OCD & Related Disorders

Which 5 disorders are included in Obsessive-Compulsive and Related Disorders (OCRD) (excluding substance/condition-induced, other/unspecified)

OCD, Body Dysmorphic Disorder (BDD), Hoarding Disorder, Trichotillomania, and Excoriation Disorder

What are the possible OCRD insight specifiers?

• Good or fair insight

• Poor insight

• Absent insight/delusional beliefs

Which OCRD disorders include an insight specifier?

• OCD

• Body Dysmorphic Disorder

• Hoarding Disorder

If insight is absent/delusional in OCD, BDD, or Hoarding, should you diagnose a psychotic disorder?

No, unless delusions extend beyond disorder-specific content.

Define obsessions.

Recurrent, persistent, intrusive thoughts/urges/images that cause anxiety and are resisted or neutralized.

Define compulsions.

Repetitive behaviors or mental acts performed to reduce anxiety or prevent feared events; excessive or unrealistic.

How much time must obsessions/compulsions take to meet OCD criteria?

More than 1 hour per day OR cause significant distress/impairment.

T or F: obsessions are defined by one’s attempts to ignore/suppress/neutralize them

True

Common OCD symptom dimensions?

• Cleaning/contamination

• Symmetry/ordering/counting

• Forbidden thoughts (aggressive, sexual, religious)

• Harm/checking

When is the tic-related specifier used for OCD?

When there is a current or past tic disorder.

How is OCD different from GAD?

OCD = intrusive, unwanted obsessions + compulsions; GAD = excessive worry.

How is OCD different from BDD?

OCD = varied obsessions; BDD = appearance-specific preoccupation.

Core feature of BDD?

Preoccupation with perceived appearance defects not observable or slight to others.

What behaviors must occur in BDD?

Repetitive behaviors or mental acts in response to the appearance concerns.

What must be ruled out in BDD?

Eating disorder (if concerns are about weight/body fat).

What is muscle dysmorphia?

Belief that one’s body is too small or insufficiently muscular.

Core feature of hoarding disorder?

Persistent difficulty discarding possessions regardless of value.

Why do individuals hoard?

Perceived need to save items + distress when discarding.

How does hoarding differ from collecting?

Hoarding causes clutter that compromises living space function.

T or F: Hoarders will declutter without intervention from third parties

False

What is the “excessive acquisition” specifier?

Excessive buying, collecting, or stealing unnecessary items.

Core feature of trichotillomania?

Recurrent hair pulling resulting in hair loss.

What must be present besides hair pulling?

Repeated attempts to decrease or stop.

T or F: Trichotillomania and excoriation are triggered by obsessions?

False

T or F: Trichotillomania and excoriation are preceded by feelings of anxiety, boredom, or increasing tension?

True

T or F: Individuals with trichotillomania and excoriation may have varying degrees of conscious awareness of the behavior while engaging in it?

True

Core feature of excoriation?

Recurrent skin picking resulting in lesions.

In excoriation, must there be attempts to stop the behavior?

Yes.

When does a diagnosis of substance/medication-induced OCRD (SI-OCRD) apply?

Symptoms develop during/after intoxication, withdrawal, or medication exposure.

What proves SI-OCRD is substance-induced?

Evidence the substance is capable of producing symptoms.

When is OCRD NOT substance-induced?

If symptoms preceded use or persist ~1 month after cessation OR occur exclusively during delirium.

What defines a diagnosis of OCRD due to a medical condition (OCRD-Med)?

Symptoms are direct physiological consequence of another medical condition.

What specifiers are used for OCRD-Med?

• OCD-like

• Appearance preoccupations

• Hoarding

• Hair-pulling

• Skin-picking

When is “Other Specified” OCRD used?

Full criteria not met, but clinician specifies reason.

Examples of other-specified OCRD?

• Obsessional jealousy

• Olfactory reference disorder

• Body dysmorphic–like disorder with actual flaws

• Body dysmorphic–like disorder without repetitive behaviors:

• Other body-focused repetitive behavior disorder:

• Shubo-kyofu (like BDD)

• Koro (fear of recession of private parts)

What is olfactory reference disorder?

Preoccupation with belief of emitting foul odor not noticeable to others.

When is “Unspecified” used?

Criteria not met and clinician does NOT specify reason OR insufficient information