Obsessive Compulsive and Related
Disorders Exam
Body Dysmorphic Disorder: Clinical course - ANSWER-Onset as an adolescent/early
adult
Usually chronic
Rarely fully remits
Can become highly incapacitating
About 1/3 housebound
Most feel embarrassed about their defect
Superimpose depression common
1/5 try suicide
*Anorexia nervosa is excluded because desire is look thin not normal. Normal
adolescent concerns are transient and most adolescents can be reassured
Body Dysmorphic Disorder: DDX - ANSWER-Social phobia - isolation
Histrionic personality
Illness anxiety disorder
Major depression
Schizophrenia
Body Dysmorphic Disorder: DSM V - ANSWER-A. Preoccupation with one or more
percieved defects or flaws in physical appearance that are not observable or appear to
others
B. The individual has performed repetitive behaviors over the course of the disorder -
mirror checking, excessive grooming, skin picking
C. Causes clinically significant distress
D. Not better explained by a preoccupation with fat in a pt who meets the criteria for an
eating disorder
Body Dysmorphic Disorder: Epidemiology - ANSWER-About 2% general population
have disorder
7-15% seek cosmetic surgery - surgery is rarely "curative," violence toward doctors by
BDD occurs
Typically get to psychiatrist on referral from derm, plastic surgery, ENT
Body Dysmorphic Disorder: Mirror gazing - ANSWER-Most common repetitive behavior
(80%)
Most disgusted by their appearance
Some try to hide by looking at a spoon
Uses mirror to compare 3 different images - what they say in the mirror, what they
perceived as ideal images of themselves, distorted images of themselves
, Body Dysmorphic Disorder: Other manifestations - ANSWER-Compulsive skin picking
(27%):
Some use knives
Most camouflage appearance in public
Some will push their noses, skin etc to try and get it to appear better
Body Dysmorphic Disorder: Treatment - ANSWER-Very difficult to Tx effectively
SSRIs have shown some modest promise
Compulsions - ANSWER-75-95% have compulsions and obsessions
Obsessions = thoughts
Compulsions = behaviors
Usually strong desire to resist, only about 50% actually do
Cause marked distress/time consuming
Interferes with normal routine, occupation or school function
Excoriation (skin picking) disorder: Associated features - ANSWER-May search for scab
to pull
May play with scab after pulling it
May be triggered by anxiety/bordeom
Pain not typically reported
Some do so in response to sense of skin irregularity
Usually only done around family
Excoriation (skin picking) disorder: DSM V - ANSWER-A. Recurrent skin picking
resulting in skin lesions
B. Repeated attempts to stop or decrease skin picking
C. Skin picking causes clinically significant distress
D. Not due to another medical condition
E. Not better explained by another mental disorder
Excoriation (skin picking) disorder: Epidemiology - ANSWER-1.4%--3:1 = W:M
25% not consciously aware
Onset around puberty
May begin with derm condition
More common in OCD
Excoriation (skin picking) disorder: Other features - ANSWER-Only about 20% seek
medical treatment
Illegal drugs, tobacco, and alcohol common
Many with BDD and OCD
Most pick about 4-5 sites at a time
Can result in infections
May require topical/systemic treatment
Disorders Exam
Body Dysmorphic Disorder: Clinical course - ANSWER-Onset as an adolescent/early
adult
Usually chronic
Rarely fully remits
Can become highly incapacitating
About 1/3 housebound
Most feel embarrassed about their defect
Superimpose depression common
1/5 try suicide
*Anorexia nervosa is excluded because desire is look thin not normal. Normal
adolescent concerns are transient and most adolescents can be reassured
Body Dysmorphic Disorder: DDX - ANSWER-Social phobia - isolation
Histrionic personality
Illness anxiety disorder
Major depression
Schizophrenia
Body Dysmorphic Disorder: DSM V - ANSWER-A. Preoccupation with one or more
percieved defects or flaws in physical appearance that are not observable or appear to
others
B. The individual has performed repetitive behaviors over the course of the disorder -
mirror checking, excessive grooming, skin picking
C. Causes clinically significant distress
D. Not better explained by a preoccupation with fat in a pt who meets the criteria for an
eating disorder
Body Dysmorphic Disorder: Epidemiology - ANSWER-About 2% general population
have disorder
7-15% seek cosmetic surgery - surgery is rarely "curative," violence toward doctors by
BDD occurs
Typically get to psychiatrist on referral from derm, plastic surgery, ENT
Body Dysmorphic Disorder: Mirror gazing - ANSWER-Most common repetitive behavior
(80%)
Most disgusted by their appearance
Some try to hide by looking at a spoon
Uses mirror to compare 3 different images - what they say in the mirror, what they
perceived as ideal images of themselves, distorted images of themselves
, Body Dysmorphic Disorder: Other manifestations - ANSWER-Compulsive skin picking
(27%):
Some use knives
Most camouflage appearance in public
Some will push their noses, skin etc to try and get it to appear better
Body Dysmorphic Disorder: Treatment - ANSWER-Very difficult to Tx effectively
SSRIs have shown some modest promise
Compulsions - ANSWER-75-95% have compulsions and obsessions
Obsessions = thoughts
Compulsions = behaviors
Usually strong desire to resist, only about 50% actually do
Cause marked distress/time consuming
Interferes with normal routine, occupation or school function
Excoriation (skin picking) disorder: Associated features - ANSWER-May search for scab
to pull
May play with scab after pulling it
May be triggered by anxiety/bordeom
Pain not typically reported
Some do so in response to sense of skin irregularity
Usually only done around family
Excoriation (skin picking) disorder: DSM V - ANSWER-A. Recurrent skin picking
resulting in skin lesions
B. Repeated attempts to stop or decrease skin picking
C. Skin picking causes clinically significant distress
D. Not due to another medical condition
E. Not better explained by another mental disorder
Excoriation (skin picking) disorder: Epidemiology - ANSWER-1.4%--3:1 = W:M
25% not consciously aware
Onset around puberty
May begin with derm condition
More common in OCD
Excoriation (skin picking) disorder: Other features - ANSWER-Only about 20% seek
medical treatment
Illegal drugs, tobacco, and alcohol common
Many with BDD and OCD
Most pick about 4-5 sites at a time
Can result in infections
May require topical/systemic treatment
