OCD

Question 1

Obsessions

Answer 1

Involuntary thoughts, images or impulses that:

• are recurrent and intrusive, and experienced as unpleasant or distressing
• enter the mind against conscious resistance (ego-dystonic)
• are recognised by the patient as being a product of their own mind

Question 2

Compulsions

Answer 2

Repetitive mental operations or physical acts that:

• patients feel compelled to perform in response to their own obsessions or irrationally defined ‘rules’
• are performed to reduce anxiety through the belief that they will prevent a ‘dreaded’ event occurring, even though they are not realistically connected to the event, or are ridiculously excessive

Question 3

ICD-10 diagnostic guidelines for OCD (5)

Answer 3

1. Obsessions or compulsions must be present for at least 2 successive weeks and are a source of distress or interfere with the patient’s functioning
2. They are acknowledged as coming from the patient’s own mind
3. The obsessions are unpleasantly repetitive
4. At least one thought or act is resisted unsuccessfully
5. A compulsive act is not in itself pleasurable (excluding the relief of anxiety)

Question 4

Rumination

Answer 4

Repeatedly thinking about the causes and experience of previous distress and difficulties. Voluntary, not resisted

Question 5

Over-valued idea

Answer 5

Plausible belief arrived at logically but held with undue importance. Not resisted or viewed as abnormal

Question 6

Thought insertion

Answer 6

Intrusive thought, image or impulse. Patient attributes origin outside self. May or may not be resisted

Question 7

Obsessions and compulsions in eating disorders

Answer 7

• Morbid fear of fatness (over-valued idea)
• Thoughts and actions are not recognized by patient as excessive or unreasonable and are not resisted (ego-syntonic)
• Thoughts do not necessarily provoke, or actions reduce, distress
• Note: there is a higher incidence of true obsessive-compulsive disorder in patients with anorexia nervosa

Question 8

Obsessive-compulsive personality disorder

Answer 8

A.k.a. anankastic personality disorder

• Enduring behaviour pattern of rigidity, doubt, perfectionism and pedantry
• Ego-syntonic
• No true obsessions or compulsions

Question 9

Gilles de la Tourette’s syndrome

Answer 9

Motor and vocal tics, echolalia, coprolalia

Note: 35–50% of patients with Gilles de la Tourette’s syndrome meet the diagnostic
criteria for obsessive-compulsive disorder, whereas only 5–7% of patients with obsessive-compulsive disorder have Tourette’s syndrome