4 - OCD and related disorders 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?
- involve repetitive behaviours or mental acts, and difficulty to stop or decrease them
- highly comorbid with eachother
- likely to be present in 1st degree relatives of probands (50% in identical twins, 20% in maternal twins)
What are the DSM-5 criteria for OCD?
- The presence of Obsessions, Compulsions, or both.
- the obsessions or compulsions are time consuming (>1hr/day)
- symptoms are not attributable to physiological effects of a substance or medical condition
- the disturbance is not better explained by the symptoms of another mental disorder
Define an Obsession.
- recurrent/persistent thoughts, urges or images that are experienced as intrusive or unwanted, causing marked anxiety or distress
- attempts to ignore or suppress thoughts/urges/images or to neutralise them with some other thought or action (ie by performing a compulsion)
Define a Compulsion.
- Repetitive behaviours or mental acts that the individual feels compelled to perform in response to an obsession or according to rules that must be applied rigidly
- The behaviours/mental acts re aimed at preventing, reducing anxiety or distress or preventing some dreaded event. They are excessive in nature, or otherwise not realistically connected to the prevention or neutralisation of the item causing distress.
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 (repeating, ordering and counting compulsions)
- Forbidden or taboo thoughts
Symptoms often reside in more than one dimension. Argued that death is an underlying theme.
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.
Lifetime prevalence is 2-3%
Mean age onset is 19.5
25% of cases start by age 14
More common in women, but men tend to start earlier (10yrs)
Chronic if untreated - spontaneous remission is rare, 80% still diagnosed after age 40
Often comorbid (anxiety, depression, bipolar)
How does operant reinforcement relate to the causation of OCD?
Compulsions are negatively reinforced by the reduction of anxiety.
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.
What are some other factors associated with causation of OCD?
Temperamental factors in childhood, including inhibitive behaviours, physical/sexual abuse
Genetic loading
What are some treatments of OCD?
- Medications (tricyclic antidepressants, SSRIs) - 40-60% benefit
- CBT (cognitive restructuring, challenging beliefs about intrusive thoughts/consequences of not engaging in compulsions, ERP) - 75% benefit
Describe Hoarding Disorder.
- Originally thought of as a subtype of OCD
- Inability to part with objects despite no utility
- Leads to clutter/impairment/unsanitary environment
- 80-90% are compelled to collect more items
- some cases of animal hoarding
- 6% prevalence
- starts early, gets worse with age
- treatments not well known
Describe Body Dysmorphic Disorder.
- Characterised by perceived defects or flaws in physical appearance that are not observable or appear slight to others
- At some point, individual has performed either physical or mental compulsions (skin picking, seeking reassurance, mirror checking, comparing appearance with others)
- Occurs slightly more in men, 2% overall prevalence
- Plastic surgery often used, to poor effect
What is the muscle dysmorphia specifier of body dysmorphic disorder?
- Very similar to eating disorders in women
- 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?
- Functional consequences;
- impaired psychosocial functioning;
- avoidance of social situations, relationships, intimacy
- around 20% of affected youths report dropping out of school due to associated symptoms
- can become house bound
- poor quality of life
- elevated suicide risk
Name and describe the disorder known for the pulling out of one’s hair.
Trichotillomania; hair-pulling in response to stress.
Repeated attempts to stop or decrease.
Not better attributed to a dermatological condition, or mental disorder (ie to improve a perceived flaw in appearance as would be caused by body dysmorphic disorder)
Can be compelled to pull hair from fabrics, pets or others.
Name and describe the disorder known for the picking of one’s skin.
Excoriation; skin picking resulting in lesions, causing clinically significant distress.
Not attributable to effects of a substance (eg cocaine) or another medical condition (eg scabies), or another mental disorder (eg delusions, tactile hallucinations in psychotic disorders, intention to harm oneself in non-suicidal self-injury, stereotypies in stereotypic movement disorder, attempts to improve perceived flaws in body dysmorphic disorder.)
