Chapter 3 (OCD and Related Disorders)

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Questions and Answers

What is the lifetime prevalence rate of recurrent skin picking disorders?

3.5 percent

2.5 percent

4.5 percent

1.5 percent (correct)

Which disorder is often comorbid with excoriation (skin-picking) disorder?

Post-Traumatic Stress Disorder (PTSD)

Social Anxiety Disorder

Trichotillomania (correct)

Generalized Anxiety Disorder (GAD)

Which treatment method is central to managing OCD-related disorders?

Psychoanalysis

Electroconvulsive therapy

Medication alone

Exposure and response prevention (correct)

Which personality trait is NOT typically associated with Obsessive-Compulsive Personality Disorder (OCPD)?

Impulsiveness Signup and view all the answers

What percentage of individuals suffering from skin-picking disorder are female?

75 percent Signup and view all the answers

What new category did the DSM-5 create for obsessive-compulsive disorders?

Obsessive-compulsive and related disorders Signup and view all the answers

Which of the following is NOT included in the obsessive-compulsive and related disorders category?

Post-traumatic stress disorder Signup and view all the answers

What is a common feature of disorders classified under obsessive-compulsive and related disorders?

Repetitive thoughts or behaviors Signup and view all the answers

Who has argued against the validity of the obsessive-compulsive and related disorders category?

Abramowitz & Jacoby Signup and view all the answers

Which of the following disorders involves skin picking?

Excoriation - Skin picking disorder Signup and view all the answers

What is the typical average improvement rate for patients undergoing effective treatment?

50% to 70% Signup and view all the answers

What percentage of patients is estimated to achieve clinically significant improvement after completing ERP?

80% Signup and view all the answers

Which of the following is a primary aim of cognitive therapy for patients with OCD?

To reduce obsessional fear and compulsive behavior Signup and view all the answers

Which cognitive therapy technique involves presenting educational material?

Didactic presentation Signup and view all the answers

What proportion of patients undergoing ERP do not respond to treatment?

20% Signup and view all the answers

What is a common dropout rate for patients in ERP therapy?

25% to 30% Signup and view all the answers

How does cognitive therapy help patients with dysfunctional thinking patterns?

By correcting and restructuring those thoughts Signup and view all the answers

What is a key concept in cognitive therapy regarding obsessional thoughts?

They are normal experiences and not harmful. Signup and view all the answers

Which of the following is a treatment approach for Body Dysmorphic Disorder?

Exposure and response prevention Signup and view all the answers

What medication class is mentioned as providing relief for Body Dysmorphic Disorder?

SSRIs Signup and view all the answers

What distinguishes Hoarding Disorder from other OCD-related disorders?

It typically involves positive or neutral thoughts about possessions. Signup and view all the answers

What is one common misconception about plastic surgery in the treatment of Body Dysmorphic Disorder?

It may be unhelpful and can backfire. Signup and view all the answers

Which statement accurately represents Hoarding Disorder?

It involves persistent difficulty in discarding possessions. Signup and view all the answers

What is a notable characteristic of thoughts associated with Hoarding Disorder?

They are often enjoyable or neutral. Signup and view all the answers

In what way is Body Dysmorphic Disorder similar to anorexia nervosa?

Both share similarities with obsessive-compulsive disorder. Signup and view all the answers

What insight can be specified in relation to Hoarding Disorder?

The individual's awareness of their hoarding behavior. Signup and view all the answers

What is the primary goal of the response prevention component in Exposure and Response Prevention (ERP)?

To help prolong exposure and facilitate extinction of anxiety Signup and view all the answers

How does anxiety naturally reduce over time according to the components of ERP?

Primarily through habituation or cognitive change Signup and view all the answers

What characterizes the delivery structure of ERP treatment sessions?

Daily sessions of 90 minutes each for a few weeks Signup and view all the answers

What type of situations are exposure exercises in ERP generally based on?

Moderately distressing to the most distressing in a specific order Signup and view all the answers

What outcome has research shown for patients who complete ERP for OCD?

Clinically significant and durable improvement Signup and view all the answers

What is an essential aspect of the assessment phase in ERP?

Determining the patient's avoidance strategies Signup and view all the answers

What might be a hindering factor when implementing exposure exercises?

Prolonged engagement in avoidance behaviors Signup and view all the answers

Why might some practitioners choose a hierarchy-driven progression for exposure exercises?

Gradually building up distress helps in managing anxiety Signup and view all the answers

What are obsessions primarily characterized by?

Intrusive and unwarranted thoughts that cause anxiety Signup and view all the answers

Which of the following defines compulsions?

Repetitive behaviors aimed at reducing anxiety but are excessive Signup and view all the answers

What is a key feature of both obsessions and compulsions in OCD?

They can consume significant time or lead to functional impairment Signup and view all the answers

How are compulsive behaviors characterized in relation to time?

They often require more than 1 hour per day Signup and view all the answers

What is NOT an example of a compulsion?

Avoiding situations that cause anxiety Signup and view all the answers

Which statement accurately reflects the nature of OCD symptoms?

Compulsions are often excessive and not realistically connected to fears. Signup and view all the answers

What is the emotional impact of obsessions in individuals with OCD?

The thoughts usually cause marked anxiety or distress. Signup and view all the answers

What distinguishes compulsions from other behaviors?

They are performed in response to an obsession and not necessarily logical. Signup and view all the answers

Study Notes

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Chapter 3: Obsessive-Compulsive Disorders

DSM-5 moved OCD from anxiety disorders to obsessive-compulsive and related disorders (OCRDs).
OCD related disorders include:
- Body dysmorphic disorder (BDD)
- Hoarding disorder
- Trichotillomania (TTM) - hair pulling disorder
- Excoriation (skin picking) disorder (SPD)
All disorders in this group involve repetitive thoughts or behaviors.

DSM-IV-TR anxiety disorders divided into three DSM-5 chapters:
- anxiety disorders
- obsessive-compulsive and related disorders
- trauma-and stressor-related disorders
Agoraphobia changed from a subtype of panic disorder to its own diagnosis.

Many researchers disagree with grouping OCD with other disorders
Tolin and Springer (2018) suggest three groups of disorders:
- Compulsive: OCD and BDD
- Impulsive: TTM and SPD
- Hoarding: largely unique

Learning Objectives

Describe the nature and diagnostic criteria for OCD.
Describe the epidemiology and aetiology of OCD.
Describe contemporary treatment approaches to OCD.
Describe the nature and diagnostic criteria for hoarding disorder, body dysmorphic disorder, trichotillomania, and excoriation disorder.

Obsessive-Compulsive Disorder (OCD)

Diagnostic criteria: obsessions and compulsions.
- Obsessions: intrusive, unwanted thoughts, urges, or images.
- Compulsions: repetitive behaviors or mental acts performed in response to obsessions.
- Causes marked interference with functioning.
DSM-5 diagnostic criteria for OCD (Presence of obsessions, compulsions, or both):
- Recurrent and persistent thoughts, urges, or images experienced as intrusive and unwarranted, causing anxiety or distress.
- Attempts to ignore or suppress thoughts or neutralize them with compulsions.
Compulsions are time-consuming and cause clinically significant distress or impairment.
Symptoms aren’t caused by substances or other medical conditions.
Specify level of insight (good, fair, poor, absent insight/delusional beliefs).
Content of obsessive thoughts: doubting, contamination, non-sensical, aggressive, religious, accidental harm to others, horrific images.
Types of compulsions: counting, checking, washing, hoarding, internal repetition, adhering to rules.

Interpersonal Aspects of OCD

Frequently has negative effects on relationships.
Dysfunctional relationships can maintain OCD cycles (symptom accommodation).
Friend or relative facilitating avoidance behavior, or assuming responsibilities for the sufferers rituals, problems etc.
Avoidance and compulsive rituals prevent extinction of obsessional fear.
Family accommodation predicts an attenuated response to CBT.
Relationship stress, conflict, and aspects like poor problem solving, etc., can contribute to OCD.
Criticism, hostility, and emotional overinvolvement are related to premature treatment discontinuation and symptom relapse.

Epidemiology of OCD

General consensus is that OCD is a relatively common disorder (2-3% lifetime prevalence).
Onset is typically between age 10 and early adulthood, with early onset more common in men, and cleaning compulsions common in women.
Associated with impairment.

OCD: Aetiology

Neuropsychological Model:
- Inhibition pathways in brain to stop behavioral macros fail.
- Brain functioning differences, not causes.
Serotonin Hypothesis:
- Abnormalities in serotonin neurotransmitter system and sensitivity of postsynaptic serotonergic receptors.
- SSRIs (selective serotonin reuptake inhibitors) are more effective than other medications.
Cognitive Deficit Models:
- Memory functioning abnormally.
- Reality monitoring problems.

Behavioral/Learning Models

Classical conditioning (neutral stimulus paired with an aversive stimulus, creating a fear response)
Operant conditioning (avoidance responses negatively reinforced by reducing anxiety)

Cognitive Factors

Intrusive thoughts are relatively universal.
Attempts to suppress intrusive thoughts can worsen the problem.
Dysfunctional assumptions (e.g., thoughts are equivalent to actions, failure to prevent harm is the same as causing it, needing control over thoughts).

Treatment of OCD

Cognitive-behavioral therapy (CBT) is the treatment of choice.
Exposure and response prevention (ERP) involves confronting feared situations, but not performing compulsive behaviors.
Cognitive therapy challenges dysfunctional beliefs and reduces anxiety/fear.
Medication (e.g., SSRIs) is helpful for some, but less effective than CBT.

Body dysmorphic disorder (BDD):
- Preoccupation with perceived physical flaws.
- Repetitive behaviours (mirror checking, excessive grooming)
Hoarding disorder:
- Difficulty discarding possessions.
- High distress associated with removing items.
Trichotillomania (TTM):
- Recurrent hair pulling, resulting in hair loss.
Excoriation (skin-picking) disorder (SPD):
- Recurrent skin picking resulting in skin lesions.
Treatment for related disorders similar to OCD (CBT effective; medications helpful for some).

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