Obsessive-

Compulsive
and Related
Disorders
OCD and Related Disorders
include…..
– Obsessive Compulsive Disorder
– Body Dysmorphic Disorder
– Hoarding Disorder
– Trichotillomania
– Excoriation
– Substance/medication induced OCD and related disorder
– OCD due to another medical condition
– Other specified/unspecified OCD
Causes and Perspectives
– Psychodynamic Perspectives
 OCD arises from the battle between id impulses (obsessive
thoughts) and ego defenses (counter thoughts or compulsions).
Isolation, undoing and reaction formation are common defenses.
 Traced from the anal stage of development specifically, harsh
toilet training resulting to intense rage and shame.
 Uses customary techniques of free association
– Behavioristic Perspective
Compulsive behavior develops
through chance associations

When fearful situations arise,

accidental associated actions bring
reduction in fear or anxiety

 This negative reinforcement

allows the compulsion to continue
– Cognitive Perspectives
OCD develops out of the normal
human tendency to have unwanted
unpleasant thoughts, blame
themselves for it and expect
something will happen

They then engage in neutralizing

behavior which then gets reinforced
– Biological Perspective
 OCD is connected to low
serotonin activity (primarily as
a possible neuromodulator for
glutamate, GABA and
dopamine)

Excess activity in the

orbitofrontal cortex (impulses)
and the caudate nuclei (filters
for the thalamus)
 Treatments most often used…
– Exposure and response prevention leading to habituation

– Psychoeducation

– Antidepressants that raise serotonin levels

– Cognitive behavioral approaches

Obsessive-Compulsive
Disorder
 OBSESSIONS COMPULSIONS
Characterized by...(Rituals)
- RECURRENT, PERSISTENT, INTRUSIVE AND - Done in RESPONSE TO AN OBSESSION. Done
UNWANTED: according to rigid rules. Consists of repetitive:
 Thoughts (e.g. contamination, made or will  Behaviors (e.g. washing, checking)
make a wrong decision)  Mental Acts (e.g. counting, repeating
 Images (e.g. violent scenes, sexual scenes)
words silently)
 Urges (e.g. stab someone, yelling out
obscenities)
-Aimed at REDUCING DISTRESS/ANXIETY
- Individual attempts to IGNORE or SUPPRESS the caused by obsessions or to prevent a feared
obsessions event

-Individuals may also attempt to NEUTRALIZE -MAY NOT BE REALISTICALLY CONNECTED to a

OBSESSIONS WITH A COMPULSION feared event

- Causes DISTRESS OR ANXIETY -Clearly EXCESSIVE AND TIME CONSUMING

A. Presence of obsessions, compulsions or both
B. Obsession or compulsions are time-consuming (take more than an hour a day),
cause significant distress and impairment in different areas.
C. Not attributable to medication or another mental condition
D. Not better explained by another disorder

Specify if:
Good or fair insight: Beliefs are definitely or probably not true (may or may not be true)
Poor insight: Beliefs are probably true
Absent/delusional beliefs: Convinced that beliefs are true

Specify if:
Tic-related: Individual has past or current history of tic disorder
Other Important Features
– Most have dysfunctional beliefs including an inflated sense of
responsibility, tendency to overestimate threat, perfectionism and
intolerance of uncertainty, over-importance of thoughts and the need
to control thoughts.

– Individuals who hoard as a consequence of obsessions and

compulsions, are given a diagnosis of OCD rather than hoarding
disorder

– OCD is different from Obsessive Compulsive Personality Disorder

Body Dysmorphic Disorder
(Dysmorphophobia)
– Preoccupation with one or more perceived defects or flaws in
physical appearance that are not observable or appear slight to
others
– Repetitive behaviors or mental acts in response to appearance
– Causes distress, impairment and not better explained by eating
disorders
Specify if:
With muscle dysmorphia (may be by proxy)
Specify insight: good/fair, poor, absent
Other important features…
– Any body feature can be a focus of concern, preoccupations last for 3-
8 hours, and are very difficult to control
– Common behaviors: comparison of performance, checking defects in
mirrors, excess grooming, camouflaging, seeking reassurance about
defects, touching, weightlifting, cosmetic procedures
– Have delusions of reference. Have high levels of anxiety, social
anxiety, social avoidance, depressed mood, low extraversion, low
Self esteem, neuroticism, and perfectionism
– Skin picking in response to BDD concerns is given BDD instead of
excoriation
Hoarding Disorder
– Persistent difficulty discarding or parting
w/ possessions regardless of actual value
– There is perceived need to save items and
distress when discarding
– Undiscarded possessions cause clutter
resulting to compromise of active living
areas. If living areas are uncluttered, it is
due to the intervention of third parties.
– Cause distress, impairment, not explained
by another medical condition or d/o
Specify if: w/ excessive acquisition
Other impt. features…

– Include indecisiveness, perfectionism, avoidance,

procrastination, difficulty planning and organizing
tasks, and distractibility.
– Some people engage in animal hoarding
– Most have unsanitary living conditions
Trichotillomania
and
Excoriation
– Recurrent pulling of one’s hair (or in
some features, others)
– Repeated attempts to stop pulling
hair
Or
– Recurrent skin picking resulting in
skin lesions (or in some features,
others)
– Repeated attempts to decrease or
stop skin picking
Associated features of
Trichotillomania…

– Pulls hair and may orally manipulate hair;

may visually or tactilely examine it.
– May lead to gratification, pleasure, or a
sense of relief
– Some may pull hair from other fibrous
materials
Associated features of
Excoriation…
– May pull skins scabs, play with, mouth or
swallow skin or scab.
– May be triggered by anxiety or boredom or
preceding tension. Isn’t typically accompanied
by pain.
– May be focused or automatic
END 