Chapter 9: Obsessive-Compulsive and Related Disorders
After reading Chapter 9 I should be able to do the following:
Describe how obsessive-compulsive disorders present themselves
Have an understanding of the prevalence (epidemiology) of obsessive-compulsive disorders
Understand the comorbidity for obsessive-compulsive disorders
Describe the causes (etiology) of the disorders
Describe treatment plans for the different disorders
Characteristics
Obsessive-Compulsive Disorder (OCD)
As suggested in the name, for an individual to have OCD, they must experience having obsessions and compulsions.
Obsession = repetitive and persistent thoughts, urges, or visuals; they are also intrusive, time-consuming, and often cause significant stress in a person’s day-to-day life
Compulsion = repetitive behaviors or mental acts that a person performs in response to an obsession; done to alleviate the anxiety associated with obsessive thinking
**A big thing to remember is that obsessions and compulsions take up a large portion of a person’s daily life. Due to this, it unfortunately can cause significant impairment in one’s ability to function daily.
Body Dysmorphic Disorder (BDD)
BDD is a type of obsessive disorder that focuses on a person’s perceived flaws or defects in their physical appearance. What’s important to recognize is that a person’s perceived flaws or defects are not observable to others. Meaning, it is an obsession that is not real and irrational.
Along with obsessions, individuals with BDD do engage in compulsive behaviors in order to relieve their obsessive thoughts. These behaviors take up a considerable amount of a person’s time in their daily life. This behavior must also produce significant impairment in a person’s daily life.
Muscle Dysmorphia
Although not an actual classification, it is a common form of BDD that is prevalent in men. Muscle Dysmorphia deals with the obsession over a person believing that their body is small or that they lack sufficient muscle definition.
**some studies found that there is a higher use of substance abuse, poorer quality of life, and an increased report of suicide attempts
Hoarding
The major feature of a Hoarding Disorder is that there is a persistent over-accumulation of possessions. These individuals continue to accumulate items without giving them away, regardless of the item’s value or sentiment. This obsession happens for a long period of time and cannot be explained by a recent stressor.
There is a fear of losing valuable information and fear of being wasteful. People with the disorder experience significant distress when asked to clear out their possessions. The hoarding behaviors impair daily functioning as it can impact their social and occupational life.
Epidemiology
Prevalence rate for the disorders:
OCD → 1.2% in the US
2/3rds of individuals with OCD had symptoms present before the age of 15.
BDD → 2.4% in the US
despite differences, symptoms across races and cultures are similar
women are more likely than men to be diagnosed
general symptoms appear to be similar across genders
Hoarding → clinically significant in 2-6%
males report a higher incidence of behaviors according to epidemiological studies
women are more likely to according to clinical samples
older individuals are 3x more likely to be diagnosed
Comorbidity
For OCD, there is a high rate for comorbidity with anxiety related disorders (about 76%). Nearly 41% of those with OCD will also be diagnosed with MDD. There is also a high comorbidity with tic disorders, and a strong triad with OCD, tic disorder, and ADHD. There are also several disorders like schizophrenia where there is a higher incidence of OCD than the general public.
While research is still in the making, people with BDD have MDD as the most common comorbid psychological disorder. MDD typically occurs after the onset of BDD. There are also reports of social anxiety, OCD, and substance-related disorders.
Hoarding has an extremely high comorbidity with other mood and anxiety disorders. 75% of people meet the criteria for MDD, social anxiety disorder, or generalized anxiety disorder. 20% of people also meet the criteria for OCD.
Etiology
Biological
genetics plays a big role in obsessive and compulsive behaviors
there is a strong role of inheritance when it comes to the development of obsessions and compulsions
serotonin is a contributing factor to obsessions and compulsions
the orbitofrontal cortex, caudate nuclei, and thalamus relate to OCD
Cognitive
individuals with OCD are more likely to overestimate the probability of harm, loss of control, or uncertainty in life
people with OCD experience a disconfirmation bias
people with OCD also report an inability to trust themselves and their instincts
Behavioral
compulsions most likely develop due to classical conditioning
as the obsession is experienced, a compulsion happens to neutralize the obsession creating a sense of relief
this action becomes reinforced over time which develops into a compulsion
Treatments
OCD
Exposure and Response Prevention (ERP)
individuals are repeatedly exposed to their obsession, causing anxiety/fear, while also simultaneously prevented from being able to engage in compulsive behavior
Psychopharmacology
medication alone is not recommended to treat those with OCD
there is some promise when medication is paired with ERP
**it is worth mentioning, however, that medication has no added benefit to treatment care
BDD
the same treatments used to treat OCD are also effective in treating BDD
Exposure and response prevention and psychopharmacology (clomipramine and SSRIs)
some individuals seek plastic surgery to correct their perceived defects
**despite this, many individuals report feeling unsatisfied even after surgery and some may seek additional surgery to correct the same defected area
Hoarding
individuals often go through a combination of exposure treatment and cognitive-behavioral therapy
individuals with hoarding disorder engage in complex decision making
oftentimes they overanalyze the value of items
cognitive restructuring and motivational interviewing are done to address the decision making
discuss motives for keeping items and fears associated with discarding items
unfortunately, the fear associated with discarding items causes patients with hoarding disorder to abandon treatment