1. Obsessive-Compulsive and Related Disorders

2. 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)

3. 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!!!!

4. 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)

5. 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

6. 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)

7. 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

8. 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

9. 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

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

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

12. 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?

13. 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

14. 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

15. 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

16. 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 years old
Most common age is 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

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

18. 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

19. 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

20. 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 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

21. 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

22. 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

23. 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

24. 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.