OBSESS/VE-COMPULSIVE AND TRAUMA RELATED DISORDERS
Clinical | description and epidemiology of obsessive-compulsive disorders and related
disorders
Obsessive-Compulsive disorder
Obsessions are intrusive and recurring thoughts. images. or impulses that are persistent
and uncontrollable
Compulsions are repetitive, clearly excessive behaviors or mental acts that the person
feels driven to perform to reduce the anxiety
Tends to begin either before age 10 or else in late adolescence/early adulthood
Described in children as young as age 2
Slightly more common among women than men
OCD is a chronic disorder
Comorbid with anxiety disorders, major depression, Substance use, Hoarding
Commonly reported compulsions include the following:
Pursuing cleanliness and orderliness, sometimes through elaborate rituals
Performing repetitive, magically protective acts, such as counting or touching a body part
Repetitive checking to ensure that certain acts are carried out
Body Dysmorphic disorder
Preoccupied with an imagined or exaggerated defect in their appearance.
Women tend to focus on their skin, hips, breasts, and legs
Men are more likely to focus on their height, penis size, or body hair
On average, people with BDD think about their appearance for 3 to 8 hours per day
Often experience high levels of shame, anxiety, and depression about their appearance
About 40 percent of people with the disorder are unable to work
Slightly more often in women than in men, but even among women it is relatively rare,
with a prevalence of less than 2 percent
Typically begins in late adolescence.
Case reports from around the world suggest that the symptoms and outcomes of BDD are
similar across cultures. The body part that becomes a focus of concern sometimes differs
by culture.
Comorbid disorders include major depressive disorder, social anxiety disorder, obsessive-
compulsive disorder, substance use disorders, and personality disorders
Hoarding disorder
For people with hoarding disorder, the need to acquire is only part of the problem.
The bigger problem is that they abhor parting with their objects
Collections of clothes, tools, or antiques may be gathered along with old containers, bottle
caps, and sandwich wrappers.
Hoarding sometimes led to extremely filthy homes for about a third of people,
characterized by overpowering odors from rotten food or feces.
More than 40 percent had accumulated so many items that they were no longer able to
use their refrigerator, kitchen sink, or bathtub, and
About 10 percent were unable to use their toilet
Three-quarters of people with hoarding disorder engage in excessive buying and many
Although hoarding is more common among men than among women, very few men are
unable to work
Hoarding behavior usually begins in childhood or early adolescence seek treatment
Comorbid with OCD, depression, generalized anxiety disorder, and social phobia
Trichotillomania (Hair-Pulling Disorder)
Recurrent pulling out of one's hair, resulting in hair loss.
Repeated attempts to decrease or stop hair pulling.
It may be triggered by feelings of anxiety or boredom, may be preceded by an
increasing sense of tension then may lead to gratification, pleasure, or a sense of relief
when the hair is pulled out.
Excoriation (Skin-Picking) Disorder
Recurrent skin picking resulting in skin lesions.
Repeated attempts to decrease or stop skin picking.
Skin picking may be triggered by feelings of anxiety or boredom, may be preceded
by an increasing sense of tension (either immediately before picking the skin or when
attempting to resist the urge to pick), and may lead to gratification, pleasure, or a sense of
relief when the skin or scab has been picked.
Etiology of Obsessive-Compulsive Disorder and related disorders
Genetic
o Moderate genetic contribution with estimates of heritability ranging from 30 to 50
percent
Neurobiological
o Hyperactive Regions of the brain in OCD and BDD
Orbitofrontal Cortex
Caudate Nucelus
Anterior Cingulate
• Loss of Neuronal Function and underlying biochemical abnormality
Cognitive and Behavioral factors
o Cognitive factors
One theory suggests that people with OCD suffer from a deficit in
yedasentience (the sense of "that is enough.")
Thought suppression
Paradoxical effect of suppressing obsessions
o Behavioral Factors
Operant Conditioning
Compulsions negatively reinforced by the the reduction of anxiety
People with BDD appear to focus on details more than on the whole
They also consider attractiveness to be vastly more important
people with BDD seem to believe that their self-worth is exclusively
dependent on their appearance
Etiology of Hoarding Disorder
Cognitive-behavioral factors
Hoarding is related to poor organizational abilities, unusual beliefs about
possessions, and avoidance behaviors
Demonstrate an extreme emotional attachment to their possessions.
Seeing the objects as core to their sense of self and identity.
Psychological Treatment of OCD and related disorders
Exposure and Response Prevention
OCD
People expose themselves to situations that elicit the compulsive act and then
refrain from performing the compulsive ritual
BDD
provide exposure to the most feared activities,
clients are asked to avoid the activities they use to reassure themselves about
their appearance, such as looking in mirrors and other reflective surfaces.
Hoarding Disorder
Exposure - getting rid of their objects.
Trauma-related disorders
Post-traumatic stress disorder
Extreme response to severe stressor
o Anxiety, avoidance of stimuli asso ciated with trauma, emotional numbing
Exposure to a traumatic event that involves actual or threatened death or injury
Trauma leads to intense fear of helplessness
Symptoms present for more than a month
Four major categories:
Intrusively reexperiencing the traumatic event.
Avoidance of stimuli associated with the event.
Mood and cognitive change after the trauma.
Increased arousal and reactivity.
Once PTSD develops, symptoms are relatively chronic.
Suicidal thoughts are common
DSM-IV-TR and DSM-5 in PTSD
DSM-IV-TR
1. Person experiences intense emotion at the time of the trauma
2. Exposure to media accounts
3. Difficulty concentrating, difficulty sleeping, and diminished interest in activities, are
also criteria for major depressive disorder.
4. Presence of either avoidance symptoms or numbing symptoms
DSM-5
1. Removed
2. Disqualify
3. These symptoms must begin after the trauma
4. Require avoidance symptoms
Acute stress disorder
Fairly similar to those of PTSD, but the duration is shorter.
Symptoms occur between 3 days and 1 month after a trauma.
Less is known about ASD
Most common disorders are other anxiety disorders, major depression, substance abuse,
and conduct disorder
Two-thirds developed Anxiety disorder
Women are twice as likely to develop PTSD
Culture may shape the risk for PTSD
cultural groups may be exposed to higher rates of trauma and, as a consequence,
manifest higher rates of PTSD
Etiology of Trauma-Related Disorders
Severity and the Type of Trauma
Neurobiological Factors
Greater activation of the amygdala
diminished activation of the medial prefrontal cortex
Smaller hippocampal volume
Super sensitivity to cortisol
Coping
People who cope with a trauma by trying to avoid thinking about it are more likely than
others to develop PTSD
Psychological Treatment of PTSD
Exposure
The person is asked to face his or her worst fears
Either direct (in vivo) or imaginal
More effective than medication
Cognitive Therapy
Enhance beliefs about coping abilities
Treatment of ASD may prevent PTSD
Shows benefits even 5 years after the traumatic event
