Obsessive-Compulsive Disorders

OCD: characterized by the Prescence of obsessions and/or compulsions

Obsessions: are recurrent and persistent thoughts, urges, or images that are experienced as

intrusive and unwanted

Individual's attempt to ignore or suppress the thoughts, urges, or images to neutralize them with

other thought or action

Compulsions: are repetitive behaviors or mental acts as individual feels driven to perform in

response to an obsession or according to rules that must be applied rigidly

Repetitive Behaviors Example: Hand washing, ordering, checking

 Some people with OCD are subject to preoccupations & by repetitive behaviors or mental

acts in response to these preoccupations

Diagnostic Criteria

A) Presence of obsession, compulsions, or both:

B) Time consuming obsessions and compulsions or cause significant distress or impairment

in social, occupational, or other functioning

C) Symptoms are not attributable to physiological effects of substance, medication, or

medical condition

D) Not better explained by another mental disorder

Specify

With Good/Fair Insight: recognizes that beliefs are not true or probably not true

With Poor Insight: thinks their beliefs are probably true

With Absent Insight: completely convinced the obsessive-compulsive beliefs are true
*Final Question (maybe): Specify if TIC DISORDER

*30% of individuals with OCD have a tic disorder

*More common in men with OCD onset in childhood

Categories in OCD

 Washers: afraid of contamination. Usually have cleaning or hand-washing compulsions

 Checkers: repeatedly check things that they associate with harm or danger

 Doubters: afraid that if everything isn’t perfect or done just right something terrible will

happen, or they will be punished

 Counters & Arrangers: obsessed with order and symmetry. They may have superstitions

about certain numbers, colors, arrangements

Prevalence

 Slightly higher rate in women than men with men more commonly affected in

childhood

 Onset: 19.5 years Onset After 35: is unusual

 OCD comorbid: anxiety, depressive and bipolar disorder

Associated Features

 Preceding compulsions are reported by 60% of individuals with OCD

 They report sensory phenomena, such as physical sensations, just-right sensations, or

feelings of incompetence

 Avoidance behaviors are common to reduce exposure to triggering situations

 CBT is best

Body Dysmorphic Disorder

 -people become preoccupied with a perceived defect or flaw in their appearance that

they believe renders them ugly, unattractive, abnormal or deformed

Criteria

A) Preoccupation with one or more perceived defects or flaws in physical appearance that

are not observed or appear slight to others

B) Individual has in disorder performed repetitive behaviors or mental acts like comparing to

others

Repetitive BX’s: mirror checking, excessive grooming, skin picking, reassurance

seeking, compensatory behaviors

C) The preoccupation causes clinically significant distress or impairment in social,

occupational, or other functioning

D) Not explained by concerns about body fat or weight in someone whose symptoms meet

criteria for eating disorder

Final Exam Question!!!!!!!!!!!: What’s different with OCD (something you don’t want & causes

distress/ can’t control) and OCD personality disorder

Hoarding Disorder

 Persistent difficulties discarding or parting with possessions regardless of actual value

 Persistent: pattern of long-standing difficulty rather than transient life circumstances,

such as inheriting property

A) Persistent difficulty discarding or parting with possessions regardless of their value

B) Due to perceived need to save items and distress with discarding them
 C) The difficulty discarding possessions results in an accumulation of possessions that

congest, and clutter living areas and compromise their integrity.

D) Causes significant distress

E) Not attributable to medical condition or mental disorder (prader willi, neurovascular

disorder, brain injury)

F) Hoarding is not better explained by another mental disorder

-decreased energy in MDD

-delusions in schizophrenia

-obsessions in OCD

Specifiers

Specify If: Excessive Acquisition of Items

 Difficulty discarding possessions is accompanied by excessive acquisition of

items unneeded or for which there is no space

Good/Fair Insight: realizes beliefs are problematic

Poor Insight: convinced beliefs are not problematic

Absent Insight: totally convinced the hoarding related beliefs are not problematic

Trichotillomania (Hair-Pulling Disorder)

will be on Exam

 Essential feature is recurrent pulling out of one’s hair causing hair loss

 Hair pulling may come from common sites: scalp, eyebrows, or eyelids

Criteria

A) Recurrent pulling out of one’s hair resulting in hair loss

B) Repeated attempts to stop or decrease hair pulling behaviors

 C) Hair pulling causes significant distress or impairment in social, occupational, or other

functioning

D) Not attributed to a medical condition or mental disorder

Features

 more common in women 10:1 ratio

 hair pulling may be triggered by anxiety or boredom, need for gratification, lack of

awareness, or tingling of scalp relieved by hair pulling

Excoriation (Skin-Picking) Disorder

 Essential Feature: recurrent picking at one’s own skin that leads to skin lesions

 Most common sites are face, arms and hands

Criteria

A) Recurrent skin picking resulting in skin lesions

B) Repeated attempts to decrease or stop skin picking

C) Causes clinically significant distress or impairment

D) Not attributable to physiological effects of substance use (amphetamine or cocaine)

E) Not explained by another mental disorder

-occurs over several hours a day and may continue for months or years

Prevalence

 ¾ of individual's are women

 Individual's may search for scabs to pull & may examine or even swallow this skin

 May be triggered by anxiety and boredom

 Some may pick the skin of others

 Good: you know its bad

Absent: you think its fine

Substance/Medication Induced O-C and Related Disorder

A) Obsessions, compulsions, skin picking, hair pulling, or other body focused

repetitive behaviors

B) Evidence findings that both…Symptoms of (Criteria A) developed during or

soon after substance intoxication or withdrawal & Involved

substance/medication can produce the symptoms

C) Disturbance not better explained by OCD that is not substance induced

D) Disturbance does not occur during course of delusion

E) Disturbance causes clinically significant distress or impairment

*Dr. Dooley might not put substance related disorders on exam

Tips for Final:

Questions: about Culture (know terms you don’t under : anxiety cultural,

depression and OCD cultural)

Example: Koro, Shub0-kyofu