OCD Disorders

Question 1

Obsessive Compulsive Disorder

What is obsessive

What is compulsive

When do you add a specifier?

Answer 1

1. Recurrent obsessions OR compulsions

Obsessions: intrusive recurrent thoughts, urges, or images that INCREASE distress (key point)- they cannot make you happy

Compulsions: repetitive behaviors/mental acts that are performed to DECREASE distress

Both are not always related, can have either/or

2. Obsessions/compulsions have to be time consuming, disruptive/distressful
3. Can’t be explained by another disorder

Add specifier when it can be of delusional intensity (they are 100% certain)-add with absent insight

Question 2

What are the neuroanatomical correlates for OCD?

There are two.

Answer 2

CSTC: cortico-striato-thalamo-cortical circuit OVERactivity

Serotonin deficiency

Question 3

Treatment for OCD

There are three.

Answer 3

1. Behavioral Therapy: Exposure and Response Prevention-ERP
2. Medications: SSRI’s-increase serotonin in cleft
3. Interrupt CSTC circuitry through:
   - Psychosurgery (cingulotomy or capsulotomy)
   - Deep Brain Stimulation

Question 4

Body Dysmorphic Disorder (BDD)

When do you add a specifier?

Answer 4

Preoccupation with a perceived flaw in physical appearance when flaw is minimal or non-observable
-Repetitive acts are performed in response to appearance concerns
Preoccupation must cause functional impairment-sequestering oneself-suicidal thoughts

Add Specifier when belief is 100% delusional-with certainty-“BDD with absent insight”

Question 5

Hoarding Disorder

Answer 5

Accumulation of possessions in areas that compromises their intended use

Question 6

Excoriation Disorder

What is the exception that you should watch out for?

Answer 6

Recurrent unwanted skin picking causing lesions

Excoriation to remove a perceived flaw in BDD is NOT Excoriation

Question 7

Trichotillomania

Answer 7

Recurrent unwanted pulling out of one’s hair