Obsessive-Compulsive-Related Disorders and Trauma-Related Disorders
DSM-IV-TR vs. DSM-5
In DSM-IV-TR, Obsessive-Compulsive and Related Disorders and Trauma-Related
Disorders were included with Anxiety Disorders
• Some common symptoms, risk factors, and treatments with anxiety disorders
DSM-5 creates new chapters for Obsessive-Compulsive and Related Disorders and
Trauma-Related Disorders
Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive and Related Disorders
1. Obsessive -Compulsive Disorder (OCD)
Repetitive thoughts and urges (obsessions)
Repetitive behaviors and mental acts (compulsions)
2. Body Dysmorphic Disorder
Repetitive thoughts and urges about personal appearance
3. Hoarding Disorder
Repetitive thoughts about possessions
Obsessive-Compulsive Disorders
Obsessions
• Intrusive, persistent, and uncontrollable thoughts or urges
Interfere with normal activities
• Often experienced as irrational
• Most common:
Contamination, sexual and aggressive impulses, body problems,
religious, symmetry and/or order
Compulsions
• Impulse to repeat certain behaviors or mental acts to avoid distress
e.g., cleaning, counting, touching, checking
• Extremely difficult to resist the impulse
• May involve elaborate behavioral rituals
• Compulsive gambling, eating, etc. NOT considered compulsions, because they
are pleasurable
Compulsions only server reduce anxiety, not give pleasure
DSM-5 Diagnostic Criteria: Obsessive-Compulsive Disorder
Obsessions and/or compulsions
• Obsessions are defined by
recurrent, persistent, intrusive, unwanted thoughts, urges, or images.
The person attempts to ignore, suppress or neutralize the thoughts,
words, or images.
• Compulsions are defined by
Repetitive behaviors or thoughts that the person feels compelled to
perform to prevent distress or a dreaded event.
The person feels driven to perform the repetitive behaviors or
thoughts in response to obsessions or according to rigid rules.
The acts are excessive or unlikely to prevent the dreaded situation
The obsessions or compulsions are time consuming (e.g. at least one hour per day)
or cause clinically significant distress or impairment
Obsessive-Compulsive Disorder (OCD)
Develops either before age 10 or during late adolescence/early adulthood
More common in women
• 1.5 times more common than in men
OCD often chronic
Pattern of symptoms is similar across cultures
Body Dysmorphic Disorder
Preoccupied with an imagined or exaggerated defect in appearance
• Perceive themselves to be ugly or “monstrous”
• Women focus on: skin, hips, breasts, legs
• Men focus on: height, penis size, body hair, muscularity
• Body part of focus can differ by culture
Engage in compulsive behaviors specific to their appearance
• Check their appearance in mirrors often
• Camouflage their appearance (tanning, makeup, plastic surgery)
High levels of shame, anxiety, and depression
Occurs slightly more often in women
2% prevalence rate; 5-7% for women seeking plastic surgery
Nearly all have another comorbid disorder
DSM-5 Criteria for Body Dysmorphic Disorder
Preoccupation with a perceived defect or markedly excessive concern over a slight
defect in appearance
Others find the perceived defect(s) as slight or unobservable
The person has performed repetitive behaviors or mental acts (e.g., mirror checking,
seeking reassurance, or excessive grooming) in response to the appearance concerns
Preoccupation is not restricted to concerns about weight or fat
DSM-5 criteria for Hoarding Disorder
Persistent difficulty discarding or parting with possessions, regardless of their actual
value
Perceived need to save items
Distress associated with discarding
The symptoms result in the accumulation of a large number of possessions that
clutter active living spaces of the home or workplace to the extent that their
intended use is compromised unless others intervene
Hoarding Disorder
Cannot part with acquired objects
• Most objects are worthless
• Extremely attached to objects
• Resistant to relinquishing objects
66% are unaware of severity of problem
33% engage in animal hoarding
• Animals often receive inadequate care
Severe consequences
Usually begins in childhood or early adolescence
Prevalence and Comorbidity
Lifetime prevalence
• 2% OCD (more common in women)
• 2% BDD (more common in women)
• 1.5% Hoarding disorder (no gender differences)
Comorbidity
• High rates of comorbidity among all three syndromes
• Also comorbid with depression and anxiety
• OCD and BDD often comorbid with substance use disorders
Treatment of the Obsessive-Compulsive and Related Disorders
Medications
• SSRIs (serotonin reuptake inhibitors)
• Tricyclic antidepressants: Anafranil (clomipramine)
Exposure plus response prevention (ERP)
• Not performing the ritual exposes the person to the full force of the anxiety
provoked by the stimulus
• The exposure results in the extinction of the conditioned response (the
anxiety)
Cognitive therapy
• Challenge beliefs about anticipated consequences of not engaging in
compulsions
Usually also involves exposure
