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
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
