8. Specific Disorders - Obsessive-Compulsive and Related Disorders Flashcards Preview

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List the obsessive-compulsive and related disorders as listed in the DSM-5 (237).

1. Obsessive-Compulsive Disorder
2. Body Dysmorphic Disorder
3. Hoarding Disorder
4. Trichotillomania (Hair-Pulling Disorder)
5. Excoriation (Skin-Picking) Disorder
6. Substance/Medication-Induced Obsessive Compulsive and Related Disorder
7. Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
8. Other Specified Obsessive-Compulsive and Related Disorder
9. Unspecified Obsessive-Compulsive and Related Disorder


Briefly, what is obsessive compulsive disorder (OCD)?

The characteristic symptoms of OCD are the presence of obsessions and compulsions (criterion A).


List the diagnostic criteria for OCD.

A. Presence of obsessions, compulsions, or both:
Obsessions are defined by
1) Recurrent and persistent thoughts, urges, or
images that are experienced as intrusive and
2) The individual attempts to ignore or suppress
these thoughts, urges, or images, or to neutralize
them with another thought or action (i.e.,
performing a compulsion)

Compulsions are defined by
1) Repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (praying,
counting, repeating words silently) that the
individual feels driven to perform in response to
an obsession or according to rigid rules
2) They are aimed at reducing anxiety or distress,
or preventing a dreaded situation. They are not
connected in a realistic way with what they aim to
neutralize or prevent, or are clearly excessive.

B. The obsessions or compulsions are time-consuming (> 1 hour per day), or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The OCD symptoms are not due to a substance or other medical condition.

D. The disturbance isn't better explained by another mental disorder.


When diagnosing OCD, what other mental disorders could explain symptoms? In other words, what are important disorders to r/o?

Excessive worries as in GED; preoccupation with physical appearance, as in BDD; difficulty discarding or parting with possessions as in hoarding disorder; hair pulling as in trichotillomania; skin picking as in excoriation; stereotypies as in stereotypic movement disorder; ritualized eating behavior as seen in eating disorders; preoccupation with substances or gambling as seen in substance-related and addictive disorders; preoccupation with having an illness as in illness anxiety disorder; sexual urges or fantasies as in paraphilic disorders; impulses as in disruptive, impulse-control, and conduct disorders; guilty ruminations as in MDD; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; repetitive patterns of behavior, as in autism spectrum disorder.


What specifiers are there for OCD?

Specify if:
With good or fair insight (realizes OCD beliefs not true or may
or may not be true)
With poor insight - thinks probably true
With absent insight/delusional beliefs - totally convinced are

Specify if:
Tic-related - the person has a current or past history of a tic


What percentage of individuals with OCD have a lifetime tic disorder?



What is the prevalence of OCD?

1.2% 12-month prevalence in the U.S.

1.1-1.8% internationally.

Females are affected at a slightly higher rate than males in adulthood, although males are more commonly affected in childhood. Males are also more likely to have co-morbid tic disorders.


What is the mean onset of OCD in the U.S.?

19.5 years; 25% of cases start by age 14

Onset after 35 is rare, but does occur

Males have earlier onset than females


What are the risk/prognostic factors for OCD?

Temperamental - greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in childhood are possible temperamental risk factors

Environmental - childhood physical and sexual abuse, and other stressful or traumatic events. Some children have experienced sudden onset of OCD symptoms, which is associated with different environmental factors such as infectious agents and autoimmune syndrome.

Genetic/Physiological - 2x higher in those w/ a first degree relative with it. If the relatives had onset in childhood or adolescence, then risk is increased 10x. Familial transmission due to genetic factors due to overlap found in twin studies. Dysfunction in orbitofrontal cortex, anterior cingulate cortex, and striatum have been most strongly implicated.


Describe suicide risk for individuals with OCD.

Suicidal thoughts occur in about half of individuals with OCD, and attempts are reported in about 25%. Co-morbid major depressive disorder exacerbates this risk.


Describe the co-morbidity of OCD and other disorders.

Many have a lifetime diagnosis of an anxiety disorder (76%; e.g. panic disorder, social anxiety disorder, generalized anxiety disorder, specific phobia) or a depressive or bipolar disorder (63% for any depressive or bipolar disorder, with 41% for MDD which is most common).

Co-morbid obsessive-compulsive personality disorder is also common in individuals with OCD (23-32%).

Up to 30% also have a lifetime tic disorder, most common in males with early-onset OCD.

Body dismorphic disorder, trichotillomania, and excoriation are also more likely.

An association was also found between OCD and oppositional defiant disorder.

OCD is also more common in individuals with certain other disorders than would be expected based on general pop. For example, in people diagnosed with schizophrenia or schizoaffective disorder, OCD is about 12%. OCD also elevated in bipolar disorder, eating disorders such as anorexia nervosa and bulimia nervosa, and Tourette's disorder.


How is body dysmorphic disorder characterized?

Preoccupation with one or more perceived deficits or flaws in physical appearance that are not observable or appear only slight to others, and by repetitive behaviors (mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (comparing one's appearance with that of other people) in response to appearance concerns.


How is hoarding disorder characterized?

Persistent difficulty discarding or parting with possessions, regardless of their actual value, as a result of a strong need to save the item and stress associated with discarding them.


How is trichotillomania characterized?

Recurrent pulling out of one's hair resulting in hair loss, and repeated attempts to decrease or stop hair pulling.


How is excoriation characterized?

Repeated picking of one's skin resulting in skin lesions and repeated attempts to decrease or stop skin picking.