Obsessive-Compulsive and Related Disorders

Question 1

Obsessive-Compulsive Disorder Diagnostic Criteria

Answer 1

A. Presence of obsessions, compulsions or both:
Obsessions are defined by 1-2:
1. Recurrent and persistent thoought/urges/images experienced as intrusive or unwanted and that cause the individual marked anxiety/distress
2. The individual attempts to ignore or suppress these through some other thought or action (i.e., compulsion)

Compulsions are defined by 1-2:
1. Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. The behaviour is aimed at preventing/reducing anxiety/distress or some dreaded event, but is not connected in a realistic way to that outcome or is clearly excessive

B. The obsessions/compulsions are time-consuming (≥1 hour per day) or cause clinically significant distress/functional impairment
C. Not attributable to substances/medication/anothewr medical condition
D. Not better explained by another mental disorder

Question 2

OCD Specifiers

Answer 2

Insight:
* With good or fair insight: Individual recognizes the OCD beliefs are definitely or porbably not true, or accepts that they may not be true
* With poor insight: Individual thinks OCD beliefs are probably true
* With absent insight/delusional beliefs: Individual is completely convinced

Tics:
* Tic-related: The individual has a current or history of tic disorder

Question 3

Body Dysmorphic Disorder Diagnostic Criteria

Answer 3

A. Preoccupaion with ≥1 perceived defects or flaws in physical appearance that are not observable or only slight to others.
B. Individual performs repetitive behaviours (e.g., mirror checking, skin picking, excessive grooming, reassurance seeking) or mental acts (e.g., comparing their appearance to others’) in response to the concerns
C. Causes clinically significant distress/functional impairment
D. Not better eplained by conerns with body fat/weight in an individual who meets criteria for an ED

Question 4

Body Dysmorphic Disorder Specifiers

Answer 4

• With muscle dysmorphia: Individual is preoccuped with the idea that their body is too small/insufficiently muscular. This specifier can be used in conjunction with preoccupations with other body areas

Insight
* With good or fair insight
* With poor insight
* With absent insight/delusional beliefs

Question 5

Differentiation of Body Dysmorphic Disorder from normal appearance concerns

Answer 5

• Body dysmoprhic disorder involves repetitie and time-consuming behaviours which cause clinically significant distress/impairment

Question 6

Differentiation of Body Dysmorphic Disorder from EDs

Answer 6

• Concerns in ED are usually related to weight and figure, rather than something else
• Weight concerns CAN occur in body dysmorphic disorder, and it can be comorbid with an ED

Question 7

Hoarding Disorder Diagnostic Criteria

Answer 7

A. Persistent difficulty discarding or parting with possessions, regardless of true value
B. Difficulty is due to a perceived need to save the items and distress associated with discarding them
C. Difficulty results in accumulation of possessions that congest/clutter active living areas and substantially compromises their acitve use. If living areas are uncluttered, it is only because a third party intervened.
D. Causes clinically significant distress/functional impairment
E. Not attributable to another medical condition
F. Not better explained by another mental disorder

Question 8

Hoarding Disorder specifiers

Answer 8

• With excessive acquisition: If difficulty discarding is accompanied by excessive acquisition of unneeded items for which there is no available space

Insight:
* With good or fair insight
* With poor insight
* With absent insight/delusional belief

Question 9

Trichotillomania Diagnostic Criteria

Answer 9

A. Recurrent pulling out of one’s hair, resulting in hair loss
B. Repeated attempts to decrease or stop hair pulling
C. Causes clinically significant distress/functional impairment
D. Not attributable to another medical condition
E. Not better explained by another mental disorder (e.g., attempts to improve a perceived flaw in body dysmorphic disorder)

Question 10

Differentiating Trichotillomania from OCD and body dysmorphic disorder

Answer 10

Individuals with symmetry concerns in OCD or in body dysmorphic disorder may pull their hair out to satisfy these preoccupations. These would not be considered motivators of trichotillomania, so another diagnosis would be given.

Question 11

Excoriation Disorder Diagnostic Criteria

Answer 11

A. Recurrent skin picking resulting in skin lesions
B. Repeated attempts to decrease or stop skin picking
C. Causes clinically significant distress/functional impairment
D. Not attributable to effects of a substance/medication/other medical condition
E. Not better explained by another mental disorder (e.g., tactile hallucinations in psychotic disorder)

Question 12

Examples of Other Specified Obsessive Compulsive and Related Disorders presentations

Answer 12

1. Body dysmorphic-like disorder with actual flaws: Like body dysmorphic disorder except that flaws are clearly observable by others and in which preoccupation with these is clearly excessive and causes significant distress/functional impairment.
2. Body dysmorphic-like disorder wihtout repetitive behaviours: Criteria met for body dysmorphic disorder but the individual has never performed repetitive behaviours to alleviate the concerns.
3. Other body-focused repetitive disorder: E.g., nail biting, lip biting, cheek shewing, accompanied by repeated attempts to stop the behaviour, which causes clinically significant distress/functional impairment.
4. Obsessional jealousy: Nondelusional preoccupation with partner’s fidelity. May lead to repetitive behaviours. Causes clinically significant distress/functional impairment. Not better explained by psychotic mental disorder.
5. Olfactory reference disorder: Persistent preoccupation with the idea that one is emitting a foul orr offensive body odor, that is unnoticeable or only slightly noticeable to others. Results in repetitive/checking behaviours. Causes clinically significant distress/funcitonal impairment.
6. Shubo-kyofusho: Similar to body dysmorphic disorder - characterized by excessive fear of having a bodily deformity.
7. Koro: Episode of sudden and intense anxiety that the genitals will recede into the body, possibly leading to death.