OCD Flashcards
recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted
obsessions
repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
Compulsions
Obsessive-Compulsive disorder
Presence of obsessions, compulsion, OR both
Obsessions: MUST HAVE THE FOLLOWING: recurrent/persistent thoughts/urges/images that are intrusive and unwanted that cause anxiety and attempts to ignore or suppress these with another thought or action
Compulsions: MUST HAVE THE FOLLOWING repetitive behaviors or mental acts done in response to an obsession or according to rules and acts aimed at preventing or reducing anxiety/distress; behaviors not realistically connected to prevent this or are excessive
For OCD, specify
good/fair insight,
poor insight, or
absent insight/delusional
Good/fair = individual recognizes OCD beliefs are probably/definitely NOT true
Poor = individual thinks OCD beliefs are PROBABLY true
Characteristic feature is the presence of obsessions and compulsions (but only one is needed)
Obsessive-Compulsive disorder
OCD Individuals tend to have
dysfunctional beliefs
inflated sense of responsibility
overestimate threats
be perfectionists
need to control thoughts
(Up to 30% have a tic disorder in their lifetime)
Most common in males
Suicide risk: SI for up to 1/2 of these patients; attempts by 1/4th of these patients
OCD
Non-pharmacologic:
Systematic desensitization
Cognitive behavioral therapy
Tx for OCD
SSRIs; may need longer than a typical course of depression to see results
Clomipramine (TCA)
Pharmacologic tx for OCD
W/ clomipramine (TCA) use caution if considering serotenergic meds
SSRIs; may need longer than a typical course of depression to see results
Clomipramine (TCA)
Pharmacologic tx for OCD
W/ clomipramine (TCA) use caution if considering serotenergic meds
Preoccupation with perceived defects in physical appearance not observable to others
Patients has performed repetitive behaviors or mental acts in response to the concerns
Body Dysmorphic Disorder
Clinically significant
Not better explained
Like OCD, with body dysmorphic disorder… specify level of insight…
For example
With muscle dysmorphia: insufficient musculature
Good/fair insight: think thoughts are not/probably not true
Poor insight: probably true
Absent insight/delusional: convinced they are true
Essential feature is preoccupation with perceived flaws that make them look ugly or deformed BUT are not obvious to others
Body Dysmorphic Disorder
Skin, hair, and nose are most common areas, but any body part can be the nidus of concern
Common repetitive behaviors include comparing themselves to others, checking mirrors, excessive grooming, camouflaging, or seeking reassurance
Muscle dysmorphia occurs almost exclusively in males
Suicide Risk: High in adults and adolescents
Body Dysmorphic Disorder
Non-pharmacologic
Psychotherapy
Pharmacologic = SSRIs
Clomipramine (TCA)
(Treatment towards a perceived organic issue (i.e. Dermatology referral/surgery) rarely successful…so use these referrals very cautiously )
Body dysmorphic disorder
but we have to get to the core of the fact they’re not having this disfigurement that they feel they’re having
A dx for body dysmorphic disorder is depression… but with depression they need?
Endorsed depressive mood
Difficulty discarding possessions
Perceived need to save item and distress with discarding it
Accumulation of possessions that congests and clutters active living areas
Hoarding Disorder
if not cluttered, ONLY because of 3rd party involvement
Essential feature is long standing difficulty discarding items regardless of value
Not a transient issue (i.e. inheriting property)
Hoarding Disorder
Many display excessive acquisition from buying or getting free items
Stealing is less common
Experience distress at the prospect of discarding the items
Hoarding Disorder
Very difficult to treat
Cognitive behavioral therapies show the best effectiveness
Mixed results with medications such as SSRIs
Hoarding Disorder
*Pulling out one’s hair with *hair loss and *repeated attempts to stop or decrease the activity
Clinically significant
Trichotillomania
Essential feature is pulling out one’s hair despite trying to stop
Can be any body region, but scalp, eyebrows, and eyelids are the most common areas
Trichotillomania
Non-pharmacologic tx =
Biofeedback
Desensitization
Habit reversal
Trichotillomania
Pharmacologic interventions for trichotillomania include?
topical steroids
hydroxyzine
antidepressants
antipsychotics
(behavioral therapy is best)
Picking at one’s skin with skin lesions and repeated attempts to stop or decrease the activity
Clinically significant
Excoriation
The essential feature of excoriation disorder is recurrent picking at one’s own skin
most commonly picked sites are the face, arms, and hands but any site is possible
Excoriation
Excoriation tx?
difficult to treat
*CBT and habit reversal may help
Some support for fluoxetine or naltrexone
