Study Notes on Obsessive Compulsive and Related Disorders

Overview of Obsessive Compulsive and Related Disorders

  • Other disorders categorized under obsessive-compulsive and related disorders include:
    • Body Dysmorphic Disorder
    • Hoarding Disorder
    • Trichotillomania
    • Excoriation Disorder
  • These four diagnoses are less researched than OCD itself.

Body Dysmorphic Disorder (BDD)

  • Definition:
    • BDD is characterized by an excessive preoccupation with perceived defects in physical appearance.
  • Key Features:
    • The perceived defect is typically not recognizable by others.
    • Commonly targeted body parts include the eyes, nose, face size, or skin.
  • Personal Experience:
    • An example of a personal account describes:
    • Constant thoughts about undergoing surgeries like ear reshaping or nose jobs due to perceived physical flaws.
    • The individual felt unable to leave the house without heavy makeup to camouflage perceived defects.
    • Experiences panic attacks when attempting to leave the house.
    • Felt housebound due to overwhelming anxiety about their appearance.
  • Clinical Insights:
    • The individual's extreme preoccupation with perceived body defects may border on delusional.
    • Often lack insight into the irrationality of their beliefs about their appearance.
    • All patients typically exhibit poor insight regarding their perceptions.
  • Associated Risks:
    • High levels of depression and suicidal ideation have been noted.
    • Around 80% of adolescents with BDD report suicidal thoughts, and nearly 50% attempt suicide.

Hoarding Disorder

  • Definition:
    • Hoarding disorder is identified by excessive and persistent difficulty discarding or parting with possessions, leading to clutter that disrupts living spaces.
  • Core Characteristics:
    • Emotional distress associated with discarding items.
    • Sizeable accumulation of items in active living spaces.
  • Prevalence:
    • Estimated prevalence rate is approximately 6%, with no significant gender difference.
  • Onset and Severity:
    • Symptoms often emerge during childhood or adolescence and become more severe with age.
    • Many individuals exhibit a strong compulsion to acquire new items despite existing clutter.
  • Treatment Approaches:
    • Exposure-based therapy is commonly used to assist patients in differentiating between necessary and superfluous items.
    • Efforts focus on categorizing and gradually discarding items, but literature on this aspect remains limited.

Trichotillomania

  • Definition:
    • Trichotillomania is characterized by repetitive hair pulling leading to noticeable hair loss.
  • Etymology:
    • "Trich" (Greek for hair), "Tillo" (to pull), and "Mania" (frenzy).
  • Personal Account:
    • A personal account explains the compulsive nature of the behavior, highlighting how it can be triggered by sensations or feelings of discomfort.
    • Patients often report a mix of awareness and automatic behavior concerning their pulling.
  • Prevalence:
    • Approximately 4% of the population may meet the diagnostic criteria for trichotillomania, with a higher incidence in women.
  • Onset and Management:
    • Typical age of onset is between 10 to 13 years. Some reports indicate earlier onset (as early as age five).
    • Treatment includes habit reversal training, though detailed discussions on these methods are outside the current scope.

Excoriation Disorder (Skin Picking Disorder)

  • Definition:
    • Excoriation disorder involves recurrent skin picking resulting in skin lesions.
  • Key Features:
    • Skin picking often leads to emotional distress and functional impairments.
    • Affected areas typically include the face, scalp, arms, legs, and chest, often leading to scars and skin infections.
  • Prevalence:
    • Estimated at around 5% of the general population, with a higher incidence in females.
  • Treatment Notes:
    • Similar to other OC-related disorders, discussions of treatment options are not detailed in this lecture.

Additional Notes on DSM Changes

  • Discussion Point:
    • The introduction of new diagnoses like hoarding disorder and excoriation in the DSM-5 raises questions about the legitimacy and implications of continuously adding new disorders.
    • The trend suggests that as each new version of DSM is released, the number of recognized mental disorders increases rather than decreases.
  • Questions for Consideration:
    • Are we creating more mental illness by continually adding new diagnoses?
    • Are the new additions to the DSM beneficial, or do they present downsides?
  • Importance of Discussion:
    • The implications of these changes on treatment, understanding, and stigmatization are significant and warrant thorough discussion.