Obsessive-Compulsive and Related

Disorders
ABNORMAL PSYCHOLOGY

© 2015 John Wiley & Sons, Inc. All rights reserved.

© 2015 John Wiley & Sons, Inc. All rights reserved.
 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
© 2015 John Wiley & Sons, Inc. All rights reserved.
 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

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Table 7.1: Diagnoses of Obsessive-Compulsive
and Related Disorders

© 2015 John Wiley & Sons, Inc. All rights reserved.

© 2015 John Wiley & Sons, Inc. All rights reserved.
 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

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 Obsessive-Compulsive Disorders
 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

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 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
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© 2015 John Wiley & Sons, Inc. All rights reserved.
4 major type of obsessions
 SYMMETRY
 FORBIDDEN THOUGHTS
 CLEANING/CONTAMINATION
 HOARDING

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• Tic disorder- involuntary movement of limbs
that is done repeatedly

• Tourette’s disorder- tics with vocalization

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 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

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 Body Dysmorphic Disorder
 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

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© 2015 John Wiley & Sons, Inc. All rights reserved.
 DSM-5 criteria
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
© 2015 John Wiley & Sons, Inc. All rights reserved.
 Hoarding Disorder

© 2015 John Wiley & Sons, Inc. All rights reserved.

 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
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 Trichotillomania- hair picking disorder
 Excoriation- skin picking disorder

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 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
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 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

© 2015 John Wiley & Sons, Inc. All rights reserved.

 DSM-5 Criteria for
Posttraumatic Stress Disorder
A. The person was exposed to death or threatened death, actual or threatened serious injury, or actual or
threatened sexual violation, in one or more of the following ways: experiencing the event personally, witnessing
the event, learning that a violent or accidental death or threat of death occurred to a close other, or experiencing
repeated or extreme exposure to aversive details of the event(s) other than through the media (e.g., first
responders collecting body parts; police officers repeatedly exposed to details of child abuse)

B. At least 1 of the following intrusion symptoms:

• Recurrent, involuntary, and intrusive distressing memories of the trauma, or in children, repetitive play
regarding the trauma themes

• Recurrent distressing dreams related to the event(s)

• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the trauma(s) were
recurring (in children reenactment during play)
• Intense or prolonged distress or physiological reactivity in response to reminders of the trauma(s)

C. At least 1 of the following avoidance symptoms:

• Avoids internal reminders (thoughts, feelings, or physical sensations) that arouse recollections of the
trauma(s)
• Avoids external reminders (people, places, conversations, activities, objects, situations) that arouse
recollections of the trauma(s).

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 DSM-5 Criteria for Posttraumatic Stress
Disorder
D. At least 3 (or 2 in children) negative alterations in cognitions and mood that began after the trauma(s):

• Inability to remember an important aspect of the trauma(s)

• Persistent and exaggerated negative beliefs or expectations about one’s self, others, or the world

• Persistently excessive blame of self or others about the trauma(s)

• Pervasive negative emotional
• Markedly diminished interest or participation in significant activities.
• Feeling of detachment or estrangement from others
• Persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic
numbing)
E. At least 3 (or 2 in children) of the following alterations in arousal and reactivity that began or worsened after
the trauma(s):
• Irritable or aggressive behavior
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance -- for example, difficulty falling or staying asleep, or restless sleep

F. The symptoms began or worsened after the trauma(s) and continued for at least one month
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 DSM-5 Criteria for
Acute Stress Disorder
A. The person was exposed to death or threatened death, actual or threatened serious injury, or actual or threatened sexual
violation, in one or more of the following ways: experiencing the event personally, witnessing the event, learning that a violent
or accidental death or threat of death occurred to a close other, or experiencing repeated or extreme exposure to aversive details
of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse)

B. At least 8 of the following symptoms began or worsened since the trauma and lasted 3 to 31 days:
 Recurrent, involuntary, and intrusive distressing memories of the traumatic event
 Recurrent distressing dreams related to the traumatic event
 Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event were recurring

 Intense or prolonged psychological distress or physiological reactivity at exposure to reminders of the traumatic event

 A subjective sense of numbing, detachment from others, or reduced responsiveness to events

 An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a
daze, time slowing)
 Inability to remember at least one important aspect of the traumatic event
 Avoids internal reminders that arouse recollections of the trauma(s)
 Avoids external reminders that arouse recollections of the trauma(s).
 Sleep disturbance
 Hypervigilance
 Irritable or aggressive behavior
 Exaggerated startle response
 Agitation or restlessness

© 2015 John Wiley & Sons, Inc. All rights reserved.