What are some forms of avoidance that people with panic disorder will engage
- Avoiding exercise
- Sexual activity
- Hot weather
What are some Obsessive Compulsive and related disorders?
- Obsessive Compulsive Disorder
- body Dysmorphic Disorder (BDD)
- Trichotillomania
- Excoriation Disorder
- Hoarding Disorder
= Substance/medication-induced OCRD
What is the Obsessions aspect of OCD?
Obsessions: Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and cause anxiety or distress; the individual attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thoughts or action.
What is the Compulsions aspect of OCD?
Compulsions: Repetitive behaviors (e.g., counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly; the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
What are some common Obsessions?
- Contamination
- Safety
- Doubting one’s memory or perception
- Scrupulosity (need to do the right thing, fear of committing a transgression, often religious)
- Need for order or symmetry
- Unwanted, intrusive sexual/aggressive thoughts
What are some common Compulsions?
- Cleaning/washing
- Checking (eg, locks, stove,
iron, safety of children) - Counting/repeating actions a certain number of times or until it “feels right”
- Arranging objects
- Touching/tapping objects
- Confessing/seeking reassurance
- List making
OCPD vs OCD
- OCPD is a personality disorder which involves perfectionism, urge to control, inflexible and rigid thinking, and adherence to rules.
- OCD involves obsessions and compulsions.
What are some treatment options for OCD?
- Behavior therapy (exposure and response prevention and some forms of cognitive- behavioral therapy [CBT])
- Virtual Reality/Video Exposure
-Education and family interventions
- Medication (SSRI’S)
What are Intrusive Thought Obsessions?
- Unwanted thoughts that are distressing and obsessive.
- HARM SOMEONE, JUMP OFF OF SOMETHING, SCRUPILOSITY ( did I violate a moral code, unacceptable sexual activity?)
What are some OCD statistics?
- Affects about 2% of the general population
- Approximately equal gender distribution
- Similar incidence and presentation across cultures
- Chronic
What are some causes of OCD?
- Parallels the other anxiety disorders
- Early life experiences
- Learning that some thoughts are dangerous/unacceptable
- Thought-action fusion – the thought is similar to the action; thinking something will make it more likely to happen
What is Trichotillomania?
Trichotillomania: The urge to pull out one’s own hair from anywhere on the body
- Leads to noticeable hair loss on scalp, eyebrows, arms, pubic region, etc.
- Behavioral habit reversal treatment is most effective treatment
Where are some commonly affected areas of Trichotillomania?
- Scalp
- Eyebrows and eyelashes
- Pubic area
- Arms
What are some triggers for
Trichotillomania?
- Sensory – Feeling the length and location of the hair
- Emotional- Feeling anxious, bored, upset, angry
- Automatic pulling- unconsciously
- Focused pulling- generally occurs when the patient sees or feels that a hair is “not right,” or that a hair feels coarse, irregular, or “out of place”
What are some associated problems with Trichotillomania?
- Low self-esteem
- Social anxiety
- Employment avoidance
- Intimacy avoidance
- Trichophagia- More than 20% of patients eat the hair after pulling it out
What is some Trichotillomania treatment?
- Behavior Therapy
- Habit reversal training.
- Using other behaviors to replace the hairpulling.
- Something they can manipulate (toy, game, etc.)
-CBT
- Acceptance and Commitment Therapy (ACT). Accepting
the urge without acting on it. - Medications in conjunction with psychotherapy.
What is Body Dysmorphic Disorder?
- It has been referred to as “Imagined Ugliness”
- Used to be considered a somatic symptom disorder; however, the similarities to OCD prompted relocation in the DSM-5
- Often comorbid with OCD
- Ideas of reference are common in BDD
What are some repetitive behaviors of BDD?
- Excessive grooming
- Mirror checking
- Comparing appearance to others
What are some of the most commonly affected areas of BDD?
- skin
- nose
- eyes
- skin
- hair
What are the similarities of OCD and BDD?
- Obsessive, intrusive, repetitive, thoughts
- Excessive time dedicated to rituals- Mirror checking, grooming
- Age of onset
- Associated anxiety and emotional distress
What are the differences between OCD and BDD?
- Underlying core beliefs in BDD focus more on unacceptability of the self – e.g., being unlovable, inadequate, worthless. Moral repugnance is unusual
- BDD patients have poorer insight. ~2% of OCD patients are currently delusional vs 27%-39% of BDD patients
