Previous DSM Diagnosis
ICD-10 (1992) created the category of “neurotic, stress-related, and somatoform disorders” - OCD was its own subcategory
Criteria A
Presence of obsessions, compulsions, or both
Criteria B
Obsessions or compulsions are time-consuming (eg, more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Criteria C
Symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition
Criteria D
The disturbance is not better explained by the symptoms of another mental disorder
Criteria E
Specify if: With good or fair insight, With poor insight, With absent insight/delusional beliefs
Criteria F
Specify if: Tic-related: the individual has a current or past history of a tic disorder
Obsessions
-Persistent ideas, thoughts, impulses, and images that are experienced as being intrusive and inappropriate, and cause marked anxiety or distress
-A sense of lack of control
-Not a “natural” part of the person’s personality
OCD vs Psychosis
-the person recognizes that these are his/her thoughts, and they do not want to be having them
-No delusional system of thought insertion
-NOT just worries about real-life problems
Ego-Dystonic
not consistent with sense of self, patient does not want to be having these thoughts (b/c intrusive and inappropriate) - almost NEVER act on the content of these obsessions - the reason that people often have these obsessions is because they NEVER want to act on these obsessions
Categories of Obsession
- Contamination (most common)
2.Uncertainty
3.Aggressive - Symmetry
-Can be with or without magical thinking - Sexual
- Somatic
Sexual
vivid, unenjoyed images - NOT sexual fantasies but intrusive unwanted thoughts, often sexual thoughts about sexual activity with religious figures in someone’s religious, sometimes thoughts of molesting children
Somatic
obsessive fears that one has an illness or some sort of physical obsession
Poor Insight
when people are convinced that doing/not doing something will result in something (very unlikely) to happen
Good Insight
-when people know that doing/not doing something will be unlikely to result in something (unlikely) to happen, though they may still feel the need to do these things
-possible to have severe OCD and good insight, these people tend to be much more “treatable” / responsive to treatment
Obsession Variation
-Most OCD patients have multiple obsessions
-Children less likely to have sexual obsessions & More likely to have aggressive obsessions
Compulsions
-Repetitive behaviors (sometimes thoughts)
-Attempts to neutralize or suppress obsessions
-Designed to reduce anxiety from the obsession
Compulsions & Pleasure
Not designed to bring pleasure or gratification - people often experience a sense of relief, but it not something necessarily pleasurable - designed to be a negative reinforcer of anxiety
Compulsion Categories
- Washing/Cleaning
2.Checking
3.Repeating - Mental
Washing/Cleaning
often associated with contamination obsessions, may wash their hands many times a day or for very long periods of time after having touched something they think has been contaminated - often see patients with cracked, dry, or bleeding skin
Diagnosis
Most people will have both obsessions and compulsions
Don’t need both for the diagnosis
¼ will have ONLY obsessions
But often these people will ritualize mentally
Very rare to have compulsion without obsessions
Compulsions w/o Obsession
would still find the compulsions distressing, they just would report that they would feel super tense or distressed about not doing the compulsion, though there is no specific thought/obsession attached to this feeling
-If seen, usually in children: counting, touching, ordering
Lifetime Prevalence
1.5%
-Prevalence the same in adults and children
Gender Difference
-slightly more common in girls/women than boys/men
-In children more common in boys
