Obsessions are characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing (APA, 2013). Common obsessions include concerns about germs and contamination, doubts (“Did I turn the water off?”), order and symmetry (“I need all the spoons in the tray to be arranged a certain way”), and urges that are aggressive or lustful. Usually, the person knows that such thoughts and urges are irrational and thus tries to suppress or ignore them, but has an extremely difficult time doing so.
Compulsions are ritualistic behaviors that an individual performs in order to mitigate the anxiety that stems from obsessive thoughts. They often include such behaviors as repeated and extensive hand washing, cleaning, checking (e.g., making sure the oven is off), counting things, hoarding, or ordering (e.g., lining up all the pencils in a particular way). They may also include such mental acts as counting, praying, or reciting something to oneself, as well as nervous rituals like touching a doorknob or opening and closing a door a certain number of times before leaving a room. These compulsions can be alienating and time-consuming, often causing severe emotional, interpersonal, and even financial distress. The ability to relieve their stress is often temporary, and individuals may have a hard time switching from one task to another.
The acts of those who have OCD may appear paranoid and potentially psychotic, or disconnected from reality; however, OCD sufferers generally recognize their obsessions and compulsions as irrational. Roughly one-third to one-half of adults with OCD report a childhood onset of the disorder.
DSM-5 Diagnostic Criteria
To be diagnosed with OCD, a person must experience obsessions, compulsions, or both. Such obsessions must be to a degree that lies outside the normal range of worries about conventional problems. A person will tend to recognize the obsessions as idiosyncratic or irrational, but still must perform them. Additionally, the degree of obsessions and compulsions must impair some aspect of the individual’s social, occupational, or daily life functioning.
Other Obsessive-Compulsive Disorders
Obsessive-compulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors. Included in this category are body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.
1. Body Dysmorphic Disorder
An individual with body dysmorphic disorder is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013). These perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror, trying to hide the offending body part, comparisons with others, and, in some extreme cases, cosmetic surgery (Phillips, 2005). Severely impairing quality of life, body dysmorphic disorder can lead to social isolation and involves especially high rates of suicidal ideation. An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).
2. Hoarding Disorder
Hoarding disorder is a pattern of behavior that is characterized by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It could also potentially put the individual and others at risk of causing fires, falling, poor sanitation, and other health concerns. Compulsive hoarders may be conscious of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.
Prevalence rates have been estimated at 2-5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age. Hoarding appears to be more common in people with psychological disorders such as depression, anxiety, and attention -deficit hyperactivity disorder (ADHD).
Trichotillomania
Trichotillomania (also known as trichotillosis or hair pulling disorder) is an obsessive compulsive disorder characterized by the compulsive urge to pull out one’s hair, leading to hair loss and balding, distress, and social or functional impairment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. Owing to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% and 4.0% of the overall population. Common areas for hair to be pulled out are the scalp, eyelashes, eyebrows, legs, arms, hands, nose and the pubic areas.
Excoriation Disorder
Excoriation disorder is an obsessive compulsive disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused. Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, and extremities such as the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal.
Excoriation disorder can cause feeling of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.
Lumen: Boundless Psychology: Obsessive-Compulsive Disorders
DSM-5 Diagnostic Criteria
To be diagnosed with OCD, a person must experience obsessions, compulsions, or both. Such obsessions must be to a degree that lies outside the normal range of worries about conventional problems. A person will tend to recognize the obsessions as idiosyncratic or irrational, but still must perform them. Additionally, the degree of obsessions and compulsions must impair some aspect of the individual’s social, occupational, or daily life functioning.
Other Obsessive-Compulsive Disorders
Obsessive-compulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors. Included in this category are body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.
1. Body Dysmorphic Disorder
An individual with body dysmorphic disorder is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013). These perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror, trying to hide the offending body part, comparisons with others, and, in some extreme cases, cosmetic surgery (Phillips, 2005). Severely impairing quality of life, body dysmorphic disorder can lead to social isolation and involves especially high rates of suicidal ideation. An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).
2. Hoarding Disorder
Hoarding disorder is a pattern of behavior that is characterized by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It could also potentially put the individual and others at risk of causing fires, falling, poor sanitation, and other health concerns. Compulsive hoarders may be conscious of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.
Prevalence rates have been estimated at 2-5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age. Hoarding appears to be more common in people with psychological disorders such as depression, anxiety, and attention -deficit hyperactivity disorder (ADHD).
Trichotillomania
Trichotillomania (also known as trichotillosis or hair pulling disorder) is an obsessive compulsive disorder characterized by the compulsive urge to pull out one’s hair, leading to hair loss and balding, distress, and social or functional impairment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. Owing to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% and 4.0% of the overall population. Common areas for hair to be pulled out are the scalp, eyelashes, eyebrows, legs, arms, hands, nose and the pubic areas.
Excoriation Disorder
Excoriation disorder is an obsessive compulsive disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused. Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, and extremities such as the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal.
Excoriation disorder can cause feeling of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.
Lumen: Boundless Psychology: Obsessive-Compulsive Disorders
No comments:
Post a Comment