OCD

3.1: Nature and diagnostic criteria for obsessive-compulsive disorder (OCD).
3.2: Epidemiology and aetiological accounts of OCD.
3.3: Contemporary treatment approaches to OCD.
3.4: Nature and diagnostic criteria for related disorders (hoarding disorder, body dysmorphic disorder, trichotillomania, excoriation disorder).

History of OCD: Initially viewed as an anxiety disorder; now classified separately in the DSM-5.
Diagnostic Criteria (DSM-5):
- Criterion 1: Presence of obsessions (intrusive thoughts, impulses) and/or compulsions (repetitive behaviors).
- Criterion 2: Symptoms cause significant distress, time-consuming (>1 hour/day), or interfere with daily functioning.
- Criterion 3: Symptoms not due to substance use or medical condition.
- Criterion 4: Symptoms not aligned with another disorder (e.g., excessive appearance concern in body dysmorphic disorder).
- Insight Specifier: Levels of insight regarding OCD beliefs (good, poor, absent).

Diverse Manifestations: Content of obsessions can vary widely: fears of contamination, harm, blasphemy, etc.
Common Compulsions: Activities like excessive checking, washing, or counting to alleviate anxiety or prevent perceived harm.
Case Studies:
- Scott Draper: High-functioning athlete battling religious and contamination obsessions.
- Mary (fear of harming others): Developed obsessions from past trauma; treatment involved exposure and response prevention.
- Peter (contamination fears): Progressed from fears of identity loss to general concerns about germs; used cognitive therapy for treatment.

Prevalence: Studies show lifetime prevalence from 1.9% to 3.3%, making it common compared to schizophrenia.
Onset: Average onset is around 10.3 years, with many recalling symptoms begin in childhood.
Chronic Nature: Symptoms can vary in intensity but rarely remit without treatment.

Neuropsychological Model: Suggests OCD is linked to faulty inhibitory pathways in the brain's basal ganglia.
Cognitive Model: Emphasizes misinterpretation of intrusive thoughts as dangerous, driving compulsive behaviors. Research indicates that OCD behaviors can be understood through the appraisal of intrusive thoughts as threats.
Death Anxiety: Emerging research highlights the relationship between fears of death and compulsive behaviors in OCD.

Cognitive Behaviour Therapy (CBT): Primary treatment with about 75% of patients showing improvement.
- Exposure and Response Prevention: Patients confront feared stimuli and refrain from compulsive behaviors.
- Behavioral Experiments and Cognitive Restructuring: Assess and challenge irrational beliefs related to threats.
Danger Ideation Reduction Therapy (DIRT): A newer approach focusing on psychoeducation and cognitive restructuring, particularly effective for compulsive washers.
Pharmacological Treatment: SSRIs and other medications can be effective, but only 40-60% may benefit significantly.

Hoarding Disorder: Severe difficulty discarding items, leading to significant distress and living area congestion. Prevalence around 2-6%.
Body Dysmorphic Disorder: Obsession with perceived flaws in appearance, affecting about 2.5% of the population.
Trichotillomania: Hair-pulling disorder, prevalence around 1-2%, often co-occurring with OCD.
Excoriation Disorder: Skin-picking disorder leading to skin lesions, with an approximate lifetime prevalence of 1.5%.

OCD was reclassified in DSM-5, leading to a better understanding of its nature and related disorders.
The cognitive model provides insight into the phenomenology of OCD and its varied presentations, underscoring the need for effective treatment strategies.