Prelim 3- OCD related disorder

What are the cores of OCD?

• presence of obsessions, compulsions 

• an obsession is an intrusive thought that cannot be easily dismissed 

• compulsion is a behavior that helps dismiss it

Body Dysmorphic Disorder

share patterns and behavioral responses with OCD

Hoarding Disorder

share cognitive patterns with OCD

Trichotillomania and Excoriation Disorder

share repetition behaviors with OCD

Body Dysmorphic Disorder 

• perceived defects or flaws in physical appearance 

• repetitive behaviors (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts in response to the appearance concerns 

Body Preoccupations

• usually, more than 1 region of the body is seen as flawed

• common areas are nose, face, skin, hair, stomach

• concerns may involve size, texture, symmetry, color, shape

• concerns are often very specific not perceived by others or not viewed as significant as they are to the person

• people believe them: very time consuming and spend hours a day

Are body preoccupations intense?

• a delusion is a strong persistent conviction that does not change, even if there is significant evidence that it is not true

  • body preoccupations in BDD are often considered delusional

• people respond in a variety of ways— most often by checking their perceived flaws in the mirror, asking other for reassurance, or engaging in elaborated social comparisons

• unlike OCD, where response behaviors alleviated distress, in BDD they often worsen the distress associated with the perceived flaws

delusion

• a strong persistent conviction that does not change, even if there is significant evidence that it is not true

Onset and Trajectory of BDD

• can start at any age, even as young as 4/5, commonly emerges during adolescence

• emerges slowly, moving from a general dislike of the body part and worsening into full BDD in 4-5 years

• prevalence is believed to be 2-3% of population

• recurrent; people may have periods of remission but often returns

Is BDD a eating disorder?

• no, considered different from an eating disorder, because perceived flaws do not center on weight and fatness 

• subset of people with BDD show muscle dysmorphia 

Muscle Dysmorphia

• belief that body is too lean and muscles are not sufficiently developed 

• can occur even when muscles are quite obvious 

• extreme exercise, protein-heavy diets, steroids

Treatment for BDD

• mirror retraining

• EX/RP: exposure to situations that usually bring on thoughts of bodily flaws

Mirror retraining

• either avoid or spend hours looking at them

• this treatment involves looking in the mirror from a distance taking the entirety of the body

• tracking the thoughts that occur and working to reframe them

Trichotillomania 

• recurrent pulling of one’s hair 

• attempts to decrease pr stop hair pulling 

2 types of pulling

• automatic

• focused

• most do both

automatic pulling 

tendency to pull hair unintentionally, almost without any awareness of the action

focused pulling

intentional hair pulling; occurs either in reaction to stress or distress or people search for a hair that feels different or wrong

What is the prevalence and trajectory of Trichotillomania 

• 2-3%

• adolescence

• women seem to develop at younger ages 

• 25% experience natural recovery 

• share numerous similarities with excoriation disorder 

excoriation disorder

• recurrent skin picking

• attempts to decrease

• something is “wrong or different” on the skin

• can lead to hospitalization

types of picking

• automatic": trancelike state

• focused

Habit Reversal Training 

• form of CBT

• awareness training: helps figure out when they are most likely to pick or pull and what sensations or urges precede picking and pulling 

• identify competing response that can be done instead 

• identify social supports 

• good for automatic picking / pulling

Acceptance and Commitment Therapy

• 3rd wave CBT

• beneficial for focused pulling/picking

• helps people observe and accept urges

• recognizes that urges may always be present

• develop discomfort with the urge without the engaging behavior

Hoarding Disorder

• difficulty discarding or parting with possessions

• perceived need to save items and distress associated with discarding them

• congest and clutter active living areas and substantially compromises their intended use

Why do people hoard?

• can be useful someday

• emotional attachment

• thinks objects reflect who they are as people

• avoid being wasteful

• good feeling: pleasure, satisfaction, security from holding on to objects

prevalence of hoarding disorder

• 2-6% 

• comorbid with MDD: 50%