OCD-Related Disorders: Understanding Obsessions and Compulsions

Obsessive-Compulsive Disorder

• Obsessions are intrusive and nonsensical thoughts, images, or urges that individuals try to resist or eliminate.
• Compulsions are thoughts or actions used to suppress obsessions and provide relief.
• Sensory phenomena are physical experiences that precede compulsions.
• Individuals with OCD often avoid people, places, and things that trigger OC.
• Accommodation involves the involvement of family and friends in compulsive rituals.
• Risks for OCD include perinatal events, premature birth, tobacco use during pregnancy, sexual and physical abuse, and environmental factors like infectious agents.
• Tic Disorders commonly co-occur with OCD.
• Obsessions usually do not involve real-life concerns and can include irrational or magical content.

Important Distinctions

• Obsessions and compulsions are not limited to concerns about weight and food.
• Compulsions are usually preceded by obsessions, while tics are often preceded by premonitory sensory urges.

Body Dysmorphic Disorder

• It is characterized by a preoccupation with an imagined defect in appearance.
• Individuals with BDD may have ideas or delusions of reference.
• BDD is associated with high levels of anxiety, social avoidance, depressed mood, negative affectivity, rejection sensitivity, and perfectionism.
• It is also associated with low extroversion and low self-esteem.
• Abnormalities in emotion regulation, attention, and executive function are common in BDD.
• Excessive appearance-related preoccupations and repetitive behaviors are time-consuming.
• BDD can be co-morbid with eating disorders, major depressive disorder, social anxiety, and substance-related disorders.

Hoarding Disorder

• It is characterized by difficulty discarding or parting with possessions.
• Prader-Willi Syndrome is a rare genetic disorder that can lead to hoarding.
• Excessive acquisition of items that are not needed or for which there is not available space can occur with difficulty discarding possessions.
• Common features of hoarding disorder include indecisiveness, perfectionism, avoidance, procrastination, difficulty planning, and organizing tasks.
• Animal hoarding is a related but distinct issue.

Trichotillomania

• It is characterized by the recurrent pulling out of one's hair, leading to noticeable hair loss.
• It should not be diagnosed when hair removal is performed solely for cosmetic reasons.
• Trichotillomania may be triggered by feelings of anxiety or boredom.### Trichotillomania
• Is an impulse control disorder characterized by recurrent hair pulling
• May be preceded by an increasing sense of tension or may lead to gratification, pleasure, or sense of relief when the hair is pulled out
• Hair pulling does not usually occur in the presence of other individuals, except immediate family members

Excoriation Disorder

• Characterized by skin picking
• Note delusion or tactile hallucination
• In the absence of deception, excoriation disorder can be diagnosed if there are repeated attempts to decrease or stop skin picking

Somatic Symptom Disorders

Somatic Symptom Disorder

• One or more symptoms cause distress and disruption of daily life
• Chronic, influenced by the number of symptoms, age, level of impairment, and any comorbidity
• Cognitive features include attention focused on somatic symptoms, attribution of normal bodily sensations to physical illness, worry about illness, and anxiety about illness

Illness Anxiety Disorder

• Preoccupation with having or acquiring serious illness (≥6 months)
• Usually minimal to no symptoms, mild intensity
• Interpret ambiguous stimuli as threatening
• Develop in the context of a stressful life

Conversion Disorder

• Altered voluntary motor or sensory function
• Incompatibility between the symptom and recognized neurological or medical conditions
• Unexpected neurological disease cause for the symptoms is rarely found at follow-up
• Too much use of denial

Psychological Factors Affecting Other Medical Conditions

• Medical symptom is present
• Psychological or behavioral factors affect medical condition
• Psychological or behavioral factors are judged to affect the course of medical condition

Factitious Disorder

• Imposed on self: Individual presents himself or herself as ill
• Imposed on another: Presents another individual as ill
• Absence of obvious rewards
• Malingering: False medical symptoms or exaggerating existing symptoms in hopes of being rewarded

Dissociative Disorders

Depersonalization-Derealization Disorder

• Depersonalization: Your perception alters so that you temporarily lose the sense of your own reality, as if you are in a dream watching yourself
• Derealization: Your sense of external world is lost; things may seem to change shape or size, people may seem dead or mechanical
• Characterized by the presence of constellation of typical depersonalization/derealization symptoms and the absence of manifestations of illness anxiety disorder

Dissociative Amnesia

• Inability to recall important autobiographical information, usually of traumatic or stressful nature, that is inconsistent with ordinary forgetting
• Usually localized or selective amnesia for specific events, then generalized, if entire life history
• Dissociative Fugue: Memory loss revolves around specific incident, an unexpected trip; individuals just take off and later find themselves in a new place, unable to remember why or how you got there

Dissociative Identity Disorder

• Disruption of identity characterized by two or more distinct personality states
• Host personality: The person who becomes the patient and asks for treatment; developed later

Sleep Disorders

Recurrent Episodes of Irrepressible Need to Sleep

• Lapsing into sleep, or napping with cataplexy
• Hypocretin deficiency, and evidence from polysomnography showing REM sleep latency less than or equal to 15 mins
• 3x/week, for at least 3 months

Obstructive Sleep Apnea Hypopnea

• At least 4 obstructive apneas or hypopneas per hour of sleep or evidence from polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep
• Apnea: absence of airflow
• Hypopnea: reduction in airflow

Central Sleep Apnea

• Evidence by polysomnography of 5 or more central apneas per hour of sleep
• Cheyne-Stokes Breathing: an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea

Sleep-Related Hypoventilation

• Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels

Circadian Rhythm Sleep-Wake Disorders

• Persistent or recurrent pattern of sleep disruption due to alteration of the circadian system or misalignment between the endogenous circadian rhythm
• Leads to excessive sleepiness or insomnia, or both

Non-REM Sleep Arousal Disorders

• Incomplete awakening from sleep: sleepwalking or sleep terrors
• Cannot remember anything when they woke up
• Occur mostly in childhood and non-rem sleeps
• Produce rapid and complete awakening without confusion, amnesia, or motor activity

Nightmare Disorder

• Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity
• Upon awakening, they become oriented and alert
• Appear in children exposed to acute or chronic psychosocial stressors
• Occur during REM Sleep

REM Sleep Behavior Disorder

• Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors
• During REM sleep
• Upon awakening, the individual is completely awake, alert, and not confused### Depressive Disorders
• "Other specified depressive disorder" or "unspecified depressive disorder" diagnosis is given when symptoms do not meet the full criteria for a depressive disorder
• A separate diagnosis of PDD is not made if symptoms occur only during the course of a psychotic disorder
• Double Depression: suffering from both MDE and PDD with fewer symptoms

Premenstrual Dysphoric Disorder

• At least 5 symptoms must be present in the majority of menstrual cycles
• Delusions and hallucinations have been described in the late luteal phase of the menstrual cycle but are rare

Seasonal Affective Disorder

• Episodes must have occurred for at least 2 years with no evidence of non-seasonal MDE during that period
• Also known as "Cabin fever"

Grief

• Integrated Grief: acute grief, acknowledging the finality of death and its consequences, and adjusting to the loss
• Complicated Grief: a reaction that can develop without a pre-existing depressed state

Dissociative Identity Disorder (DID)

• Switch: transitioning from one personality to another
• Extreme subtype of PTSD
• Hypnotic Trance: focused on one aspect of their world, becoming vulnerable to suggestions by the hypnotist
• Often presents with comorbid depression, anxiety, substance abuse, self-injury, or other common symptoms
• Early life trauma is a risk factor
• Implicated brain regions: orbitofrontal cortex, hippocampus, parahippocampal gyrus, and amygdala
• Does not have a classic bipolar sleep disturbance
• Individuals with DID have the highest hypnotic capacity among all clinical groups

Sexual Disorders

• Female Sexual Interest/Arousal Disorder: absent or reduced interest in sexual activity, associated with problems in experiencing orgasm, pain during sexual activity, infrequent sexual activity, and couple-level discrepancies in desire
• Genito-Pelvic Pain/Penetration Disorder: difficulties in vaginal penetration, vaginal pain during intercourse or penetration attempts, and anxiety about anticipating vulvovaginal or pelvic pain
• Male Hypoactive Sexual Disorder: persistently deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity
• Premature (Early) Ejaculation: ejaculation approximately 1 minute following vaginal penetration or even before the individual wishes it, with a sense of lack of control over ejaculation and apprehension about anticipated inability to delay ejaculation
• Voyeuristic Disorder: intense arousal from observing an unsuspecting naked person, nonconsensual, and often associated with childhood sexual abuse, substance misuse, and sexual preoccupation/hypersexuality
• Exhibitionistic Disorder: intense arousal from exposing genitals to an unsuspecting person, nonconsensual
• Frotteuristic Disorder: intense arousal from touching or rubbing genitals against a nonconsenting person
• Sexual Masochism: intense sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer
• Sexual Sadism: intense sexual arousal from the physical suffering of another person

Substance-Related and Addictive Disorders

• Substance: a chemical compound ingested to alter mood or behavior
• Psychoactive substances: alter mood, behavior, or both
• Substance Use: ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning
• Substance Intoxication: physiological reaction to ingested substances
• Substance Use Disorders: problematic use of substances
• Physiological Dependence: tolerance and withdrawal

Alcohol

• Produced through fermentation of yeast, sugar, and water
• Depressant: reduces inhibitions, induces relaxation, and impairs brain function
• Withdrawal Delirium (Delirium Tremens): a condition that can produce frightening hallucinations and body tremors
• Breathalyzer: measures levels of intoxication
• GABA: particularly sensitive to alcohol
• Glutamate system: involved in alcohol's effects on cognitive abilities
• Two types of organic brain syndromes can result from long-term alcohol use: Dementia and Wernicke-Korsakoff Syndrome
• Fetal Alcohol Syndrome: a condition caused by maternal alcohol use during pregnancy
• Alcohol Dehydrogenase: metabolizes alcohol
• Korsakoff syndrome: a chronic memory disorder caused by a severe deficiency of thiamine (vitamin B-1)

Four-Stage Model for the progression of Alcoholism

• Pre-Alcoholic Stage: drinking occasionally with few serious consequences
• Prodromal Stage: drinking heavily but with few outward signs of a problem
• Crucial Stage: loss of control, with occasional binges
• Chronic Stage: primary daily activities involve getting and drinking alcohol

Other Substances

• Caffeine: a gentle stimulant found in tea, coffee, soda, and cocoa products
• Cannabis (Marijuana): reactions include mood swings or even dream-like experiences, with chronic and heavy users reporting tolerance
• Hallucinogens: most commonly "LSD", produced synthetically in the laboratory
• Phencyclidine (PCP): causes impulsivity and aggressiveness
• Inhalant: solvents, aerosol sprays, gases, and nitrites, often found at home or workplace
• Opioid: natural chemicals in the opium poppy that have a narcotic effect, including natural opiates, synthetic variations, and comparable substances that occur naturally in the brain
• Sedative, Hypnotic, or Anxiolytic: calming, sleep-inducing, and anxiety-reducing substances, including barbiturates and benzodiazepines