Week 6: OCD

How do we know when a person has OCD?

“Step on a crack, break your mother’s back.” People who considered obsessive or compulsive are not the same as those who have obsessions or perform compulsions. Obsession is a personality style, while obsessive represents a mental disorder that is often debilitating. This disorder and related conditions within this spectrum include syndromes where symptoms tend to cluster together and can lead to significant dysfunction in occupational, social, or some other life function.

What are the obsessive compulsive disorders?

Obsessive-Compulsive Disorder 300.3 (F42)

Body Dysmorphic Disorder 300.7 (F45.22)

Hoarding Disorder 300.3 (F42)

Trichotillomania (Hair Pulling) Disorder 312.39 (F63.2)

Excoriation (Skin-Picking) Disorder 698.4 (L98.1)

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder 292.89 (F15.88)

Obsessive-Compulsive and Related Disorder due to Another Medical Condition 294.8 (F06.8)

Other Specified Obsessive-Compulsive and Related Disorder 300.3 (F42)

Unspecified Obsessive-Compulsive and Related Disorder 300.3 (F42)

What is Obsessive-Compulsive Disorder 300.3 (F42)?

People with this are plagued with unwanted and recurrent obsessions or compulsions or both. We all have some obsessions: (Can’t get a particular song out of your head, worry that you may not have locked the front door, worry that you may not have turned off the stove). People with this who have to fight the thoughts every minute of the day, which are: (Recurrent and persistent, Intrusive and unwanted, Time consuming and cause significant distress or impairment). The obsessions take over people’s lives.

What is the OCD Prevailing pattern?

This occurs in 1.2% of the US population within a 12-month period. Females are slightly more affected than males. However, male children have a slightly higher incidence than female children.

What is the OCD Differential Assessment?

It has two components: Obsessions (which are thoughts, doubts, ideas) and Compulsions (which are activities that a person engages in to stop the obsession). The obsessions or compulsions are time consuming and cause distress in social, occupational, or some other important life role functioning.

What are obsessions?

Thoughts, doubts, ideas; they are typically automatic, frequent, distressing for the person, and difficult to control or extinguish. They are distinguished by: (Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress, The person attempts to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action). It causes impairment

What are the different kinds of obsessions?

The most prevalent is associated with symmetry - Having things aligned in a certain way: (Having pictures on a wall in a particular position, Lining up the silverware in a drawer, Doing something in a specific way). The second most prevalent is having forbidden thoughts or actions - Fears of: (Injuring a person while driving - big one, Shouting obscenities, Sexual thoughts). The third most prevalent is obsession in cleaning and a fear of contamination that leads to washing rituals.

What are compulsions?

They are about doing. They refer to the specific actions that the person performs, usually repeatedly, in an attempt to make the obsessions go away - Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The act doesn’t have to line up with the obsession, although it can. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation (HOWEVER!! These behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or they can be considered clearly excessive).

What repetitive acts would we see with OCD?

Hand washing, checking, counting objects a precise number of times, or silently repeating words over and over. (It doesn’t have to be related to obsession). The person may feel compelled to count, to touch, to check, to wash, to buy, and/or to have everything lined up in a perfect order. Some compulsions are relatively simple, such as speaking or thinking a word or phrase to protect against an obsessive thought. Others may be very elaborate, such as washing dishes in a very particular way, dressing is specific clothes, or placing items around the room in exact and complex patterns.

What are OCD Symptoms?

A need for both sides of the body to feel even. A need to do everything perfectly so that terrible things will not happen. A need to prevent contamination (usually by dirt or germs) be repeated hand washing. A strict need for order and symmetry. A need to banish sexual thoughts because sex is perceived as “indecent.”

What are OCD specifiers?

With good or fair insight - The person is able to recognize the obsession-compulsive disorder beliefs are definitely not true or that they may not be true. With poor insight - The person things OCD beliefs are probably true. With absent insight/delusional beliefs - The person is completely convinced that OCD beliefs are true. Also included for OCD is a tic-related specifier.

What is specific for children with OCD?

Some kids will outgrow it

What is Body Dysmorphic Disorder 300.7 (F45.22)?

Enrico Morselli, in the 19th century referred to specifiable behaviors that described an ‘attitude’ toward parts of oneself and/or one’s body and often referred to and an imagined ugliness. The disorder seems to exist around the world. The person is hung up on a specific part or parts of the body they find somehow revolting.

What is dysmorphophobia?

Fear of being ugly.

What is the BDD Prevailing Pattern?

Tends to develop around the age of 16 to 17. Median age of onset is 15 years. Slightly more prevalent in females (2.4%) than in males (2.2%)

What is BDD Differential Assessment?

Remember: The person is preoccupied about some IMAGINED body defect - Virtually any body part can be the focus of concern. The focus is typically on the shape, size, or appearance of some part of the body. Many people become fixated on mirrors. Many will avoid mirrors believing they’re too grotesque. The concern is GROSSLY exaggerated and well in excess of what is considered normal - The person appears perfectly normal to others.

What will people do when they have BDD?

The person who addresses one part (e.g., plastic surgery to the nose) may go on to become obsessed with another body part (e.g., lips or eyes). The person may use excessive amounts of makeup, clothing, or hats. They tend to withdraw from most social and occupational activities and even become housebound. Most often, both men and women seek out plastic surgery or dermatological interventions, which do little to change the person’s perceptions about the defect. Significant impairment in important social, academic, or occupational areas of one’s life.

What does BDD preoccupation include?

Extreme self-consciousness and embarrassment, Excessive importance given to appears in self-evaluation, Avoidance of activities, Body camouflaging, and A pattern of ongoing body checking.

How does anorexia relate to BDD?

People with Anorexia Nervosa have a pervasive concern with the shape and size of their bodies and want to be absolutely thin rather than to address body shape as in BDD.

What are the most common symptoms that social workers will encounter in BDD?

involve facial flaws such as wrinkles, spots and/or texture of the skin, excessive facial hair, and the shape of certain features (e.g., the nose, jaw, moth, eyes).

What do women focus on in BDD?

more varied areas of the body such as the size of their hips and the texture of their skin, breast size, and the shape of their legs.

What do men focus on in BDD?

more concerned about their genitals, body height or build, and either excess hair or thinning hair.

What is muscle dysmorphia?

Some people are very focused on muscle defects; it is a diagnostic specifier. The person may spend many hours in the gym in lieu of both social and occupational pursuits.

What is Hoarding Disorder 300.3 (F42)?

The person whose house is filled floor to ceiling with junk. The person has difficulty discarding or parting with any possessions regardless of their value because of sentimental attachment or the possessions may come in handy some day. Countertops, sinks, stairways, the stove, desk, and virtually all surfaces are packed with stuff. The clutter spreads to the garage, cars, and even into the yard. Someone with the disorder does not see this as a problem. We may see neurological signs as well including slower and more variable reaction times, increased impulsivity, and decreased spatial attention. Can be a public health issue. 

What is the hoarding Disorder Prevailing Pattern?

The 4th most common obsession. Symptoms usually start with clutter and a difficulty discarding things – often during adolescence - This begins to interfere with daily functioning in the mid-20s. Significant impairment becomes apparent around the mid-30s. By middle age, symptoms are often quite severe - We don’t know much about prevalence. But, the symptoms are about 3x more prevalent in older adults.

What is Hoarding Disorder Differential Assessment?

The defining feature: the individual’s persistent difficulties discarding possessions regardless of their actual value because of a perceived need to save them or sentimental attachment - Some may consider an item too big of a bargain to simply throw away. Some items may seem useless - Napkins or old menus. Things get lost in the clutter, and organization becomes a challenge - Fire and tripping hazards & Health code violations. Some people may feel ashamed and embarrassed about how they live and not want anyone to enter their home, thus limiting social interactions - They are often in debt & Family strain and loneliness are common. Some people with hoarding often do not see it as a problems, which makes the assessment very challenging.

What should we look for regarding hoarding disorder?

depression, anxiety, ADHD, alcohol use disorder. A stressful life event, such as the death of a loved on (and possibly inheriting the loved one’s possessions) can also trigger or aggravate this. The disorder is most often associated with OCD. Someone with schizophrenia spectrum and other psychotic disorders may accumulate items, but this can be attributed to the person’s delusions or negative symptoms. Significant impairment in important social, academic, or occupational areas of one’s life.

What is Trichotillomania Disorder 312.39 (F63.2)?

Involves the recurrent pulling out (or twisting) of one's own hair, resulting in hair loss. Hair may be targeted from just about any part of the body where hair grows, most commonly the scalp, eyebrows, and eyelids. Patterns may vary ranging from brief episodes throughout the day to or sustained periods of several hours during the day. The person may try to cover up or camouflage the hair loss. Look for trauma - bullied in school, rough home life? Is this a form of self-harm?

What is Trichotillomania Disorder Prevalence?

Roughly 1 to 2%. Females are more likely affected than males by a ratio of 10:1!!! Most commonly occurs with major depressive disorder, excoriation disorder. Significant impairment in important social, academic, or occupational areas of one’s life.

What is Excoriation Disorder 698.4 (L98.1)?

Recurrent skin-picking, most commonly on the arms, face, and hands resulting in skin lesions/scarring. Most people pick at their skin with their fingernails but they may also use tweezers, pins, or other objects. The person may try to conceal or camouflage lesions with makeup or clothing.

What is the Excoriation Disorder Prevailing Pattern?

Affects 1.4% of the general US population and is more common in individuals with OCD and their first-degree family members. Females constitute 75% of those affected. While onset may occur at any age, it most frequently coincides with the onset of puberty. There can be associated rituals, such as looking for a particular kind of scab to pull, and/or examining, playing with, or swallowing the skin.

What is Excoriation Disorder Highly comorbid with?

OCD, trichotillomania, and major depressive disorder. Significant impairment in important social, academic, or occupational areas of one’s life.

What is Substance/Medication-Induced Obsessive-Compulsive and Related Disorder 292.89 (F15.88)?

Here, we have a substance or a medication that is causing the obsessions and compulsions!! The disturbances do not occur during the course of delirium. So, make sure the person’s obsessions or compulsions were not present before using the drug or medication thought to be responsible. Here, the substance/medication-induced is considerably more serious and difficult for the person to control.

What are the substance/medication-induced OCD specifiers?

“With onset during intoxication” when the person is intoxicated or “With onset during withdrawal” when the person develop during or shortly after withdrawal or“With onset after medication use”

What is Obsessive-Compulsive and Related Disorder due to Another Medical Condition 294.8 (F06.8)?

We note if the symptoms appear after the onset of another medical disorder. Can result from certain disorders such as pediatric autoimmune disorder.

What is Other Unspecified Obsessive-Compulsive and Related Disorder 300.3 (F42)?

Used in situations in which the symptoms do not meet all of the criteria of an obsessive compulsive or related disorder and the clinician does not have sufficient information to make a more specific diagnosis.

What are the other specified reasons for Other Specified (Obsessive-Compulsive and Related Disorder 300.3 (F42)?

We would indicate the reasons for using this diagnosis such as: (Body dysmorphic-like disorder with actual flaws: the preoccupation becomes obsessive and interferes with daily functioning. Body dysmorphic-like disorder without repetitive behaviors. Body-focused repetitive behaviors (nail biting, lip biting, self-pinching, cheek chewing), which have resulted in failed attempts to extinguish or reduce the behaviors. Non-delusional obsessional jealousy, which involved a preoccupation with thoughts that one’s partner is involved in infidelity and may lead to repetitive behaviors (checking, calling, etc. - takes a life of its own) Koro: An intense anxiety that the penis will recede into the body (in females the belief of the vulva or nipples). Shubo-kyofo (Intense fear of having a deformity; similar to body dysmorphic disorder) or Jikoshu-kyofu (olfactory reference syndrome), an intense fear of having a foul body odor.