Obsessive-Compulsive & Related Disorders

Obsessions

Excessive, intrusive thoughts, impulses or images causing anxiety & distress

Common obsessions (OCD)?

• Fear of contamination

• Pathologic doubt

• Need for symmetry/completion

• Thoughts of harming others

• Sexual intrusive thoughts/images

Compulsions

Repetitive behaviors & mental acts performed in a ritualistic fashion

Common compulsions?

Handwashing, excessive cleaning, checking, arranging things, counting, hoardin’

OCD diagnostic criteria – core features?

Recurrent obsessions/compulsions

1 hr/day

Cause significant distress Not due to substances/other disorders

Insight in OCD?

• Some recognize thoughts are excessive/unreasonable

• Others have limited insight but still perform behaviors

Compulsions – key features?

• Done to reduce anxiety

• Repetitive acts/mental rituals

• Time-consuming

Obsessions – common themes?

• Contamination (most common)

• Doubts/taboo thoughts

• Responsibility for harm

• Need for symmetry/completeness

• Intrusive, unwanted thoughts

Other OCD-related patterns?

• Cyberchondria (excessive health searching)

• Scrupulosity (hyper-religiosity)

OCD medication interventions – key points?

• SSRIs + CBT (ERP)

• Continue meds 1–2 years if effective

• TCA: Clomipramine

OCD inpatient interventions (key points)?

• Initially do NOT stop rituals

• Recognize meaning of rituals & empathize

• Set reasonable limits & expectations

What is trichotillomania?

Compulsive hair pulling causing noticeable hair loss.

What is excoriation disorder?

Compulsive skin picking that causes tissue damage.

What is body dysmorphic disorder?

Preoccupation with perceived defects in appearance causing distress.

What is hoarding disorder?

Persistent difficulty discarding items regardless of value, leading to clutter.