OCD and Related

Disorders

PSY 321 Abnormal Psychology

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Learning Outcome
• Distinguish obsession and compulsion.
• Explain the essential features of OCD-related disorder.
• Explain the etiology of OCD-related disorder.
• Suggest treatments to treat OCD-related disorder.

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OCD is one of the most disabling disorders, in terms of quality of life

It comprises of obsessions and compulsions

Lack of insight

Awareness about the thoughts being from within not without

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Obsession and Compulsion
Obsession
• Persistent, recurrent unwanted intrusive thoughts, images, urges experienced as
disturbing, inappropriate, and uncontrollable
• People attempt to resist, suppress or neutralise these obsessions with some other
thought or action
• Contamination, harming, doubt
Compulsion
• Overt repetitive behaviors or covert mental acts performed in response to
obsessions or according to rules that must be applied rigidly
• They aim at reducing the distress or preventing some dreaded events, but are
clearly excessive
• Cleaning, checking, repeating, ordering, counting
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Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions, or both.
B. The obsessions or compulsions are time-consuming, or cause clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological
effects of a substance or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental
disorder.

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Obsessive-Compulsive and Related Disorders
CATEGORY EXAMPLE

Contamination Fear of germs from saliva or genitals

Responsibility for harm If I don’t count till 5 before stepping out, it will rain.
What if I hit a pedestrian with my car by mistake?

Sex and morality Unwanted thoughts of incestuous relationships

Violence Thought of stabbing someone with the knife one is using to eat
Thoughts of loved ones losing their lives in terrible accidents

Religion What if I don’t really believe in God?

Symmetry and order The sense that odd numbers are “bad”
The feeling that books have to be arranged “just right” on the shelf

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Obsessive-Compulsive and Related Disorders
Category Example
Decontamination Washing hands for 30 minutes at a time after touching one’s shoes
Wiping down all mail and groceries brought into the house for fear of germs
from the letter carrier and store clerks
Checking Driving back to check that no accidents were caused at the intersection
Checking locks, appliances, electrical outlets, and windows
Repeating routine Getting up and down out of a chair until the obsessional thought has been
activities dismissed
Ordering/arranging Saying the word “correct” whenever one hears the word “right”
Fixing pictures on the wall until they are hung “just right”
Mental rituals Replacing a “bad” thought by thinking of a “good” thought
Repeating a prayer until it is said “just right”
Source: Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive and related disorders: A critical review of the
new diagnostic class. Annual Review of Clinical Psychology, 11, 165-186. doi:10.1146/annurev-clinpsy-032813-
153713 7
Body Dysmorphia
• Perceived imaginary physical
defects or imperfections that
have little to no basis in reality,
keeps one preoccupied
• Leads to constant checking,
grooming, fixing or even
cosmetic surgery and eating
disorders

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Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD)
A. Preoccupation with one or more perceived defects or flaws in physical appearance
that are not observable to others
B. At some point during the course of the disorder, the individual has performed
repetitive behaviors (eg: mirror checking, excessive grooming, reassurance seeking)
or mental acts (comparing their appearances with others) in response to the
appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in important
areas of functioning
D. It is not better explained by other mental disorder.

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Compulsive hoarding
• “If I throw this, I am throwing away a part of
myself”
• “I need to keep food in stock. What if there’s
an emergency?”
• “What if I need this later?”
• Stocking up on toilet paper rolls during the
pandemic

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Hoarding Disorder
Hoarding Disorder
A. Persistent difficulty parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress
associated with discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions
that congest and clutter active living areas and substantially compromises their
intended use. If living areas are uncluttered, it is only because of the
interventions of third parties.
D. The hoarding causes clinically significant distress and impairment in
functioning.
E. & F. The hoarding is not attributable to another medical condition or other
mental disorder. 11
Trichotillomania / Hair-Pulling Disorder
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in
functioning.
D. The hair pulling or hair loss is not attributable to
another medical condition.
E. The hair pulling is not better explained by the
symptoms of another mental disorder.

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Excoriation Disorder / Skin-Picking Disorder
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clin sig distress or impairment in social, occupation, or other
important areas of functioning.
D. The skin picking is not attributable to the physiological effects of a substance (e.g.,
cocaine) or another medical condition (e.g., scabies).
E. The skin picking is not better explained by symptoms of
another mental disorder.

This Photo by Unknown Author is licensed under CC BY-NC

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 Etiology of OCD-Related Disorders
Psychological perspective
• As a result of learning – Mowrer’s Two Process Theory (1960)
• Classical conditioning - doorknob is associated with the idea of contamination
• Operant conditioning – anxiety induced by touching a doorknob can be reduced by
hand washing (negative reinforcement)
Don’t
think
about…
• Difficulty blocking out negative, irrelevant input of distracting information
• Attempt to suppress the resulting negative thoughts—which may paradoxically
increase their frequency
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Etiology of OCD-Related Disorders
Psychological perspective – Cognitive distortions
Inflated sense of responsibility - thought-action fusion beliefs
• Simply having a thought about something is morally equivalent to actually
doing it or it will increase the chances of actually doing it
• Compulsive behaviors to try to reduce perceived likelihood of harm
Low confidence in their memory ability may contribute to their compulsion – “I
can’t remember if I checked the stove”
• Attentional bias
• People with OCD tend to focus on obsession-related materials
• People with BDD showed biased attention and interpretation towards
information relating to attractiveness
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Etiology of OCD-Related Disorders
Biological perspective
• Genetic contribution
• Genetic heritability for OCD is moderate; greater in early-onset OCD
• Concern in physical appearance is a moderately heritable trait
• Neurotransmitter - Serotonin
• Increased serotonin activity and increased sensitivity of some brain
structures to serotonin are involved in OCD symptoms
• Clomipramine and fluoxetine (which stimulate serotonergic system) worsen
the symptoms in short-term, but improve the symptoms in long run

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Etiology of OCD-Related Disorders
Biological perspective
• Brain abnormalities
• Abnormally high level of activity in
• Orbito frontal cortex – involved in primitive urges, such as sex, aggression,
hygiene, and danger
• Cingulate gyrus – emotion processing and behaviour regulation
• Basal ganglia (especially caudate nucleus) – involved in executing primitive
behaviors
• Dysfunction of the cortico-basal-ganglionic-thalamic circuit leads to
inappropriate behavioral responses that are normally inhibited or “filtered”

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Etiology of OCD-Related Disorders
Sociocultural perspective
• Especially applicable for BDD
• In OCD, cultures with excessive importance to perfectionism, cleanliness or
manners may cultivate a climate that fosters anxiety and OC features.
• E.g. CBS Taijin Kyofusho – the fear of offending others by eye contact, blushing or
body odor

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Treatment for OCD-Related Disorders
Psychological Treatment - CBT
• Most effective: exposure and response prevention to encounter the source of
obsessions and preventing clients from engaging in compulsive behaviors
• Clients are asked to touch the “contaminated” object and refrain from hand
washing
• This is so that clients can learn that anxiety will drop despite not engaging in
the compulsion

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Treatment for OCD-Related Disorders
Pharmacological Treatment
• Clomipramine (Anafranil) and fluoxetine (Prozac) reduce the OCD symptoms
• Target serotonergic system - SSRI
• Require higher dose to effectively treat BDD than OCD
• Relapse rates are high when medication is discontinued
Antidepressants may sometimes be prescribed.

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 Treatment for Trichotillomania & Excoriation
Disorder
Psychological treatment – Behaviour therapy
• Habit reversal training
• Engage in action incompatible with hair-pulling/skin-picking
Pharmacological treatment
• Inconclusive findings on the effect of antidepressant to treat trichotillomania and
excoriation disorder
• Generally, behavioral therapy seems to be a more viable treatment option
Source:
Duke, D. C., Keeley, M. L., Geffken, G. R., & Storch, E. A. (2010). Trichotillomania: A current review. Clinical Psychology Review,
30, 181-193. doi:10.1016/j.cpr.2009.10.008
Lochner, C., Roos, A., & Stein, D. J. (2017). Excoriation (skin-picking) disorder: A systematic review of treatment
options.Neuropsychiatric Disease and Treatment, 13, 1867-1872. http://dx.doi.org/10.2147/NDT.S121138 21