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6. Obsessive-Compulsive and Related Disorders > Obsessive-Compulsive and Related Disorders DSM (all) > Flashcards

Obsessive-Compulsive and Related Disorders DSM (all) Flashcards

1
Q

define obsessions

A

recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted

*not pleasurable and not experiences as voluntary

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2
Q

define compulsions

A

repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

*not done for pleasure though some people experience relief from anxiety or distress

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3
Q

how do obsessive compulsive and related disorders differ from developmentally normative peoccupations and rituals

A

by being EXCESSIVE or persisting beyond developmentally appropriate periods

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4
Q

list symptom dimensions (themes) that are common in OCD

A

cleaning

symmetry

forbidden or taboo thoughts

harm

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5
Q

are the body-focused repetitive behaviours that characterize trichotillomania and excoriation disorder triggered by obsessions or preoccupations?

A

no

but may be preceded or accompanied by various emotional states such as anxiety or boredom

may also be preceded by an increasing sense of tension or may lead to gratification, pleasure, or sense of relief when hair pulled out or skin picked

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6
Q

criterion A for OCD

A

presence of obsessions, compulsions, or both

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7
Q

define obsessions per criterion A of OCD

A
  1. recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as INTRUSIVE and UNWANTED and that in most individuals cause marked ANXIETY and DISTRESS
    AND
  2. 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
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8
Q

define compulsion per criterion A of OCD

A
  1. repetitive behaviours (i.e hand washing, ordering, checking) or mental acts (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
    AND
  2. behaviours or 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
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9
Q

criterion B OCD

A

obsessions are TIME CONSUMING (i.e take more than 1 hour per day) OR cause clinically significant distress or impairment

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10
Q

criterion C for OCD

A

symptoms not attributable to physiological effects of a substance or another medical condition

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11
Q

criterion D OCD

A

not better explained by another mental disorder

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12
Q

what specifiers are there for OCD in the DSM

A
  1. with good or fair insight–> individual recognizes that the O-C disorder beliefs are definitely or probably not true or that they may or may not be true
  2. with poor insight–> things OCD beliefs are probably true
  3. with absent insight/delusional beliefs–> individual completely convinced that OCD beliefs are true
  4. specify if “tic related”–> individual has current or past history of tic disorder
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13
Q

name some common dysfunctional beliefs found in individuals with OCD

A

an inflated sense of responsibility

tendency to overestimate threat

perfectionism

intolerance of uncertainty

over-importance of thoughts (i.e believing that having a forbidden thought is as bad as acting on it) and the need to control thoughts

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14
Q

what proportion of people with OCD have absent insight/delusional beliefs

A

about 4% or less

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15
Q

how does degree of insight in OCD help prognostically

A

while degree of insight can vary of the course of the illness, generally poorer insight has been linked to worse long term outcome

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16
Q

what proportion of people with OCD have a lifetime tic disorder? which populations tends to present with this constellation of symptoms?

A

about 30%

*most common in males with onset of OCD in childhood

*these individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course and pattern of familial transmission

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17
Q

how do those with both tics disorders and OCD tend to differ from those with OCD but no tic disorder

A

those with tic-related OCD had:

–more OC symptoms, including more aggressive, religious and sexual obsessions
–more checking, counting, ordering, touching and boarding compulsions

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18
Q

are OCD themes generally consistent over time for adults with the disorder or do they change over time

A

generally consistent

(may be associated with different neural substrates)

people tend to have symptoms in more than one dimension

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19
Q

what is the 12 month prevalence of OCD

A

about 1-2%

males more commonly affected in childhood, females more commonly affected in adulthood

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20
Q

what % of cases of OCD start before/by age 14 years

A

25%

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21
Q

what is the upper limit of the normal age of onset of OCD

A

onset of OCD above age 35 is rare but does happen

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22
Q

what is the mean age of onset of OCD in the USA

A

19.5 years

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23
Q

what is the typical course of onset of OCD symptoms

A

typically gradual but acute onset has also been reported

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24
Q

who has earlier age of onset of OCD, males or females

A

males–> nearly 25% of males have age of onset before age 10

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25
Q

what is the usual course of OCD if untreated

A

usually CHRONIC often with WAXING and WANING symptoms

some people have EPISODIC course

minority have deteriorating course

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26
Q

what are remission rates in adults if OCD remains UNtreated

A

remission rates LOW if untreated–> 20% for those reevaluated 40 years later

however, 40% of people with onset of OCD in childhood and adolescence may experience remission by early adulthood

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27
Q

name 3 temperamental risk factors for OCD

A

greater internalizing symptoms

higher negative emotionality

behavioural inhibition

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28
Q

list environmental risk factors for OCD

A

physical and sexual abuse in childhood

other stressful or traumatic events

various infectious agents and post infectious autoimmune syndrome (ie PANDAS) have been associated with sudden onset OCD

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29
Q

how does having a first degree relative with OCD affect someones risk of developing OCD themselves

A

risk is 2x higher if you have a first degree relative with the disorder

BUT–> if your first degree relative had onset in childhood or adolescence, risk increases by 10x

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30
Q

dysfunction in which three brain regions is most strongly implicated in OCD

A

orbitofrontal cortex

anterior cingulate cortex

striatum

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31
Q

is the presentation of OCD fairly consistent worldwide

A

yes–> substantial similalarity across cultures in gender distribution, age at onset, and comorbidity of OCD, as well as in symptom structure involving cleaning, symmetry, taboo thoughts or fear of harm

(there is some regional variation though)

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32
Q

which gender is more likely to have comorbid tic disorders with OCD

A

males

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33
Q

which gender is more likely to have symptoms in the cleaning symptom dimension in OCD

A

females

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34
Q

which gender is more likely to have symptoms in the forbidden thoughts dimension in OCD

A

males

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35
Q

which gender is more likely to have symptoms in the symmetry dimension in OCD

A

males

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36
Q

is there a period of life that is an at risk time for development or exacerbation of OCD symptoms

A

have been reported in the peripartum period (including aggressive obsessions leading to avoidance of the infant)

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37
Q

SI occurs in what proportion of those with OCD?

suicide attempts occur in what proportion of those with OCD?

A

SI–> occurs at some point in about half of people with OCD

attempts–> reported in about 25% of people with OCD

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38
Q

what comorbidity increases the risk of suicide in those with OCD

A

MDD

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39
Q

ddx OCD

A

anxiety disorders

MDD

other OCD and related disorders

eating disorders

tics

stereotyped movements

psychotic disorders

other compulsive like behavious (i.e paraphilias, gambling, substance use_

OCPD

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40
Q

how do you distinguish between the recurrent thoughts in other anxiety disorders like GAD vs those found in OCD

A

in GAD–> recurrent thoughts generally about real-life concerns

in OCD–> recurrent thoughts generally do not involve real-life concerns and can include content that is “odd, irrational or seemingly of a magical nature”
+compulsions often present and usually linked to obsessions

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41
Q

how do you distinguish between the rumination of MDD vs OCD

A

MDD–> usually mood congruent and not necessarily experienced as intrusive or distressing + no compulsions

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42
Q

how does one distinguish between other compulsive like behaviours (i.e gambling, paraphilias) and OCD

A

usually in the other behaviours, the person derives pleasure from the behaviour and only wishes to refarin from it due to deleterious consequences

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43
Q

how does OCPD differ from OCD

A

OCPD–> enduring and pervasive maladaptive pattern of excessive PERFECTIONISM and RIGID CONTROL

OCD–> O-C symptoms

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44
Q

can you have both OCPD and OCD

A

yes

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45
Q

what is the most common comorbidity with OCD

A

anxiety disorders–> 76% of adults with OCD have a lifetime diagnosis of anxiety disorder

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46
Q

other than anxiety disorder, what are some other common comorbidities with OCD

A

depressive or bipolar disorder (most commonly MDD–> 41%)

OCPD (23-32%)

tic disorder (up to 30%)

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47
Q

there is a triad of disorders including OCD that can be seen in children–what are the other two disorders in that triad?

A

OCD, tic disorders and ADHD

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48
Q

list disorders that occur more commonly in those with OCD than those without OCD

A

BDD

trichotillomania

excoriation disorder

*there is also an association between OCD and some disorder related to impulsivity like ODD have been reported

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49
Q

rates of OCD are elevated in people with which other disorders?
(i.e if someone gets diagnosed with one of these other disorders, you should assess for OCD as the rates of OCD are higher in these people than would be expected based on the general population rates)

A

schizophrenia or schizoaffective disorder –> prevalence of OCD = 12%

bipolar disorder

eating disorders

tourettes disorder

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50
Q

criterion A for BDD

A

preoccupation is ONE or MORE perceived DEFECTS or flaws in PHYSICAL APPEARANCE that are NOT observable or appear SLIGHT to others

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51
Q

criterion B for BDD

A

at some point during the course of the disorder, the individual has performed REPETITIVE BEHAVIOURS (i.e mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (i.e comparing their appearance to that of others) in response to the appearance concerns

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52
Q

criterion C for BDD

A

preoccupation causes clinically significant distress/impairment

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53
Q

criterion D for BDD

A

not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

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54
Q

list specifiers associated with BDD

A
  1. with muscle dysmorphia–> preoccupied with idea body build is too small or insufficiently muscular
  2. indicate degree of insight (i.e with good or fair insight, with poor insight or with absent insight/delusional beliefs)
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55
Q

which body areas are most commonly the cause for concern in BDD

A

skin–> perceived lines, acne, scars, wrinkles, paleness

hair–> “thinning” hair or “excessive” body hair or facial hair

nose–> size or shape

*however any body area can be area of concern i.e eyes, teeth, weight, stomach, breasts, chin, eyebrows etc

*some individuals are concerns with perceived asymmetry of body areas

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56
Q

how would you describe the nature of the body related preoccupations in BDD

A

intrusive

unwanted

time consuming

usually difficult to resist or control

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57
Q

how much time during the day do the body related preoccupations in BDD typically occur for

A

on average 3-8 hours per day

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58
Q

what is “muscle dysmorphia”

A

a form of BDD occurring almost exclusively in MALES–> preoccupation with idea that ones body is too small or insufficiently lean or muscular

typically have normal looking body or are muscular

may also be preoccupied with other body areas

majority (not all) use diet, exercize and/or lift weights–> may cause body damage–> may use anabolic steroids or other substances to make body look bigger and more muscular

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59
Q

what is BDD by proxy?

A

form of BDD in which individuals are preoccupied with defects they perceive in another person’s appearance

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60
Q

on average, what is people’s insight like when they have BDD

A

generally poor–> 1/3 or more currently have DELUSIONAL BDD beliefs

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61
Q

why do we care about level of insight in BDD

A

those with delusional BDD tend to have greater morbidity in some areas i.e suicide

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62
Q

what is a common type of idea/delusion in BDD

A

ideas or delusions of reference (believing that other people take special notice or mock them becuase of how they look)

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63
Q

what other features are often associated with those who have BDD

A

high levels of anxiety

social anxiety

social avoidance

depressed mood

neuroticism

perfectionism

low extroversion

low self esteem

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64
Q

what interventions to those with BDD often undertake due to their disorder

A

majority receive cosmetic treatment to try and improve perceived defects–> derm treatment and surgery are most common

some people may perform surgery on themselves

65
Q

do cosmetic treatments tend to help in BDD

A

no–> BDD tends to respond poorly to such treatments and sometimes becomes worse

some individuals take legal action or are violent against the clinician because they are dissatisfied with the cosmetic outcome

66
Q

what neurocognitive dysfunctions have been associated with BDD

A

executive dysfunction

visual processing abnormalities
–> bias for analyzing and encoding details rather than holistic or configural aspects of visual stimuli

tend to have a bias towards negative or threatening interpretations of facial expressions and ambiguous scenarios

67
Q

what is the prevalence of BDD in the general population

A

about 2% (very slightly higher in females)

68
Q

what is the prevalence of BDD amongst dermatology patients? cosmetic surgery patients? adult orthodontia patients? those presenting for oral or maxillofacial surgery?

A

derm–> 9-15%

cosmetic surgery–> 7-16%

adult orthodontia–> 7-8%

oral surgery–> 10%

69
Q

what is the usual age of onset for BDD

A

mean/median is around 15-17 years but most common age is 12-13 years old

(2/3 have onset before age 18)

70
Q

what is a bad prognostic factor for BDD

A

onset before age 18

onset before age 18 means person is more likely to attempt suicide, have more comorbidity, and have gradual, rather than acute, disorder onset

71
Q

name an environmental RF for BDD

A

childhood abuse and neglect

72
Q

name a genetic risk factor for BDD

A

higher rates in people with a first degree relative with OCD

73
Q

how do males and females with BDD differ

A

actually have more similarities than differences (i.e in severity, disliked body areas, types of repetitive behaviours, illness course)

males–> more likely to genital preoccupations

females–> more likely to have comorbid eating disorder

muscle dysmorphia = almost exclusively males

74
Q

does BDD affect suicide risk

A

yes–> SI and SA rates are high in this population

75
Q

on average, how much functional impairment is there in BDD

A

psychosocial functioning and quality of life for those with BDD tends to me “markedly poor”

about 20% of youth with BDD report dropping out of school primarily due to their BDD sx

high proportion of adults and kids with BDD have been hospitalized

76
Q

ddx for BDD

A

normal appearance concerns and clearly noticeable physical defects

eating disorders

other O-C and related disorders

illness anxiety disorder

MDD

anxiety disorders

psychotic disorders

other disorders and symptoms

77
Q

which tends to have worse insight, OCD or BDD

A

BDD

78
Q

when should you diagnose BDD vs excoriation disorder

A

if the skin picking is intended to improve the appearance of perceived skin defects

(same with trichotillomania and hair()

79
Q

what is body identity integrity disorder

A

(not DSM)

involves desire to have a limb amputated to correct an experience of mismatch between a persons sense of body identity and his or her actual anatomy –> concern does not focus on limbs appearance

80
Q

what is “koro”

A

a culturally related disorder that usually occurs in epidemics in SE Asia = fear that the penis (or labia/nipples/breasts in females) is shrinking or retracting and will disappear into the abdomen

often accompanied by belief that death will result

*focus is often on death rather than perceived ugliness so differs from BDD

81
Q

what is apotemnophilia

A

another word for body identity integrity disorder (not DSM)

82
Q

what is olfactory reference syndrome

A

not DSM

belief that one emits foul or offensive body odor

83
Q

what is the most commonly comorbid disorder with BDD

A

MDD
-> onset usually after BDD

social anxiety, OCD, SUDs are also common

84
Q

criterion A for hoarding disorder

A

persistent difficulty discarding or parting with possessions regardless of their actual value

85
Q

criterion B for hoarding disorder

A

this difficulty (with discarding or parting with possessions) is due to a perceived need to save the items and to distress associated with discarding them

86
Q

criterion C for hoarding disorder

A

difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and sustantially compromises their intended use

if living areas are uncluttered, it is only because of the interventions of third parties

87
Q

criterion D-F for hoarding disorder

A

clinically significant distress/impairment

not attributable to another medical condition

not better explained by another mental disorder

88
Q

what medical conditions may be associated with hoarding behaviours

A

brain injury

cerebrovascular disease

prader-willi syndrome

89
Q

what specifiers are there for hoarding disorder

A
  1. with excessive acquisition
  2. related to insight (good or fair insight–> recognizes behaviours are problematic, poor insight–> mostly does not think behaviours are problematic despite evidence to the contrary, absent insight/delusional beliefs–> completely convinced behaviours are not problematic)
90
Q

what is hoarding disorder “with excessive acquisition”

is this common?

A

hoarding disorder + if difficulty discarding possessions is accompanied by excessive acquisition of items that are NOT NEEDED or for which there is NO SPACE

yes–> approx 80-90% of those with hoarding disorder display excessive acquisition

ppl with hoarding disorder tend to experience distress is unable to or prevented from acquiring items

91
Q

what are the most common methods of excessive acquisition in hoarding disorder

A

most common–> buying

next common–> acquisition of free items (i.e leaflets, items discarded by others)

stealing is less common

92
Q

is the saving of items intentional or passive in hoarding disorder

A

intentional

(differs from other psychopathology in which you can have the passive accumulation of detritus)

93
Q

how does normative collecting differ from hoarding disorder

A

normative collecting = systematic, organized; does not produce the clutter, distress or impairement typical of hoarding disorder

94
Q

list some other common features found in those with hoarding disorder

A

indecisiveness

perfectionism

avoidance

procrastination

difficulty planning and organizing tasks

distractability

95
Q

why do some people with hoarding disorder live in unsanitary conditions

A

may be logical consequence of the hoarding behaviours and/or challenges with planning and organizing

96
Q

what are the most prominent differences between animal hoarding and object hoarding

A

extent of unsanitary conditions and poorer insight in animal hoarding

(those who hoard animals though tend to also hoard objects)

97
Q

what is the estimated point prevalence of hoarding disorder

A

2-6%

98
Q

is there a gender difference in hoarding disorder

A

significantly greater prevalence in males

(though clinical samples are predominantely female)

99
Q

how does age affect prevalence of hoarding symptoms

A

almost 3x more prevalence in older adults (55-94 years) compared with younger adults

100
Q

what is the usual age of onset and course of hoarding disorder

A

appears to begin EARLY in life and to be chronic and worsening

sx may first appear around ages 11-15–> start interfering with functioning in mid 20s–> clinically significant impairment by mid-30s

severity of hoarding increases with each decade of life

course is often chronic –> few people report waxing and waning

101
Q

what is a prominent temperamental risk factors for hoarding disorder

A

indecisiveness

102
Q

what is an environmental risk factor for hoarding disorder

A

stressful and traumatic life events preceding onset of disorder

103
Q

does hoarding disorder run in families?

A

yes–> about 50% of people with hoarding disorder report a family member who also hoards

twin studies–> about 50% of variability in hoarding behaviour is genetic factors

104
Q

is hoarding a western phenomenon?

A

no–> little data but appears to be universal with consistent clinical features

105
Q

how does hoarding disorder tend to present differently in females vs males

A

females tend to display more excessive acquisition, particularly excessive buying, than males

106
Q

ddx hoarding disorder

A

other medical conditions

neurodevelopmental disorders

schizophrenia spectrum and other psychotic disorders

MDE

OCD

neurocognitive disorders

107
Q

damage to which parts of the brain has been particularly associated with excessive accumulation of objects

A

anterior ventromedial prefrontal and cingulate cortices

(in people with damage to this part of the brain, hoarding was not present before the brain damage and presents shortly after the injury)

108
Q

do you diagnose hoarding disorder if the hoarding is felt to be direct consequence of i.e autism or other neurodevelopmental d/o

A

no

109
Q

can you get hoarding behaviours in OCD?

A

yes–> and if felt to be specifically related to the OCD then you just diagnose OCD

110
Q

how do hoarding behaviours tend to differ if a result of OCD vs hoarding disorder

A

in OCD–> behaviour generally unwanted, no pleasure or reward

excessive acquisition generally not present

more likely to accumulate bizarre items like trash, feces, urine, nails, hair, used diapers, rotten food (accumulation of these items in hoarding disorder is very rare)

usually secondary to feelings of incompleteness (i.e losing identity, need to document all life experiences) or to avoid onerous rituals (i.e decontamination rituals)

111
Q

what are the most commonly comorbid conditions with hoarding disorder

A

MDD (up to 50%)

social anxiety disorder

GAD

OCD (up to 20%)

*these comorbidities are often main reason for consult as people are unlikely to spontaneously report hoarding symptoms and are often not asked about in routine interviews

112
Q

what % of people with hoarding disorder have a comorbid mood or anxiety disorder

A

about 75%

113
Q

what are the criteria for trichotillomania in the DSM

A

A–recurrent pulling out of one’s hair, resulting in hair loss

B–repeated attempts to DECREASE or stop hair pulling

C–the hair pulling cuases clinically significant distress/impairment

D–hair pulling or loss is not attributable to another medical condition

E–not better explained by another mental disorder (i.e BDD)

114
Q

what are the most common sites for hair pulling in trichotillomania

A

scalp

eyebrows

eyelids

115
Q

how does the hair pulling in trichotillomania present during the day

A

may be brief periods scattered throughout the day or may be less frequent but more sustained periods that can continue for hours

hair pulling pay persist for months or years

116
Q

what types of behaviours may accompany the hair pulling in trichotillomania

A

may search for particular kind of hair to pull (i.e particular texture or color)

may try to pull hair in a specific way (i.e so root comes out intact)

may visually examine or tactilely or orally manipulate the hair after it is pulled

117
Q

what types of affective states may accompany hair pulling in trichotillomania

A

may be preceded or accompanied by varied states

may be triggered by anxiety or boredome

may be preceded by increasing sense of tension either immediately before pulling hair or trying to resist pulling

may have gratification, pleasure, sense of relief when pulls out hair

118
Q

does pain usually accompany hair pulling in trichotillomania

A

no

119
Q

what sensation do many people with trichotillomania describe before pulling hair

A

an “itch like” or tingling sensation in the scalp that is relieved by the hair pulling

120
Q

what is “tonsure trichotillomania”

A

pattern of nearly complete baldness except for narrow perimeter around outer margins of the scalp, particulalry at nape of the neck

121
Q

does hair pulling in trichotillomania usually occur in the presence of others

A

no, not usually (except for immediate family members)

122
Q

is the urge to pull hair in trichotillomania exclusive to ones own hairs?

A

some people have urges to pull hair from others and may sometimes try and find opportunities to do so surrepticiously

may pull hair from dolls, pets or other fibrous materials

123
Q

do people with trichotillomania have other body focused repetitive behaviours

A

yes–> majority have one or more other behaviours such as skin picking, nail biting, lip chewing

124
Q

what is the prevalence of trichotillomania in the general population

A

1-2% (12 month prevalence)

125
Q

what is the gender difference in trichotillomania

A

females affected more than males in 10:1 ratio

(may also reflect help seeking patterns rather than true difference between affected individuals–in kids with trichotillomania, males and females are more equally represented)

126
Q

is hair pulling ever normal

A

can be seen in infants but this behaviour typically resolves during early development

127
Q

onset of hair pulling in trichotillomania often coincides with or follows onset of what period of life

A

puberty

128
Q

what is the usual course of trichotillomania

A

chronic

some waxing and waning if untreated

symptoms may worsen in females with hormonal changes i.e menstruation, perimenopause

for some, disorder may come and go from weeks/months at a time

minority remit without subsequent relapse after a few years

129
Q

name risk factors for trichotillomania

A

genetic vulnerability

more common in those with OCD and their first degree relatives

130
Q

how might you differentiate trichotillomania from other types of hair loss if the person does not admit to hair pulling

A

(usually people admit to the hair pulling so this is not necessary)

can do skin biopsy or dermoscopy–> would see short vellus hair, decreased hair density, and broken hair with different shaft lengths

131
Q

what are some of the possible medical consequences of trichotillomania

A

may be irreversible damage to hair growth and hair quality

digit purpura

MSK injury (i.e carpal tunnel)

blepharitis

dental damage due to hair biting

swallowing of hair may lead to trichobezoars–> can lead to anemia, abdo pain, hematemesis, N/V, bowel obstruction, perforation

132
Q

what is tricophagia

A

swallowing of hair

133
Q

ddx trichotillomania

A

normative hair removal/manipulation

other OC related disorders

neurodevelopmental disorders

psychotic disorder

another medical condition

SUDs

134
Q

is it trichotillomania if hair removed solely for cosmetic reasons?

A

no

135
Q

do tics commonly lead to hair pulling

A

no–> tics rarely lead to hair pulling

136
Q

name a class of substance that may lead to hair pulling

A

stimulants

less likely that substances are the cause of persistent hair pulling however

137
Q

what are the most commonly comorbid conditions with trichotillomania

A

MDD

excoriation disorder

138
Q

what are the criteria for excoriation (skin picking) disorder

A

A–recurrent skin picking resulting in SKIN LESIONS

B–repeated attempts to DECREASE or stop skin picking

C–skin picking causes clinically significant distress or impairment

D–not attributable to substance (i.e cocaine) or medical condition (i.e scabies)

E–not better explained by another mental disorder (i.e delusions or tactile hallucinations, BDD beliefs, NSSI, stereotypies)

139
Q

what are the most commonly picked sites on the body in excoriation (skin picking) disorder

A

hands

arms

face

*may pick at healthy skin, skin irregularities, lesions like pimples or calluses, scabs from nervous picking

140
Q

what other behaviours may be present in addition to skin picking in excoriation (skin picking) disorder

A

skin rubbing, squeezing, lancing, biting

141
Q

how much time do people with excoriation (skin picking) disorder tend to spend picking at skin

A

often significant amounts of time–>sometimes several hours per day

may endure for months or years

142
Q

what is the gender difference in excoriation (skin picking) disorder

A

3/4 affected are female

143
Q

excoriation (skin picking) disorder is more common in which population

A

those with OCD or their relatives

144
Q

when does excoriation (skin picking) disorder often begin

A

around puberty

145
Q

how much time does skin picking generalyl take up in excoriation (skin picking) disorder

A

most spend at least 1 hour per day picking at skin, thinking about picking and resisting urges to pick

146
Q

ddx excoriation (skin picking) disorder

A

psychotic disorder

other O-C related disorder

neurodevelopmental disorders

somatic symptoms and related disorders

NSSI

other medical conditions

sub/med induced

147
Q

when might you see skin picking in psychosis

A

i.e due to delusion like parasitosis or tactile hallucination ie formication

148
Q

what neurogenetic condition may be associated with early onset of skin picking

A

prader-willi

149
Q

what disorders are commonly comorbid with excoriation (skin picking) disorder

A

OCD

trichotillomania

MDD

150
Q

criterion A for substance/medication induced O-C and related disorder

A

obessions, compulsions, skin picking, hair pulling or other body focused repetitive behaviour or other symptoms characteristic of the O-C and related disorders predominate in the clinical picture
(B–> evidence from hx, physical or lab that its related to a sub/med and that that sub/med can cause those symptoms)

151
Q

what substances may be known to cause symptoms that would meet criteria for substance/medication induced O-C and related disorder

A

stimulants (incl cocaine)

heavy metals and toxins

152
Q

what is Sydenham’s chorea

A

the neurological manifestation of rheumatic fever (due to Group A strep infection)

has motor and nonmotor features

nonmotor features: obsessions, compulsions, attention deficit, emotional lability

153
Q

what would be the diagnosis for someone who presents with Sydenham’s chorea/evidence of GAS followed by obsessive and compulsive symptoms?

A

obsessive-compulsive and related disorder due to another medical condition

*Sydenham’s chorea often presents with other signs of the underlying infectious cause like carditis, arthritis, as well as the motor symptoms of chorea

154
Q

name two manifestations of obsessive-compulsive and related disorder due to another medical condition

A

Sydenham’s chorea

PANDAS

disorders leading to striatal damage (i.e stroke)

155
Q

what is PANDAS

A

a post infectious autoimmune disorder (after strep infection) characterized by sudden onset of obsessions, compulsions, and/or tics accompanied by variety of acute neuropsychiatic symptoms in absence of chorea, carditis, or arthritis

*remains controversial dx though there is body of evidence for it

*PANS/CANS are modified versions of PANDAS removing the GAS etiological requirement

156
Q

list some disorders that would fall under the “other specified O-C and related disorders” category

A
  1. body dysmorphic-like disorder with actual flaws
  2. body-dysmorphic like disorder without repetitive behaviours
  3. body-focused repetitive behaviour disorder
  4. obsessionla jealousy
  5. shubo-kyofu
  6. koro
  7. jikoshu-kyofu
157
Q

what is obsessional jealousy

A

nondelusional preoccupation with partner’s perceived infidelity

may lead to repetitive behaviours or mental acts in response to the infidelity concerns and cause clinically significant distress/impairment

158
Q

what is “shubo-kyofu”

A

variant of taijin kyofusho–> similar to BDD–> excessive fear of having a bodily deformity

159
Q

what is “jikoshu-kyofu”

A

variant of taijin kyofusho–> fear of having an offensive body odor

aka olfactory reference syndrome

6. Obsessive-Compulsive and Related Disorders (3 decks)

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