Obsessive Compulsive

Disorder and related

disorder

DR AHMED KHALIFA
▪ Obsessive Compulsive
Disorder
Clinical Features
▪ .
▪ OBSESSIONS:
Recurrent and persistent thoughts

▪ COMPULSIONS:
Repetitive behaviors or mental acts

▪ Distress/Dysfunction

▪ They are both egodystonic means unwanted

thought
▪ Obsession-------- anxiety-------- compulsion

▪ Compulsions are carried out in an attempt to

reduce anxiety however they do not always
succeed, on the contrary anxiety may increase
or remain the same
▪ Contamination concerns ➔ hand-
washing

▪ Possible harm concerns ➔ checking

Epidemiology

▪ Life time prevalence of OCD in general

population is 2-3%
▪ Among adults men and women are equally
affected, among adolescents boys are more
commonly affected.
▪ Mean age of onset 19 in men and 22 in
women.
▪ 4th most common psychiatric disorder in
one USA study
▪ 10th most disabling of all medical disorders
in WHO BoD study
Etiology

▪ Biological Factors:
Neurotransmitters: serotonergic dysregulation
is involved in the symptom formation of
obsessions and compulsions.
CSF 5HIAA was assessed in many studies with
variable results
CSF concentration of 5HIAA was decreased
after treatment with clomipramine.
Biological factors

▪ Noradrenergic System: some studies on OCD

patients showed improvement after
treatment with clonidine (catapress) which
lowers presynaptic norepinephrine release.

▪ Neuroimmunology: a possible link between

group A b hemolytic streptococcal infection
and OCD. 30% of patients with sydenham’s
chorea show OC symptoms
Biological factors

▪ Brain imaging:

structural brain imaging as CT and MRI showed

bilateral small caudate .

Functional brain imaging showed data implicating

altered neurocircuity between orbitofrontal
cortex, caudate and thalamus.

PET showed increased activity( metabolism and

blood flow) in the frontal lobe, basal ganglia, and
the cingulum
Biological Factors

Genetics:
Family studies: 35% of first degree relatives of
OCD patients are also affected with the
disorder

Twin studies: MZT> DZT

DSM-V Diagnostic Criteria

▪ The presence of obsessions and / or

compulsions:

▪ Obsessions are defined by 1&2

1-Recurrent and persistent thoughts, images,
or urges that are experienced in the same
time of the disturbance, they are intrusive
and unwanted and in most individuals cause
anxiety and distress.
DSM-V

2- the individual attempts to ignore or suppress

such thoughts, urges, or images, or to
neutralize them with some other thoughts or
actions (compulsion).

Compulsions are defined by 1 & 2:

1-repetitive behaviors( washing, ordering,
checking) or mental compulsions as praying,
and counting, the individual feels driven to
perform in response to obsession.
DSM-V

▪ 2- The behaviors or mental acts are aimed at

preventing some dreaded event or situation;.

▪ The obsessions or compulsions are time

consuming ( more than one hour every
day),or cause significant distress or
impairment in social or occupational
functioning.
DSM-V

▪ C- not due to the effect of substance

▪ D-the symptoms are not better explained by

another mental disorder
▪ Specify if:
with good insight
with poor insight
with absent insight/ delusional
Specify if tic related
Course and Prognosis

▪ More than half of the cases have sudden onset

after stressor

▪ 5-10 years delay before they come to psychiatric

attention

▪ 20-30 % significant improvenent

▪ 40-50% moderate improvement
▪ 20-40% either remain sick or heir symptom
worsen
Treatment

▪ Pharmacotherapy:
SSRI, 50-70% of patients respond to SSRI.
Initial effect seen in 4-6 weeks
Maximal Therapeutic effect in 8-16 weeks
Fluoxetine, fluvoxamine, paroxetine, sertraline
are approved by FDA Higher doses are
needed e.g. 80mg of fluoxetine per day
Behavioral Therapy

▪ Exposure and response prevention

▪ CBT
BODY DYSMORPHIC DISORDER

▪ describes repetitive behaviors or

mental acts in response to
preoccupations with perceived defects
or flaws in physical appearance
▪ Signs and symptoms of body dysmorphic
disorder include:
▪ Preoccupation with your physical appearance
with extreme self-consciousness
▪ Frequent examination of yourself in the mirror,
or the opposite, avoidance of mirrors altogether
Strong belief that you have an abnormality or
defect in your appearance that makes you ugly
Belief that others take special notice of your
appearance in a negative way s0 patient
avoide of social situations
▪ Feeling the need to stay housebound
▪ The need to seek reassurance about your
appearance from others
▪ Frequent cosmetic procedures with little
satisfaction
▪ Excessive grooming, such as hair plucking or skin
picking, or excessive exercise in an unsuccessful
effort to improve the flaw
▪ The need to grow a beard or wear excessive makeup
or clothing to camouflage perceived flaws
▪ Comparison of your appearance with that of others
▪ Reluctance to appear in pictures
▪ HOARDING DISORDER
▪ Hoarding disorder is characterized by the
persistent difficulty discarding or parting with
possessions, regardless of the value others may
attribute to these possessions, according to the
APA’s new criteria:
▪ The behavior usually has harmful effects —
emotional, physical, social, financial, and even
legal — for the person suffering from the
disorder and family members. For.
TRICHOTILLOMANIA (HAIR-
PULLING DISORDER)

▪ This disorder remains largely unchanged

from the DSM-IV, although the name has
been updated to add “Hair-pulling disorder”
(we guess because people didn’t know what
trichotillomania actually meant).
▪ Signs and symptoms of trichotillomania often
include:
▪ Repeatedly pulling your hair out, typically from
your scalp, eyebrows or eyelashes, but can be
from other body areas, and sites may vary over
time
▪ An increasing sense of tension before pulling,
or when you try to resist pulling
▪ A sense of pleasure or relief after the hair is
pulled
▪ Shortened hair or thinned or bald areas on
the scalp or other areas of your body,
including sparse or missing eyelashes or
eyebrows
▪ Preference for specific types of hair, rituals
that accompany hair pulling or patterns of
hair pulling
▪ Biting, chewing or eating pulled-out hair
▪ Playing with pulled-out hair or rubbing it
across your lips or face
Thank You