kaplan ocd

What is the definition of an obsession?

A recurrent and intrusive thought, feeling, idea, or sensation.

What is the definition of a compulsion?

A conscious, standardized, recurrent behavior, such as counting, checking, or avoiding.

How do patients with OCD experience their obsessions and compulsions?

As ego-dystonic (unwanted behavior).

What is the lifetime prevalence of OCD in the general population?

2 to 3 percent.

What is the mean age of onset for OCD?

About 20 years (men about 19 years, women about 22 years).

Before what age do symptoms of OCD have onset in about two thirds of affected persons?

Before age 25.

What is the lifetime prevalence for major depressive disorder in persons with OCD?

About 67 percent.

What percentage of patients with OCD have a history of tics?

20 to 30 percent.

What neurotransmitter system is most strongly implicated in the symptom formation of obsessions and compulsions?

Serotonergic system.

Which brain regions have functional brain imaging studies shown increased activity in patients with OCD?

Frontal lobes, basal ganglia (especially the caudate), and the cingulum.

What is the incidence of Tourette's disorder in patients with OCD?

5 to 7 percent.

What percentage of patients with OCD have both obsessions and compulsions?

Up to 75 percent (some believe closer to 100 percent if mental compulsions are included).

What is the most common symptom pattern in OCD?

Contamination obsession followed by washing or compulsive avoidance.

What is the second most common symptom pattern in OCD?

Pathological doubt followed by checking compulsion.

What is the third most common symptom pattern in OCD?

Intrusive obsessional thoughts without a compulsion.

What is the fourth most common symptom pattern in OCD?

Need for symmetry or precision, leading to a compulsion of slowness.

What is the placebo response rate in pharmacotherapy studies for OCD?

Only about 5 percent.

What is the standard approach to pharmacotherapy for OCD?

Start treatment with an SSRI or clomipramine and then move to other strategies if ineffective.

Which drug was the first FDA-approved for the treatment of OCD?

Clomipramine (Anafranil).

What are the two principal behavioral approaches in OCD treatment?

Exposure and response prevention.

What percentage of OCD patients have a sudden onset of symptoms?

More than half.

What percentage of OCD patients have symptom onset after a stressful event?

50 to 70 percent.

How long do patients typically delay before coming to psychiatric attention for OCD?

5 to 10 years.

What percentage of OCD patients have significant improvement in symptoms?

20 to 30 percent.

What percentage of OCD patients have moderate improvement in symptoms?

40 to 50 percent.

What percentage of OCD patients either remain ill or their symptoms worsen?

20 to 40 percent.

What factor indicates a poor prognosis in OCD?

Yielding to (rather than resisting) compulsions, childhood onset, bizarre compulsions, need for hospitalization, coexisting major depressive disorder, delusional beliefs, presence of overvalued ideas, presence of personality disorder.

What is body dysmorphic disorder characterized by?

A preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment.

Who first recognized and named dysmorphophobia (body dysmorphic disorder) more than 100 years ago?

Emil Kraepelin.

What is the point prevalence of body dysmorphic disorder in the United States according to DSM-5?

2.4 percent.

What is the most common age of onset for body dysmorphic disorder?

Between 15 and 30 years.

What is the most common concern in body dysmorphic disorder?

Facial flaws, particularly those involving the nose.

What is the estimated percentage of patients with body dysmorphic disorder who attempt suicide?

Approximately one-fifth.

What treatment for body dysmorphic disorder is almost invariably unsuccessful?

Surgical, dermatological, dental, and other medical procedures to address the alleged defects.

What percentage of patients with body dysmorphic disorder respond to serotonin-specific drugs?

At least 50 percent.

What is the prevalence of hoarding disorder in the general population?

Approximately 2 to 5 percent.

What is the most significant comorbidity found with hoarding disorder?

OCD, with as many as 30 percent of OCD patients showing hoarding behavior.

What percentage of hoarders report at least one first-degree relative with hoarding behavior?

About 80 percent.

What is the most effective treatment for hoarding disorder?

A cognitive behavioral model that includes training in decision making and categorizing, exposure and habituation to discarding, and cognitive restructuring.

What is hair-pulling disorder (trichotillomania)?

A chronic disorder characterized by repetitive hair pulling, leading to variable hair loss that may be visible to others.

Who coined the term trichotillomania in 1889?

French dermatologist Francois Hallopeau.

What is the lifetime prevalence of hair-pulling disorder in general populations?

Ranging from 0.6 percent to as high as 3.4 percent.

What is the female to male ratio in chronic hair-pulling disorder?

As high as 10 to 1.

What is focused pulling in hair-pulling disorder?

The use of an intentional act to control unpleasant personal experiences such as an urge, bodily sensation, or thought.

What is automatic pulling in hair-pulling disorder?

Hair pulling that occurs outside the person's awareness, most often during sedentary activities.

What is excoriation (skin-picking) disorder characterized by?

Compulsive and repetitive picking of the skin that can lead to severe tissue damage.

What is the lifetime prevalence of skin-picking disorder in the general population?

Between 1 to 5 percent.

What is the most common site of skin-picking?

The face.

What is the mean age of onset for skin-picking disorder?

Between 12 to 16 years of age.

What is factitious dermatitis (dermatitis artefacta)?

A disorder in which skin-picking is the target of self-inflicted injury using more elaborate methods than simple excoriation.

What is the female to male ratio in factitious dermatitis?

8 to 1.