4 Obsessive-Compulsive and Related Disorders: OCD Flashcards
What is listed in the DSM-5 under Obsessive-Compulsive and Related Disorders?
- OCD
- Body Dysmorphic Disorder
- Hoarding Disorder
- Excoriation (Skin-Picking)
- Trichotillomania (hair-pulling)
What are the commonalities of Obsessive-Compulsive and Related Disorders?
- All hallmarked by repetitive behaviours or mental acts that are difficult to stop or decrease
- Person feels compelled for some sort of thing and that aspect is not part of anxiety disorders
Describe Hoarding Disorder.
Hoarding is characterised by difficulty parting with possessions regardless of their value. It stems from a perceived need to save the items and to distress associated with discarding them. As a result, hoarding disorder patients accumulate many items that clutter living areas and compromise their use.
Describe Body Dysmorphic Disorder
Body dysmorphic disorder involves a preoccupation with perceived defects in physical appearance - that are not observable to others i.e. the person sees a body feature(s) as exaggerated or worse than they are - this is different to normal appearance concerns.
What is the muscle dysmorphia specifier of body dysmorphic disorder?
The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas
- Associated with high levels of anxiety, depression, shame, low self esteem
- Onset in adolescence (most developed by age 18)
What are some effects of body dysmorphic disorder?
Different from normal appearance concerns
Impaired psychosocial functioning
- Avoidance of social situations, relationships, intimacy
- About 20% of affected youths report dropping out of school due to associated symptoms
- can become housebound
- poor quality of life
- elevated suicide risk
Name and describe the disorder known for the pulling out of one’s hair.
Trichotillomania (Hair-pulling disorder)
Recurrent pulling out of one’s hair, resulting in hair loss. It requires repeated attempts to decrease or stop hair pulling. This hair pulling must cause clinically significant distress or impairment and not be attributable to another medical condition.
Name and describe the disorder known for the picking of one’s skin.
Excoriation (Skin-Picking) Disorder
Recurrent skin picking resulting in skin lesions. It requires repeated attempts to decrease or stop skin picking. The skin picking causes clinically significant distress or impairment and not be attributable to the physiological effects of the substance or another medical condition.
How does OCD differ from the other disorders listed in the same category in the DSM?
Sometimes when people say they’re triggered by emotional states (anxiety or boredom) and what makes them different to OCD is they’re preceded by mounting tension and after completed there is gratification
What are the DSM-5 criteria for OCD?
To qualify for OCD a person must be experiencing obsession, compulsions or both as defined by DSM (A). These behaviours must be time-consuming or cause significant distress or dysfunction (B).
Individuals may vary in their level of insight into the problematic nature of their behaviours, better insight = better treatment outcome. OCD may be tic-related.
Define an Obsession
Recurrent and persistent thoughts, urges or images that are unwanted and cause distress
- Are unwanted and perceived as intrusive and senseless = egodystonic
- Result in efforts to resist, ignore or suppress obsessions
Define a Compulsion.
Repetitive behaviours or mental acts that are performed in response to an obsession in order to prevent the occurrence of a feared event or to prevent discomfort, distress or anxiety.
- Aimed at neutralising the obsessions
- Any behaviour, overt or covert, has the potential to be a compulsion
○ Washing (contamination
○ Checking (responsibility for harm)
○ Ordering (perfection and fear of harm)
What are the specifiers of OCD?
- Insight, which can range from good/fair, to poor, absent, or completely delusional beliefs.
- Symptoms must be in response to intrusive thought
- Some OCD can be tic-related (tends to occur with childhood onset, or otherwise associated with neurological disorders, eg ADHD)
What are the 4 dimensions of presenting symptoms in OCD?
- Cleaning (contamination obsessions, cleaning compulsions)
- Harm (fears of harm to oneself or others, checking compulsions)
- Symmetry (obsession with symmetry, repeating, ordering and counting compulsions)
- Forbidden or taboo thoughts (Aggressive, sexual, religious obsessions & related disorders)
What is the one possible common underlying theme in the dimensions of symptoms in OCD according to Menzies & Dar nimrod (2018)
Death
Are symptoms in OCD only allowed in one dimension?
Symptoms often reside in more than one dimension
What are the common compulsions in OCD?
- Washing and cleaning
- Checking (harm, mistakes)
- Repeating
- Mental compulsions
- Ordering and arranging objects
Describe the prevalence of OCD.
Mean age of onset is 19.5 years, but can be very early on. Lifetime prevalence of 2-3%, more common in women, but men have earlier onset. OCD is chronic if untreated, it is unlikely the individual will get better by themselves. OCD is often comorbid - high levels of comorbidity with anxiety (76%), depression and bipolar (63%)
How does operant reinforcement relate to the causation of OCD?
OCD is maintained by operant reinforcement; compulsions are negatively reinforced through reduction of anxiety forming a self-feeding maintenance cycle.
Avoidance maintains anxiety
How would a cognitive model explain the causation and maintenance of OCD?
Obsessions are not qualitatively different from intrusive thoughts in the general population.
OCD is caused by a misinterpretation of the thoughts - thought-action fusions and unrealistic ownership of imagined negative events.
What are some cognitive factors associated with OCD?
- Intolerance of uncertainty
- Inflated responsibility
- Thought-action fusion
- Magical Ideation
Why would attempts to suppress intrusive thoughts make things worse?
Trying to suppress thoughts results in checking for those thoughts. This hypervigilance results in those thoughts being created.
How does Rachman’s (1997) Cognitive Theory of Obsessions explain the causation of OCD?
Whilst obsessions are not uncommon people with OCD respond to obsessive thoughts differently or misinterpret them, sometimes perceiving the thought as an intention (harm compulsion). Attempts to supress thoughts leads to thought checking which actually creates the thoughts making matters worse
What is thought-action fusion (Rachman, 1987)?
Thinking a bad thought increases the probability that the feared event will occur, and believing that having a bad thought is equivalent to carrying out the action -> increases the sense of personal responsibility and guilt
