AP OCD & Feeding and Eating Disorders (Week 9)

Obsessions

Recurrent, persistent, invasive thoughts or images which are unwanted and that the person has difficulty controlling

Compulsions

Repetitive behaviors an individual feels compelled to perform in response to an obsession or rigid rules

Obsessive-Compulsive Disorder

• Presence of obsessions, compulsions, or both

• Time-consuming or causes clinical distress

• Insight amount varies (specifier)

• Thoughts and behaviors are often kept secret for long periods of time (shame)

• Rule outs: obsessive-compulsive personality disorder, psychosis, anxiety disorders

Genetics of OCD

• 25% have an immediate family member with OCD

• 35-65% have a twin with OCD

6 types of dysfunctional beliefs associated with OCD

1. Inflated responsibility: causing or preventing negative outcomes

2. Thought-action fusion: bad thought influences outcome 

3. Control of thoughts: beliefs that it is essential and possible to have total control over one’s thoughts 

4. Overestimation of threat: probability and severity

5. Perfectionism 

6. Intolerance for uncertainty: belief that it is essential and possible to know without doubt about negative events 

OCD’s cycle 

Obsessions —> Distress —> Urge to neutralize distress —> Compulsions —> Temporary relief 

Body Dysmorphic Disorder

Preoccupation with I + perceived defects/flaws in physical appearance that are not observable or appear slight to others 

Preoccupation is grossly out of proportion to the actual defect

A person with body dysmorphic disorder may engage in…

repetitive behaviors (mirror checking, excessive grooming, skin picking, etc.) or comparing themselves to others in response to the preoccupation 

Common symptoms of body dysmorphic disorder

• persistent avoidance of mirrors 

• incessant seeking of reassurance about appearance 

• engaging in ritualistic behaviors that disrupt daily life 

Hoarding Disorder

• Persistent difficulty parting with possessions, regardless of actual value 

• Perceived need to save items & distress discarding them 

Hoarding Disorder Etiology

• Typical onset: around ages 15 to 19

• Tends to worsen with age 

• More common in older adults than in younger adults 

• Family History: There is a strong association between having a family member who has hoarding disorder and having the disorder yourself 

Feeding and Eating disorders

• Pica 

• Rumination disorder

• Avoidant/restrictive food intake disorder 

• Anorexia nervosa 

• Bulimia nervosa 

• Binge-eating disorder 

• Other specified

• Unspecified

History of ___, ___. and ___ is apart of the etiology of eating disorders

• Physical & sexual abuse

• Neglect

• Medical conditions ( gastrointestinal conditions)

Pica

• Persistent eating of nonnutritive, nonfood substances

• Inappropriate to the developmental level of the individual

Duration of Pica

At least one month

Rumination Disorder

• Repeated regurgitation of food ( re-chewed, re-swallowed, or spit out) 

• Does not occur in the course of other eating disorders

Duration of rumination disorder

At least one month

Avoidant/Restrictive food intake disorder

• Apparent lack of interest in eating/food

• Avoidance based on sensory characteristics of food

• Concern about the aversive consequences of eating 

Anorexia Nervosa

• Restriction of energy intake relative to requirements 

• Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain 

• Significant disturbance in perception of body weight or size 

• Persistent lack of recognition of the seriousness of the current low body weight 

Subtypes of Anorexia Nervosa

• Restricting type: last 3 months; no binging/purging; weight loss is accomplished through dieting, fasting, and/ or excessive exercise

• Binge-eating/Purging type: last 3 months; recurrent episodes of bingeing/purging 

Bulimia Nervosa

• Recurrent episodes of “binge eating”

  • Eating in a period of time, an amount of food that is larger than what most individuals would eat in a similar period of time under similar circumstances 

• A sense of a lack of control overeating behaviors during the episode 

• Recurrent inappropriate compensatory methods to prevent weight gain 

  • self-induced vomiting, laxatives, excessive exercise 

How is Binge-Eating disorder defined?

• episodes are associated with 3+ of the following: eating more rapidly than normal, until you are uncomfortably full, eating a lot when not physically hungry, eating alone because embarrassed by eating behaviors, feeling disgusted, depressed, or guilty about eating behaviors 

• Marked distress regarding binge eating 

• At least 1x/week for 3 months 

Anorexia nervosa ( binge-eating/purging type) vs. Bulimia 

• Individuals with bulimia nervosa maintain body weight at or above a minimally normal level 

• When binge-eating behavior occurs only during episodes of anorexia nervosa, individuals are given the diagnosis of anorexia nervosa (binge-eating/purging type) and should not be given the additional diagnosis of bulimia nervosa 

Binge-eating disorder vs. Bulimia

• Binge-eating disorder has the absence of inappropriate compensatory behaviors

• Binge-eating do not show marked or sustained dietary restriction designed to influence body weight and shape 

ARFRID vs Anorexia Nervosa 

• AFRID: no fear of gaining weight/becoming fat, nor do they have a disturbance in the way they experience their body shape and weight