7. Obsessive-Compulsive and Related Disorders

Question 1

Name DSM-5 diagnostic criteria: Obsessive-Compulsive disorder (5)

Answer 1

1. presence of obsessions, compulsions, or both
2. the obsessions or compulsions are time-consuming (i.e. take >1 h/d) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
3. the obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
4. the disturbance is not better explained by the symptoms of another mental disorder

• specifiers: with good or fair insight, with poor insight, with absent insight/delusional beliefs, tic-related

Question 2

Define: Obsessions (2)

Answer 2

• obsessions are defined by (1) and (2)

1. recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and cause marked anxiety or distress in most individuals
2. the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion; see below)

Question 3

Define: Compulsions (2)

Answer 3

• compulsions are defined by (1) and (2)

1. repetitive behaviours (i.e. hand washing, ordering, checking) or mental acts (i.e. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. behaviours mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

Question 4

Describe epidemiology: Obsessive-Compulsive disorder (3)

Answer 4

• 12 mo prevalence 1.1-1.8%; females affected at slightly higher rates than males
• rate of OCD in first-degree relatives is higher than in the general population
• common comorbidities: anxiety disorders, depression, obsessive-compulsive PD, tic disorders, body dysmorphic disorder, trichotillomania, and excoriation disorder

Question 5

Describe risk factors: Obsessive-Compulsive disorder (2)

Answer 5

• genetic: neurological dysfunction, family history
• environmental: adverse childhood experiences (i.e. abuse, behavioural inhibition), exposure to traumatic events, group A streptococcal infection

Question 6

Describe tx: Obsessive-Compulsive disorder (2)

Answer 6

• CBT: exposure with response prevention (ERP) – involves exposure to feared situations with the addition of preventing the compulsive behaviours; cognitive strategies include challenging underlying beliefs
• pharmacotherapy: SSRIs/SNRIs (12-16 week trials, higher therapeutic dosages than used for depression), clomipramine; adjunctive antipsychotics (risperidone)

Question 7

Describe prognosis: Obsessive-Compulsive disorder (1)

Answer 7

• may be refractory and chronic

Question 8

Define: Body Dysmorphic Disorder (5)

Answer 8

• preoccupation with ≥1 perceived flaws in physical appearance not observed by others
• repetitive behaviours (i.e. mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (i.e. comparing self to others) related to appearance
• ± muscle dysmorphia
• causes clinically significant distress or functional impairment
• rule out eating disorder

Question 9

Define: Hoarding Disorder (5)

Answer 9

• persistent difficulty discarding possessions regardless of actual value
• feels the need to save items, discarding creates distress
• results in possessions cluttering/compromising active living areas (may be uncluttered with 3rd party intervention, i.e. family member, cleaners, authorities)
• causes clinically significant distress or functional impairment
• rule out brain injury, cerebrovascular disease, Prader-Willi syndrome, OCD, MDD (low energy), psychotic disorder (delusions), neurocognitive disorder, ASD (restricted interests)

Question 10

Describe: Trichotillomania (5)

Answer 10

• aka Hair-Pulling Disorder
• recurrent pulling out own hair resulting in hair loss
• repeated attempts to stop or decrease hair pulling
• causes clinically significant distress or functional impairment
• rule out dermatological condition, body dysmorphic disorder

Question 11

Describe: Excoriation (Skin-Picking) Disorder (4)

Answer 11

• recurrent skin picking resulting in lesions
• repeated attempts to stop or decrease skin picking
• causes clinically significant distress or functional impairment
• rule out scabies, substance use (i.e. cocaine), psychotic disorder (delusions, tactile hallucinations), body dysmorphic disorder, stereotypic movement disorder, non-suicidal self-injury