Chapter 11: Obsessive Compulsive and Related Disorders

What 2 things do Obsessive Compulsive Disorder (OCD) and related disorders all have in common?

1. Obsessive preoccupation/thoughts

2. Repetitive behaviors or mental acts to reduce anxiety

What are the 4 disorders related to Obsessive Compulsive Disorder (OCD), and what are their:

1. Obsessive preoccupations/thoughts

and their

2. Repetitive behaviors or mental acts?

1. Body Dysmorphic Disorder

   → Preoccupation: perceived flaws in physical appearance

   → Repetitive Behavior: mirror checking, excessive grooming, and comparisons

2. Hoarding Disorder

   → Preoccupation: discarding or parting with possessions

   → Repetitive Behavior: accumulation of possessions to the point of clutter and disuse

3. Trichotillomania

   → Preoccupation: non-specific tension or urge

   → Repetitive Behavior: hair pulling

4. Excoriation

   → Preoccupation: act of skin picking

   → Repetitive Behavior: skin picking

Is Obsessive Compulsive Disorder (OCD) an anxiety disorder?

No

What 2 things is Obsessive Compulsive Disorder (OCD) characterized by?

1. Obsessions: intrusive and unwanted nonsensical and irrational thoughts or urges one tries to resist

2. Compulsions: behaviors designed to suppress the obsessive thoughts and provide relief

Is the relief provided by compulsions long-term?

No, relief is immediate but short-term

Do people with Obsessive Compulsive Disorder (OCD) only have to perform their compulsions once?

No, they will perform the compulsions over and over and over again until they feel that they got it “just right”

In order to be diagnosed with Obsessive Compulsive Disorder (OCD), a person’s obsessions and compulsions must cause:

1. Distress

2. Impairment

3. Or???

Someone to spend 1 hour or more on their compulsions each day

What are the 3 insight specifiers for Obsessive Compulsive Disorder (OCD) in the DSM?

1. Good insight: “I know it’s 100% irrational”

2. Poor insight: “I’m pretty sure it’s irrational…”

3. Absent insight: “My obsessions and compulsions are 100% real” (delusions)

Do most people with Obsessive Compulsive Disorder (OCD) have good insight?

Yes!

What is the range of prevalence rates for Obsessive Compulsive Disorder (OCD)?

Between 1% and 2.5%

Is Obsessive Compulsive Disorder (OCD) more common in males or females?

OCD is 2x more common in males

What is the average age of onset for Obsessive Compulsive Disorder (OCD)?

Between 9 and 12 years old

What are the 2 peak age ranges of Obsessive Compulsive Disorder (OCD) onset?

1. Between 6 and 10 years old

2. Between 13 and 14 years old

What is the golden standard of treatment for Obsessive Compulsive Disorder (OCD)?

Exposure and Response Prevention (ERP)!

How does Exposure and Response Prevention (ERP) work to treat Obsessive Compulsive Disorder (OCD)?

1. Trigger and expose obsessions

2. Prevent compulsive behaviors

3. Make them sit with their anxiety until it goes away

How do people with OCD respond to Exposure and Response Prevention (ERP) at first?

Their anxiety increases dramatically and can take hours to go away

→ Teaches them that their anxiety cannot cause them long term harm or danger, and that their anxiety will eventually go away

How might Exposure and Response Prevention (ERP) treatment be applied to someone with an obsession of cleanliness whose repetitive behavior is taking 2+ hour long showers?

Tell them they will only be allowed to take a shower for 10 minutes and then shut the water off

What type of medication is the most common and most effective in treating Obsessive Compulsive Disorder (OCD)?

SSRIs!

What disorders are most commonly comorbid with Obsessive Compulsive Disorder (OCD)?

Anxiety disorders and depressive disorders

Is there one cause of Obsessive Compulsive Disorder (OCD)?

No! There are many pathways to develop OCD, including:

1. Genetic and neurobiological risk

2. Temperament

3. Family influences

4. Environmental factors

5. Learned behaviors