Obsessive-Compulsive and Related Disorders

Categories1. Obsessive Compulsive Disorder2. Body Dysmorphic Disorder3. Hoarding Disorder4. Tricholtillomania5. Excoriation Disorder6. Substance/Medication Induced OCD7. OCD due to another medical condition8. Other Specified OCD9. Unspecified OCD (example: Exceptional

Jealousy)

DefinitionsObsessions-recurrent and persistent

thoughts, urges, or images that are experienced as intrusive and unwanted.

Compulsions-repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession

Very similar to anxiety disorders!!!!

1.Obsessive Compulsive DisorderOCD occurs all over the world!!!!When does OCD become a problem?We all have normal preoccupations and rituals, but

people with OCD have excessive and persisting preoccupations. These persist beyond developmentally appropriate periods.

Specific content of obsessions and compulsions varies among individuals, but most people are preoccupied with: Cleaning (contamination)Symmetry (repeating, ordering, counting)Forbidden or taboo thoughts (aggressive, sexual, religious)Harm (fears of hurting self or others)

OCD Diagnostic Criteria1. Presence of obsessions and/or

compulsions (children who can’t act out compulsions may just talk about them)

2. The obsessions and compulsions must be time-consuming (take more than 1 hour per day), which causes impairment in social, occupational, or other areas of functioning

The symptoms can not be attributed to drug use or medication

OCD Specifiers1. With good or fair insight2. With poor insight3. With absent insight/delusional beliefs4. If Tic-Related (current or past tic

disorder, up to 30% of people with OCD have a lifetime tic disorder)

Other SymptomsAnxietyPanic attacksFeelings of disgustFeelings of things being incompleteAvoid people, places, and things that

trigger obsessions and compulsionsAvoid public placesAvoid social interactions

Prevalence and Course1.2% of the US population have OCDSlightly higher in females than in males in

adulthoodSlightly higher in males than in females in

childhoodMean age of onset is 19 years old, 25% of

cases start by ate 14 (for males, 25% start by age 10!)

If OCD is untreated, the course is chronic and only 20% will get rid of it

Risk Factors1. Tempermental-Internalize things,

negative emotionality, behavioral inhibition2. Environmental-Physical and sexual abuse

in childhood, stressful and traumatic events, exposure to infectious agents

3. Genetic and Physiological-Twin studies showed 57% for monozygotic twins, and 22% for fraternal twinsDisfunction of several brain structures,

including the frontal lobe, has been found in OCD

Differential DiagnosisOCD Looks like:Anxiety DisordersMajor Depressive DisorderEating DisordersTic DisorderPsychotic Disorders

ComorbidityOCD is sometimes comorbid with:Anxiety Disorder (76%)Depression or Bipolar (63%)OCD Personality Disorder (23%)Tic Disorder (30%)

When are you obsessive and compulsive?

We all obsess over things sometimes. What do you obsess over?

We all have compulsions that we act on as well. What compulsions do you act on?

2. Body Dysmorphic DisorderDiagnostic Criteria Include:1. Preoccupation with one or more

perceived flaws in physical appearance that are NOT observable to others

2. The individual performs repetitive behaviors (mirror checking, grooming, picking skin, seeking reassurance)

3. The preoccupation causes significant distress or impairment in social, occupation, or other important areas of functioning

4. The symptoms can not be explained by an eating disorder

Specifiers1. With muscle dysmorphia (preoccupied

with body build being too small or not muscular enough)

2. With good or fair insight3. With poor insight4. Absent insight/delusional beliefs

Other SymptomsHigh levels of anxiety and social anxietySocial avoidanceDepressed moodNeuroticismPerfectionismLow self-esteemObsessed with how they lookReceive cosmetic treatmentsPerform surgery on themselvesPerceive everyone’s responses as negative

Prevalence and Course2.5% in females, 2.2% in malesHigher among dermatology patients and

cosmetic surgery patients (about 10-16%)Higher among orthadontia patients (about

10%)Mean age of onset is 16-17 years oldMost common age is 12-13 years oldThe disorder is chronic if no treatment is

providedIndividuals diagnosed before age 18 have a

higher risk of suicide, have more comorbidity, and have a gradual onset of the disorder

Risk Factors1. Environmental-childhood neglect and

abuse2. Genetic-higher prevalence in first-degree

relatives with OCD

Consequences of BDD1. Impaired psychosocial functioning

(sometimes to the point of incapacitation)2. Quality of life decreases3. Impairment in job or school4. 20% of youth with BDD report dropping

out of school5. Psychiatric hospitalization is common

Interesting FactsBDD has been reported internationallyMales are more likely to have genital

preoccupationsFemales more likely to have a comorbid

eating disorderMuscle dysphoria occurs mostly in malesRates of suicidal ideation and attempts are

highComorbid with eating disorders, social

anxiety, and OCD

3. Hoarding DisorderPersistent difficulty parting with possessions, regardless

of their actual value...includes animal hoardingStrong perceived need to save items, and causes extreme

distress when they consider discarding themSymptoms include the accumulation of a large number of

possessions that congest and clutter active living areasMost collect, buy, or steal items that are not needed, or

for which there is no available spaceSymptoms start to emerge around 11-15 years old, but is

the diagnosis is3 times more prevalent in older adults (age 55-94)

Prevalence in Europe and North America is 2-6%50% of cause is due to genetics, according to twin studiesOften comorbid with mood or anxiety disorders

4. Trichotillomania (hair-pulling disorder)Recurrent pulling out of one’s hair, resulting in hair lossThere are repeated attempts to stop, and causes extreme

distressMost common areas are the head, eyebrows, and eyelashesMay be preceded with various emotional states, such as

anxiety or boredomThey feel gratification, pleasure, or a sense of relief when

the hair is pulled outPerson can have various degrees of consciousness when

pulling out their hairUsually do aloneMay pull hair out on other objectsOften have other body-focused repetitive behaviors, such

as nail biting

4. TrichotillomaniaFollows the onset of pubertySites of hair pulling varies over timeCourse is chromic if left untreatedEvidence for genetic vulnerabilityCan cause irreversible damageSome people eat the hair, which is harmful

5. Excoriation Disorder (skin-picking)Recurrent skin picking, resulting in skin lesionsRepeated attempts to decrease or stop skin

pickingCan become ritualistic, and individuals may

play with, examine, or swallow the skin or scabs after they have been picked

Pain is not reportedUsually do aloneCauses scarring

6. Substance/Medication Induced OCDObsessions, compulsions, skin picking, hair

pulling, or other repetitive behaviors due to substance intoxication, substance withdrawl, or medication exposure.

Most common drugs are amphetamines, cocaine, and other stimulants

This disorder is extremely rare.