide

the offending body part, com parisons w ith others, and, in som e extrem e cases, cosm etic surgery. An estim ated 2.4% of the adults in the U nited

States m eet the criteria for body dysm orphic disorder, w ith slightly higher rates in w om en than in m en.

H o a rd in g D is o rd e r

Although hoarding w as traditionally considered to be a sym ptom of O CD , considerable

evidence suggests that hoarding represents an entirely different disorder. People w ith

hoarding disorder cannot bear to part w ith personal possessions, regardless of how

valueless or useless these possessions are. As a result, these individuals accum ulate

excessive am ounts of usually w orthless item s that clutter their living areas (Figure 13.11).

O ften, the quantity of cluttered item s is so excessive that the person is unable use his

kitchen, or sleep in his bed. People w ho suffer from this disorder have great diﬃ culty

parting w ith item s because they believe the item s m ight be of som e later use, or because

they form a sentim ental attachm ent to the item s. Im portantly, a diagnosis of hoarding

disorder is m ade only if the hoarding is not caused by another m edical condition and if the

hoarding is not a sym ptom of another disorder (e.g., schizophrenia).

C a u s e s o f O C D

A brain region that is believed to play a critical role in O CD is the orbitofrontal cortex, an area of the frontal lobe involved in learning and

decision-m aking (Figure 13.13). In people w ith O CD , the orbitofrontal cortex becom es especially hyperactive w hen they are provoked w ith tasks

in w hich, for exam ple, they are asked to look at a photo of a toilet or of pictures hanging crookedly on a w all. The orbitofrontal cortex is part of

a series of brain regions that, collectively, is called the O CD circuit; this circuit consists of several interconnected regions that inﬂuence the

perceived em otional value of stim uli and the selection of both behavioral and cognitive responses. As w ith the orbitofrontal cortex, other

regions of the O CD circuit show heightened activity during sym ptom provocation, w hich suggests that abnorm alities in these regions m ay

produce the sym ptom s of O CD . Consistent w ith this explanation, people w ith O CD show a substantially higher degree of connectivity of the 2017/8/2 PSY101 - Module 13.5

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Figure 13.13 Different regions of the brain m ay be associated with

different psychological disorders.

orbitofrontal cortex and other regions of the O CD circuit than do those

w ithout O CD .

The ﬁndings discussed above w ere based on im aging studies, and they

highlight the potential im portance of brain dysfunction in O CD . H ow ever,

one im portant lim itation of these ﬁndings is the inability to explain

differences in obsessions and com pulsions. Another lim itation is that the

correlational relationship betw een neurological abnorm alities and O CD

sym ptom s cannot im ply causation.

C o n n e ct th e C o n ce p ts

Conditioning and O CD

The sym ptom s of O CD have been theorized to be learned

responses, acquired and sustained as the result of a com bination

of tw o form s of learning: classical conditioning and operant conditioning. Speciﬁcally, the acquisition of O CD m ay occur ﬁrst

as the result of classical conditioning, w hereby a neutral stim ulus becom es associated w ith an unconditioned stim ulus that

provokes anxiety or distress. W hen an individual has acquired this association, subsequent encounters w ith the neutral

stim ulus trigger anxiety, including obsessive thoughts; the anxiety and obsessive thoughts (w hich are now a conditioned

response) m ay persist until she identiﬁes som e strategy to relieve it.

Relief m ay take the form of a ritualistic behavior or m ental activity that, w hen enacted repeatedly, reduces the anxiety. Such

efforts to relieve anxiety constitute an exam ple of negative reinforcem ent (a form of operant conditioning). Recall from the

lesson on learning that negative reinforcem ent involves the strengthening of behavior through its ability to rem ove

som ething unpleasant or aversive. H ence, com pulsive acts observed in O CD m ay be sustained because they are negatively

reinforcing, in the sense that they reduce anxiety triggered by a conditioned stim ulus.

Suppose an individual w ith O CD experiences obsessive thoughts about germ s, contam ination, and disease w henever she

encounters a doorknob. W hat m ight have constituted a viable unconditioned stim ulus? Also, w hat w ould constitute the

conditioned stim ulus, unconditioned response, and conditioned response? W hat kinds of com pulsive behaviors m ight w e

expect, and how do they reinforce them selves? W hat is decreased? Additionally, and from the standpoint of learning theory,

how m ight the sym ptom s of O CD be treated successfully? 2017/8/2 PSY101 - Module 13.5

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M odule 13.4 M odule 13.6