Obsessive-Compulsive and Related Disorders

Question 1

OCD and related dx

DSM 5

Answer 1

1. New to DSMS 5, greater evidence to group these disorders
2. New Disorders: hoarding, excoriation, substance-/medication-induced OCD, and OCD not related to medical condition.
3. Trichotillomania now in OCD
4. ‘with poor insight’: distinction between those with good/fair insight, poor insight, and ‘absent insight/delusional’ OCD beliefs.
5. ‘insight’ specifiers added to body dysmorphic and hoarding disorders.
   
   1. recognizes that the presence of absent insight/delusional beliefs warrants a diagnosis of the relavent OCD, not schizophrenia and other psychotic dx.
6. ‘tic-related’ specifier also reflects evidence of clinical importance.

Question 2

OCD

defined

Answer 2

OCD: recurrent obsessions and/or compulsions that are severe enought to cause significant distress, time consuming (more than one hour), or markedly interfere with the person’s usual routine, occupation/school, social activities, and relationships.

1. Obsessions: persistent thoughts, impulses, or images that the person experiences as senseless/intrusive and distress. contamination, doubts about actions, aggressive impulses, and sexual imagery.
2. Compulsions: repetitious and deliberate bx or mental acts that one feels driven to perform in response to obsessions or according to rigid rules. goal of the compulsive acts is to reduce distress or prevent a dreaded situation from happening, but acts are excessive or not connected logically to the goal.

Gender: equal, but earlier for males; children and adolescents also more prevalent in men.

Etiology: Low level of serotonin, as SSRIs are effective treatment.

right caudate nucleaus: over active and involved in converting sensory input into cognition and action.

orbitofrontal cortex and cingulate cortex: also implicated which mediate emotional reactions.

TREATMENT: combination of exposure with response prevention (flooding) and the tricyclic clomipramine (antidepressent) or an SSRI is the treatment of choice.

Exposure is often paired with thought stopping or other CBT techniques. Drugs not used alone, as relapse is high once stopped.

not related to OC-Personality Dx (OCPD): preoccupation with order, perfection, and control. Rituals for perfection, not reduce anxiety.

Question 3

Body Dysmorphic Disorder

Answer 3

1. repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance has been added.
2. “with muscle dysmorphia” specifier added.
3. Delusional variant is now designated only as body dsymorphic disorder with the absent insight/delusional beleifs specifier.

Question 4

Hoarding Disorder

Answer 4

1. New Disorder: persistent difficulty discarding or parting with possessions dure to a perceived need to safe the items and distress associated with discarding them.

Symptoms of the disorder cause clinically significant distress or impairment in social, occupational or other important areas of functioning including maintaining an environment for self and/or others.

While some people who hoard may not be particularly distressed by their behavior, their behavior can be distressing to other people, such as family members or landlords.

Hoarding disorder is included in DSM-5 because research shows that it is a distinct disorder with distinct treatments.

prevalence of hoarding disorder is estimated at approximately two to five percent of the population.

These behaviors can often be quite severe and even threatening. Beyond the mental impact of the disorder, the accumulation of clutter can create a public health issue by completely filling people’s homes and creating fall and fire hazards.

Question 5

Trichotillomania

Excoriation Disorder

Answer 5

1. Trichotillomania: included, compulsive hair pulling
2. Excoriation (skin-picking) disorder is a new disorder added to the DSM-5. It is estimated that between 2 and 4 percent of the population could be diagnosed with this disorder.
3. Resulting problems may include medical issues such as infections, skin lesions, scarring and physical disfigurement.

According to the APA, this disorder is characterized by constant and recurrent picking at your skin, resulting in skin lesions.

4. “Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin picking, which must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms must not be better explained by symptoms of another mental disorder.”

Question 6

Substance/Medication-Induced OCD

OCD due to another medical condition

Other Specified and unspecified OCD and related Dx

Answer 6

Recognition that substances, medications, and medical conditions can present with symptoms similar to primary obsessive-compulsive and related disorders.

1. DSM-5 includes the diagnoses other specified obsessive-compulsive and related disorders. These disorders can include conditions such as body-focused repetitive behavior disorder and obsessional jealousy, or unspecified obsessive-compulsive and related disorder.
2. Body-focused repetitive behavior disorder, for instance, is characterized by recurrent behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) and repeated attempts to decrease or stop the behaviors
3. Obsessional jealousy is characterized by nondelusional preoccupation with a partner’s perceived infidelity.