Lecture 6 - Obsessive Compulsive and Related Disorders

Question 1

Obsessive Compulsive and Related Disorders

Answer 1

• OCD
• Hoarding
• Body dysmorphic disorder
• Trichotillomania (compulsive hair pulling)
• Excoriation (skin picking)

Question 2

DSM-5 diagnostic criteria of OCD

Answer 2

• presence of obsessions, compulsions or both
• obsessions or compulsions are time consuming (e.g. take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational or other areas
• OCD symptoms are not attributable to the physiological effects of a substance
• disturbances do not meet another mental disorder

Question 3

obsessions

Answer 3

recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted and in most, cause marked anxiety or distress

Question 4

compulsions

Answer 4

1. repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules
2. the compulsions are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation, not realistic

Question 5

obsessions consist most often of:

Answer 5

• contamination fears
• fears of harming oneself or others
• lack of symmetry
• pathological doubt

Question 6

compulsions include:

Answer 6

• cleaning
• checking
• repeating
• ordering/arranging
• counting

Question 7

OCD comorbidity

Answer 7

• frequently co-occurs w/ other anxiety disorders and mood disorders
• also co-occurs w/ Body Dysmorphic Disorder w/ some frequency

Question 8

psychological causal factors of OCD

Answer 8

• OCD is a learned behavior (Mowrer’s two-process theory of avoidance learning, classical conditioning and reinforcement)
• OCD and preparedness
• cognitive causal factors: thought suppression (may increase frequency), inflated sense of responsibility (thought action fusion), cognitive biases (attentional bias) and distortions

Question 9

biological causal factors of OCD

Answer 9

• OCD appears moderately heritable
• abnormalities in brain function may include cortico-basal-ganglionic thalamic circuit
• serotonin is strongly implicated in OCD

Question 10

behavioral and cognitive behavioral treatments of OCD

Answer 10

exposure and response prevention may be the most effective approach to OCD

• exposure to anxiety-producing obsession, prevention of compulsion typically used
• gradually move through hierarchy of stimuli

Question 11

medical treatments of OCD

Answer 11

medications that affect the neurotransmitter serotonin have also been found helpful in some individuals

• major disadvantage when meds are discontinued, relapse rates are high

Question 12

Body Dysmorphic Disorder

Answer 12

• previously classified as a somatoform disorder
• obsessed w/ a perceived or imagined flaw or flaws in their appearance to the point they firmly believe they are disfigured or ugly
• most have compulsive checking behaviors
• avoidance of usual activities due to fear that people will see the defect
• frequently seek reassurance, but only provides temporary relief

Question 13

DSM-5 diagnostic criteria of BDD

Answer 13

• preoccupation w/ one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
• individual has performed repetitive behaviors or mental acts in response to the appearance concerns
• the preoccupation causes clinically significant distress
• appearance preoccupation is not better explained by concerns w/ body fat or weight in an individual whose symptoms meet criteria for an eating disorder

Question 14

BDD and OCD

Answer 14

• obsessions, ritualistic behaviors
• BDD: more convinced that their obsessives beliefs are accurate in comparison to OCD
• common neural substrate (serotonin)

Question 15

causal factors of BDD

Answer 15

biopsychosocial

• biological substrate (serotonin, prefrontal cortex deficits)
• psychological: biased attention and interpretation of information relating to attractiveness
• social: family emphasis on attractiveness, teasing

Question 16

treatment of BDD

Answer 16

• antidepressant medications (SSRI)
• CBT: exposure/response prevention (preventing checking, wearing something that highlights defect)

Question 17

Hoarding Disorder

Answer 17

• acquire and fail to discard many possessions that seem useless or of very limited value
• living spaces often cluttered
• compulsive hoarders are often more disabled than normal population (work, social life)
• high risk for fire, falling, sanitation, health problems
• medications and behavioral therapy less effective than OCD

Question 18

DSM-5 criteria of Hoarding Disorder

Answer 18

• persistent difficulty discarding or parting w/ possessions
• difficulty is due to a perceived need to save the items and to distress associated w/ discarding them
• difficulty discarding results in accumulation of possessions that congest and clutter active living areas and compromises their use
• hoarding causes clinically significant distress or impairment in social, occupational, or other areas
• hoarding is not attributable to a medical condition nor better explained by the symptoms of another mental disorder

Question 19

Trichotillomania (Hair-Pulling) Disorder

Answer 19

• the urge to pull one’s hair from anywhere on the body (most often scalp, eyebrows, or arms)
• tension followed by temporary relief when hair is pulled
• usually occurs when person is alone or w/ family members
• person often examines hair root, twirls, pulls between teeth

Question 20

DSM-5 diagnostic criteria for Trichotillomania

Answer 20

• recurrent pulling out of one’s hair resulting in hair loss
• repeated attempts to decrease or stop hair pulling
• the hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• the hair pulling is not attributed to another medical condition
• the hair pulling is not better explained by the symptoms of another mental disorder

Question 21

Excoriation (Skin-picking) Disorder

Answer 21

• recurrent skin picking resulting in skin lesions
• repeated attempts to decrease or stop skin picking
• the skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• the skin picking is not attributable to the physiological effects of a substance (e.g. cocaine) or another medical condition
• the skin picking is not better explained by symptoms of another mental disorder (e.g. delusions or tactile hallucinations)

Question 22

unresolved issues

Answer 22

the choice of treatments is a challenge for patients