Obsessive-Compulsive Disorder PDF

11/16/23, 11:23 AM Realizeit for Student Introduction Obsessive–compulsive disorder (OCD) was previously classified as an anxiety disorder due to the sometimes extreme anxiety that people experience. However, it varies from other anxiety disorders in significant ways. Certain disorders characteriz...

11/16/23, 11:23 AM Realizeit for Student Introduction Obsessive–compulsive disorder (OCD) was previously classified as an anxiety disorder due to the sometimes extreme anxiety that people experience. However, it varies from other anxiety disorders in significant ways. Certain disorders characterized by repetitive thoughts and/or behaviors, such as OCD, can be grouped together and described in terms of an obsessive–compulsive spectrum. The spectrum approach includes repetitive behaviors of various types: self-soothing behaviors, such as trichotillomania, dermatillomania, or onychophagia; reward-seeking behaviors, such as hoarding, kleptomania, pyromania, or oniomania; and disorders of body appearance or function, such as body dysmorphic disorder (BDD). Some of the disorders described in the obsessive–compulsive spectrum have not been accepted by the American Psychiatric Association as official diagnoses. Scholarly debate continues among psychiatrists as different clusters of behaviors are identified and studied to determine whether or not they are a stand-alone disorder or a symptom/behavior that should be included in another diagnosis. Sometimes the discussions and debates go on for many years with no consensus as is the case with dissociative identity disorder, formerly known as multiple personality disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses include OCD, BDD, hoarding disorder, trichotillomania (hair-pulling), excoriation (skin-picking), and disorders due to substances, medication, or other origins. Obsessive-Compulsive Disorder Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function. The person knows these thoughts are excessive or unreasonable but believes he or she has no control over them. Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. Usually, the theme of the ritual is associated with that of the obsession, such as repetitive hand washing when someone is obsessed with contamination or repeated prayers or confession for someone obsessed with blasphemous thoughts. Common compulsions include the following: Checking rituals (repeatedly making sure the door is locked or the coffee pot is turned off) Counting rituals (each step taken, ceiling tiles, concrete blocks, or desks in a classroom) Washing and scrubbing until the skin is raw Praying or chanting Touching, rubbing, or tapping (feeling the texture of each material in a clothing store; touching people, doors, walls, or oneself) Ordering (arranging and rearranging furniture or items on a desk or shelf into perfect order; vacuuming the rug pile in one direction) Exhibiting rigid performance (getting dressed in an unvarying pattern) Having aggressive urges (for instance, to throw one’s child against a wall) https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/4 11/16/23, 11:23 AM Realizeit for Student OCD is diagnosed only when these thoughts, images, and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational functions. Examples include a man who can no longer work because he spends most of his day aligning and realigning all items in his apartment or a woman who feels compelled to wash her hands after touching any object or person. Related Disorders The following are DSM-5 diagnoses. They are included in the diagnostic classification by the American Psychiatric Association. Excoriation disorder, skin-picking, also known as dermatillomania, is categorized as a self-soothing behavior; that is, the behavior is an attempt of people to soothe or comfort themselves, not that picking itself is necessarily a positive sensation. Eventually, the behavior can cause significant distress to the individual and may also lead to medical complications and loss of occupational functioning. It may be necessary to involve medicine, surgery, and/or plastic surgery, as well as psychiatry on the treatment team. Alternative therapies, such as yoga, acupuncture, and biofeedback, are helpful when included in the treatment plan (Torales, Barrios, & Villalba, 2017). Trichotillomania, or chronic repetitive hair-pulling, is a self-soothing behavior that can cause distress and functional impairment. Onset in childhood is most common, but it can also persist into adulthood with development of anxiety and depression. It occurs more often in females than in males. Trichotillomania can be successfully treated with behavioral therapy, although results are mixed and long-term outcomes are not well documented (Cison, Kus, Popowicz, Szyca, & Reich, 2018). BDD is a preoccupation with an imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life. The person ruminates and worries about the defect, often blaming all of life’s problems on his or her “flawed” appearance, that is, the appearance is the reason the person is unsuccessful at work or finding a significant other, for feelings of unhappiness, and so forth. Elective cosmetic surgery is sought repeatedly to “fix the flaw,” yet after surgery, the person is still dissatisfied or finds another flaw in his or her appearance. It becomes a vicious cycle. There is considerable overlap between BDD and other diagnoses, such as anxiety, depression, social anxiety disorder, and excoriation disorder. Treatment with selective serotonin reuptake inhibitors (SSRIs) has been effective in relapse prevention (Hong, Nezgovorova, & Hollander, 2018). Hoarding disorder is a progressive, debilitating, compulsive disorder only recently diagnosed on its own. Hoarding had been a symptom of OCD previously but differs from OCD in significant ways. Diagnosis most commonly occurs between the ages of 20 to 30. The prevalence and severity of the disorder is 2% to 5% of the population and increases with age. It is more common in females, with a https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/4 11/16/23, 11:23 AM Realizeit for Student parent or first-degree relative who hoards as well (Dozier, Porter, & Ayers, 2016). Hoarding involves excessive acquisition of animals or apparently useless things, cluttered living spaces that become uninhabitable, and significant distress or impairment for the individual. Hoarding can seriously compromise the person’s quality of life and even become a health, safety, or public health hazard. Treatment and interventions can be medication, cognitive–behavioral therapy (CBT), self-help groups, or the involvement of outside community agencies. Not a great deal is known about the success of these approaches at this time. The following disorders are sometimes viewed as related to OCD, that is, repetitive, compulsive behavior that is potentially harmful to the individual. Others view them as behavioral addictions, characterized by an inability to resist the urge to engage in potentially harmful actions. Onychophagia, or chronic nail-biting, is a self-soothing behavior. Typical onset is childhood, with a decrease in behavior by age 18. However, some nail-biting persists into adulthood. It may lead to psychosocial problems or cause complications involving the nails and oral cavity. SSRIs have proven effective in the treatment of onychophagia (Halteh, Scher, & Lipner, 2017). Kleptomania, or compulsive stealing, is a reward-seeking behavior. The reward is not the stolen item, but rather the thrill of stealing and not getting caught. Kleptomania is different than stealing items needed for survival, such as a parent stealing food for a hungry child. Kleptomania is more common in females with frequent comorbid diagnoses of depression and substance use. It is associated with significant legal repercussions. There is a lack of standardized treatment for kleptomania, but it seems that longer term therapy, as opposed to limited 10 or 12 sessions, may be needed (Grant & Chamberlain, 2018). Oniomania, or compulsive buying, is an acquisition type of reward-seeking behavior. The pleasure is in acquiring the purchased object rather than any subsequent enjoyment of its use. Spending behavior is often out of control, well beyond the person’s financial means. Once acquired, the object may be infrequently or never used. Approximately 80% of compulsive buyers are females with onset of the behavior in the early 20s; it is often seen in college students. Compulsive shopping runs in families who also have a high comorbidity for depression and substance use (Leite & Silva, 2016). Body identity integrity disorder (BIID) is the term given to people who feel “overcomplete,” or alienated from a part of their body and desire amputation. This condition is also known as amputee identity disorder and apotemnophilia or “amputation love.” This is not an officially APA-accepted diagnosis, and there is disagreement about the existence of the condition. People describe feelings of anguish and distress with their intact bodies and report feeling “natural, like they were intended to be” after an amputation. From an ethical standpoint, few surgeons will amputate a limb merely on a person’s request. People with BIID resort to actions such as packing the limb in dry ice until the https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 3/4 11/16/23, 11:23 AM Realizeit for Student damage is so advanced that amputation becomes a medical necessity, or in some cases, amputation is done with a power tool by nonmedical persons, leaving a physician to save the person’s life and mitigate with the damage. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 4/4