Obsessive-Compulsive and Related Disorders

Obsessions

are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

compulsions

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

Obsessive-compulsive disorder

is defined by the occurrence of both obsessive thoughts and compulsive behaviors performed in an attempt to neutralize such thoughts

1

The obsessions or compulsions are time-consuming (e.g., take more than ____ hour per day)

With good or fair insight

The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight

The individual thinks obsessive-compulsive disorder beliefs are probably true

With absent insight/delusional beliefs

The individual is completely convinced that obsessive-compulsive disorder beliefs are true

Body Dysmorphic Disorder

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

repetitive behavior, mental acts

In BDD, the individual performs ________ (e.g., mirror checking, grooming, skin picking, reassurance seeking) or ______________ (e.g., comparing appearance with others) in response to appearance concerns.

With muscle dysmorphia

The individual is preoccupied with the idea that their body build is too small or insufficiently muscular, even if other body areas are also involved.

Body Dysmorphic Disorder by proxy

It is a form of Body Dysmorphic Disorder in which the individual is preoccupied with perceived defects in another person’s appearance, most often a significant other, but sometimes a parent, child, sibling, or even a stranger.

Koro

a culturally related disorder that usually occurs in epidemics in Southeastern Asia, consists of a fear that the penis (labia, nipples, or breasts in females) is shrinking or retracting and will disappear into the abdomen, often accompanied by a belief that death

Hoarding Disorder

Persistent difficulty discarding or parting with possessions, regardless of their actual value

save

In hoarding disorder, This difficulty is due to a perceived need to ____ the items and to distress associated with discarding them

With excessive acquisition

If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space

With good or fair insight

The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

With poor insight

The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary

With absent insight/delusional beliefs

The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary

Clutter

is defined as a large group of usually unrelated or marginally related objects piled together in a disorganized fashion in spaces designed for other purposes

Animal hoarding

can be defined as the accumulation of a large number of animals and a failure to provide minimal standards of nutrition, sanitation, and veterinary care, as well as failure to act on the deteriorating condition of the animals

Trichotillomania

Recurrent puling out of one’s hair, resulting in hair loss.

scalp, eyebrows, and eyelids

the most common sites in trichotillomania are the

Excoriation

Recurrent skin picking resulting in skin lesions.

Body dysmorphic–like disorder with actual flaws

This is similar to body dysmorphic disorder except that the defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than “slight”). In such cases, the preoccupation with these flaws is clearly excessive and causes significant impairment or distress.

Body dysmorphic–like disorder without repetitive behaviors

Presentations that meet body dysmorphic disorder except that the individual has never performed repetitive behaviors or mental acts in response to the appearance concerns.

Obsessional jealousy

characterized by nondelusional preoccupation with a partner’s perceived infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity concerns

Other body-focused repetitive behavior disorder

Presentations involving recurrent body-focused repetitive behaviors other than hair puling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are accompanied by repeated attempts to decrease or stop the behaviors and that cause clinicaly significant distress or impairment in social, occupational, or other important areas of functioning.

Olfactory reference disorder

characterized by the individual’s persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is unnoticeable or only slightly noticeable to others

Shubo-kyofu

A variant of taijin kyofusho that is similar to body dysmorphic disorder and is characterized by excessive fear of having a bodily deformity

exposure and response prevention

most effective treatment for OCD, involves having individuals with OCD repeatedly expose themselves (either in guided fantasy or directly) to stimuli that provoke their obsessions (e.g., for someone with contamination fears this may involve touching a toilet seat in a public bathroom)

clomipramine and fluoxetine

OCD seems to respond best to medications that affect the serotonin system. These medi cations, such as