Day # 90: Introduction to Obsessive Compulsive Disorder (OCD)

If you are following along in the suggested curriculum you have now finished the first five themes (psychotic disorders, depressive disorders, bipolar disorder, anxiety disorders, and emergency psychiatry). Nice work! Today will be our first day of the sixth theme in the Bullet Psych curriculum which is OCD and related disorders. This will include OCD, body dysmorphic disorder (BDD), hoarding disorder, trichotillomania, and excoriation disorder.

Today we will cover an introduction to OCD which will include definitions, overview diagnostic criteria, and discuss some common examples / themes.

Today's Content Level: Beginner; Intermediate

DEFINITIONS

•OCD is characterized by the presence of obsessions, compulsions, or both.

Obsessions

• Thoughts, urges, or images that are...

• Recurrent, intrusive, and undesired.

• Causes distress/anxiety.

Compulsions

• Repetitive behaviors or mental rituals.

• Feels driven to perform these rituals (often in response to obsessions).

• Aimed at preventing or reducing anxiety/distresses. May believe that some disaster will occur if they do not complete the ritual.

• Not realistically able to prevent/neutralize the distress and/or are clearly excessive (ego-dystonic).

• Anxiety may increase if a patient resists acting out a compulsion.

DIAGNOSTIC CRITERIA

Obsessive Compulsive Disorder (OCD)

• Presence of obsessions, compulsions, or both.

• Time consuming (ex: take >1 hour per day) or cause significant distress or impairment (ex: social or occupational).

• Symptoms are not attributable to a substance/medication or another medical or mental disorder (such as MDD, GAD, autism, etc...).

Specifiers

• Insight: Individuals with OCD have varying levels of insight regarding their symptoms. They may recognize their obsessions/compulsions to be definitely not true or they may be convinced that they are true. This can be specified as good/fair insight, poor insight, or absent insight/delusional beliefs.

• Tic-related: Up to 30% of individuals with OCD have a lifetime tic disorder. This is most common in males with onset of OCD in childhood. 1

COMMON EXAMPLES / THEMES

Contamination 2

• Obsession: fear of becoming personally contaminated or contaminating others. Can include real things (viruses, bacteria, bodily waste, toxins, radiation) or less concrete things (bad luck, people with bad traits).

• Compulsion: repetitive hand washing, showering, disinfecting clothes/possessions, throwing things away, avoiding certain people or places, repeatedly asking others for reassurance, or researching to find out whether certain items may be contaminated.

Symmetry 3

• Obsession: need for things to be "just right", symmetrical, correctly aligned, perfect, or exact.

• Compulsion: arranging, ordering, aligning things, and sometimes touching or tapping.

Violence or Sexual 4

• Obsession: repeated thoughts of killing or injuring others or oneself or thoughts about acting in unacceptable sexual ways toward others. Examples include thoughts or urges of hitting, stabbing, strangling, raping, or mutilating others or themselves. May have urges to push others into the paths of cars or out of windows or to hit pedestrians in their cars. May have repeated images of graphic scenes. It is important to understand that these are unwanted and intrusive thoughts and they cause distress. This is not the same as having a violent or sexual fantasy.

• Compulsion: these patients do not act these thoughts out. They experience significant distress and sometimes believe they may be potential criminals or perverts or insane and may ask questions such as "what kind of person am I that could think such thoughts?".

Morality / Religion 5

• Obsession: being good, honest, perfectly obedient/devote, taboo thoughts, or excessive concern with rules or past actions that were immoral.

• Compulsion: prayer, religious ceremonies, counting.

CONCLUSION

Congrats on finishing day 1 of the OCD theme. Next post we will discuss the epidemiology, etiology, and expected course and prognosis in these patients.

Resources for today's post include DSM-V, First Aid for Psychiatry, Pocket Psychiatry, and the articles referenced above.

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