Obsessive-Compulsive and Related Disorders

1. Obsessive-Compulsive and Related Disorders

2. Categories • 1. Obsessive Compulsive Disorder • 2. Body Dysmorphic Disorder • 3. Hoarding Disorder • 4. Tricholtillomania • 5. Excoriation Disorder • 6. Substance/Medication Induced OCD • 7. OCD due to another medical condition • 8. Other Specified OCD • 9. Unspecified OCD (example: Exceptional Jealousy)

3. Definitions • Obsessions-recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. • Compulsions-repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession • Very similar to anxiety disorders!!!!

4. 1.Obsessive Compulsive Disorder • OCD occurs all over the world!!!! • When does OCD become a problem? • We all have normal preoccupations and rituals, but people with OCD have excessive and persisting preoccupations. These persist beyond developmentally appropriate periods. • Specific content of obsessions and compulsions varies among individuals, but most people are preoccupied with: • Cleaning (contamination) • Symmetry (repeating, ordering, counting) • Forbidden or taboo thoughts (aggressive, sexual, religious) • Harm (fears of hurting self or others)

5. OCD Diagnostic Criteria • 1. Presence of obsessions and/or compulsions (children who can’t act out compulsions may just talk about them) • 2. The obsessions and compulsions must be time-consuming (take more than 1 hour per day), which causes impairment in social, occupational, or other areas of functioning • The symptoms can not be attributed to drug use or medication

6. OCD Specifiers • 1. With good or fair insight • 2. With poor insight • 3. With absent insight/delusional beliefs • 4. If Tic-Related (current or past tic disorder, up to 30% of people with OCD have a lifetime tic disorder)

7. Other Symptoms • Anxiety • Panic attacks • Feelings of disgust • Feelings of things being incomplete • Avoid people, places, and things that trigger obsessions and compulsions • Avoid public places • Avoid social interactions

8. Prevalence and Course • 1.2% of the US population have OCD • Slightly higher in females than in males in adulthood • Slightly higher in males than in females in childhood • Mean age of onset is 19 years old, 25% of cases start by ate 14 (for males, 25% start by age 10!) • If OCD is untreated, the course is chronic and only 20% will get rid of it

9. Risk Factors • 1. Tempermental-Internalize things, negative emotionality, behavioral inhibition • 2. Environmental-Physical and sexual abuse in childhood, stressful and traumatic events, exposure to infectious agents • 3. Genetic and Physiological-Twin studies showed 57% for monozygotic twins, and 22% for fraternal twins • Disfunction of several brain structures, including the frontal lobe, has been found in OCD

10. Differential Diagnosis • OCD Looks like: • Anxiety Disorders • Major Depressive Disorder • Eating Disorders • Tic Disorder • Psychotic Disorders

11. Comorbidity • OCD is sometimes comorbid with: • Anxiety Disorder (76%) • Depression or Bipolar (63%) • OCD Personality Disorder (23%) • Tic Disorder (30%)

12. When are you obsessive and compulsive? • We all obsess over things sometimes. What do you obsess over? • We all have compulsions that we act on as well. What compulsions do you act on?

13. 2. Body Dysmorphic Disorder • Diagnostic Criteria Include: • 1. Preoccupation with one or more perceived flaws in physical appearance that are NOT observable to others • 2. The individual performs repetitive behaviors (mirror checking, grooming, picking skin, seeking reassurance) • 3. The preoccupation causes significant distress or impairment in social, occupation, or other important areas of functioning • 4. The symptoms can not be explained by an eating disorder

14. Specifiers • 1. With muscle dysmorphia (preoccupied with body build being too small or not muscular enough) • 2. With good or fair insight • 3. With poor insight • 4. Absent insight/delusional beliefs

15. Other Symptoms • High levels of anxiety and social anxiety • Social avoidance • Depressed mood • Neuroticism • Perfectionism • Low self-esteem • Obsessed with how they look • Receive cosmetic treatments • Perform surgery on themselves • Perceive everyone’s responses as negative

16. Prevalence and Course • 2.5% in females, 2.2% in males • Higher among dermatology patients and cosmetic surgery patients (about 10-16%) • Higher among orthadontia patients (about 10%) • Mean age of onset is 16-17 years old • Most common age is 12-13 years old • The disorder is chronic if no treatment is provided • Individuals diagnosed before age 18 have a higher risk of suicide, have more comorbidity, and have a gradual onset of the disorder

17. Risk Factors • 1. Environmental-childhood neglect and abuse • 2. Genetic-higher prevalence in first-degree relatives with OCD

18. Consequences of BDD • 1. Impaired psychosocial functioning (sometimes to the point of incapacitation) • 2. Quality of life decreases • 3. Impairment in job or school • 4. 20% of youth with BDD report dropping out of school • 5. Psychiatric hospitalization is common

19. Interesting Facts • BDD has been reported internationally • Males are more likely to have genital preoccupations • Females more likely to have a comorbid eating disorder • Muscle dysphoria occurs mostly in males • Rates of suicidal ideation and attempts are high • Comorbid with eating disorders, social anxiety, and OCD

20. 3. Hoarding Disorder • Persistent difficulty parting with possessions, regardless of their actual value...includes animal hoarding • Strong perceived need to save items, and causes extreme distress when they consider discarding them • Symptoms include the accumulation of a large number of possessions that congest and clutter active living areas • Most collect, buy, or steal items that are not needed, or for which there is no available space • Symptoms start to emerge around 11-15 years old, but is the diagnosis is3 times more prevalent in older adults (age 55-94) • Prevalence in Europe and North America is 2-6% • 50% of cause is due to genetics, according to twin studies • Often comorbid with mood or anxiety disorders

21. 4. Trichotillomania (hair-pulling disorder) • Recurrent pulling out of one’s hair, resulting in hair loss • There are repeated attempts to stop, and causes extreme distress • Most common areas are the head, eyebrows, and eyelashes • May be preceded with various emotional states, such as anxiety or boredom • They feel gratification, pleasure, or a sense of relief when the hair is pulled out • Person can have various degrees of consciousness when pulling out their hair • Usually do alone • May pull hair out on other objects • Often have other body-focused repetitive behaviors, such as nail biting

22. 4. Trichotillomania • Follows the onset of puberty • Sites of hair pulling varies over time • Course is chromic if left untreated • Evidence for genetic vulnerability • Can cause irreversible damage • Some people eat the hair, which is harmful

23. 5. Excoriation Disorder (skin-picking) • Recurrent skin picking, resulting in skin lesions • Repeated attempts to decrease or stop skin picking • Can become ritualistic, and individuals may play with, examine, or swallow the skin or scabs after they have been picked • Pain is not reported • Usually do alone • Causes scarring

24. 6. Substance/Medication Induced OCD • Obsessions, compulsions, skin picking, hair pulling, or other repetitive behaviors due to substance intoxication, substance withdrawl, or medication exposure. • Most common drugs are amphetamines, cocaine, and other stimulants • This disorder is extremely rare.