Module 7 – OCD & Related Disorders

Obsessions

Recurrent, persistent thoughts, images, or urges that are intrusive, inappropriate, or cause distress/anxiety.

Compulsions

Repetitive behaviors or mental acts performed in response to an obsession or rigid rules aimed at reducing distress or preventing a dreaded event.

Example of Obsession

Fear of contamination, aggressive impulses, immoral thoughts, or sexual images.

Example of Compulsion

Repeated handwashing, checking locks/lights, counting, or mental rituals.

Relationship Between Obsessions and Compulsions

Compulsions temporarily relieve the anxiety caused by obsessions, reinforcing the behavior.

Do you need both obsessions and compulsions for diagnosis?

No — either obsessions or compulsions (or both) can be present in OCD.

Magical Thinking

Belief that one’s thoughts or actions can cause or prevent unrelated events (common in OCD).

Negative Effects of OCD

Causes distress, consumes time, and leads to social or occupational impairment.

Difference Between Obsessions and Worries

Worries are more realistic, triggered by specific events, and verbal; obsessions are bizarre, image-based, and untriggered.

Lifetime Prevalence of OCD

2–3%.

Average Age of Onset of OCD

Around 19 years old.

Course of OCD

Chronic — only about 20% remit after 40 years.

Common Comorbidities with OCD

Depression, other anxiety disorders, eating disorders.

Genetic Risk for OCD

About 40% heritability; twice as common with a first-degree relative with OCD.

Neurobiological Explanation of OCD

Imbalance in cortico-basal ganglionic-thalamic circuits (especially orbitofrontal cortex and caudate nucleus).

Neurotransmitter Implicated in OCD

Serotonin — medications that increase serotonin (SSRIs) help reduce symptoms.

Behavioral Theory of OCD

Classical conditioning pairs neutral objects with fear; operant conditioning (negative reinforcement) maintains compulsions by reducing anxiety.

Preparedness Theory

Certain fears (e.g., contamination) are evolutionarily adaptive, making them more common in OCD.

Cognitive Theory of OCD

People have rigid, moralistic thinking, overestimate responsibility, and believe they should control all thoughts.

Thought–Action Fusion

Belief that thinking about an action is morally equivalent to doing it (“If I think it, I’ll do it”).

Example of Thought–Action Fusion

Believing that thinking about harming someone makes you likely to do it.

Biological Treatments for OCD

SSRIs, tricyclic antidepressants, and deep brain stimulation for treatment-resistant cases.

Exposure and Response Prevention (EXRP)

Treatment involving exposure to feared thoughts/situations while preventing compulsive behavior to reduce anxiety over time.

Example of EXRP

Having someone afraid of germs eat food in a waiting room without washing their hands.

Effectiveness of Treatments for OCD

EXRP/CBT is more effective than antidepressants; adding medication doesn’t significantly improve outcomes.

Response Rates for OCD Treatments

Therapy 62–68%, medication 33%, placebo 27%

Body Dysmorphic Disorder (BDD)

Preoccupation with perceived physical defects; repetitive behaviors like mirror checking or grooming.

Persistent difficulty discarding possessions regardless of value, leading to cluttered living spaces and distress.

Hoarding Disorder

Recurrent pulling of one’s hair causing hair loss, often preceded by tension and followed by relief.

Trichotillomania (Hair-Pulling Disorder)

Repeated skin picking causing lesions and distress, often beginning around puberty.

Excoriation (Skin-Picking) Disorder

BDD Risk Factors

History of teasing/criticism about appearance, focus on facial details over global features, and low self-worth based on appearance.

Example Scenario – Identify the Disorder: A patient checks the stove 20 times before leaving the house because they fear it might explode.

Compulsion associated with OCD.

Example Scenario – Identify Treatment Target: A patient who avoids touching doorknobs to prevent contamination.

Exposure target for EXRP.

Example Scenario: A client spends hours checking the mirror, convinced their nose is disfigured despite reassurances.

Body Dysmorphic Disorder.

Example Scenario –An individual’s home is filled with clutter due to inability to throw anything away.

Hoarding Disorder