Obsessive-Compulsive and Related Disorders

Flashcards covering Obsessive-Compulsive and Related Disorders, including diagnostic criteria, prevalence, models, comorbidity, and treatment for OCD, BDD, Hoarding Disorder, Trichotillomania, and Excoriation.

Obsessive-Compulsive Spectrum Disorders (OCSD)

A new DSM-5 category separate from anxiety disorders, based on similarities and differences between OCD and other anxiety disorders.

Similarities of OCSD with Anxiety Disorders

Include patterns of comorbidities, shared cognitive and emotional processing, and temperamental antecedents like behavioral inhibition.

Differences of OCSD from Anxiety Disorders

Characterized by anxiety symptoms being less central (in OCD) and involving distinct neurobiological pathways (frontostriatal abnormalities for OCD vs. amygdala hyperresponsivity for anxiety disorders).

Disorders in OCSD DSM-5 Category

Obsessive-compulsive disorder, Body dysmorphic disorder, Hoarding disorder, Hair-pulling disorder (trichotillomania), and Skin picking disorder (excoriation).

Obsessions (in OCD Diagnostic Criteria)

Recurrent, persistent, intrusive, and unwanted thoughts, urges, or images that cause significant anxiety or distress, which the individual attempts to neutralize.

Compulsions (in OCD Diagnostic Criteria)

Repetitive behaviors or mental acts performed to reduce anxiety or prevent a dreaded event, often not realistically connected or clearly excessive, and applied rigidly.

OCD Diagnostic Impact

Obsessions or compulsions are time-consuming (more than 1 hour/day) or cause clinically significant distress or functional impairment.

OCD Prevalence and Burden

Worldwide prevalence of 1.5% to 3%, ranked by the World Health Organization as the 10th most burdensome medical condition.

Obsessive-Compulsive Disorder (OCD)

Defined by the presence of obsessions and compulsions, which are recurrent intrusive thoughts/images/impulses and repetitive behaviors/mental rituals performed to neutralize them.

Ego-dystonic Disorder (OCD)

A disorder where most patients have good insight, recognizing their obsessions or compulsions as excessive or unreasonable, but still feel compelled to perform them.

Cognitive-Behavioral Model of OCD

Explains how misinterpretation of normally occurring intrusive thoughts as overly important or dangerous leads to distress, which is transiently reduced by ritualistic and avoidance behaviors, paradoxically reinforcing them.

Maladaptive Beliefs in OCD (CBT Model)

Maintained by ritualistic and avoidance behaviors, preventing disconfirmation that intrusive thoughts are dangerous and creating a vicious cycle where beliefs are never challenged.

Inflated Sense of Responsibility (OCD)

A feeling that individuals with OCD have the power to cause or prevent highly probable negative outcomes, sometimes referred to as 'magical thinking' (not narcissistic or psychotic).

Thought-Action-Fusion (TAF)

Cognitive biases seen in OCD patients, including Moral TAF (belief that thoughts have equal moral weight to actions) and Likelihood TAF (belief that thoughts increase the probability of real-life events).

OCD Symptom Dimensions

OCD is a heterogeneous disorder with different symptomatic manifestations, most prevalent being contamination/washing and checking, also including symmetry, forbidden thoughts, and hoarding categories.

Yale-Brown Obsessive Compulsive Scale (YBOCS)

The most widely used scale for OCD, identifying four basic symptom categories: symmetry, forbidden thoughts, cleaning, and hoarding.

OCD Course of Illness

Typically chronic and persistent with an average onset of 19.5 years (bimodal peak at 10 years), showing low rates of full remission.

Pharmacological Treatment for OCD

Primarily Serotonin Reuptake Inhibitors (SRIs) at relatively high doses, sometimes augmented with dopamine antagonists (antipsychotics/neuroleptics).

Psychological Treatment for OCD

Cognitive-Behavioral Therapy (CBT) with a prominent Exposure and Response Prevention (ERP) component, or cognitive therapy developed to challenge maladaptive cognitive processes.

Deep Brain Stimulation (DBS) for OCD

A treatment option for at least 50% of severe OCD cases unresponsive to pharmacological and psychological interventions.

OCD Genetics and Familiality

Twin studies attribute 45-61% of OCD symptoms to genetics; prevalence in families with an OCD member is 11.7% compared to 2.7% in non-psychiatric controls.

OCD Comorbidity

Around 90% of OCD patients have at least one other psychiatric disorder, most commonly Major Depressive Disorder (10x general population rate) and various anxiety disorders.

Body Dysmorphic Disorder (BDD)

Preoccupation with one or more perceived defects or flaws in physical appearance that are unobservable or appear slight to others, leading to repetitive behaviors or mental acts in response.

BDD Diagnostic Impact

The appearance preoccupation causes clinically significant distress or impairment, and is not better explained by concerns with body fat or weight in an eating disorder.

History of Body Dysmorphic Disorder (BDD)

Formerly known as dysmorphophobia (Greek for 'facial ugliness'), previously classified as a somatoform disorder due to associations with hypochondriasis and somatic complaints.

Cosmetic Interventions for BDD

Patients with BDD often seek dermatological and cosmetic procedures, but these are generally not effective in treating symptoms and can sometimes exacerbate them, with 90% reporting no symptomatic change.

Shared Clinical Features of OCD and BDD

Both disorders involve obsessions or preoccupations, though BDD is primarily appearance-related and more closely resembles MDD than OCD in its focus on self-defeating beliefs.

Level of Insight in OCD vs. BDD

OCD patients generally perceive their thoughts as irrational (intact insight in 66-85%), while BDD patients frequently have 'delusional insight' (32-39%) and delusions of reference (2/3).

Suicidal Risk in BDD

Patients with BDD have significantly higher rates of suicidal ideation (nearly 80%) and attempts (28%) compared to OCD patients, attributed to delusional insight and self-defeating perceptions.

BDD Course of Illness

Typically begins in adolescence (2/3 before age 18) and is a disabling, chronic condition with low rates of full remission.

Hoarding Disorder Diagnostic Criteria

Persistent difficulty discarding possessions regardless of their actual value, due to a perceived need to save them and distress, resulting in cluttered living areas that compromise their intended use.

Hoarding Disorder Exclusions

Hoarding must cause clinically significant distress/impairment, not be attributable to another medical condition (e.g., brain injury), nor better explained by symptoms of another mental disorder (e.g., OCD obsessions, MDD decreased energy).

Hoarding Disorder (DSM-5)

A separate DSM-5 disorder characterized by persistent difficulty in discarding or parting with possessions, leading to accumulation that clutters active living areas to the extent that their intended use is no longer possible.

Hoarding Disorder Prevalence

Estimated at 2% to 5.8% of the general population and 10% to 20% of patients in anxiety disorder or OCD clinics.

Differences between OCD and Hoarding Disorder

OCD thoughts are intrusive and unpleasant (ego-dystonic), aimed at reducing anxiety; HD thoughts are ego-syntonic, with distress coming from clutter/interference rather than collecting, and items saved to avoid loss or difficult decisions.

Hoarding Disorder Course of Illness

Commonly onsets in adolescence, has a chronic course with very little waxing and waning, distinct from OCD's variable course, with symptoms typically becoming interfering in middle age.

Trichotillomania (Hair-Pulling Disorder)

Recurrent pulling out of one's hair, resulting in hair loss, repeated attempts to decrease or stop, and clinically significant distress or impairment, not attributable to medical or other mental conditions.

Excoriation (Skin-Picking Disorder)

Recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop, clinically significant distress or impairment, not attributable to substance effects, medical conditions, or other mental disorders.

Hair Pulling Disorder (HPD)

A psychological condition in DSM-5 involving the recurrent pulling out of one's hair resulting in hair loss, consequential distress or functional impairment, and repeated attempts at reducing hair-pulling behaviors.

Skin Picking Disorder (SPD)

A psychological condition in DSM-5 involving recurrent skin picking resulting in skin lesions, clinically significant distress or functional impairment, and repeated attempts to decrease or stop skin picking.

Hair Pulling Disorder Prevalence

Estimated to occur in 3 million individuals in the U.S.; true prevalence is unknown due to lack of epidemiological studies.

Skin Picking Disorder Prevalence

Estimated at 2% of dermatology patients and 5% of clinical samples.

Symptom Similarities: HPD, SPD, and OCD

All involve repetitive behaviors in response to urges; behaviors are anxiety relieving, often symmetrical, and possess ritualistic characteristics.

Symptom Differences: HPD/SPD vs. OCD (Post-Behavior Feelings)

Patients with grooming disorders (HPD, SPD) experience a sense of gratification after behaviors, whereas patients with OCD experience a reduction of anxiety.

Symptom Differences: HPD/SPD vs. OCD (Obsessional Preoccupation)

Neither hair pulling nor skin picking disorders are associated with obsessional preoccupation prior to the repetitive behavior, unlike OCD.