Theoretical Approaches to Obsessive-Compulsive Disorder

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ISBN: 9780521027397 | 052102739X
Cover: Paperback
Copyright: 11/2/2006

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Obsessive-compulsive disorder is currently the subject of considerable research, since recent epidemiological studies have suggested that the condition is more prevalent than was originally believed. This book offers a critical discussion of the most important theories that have been put forward to explain this disorder. The book includes behavioural/learning accounts (and cognitive-behavioural supplements of these), based on Pavlovian personality theories (such as those by Eysenck, Gray and Claridge), Pierre Janet's account, cybernetic approaches, psychodynamic approaches, Reed's 'cognitive-structural' account, and biological approaches. Therapeutic approaches to the disorder are also considered, insofar as they are relevant to these theories. This book is unique in both the comprehensiveness and the depth of its coverage of theories of OCD. It also offers an entirely new approach to the definition of the disorder.

Synopsis of Theoretical approaches to obsessive-compulsive disorder

Acknowledgments, and provenance of Theoretical approaches to obsessive-compulsive disorder

xxiii

The natural history and definition of obsessive-compulsive disorder

(27)

Introduction and natural history

(2)

OCD: existing suggestions for the diagnostic criteria

(9)

Introduction

(1)

The major authorities

(1)

Lewis on the definition of OCD

(1)

The DSM-III-R criteria: the separate definitions of obsession and compulsion

(1)

The ordinary uses of obsession and compulsion

(1)

Evaluation of the standard defining criteria

(1)

The DSM criteria: stipulation versus description

(1)

Obsessions

(1)

Compulsions

(1)

Implications of these criticisms

(2)

A different approach to the definition of OCD

(6)

Introduction: the approach to be adopted

(1)

No unitary criteria for OCD

(1)

The limits of the present account of the definition of OCD

(1)

The distinction between phobias and OCD

(1)

Introduction

(1)

Characteristic (i): symptoms that concern the exercise of one's own will

(1)

Characteristic (ii): ``covert object'' of fear or discomfort

(1)

Characteristic (iii): superstitious and bizarre thinking

(1)

Characteristic (iv): repetitive behaviour

(1)

Characteristic (v): arrangement of objects

(1)

The independence of characteristics (i)-(v)

(1)

Connecting themes between characteristics (i)--(v)

(3)

The criterion of senselessness

(1)

The distinction between obsessional and psychotic thinking

(1)

A content-based distinction between obsessions and partial delusions/delusions?

(1)

Ego boundaries

(2)

Summary and discussion

(2)

Behavioural/learning accounts of OCD

(18)

An outline of the model

(1)

Preparedness and incubation

(2)

The anxiety reduction hypothesis

(1)

Behaviour therapy

(1)

The repetitiveness of some compulsive behaviour

(1)

Obsessions that are not provoked by environmental cues

(3)

Emotional processing

(2)

The cognitive-behavioural account of OCD

(6)

The distress experienced by OCD patients

(3)

The genesis of OCD

(1)

Summary

(2)

Accounts of OCD based upon personality theories derived from the work of Pavlov

(15)

Introduction

(1)

Eysenck's account, and suggested modifications of it

(1)

OCD and neurotic introversion

(1)

Preparedness and innate fear

(1)

Evolutionary accounts and OCD

(4)

Gray on OCD

(4)

The Behavioural Inhibition System: an outline of Gray's account

(1)

OCD, anxiety and anxiolytic treatments

(1)

BIS hyperactivity and checking behaviour

(1)

The BIS and Gray's dimensional approach

(1)

Claridge on OCD

(3)

Anxiety in animals and man: Claridge's views on Gray

(1)

OCD: Claridge's account

(2)

Summary

(2)

Janet on OCD

(22)

Introduction

(1)

Janet on the clinical stages of psychasthenic illness

(1)

Commentary on the clinical stages of psychasthenic illness

(1)

The psychasthenic state and compulsive personality disorder

(1)

Psychasthenia, OCD and other neurotic disorders

(1)

Psychasthenia, OCD and anxiety

(1)

Janet on the hierarchy of psychological phenomena, and psychological tension

(1)

Commentary on the hierarchy of psychological phenomena, and psychological tension

(6)

Psychological tension

(1)

The reality function

(1)

Psychasthenic illness and Janet's hierarchy

(1)

Displacement activity

(2)

Conflict and OCD

(1)

The physiological basis of displacement

(1)

Janet on diagnostic and treatment issues

(1)

Commentary on diagnostic and treatment issues

(4)

Hysterical and psychasthenic illness

(1)

Empirical evidence relevant to Janet's position

(1)

Janet and behaviour therapy

(3)

Summary of comments of Janet

(1)

Pitman's cybernetic model of OCD

(7)

The principle of a control system

(1)

Pitman's general remarks regarding the cybernetic model

(1)

The three accounts presented by Pitman

(1)

The faulty internal comparator account

(1)

The attentional disturbance account

(1)

The conflict/displacement account

(2)

Summary of Pitman's cybernetic model

(1)

Psychodynamic approaches to OCD

(19)

Introduction

(1)

Some psychodynamic theories of OCD

(2)

Malan on psychodynamic theory and therapy

(2)

Psychodynamic explanations and the ``act of insight''

(1)

Evidence relevant to psychodynamic formulations

(1)

The two triangles

(1)

The case of the pesticide chemist

(2)

Malan's account of the pesticide chemist

(1)

The triangle of conflict for the pesticide chemist

(1)

The triangle of person for the pesticide chemist

(1)

Evaluation of the psychodynamic aspects of this case discussion

(5)

Introduction

(1)

The ``unconscious''

(1)

Symbolisation

(2)

The patient's purposes

(1)

Insight

(1)

The role of childhood experience

(3)

The elimination of body products

(2)

Summary and discussion

100

(2)

Cognitive style/deficit approaches to OCD

102

(34)

Reed's account

102

(7)

Reed's hypothesis of the central problem

102

(2)

Reed's first controversial empirical claim

104

(1)

Reed's second controversial empirical claim

105

(1)

Reed on therapeutic approaches

106

(1)

The redintegration hypothesis

106

(3)

Objections to the redintegration hypothesis

109

(1)

A motivational problem for Reed's account

110

(3)

A revision of Reed's account

113

(2)

Objections to the Revised Thesis

115

(3)

Further objections to Reed's account

118

(4)

Obsessional problems not involving doubts, indecision or ritualising

118

(1)

Obsessional problems that do involve doubts and indecision

119

(3)

Comments on Reed's remarks regarding therapeutic approaches

122

(1)

Further comments on Reed's account, and the supporting evidence cited by Reed

123

(6)

The nature of Reed's causal claim

123

(1)

An explanation of the hypothesised thinking style of obsessionals?

124

(1)

Reed's laboratory tasks

124

(5)

Evidence for Reed's account based on clinical observations

129

(1)

Reed's account and the definition of the obsessional personality and personality disorder

129

(1)

The experience of compulsion

130

(2)

The role of anxiety

132

(1)

The obsessional personality/personality disorder, OCD and nonobsessional symptoms

132

(1)

External structuring

133

(1)

Reed's account of Janet

133

(1)

Summary

134

(2)

Biological approaches to OCD

136

(15)

Introduction

136

(1)

The work of Rapoport and Wise, and Insel

136

(2)

Further evidence of relevance to the work of Rapoport and Wise, and to the work of Insel

138

(1)

Gilles de la Tourette syndrome and OCD

139

(2)

The work of Pitman

141

(1)

Psychological accounts offered by biological approaches

141

(5)

A causal role in OCD for the basal ganglia and the other brain structures discussed by biological approaches

146

(4)

Summary

150

(1)

Concluding remarks

151

(15)

Introduction

151

(3)

Progress in scientific research

154

(2)

OCD and assertiveness

156

(1)

Alternative bases for the prediction that assertion training may help some OCD patients

157

(5)

Introduction

157

(1)

Boyd and Levis's work

157

(2)

Another exposure-based account?

159

(1)

Assertive behaviour as reciprocal inhibition

159

(1)

Assertive behaviour and perceived self-efficacy

160

(1)

Conclusion

161

(1)

Evidence that confirms the prediction that assertiveness training may help some OCD patients

162

(2)

Further points and questions raised by Emmelkamp and van der Heyden's study

164

(1)

Final comment

165

(1)

References

166

(9)

Author index

175

(6)

Subject index

181

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Theoretical Approaches to Obsessive-Compulsive Disorder

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Theoretical Approaches to Obsessive-Compulsive Disorder

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