Obsessive- Compulsive and Related DisorderQuick Guide to the Obsessive- Compulsive and Related Disorders »Obsessive-compulsive disorder. These patients are bothered by repeated thoughts or behaviors that appear senseless, even to them »Body dysmorphic disorder. In this disorder, physically normal patients believe that parts of their bodies are misshapen or ugly Hoarding disorder. An individual accumulates so many objects (perhaps of no value) that they interfere with life and living »Trichotillomania (hair-pulling disorder). Pulling hair from various parts of the body is often accompanied by feelings of “tension and release” »Excoriation (skin-picking) disorder. Patients so persistently pick at their skin that they traumatize itObsessive- Compulsive Disorder OBSESSIONS are — persistent thoughts, ideas, impulses, or images that seem to invade a person's consciousness. COMPULSIONS are repetitive and rigid behaviors or mental acts that people feel they must perform in order to prevent or reduce anxiety.Steep on rights Percentage of Population Who Follow RoutineEssential Features of Compulsive Disorder The patient has distressing obsessions or compulsions that occupy $0 much time they interfere with accustomed routines. ‘Obsessions are recurring, unwanted ideas that intrude into awareness; the patient usually tries to suppress, disregard, or neutralize them, Compulsions are repeated physical (sometimes mental) behaviors that follow rules (or respond to obsessions) in an attempt to alleviate distress; the patient may try to resist them. The behaviors are unreasonable, meaning that they don’t have any realistic chance of helping the obsessional distress. The D's: Distress or disability (typically, the obsessions and/or compulsions occupy an hour a day or more or cause work/educational, social, or personal impairment) Differential diagnosis (substance use and physical disorders, “normal” superstitions and rituals that don’t actually cause distress or disability, depressive and psychotic disorders, anxiety and impulse-control disorders, Tourette's disorder, obsessive- compulsive personality disorder)Obsessions often take the form of obsessive... wishes impulses images ideas doubtsCOMMON MMOs) dirt or contamination Other common ones are violence and aggression, orderliness, religion, and Ero atl biats Religious obsessions, for example, seem tobe more common in cultures or countries with strict moral codes and Senet CR TomCOMMON OBSESSIONS Looe ee ee Seo oe ee ue Peeage ve acy SU ead cee Re Re Ce Reece Ree Rm ree Menu d Fear of harming oneself or others ares Fear of causing something bad ta happens 8. Fear of committing a crime See eu cn a Peer Se ee eee ed eee a ate eee ee Rt Te ae es od ‘sound or wordsCOMPULSIONS After performing a compulsive act, they usually feel less anxious for a short while. For some people, the compulsive acts develop into detailed rituals.Compulsions take various forms... Cleaning compulsions are very common. People with checking compulsions check the same items over and over—door locks, gas taps, important papers—to make sure that all is as it should be. Another common compulsion is the constant effort to seek order or balance. Touching , verbal, and counting compulsions are also common>The id impulses usually take the form of obsessive thoughts, and the ego defenses appear as counterthoughts or compulsive actions. >People who engage In undoing perform acts that PSYCHODYNAMIC PERSPECTIVE are meant to cancel out their undesirable impulses. People who develop a reaction formation take on a lifestyle that directly opposes their unacceptable impulses,The Cognitive-Behavioral Perspective Those who develop this disorder, however, typically blame themselves for such thoughts and expect that somehow terrible things will happen. Neutralizing - A person's attempt to eliminate unwanted thoughts by thinking or behaving in ways that put matters right internally, making up for the unacceptable thoughtOCD-BEHAVIORISM Compulsions do appear to be rewarded by a reduction See eee ea see ert Re ae en tee te prevention), first developed by psychiatrist Victor Meyer, clients are repeatedly exposed to objects or situations that produce anxiety, obsessive fears, and compulsive behaviors, but Ce Rs en Ree gece rca Because people find it very difficult to resist such behaviors, Beart] 9) ual bari 121 dLSome of them also have people carry out self help procedures at home this, eel CTEM ed Pe ees Ems of your bathroom for BM mon “Use this mop Cee unas Pont ean que ieeey DER oa) it erg off at night do not tears Peet at eer) bade Le verl hh Cee un acs Ur t acu Caen o e Cees and eat it. eet Cie) coe Ron ge and children all have Jumma Popo tou)The Biological Perspective Studies of twins found that if one identical twin has this disorder, the other twin also develops it in 53 percent of cases. In contrast, among fraternal twins (twins who share some rather than all of their genes), both twins display the disorder in only 23 percent of the cases. The most widely used biological treatment for obsessive-compulsive disorder is antidepressant drugs. The effectiveness of these drugs was first discovered in the 1970s when an antidepressant named clomipramine (trade name Anafranil) brought significant improvement to many patients with the disorderBe Sri tlie sector wut 5 Be 7 » 4Body Dysmorphic Disorder »People with bady dysmorphic disorder become preoccupied with the or flaw in their physical appearance. Such beliefs dri the individuals to repeatedly check themselves in the mirror, at the percel smpare themselves with others, ek reassurance, try to hide their perceived deformities with jothing or body hair, or avoid social situation become housebound > Although they frequently request medical procedure: ermabrasion) or pl ry to corr ir imagined defects, patients are often dissatisfied with the results. »It tends to begin during the teen again after menopause. »Men and women are probably about equally affectedSEKScoye LAKE Features of Body Dysmorphic Disorder In response to a miniscule, sometimes invisible physical flaw, the patient repeatedly checks in a mirror, asks for reassurance, or picks at patches of skin—or makes mental comparisons with other people. The D's: >Distress or disability (work/educational, social, or personal impairment) > Differential diagnosis (substance use and physical disorders, mood and psychotic disorders, anorexia nervosa or other eating disorders, OCD, illness anxiety disorder, ordinary dissatisfaction with personal appearancePeople who would change something about the'e appearance IW they could People whe daydream about Being beautiful or handsome People who wear uncomfortable ‘shoes because they look good People who ate dissatisfied with rreneral appearance of their teeth People who undergo surgical ‘or nonsurgical cosmetic procedures each year People who have stuffed their bras (wamen} or shorts (men)Hoarding Disorder Beowulf legend referred to ahoardas amass of something valuable Adisorder in which individuals feel compelled tosave items and become very distressed if they try todiscard them, resulting inan excessive accumulation of items.MOTIVATION BEHIND HOARDING Some people believe their things are valuable when they’re not. Others may be imitating behavior they’ve encountered in family members (a genetic component is also suspected). Still others apparently feel comforted by the presence of things they've grown used to having, or that they think they may need later.BeRsIsieVOLME UE Features of Hoarding Disorder Be eR ee tea ena ek kes Meee hi mand Cee ae Ret ee te eS a Cee Re eR Ra) Pee RA ae Rea Ce things pile up, cluttering up living areas to render them (oe ae ase ee ae a) > Distress or disability (work/ educational, social, or personal Ta) iL Ue ie Re a eet Does eee ee Ceres)Trichotillomania »Trichotillomania comes from the Greek meaning “passion for pulling hair.” > Usually beginning in childhood, hair-pullers repeatedly extract their own hair, beards, eyebrows, or eyelashes. Less often, they will pull hair from armpits, the pubic area, or other body locations. People don’t report pain associated with the hair pulling, although they may note a tingling sensation. »Some people put the hair into their mouths, and about 30% swallow it. If the hair is | it can accumulate in the stomach or intestin a bezoar (hairball) that may require surgical removal,Repeated pulling out of the patient’s own hair results in bald patches and attempts to control the behavior. Essential | "The O's: * Duration (“recurrent”) * Distress or disability (work/educational, social, Features of Trichotillomania or personal impairment) * Differential diagnosis (substance use and physical disorders, mood and psychotic disorders, body dysmorphic disorder, OCD, ordinary grooming)Excoriation Disorder A disorder in which people repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder. Most will focus on head or face; fingernails tend to be the instruments of choice, though some people employ tweezers.Essential Features of Excoriation (Skin- Picking) Disorder »The patient frequently tries to stop the repeated digging, scratching, or picking at skin, which has caused lesions. »The D's: >Duration (recurring) ¥ Distress or disability (work/educational, social, or personal impairment) » Differential diagnosis (substance use and physical disorders, psychotic disorders, OCD, body dysmorphic disorder, stereotypic movement disorder)