psychology 101 class, 9wks tasks

disorder), and substance use (e.g., alcohol use disorder). However, these behaviors differ from the compulsions of OCD in that the person usually derives pleasure from the activity and may wish to resist it only because of its deleterious consequences. Obsessive-compulsive personality disorder. Although obsessive-compulsive person­ ality disorder and OCD have similar names, the clinical manifestations of these disorders are quite different. Obsessive-compulsive personality disorder is not characterized by in­ trusive thoughts, images, or urges or by repetitive behaviors that are performed in re­ sponse to these intrusions; instead, it involves an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control. If an individual manifests symptoms of both OCD and obsessive-compulsive personality disorder, both diagnoses can be given.

Comorbidity Individuals with OCD often have other psychopathology. Many adults with the disorder have a lifetime diagnosis of an anxiety disorder (76%; e.g., panic disorder, social anxiety disorder, generalized anxiety disorder, specific phobia) or a depressive or bipolar disorder (63% for any depressive or bipolar disorder, with the most common being major depres­ sive disorder [41%]). Onset of OCD is usually later than for most comorbid anxiety disor­ ders (with the exception of separation anxiety disorder) and PTSD but often precedes that of depressive disorders. Comorbid obsessive-compulsive personality disorder is also common in individuals with OCD (e.g., ranging from 23% to 32%).

Up to 30% of individuals with OCD also have a lifetime tic disorder. A comorbid tic disorder is most common in males with onset of OCD in childhood. These individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course, and pattern of familial transmission. A triad of OCD, tic disorder, and attention-deficit/hyperactivity disorder can also be seen in children.

Disorders that occur more frequently in individuals with OCD than in those without the disorder include several obsessive-compulsive and related disorders such as body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-pick­ ing) disorder. Finally, an association between OCD and some disorders characterized by impulsivity, such as oppositional defiant disorder, has been reported.

OCD is also much more common in individuals with certain other disorders than would be expected based on its prevalence in the general population; when one of those other disorders is diagnosed, the individual should be assessed for OCD as well. For ex­ ample, in individuals with schizophrenia or schizoaffective disorder, the prevalence of OCD is approximately 12%. Rates of OCD are also elevated in bipolar disorder; eating dis­ orders, such as anorexia nervosa and bulimia nervosa; and Tourette's disorder.

Body Dysmorphic Disorder Diagnostic Criteria 300.7 (F45.22)

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seek­ ing) or mental acts (e.g., comparing his or her appearance with that of others) in re­ sponse to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occu­ pational, 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 m uscle dysm orphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the indi­ vidual is preoccupied with other body areas, which is often the case.

Specify if: Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly” or “I lool< deformed”).

W ith good or fair insight: The individual recognizes that the body dysmorphic disor­ der beliefs are definitely or probably not true or that they may or may not be true. W ith poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true. W ith absent insight/delusionai beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.

Diagnostic Features Individuals with body dysmorphic disorder (formerly known as dysmorphophobia) are pre­ occupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed (Criterion A). The perceived flaws are not observable or appear only slight to other individuals. Concerns range from looking "unattractive" or "not right" to looking "hideous" or "like a monster." Preoccu­ pations can focus on one or many body areas, most commonly the skin (e.g., perceived acne, scars, lines, wrinkles, paleness), hair (e.g., "thinning" hair or "excessive" body or fa­ cial hair), or nose (e.g., size or shape). However, any body area can be the focus of concern (e.g., eyes, teeth, weight, stomach, breasts, legs, face size or shape, lips, chin, eyebrows, genitals). Some individuals are concerned about perceived asymmetry of body areas. The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3-8 hours per day), and usually difficult to resist or control.

Excessive repetitive behaviors or mental acts (e.g., comparing) are performed in re­ sponse to the preoccupation (Criterion B). The individual feels driven to perform these be­ haviors, which are not pleasurable and may increase anxiety and dysphoria. They are typically time-consuming and difficult to resist or control. Common behaviors are com­ paring one's appearance with that of other individuals; repeatedly checking perceived defects in mirrors or other reflecting surfaces or examining them directly; excessively grooming (e.g., combing, styling, shaving, plucking, or pulling hair); camouflaging (e.g., repeatedly applying makeup or covering disliked areas with such things as a hat, clothing, makeup, or hair); seeking reassurance about how the perceived flaws look; touching dis­ liked areas to check them; excessively exercising or weight lifting; and seeking cosmetic procedures. Some individuals excessively tan (e.g., to darken "pale" skin or diminish per­ ceived acne), repeatedly change their clothes (e.g., to camouflage perceived defects), or compulsively shop (e.g., for beauty products). Compulsive skin picking intended to improve perceived skin defects is common and can cause skin damage, infections, or ruptured blood vessels. The preoccupation must cause clinically significant distress or im­ pairment in social, occupational, or other important areas of functioning (Criterion C); usually both are present. Body dysmoφhic disorder must be differentiated from an eating disorder.

Muscle dysmorphia, a form of body dysmoφhic disorder occurring almost exclusively in males, consists of preoccupation with the idea that one's body is too small or insuffi­ ciently lean or muscular. Individuals with this form of the disorder actually have a nor­ mal-looking body or are even very muscular. They may also be preoccupied with other body areas, such as skin or hair. A majority (but not all) diet, exercise, and/or lift weights excessively, sometimes causing bodily damage. Some use potentially dangerous anabolic-