Obsessive-Compulsive Disorder (OCD) Exam Notes

Obsessive-Compulsive and Related Disorders

Learning Objectives
  • Learn about the clinical characteristics and diagnostic criteria of OCD
  • Understand the cognitive factors contributing to OCD
  • Recognize exposure and response prevention (ERP) and medication treatment for OCD
  • Explore the neurobiological aspects of OCD
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) Overview
  • List of Obsessive-Compulsive and Related Disorders:
    • Obsessive-Compulsive Disorder (OCD)
    • Body Dysmorphic Disorder
    • Hoarding Disorder
    • Trichotillomania
    • Excoriation Disorder
    • Substance/Medication-Induced Obsessive-Compulsive Disorder
Understanding OCD
  • Obsessions:
    • Recurrent, persistent thoughts/images/urges that are intrusive and inappropriate.
    • Result in distress; individuals attempt to suppress, ignore, or neutralize through compulsions.
  • Compulsions:
    • Repetitive behaviors or mental acts (e.g., hand washing, checking).
    • Performed to reduce distress or prevent feared events from occurring.
DSM-5-TR Criteria for OCD
  1. Presence of obsessions, compulsions, or both.
  2. Obsessions/compulsions are time-consuming (e.g., >1 hour/day) or cause significant distress/impairment.
  3. Symptoms not attributable to substance effects or a medical condition.
  4. Disturbance not better explained by another mental disorder.
Specifiers in DSM-5-TR
  • Insight:
    • Good or fair insight: individual recognizes OCD beliefs may not be true.
    • Poor insight: individual thinks beliefs are probably true.
    • Absent insight/delusional beliefs: individual is completely convinced of the truth of their beliefs.
  • Tic-related: Current or past history of tic disorder.
Essential Features of OCD
  • Symptoms are time-consuming, cause marked distress, and interfere with social or occupational functioning.
Common Thoughts and Actions
  • Examples from non-clinical samples include fears about locks, causing accidents, or harming others, indicating intrusive thought patterns.
OCD Symptom Dimensions
  • Studies have identified key dimensions of OCD symptoms:
    • Contamination obsessions with cleaning compulsions.
    • Sexual/religious/aggressive obsessions with checking compulsions.
    • Symmetry obsessions with associated compulsions (counting, ordering).
Mental Compulsions
  • Examples include:
    • Mental counting, list-making, and reciting special prayers.
Prevalence and Comorbidity
  • Lifetime prevalence of OCD: approximately 1.6 to 2.3%.
  • Onset typically occurs from childhood to the 30s (median age of onset is 19).
  • More common in males during childhood, with a 1:1 gender ratio in adults.
  • Common co-occurring disorders include anxiety disorders, depression, ADHD, tic disorders.
Biological Components
  • Neurotransmitters:
    • Serotonin's role with evidence from serotonin-based antidepressants alleviating OCD symptoms.
  • Brain Structure Abnormalities:
    • Linked to the orbital frontal cortex and the caudate nucleus, influencing intrusive thoughts and compulsive behaviors.
Neurobiological Underpinnings
  • Over-activation of the orbital frontal cortex leads to obsessions.
  • Dysfunctional interaction between the orbital frontal cortex and caudate nucleus impairs behavioral regulation, resulting in compulsions.
Biological Treatments
  • Medications:
    • Use of SSRIs (e.g., Prozac, Zoloft) and tricyclics (e.g., Anafranil).
    • Show effectiveness with about 50-80% improvement rate in OCD symptoms; risks of relapse when stopped.
Cognitive-Behavioral Component
  • Cognitive Theory:
    • Everyone has intrusive thoughts, but individuals with OCD feel accountable for preventing their perceived consequences.
  • Behavioral Aspect:
    • Neutralizing thoughts with compulsive actions reinforced through negative reinforcement, which increases anxiety regarding thoughts.
Cognitive Distortions in OCD
  • Significance of Thoughts:
    • Seeing intrusive thoughts as indicators of personal flaws.
  • Overestimation of Responsibility:
    • Feeling responsible for preventing harmful outcomes because of intrusive thoughts.
  • Thought-Action Fusion:
    • Belief that having a thought implies it will happen.
Treatment Approaches
  • Cognitive-Behavioral Therapy (CBT) with ERP:
    • Combines cognitive and behavioral strategies, often yielding better results compared to either alone.
  • Sample Ritual Hierarchies:
    • Exposure tasks designed to gradually confront fears, with varying levels of anxiety associated (Subjective Units of Distress Scale - SUDS).