Obsessive-Compulsive and Related Disorders

What disorders are included in obsessive compulsive and related disorders

OCD / body dysmorphic disorder / hoarding disorder / trichotillomania / excoriation disorder / substance or 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

What broadly separates clinical obsessive compulsive symptoms from normal habits or rituals

Symptoms are excessive / developmentally inappropriate / persistent / distressing / impairing

What is OCD

Presence of obsessions / compulsions / or both that are time consuming or cause significant distress or impairment

What is an obsession

Recurrent persistent thought / urge / or image experienced as intrusive and unwanted

How do obsessions usually affect the person

They usually cause marked anxiety or distress

What does a person usually try to do with an obsession

Ignore it / suppress it / or neutralize it with another thought or action

What is a compulsion

Repetitive behavior or mental act the person feels driven to perform in response to an obsession or rigid rule

What are examples of behavioral compulsions

Hand washing / checking / ordering / repeating behaviors

What are examples of mental compulsions

Praying / counting / silently repeating words

What is the purpose of compulsions

Reduce anxiety or distress / or prevent a feared event

What makes a compulsion pathological

It is not realistically connected to the feared outcome or is clearly excessive

Are compulsions usually performed for pleasure

No / they may provide temporary relief but are not primarily pleasurable

Can young children have OCD without explaining why they perform compulsions

Yes / young children may not be able to explain the purpose of their rituals

How time consuming must OCD symptoms be if impairment is otherwise absent

Usually more than 1 hour per day

Can OCD be diagnosed if symptoms take less than 1 hour per day

Yes / if they cause clinically significant distress or impairment

What are the 4 common OCD symptom dimensions

Contamination and cleaning / symmetry and ordering / forbidden or taboo thoughts / harm and checking

What is the contamination dimension of OCD

Fears of contamination associated with washing or cleaning rituals

What is the symmetry dimension of OCD

Need for symmetry or things feeling just right associated with ordering / counting / repeating

What are taboo obsessions

Aggressive / sexual / religious or other unwanted intrusive thoughts

What is the harm dimension of OCD

Fears of harming oneself or others often associated with checking rituals

Are intrusive violent or sexual thoughts in OCD usually wanted

No / they are typically intrusive unwanted and distressing

What is thought action fusion

Belief that having an unacceptable thought is morally similar to performing the action or may increase the chance it occurs

What dysfunctional beliefs are common in OCD

Inflated responsibility / overestimating threat / perfectionism / intolerance of uncertainty / excessive importance of thoughts / need to control thoughts

What are sensory phenomena in OCD

Physical sensations / incompleteness / or just right feelings that may precede compulsions

What is family accommodation in OCD

Family or friends participate in rituals or modify behavior to reduce the persons distress

Why is family accommodation important

It may maintain or worsen OCD symptoms

What does good or fair insight mean in OCD

Person recognizes OCD beliefs are probably untrue or may or may not be true

What does poor insight mean in OCD

Person believes OCD beliefs are probably true

What does absent insight or delusional beliefs mean in OCD

Person is completely convinced OCD beliefs are true

Does absent insight in OCD automatically mean a psychotic disorder

No

When might a separate psychotic disorder be considered with OCD

When delusional or psychotic content extends beyond the OCD related beliefs

What does tic related OCD mean

Person has a current or past tic disorder

How common is lifetime tic disorder among people with OCD

Up to about 30 percent

What is a major difference between OCD and generalized anxiety disorder

GAD worry usually involves real life concerns while OCD obsessions are intrusive unwanted and often accompanied by compulsions

What is a major difference between OCD and specific phobia

Specific phobia centers on a circumscribed feared stimulus and usually lacks rituals

What is a major difference between OCD and social anxiety disorder

Social anxiety focuses on negative evaluation while OCD involves obsessions and compulsions across broader themes

How does depressive rumination differ from OCD obsessions

Depressive rumination is usually mood consistent and is not typically linked to compulsions

How does OCD differ from obsessive compulsive personality disorder

OCD involves intrusive obsessions and compulsions while OCPD involves enduring perfectionism rigidity and control

Can OCD and obsessive compulsive personality disorder occur together

Yes

How do tics differ from compulsions

Tics are usually sudden brief movements or sounds often preceded by sensory urges while compulsions usually neutralize obsessions

How do compulsive gambling or substance use differ from OCD compulsions

Those behaviors are often pleasurable or rewarding while OCD compulsions are performed mainly to reduce distress

What is body dysmorphic disorder

Preoccupation with perceived appearance defects that are not observable or appear slight to others

What repetitive behaviors occur in body dysmorphic disorder

Mirror checking / excessive grooming / skin picking / reassurance seeking / appearance comparing

Are repetitive behaviors required for body dysmorphic disorder

Yes / at some point the person must perform repetitive behaviors or mental acts related to the appearance concern

What functional requirement applies to body dysmorphic disorder

Appearance concerns must cause clinically significant distress or impairment

What appearance concern argues for an eating disorder rather than body dysmorphic disorder

Concern primarily about body fat or weight when eating disorder criteria are met

What body areas are commonly involved in body dysmorphic disorder

Skin / hair / nose although any body area may be involved

What is muscle dysmorphia

Form of body dysmorphic disorder involving belief that the body is too small or insufficiently muscular

Can someone with muscle dysmorphia actually be muscular

Yes / the person may have a normal or very muscular build

What behaviors can occur with muscle dysmorphia

Excessive weight lifting / exercise / dieting / substance use intended to increase muscularity

What insight specifiers are used for body dysmorphic disorder

Good or fair insight / poor insight / absent insight or delusional beliefs

Can body dysmorphic beliefs reach delusional intensity

Yes

Does delusional conviction about appearance automatically require delusional disorder

No / body dysmorphic disorder with absent insight may be diagnosed

How does body dysmorphic disorder differ from normal appearance dissatisfaction

BDD involves excessive preoccupation / repetitive behaviors / and significant distress or impairment

How does body dysmorphic disorder differ from an eating disorder

BDD is not primarily focused on body fat or weight when eating disorder criteria are present

How does body dysmorphic disorder differ from excoriation disorder when skin picking occurs

BDD skin picking is intended to improve a perceived appearance defect

How does body dysmorphic disorder differ from trichotillomania when hair pulling occurs

BDD hair removal is intended to improve perceived appearance while trichotillomania involves recurrent pulling itself

What is hoarding disorder

Persistent difficulty discarding possessions because of a perceived need to save them and distress associated with discarding

Does the actual value of possessions matter in hoarding disorder

No

What must difficulty discarding lead to in hoarding disorder

Accumulation that clutters active living areas and substantially compromises their intended use

What are active living areas in hoarding disorder

Spaces normally used for daily activities such as kitchens / bedrooms / hallways / living rooms

Can hoarding disorder be diagnosed if a home is uncluttered because relatives repeatedly clean it

Yes / third party intervention may hide the clutter

Why do people with hoarding disorder commonly save possessions

Perceived usefulness / sentimental attachment / fear of wasting items / fear of losing information / responsibility for possessions

Is saving intentional in hoarding disorder

Yes

What distress occurs in hoarding disorder

Anxiety / sadness / guilt / frustration / regret when discarding is attempted

What does excessive acquisition mean in hoarding disorder

Acquiring items that are unnecessary or for which there is no available space

How common is excessive acquisition in hoarding disorder

Approximately 80 to 90 percent

What forms can excessive acquisition take

Excessive buying / collecting free items / occasionally stealing

What insight specifiers are used in hoarding disorder

Good or fair insight / poor insight / absent insight or delusional beliefs

How does normal collecting differ from hoarding disorder

Normal collecting is organized and selective and does not produce severe clutter distress or impairment

What dangers can severe hoarding create

Fire risk / falls / sanitation problems / impaired hygiene / inability to cook or sleep / eviction risk

How does hoarding disorder differ from OCD related hoarding

OCD hoarding is driven by specific obsessions or rituals while hoarding disorder is driven by perceived need to save possessions

How does hoarding disorder differ from depression related clutter

Depression may cause passive accumulation from low energy while hoarding disorder involves intentional saving and distress about discarding

How does hoarding disorder differ from psychotic accumulation

Psychotic accumulation may result directly from delusions or negative symptoms

How does hoarding due to brain injury differ from hoarding disorder

Hoarding caused directly by neurological injury or disease is not diagnosed as primary hoarding disorder

What is trichotillomania

Recurrent hair pulling resulting in hair loss

What is additionally required for trichotillomania

Repeated attempts to decrease or stop hair pulling

What impairment is required for trichotillomania

Clinically significant distress or impairment

What emotional states may precede hair pulling

Anxiety / boredom / tension / urge or uncomfortable sensation

What may occur after hair pulling

Relief / pleasure / gratification

Can trichotillomania occur automatically without much awareness

Yes

Can trichotillomania occur with focused awareness

Yes / some individuals intentionally focus on pulling and experience tension before and relief afterward

Does hair pulling have to occur only from the scalp

No / eyebrows / eyelashes and other areas may be involved

What is trichophagia

Swallowing pulled hair

What dangerous complication can trichophagia cause

Trichobezoar or hair mass that may obstruct or damage the gastrointestinal tract

How does cosmetic hair removal differ from trichotillomania

Cosmetic removal is performed to improve appearance rather than because of recurrent hair pulling urges

How does trichotillomania differ from OCD related hair pulling

OCD hair pulling occurs as part of an obsession driven ritual

How does trichotillomania differ from body dysmorphic hair removal

BDD hair removal is intended to correct a perceived appearance flaw

How does trichotillomania differ from stereotypic movement disorder

Stereotypic pulling is part of a broader repetitive developmental motor pattern rather than the characteristic hair pulling disorder

What is excoriation disorder

Recurrent skin picking resulting in skin lesions

What is additionally required for excoriation disorder

Repeated attempts to decrease or stop skin picking

What impairment is required for excoriation disorder

Clinically significant distress or impairment

What medical consequences can occur from excoriation disorder

Scarring / tissue damage / infection and occasionally need for medical or surgical treatment

Can excoriation disorder begin after acne or another skin condition

Yes / but picking must become sufficiently independent of the underlying condition

How does excoriation disorder differ from skin picking due to psychosis

Psychotic skin picking is driven by delusions or hallucinations such as belief in parasites

How does excoriation disorder differ from nonsuicidal self injury

Excoriation disorder is repetitive picking rather than intentional tissue damage for self injury purposes

How does excoriation disorder differ from body dysmorphic disorder

BDD picking is specifically intended to correct a perceived appearance defect

How does excoriation disorder differ from OCD

Picking caused by contamination rituals or another obsession is better explained by OCD

Can cocaine or another substance cause clinically significant skin picking

Yes / substance induced obsessive compulsive and related disorder should be considered

What is substance or medication induced obsessive compulsive and related disorder

Obsessive compulsive related symptoms caused by intoxication / withdrawal / medication exposure / or medication withdrawal