OCD Disorders

Obsessive-Compulsive Disorders
OCD: characterized by the Prescence of obsessions and/or compulsions
Obsessions: are recurrent and persistent thoughts, urges, or images that are experienced as
intrusive and unwanted
Individual's attempt to ignore or suppress the thoughts, urges, or images to neutralize them with
other thought or action
Compulsions: are repetitive behaviors or mental acts as individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly
Repetitive Behaviors Example: Hand washing, ordering, checking
 Some people with OCD are subject to preoccupations & by repetitive behaviors or mental
acts in response to these preoccupations
Diagnostic Criteria
A) Presence of obsession, compulsions, or both:
B) Time consuming obsessions and compulsions or cause significant distress or impairment
in social, occupational, or other functioning
C) Symptoms are not attributable to physiological effects of substance, medication, or
medical condition
D) Not better explained by another mental disorder
Specify
With Good/Fair Insight: recognizes that beliefs are not true or probably not true
With Poor Insight: thinks their beliefs are probably true
With Absent Insight: completely convinced the obsessive-compulsive beliefs are true
*Final Question (maybe): Specify if TIC DISORDER
*30% of individuals with OCD have a tic disorder
*More common in men with OCD onset in childhood
Categories in OCD
 Washers: afraid of contamination. Usually have cleaning or hand-washing compulsions
 Checkers: repeatedly check things that they associate with harm or danger
 Doubters: afraid that if everything isn’t perfect or done just right something terrible will
happen, or they will be punished
 Counters & Arrangers: obsessed with order and symmetry. They may have superstitions
about certain numbers, colors, arrangements
Prevalence
 Slightly higher rate in women than men with men more commonly affected in
childhood
 Onset: 19.5 years Onset After 35: is unusual
 OCD comorbid: anxiety, depressive and bipolar disorder
Associated Features
 Preceding compulsions are reported by 60% of individuals with OCD
 They report sensory phenomena, such as physical sensations, just-right sensations, or
feelings of incompetence
 Avoidance behaviors are common to reduce exposure to triggering situations
 CBT is best
Body Dysmorphic Disorder

-people become preoccupied with a perceived defect or flaw in their appearance that
they believe renders them ugly, unattractive, abnormal or deformed
Criteria
A) Preoccupation with one or more perceived defects or flaws in physical appearance that
are not observed or appear slight to others
B) Individual has in disorder performed repetitive behaviors or mental acts like comparing to
others
Repetitive BX’s: mirror checking, excessive grooming, skin picking, reassurance
seeking, compensatory behaviors
C) The preoccupation causes clinically significant distress or impairment in social,
occupational, or other functioning
D) Not explained by concerns about body fat or weight in someone whose symptoms meet
criteria for eating disorder
Final Exam Question!!!!!!!!!!!: What’s different with OCD (something you don’t want & causes
distress/ can’t control) and OCD personality disorder
Hoarding Disorder
 Persistent difficulties discarding or parting with possessions regardless of actual value
 Persistent: pattern of long-standing difficulty rather than transient life circumstances,
such as inheriting property
A) Persistent difficulty discarding or parting with possessions regardless of their value
B) Due to perceived need to save items and distress with discarding them
C) The difficulty discarding possessions results in an accumulation of possessions that
congest, and clutter living areas and compromise their integrity.
D) Causes significant distress
E) Not attributable to medical condition or mental disorder (prader willi, neurovascular
disorder, brain injury)
F) Hoarding is not better explained by another mental disorder
-decreased energy in MDD
-delusions in schizophrenia
-obsessions in OCD
Specifiers
Specify If: Excessive Acquisition of Items
 Difficulty discarding possessions is accompanied by excessive acquisition of
items unneeded or for which there is no space
Good/Fair Insight: realizes beliefs are problematic
Poor Insight: convinced beliefs are not problematic
Absent Insight: totally convinced the hoarding related beliefs are not problematic
Trichotillomania (Hair-Pulling Disorder)
will be on Exam
 Essential feature is recurrent pulling out of one’s hair causing hair loss
 Hair pulling may come from common sites: scalp, eyebrows, or eyelids
Criteria
A) Recurrent pulling out of one’s hair resulting in hair loss
B) Repeated attempts to stop or decrease hair pulling behaviors

C) Hair pulling causes significant distress or impairment in social, occupational, or other
functioning
D) Not attributed to a medical condition or mental disorder
Features
 more common in women 10:1 ratio
 hair pulling may be triggered by anxiety or boredom, need for gratification, lack of
awareness, or tingling of scalp relieved by hair pulling
Excoriation (Skin-Picking) Disorder
 Essential Feature: recurrent picking at one’s own skin that leads to skin lesions
 Most common sites are face, arms and hands
Criteria
A) Recurrent skin picking resulting in skin lesions
B) Repeated attempts to decrease or stop skin picking
C) Causes clinically significant distress or impairment
D) Not attributable to physiological effects of substance use (amphetamine or cocaine)
E) Not explained by another mental disorder
-occurs over several hours a day and may continue for months or years
Prevalence
 ¾ of individual's are women
 Individual's may search for scabs to pull & may examine or even swallow this skin
 May be triggered by anxiety and boredom
 Some may pick the skin of others

Good: you know its bad
Absent: you think its fine
Substance/Medication Induced O-C and Related Disorder
A) Obsessions, compulsions, skin picking, hair pulling, or other body focused
repetitive behaviors
B) Evidence findings that both…Symptoms of (Criteria A) developed during or
soon after substance intoxication or withdrawal & Involved
substance/medication can produce the symptoms
C) Disturbance not better explained by OCD that is not substance induced
D) Disturbance does not occur during course of delusion
E) Disturbance causes clinically significant distress or impairment
*Dr. Dooley might not put substance related disorders on exam
Tips for Final:
Questions: about Culture (know terms you don’t under : anxiety cultural,
depression and OCD cultural)
Example: Koro, Shub0-kyofu

OCD Disorders

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Obsessive-Compulsive Disorders

OCD: characterized by the Prescence of obsessions and/or compulsions

intrusive and unwanted

other thought or action

response to an obsession or according to rules that must be applied rigidly

Repetitive Behaviors Example: Hand washing, ordering, checking

acts in response to these preoccupations

A) Presence of obsession, compulsions, or both:

B) Time consuming obsessions and compulsions or cause significant distress or impairment

in social, occupational, or other functioning

C) Symptoms are not attributable to physiological effects of substance, medication, or

D) Not better explained by another mental disorder

With Poor Insight: thinks their beliefs are probably true

*30% of individuals with OCD have a tic disorder

*More common in men with OCD onset in childhood

 Washers: afraid of contamination. Usually have cleaning or hand-washing compulsions

happen, or they will be punished

about certain numbers, colors, arrangements

 Onset: 19.5 years Onset After 35: is unusual

 OCD comorbid: anxiety, depressive and bipolar disorder

 Preceding compulsions are reported by 60% of individuals with OCD

 They report sensory phenomena, such as physical sensations, just-right sensations, or

 Avoidance behaviors are common to reduce exposure to triggering situations

Body Dysmorphic Disorder

they believe renders them ugly, unattractive, abnormal or deformed

are not observed or appear slight to others

Repetitive BX’s: mirror checking, excessive grooming, skin picking, reassurance

seeking, compensatory behaviors

C) The preoccupation causes clinically significant distress or impairment in social,

occupational, or other functioning

criteria for eating disorder

distress/ can’t control) and OCD personality disorder

 Persistent difficulties discarding or parting with possessions regardless of actual value

 Persistent: pattern of long-standing difficulty rather than transient life circumstances,

such as inheriting property

A) Persistent difficulty discarding or parting with possessions regardless of their value

congest, and clutter living areas and compromise their integrity.

D) Causes significant distress

E) Not attributable to medical condition or mental disorder (prader willi, neurovascular

disorder, brain injury)

F) Hoarding is not better explained by another mental disorder

-decreased energy in MDD

Specify If: Excessive Acquisition of Items

 Difficulty discarding possessions is accompanied by excessive acquisition of

items unneeded or for which there is no space

Good/Fair Insight: realizes beliefs are problematic

Poor Insight: convinced beliefs are not problematic

Trichotillomania (Hair-Pulling Disorder)

A) Recurrent pulling out of one’s hair resulting in hair loss

B) Repeated attempts to stop or decrease hair pulling behaviors

D) Not attributed to a medical condition or mental disorder

 more common in women 10:1 ratio

awareness, or tingling of scalp relieved by hair pulling

Excoriation (Skin-Picking) Disorder

 Most common sites are face, arms and hands

A) Recurrent skin picking resulting in skin lesions

B) Repeated attempts to decrease or stop skin picking

C) Causes clinically significant distress or impairment

D) Not attributable to physiological effects of substance use (amphetamine or cocaine)