Obsessive-Compulsive and Related Disorders I

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Overview – Obsessive-Compulsive and Related Disorders, Part 1

Obsessive-Compulsive and Related Disorders are mental illnesses in the Obsessive-Compulsive Disorders spectrum that are characterized by key features of obsessions, compulsions, or both. The obsessions involve recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance. They are perceived as intrusive, unwanted, and in most individuals cause marked anxiety or distress. The compulsions are attempts to ignore or suppress the persistent thoughts, urges, or images, or to neutralize them with thoughts, feelings, ideas, and sensations that compel a person to do specific behaviors.

A diagnosis is considered when the Obsessive-Compulsive symptoms are disruptive to the individual’s daily existence and functioning. Disorders listed in this category all share the common features of excessive preoccupation with thoughts, urges, or images, along with the subsequent engagement in repetitive behaviors in an attempt to suppress the obsessions that seem impossible to stop. These disorders are quite common with over three million cases diagnosed per year in the United States. They can last several years or be lifelong. The specific cause has not been identified.

Although Obsessive-Compulsive and other Disorders share some features with Obsessive-Compulsive Personality Disorder (OCPD), a main difference is that those with OCD experience unwanted or obtrusive thoughts, which is not observed in OCPD. In addition, individuals with OCD are aware that their thoughts and actions are abnormal or irrational, while those with OCPD may not think they have a problem.

Symptoms may be mild and gradually progress in severity. They can involve obsessions or compulsions, or both with:

  • Persistent, repeated, and unwanted thoughts
  • Urges or images that are intrusive
  • Compulsive or ritualistic behavior to get rid of the thoughts.

In Obsessive-Compulsive and other Disorders, Part 1, information is presented on four subcategories of the Obsessive-Compulsive Disorders spectrum. They are:

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder is a serious mental illness. It is characterized by obsessions or compulsions or both. The extreme fears, anxiety, and thought patterns cause the patient to behave in an obsessive manner and often exhibit compulsions in an attempt to reduce the anxiety due to the extreme fears and thought patterns. With a severe case, the individual becomes totally consumed with persistent and recurrent impulses, thoughts, and images that are unwanted and that causes extreme discomfort. It is most common in older teens or young adults, although it can begin as early as preschool age and as late as age 40.

Definitions for Obsessive-Compulsive Disorder include:

  • Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
  • Attempts are made in an attempt to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).

Obsessive-Compulsive Disorder is often comorbid with other mental health illnesses, including Anxiety disorders, Depressive disorders, Tourette syndrome, Attention-deficit hyperactivity disorder (ADHD), Substance abuse, Eating disorders, and some Personality Disorders. However, Obsessive-Compulsive Disorder is not to be confused with Obsessive Compulsive Personality Disorder (OCPD). Obsessive-Compulsive Disorder is an anxiety disorder thought to be related to emotional processing problems, while OCPD is a personality disorder. Individuals with OCPD may not think they have a problem, while individuals with Obsessive-Compulsive Disorder are aware that their thoughts and actions are abnormal or irrational. 

Body Dysmorphic Disorder

Body Dysmorphic Disorder is a mental illness characterized by A focus on a perceived flaw in appearance. There is a persistent preoccupation with one or more perceived defects or flaws in appearance that are either not apparent to others or only slightly noticeable. The typical age of onset of Body Dysmorphic Disorder is ages 12-13, with an average onset of 16-17. 

The individual experiences distress due to a perceived physical anomaly, such as a scar, the shape or size of a body part, scoliosis syndrome, or some other personal feature. They frequently examine themselves in the mirror, comparing their appearance to that of other people, often avoiding social events and photos. 

Those with Body Dysmorphic Disorder may undergo unneeded cosmetic surgery, dental procedures, or dermatological procedures to correct the perceived flaw but are typically unsatisfied with the results, as this is an internal perceptual problem.

Hoarding Disorder

Hoarding Disorder is a mental illness in the Obsessive-Compulsive Disorders spectrum. It is characterized by difficulty in parting with or discarding possessions. A Hoarding Disorder may be assigned to individuals who excessively save items and in whom the idea of discarding items causes extreme stress. Hoarders cannot bear to depart from any of their belongings, which results in excessive clutter to an extent that impairs functioning and may create health and safety risks. Those with Hoarding Disorder tend to have rooms that are stacked full of items, hallways are difficult to pass through because of the amount of clutter, while sinks and tables are unusable. They may come to the attention of authorities because of health and safety concerns related to their home. The exact cause is unknown.

Hoarders are uncomfortable inviting guests over to the chaos. Hoarders may have good insight and realize that their hoarding is a problem or have poor insight and not recognize their behavior is unhealthy. An estimated 80 percent of hoarders engage in excessive shopping, buying unnecessary items or duplicates of what they already own but cannot locate. Some hoard animals that they cannot care for. Although hoarding is more common in older adults (55-94 years), it appears to begin at ages 11-15 years, and starts to cause significant impairment when people are in their 30’s. Common comorbidities include depression (57 percent), social phobia (29 percent), generalized anxiety disorder (28 percent), and attention deficit disorder. (28 percent).

Other Specified/Unspecified

Other specified or Unspecified Obsessive-Compulsive and Related Disorder is a category of diagnoses that applies to individuals who have symptoms characteristic of the Obsessive-Compulsive Disorders spectrum (e.g., obsessive-compulsive disorder, body dysmorphic disorder) but do not meet the full criteria for any of them. This category in Obsessive-Compulsive and Related Disorders also includes disorders with cultural components that have symptoms characteristic of Obsessive-Compulsive Disorders. 

Following are three examples that can cause significant distress or impairment.

  • Taijin kyofusho or an obsession of shame, embarrassment, and anxiety. It is characterized as a fear that one’s appearance or behaviors are embarrassing or are offensive to others. fear of interpersonal relations and offending others. A culturally bound syndrome, it is found predominantly in Japan and Korea. 
  • Jikoshi-kyofu or Olfactory Reference Syndrome is a cultural component involving a preoccupation with the belief of having a foul or offensive body odor. There are repetitive behaviors in response to odor concerns (e.g., washing, comparing to others), which can cause significant distress/impairment.
  • A study on “The influence of cultural factors on obsessive-compulsive disorder: religious symptoms in a religious society” found that many religions inculcate the performance of rituals from childhood and view nonperformance as wrong or sinful. Rituals concerning cleanliness, exactness, prayer, dietary choices, and menstrual practices are the most common presentations. In many cases, repeating rituals are encouraged. Nevertheless, repetitive performance of religious rituals is recognized by OCD sufferers and their religious leaders as expressing psychopathology rather than heightened spirituality. Religion appears not to be a distinctive topic of OCD, rather it is the setting for the condition in very religious patients.

A diagnosis of other Specified or Unspecified Disorder may be assigned when it is unclear whether the obsessive-compulsive disorder and related symptoms are primary, substance-induced, or due to another mental or condition.

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