Obsessive-compulsive or related disorders

Question 1

Define obsessions

Answer 1

• Repetitive and persistent
• Thoughts (e.g. of contamination, loved one getting cancer), images (e.g. of violent scenes), or impulses/urges (e.g. to crush head in hydralic press)
• Intrusive, unwanted
• Commonly associated with anxiety.

Question 2

Define compulsions

Answer 2

Repetitive behaviours performed to neutralize obsessions:
* According to rigid rules, or
* To achieve a sense of ‘completeness’

Either:
* Not connected in a realistic way to the feared event (e.g. facing a specific direction to prevent harm to loved one), or
* Are clearly excessive (e.g. washing for hours to prevent illness)

Question 3

Outline the two categories of compulsions

Answer 3

• Overt behaviours (e.g. handwashing, checking, ordering)
• Repetitive mental acts (e.g. specific phrases, counting)

Question 4

Outline the ICD-11 diagnostic criteria for Obsessive-compulsive disorder

Answer 4

• Presence of persistent obsessions and/or compulsions
• These are time-consuming or result in significant distress/impairment (unless significant additional effort applied)
• Not caused by another medical condition, substance use or substance withdrawal

Question 5

What is the prognosis of OCD?

Answer 5

CAMHS: Typically follows a chronic course, symptoms tend to wax and wane. 40% experience full remission by early adulthood.

Adults: Generally considered a chronic condition with waxing and waning of symptoms.

Question 6

What are the common co-morbitidies with OCD?

Answer 6

• Up to 30% of all individuals: Tourette Syndrome, or another primary tic disorder.
• Children: Primary tic disorder and/or ADHD.
• Adolescents: Body dysmorphia disorder or hoarding disorder.
• Eldery: up to 50% display personality disorder with anankastic traits.