Obsessive-Compulsive and Related Disorders Lecture Review

60 question-and-answer flashcards covering definitions, diagnostic criteria, specifiers, prevalence, risk factors, neurobiology, comorbidity, differential diagnosis, and treatment for OCD and related disorders.

What are the core features that characterize Obsessive-Compulsive Disorder (OCD)?

The presence of obsessions, compulsions, or both.

According to DSM-5 Criterion A, how are obsessions defined?

Recurrent, persistent thoughts, urges, or images experienced as intrusive and unwanted that cause marked anxiety or distress, which the individual attempts to ignore, suppress, or neutralize.

According to DSM-5 Criterion A, what defines a compulsion?

Repetitive behaviours or mental acts performed in response to an obsession or according to rigid rules, aimed at reducing anxiety or preventing a dreaded event, but not realistically connected or clearly excessive.

How much time must obsessions or compulsions consume, or what impact must they have, to meet DSM-5 Criterion B for OCD?

They must be time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment in important areas of functioning.

Which DSM-5 criterion rules out substance or medical causes for OCD symptoms?

Criterion C.

Which DSM-5 criterion distinguishes OCD from other mental disorders with similar symptoms?

Criterion D.

In OCD, what does the specifier “with good or fair insight” indicate?

The person recognizes that their OCD beliefs are definitely or probably not true, or may or may not be true.

What does the specifier “with poor insight” mean in OCD?

The individual thinks their OCD beliefs are probably true.

What does “with absent insight/delusional beliefs” signify in OCD?

The person is completely convinced their OCD beliefs are true.

Which additional specifier can be added to OCD if the person currently has or had a tic disorder?

“With current or past history of a tic disorder.”

Give two common symptom dimensions seen in OCD.

Cleaning/contamination and symmetry/ordering (others include taboo thoughts, harm, and hoarding).

List two common dysfunctional beliefs associated with OCD.

Inflated sense of responsibility and overestimation of threat (also perfectionism, intolerance of uncertainty).

What is the lifetime prevalence of OCD in U.S. adults?

About 1.2%.

At what average age does OCD typically begin?

Around 19.5 years.

In males, when is onset of OCD more common?

Before age 10.

Name one environmental risk factor for OCD.

Childhood physical or sexual abuse or other traumatic events.

What is the approximate concordance rate for OCD in monozygotic twins?

0.57.

Which three brain areas are most strongly implicated in OCD pathophysiology?

Orbitofrontal cortex, anterior cingulate cortex, and striatum (caudate/nucleus accumbens).

What neurotransmitter abnormality is commonly linked to OCD?

Serotonin receptor deficits or dysfunction (and excess dopamine).

What percentage of adults with OCD report lifetime suicidal ideation?

About 44.1%.

Which anxiety disorders are most commonly comorbid with OCD?

Panic disorder, social anxiety disorder, and generalized anxiety disorder.

What mood disorder is present in up to 63% of OCD patients?

Bipolar disorder.

Which disorder must be considered when differentiating OCD obsessions from mood-congruent ruminations?

Major depressive disorder.

What is the frontline psychotherapeutic treatment for OCD?

Cognitive-behavioural therapy with exposure and response prevention.

Which class of medications is first-line for OCD?

Serotonin reuptake inhibitors (SSRIs or clomipramine).

What is the central preoccupation in Body Dysmorphic Disorder (BDD)?

Perceived defects or flaws in physical appearance that are not observable or appear slight to others.

Name one repetitive behaviour commonly performed in BDD.

Mirror checking, excessive grooming, skin picking, or comparing appearance with others.

Which specifier indicates concern that one’s body is too small or insufficiently muscular?

With muscle dysmorphia.

What is the lifetime prevalence of BDD in U.S. adults?

Approximately 2.4%.

At what average age do BDD symptoms typically emerge?

Around 16–17 years.

List one environmental risk factor for BDD.

High rates of childhood neglect or abuse.

What proportion of dermatology patients may meet criteria for BDD?

About 9–15%.

Which disorders are most frequently comorbid with BDD?

Major depressive disorder, social anxiety disorder, and OCD.

How does BDD differ diagnostically from an eating disorder?

In BDD the concern is about specific body features, not overall weight or body fat.

What is the defining difficulty in Hoarding Disorder (HD)?

Persistent difficulty discarding or parting with possessions regardless of their actual value.

According to DSM-5, what causes the difficulty discarding items in HD?

A perceived need to save the items and distress associated with discarding them.

What must accumulated possessions do to meet Criterion C for Hoarding Disorder?

Congest and clutter active living areas and compromise their intended use unless third parties intervene.

What specifier is used when hoarding is accompanied by excessive buying or collecting free items?

With excessive acquisition.

What is the estimated prevalence of Hoarding Disorder in U.S. and Europe?

Approximately 2–6% of the population.

At what age do hoarding symptoms often first appear?

Between 11 and 15 years.

Name one serious functional consequence of Hoarding Disorder.

Increased risk of fire, falls, unsanitary living conditions, eviction, or strained family relationships.

What percentage of individuals with Hoarding Disorder also have a mood or anxiety disorder?

About 75%.

What behaviour characterizes Trichotillomania?

Recurrent pulling out of one’s hair resulting in hair loss.

What DSM-5 criterion distinguishes Trichotillomania from normal grooming?

Repeated attempts to decrease or stop hair pulling.

When does Trichotillomania typically onset?

Around puberty.

Give one possible medical complication of Trichotillomania.

Trichobezoar formation (hair ingestion) or permanent follicle damage.

Which disorders are commonly comorbid with Trichotillomania?

Major depressive disorder and excoriation (skin-picking) disorder.

What is the core feature of Excoriation (Skin-Picking) Disorder?

Recurrent skin picking resulting in skin lesions.

What percentage of adults experience lifetime Excoriation Disorder?

About 1.4%.

Name one common consequence of Excoriation Disorder.

Infection, scarring, or significant distress and time consumption (≥1 hour/day).

How is Excoriation Disorder differentiated from psychotic disorders?

There are no tactile hallucinations or delusional explanations for the picking.

When can OCD or related symptoms be diagnosed as substance/medication-induced?

When obsessions or compulsions start during intoxication, withdrawal, or soon after exposure to a substance/medication and are best explained by that effect.

Give one clinical clue that OCD symptoms are due to a medical condition.

Onset after brain injury, stroke, or another neurological/endocrine disease with anatomical correlates.

When is the “Other Specified OCD and related disorder” diagnosis used?

When clinically significant OCD-related symptoms are present but do not fully meet criteria for a specific disorder and the clinician specifies why.

Provide one example of an “Other Specified” OCD-related presentation.

Obsessional jealousy; koro; body-focused repetitive behaviour like nail biting; taijin kyofusho subtype jikoshū-kyōfu.

What insight specifiers are shared across OCD, BDD, Hoarding, and related disorders?

Good/fair insight, poor insight, and absent insight/delusional beliefs.

Which triad of disorders is commonly observed in children with OCD?

OCD, tic disorder, and ADHD.

What executive-function difficulties are linked to both BDD and Hoarding Disorder?

Problems with planning, organization, and decision making.

Which brain circuit is repeatedly implicated across OCD and related disorders?

The cortico-striato-thalamo-cortical (CSTC) circuit involving the orbitofrontal cortex and striatum.

Which treatment approach is common to most OCD-related disorders?

Cognitive-behavioural therapy tailored to the specific symptoms, often combined with SSRIs.