Obsessive-Compulsive and Related Disorders

Categories 1. Obsessive Compulsive Disorder 2. Body Dysmorphic Disorder 3. Hoarding Disorder 4. Tricholtillomania 5. Excoriation Disorder 6. Substance/Medication Induced OCD 7. OCD due to another medical condition 8. Other Specified OCD 9. Unspecified OCD (example: Exceptional Jealousy)

Definitions Obsessions-recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Compulsions-repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession Very similar to anxiety disorders!!!!

1.Obsessive Compulsive Disorder OCD occurs all over the world!!!! When does OCD become a problem? We all have normal preoccupations and rituals, but people with OCD have excessive and persisting preoccupations. These persist beyond developmentally appropriate periods. Specific content of obsessions and compulsions varies among individuals, but most people are preoccupied with: Cleaning (contamination) Symmetry (repeating, ordering, counting) Forbidden or taboo thoughts (aggressive, sexual, religious) Harm (fears of hurting self or others)

OCD Diagnostic Criteria 1. Presence of obsessions and/or compulsions (children who can’t act out compulsions may just talk about them) 2. The obsessions and compulsions must be time-consuming (take more than 1 hour per day), which causes impairment in social, occupational, or other areas of functioning The symptoms can not be attributed to drug use or medication

OCD Specifiers 1. With good or fair insight 2. With poor insight 3. With absent insight/delusional beliefs 4. If Tic-Related (current or past tic disorder, up to 30% of people with OCD have a lifetime tic disorder)

Other Symptoms Anxiety Panic attacks Feelings of disgust Feelings of things being incomplete Avoid people, places, and things that trigger obsessions and compulsions Avoid public places Avoid social interactions

Prevalence and Course 1.2% of the US population have OCD Slightly higher in females than in males in adulthood Slightly higher in males than in females in childhood Mean age of onset is 19 years old, 25% of cases start by ate 14 (for males, 25% start by age 10!) If OCD is untreated, the course is chronic and only 20% will get rid of it

Risk Factors 1. Tempermental-Internalize things, negative emotionality, behavioral inhibition 2. Environmental-Physical and sexual abuse in childhood, stressful and traumatic events, exposure to infectious agents 3. Genetic and Physiological-Twin studies showed 57% for monozygotic twins, and 22% for fraternal twins Disfunction of several brain structures, including the frontal lobe, has been found in OCD

Differential Diagnosis OCD Looks like: Anxiety Disorders Major Depressive Disorder Eating Disorders Tic Disorder Psychotic Disorders

Comorbidity OCD is sometimes comorbid with: Anxiety Disorder (76%) Depression or Bipolar (63%) OCD Personality Disorder (23%) Tic Disorder (30%)

When are you obsessive and compulsive? We all obsess over things sometimes. What do you obsess over? We all have compulsions that we act on as well. What compulsions do you act on?

2. Body Dysmorphic Disorder Diagnostic Criteria Include: 1. Preoccupation with one or more perceived flaws in physical appearance that are NOT observable to others 2. The individual performs repetitive behaviors (mirror checking, grooming, picking skin, seeking reassurance) 3. The preoccupation causes significant distress or impairment in social, occupation, or other important areas of functioning 4. The symptoms can not be explained by an eating disorder

Specifiers 1. With muscle dysmorphia (preoccupied with body build being too small or not muscular enough) 2. With good or fair insight 3. With poor insight 4. Absent insight/delusional beliefs

Other Symptoms High levels of anxiety and social anxiety Social avoidance Depressed mood Neuroticism Perfectionism Low self-esteem Obsessed with how they look Receive cosmetic treatments Perform surgery on themselves Perceive everyone’s responses as negative

Prevalence and Course 2.5% in females, 2.2% in males Higher among dermatology patients and cosmetic surgery patients (about 10-16%) Higher among orthadontia patients (about 10%) Mean age of onset is 16-17 years old Most common age is 12-13 years old The disorder is chronic if no treatment is provided Individuals diagnosed before age 18 have a higher risk of suicide, have more comorbidity, and have a gradual onset of the disorder

Risk Factors 1. Environmental-childhood neglect and abuse 2. Genetic-higher prevalence in first-degree relatives with OCD

Consequences of BDD 1. Impaired psychosocial functioning (sometimes to the point of incapacitation) 2. Quality of life decreases 3. Impairment in job or school 4. 20% of youth with BDD report dropping out of school 5. Psychiatric hospitalization is common

Interesting Facts BDD has been reported internationally Males are more likely to have genital preoccupations Females more likely to have a comorbid eating disorder Muscle dysphoria occurs mostly in males Rates of suicidal ideation and attempts are high Comorbid with eating disorders, social anxiety, and OCD

3. Hoarding Disorder Persistent difficulty parting with possessions, regardless of their actual value...includes animal hoarding Strong perceived need to save items, and causes extreme distress when they consider discarding them Symptoms include the accumulation of a large number of possessions that congest and clutter active living areas Most collect, buy, or steal items that are not needed, or for which there is no available space Symptoms start to emerge around 11-15 years old, but is the diagnosis is3 times more prevalent in older adults (age 55-94) Prevalence in Europe and North America is 2-6% 50% of cause is due to genetics, according to twin studies Often comorbid with mood or anxiety disorders

4. Trichotillomania (hair-pulling disorder) Recurrent pulling out of one’s hair, resulting in hair loss There are repeated attempts to stop, and causes extreme distress Most common areas are the head, eyebrows, and eyelashes May be preceded with various emotional states, such as anxiety or boredom They feel gratification, pleasure, or a sense of relief when the hair is pulled out Person can have various degrees of consciousness when pulling out their hair Usually do alone May pull hair out on other objects Often have other body-focused repetitive behaviors, such as nail biting

4. Trichotillomania Follows the onset of puberty Sites of hair pulling varies over time Course is chromic if left untreated Evidence for genetic vulnerability Can cause irreversible damage Some people eat the hair, which is harmful

5. Excoriation Disorder (skin-picking) Recurrent skin picking, resulting in skin lesions Repeated attempts to decrease or stop skin picking Can become ritualistic, and individuals may play with, examine, or swallow the skin or scabs after they have been picked Pain is not reported Usually do alone Causes scarring

6. Substance/Medication Induced OCD Obsessions, compulsions, skin picking, hair pulling, or other repetitive behaviors due to substance intoxication, substance withdrawl, or medication exposure. Most common drugs are amphetamines, cocaine, and other stimulants This disorder is extremely rare.