Chapter 7 (191-197)

Question 1

What are the two main symptoms of OCD?

Answer 1

Obsessions and compulsions.

Question 2

What are obsessions in OCD?

Answer 2

Intrusive, unwanted thoughts, images, or urges that cause distress.

Question 3

What are compulsions in OCD?

Answer 3

Repetitive behaviors or mental acts done to reduce anxiety or prevent a feared event.

Question 4

Are OCD compulsions experienced as pleasurable?

Answer 4

No, they are not pleasurable and often feel forced or driven.

Question 5

What distinguishes OCD from normal routines or habits?

Answer 5

OCD behaviors are excessive, time-consuming, and distressing.

Question 6

What is the purpose of compulsions in OCD?

Answer 6

To reduce anxiety caused by obsessions or prevent something bad from happening.

Question 7

Give an example of an OCD obsession.

Answer 7

Fear of contamination from touching a doorknob.

Question 8

Give an example of an OCD compulsion.

Answer 8

Repeated handwashing or checking that the stove is off.

Question 9

What is the minimum time per day OCD obsessions or compulsions must take to meet diagnosis?

Answer 9

More than one hour per day, or cause significant distress or impairment.

Question 10

What is thought-action fusion in OCD?

Answer 10

The belief that having a thought is morally equivalent to acting on it or that thoughts can cause events.

Question 11

What is Body Dysmorphic Disorder (BDD)?

Answer 11

A disorder involving preoccupation with imagined or exaggerated physical flaws.

Question 12

What behaviors are common in BDD?

Answer 12

Mirror checking, excessive grooming, camouflaging, or seeking reassurance.

Question 13

What is the difference between BDD and normal body concerns?

Answer 13

BDD concerns are excessive, obsessive, and cause significant distress or impairment.

Question 14

What body areas are commonly focused on in BDD?

Answer 14

Skin, hair, nose, face, or body shape.

Question 15

How is insight often in BDD?

Answer 15

Poor to absent; people may be convinced the flaw is real.

Question 16

What is hoarding disorder?

Answer 16

Persistent difficulty discarding possessions, regardless of value, leading to cluttered living spaces.

Question 17

How does hoarding disorder differ from OCD?

Answer 17

Hoarding is not driven by obsessions or compulsions, and items are often seen as valuable or meaningful.

Question 18

What is the main emotional driver behind hoarding?

Answer 18

Distress at the thought of discarding items and fear of losing something important.

Question 19

How long must symptoms persist for OCD or BDD diagnosis?

Answer 19

At least 6 months (BDD), OCD doesn’t have a fixed duration but must cause functional impairment.

Question 20

What percentage of people with OCD report more than one obsession or compulsion?

Answer 20

The majority — most have multiple symptom types.

Question 21

What is the gender ratio for OCD?

Answer 21

Roughly equal, though males often show earlier onset.

Question 22

What is the typical age of onset for OCD?

Answer 22

Late childhood to early adulthood (often before age 25).

Question 23

What cultural factors can influence OCD content?

Answer 23

Cultural beliefs and values can shape the specific obsessions and compulsions (e.g., religious themes).

Question 24

Is OCD ego-syntonic or ego-dystonic?

Answer 24

Ego-dystonic — the thoughts and behaviors feel foreign or distressing to the person.

Question 25

What is the difference between OCD and OCPD (Obsessive-Compulsive Personality Disorder)?

Answer 25

OCPD involves rigid perfectionism and orderliness, but without true obsessions or compulsions.

Question 26

What is the suicide risk like for OCD and BDD?

Answer 26

High — especially for BDD; more than 10% of people with OCD attempt suicide.

Question 27

What is a common compulsion seen in BDD?

Answer 27

Excessive mirror checking or avoiding mirrors completely.

Question 28

What is the primary treatment for OCD?

Answer 28

Exposure and Response Prevention (ERP) and/or SSRIs.

Question 29

What is Exposure and Response Prevention (ERP)?

Answer 29

A type of CBT where the person is exposed to their fear without performing the compulsion.

Question 30

Can insight vary in OCD and related disorders?

Answer 30

Yes, insight can range from good to completely absent (delusional beliefs).

Question 31

What Differentiates Hoarding Disorder from Normal Collecting?

Answer 31

Collecting = intentional, organized, often valuable or meaningful. Hoarding Disorder = excessive acquiring + extreme difficulty discarding even worthless items. Emotional attachment + distress when discarding. Often leads to clutter, impaired living spaces, and safety issues. Most hoarders lack insight.

Question 32

Functional Impairment in Hoarding Disorder

Answer 32

Clutter blocks kitchens, bathrooms, exits. Leads to poor hygiene, respiratory issues, poverty, even eviction or homelessness. ~75% engage in excessive buying, many are unemployed. ~10% face eviction (Tolin et al., 2008).

Question 33

What is Animal Hoarding?

Answer 33

A subtype of hoarding disorder. Often seen more in women. Hoarders may see themselves as rescuers, but animals are neglected. Often results in squalor, health violations, and involvement from animal protection agencies.

Question 34

Prevalence & Comorbidity

Answer 34

OCD: ~1.3% BDD: ~3% Hoarding Disorder: ≥1.5% Hoarding = equally common in men and women. High comorbidity with anxiety, depression, substance use disorders. All tend to be chronic, begin in childhood/adolescence.

Question 35

Genetic & Neurobiological Causes

Answer 35

Heritability: ~40–50% for OCD, hoarding, BDD. Shared brain circuit: CSTC loop (orbitofrontal cortex, caudate nucleus, anterior cingulate cortex). Overactivity in CSTC linked to OCD, BDD, hoarding. BDD shows hyperactive visual processing.

Question 36

Behavioral Model of OCD

Answer 36

OCD behaviors (e.g. checking, cleaning) are maladaptive responses to threat. People with OCD struggle to extinguish fear even when threat is gone. Example: Foot pedal study—people still responded to a non-existent shock threat.

Question 37

Cognitive Models of OCD

Answer 37

Cognitive Models of OCD a. Evidence-Trusting Deficits Difficulty trusting decisions = excessive checking, slow decision-making. Transition uncertainty: Loss of confidence during context changes (e.g., leaving a room after turning off stove). b. Thought–Action Fusion Model Belief that thinking = doing (e.g. "thinking about harm = causing harm"). Thought suppression backfires: Leads to rebound effect and more obsessions. OCD develops from interpretation of intrusive thoughts, not the thoughts themselves.

Question 38

Cognitive Causes of BDD

Answer 38

Triggered often by appearance-related teasing. People with BDD process visual detail over the whole, obsessing over flaws. May accurately see features, but fixate intensely on minor imperfections.

Question 39

What are the cognitive and behavioral causes of Hoarding Disorder?

Answer 39

Poor organizational skills → difficulty sorting, categorizing. Unusual beliefs about possessions → "everything has potential or emotional value." Avoidance behaviors → anxiety leads to procrastination. Supported by research: Wincze et al. (2007), Frost & Steketee (2010), Timpano et al. (2016).

Question 40

What is the evolutionary theory of Hoarding Disorder?

Answer 40

Hoarding may reflect ancestral adaptations to store resources in scarcity (Zohar & Felz, 2001). Becomes maladaptive when modern environments trigger uncontrollable urges to save.

Question 41

How do people with Hoarding Disorder struggle with decision-making?

Answer 41

Sorting is slow, stressful; more categories created (Wincze et al., 2007). Worse when items are personally meaningful (Stumpf et al., 2022). Often can't even describe items clearly—"stuff from last year" (Franklin et al., 2019).

Question 42

What emotional and cognitive beliefs fuel Hoarding Disorder?

Answer 42

Strong emotional attachment to objects. Feelings of comfort, identity, grief, and even responsibility for items (Frost & Steketee, 2010). Belief that every item has value or purpose, even junk mail.

Question 43

How is animal hoarding different?

Answer 43

Stronger attachments. People see animals as confidants (Patronek & Nathanson, 2009). Often leads to neglect, squalor, and legal/health consequences.

Question 44

Why do people with Hoarding Disorder avoid cleanup?

Answer 44

Sorting triggers overwhelming anxiety. Avoidance becomes a coping strategy, reinforcing the clutter.

Question 45

What medications treat OCD, BDD, and Hoarding Disorder?

Answer 45

SSRIs (e.g., fluoxetine) and clomipramine (tricyclic) = effective for OCD. Higher doses & longer treatment needed than for depression. BDD responds to antidepressants (3 RCTs); Hoarding: limited support from 2 small studies. Hoarding + OCD = poorer med response (Bloch et al., 2014).

Question 46

What is Exposure and Response Prevention (ERP) and how does it treat OCD?

Answer 46

Clients face feared stimuli (exposure) while refraining from rituals (response prevention). Reduces anxiety via extinction and builds new thoughts. About 69–75% improve (Abramowitz & Jacoby, 2015). Demanding: ~⅓ drop out; many therapists prefer less effective methods.

Question 47

How is ERP adapted for Body Dysmorphic Disorder (BDD)?

Answer 47

Exposure: interacting with people who may judge appearance. Response prevention: stop mirror checking, reassurance seeking. Includes cognitive techniques to challenge beliefs about self-worth and appearance.

Question 48

How is ERP used for Hoarding Disorder?

Answer 48

Exposure = discarding items. Response prevention = stopping rituals like counting or rechecking. ERP helps but ~50% still show significant symptoms post-treatment (Tolin et al., 2021). Peer groups and readings can help (Mathews et al., 2018).

Question 49

How does hoarding affect families & how are they involved in treatment?

Answer 49

Families often feel helpless or angry. May resort to coercive clean-ups, worsening trust. Therapy focuses on safety-first goals (e.g., emergency exits), not perfection. Support groups like Children of Hoarders are common.

Question 50

What are brain stimulation options for treatment-resistant OCD?

Answer 50

dTMS = magnetic stimulation to scalp. DBS = implanted electrodes in basal ganglia. Both offer relief in ~50% of severe, treatment-resistant cases (Carmi et al., 2019). DBS is riskier and only used with strict oversight.