A persistent thought, idea, impulse or image that is experienced repeatedly, feels intrusive and causes anxiety

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Obsession: “A persistent thought, idea, impulse or image that is experienced repeatedly, feels intrusive and causes anxiety”. (Comer, 2008)
Obsessive thoughts are uncontrollable and often very disturbing. Sexual, aggressive and religious thoughts are the most common types of obsessive thoughts. They can lead to high levels of panic and anxiety.
Compulsion: “A repetitive and rigid behaviour or mental act that a person feels driven to perform in order to prevent or reduce anxiety”.
Also largely uncontrollable - the person feels compelled to act out the certain ‘act’ in a certain way over and over again. The repetition helps the individual to reduce their high levels of anxiety. The most common forms of compulsions are washing, showering, checking (lights), and ordering items. Mental compulsive acts include repeating the same phrase, poem or set of prayers over and over again.
Definition of obsessive-compulsive disorder:
“A disorder where a person has recurrent and unwanted thoughts,

a need to perform repetitive and rigid actions, or both”. (Comer, 2008)

Additionally if the person is prevented for some reason from performing the compulsion, feelings of dread and panic occur. People with OCD also feel that they should resist the compulsion but are unable to do so. Attempts are made to resist but end up feeling defeated and so they give in.

Some facts

  • OCD is equally common in males and females however women more likely to suffer from compulsions of cleanliness

  • A third who report it say it started in childhood, however, in many cases it goes undetected

  • Can last a few years to decades

  • Sufferers can go through intermittent periods of depression

  • Affects around 1-3% of population (Source: National Institute of Mental Health)

  • It develops from late adolescence to early adulthood

  • People can function well in their daily lives by keeping it a secret, or avoiding the actual act

  • Sometimes they will be unable to hold a job – for example if they need to shower ritualistically they will be unable to work

Types of OCD
Obsessional Cleanliness obsession with dirt/contamination leads to compulsive behaviours e.g. hand-washing

Compulsive Rituals specific ways/order of doing things, yet have the urge to stop, but cant

Obsessional Doubts usually related to health and safety concerns e.g. locking the house door

Compulsive Checking follows on from obsessional doubts, will have to keep checking, double-checking things e.g. the house door…….and never end up leaving

Obsessional Ruminations internal debates with self, will present themselves with an issue and debate for and against it, even over simple things

Obsessional Impulses strong urge to perform an embarrassing, dangerous or violent act.
Read the case studies on the handout provided and decide what obsessional problem the people are suffering from…

Once you have finished that you must do some exam paper questions…


OCD is an anxiety disorder because the obsessive thoughts cause high levels of anxiety. Compulsive behaviours and mental acts are carried out in order to reduce the high levels of anxiety.

Family Studies

The research suggests that the closer the family relatives are with OCD the more likely another person will also develop it. Carey & Gottesman (1981) – reported a prevalence of up to 10% in 1st degree relatives. Lenane (1990) – 30% of 1st degree relatives in their study also had an OCD.

Twin Studies

Hoaker & Schnurr (1980) – found concordance rate of 50-60%, i.e. if one MZ twin suffered from OCD then 60% of the other twin had it also.

The problem with twin studies is that they may not have developed the disorder due to genetics but instead because they are treated more similarly in their home/societal environments and so this could be the cause.

Genetics could also be criticized as when OCD runs in families they inherit the general nature of it, but not exactly the same symptoms (again, suggests that it could be partly genetic and also environment).

The use of PET scans show that people with OCD have two different types of abnormal brain activity - Low levels of the neurotransmitter serotonin and high levels of activity in the orbital frontal cortex of the brain.

Serotonin is an important neurotransmitter that is responsible for communication between neurons. Drugs that increase the levels of serotonin in the brain have been found to reduce the symptoms of OCD – these drugs would include Prozac- antidepressants.
Also the high levels of glucose metabolism and blood flow have been found in the left frontal cortex of the brain called the orbital frontal cortex.

Difficult to identify whether its genetics causes OCD or the effects of the shared environment

Inconsistent findings regarding serotonin, i.e. is OCD the cause of low serotonin levels or is low levels of serotonin a cause of OCD?

Psychological therapy is very good, due to its success rates and so contradicts the serotonin or any biological therapy.

Inconsistency with results regarding the orbital cortex e.g. Aylward (1996) – found no difference between OCD and non-OCD sufferers.

Head injuries and brain tumours have been associated with the development of OCD – thus proving a biological basis.

Research into brain structures are still in their infancy due to the technological advancements. Rappoport (1989) – About 20% of OCD patients display nervous tics, implying that there is a link with the anatomy of the nervous system

What causes abnormal brain functions? Answer may lie in the diathesis-stress model which links the biological basis with the findings that the OCD occurs after a stressful event .

The cognitive explanation of ocd starts fro the explanation that everyone has an undesirable thought sometimes that they would not like to admit to others. For example, most of us have at one time worried about touching something that could have germs on it or forgetting to pull out all the plugs at bed time might start a fire. Cognitive psychologists have argued people who suffer from OCD suffer from the following characteristics:

  • They have very high moral standards and standards of conduct

  • They believe their thoughts are just like performing the actual behaviour – and so worry their thoughts can be harmful to others.

  • They believe they should have total control over their thoughts and behaviours.

OCD’s are the result of faulty and irrational ways of thinking at an extreme level. It has been suggested that specific environmental stimuli are paired at some point with an anxiety-provoking thought and then this equals the conditioned response i.e. if I don’t clean, I’ll get AIDS. Thus the person will avoid the possible threat by undertaking the compulsive behaviour.

This triggers the obsessional thoughts BUT the compulsive rituals try to counter-balance and neutralise them. Rachman & Hodges (1987) – Argue that some people are more susceptible to obsessional thoughts due to vulnerability factors e.g. genetically determined hyper-arousability, depressed mood or poor socialisation experience (as above).
Lack of evidence supporting the view that OCD’s are a result of poor socialisation experiences.
Sher et al (1983) – Patients who scored highly on a measure of compulsive behaviour also showed a memory deficit for actions recently performed.
Davison & Neale (1994) – Suggest that OCD patients are unable to distinguish between reality and imagination.
Neither biological (specifically medication) nor psychological therapies provide a long term solution to OCD’s. Suggests that it is a very complex disorder to understand and treat.

The Freudian explanation of ocd disorder is to do with conflict between the id, ego and superego. The conflict is said to date back to early childhood, especially the anal and phallic stages of psychosexual development.
Id, ego and superego
The id produces obsessive and disturbing thoughts which makes the superego feel guilty and bad. The ego tries to reduce these feelings by using the following defence mechanisms.
Reaction formation – Behaviour is opposite to that if the obsessive thoughts. For example, thoughts of aggression are changed to being kind and giving money to charities.
Isolation – the ego tries not to respond emotionally to the obsessive thoughts and so someone may act in a highly intellectual and aloof way
Undoing – the person behaves in ways to undo thoughts – for example hand washing will und the unacceptable dirty sexual thoughts.
Fixation in the anal stage

  • Child accepts will of parents being neat and clean → when their natural preference may be messy.

  • If preference is too strong and parents are too strict → child becomes anally fixated

  • Occurs at an unconscious level → sufferer believes there really concerned with keeping clean and tidy.

  • Psychoanalysts believe OCD is most likely to be found in people who show anal personality characteristics e.g. being excessively neat, orderly and punctual.


  • Hard to experimentally test the idea of the unconscious motivation

  • Gross (1996) – Reports that studies that examine the potty training of anal personality types (who are not as severe as OCD) find no difference from the potty training of other personality types.

Suggests that OCD is an extreme form of ‘learned avoidance’ behaviour:

The behavioural explanation uses classical conditioning to show how compulsive behaviours develop. Behaviourists claim it occurs by chance.

  • A person who has a high level of anxiety or is extremely fearful happens by chance to wash their hands or organise something into alphabetical order. This then reduces their feelings of anxiety.

  • This behaviour is then performed again when the person is anxious and after performing the same action many times when anxious and then finding that the level of anxiety is reduced, the behaviour becomes a learned response. The reduction in anxiety is positively reinforced and so the behaviour is repeated.

Compulsive behaviour or mental acts are the result of many pairings of the behaviour with the lowering of anxiety. Having learned this they will engage in the compulsion to prevent the high level of anxiety developing in the first place.

Hodson and Rachman (1972) conducted a study to show that compulsive behaviours reduced the high levels of anxiety they were experiencing. P’s with washing their hand compulsions were put in a room with objects they believed to be dirty or contaminated. P’s showed ritual hand washing behaviour and reported this reduced their anxiety. Proof that ritualistic behaviours reduces anxiety.


Positive or negative?

  • Symptoms of OCD e.g. avoidance behaviour, themselves create anxiety so it is hard to argue/believe that people learn these responses in order to reduce their anxiety.

  • Behavioural therapies are very effective → Baxter et al (1992) and Schwartz et al (1996) both found that behavioural therapies not only  reduces the symptoms but also brings about changes in biochemical activity e.g. athletes ‘psych themselves up’ before an event, to suppress self-defeating thoughts.

  • An OCD patient will use strategies to reduce the negative thoughts, but the effort they put in to trying to inhibit the thoughts ends up inducing a preoccupation with it.

  • The behavioural approach has focused on the compulsion but has not adequately been able to explain the origins of the disorder.

  • It also cannot explain why people have obsessions – not just the compulsions

Exam questions for revision
Briefly discuss a biological explanation for phobias.(4 marks)
Briefly discuss a biological treatment for phobias.(4 marks)
NB. Do the same for all the explanations/phobias….
Katy constantly worries about germs. Each time she touches a door handle she becomes extremely anxious and starts to panic. Her doctor thinks that katy is suffering from obsessive-compulsive disorder and says she needs to see a specialist With reference to Katy, explain what is meant by obsessions and compulsions. (4 marks)

  1. Define OCD (2 marks)

  2. Give at least three diagnostic criteria for OCD using the DSM IV. (3 marks)

  3. Discuss one biological explanation for OCD. (3 marks)

  4. Describe one other biological explanation for OCD different to the one mentioned in question 3. (4 marks)

  5. Give two strengths and 2 weaknesses of the biological explanations of OCD. (4 marks)

  6. How is positive reinforcement related to the development of OCD? (5 marks)

  7. Give two criticisms of the behavioural explanations of OCD. (2 marks)

  8. From a cognitive point of view, psychologists argue that people who suffer from OCD are also more likely to show what characteristics? (3 marks)

  9. Give one strength of the cognitive explanation of OCD. (2 marks)

  10. Describe from a psychoanalytical perspective how someone might develop OCD (4 marks)

Describe and discuss at least one treatment for phobias. Refer to empirical evidence in your answer. (10 marks)

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