Study Notes on Obsessive-Compulsive Disorder and Related Disorders

Introduction to Obsessive-Compulsive Disorder (OCD)

  • Common daily behaviors for order can evolve into OCD.

  • Definition of OCD: Involves one or both of the following:

    • (1) Obsessions: Intrusive, unwanted thoughts, impulses, or images causing significant anxiety.

    • (2) Compulsions: Repetitive behaviors performed to alleviate anxiety from obsessions.

Characteristics of Obsessions

  • Nature of obsessions:

    • Spontaneous, frequent, intrusive, unwanted, and uncontrollable thoughts.

    • Can be bizarre or extreme (e.g., contamination).

  • Examples of common obsessions:

    • Doubt: Concern about leaving doors unlocked.

    • Need for Order: Arranging items precisely.

    • Aggressive Impulses: Distressing thoughts of harming others.

    • Sexual Imagery: Intrusive pornographic thoughts.

Definition and Criteria of OCD

  • A. Presence of obsessions and/or compulsions:

    1. Obsessions: Recurrent, intrusive thoughts/urges/images causing anxiety, which individuals try to ignore or neutralize.

    2. Compulsions: Repetitive behaviors or mental acts performed in response to obsessions, often excessive or unrealistic, aimed at preventing anxiety or dreaded events.

  • B. Distress and Impairment: Obsessions or compulsions consume significant time (e.g., >1 hour/day) or cause clinically significant distress or impairment.

  • C. Exclusion of Other Causes: Symptoms not due to substance use or other medical conditions.

  • D. Differential Diagnosis: Symptoms not better explained by another mental disorder.

  • Reference: American Psychiatric Association (2013).

Compulsions Explained

  • Nature of compulsions: Motor behaviors or mental acts in response to obsessions.

  • Example: Repeated door checking, leading to missed responsibilities.

  • Common compulsions include:

    • Hand washing.

    • Ordering.

    • Counting.

    • Seeking reassurance.

  • Impact on Daily Life: Compulsions cause significant distress and difficulty in concentration.

Related Disorders in DSM-5

  • The DSM-5 includes disorders related to OCD:

    • Hoarding Disorder: Difficulty parting with possessions.

    • Trichotillomania: Repetitive hair pulling.

    • Excoriation Disorder: Frequent skin picking.

    • Body Dysmorphic Disorder (BDD): Preoccupation with perceived appearance flaws.

Characteristics of Body Dysmorphic Disorder (BDD)

  • Diagnostic Criteria (Table 5.8):

    • A. Preoccupation with perceived flaws in appearance.

    • B. Repetitive behaviors or mental acts in response to appearance concerns.

    • C. Preoccupation causes clinically significant distress or impairment.

    • D. Not better explained by concerns about body fat/weight (eating disorders).

  • Reference: American Psychiatric Association (2013).

  • Cultural Comparisons: Similar to Koro syndrome (body parts retracting) and Shubo-Kyofu (facial deformity fear).

Summary of Implications

  • OCD rituals and compulsions significantly affect daily life, causing distress and impairment. Understanding these disorders is crucial for effective diagnosis and treatment.