Study Notes on Obsessive-Compulsive and Related Disorders

Compulsive Disorders: Examples include Obsessive-Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD).
- Characteristics: Involves repetitive behaviors that aim to reduce risk and harm.
Impulse Control Problems: Examples include skin picking and hair pulling.
- Characteristics: These behaviors often provide pleasurable consequences even if they cause distress.

Definition: OCD is defined by the occurrence of obsessive thoughts and compulsive behaviors that are meant to neutralize these thoughts.
Components:
- Obsessions: Persistent, recurrent intrusive thoughts, images, or impulses recognized by the individual as disturbing, inappropriate, and uncontrollable.
- Compulsions: Overt, repetitive behaviors performed as lengthy rituals intended to reduce anxiety caused by obsessions.
Common Themes of Obsessions:
- Contamination fears.
- Fears of harming oneself or others.
- Pathological doubt regarding one's decisions or actions.

Types of obsessions leading to compulsions include:
- Responsibility for harm and mistakes.
- Incompleteness and need for symmetry/exactness.
- Contamination obsessions.
- Religious, sexual, or violent obsessions.

What OCD is Not:
- It is not Obsessive-Compulsive Personality Disorder.
- Misconceptions include ideas about perfectionism or casual references like "just a little OCD".
- OCD is often inaccurately likened to excessive worries about real-life problems.

Prevalence: Approximately 2–3% of individuals meet the criteria for OCD at some point in their lifetime.
Demographics: Overrepresentation of divorced and unemployed individuals.
- Onset and Course:
- Gradual onset in most cases.
- Tends to be chronic once it becomes serious.
Treatment-Seeking Sample: Over 90% of treatment-seeking individuals with OCD report experiencing both obsessions and compulsions.
Gender Differences: Little to no gender difference in adults diagnosed with OCD.

A study employing the International Intrusive Thoughts Interview Schedule (IITIS) assessed n=777 university students across 15 sites in 13 countries.
- Findings: 93.6% of participants reported experiencing at least one intrusive thought within the past three months.

Components of the Cycle:
- Obsessive Thought → Distress → Anxiety → Compulsive Urges → Compulsion.
Relief: Engaging in compulsive behavior provides temporary relief.
- Source: https://iocdf.org/blog/2023/08/04/how-to-win-against-ocd-intrusive-thoughts/

People with normal and abnormal obsessions differ mainly in their responses to their thoughts, particularly in the degree to which they resist them and perceive them as unacceptable.

Brain Areas: Implicated areas include the orbital frontal cortex, basal ganglia, and frontal-subcortical circuits.
- Altered Circuitry: A cortico-basal ganglionic-thalamic circuit may show alterations in individuals with OCD.
Neurotransmitter Abnormalities: Effective medications include Clomipramine and Fluoxetine (Prozac).
- Associated with serotonergic systems as well as dopaminergic, GABA, and glutamate systems.

Definition: BDD is characterized by preoccupation with perceived or imagined flaws in one or more aspects of one’s body.
- Compulsive Behaviors: May include avoidance of usual activities and seeking reassurance from others about perceived defects.

Problems Associated with BDD:
- Interference with social functioning: 99%
- Avoidance of social interactions: 95%
- Episodes of depression: 94%
- Involvement with work or academic functioning: 90%
- Suicidal thoughts: 63%
- Complete houseboundness for over a week: 29%
- History of psychiatric hospitalization: 26%
- Attempts at suicide: 25%; successful attempts: 14%
- Average days of work missed: 52 days; days of school missed: 49 days.
- Source: Phillips, Katherine A. (2005).

Foci of Concern: Include but are not limited to:
- Skin (73%), Hair (56%), Nose (37%), Weight (22%), Abdomen (22%), Breasts (21%), Eyes (20%), and various other features.

Individuals with BDD have prominent obsessions and engage in ritualistic behaviors similar to those seen in eating disorders like anorexia nervosa.
- Dissatisfaction: Excessive concern regarding physical appearance and dissatisfaction with one’s body are common themes.

Prevalence: Approximately 2% of individuals meet the diagnostic criteria for BDD.
Gender Differences: Prevalence is roughly equal in males and female populations.
Age of Onset: Typically occurs during adolescence, often co-occurring with depressive disorders.

Causal Factors: BDD appears to be influenced by sociocultural contexts emphasizing attractiveness.
- A recent twin study suggests that concerns about physical appearance are moderately heritable.
Treatment: Closely related to OCD treatments involving SSRIs (which may require higher doses) and cognitive-behavioral therapy (CBT) focusing on exposure to anxiety-provoking situations and preventing checking responses.

Definition: Characterized by persistent difficulty in discarding possessions regardless of their actual values leading to significant clutter.
- Associated with perceived needs to save items and the emotional distress tied to discarding.

Contributors:
- Personal and family vulnerability factors.
- Information processing issues.
- Specific thoughts and beliefs.
- Emotional responses and efforts to obtain pleasure by saving.
- Avoidance of unpleasant emotions and challenges in discarding.

Overview: Involves recurrent pulling out of hair resulting in noticeable hair loss, with repeated attempts to limit or cease the behavior. It typically causes clinically significant distress or impairment in various aspects of functioning.

Overview: Defined as recurrent skin picking that leads to skin lesions, with attempts to reduce the behavior being unsuccessful. Similar to trichotillomania, excoriation can significantly impact social, occupational, or other critical areas of functioning.