Class notes

Chapter 6 - Obsessive Compulsive Disorder

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Course
PSYC 300A

Institution
University Of British Columbia (UBC )

Welcome to the lecture notes on Obsessive-Compulsive Disorder (OCD). In this comprehensive collection, I explored the intricate aspects of OCD, an anxiety-related disorder. I delved into the diagnostic criteria, symptoms, and subtypes of OCD, providing an in-depth understanding of its clinical pres...

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Uploaded on May 11, 2023
Number of pages 14
Written in 2021/2022
Type Class notes
Professor(s) Sheila woody
Contains Obsessive-compulsive disorder

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PSYC 300
Chapter 6 – OCD & Trauma Disorders
6.1 Obsessive-Compulsive and Related Disorders (OCRDs)
- OCD is less common than many of the anxiety disorders
- 12-month prevalence of about 1% and a lifetime prevalence of about 2%
- Causes a high degree of impairment.
 The World Health Organization listed OCD as one of the top 10 most impairing conditions based
on lost income and decreased quality of life
- High degree of comorbidity  majority of people with OCD are diagnosed with other conditions
 These include anxiety disorders, mood disorders, impulse-control disorders, and substance use
disorders
 Contributes to a higher degree of impairment and difficulty in treating this disorder
- Evidence of the high level of chronicity, impairment, and distress associated with OCD can be gleaned
from research examining links to suicidality and mortality.
 Research concluded there is a moderate to high link between OCD and suicidal ideation as well
as suicide attempts
 Variety of factors strengthen relationship between OCD and suicidality
o Including being diagnosed with a comorbid disorder and having more severe anxious
and depressive symptoms.
 Severe obsessions were more relevant for predicting suicide risk than compulsions.
- People with OCD also have higher rates of mortality than the general population for both natural and
unnatural causes of death
 Factors related to mortality were considered (e.g., somatic comorbidities, age), leading to the
conclusion that a diagnosis of OCD is associated with increased mortality risk.
 Comorbidity increases the likelihood of mortality  being diagnosed with a comorbid anxiety
disorder, depression, or a substance use disorder is associated with higher mortality rates than
OCD alone.
- Prior to DSM-5, OCD was considered an anxiety disorder  OCD differs in key respects
 Differ in the domains of repetitive thoughts and behaviours and inability to resist impulses and
urges.
 Research Planning Agenda for DSM-5 created a new DSM-5 category entitled obsessive-
compulsive and related disorders (OCRDs).
- DSM-5 Categories
 OCRDs: a new category in the DSM-5 that includes obsessive-compulsive disorder, hoarding
disorder, body dysmorphic disorder, and body-focused repetitive behaviour disorders.
 OCRD “related disorders”  viewed as hoarding disorder
 Body dysmorphic disorder  formerly considered a subtype of OCD & considered a
somatoform disorder
 Trichotillomania (hair-pulling disorder)  formerly categorized as an impulse control disorder
 Excoriation (skin-picking disorder)  did not appear in previous versions of the DSM.
o Trichotillomania and excoriation are often grouped together as body-focused repetitive
behaviours
- Anxiety plays a prominent role in OCD  obsessions typically trigger an anxious response that is
relieved with the compulsions.
 Repetitive behaviours seen in OCD are not typically present in the anxiety disorders but present
among the other OCRDs.
 Researchers focus on how the function of repetitive behaviours are different in OCD (reduce
obsessional fear) compared with hair-pulling or skin-picking (no obsessional fear, but trigger is
often general tension or boredom).
 People diagnosed with body-focused repetitive behaviours may pull hair or pick skin out of
habit, without conscious awareness.

, SUMMARY
- Obsessive-compulsive and related disorders (OCRDs) is a new category in DSM-5.
- Included in this category are the following disorders:
 Obsessive-compulsive disorder (OCD)
 Hoarding disorder
 Body dysmorphic disorder (BDD)
 Trichotillomania disorder (hair-pulling)
 Excoriation disorder (skin-pulling)

6.2 OCD
Obsession
- Obsessive-compulsive disorder is a chronic disorder
- The mind is flooded with persistent and uncontrollable thoughts (obsessions) and the individual is
compelled to repeat certain acts (compulsions), suffering significant distress and interference with
everyday functioning.
 Formerly classified as an anxiety disorder, currently part of the obsessive-compulsive and related
disorders category.
 OCD affects men and women equally
 Can occur in children  typical age of onset is around 20
 Developing OCD later in life (beyond early 30s) is rare
- Obsessions: intrusive and recurring thoughts, impulses, and images that come unbidden to the mind and
appear irrational and uncontrollable to the individual experiencing them.
 Individuals with OCD find the disorder severely interfering with normal functioning.
 Frequent obsessions concern fears of contamination, fears of expressing sexual or aggressive
impulses, and hypochondriacal fears of bodily dysfunction
o Contamination obsessions may include a fear of germs from others or using public
toilets.
 Obsessions are ego-dystonic (foreign to their personality) and obsessional themes vary across
individuals  often have great personal relevance.
 Most people with OCD keep the content and frequency of their obsessions secret for
 Severity of obsessions are a factor that contributes to poorer quality of life

Compulsions
- Compulsion: the irresistible impulse to repeat an irrational act repeatedly.
 A repetitive behaviour or mental act that the person feels driven to perform to reduce the distress
caused by obsessive thoughts or to prevent some calamity from occurring.
 Activity is not realistically connected with its apparent purpose and is excessive.
- Some examples of commonly reported compulsions include:
 Checking, going back many times to verify already performed acts were carried out
 Pursuing cleanliness (e.g., handwashing, cleaning the house)
 Orderliness (arranging objects until they are “just right”), sometimes through elaborate
ceremonies that take hours and even most of the day.
 Mental rituals (e.g., repeating prayers in response to “bad” thoughts)  compulsions are not
always behaviours, can be mental acts.
 Performing repetitive, magical, protective practices, such as counting, saying certain numbers, or
touching a talisman or a particular part of the body.
 Performing a particular act  such as eating extremely slowly.
- Compulsions are most often viewed because of obsessions.
 Typically done to decrease the anxiety associated with an obsession.
 EXAMPLE: teenage boy has unwanted thoughts he will cause harm to his baby sister

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