Obsessive Compulsive Related Disorders

PSYC 340
Obsessive Compulsive Related Disorders
These are defined by repetitive thoughts and behaviors
that are so extreme that they interfere with everyday
life.
Earlier a part of anxiety disorders but separated in
DSM V.
 Obsessive Compulsive Disorder
Obsession – repetitive thoughts, images, impulses or
urges.
Compulsions – an irresistible need to engage in repetitive
behaviors or mental acts.
The repetitive thoughts and behaviors are:
• distressing
• feel uncontrollable and
• require a considerable amount of time.
 Obsessions
 Intrusive and recurring thoughts
 Images
 Impulses
 Persistent and uncontrollable
 Usually appear irrational to the person
 Interference with normal activities
 Fear of contamination, sexual or aggressive impulses,
body problems, religion and symmetry or order.
 Prone to extreme doubt, procrastination and
indecision.
 Compulsions
 Repetitive and clearly excessive behaviors or mental
acts that the person feels driven to perform to reduce
the anxiety or prevent some calamity from occurring.
 Though rationally understanding that there is no need
 They may still do it to prevent some danger.
 Common ones include, cleanliness and orderliness.
 Repetitive magically protecting acts
 Repetitive checking to see lights, stoves, faucets,
burners are off, doors locked.
Begins either before age 10 or else in late adolescence
and early adulthood
Slightly more common among women
 DSM V Criteria
Obsessions
Compulsions
Time consuming (at least one hour per day)
Cause clinically significant distress or impairment.
 Body Dysmorphic Disorder
 Preoccupation with an imagined or exaggerated defect
in their appearance.
 Perception of being ugly or monstrous.
 Women focus on skin, hips, breasts and legs
 Men focus on height, penis size, body hair, or being less
muscular.
 Think about their appearance 3-8 hours per day.
 Compulsive behaviors of checking their appearance in
the mirror, comparing with others and asking for
reassurance.
 Using strategies to change or hide their body areas.
 Others may avoid mirrors, or bright lights
 Inordinate time and energy spent
 Delusions about ones’ appearance and being
convinced that others laugh or stare at their flaws.
 Numerous plastic surgeries
 Suicidal ideation
 Avoiding people and isolation
 More common in women
 Typically begins in late adolescence.
BDD – DSM V criteria
Preoccupation with a perceived defect in appearance
Repetitive behaviors or mental acts in response to the
concerns
 Hoarding Disorder
Hoarding things that do not have a potential value.
Very attached to possessions
Animal hoarding
Extremely filthy homes, odors, rotten food or feces.
Hoarding DSM V Criteria
Persistent difficulty in discarding possessions or
parting from them
Strong urge to save items and distress associated with
discarding them
Accumulation of a large number of possessions that
clutter home, workplace etc until others do not
intervene.
Trichotillomania (hair pulling)
Recurrent pulling of one’s hair
Repeated attempts to decrease or stop
Distress
Not due to another medical condition
Not due to another mental disorder.
Excoriation (skin picking)
Recurrent skin picking
Repeated attempts to decrease or stop
Distress
No other substance
No other mental disorder.
Try to conceal it with makeup, clothes etc.
 Etiology of Hoarding
Evolutionary perspective
CBT model : poor organizational abilities, unusual
beliefs about possessions and avoidance behaviors
Difficulty with attention or categorization of objects
and decision making
Extreme emotional attachment to possessions - attach
it to their self identity. Even more strong with animals
Avoidance of losing a valued possession.
 Etiology of OCD
People suffering from OCD lack the sense of
yedasentience. (subjective feeling of knowing)-
internal sense that things are complete.
Compulsions are reinforced because they reduce
anxiety.
Mistrust their memories.
Try to suppress their feelings which worsens their
obsessions
 Etiology of Body Dysmorphic Disorder
Cognitive models: they are more prone to focusing
upon those features of attractiveness.
They focus more on details, not on the whole.
Not focusing on positive stimuli.
Avoidance of situations in which their appearance
would be judged.
 Treatment
Medications – Serotonin Reuptake inhibitors are the
most commonly used meds.
Initially made to help with depression
Also Selective Serotonin Reuptake inhibitors
Usually for hoarding
 Psychological Treatment
Exposure and response prevention for OCD related
disorders.
 For OCD
 Exposure to situations that elicit the compulsive act
and refrain from performing the compulsive ritual.
1. Not performing the ritual elicits anxiety in full force
2. The exposure results in the extinction of the
conditioned response (anxiety)
 ERP for BDD
Interact with people who would be critical to their
looks
Avoid running away from that situation
 ERP for Hoarding
Getting rid of their possessions
Not engaging in counting or sorting out their
possessions.
Family therapy can work too