Obsessive Compulsive and Related Disorders

Obsessive Compulsive & Related Disorders: DSM IV vs DSM 5

These disorders are a separate category in DSM 5. In DSM IV, they were part of anxiety disorders.

Obsessive Compulsive Disorder

A: Presence of obsession, compulsions, or both. These behaviors or mental acts are not realistically connected to what they were designed to prevent, clearly excessive. Behaviors or mental acts aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation.
B: Time consuming obsessions & compulsions or cause significant distress or impairment.
C: Not attributable to physiological effects of substance or medical condition
D: Not better explained by another mental disorder

Obsessions

-Recurrent persistent thoughts, urges, or images that are experienced as intrusive and unwanted and cause marked anxiety and distress
-Individual attempts to ignore or suppress the thoughts, urges, or images or neutralize them with other thought or action

Compulsions

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

Specifiers of OCD

-With good insight: recognizes that beliefs are definitely or probably not true or may not be true
-With poor insight: thinks their beliefs are probably true
-With absent insight/delusional beliefs: completely convinced the obsessive-compulsive beliefs are true

30%

DSM 5 indicates that up to _____ of individuals with OCD may also have a tic disorder. More common in men with OCD onset in childhood

Washers

afraid of contamination. Usually have a cleaning or hand-washing compulsions

Checkers

repeatedly check things that they associate with harm or danger

Doubters and sinners

afraid that if everything isn't perfect or done just right, something terrible will happen, or they will be punished

Counters and arrangers

obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements

Hoarders

fear that something bad will happen if they throw anything away. Hold on to things they don't need or use

Body dysmorphic disorder

A: preoccupation with one or more perceived defects or flaws in physical appearance that are not observed or appear slight to others
B: individual has performed repetitive behaviors or mental acts like comparing to others
C: significant distress or impairments
D: not explained by concerns about body fat or weight in someone whose symptoms meet criteria for an eating disorder

Bigorexia

Muscle Dysmorphia
Form of body dysmorphic disorder occurring in males
Preoccupation with idea that one's body is too small or lean
Obsess over their physical imperfections and this perceived inadequacy can in turn affect many areas of the person's life.

Body dysmorphic disorder specifiers

Good or fair insight: recognizes body dysmorphic beliefs are definitely or probably not true
Poor insight: thinks beliefs are probably true
Absent insight/delusional beliefs: completely convinced beliefs are true.

Hoarding Disorder

A: persistent difficulty discarding or parting with possessions regardless of their value
B: due to perceived need to save items and distress with discarding them
C: Accumulation of possessions that congest and clutter living areas and compromise their integrity. Uncluttered only because of intervention by relatives.
D: Hoarding causes significant distress or impairment, or maintaining safe environment for self or others
E: Not attributable to medical condition or mental disorder (Prader Willi, neurovascular disease, brain injury)
F: Not better explained by another mental disorder (decreased energy in MDD, delusions in schizophrenia, obsessions in OCD)

Specifiers for hoarding disorder

-Excessive acquisition of items: difficulty discarding possessions is accompanied by excessive acquisition of items unneeded or for which there is no space
-Good to fair insight: realizes beliefs & behaviors are
-Poor insight: convinced beliefs & are not problematic, evidence to contrary
-Absent insight or delusional beliefs: totally convinced that hoarding related beliefs and behaviors are not problematic due to evidence to contrary

Trichotillomania

A: Essential feature is recurrent pulling out of one's hair causing hair loss
B: Repeated attempts to stop pulling behaviors
C: hair pulling causes significant distress or impairment
D: not attributed to a medical condition or mental disorder

Excoriation Disorder

A: recurrent picking at one's own skin that leads to skin lesions,
B: Repeated attempts to decrease or stop skin picking
C: causes clinically significant distress or impairment
D: Not attributable to physiological effects or substance use
E: Not explained by another mental disorder

Substance/Medication-Induced Obsessive-compulsive disorder

A: obsessions, compulsions, skin picking, hair pulling, or other body-focused repetitive behaviors or other symptoms predominate the clinical picture
B: there is evidence from history, physical exam, or lab findings that both (symptoms of criteria A developed during or soon after substance intoxication or withdrawal or exposure to a medication. Or involved substance/medication is capable of producing the symptoms
C: Disturbance not better explained by obsessive compulsive disorder that is not substance induced
D: disturbance does not occur during course of delusion
E: disturbance causes clinically significant distress or impairment