Obsessive Compulsive and Related Disorders

This set of flashcards provides definitions and explanations of key terms related to Obsessive Compulsive and Related Disorders, aiding in the understanding of various mental health conditions.

Obsessive Compulsive Disorder (OCD)

A mental disorder characterized by obsessions (repetitive, intrusive thoughts) and compulsions (repetitive behaviors or mental acts) performed to reduce anxiety.

Obsessions

Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, causing anxiety or distress.

Compulsions

Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession.

Hoarding Disorder

A condition where individuals have persistent difficulty discarding possessions, leading to clutter that disrupts the intended use of living spaces.

Body Dysmorphic Disorder (BDD)

A mental disorder characterized by preoccupation with perceived defects or flaws in physical appearance that are not observable or appear slight to others.

Trichotillomania

A mental disorder involving the recurrent pulling out of one’s hair, resulting in noticeable hair loss.

Excoriation Disorder

A condition involving recurrent skin picking that leads to skin lesions.

Time-consuming compulsions

Behaviors or mental acts that take more than an hour per day and cause significant impairment in functioning.

Muscle dysmorphia

A specific type of BDD focused on the belief that one’s body build is too small or insufficiently muscular.

Prevalence of OCD

Approximately 1.2\% of U.S. adults experience OCD in a given year, with a lifetime prevalence of around 2.3\%.

Etiology of OCD

Believed to result from a combination of genetic, neurobiological (e.g., abnormalities in brain circuits involving serotonin), and environmental factors (e.g., stressful life events, childhood trauma).

Etiology of Hoarding Disorder

Believed to be influenced by a combination of genetic factors, neurobiological differences (especially in brain regions related to decision-making and emotional regulation), stressful life events, and personality traits like indecisiveness and perfectionism.

Treatment for Hoarding Disorder

Primarily involves specialized Cognitive Behavioral Therapy (CBT), often including Exposure and Response Prevention (ERP), skill training for organizing and decision-making, and sometimes medication, such as SSRIs, particularly if co-occurring conditions are present.

Etiology of Body Dysmorphic Disorder (BDD)

Believed to be influenced by a combination of genetic predispositions, neurobiological factors (e.g., abnormalities in visual processing or serotonin dysfunction), psychological factors (e.g., perfectionism, negative self-esteem), and environmental factors (e.g., teasing, trauma).

Etiology of Trichotillomania

Believed to result from a combination of genetic factors, neurobiological differences (e.g., abnormalities in brain circuits involved in habit formation and impulse control), and environmental or psychological factors (e.g., stress, anxiety, emotional dysregulation).

Diagnostic Features of Obsessive Compulsive Disorder (OCD)

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

OCD Case Vignette 1

Sarah, a 32-year-old accountant, experiences intrusive thoughts about contracting a severe illness by touching doorknobs or shaking hands. These thoughts cause her extreme anxiety. To alleviate this, she washes her hands rigorously, often for 10-15 minutes at a time, and cleans her office desk multiple times a day. This routine takes her upwards of 2 hours daily, making her late for meetings and affecting her productivity. She knows her fears are irrational but feels powerless to stop the compulsions.

OCD Case Vignette 2

David, a 45-year-old teacher, is plagued by persistent doubts about whether he has turned off the stove or locked the front door. Once he leaves his house, he often has to return multiple times to check, sometimes driving back from half an hour away. He also repeatedly checks his grading for errors, spending hours extra on each assignment, even when he knows he's been thorough. These checking rituals consume at least 3 hours of his day, causing him significant distress and making him frequently late for work, impacting his professional and personal life.

Diagnostic Features of Hoarding Disorder

Persistent difficulty discarding or parting with possessions, regardless of their actual value (Criterion A). This difficulty is due to a perceived need to save items and to distress associated with discarding them (Criterion B). The difficulty results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use (Criterion C). The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others) (Criterion D). The hoarding is not attributable to another medical condition (e.g., brain injury, Prader-Willi Syndrome) (Criterion E) and is not better explained by symptoms of another mental disorder (e.g., obsessions in OCD, decreased energy in major depressive disorder) (Criterion F).

Hoarding Disorder Case Vignette 1

Eleanor, a 68-year-old widow, lives in a house so filled with newspapers, old clothes, and packaging materials that she can only navigate narrow pathways between piles. She finds it intensely distressing to throw anything away, fearing she might need it someday or that it holds sentimental value. Her kitchen counters are completely covered, making cooking impossible, and her bed is perpetually laden with stacks of magazines and mail, forcing her to sleep on a recliner. Despite multiple warnings from her local fire department about safety hazards, she remains unable to discard items, which has led to isolation as family and friends refuse to visit due to the unsanitary and impassable conditions.

Hoarding Disorder Case Vignette 2

Mark, a 40-year-old graphic designer, began collecting free promotional items and discarded electronics years ago. He has an entire room in his apartment that is completely inaccessible due to floor-to-ceiling stacks of boxes, broken gadgets, and advertising flyers. He spends hours each day sorting through new acquisitions and organizing them, but never actually discards anything. This has caused significant marital strain, as his wife is frustrated by the lack of usable space and the constant presence of clutter. Mark acknowledges the problems it causes but experiences severe anxiety and a sense of loss at the mere thought of throwing anything away, believing each item might contain a crucial component for a future project or a valuable piece of information.

Diagnostic Features of Body Dysmorphic Disorder (BDD)

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others (Criterion A). 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 one's appearance with that of others) in response to the appearance concerns (Criterion B). The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C). 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 (Criterion D).

Body Dysmorphic Disorder (BDD) Case Vignette 1

Maria, a 22-year-old college student, spends several hours a day analyzing her nose in the mirror, convinced it is too large and crooked, despite friends assuring her it looks normal. She constantly applies makeup to conceal it, often missing classes because she can’t leave the house until she feels it’s adequately hidden. She avoids social gatherings and dates, fearing others are staring at and judging her nose. This preoccupation causes her extreme anxiety and has led to a significant decline in her academic performance and social life.

Body Dysmorphic Disorder (BDD) Case Vignette 2

Michael, a 30-year-old software engineer, is consumed by thoughts that his hair is thinning excessively, even though others perceive his hair as full. He spends over 2 hours daily examining his scalp, trying different hairstyles to cover perceived sparse areas, and searching online forums for hair loss remedies. He constantly seeks reassurance from his partner, who has grown frustrated by his repetitive questions. Michael often feels too self-conscious to attend work events or even go to the gym, believing everyone is noticing his 'baldness,' which significantly impacts his career advancement and personal relationships.

Diagnostic Features of Trichotillomania

1. Recurrent pulling out of one's hair, resulting in hair loss (Criterion A).

2. Repeated attempts to decrease or stop hair pulling (Criterion B).

3. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C).

4. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition) (Criterion D).

5. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder) (Criterion E).

Trichotillomania Case Vignette 1

Emily, a 28-year-old graphic designer, has been pulling out hair from her scalp for several years, resulting in noticeable bald patches that she tries to cover with scarves and elaborate hairstyles. She often finds herself mindlessly pulling when stressed or bored. Despite numerous attempts to stop – including wearing gloves and trying fidget toys – she hasn't been successful. Her struggle with hair pulling causes her immense embarrassment and anxiety, leading her to avoid social gatherings and intimate relationships, significantly impacting her quality of life.

Trichotillomania Case Vignette 2

Daniel, a 19-year-old college student, compulsively pulls out his eyebrows and eyelashes, often while studying or watching TV. He has significant gaps in both, making him feel extremely self-conscious. His friends sometimes comment on his missing eyebrows, which causes him distress. He has tried to grow them back multiple times using various creams and has even made pacts with himself not to pull, but the urge becomes overwhelming. The time spent pulling and the subsequent shame interfere with his concentration in classes and his willingness to participate in extracurricular activities.

Diagnostic Features of Excoriation Disorder

1. Recurrent skin picking resulting in skin lesions (Criterion A).

2. Repeated attempts to decrease or stop skin picking (Criterion B).

3. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C).

4. The skin picking is not attributable to the physiological effects of a substance or another medical condition (Criterion D).

5. The skin picking is not better explained by symptoms of another mental disorder (Criterion E).

Excoriation Disorder Case Vignette 1

Jessica, a 35-year-old accountant, has been recurrently picking at the skin on her arms and face for several years, leading to noticeable sores and scabs. She often picks when she's stressed at work or feeling anxious at home. Despite trying various methods to stop, like wearing bandages or keeping her hands busy with fidget toys, she finds herself unable to resist the urge. This behavior causes her significant embarrassment, leading her to wear long-sleeved clothing even in warm weather and avoid social gatherings, which has impacted her friendships and overall quality of life.

Excoriation Disorder Case Vignette 2

Robert, a 25-year-old student, frequently picks at his cuticles and the skin around his fingernails until they bleed and become infected. He often does this unconsciously while studying or watching TV, but also as a way to cope with boredom or frustration. He has made multiple attempts to stop, applying bitter-tasting polish and trying to consciously keep his hands away from his face, but he always relapses. The constant pain and visible damage to his fingers make him self-conscious, and he often struggles with tasks requiring fine motor skills, affecting his ability to perform well in art classes and his confidence in social interactions.