Understanding Obsessive-Compulsive Disorder
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Questions and Answers

Compulsions are always effectively connected in a realistic way to the events they are meant to prevent.

False

Obsessive-compulsive symptoms can contribute to significant distress or impairment in social and occupational functioning.

True

Individuals with good insight recognize that their obsessive-compulsive beliefs are probably true.

False

Tic disorders can be unrelated to the symptoms of obsessive-compulsive disorder.

<p>False</p> Signup and view all the answers

Young children may struggle to explain the purpose of their compulsive behaviors.

<p>True</p> Signup and view all the answers

Obsessions and compulsions are always caused by the physiological effects of medications.

<p>False</p> Signup and view all the answers

Mental acts like counting can be considered compulsions.

<p>True</p> Signup and view all the answers

Clinically significant distress from OCD symptoms typically lasts less than one hour per day.

<p>False</p> Signup and view all the answers

Up to 30% of individuals with OCD also have a lifetime tic disorder.

<p>True</p> Signup and view all the answers

The mean age at onset of OCD in the United States is 25 years.

<p>False</p> Signup and view all the answers

Compulsions in children are more challenging to diagnose than obsessions.

<p>False</p> Signup and view all the answers

In Freud's view, OCD is linked to unresolved conflicts from childhood experiences.

<p>True</p> Signup and view all the answers

A disturbed mother-child relationship is a psychosocial factor linked to OCD.

<p>True</p> Signup and view all the answers

The presence of identical twins shows no relationship to the biological factors of OCD.

<p>False</p> Signup and view all the answers

Acceptance Commitment Therapy is one of the treatment methods for OCD.

<p>True</p> Signup and view all the answers

Dysfunctional beliefs are considered a secondary cause of OCD according to Cognitive Theory.

<p>False</p> Signup and view all the answers

70% of patients with Body Dysmorphic Disorder (BDD) are satisfied with the results of their cosmetic surgeries.

<p>False</p> Signup and view all the answers

The average onset age for sub-clinical BDD is around 12.9 years.

<p>True</p> Signup and view all the answers

The prevalence of BDD in psychiatric outpatients ranges from 10-12%.

<p>False</p> Signup and view all the answers

Major depression has a lifetime prevalence of 75-80% among individuals with BDD.

<p>True</p> Signup and view all the answers

Hoarding disorder involves acquiring items that have great utility and high value.

<p>False</p> Signup and view all the answers

External critique of appearance is reported as a self-reported origin of BDD.

<p>True</p> Signup and view all the answers

Cognitive Behavioral Therapy (CBT) for BDD primarily focuses on the client's objective evaluation of their features.

<p>False</p> Signup and view all the answers

The male-to-female ratio of BDD is approximately 1:1.

<p>True</p> Signup and view all the answers

Compulsive hoarding usually begins in adulthood, around age 30.

<p>False</p> Signup and view all the answers

Men are believed to hoard more often than women.

<p>True</p> Signup and view all the answers

Collectors and hoarders share the same relationship with their items.

<p>False</p> Signup and view all the answers

The primary symptom of excoriation disorder is an impulsive urge to eat.

<p>False</p> Signup and view all the answers

The face is the most commonly affected area in skin picking disorders.

<p>True</p> Signup and view all the answers

Excoriation disorder is classified as a disorder of impulse control.

<p>True</p> Signup and view all the answers

Excoriation disorder has been recognized for centuries, but its formal description was published in the 20th century.

<p>False</p> Signup and view all the answers

People with excoriation disorder often use tools such as needles or tweezers to pick at their skin.

<p>True</p> Signup and view all the answers

Skin-picking behaviors can lead to significant distress or impairment in various aspects of life.

<p>True</p> Signup and view all the answers

Skin-picking disorder is solely associated with obsessive-compulsive disorder.

<p>False</p> Signup and view all the answers

The prevalence of skin-picking disorder in the population is estimated to be between 1.4 and 5.4 percent.

<p>True</p> Signup and view all the answers

All individuals with skin-picking disorder have made repeated efforts to increase the frequency of their behavior.

<p>False</p> Signup and view all the answers

Skin-picking behaviors are often triggered by anxiety or depression.

<p>True</p> Signup and view all the answers

The onset of dermatillomania typically occurs after age 45.

<p>False</p> Signup and view all the answers

Maladaptive coping mechanisms are not suggested as a cause of dermatillomania.

<p>False</p> Signup and view all the answers

Skin-picking disorder has been compared to substance abuse in terms of its psychological implications.

<p>True</p> Signup and view all the answers

Dopamine antagonists can reduce skin-picking behavior.

<p>True</p> Signup and view all the answers

Trichotillomania is a behavioral disorder that only affects males.

<p>False</p> Signup and view all the answers

Habit reversal training is used to increase the frequency of hair pulling in trichotillomania treatment.

<p>False</p> Signup and view all the answers

The onset of trichotillomania typically occurs in early adolescence.

<p>True</p> Signup and view all the answers

Trichotillomania affects up to 4% of the population.

<p>True</p> Signup and view all the answers

Patients with trichotillomania experience tension before pulling their hair.

<p>True</p> Signup and view all the answers

Doxepin and clomipramine are examples of SSRI antidepressants recommended for trichotillomania treatment.

<p>False</p> Signup and view all the answers

Individuals with trichotillomania have a poor self-image and often feel depressed or anxious.

<p>True</p> Signup and view all the answers

Study Notes

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania (hair pulling disorder)
  • Excoriation disorder (skin picking)
  • Substance/medication-induced OCD and related disorders
  • Obsessive-compulsive disorder due to medical condition
  • Other specified obsessive-compulsive disorder
  • Unspecified obsessive-compulsive disorder

What is OCD?

  • OCD is characterized by obsessions and/or compulsions.
  • Obsessions are recurrent, intrusive, unwanted thoughts, urges, or images that cause distress. They cannot be settled by logic or reasoning.
  • Typical obsessions involve contamination, harm, symmetry or exactness, or forbidden sexual or religious thoughts.
  • Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  • Common compulsions include cleaning, repeating, checking, ordering, and arranging. Mental compulsions also exist.
  • OCD is a chronic and long-lasting disorder where uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) create significant distress or impairment in social, occupational, and other areas of functioning.
  • Most individuals with OCD experience symptoms for more than 1 hour per day.

Myth Busting OCD

  • Repetitive behaviors or ritualistic behaviors are not synonymous with OCD.
  • Excessive hand washing is not the only symptom of OCD.
  • Individuals with OCD do understand that they're acting irrationally.

What is Obsession?

  • Obsessions are recurrent and persistent thoughts, urges, or images. Individuals experience them as intrusive. They are unwanted.
  • Such thoughts, impulses, or images cause distressing emotions, such as anxiety or disgust.
  • These intrusive thoughts cannot be settled using logic or reasoning.
  • Common obsessions include excessive concerns about contamination or harm, symmetry, or exactness, or forbidden sexual or religious thoughts.

What are Compulsions?

  • Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession.
  • They occur according to rigidly applied rules.
  • Although compulsions can bring temporary relief from the worry, the obsession continues and triggers the cycle to repeat itself.
  • Common compulsions include cleaning, repeating, checking, ordering, and arranging.

Obsessive-Compulsive Disorder (DSM-5 Diagnostic Criteria)

  • A. Presence of obsessions, compulsions, or both:

      1. Recurrent and persistent thoughts, urges, or images that are experienced at some point in the disturbance as intrusive and unwanted, and cause significant anxiety or distress in most individuals.
      1. The individual attempts to ignore, suppress, or neutralize these thoughts/urges/images. They may do this by engaging in another thought or action (i.e., a compulsion).

  • B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour a day) causing significant distress or impairment in social, occupational, or other important areas of functioning.

  • C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries as in generalized anxiety disorder; preoccupation with appearance as in body dysmorphic disorder; difficulty discarding or parting with possessions as in hoarding disorder; hair pulling as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder;

Specifying Insight

  • With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true, or that they may or may not be true.
  • With poor insight: The individual thinks that obsessive-compulsive disorder beliefs are probably true.
  • With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
  • Tic-related: The individual has a current or past history of a tic disorder.

OCD: Dysfunctional Beliefs

  • Many individuals with obsessive-compulsive disorder (OCD) have dysfunctional beliefs.
  • These beliefs can include an inflated sense of responsibility, perfectionism (and intolerance of uncertainty), and over-importance of thoughts (e.g., believing that having a forbidden thought is as bad as acting on it) and an apparent need to control thoughts.

OCD: Development and Course

  • In the United States, the mean age at onset of OCD is 19.5 years. There is a 25% chance it starts before age 14. Onset after age 35 is uncommon. Males have an earlier age at onset (nearly 25% before age 10) than females. Onset is typically gradual, although acute onset is reported.

Compulsions are Diagnosed in Children More Easily

  • Children's compulsions are observable, unlike obsessions.
  • Still, most children have both obsessions and compulsions (like adults).

OCD Cycle

  • Obsessions lead to anxiety.
  • Compulsions are enacted to alleviate this anxiety—temporarily.
  • The relief from the compulsive behavior triggers a repeat of the cycle.

Etiological Factors (Theoretical Perspectives)

  • Psychoanalytic Theory: Unacceptable wishes and impulses from the id are partially repressed. OCD is a manifestation of unresolved conflicts—often linked to childhood experiences and repressed emotions. OCD reflects a struggle between the ego and superego. Superego imposes strict moral standards.
  • Psychosocial Factors: Include a disturbed mother-child relationship, fear of abandonment, recent object loss, emotional neglect, and childhood abuse.
  • Cognitive Theory: Dysfunctional beliefs are the cause of OCD. The strength with which beliefs are held determines the risk of developing OCD.
  • Biological Factors:
    • First-degree relatives.
    • Identical twins.
    • Neurotransmitters (serotonin, dopamine, glutamate) imbalance.
    • Neuroanatomical factors (abnormal brain structure and activity).
    • Orbitofrontal cortex, Caudate nucleus, Cingulate gyrus are brain areas involved.

OCD Treatment

  • Cognitive-behavioral therapy (CBT): Averages 12–20 sessions focused on exposure and response prevention, which is a first-line treatment for obsessive-compulsive disorder.
  • Medication: First-line medicinal agents for obsessive-compulsive disorder include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake Inhibitors (SNRIs).

Types of OCD, Examples

  • Contamination
  • Perfectionism
  • Checking
  • Harm
  • Superstitious
  • Religious or Moral
  • Sexual Orientation
  • Relationships

Body Dysmorphic Disorder (BDD) (DSM-5 Diagnostic Criteria)

  • A. Preoccupation with one or more perceived defects or flaws in physical appearance. These are not observable or appear slight to others.
  • B. At some point during the course of the disorder, repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing appearance to others, excessive grooming, skin picking) are performed in response to the appearance concerns that trigger the preoccupation.
  • C. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
  • Possible Specifications:
    • With muscle dysmorphia: Individual preoccupied with a belief that body build is too small or inadequately muscular.
    • Indicate degree of insight regarding bodily dysmorphic disorder beliefs (e.g., "I look ugly" or "I look deformed"):
      • Good or fair insight: Individual recognizes that beliefs are probably not true or may or may not be true.
      • Poor insight: Individual thinks beliefs are probably true.
      • Absent insight/delusional beliefs: Individual is completely convinced that beliefs are true.

BDD: Description and Characteristics

  • BDD is not vanity; it's the opposite. Individuals fear or believe they are ugly or deformed.
  • Appearance obsessions, usually involving multiple body parts (Skin, Face, Hair, Nose, Stomach, Teeth, Breasts, Genitals, Muscles), can be specific or vague.
  • Intense shame and disgust regarding the body area of preoccupation.

BDD: Insight and Characteristics

  • 70% of patients have ideas of reference (IOR).
  • 35-50% are delusional about their appearance.
  • Poorer insight is correlated with higher negative affect, lower positive affect, and lower self-esteem in BDD.
  • Across time, self-esteem and insight influence each other reciprocally. A lower self-esteem will lead to a poorer perception of insight.

BDD: Clinical Presentation

  • Compulsions: grooming, mirror-checking, skin-picking, camouflaging, comparing body to others', and reassurance seeking.
  • Avoidance: school, work, social events; majority are unmarried; significant functional impairment with low Quality-of-Life scores.

BDD: Epidemiology

  • Prevalence: 1.9%-point in the community, and shifts with age (2% in adolescents; 4% in 18-44; 1.4% in >45).
  • Onset: usually at 16 (±7 years; 4-43 range); begins gradually.
  • Mean onset of subclinical BDD is 12.9. There is a second peak in incidence of the disorder after menopause.

BDD: Comorbidity

  • Major Depression: 75–80% lifetime prevalence.
  • OCD: 20–35% prevalence among BDD patients; 10–25% of OCD patients have BDD,
  • Substance abuse: 49% lifetime.
  • Social phobia: 37–39% lifetime, 31–34% current.
  • Eating disorders: 20–33% lifetime.
  • Panic disorder: 20% lifetime.
  • Personality disorders: 40% (mostly avoidant and dependent).

BDD: Signs

  • Preoccupation with appearance
  • Frequent examination in mirrors or avoiding mirrors.
  • Belief that others notice the appearance negatively.
  • The need to seek reassurance about appearance from others.
  • Frequent cosmetic procedures but with little satisfaction.
  • Excessive grooming (hair plucking)
  • Skin picking
  • Refusal to appear in pictures.

Hoarding Disorder

  • Acquisition and failure to discard a large number of items that appear to be useless or of limited value.
  • Significant clutter prevents engagement in activities for which the space was designed or intended
  • Leads to significant distress or impairment in functioning.

Hoarding Disorder: DSM-5 Diagnostic Criteria

  • A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
  • B. This difficulty is due to a perceived need to save the items and distress associated with discarding them.
  • C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas, which substantially compromises their intended use. If living areas appear uncluttered, it's because of interventions by third parties (e.g., family members, cleaners, authorities).
  • D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
  • E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).
  • F. The hoarding is not better explained by the symptoms of another mental disorder

Hoarding Disorder: Specifying Insight

  • With excessive acquisition: Difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed.
  • With good or fair insight: Individual recognizes that hoarding-related beliefs and behaviors are problematic.
  • With poor insight: Individual is mostly convinced that hoarding beliefs and behaviors are not problematic.
  • With absent insight/delusional beliefs: Individual completely convinced that hoarding-related beliefs and behaviors are not problematic.

Hoarding Disorder: Description

  • Hoarding Disorder falls under the category of OCD and related conditions. It resembles OCD in having obsessions and compulsions; however, the obsessions concerning hoarding are not bizarre, unwanted, or intrusive.
  • The compulsive relief acquired in hoarding is a pleasurable aspect.
  • It typically starts in adolescence, though the disorder worsens with age. People living alone; single; or with specific educational ranges are more likely to be affected.

Hoarding Disorder: Prevalence and Statistics

  • The average age of onset is 12 years.
  • The condition tends to worsen with age.
  • Singlehood and living alone tend to be risk factors.
  • Men hoard more frequently than women.
  • A risk factor is having close family members who engage in similar behaviors.

Hoarding Disorder: Common Behaviors

  • Compulsive shopping
  • Tremendous anxiety over discarding objects.
  • Difficulty making decisions.
  • Perfectionism.
  • Avoidance of tasks.
  • Procrastination/good intentions.
  • Excessive time spent acquiring items

Hoarding Disorder: Other Aspects

  • Overvalued ideation of the objects.
  • Excessive emotional attachment to possessions.
  • Filling a void.

Hoarding Disorder: Commonly Hoarded Items

  • Paper products (receipts, schoolwork, trash, containers, bags...)
  • Magazines, books, mail, lists, notes
  • Craft supplies (beading, scrapbooking, stencils, markers)
  • Holiday items (Christmas, Easter, Fourth of July)
  • Personal clothing (shoes, purses, scarves)
  • Collectibles (stuffed animals, dolls, Barbies, model cars, childhood items)

Hoarding Disorder: When Behaviors Become a Problem?

  • Safety issues (e.g., fire risk)
  • Health concerns (e.g., respiratory problems)
  • Decreased quality of life.
  • Social isolation.
  • Distress.
  • Conflict with family and friends.
  • Financial strain.

Hoarding Disorder: Causal Factors

  • Nature versus nurture
  • Chemical imbalance
  • Environment
  • Trauma
  • Grief and loss
  • Attachment issues

Hoarding Disorder: Other Contributing Factors

  • Lack of parental training as a child.
  • Role modeling.
  • Acquiring behaviors as a way to feel good.
  • Onset from stressful life events (divorce, death of a loved one, work-related stress, relational stress, psychological illness, medical illness).

Collector vs. Hoarder

  • Collector: Admires, enjoys, and can use or display items.
  • Hoarder: Excessive number of items; repeat purchasing; items lost/damaged; no system for acquired items.

Excoriation Disorder

  • Excoriation disorder (also dermatillomania or skin-picking disorder) is a new entry in the DSM-5 Diagnostic criteria for impulse control disorders.
  • A compulsion to pick at the skin, even to the extent that damage results

Excoriation Disorder: Symptoms

  • Compulsive urge to pick, squeeze, or scratch skin, often a perceived skin defect.
  • Common areas of involvement: face, extremities, and scalp.
  • Repeated attempts to stop picking.
  • Picking usually occurs in brief periods but can be incessant, especially for those with developmental disabilities.
  • Tools (e.g., needles, tweezers) may enhance damage.

Excoriation Disorder: Diagnostic Criteria

  • A. Recurrent skin picking, resulting in skin lesions.
  • B. Repeated attempts to stop.
  • C. Distress or impairment due to the behavior.
  • D. Not attributable to a substance or medical condition.

Excoriation Disorder: Justification and Additional Considerations

  • Skin excoriation may occur as a primary disorder (without obsessions or compulsions), and concerns about bodily abnormality may not be present.
  • Treated effectively if patients can be encouraged to seek help.
  • Skin-picking is more akin to substance abuse than obsessive-compulsive disorder (Orlaug and Grant, 2010).

Excoriation Disorder (cont.) - Analogy to other Conditions

  • Analogous to compulsive hair pulling (trichotillomania), as both are obsessive ritualistic behaviors, not preceded by obsessive thoughts, and are triggered by anxiety or depression.

Excoriation Disorder: Epidemiology

  • Prevalence estimated at 1.4–5.4% of the population.
  • Skin-picking in the community is found in 4–5%
  • Point-prevalence surveys found skin-picking point of causing lesions in 16% and criteria for diagnosis in 1–2%.
  • 2% of dermatology patients have skin excoriation.
  • About half of patients have onset before age 10, with a significant minority developing the disorder between 30 and 45 years old.

Excoriation Disorder: Causes

  • Self-disfigurement: Reduce attractiveness due to psychosexual conflicts.
  • Repressed rage of children against authoritarian parents
  • Maladaptive coping: Stress/anxiety/developmental disabilities
  • Other: Use of drugs (cocaine, methamphetamine) that enhance dopamine levels. Dopamine antagonists (like naltrexone) can be effective treatments for dermatillomania.

Excoriation Disorder: Treatment

  • SSRIs: Antidepressants.
  • Competing Response Training: Execute a different motor response instead of the picking behavior.
  • Acceptance and Commitment Therapy
  • Cognitive-Behavioral Therapy

Trichotillomania (Hair-Pulling Disorder)

  • Trichotillomania (HPD), a psychiatric illness, affects up to 4% of the population.
  • Individuals feel compelled to pull hair from their head or elsewhere.
  • Results in hair loss and other impairment.

Trichotillomania (cont.) - Body-Focused Repetitive Behaviors

  • A body-focused repetitive behavior.
  • Similar to other conditions: Pulling, picking, scraping (or even biting) of hair, nails, or skin.

Trichotillomania (cont.) - Individual Experiences

  • Irresistible urge to pull hair (scalp, eyelashes or eyebrows).
  • More prevalent in females than males.
  • Typically begins in early adolescence.

Trichotillomania: Symptoms

  • Frequent pulling or twisting hair.
  • Bald patches or hair loss.
  • Uneven hair appearance.
  • Denial of hair pulling.
  • Obstructed bowels (if hair is consumed).
  • Tension before pulling with relief/gratification afterward.
  • Other self-injury behaviors.
  • Poor self-image.
  • Sadness, depression or anxiety.

Trichotillomania: Diagnostic Criteria

  • A. Noncosmetic hair removal.
  • B. Repeated attempts to decrease/stop pulling.
  • C. Distress or impairment, and
  • D. Not related to another medical condition.
  • E. Not caused by another mental condition.

Trichotillomania: Causes

  • No singular cause.
  • Genetics (nature) and environment (nurture).
  • Chemical imbalances in the brain, hormonal changes during puberty
  • Coping mechanisms (for stress), and/or self-harm to alleviate distress.

Trichotillomania: Living with the Disorder

  • Severity of trichotillomania can range from mildly to severely affected.
  • Individuals may experience the disorder as annoying or frustrating. Many feel shame and embarrassment, withdrawing from social situations out of fear about others' judgment

Trichotillomania: Physical Effects

  • Susceptibility to infection, tissue damage, and muscle/joint injuries from the repetitive motion.

Trichotillomania: Treatment

  • Cognitive Behavioral Therapy (CBT) and habit reversal training (HRT): First-line treatment
  • HRT + stimulus control will help patients understand triggers to develop competing responses.
  • Identify supports (or a support person) for the patient to aid in pulling alternatives.

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Obsessive-Compulsive and Related Disorders PDF

Description

This quiz explores the key concepts surrounding Obsessive-Compulsive Disorder (OCD), including symptoms, characteristics, and diagnostic challenges. It delves into the nature of compulsions and the significance of insight within OCD, as well as the association between OCD and tic disorders. Test your knowledge on the intricacies of OCD and its impact on individuals.

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