OC related Disorders

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1. Criteria (OCD) A): Presence of obsessions, compulsions, or both:

1. Obsessions:
-Recurrent and persistent thoughts, urges, or images that
are intrusive and unwanted; cause anxiety or distress
-individual attempts to ignore or suppress or neutralize
such things with some other thought or action
2. Compulsions:
-Repetitive behaviors or mental acts that they feel driven
to perform in response to an obsession
-The behavior or mental acts are aimed at preventing or
reducing anxiety or distress, but are clearly excessive

B): Os & Cs are time-consuming (1+ hr/day) or cause

clinically significant distress or impairment in social, occu-
pational, or other important areas of functioning

C): O-C sxs are not attributable to effects of a substance

or AMC

D): Disturbance is not better explained by sxs of another

mental dx

**Specify if with:
1) Good or fair insight
2) Poor insight
3) Absent insight/delusional beliefs
4) Tic-related (they have a current or past hx of a tic dx)

2. Rule Out (OCD) 1) Anxiety dx

a.GAD, specific or social phobia
2) MDD
3) Other OCD-related dx
a. Hoarding
b. BDD
c. Hair-pulling
4) Eating dx
5) Tics & stereotyped movements
6) Psychotic dx
7) Other compulsive-like behavior (i.e., gambling addic-
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tion)
8) OCPD
9) Bipolar dx

3. Prevalence Rates US rate: 1.2% (females affected at a slightly higher rate

(OCD) than males in adulthood, but males are more commonly
affected in childhood)

International rate: similar to US

4. Cultural Consid- Similarity across cultures & nations

erations (OCD)

5. Gender Consid- males diagnosed earlier than females; more males in

erations (OCD) childhood, but more females in adulthood

6. Develop- Onset: mean onset age is 19.5 years; 25% of cases start
ment/Course by 14; onset after 35 is rare; males have earlier onset
(OCD) (~25% by age 10); usually gradual onset, but can be acute

Course: if untreated, chronic course (often waxing & wan-

ing sxs); some have episodic course; some have a deteri-
orating course

Recovery: low remission rates in adults w/out treatment;

40% w/ childhood onset may have remission by early
adulthood; course is complicated by comorbid dx

7. Risk Factors ¢ reater internalizing sxs, higher negative emotionality, &

G
(OCD) behavioral inhibition in childhood
¢Physical & sexual abuse in childhood
¢Rate of OCD among 1st degree relatives of adults w/ OCD
is ~2x higher than those w/out (of childhood onset, 10x
increased rate)
¢80-90% in MZ twins!

8. Other Notes Suicidal thoughts occur in 50%; attempts reported up to

(OCD) 1/4

Comorbid MDD increases SUI risk

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9. Criteria (Body A. Preoccupation with one or more perceived defects or

Dysmorphic Dis- flaws in physical appearance that are not observable or
order) appear slight to others

B. At some point during the course of the disorder, they

have performed repetitive behaviors or mental acts in
response to the appearance concerns.

C. The preoccupation causes clinically significant distress

or impairment in social, occupational, or other important
areas of functioning.

D. The appearance preoccupation is not better explained

by concerns with body fat or weight in an individual whose
symptoms meet diagnostic criteria for an eating disorder.

**Specify if with:
1) Muscle dysmorphia ’ focus is on body build being
too small or insufficiently muscular (almost exclusively in
males)
2) With good or fair insight ’ they recognize the BDD beliefs
are probably not true
3) With poor insight ’ they think the BDD beliefs are prob-
ably true
4) With absent insight/delusional beliefs ’ they are com-
pletely convinced that the BDD beliefs are true

10. Rule Out (Body 1) Defects that don't cause impairment

Dysmorphic Dis- 2) Eating disorders (focus isn't necessarily on weight)
order) 3) MDD (lacks preoccupation w/ appearance)
4) Social Anxiety Dx
5) Agoraphobia
6) Avoidant PD
7) Psychosis
8) Gender Dysphoria

11.

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Prevalence Rates US Rates: 2.4% for adults (2.5% in females & 2.2% in
(Body Dysmor- males)
phic Disorder) International Rates: 1.7-1.8%

12. Cultural Consid- reported internationally w/ many similarities across races

erations (Body and cultures
Dysmorphic Dis-
order)

13. Gender Consid- Very similar clinical features in M & F; males more likely to
erations (Body have genital preoccupations & females more likely to have
Dysmorphic Dis- comorbid eating disorders
order)

14. Development Onset: mean age onset = 16-17; most common age at
and Course onset is 12-13 (2/3 of those have onset before 18)
(Body
Dysmorphic Course: usually chronic
Disorder)
Recovery: improvement is likely when evidence-based
treatment is received
Relapse

15. Risk Factors ¢Those with onset prior to 18 y/o are at greater risk for SUI
(Body Dysmor- & more comorbidity
phic Disorder) ¢ High SUI attempts & ideation in adults and children/ado-
lescents
¢ High SUI risk in adolescents

16. Other Notes -Clinical features appear the same across children, ado-
(Body Dysmor- lescents, and adults
phic Disorder)
-Associated w/ high rates of childhood neglect & abuse

-Elevated prevalence in 1st degree relatives of people w/

OCD

17. Criteria (Hoard- A. Persistent difficulty discarding or parting w/ posses-

ing Disorder) sions, regardless of actual value

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B. Difficulty is due to a perceived need to save the items
and to distress associated w/ discarding them

C. Difficulty discarding possessions results in accumula-

tion of possessions that congest & clutter active living
areas & substantially compromises intended use

D. Hoarding causes clinically significant distress or impair-

ment in school, occupational, or other important areas of
functioning

E. Hoarding is not attributable to AMC

F. Not better explained by sxs of another mental dx

**Specify if with:
1) Excessive acquisition ’ 80-90% display this (most com-
monly seen as excessive buying)
2) Good or fair insight
3) Poor insight
4) Absent insight/delusional beliefs

18. Rule Out (Hoard- 1) Neurodevelopmental disorders (i.e., autism spectrum)

ing Disorder) 2) Schizophrenia
3) MDD
4) OCD
5) Neurocognitive disorders (i.e., Alzheimer's)
6) Other medical conditions (i.e., TBI, Prader-Willi syn-
drome)

19. Prevalence US rates: not available

(Hoarding
Disorder) US & Europe estimates: 2-6%

Gender: affects both M & F (conflicting reports of which

gender shows greater prevalence)

Age: 3x more prevalent in older adults (55-94) than

younger adults (34-44)

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20. Development Onset: appears early in life & spans throughout life; may
and Course first show at 11-15 and get increasingly worse through
(Hoarding each decade
Disorder)
Course: once sxs begin, chronic course (a few report
waxing & waning course)

21. Risk Factors ¢Indecisiveness is a prominent features in those with this

(Hoarding Disor- dx
der) ¢Frequent reports of stressful & traumatic life events pre-
ceding onset
¢Familial (50% have a relative who also hoards); 50% due
to genetic factors

22. Other Notes -75% have comorbid mood or anxiety dx

(Hoarding Disor- -20% meet criteria for OCD
der)

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