PSY360: Abnormal Psychology-2nd week

Obsessive-Compulsive and Related

Disorders

Dr. Sumaira Khurshid Tahira

Associate Prof

NNU, China

Obsessive-Compulsive and related disorders

• DSM-5 has created the group name obsessive-compulsive-related disorders and assigned four of these patterns to that group:

• Hoarding disorder • Trichotillomania (hair-pulling disorder) • Excoriation (skin-picking) disorder • Body dysmorphic disorder. Collectively, these four disorders are displayed by at least 5 percent of

all people (Frost et al., 2012; Keuthen et al., 2012, 2010; Wolrich, 2011;

Duke et al., 2009)

DSM-V And OCSDs

1. Obsessive-compulsive disorder (OCD)

2. Body Dysmorphic Disorder

3. Hoarding disorder

4. Trichotillomania (hair-pulling disorder)

5. Excoriation (skin-picking) disorder

6. Substance/medication-induced obsessive-compulsive and

related disorder

7. Obsessive-compulsive and related disorder due to another

medical condition

8. Other specified obsessive-compulsive and related disorder

9. Unspecified obsessive-compulsive and related disorder (e.g.,

body-focused repetitive behavior disorder, obsessional

jealousy).

Diagnostic Criteria

A. Presence of obsessions, compulsions, or both

B. The obsessions or compulsions are time-consuming (e.g., take more

than 1 hour per day) or cause clinically significant distress or

impairment in social, occupational, or other important areas of

function.

C. The obsessive-compulsive symptoms are not attributable

to the physiological effects of a substance (e.g., a drug of abuse, a

medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another

mental disorder

Epidemiological data

• International prevalence (1.1%–1.8%)

( Weissman et al. 1994 ).

• Females are affected at a slightly higher rate than males in

adulthood

• Although males are more commonly affected in childhood

(Ruscio et al. 2010 ; Weissman et al. 1994 )

Epidemiology

:study of the incidence and distribution of

specific diseases and disorders.

The epidemiologist also seeks to

establish relationships to such factors as

heredity, environment, nutrition, or age at onset.

Development and Course

• In the United States, the mean age at onset of OCD is 19.5 years

(25% of cases start by age 14 years ( Kessler et al. 2005 ; Ruscio et al.

2010 ).

• Onset after age 35 years is unusual but does occur.

• Males have an earlier age at onset than females: nearly 25% of males

have onset before age 10 years ( Ruscio et al. 2010 ).

• The onset typically gradual; however, acute onset has also been

reported.

OCD is also much more common in individuals

with certain other disorders

• Schizophrenia or schizoaffective disorder

• Bipolar disorder

• Eating disorders

• Turette’s disorder

2. Body Dysmorphic Disorder

• People with body dysmorphic disorder become preoccupied with the belief that they have a particular defect or flaw in their

physical appearance.

• Actually, the perceived defect or flaw is imagined or greatly exaggerated in the person’s mind (APA, 2013).

• Such beliefs drive the individuals to repeatedly check themselves in the mirror, groom themselves, pick at the perceived flaw,

compare themselves with others, seek reassurance, or perform

other, similar behaviors.

2. Body Dysmorphic Disorder

• Body dysmorphic disorder is the obsessive-compulsive-related disorder that has received the most study to date.

• Researchers have found that, most often, individuals with this problem focus on wrinkles; spots on the skin; excessive facial hair; swelling of the face; or a misshapen nose, mouth, jaw, or eyebrow (Week et al., 2012; Marques et al., 2011).

• Some worry about the appearance of their feet, hands, breasts, penis, or other body parts

• Also woman worry about bad odors coming from sweat, breath, genitals, or the rectum (Rocca et al., 2010).

2. Body Dysmorphic Disorder

Diagnostic Criteria

• 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 seeking) or mental

acts (e.g., comparing his or her appearance with that of others) in

response to the appearance concerns.

2. Body Dysmorphic Disorder

• 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.

Prevalence

• U.S. adults is 2.4% (2.5% in females and 2.2% in males)

• Outside approximately 1.7%–1.8%, with a similar gender distribution

Associated Features Supporting

Diagnosis

• Ideas or delusions of reference

• high levels of anxiety, social anxiety, social

avoidance,

• Dermatological treatment and surgery are

most common, Body dysmorphic disorder

appears to respond poorly to such treatments

and sometimes becomes worse

Delusion of reference: A delusion in which

the patient believes that unsuspicious

occurrences refer to him or her in person.

Patients may, for example, believe that

certain news bulletins have a

direct reference to them, that music played

on the radio is played for them, or that car

licence plates have a meaning relevant to

them.

A delusion is a fixed false

belief that is based on an

incorrect interpretation of

reality.

Development and Course

• The mean age at disorder onset is 16–17 years

• Two-thirds of individuals have disorder onset before age 18.

• Chronic course

• Individuals with disorder onset before age 18 years are more likely

to attempt suicide, have more comorbidity,

Course: The period of time in which a

disease, sickness, or disorder, generally takes

to reach completion.

Risk and Prognostic Factors

• Environmental: childhood neglect and abuse

• Genetic and physiological: Elevated in first-

degree relatives of individuals with obsessive-

compulsive disorder (OCD)

• Gender-Related Diagnostic Issues: similarities

than differences in terms of most clinical features

although

male: genital preoccupations, Muscle dysmorphia

female: comorbid eating disorder .

Prognostic Factors A situation or

condition, or a characteristic of a

patient, that can be used to estimate

the chance of recovery from a disease

or the chance of the disease recurring

(coming back).

Prognosis: The likely

outcome or course of a

disease; the chance of

recovery or recurrence

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• Suicide Risk

• Rates of suicidal ideation and suicide attempts are high in both

adults and children/adolescents

• More risk is in adolescents

• Many risk factors for completed suicide.

Functional Consequences of Body

Dysmorphic Disorder

• On average, psychosocial functioning and quality of life are markedly

poor

• About 20% of youths : dropping out of school.

• Impairment in social functioning

Comorbidity

• Major depressive disorder

• Social anxiety disorder (social phobia)

• OCD

• Substance-related disorders

Comorbidity is defined as the co-occurence of

more than one disorder in the same individual.

3. Hoarding Disorder

• A disorder in which individuals feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive

accumulation of items.

• People who display hoarding disorder feel that they must save items, and they become very distressed if they try to discard them (APA, 2013).

• These feelings make it difficult for them to part with possessions, resulting in an extraordinary accumulation of items that clutters their lives and living

areas.

3. Hoarding Disorder

• This pattern causes the individuals significant distress and may greatly impair their personal, social, or occupational functioning ( Jabr, 2013; Frost

et al., 2012; Mataix-Cols & Pertusa, 2012).

• It is common for them to wind up with numerous useless and valueless items, from junk mail to broken objects to unused clothes. Parts of their

homes may become inaccessible because of the clutter.

• For example, sofas, kitchen appliances, or beds may be unusable. In addition, the pattern often results in fire hazards, unhealthful sanitation conditions, or

other dangers

3. Hoarding Disorder

Diagnostic Criteria

• A. Persistent difficulty discarding or 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 (e.g., family members, cleaners, authorities).

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• D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of

functioning (including maintaining a safe environment for self and

others).

• E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease).

• F. The hoarding is not better explained by the symptoms of another mental disorder

Associated Features Supporting

Diagnosis

• Common features of hoarding disorder include indecisiveness,

perfectionism, avoidance procrastination, difficulty planning and

organizing tasks, and distractibility

• Animal hoarding ( The most prominent differences between animal

and object hoarding are the extent of unsanitary conditions and the

poorer insight in animal hoarding.)

Prevalence

• Nationally representative prevalence studies of hoarding disorder are not available

• Affects both males and females,? Greater prevalence among males. • Symptoms appear to be almost three times more prevalent in older

adults (ages 55–94 years)

• Compared with younger adults (ages 34–44 years) females tend to display more excessive

• Acquisition, particularly excessive buying, than do males

Prevalence

The total number or percentage of cases (e.g., of a disease or

disorder) existing in a population, whereas incidence is the

number of new cases that develop during a specified time period.

Development and Course

• Hoarding appears to begin early in life • May first emerge around ages 11–15 years, start interfering with

the individual’s everyday functioning by the mid-20s, and cause

clinically significant impairment by the mid-30s

Comorbidity

• The most common comorbid conditions are major depressive disorder (up to 50% of cases), social anxiety disorder (social

phobia),and generalized anxiety disorder

Trichotillomania (Hair-Pulling Disorder)

• A disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body. Also called hair-

pulling disorder.

• People with trichotillomania, also known as hair-pulling disorder, repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other

parts of the body (APA, 2013).

• The disorder usually centers on just one or two of these body sites, most often the scalp.

• Typically, those with the disorder pull one hair at a time. • It is common for anxiety or stress to trigger or accompany the hair-

pulling behavior.

Trichotillomania (Hair-Pulling Disorder)

• Some sufferers follow specific rituals as they pull their hair, including pulling until the hair feels “just right” and selecting certain types of hairs

for pulling (Keuthen et al., 2012; Mansueto & Rogers, 2012).

• Because of the distress, impairment, or embarrassment caused by this behavior, the individuals often try to reduce or stop the hair-pulling.

The term ritual is sometimes used in a technical sense

for a repetitive behavior systematically used by a

person to neutralize or prevent anxiety

Associated Features

• Hair pulling may be accompanied by a range of behaviors or rituals

involving hair.(search for a particular kind of hair to pull, try to pull

out hair in a specific way, may visually examine or orally

manipulate)

• may be triggered by feelings of anxiety or boredom

• varying degrees of conscious awareness,

• Hair pulling does not usually occur in the presence of other

individuals, except immediate family members.

• Some individuals have urges to pull hair from other individuals and

may sometimes try to find opportunities to do so surreptitiously.

Prevalence

• 1%–2% : adult Females are more frequently affected • Among children with trichotillomania, males and females are

more equally represented

Development and Course

• Hair pulling may be seen in infants and this behavior typically resolves during early development

• Onset of hair pulling in trichotillomania most commonly coincides with, or follows the onset of, puberty. The usual course is chronic

• Symptoms may possibly worsen in females accompanying hormonal changes (e.g., menstruation, perimenopause).

Functional Consequences of

Trichotillomania (Hair-Pulling Disorder)

• distress as well as with social and occupational impairment • irreversible damage to hair growth and hair quality. • Infrequent medical consequences like musculoskeletal injury

(e.g., carpal tunnel syndrome; back, shoulder and neck pain

Diagnostic Markers

• A. Dermatopathological diagnosis is rarely required. B. Skin biopsy and dermoscopy (or trichoscopy) of trichotillomania are

able to differentiate the disorder from other causes of alopecia.

• C. Dermoscopy shows characteristic features like including decreased hair density, short vellus hair, and broken hairs with different shaft

lengths (Abraham et al. 2010).

Excortiation disorder

• A disorder in which people repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder.

• People with excoriation (skin-picking) disorder keep picking at their skin,

• resulting in significant sores or wounds (APA, 2013). Like those with hair-pulling disorder, they often try to reduce or stop the

behavior.

Excortiation disorder

• Most sufferers pick with their fingers and center their picking on one area, most often the face (Grant et al., 2012; Odlaug & Grant,

2012).

• Other common areas of focus include the arms, legs, lips, scalp, chest, and extremities such as fingernails and cuticles. The

behavior is typically triggered or accompanied by anxiety or

stress

4. Excoriation (Skin-Picking) Disorder

Diagnostic Criteria

• A. Recurrent skin picking resulting in skin lesions. • B. Repeated attempts to decrease or stop skin picking. • C. The skin picking causes clinically significant distress or

impairment in social, occupational, 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.

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