Obsessive-compulsive and related disorders

Obsessive-compulsive and related disorders

These disorders are characterized by obsessions, compulsions, or repetitive behaviors in response to preoccupations. They include:

• Obsessive-Compulsive Disorder (OCD)

• Body Dysmorphic Disorder (BDD) Hoarding Disorder

• Trichotillomania (Hair-Pulling Disorder)

• Excoriation Disorder (Skin-Picking)

• Substance/Medication-Induced Obsessive-Compulsive and Related Disorder Obsessive-Compulsive and Related Disorder Due to Another Medical Condition

• Other Specified Obsessive-Compulsive and Related Disorder

• Unspecified Obsessive-Compulsive and Related Disorder

Characteristics of Disorders

Characteristics of Disorders

Cognitive Components:

• Some disorders (OCD, BDD, Hoarding) involve cognitive distortions and include specifiers for insight levels (good, poor, or absent insight).

Body-Focused Repetitive Behaviors

• Disorders like trichotillomania and excoriation are marked by repetitive actions focused on the body. These behaviors may provide relief or gratification.

Clinical Considerations

Clinical Considerations

Overlap with Anxiety Disorders:

• OCD is closely related to anxiety disorders, reflecting similarities in clinical presentations.

Differentiation from Normative Behaviors:

• These disorders are distinguished from normal preoccupations by their excessive nature and persistence beyond developmentally appropriate periods.

Importance of Distress and Impairment:

• Diagnosis requires evaluating the individual’s level of distress and functional impairment.

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD)

Diagnostic Criteria of obsession

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action

Diagnostic Criteria of compulsion

A. Presence of obsessions, compulsions, or both:

Compulsions are defined by (1) and (2):

1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Diagnostic Criteria of obssesive-compulsive

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder

Diagnostic Criteria:

Specify if:

With good or fair insight:

• The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight:

• The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs:

• The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Tic-related:

• The individual has a current or past history of a tic disorder.

Associated Features:

• Sensory phenomena - defined as physical experiences that precede compulsions, are common in OCD.

• Individuals with OCD experience a range of affective responses when confronted with situations that trigger obsessions and compulsions.

• It is common for individuals with the disorder to avoid people, places,and things that trigger obsessions and compulsions.

• Accommodation - the involvement of family or friends in compulsive rituals,

- can exacerbate or maintain symptoms and is an important target in treatment, especially in children.

Development and Course:

• In the United States, the mean age at onset of OCD is 19.5 years, and 25% of cases start by age 14 years.

• 40% of individuals with onset of OCD in childhood or adolescence may experience remission by early adulthood.

• Compulsions are more easily diagnosed in children than obsessions are because compulsions are usually observable.

Risk and Prognostic Factors:

Risk and Prognostic Factors:

Temperamental.

• Greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in childhood are possible temperamental risk factors.

Environmental

• Include adverse perinatal events, premature birth, maternal tobacco use during pregnancy, physical and sexual abuse in childhood, and other stressful or traumatic events.

Genetic and physiological

• The rate of OCD among first-degree relatives of adults with OCD is approximately two times that among first-degree relatives of those without the disorder; however, among first-degree relatives of individuals with onset of OCD in childhood or adolescence, the rate is increased 10-fold.

Culture-Related Diagnostic Issues:

• Regional variation in symptom expression exists, and cultural factors may shape the content of obsessions and compulsions.

Sex-and Gender-Related Diagnostic Issues:

• Men have an earlier age at onset of OCD than women, often in childhood, and are more likely to have comorbid tic disorders.

• among adults, OCD is slightly more common in women than in men.

Association With Suicidal Thoughts or Behavior:

• A systematic literature review of suicidal ideation and suicide attempts in clinical samples with OCD from multiple countries found a mean rate of lifetime suicide attempts of 14.2%, a mean rate of lifetime suicidal ideation of 44.1%, and a mean rate of current suicidal ideation of 25.9%.

Functional Consequences of Obsessive-Compulsive Disorder:

• OCD is associated with reduced quality of life as well as high levels of social and occupational impairment.

• Specific symptoms can create specific obstacles.

• When the disorder starts in childhood or adolescence, individuals may experience developmentaldifficulties

Differential Diagnosis:

Differential Diagnosis:

Anxiety disorders

• Recurrent thoughts, avoidant behaviors, and repetitive requests for reassurance can also occur in anxiety disorders.

Major depressive disorder

Rumination

• of major depressive disorder, in which thoughts are usually mood-congruent and not necessarily experienced as intrusive or distressing

Other obsessive-compulsive and related disorders

Body dysmorphic disorder

Trichotillomania

Hoarding disorder

Eating disorders

Tics (in tic disorder) and stereotyped movements

Tic -

• is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization

Stereotyped movement

• - is a repetitive, seemingly driven, nonfunctional motor behavior

Differential Diagnosis:

Psychotic disorders

• Some individuals with OCD have poor insight or even delusional OCD beliefs.

Other compulsive-like behaviors

• Certain behaviors are sometimes described as “compulsive,” including sexual behavior (in the case of paraphilias), gambling (i.e., gambling disorder), and substance use (e.g., alcohol use disorder)

Obsessive-compulsive personality disorder

• Obsessive-compulsive personality disorder is not characterized by intrusive thoughts, images, or urges or by repetitive behaviors that are performed in response to these intrusive symptoms; instead, it involves an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control.

Comorbidity

• Individuals with OCD often have other psychopathology. Many adults with the disorder in the United States have a lifetime diagnosis of an anxiety disorder or a depressive or bipolar disorder; a lifetime diagnosis of an impulse-controldisorder or a substance use disorder is also common.

Body Dysmorphic Disorder

Body Dysmorphic Disorder

Diagnostic Criteria of BDD

Body dysmorphic disorder formerly known as dysmorphophobia

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Specify if:

• With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

With good or fair insight

With poor insight

With absent insight/delusional beliefs

Specifiers:

Muscle dysmorphia

• - a form of body dysmorphic disorder occurring almost exclusively in men and adolescent boys, consists of preoccupation with the idea that one’s body is too small or insufficiently lean or muscular.

Common behaviors are:

1. Comparing one’s appearance with that ofother individuals

2. Excessively grooming Seeking reassurance about how the perceived flaws look

3. Excessively exercising or weight lifting; and seeking cosmetic procedures

4. Compulsive skin picking

5. Camouflaging

Associated Features

• Body dysmorphic disorder is associated with high levels of anxiety, social anxiety, social avoidance, depressed mood, negative affectivity (neuroticism), rejection sensitivity, and perfectionism aswell as low extroversion and low self-esteem.

• Body dysmorphic disorder has been associated with abnormalities in emotion recognition, attention, and executive function, as well as information-processing biases and inaccuracies in interpretation of information and social situations.

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