2. Obsessive-Compulsive Disorder
Key Features:
• Repetitive, intrusive, uncontrollable thoughts or
urges (obsessions)
• Repetitive behaviors or mental acts that the person
feels compelled to perform (compulsions)
Obsessive-Compulsive Disorder
3. Important Facts about OCD
• OCD is a disorder that has a neurobiological basis.
• It equally affects men, women and children of all
races, ethnicities and socioeconomic backgrounds.
• Based on community studies, it is estimated that
between 1 to 3 % of the population have OCD.
• In the United States, about 1 in 40 adults (or 2.3% of
total population) and 1 in 100 children have OCD.
• On average, people are diagnosed with OCD when
they are 19-years-old.
Obsessive-Compulsive Disorder
4. Important Facts about OCD
• According to theWorld Health Organization, OCD is
one of the top 20 causes of illness-related disability,
worldwide, for individuals between 15 and 44 years
of age.
• In the Philippines, it is estimated 1,046,314 million
people are affected by the disorder (ThePOC.net)
• Harrison Ford, Daniel Radcliffe, Cameron Diaz,
Leonardo DiCaprio, David Beckham, Megan Fox and
JustinTimberlake are all celebrities who have lived
with OCD.
Obsessive-Compulsive Disorder
5. Prevalence
• The 12-month prevalence of OCD in the United
States is 1.2%, with a similar prevalence
internationally (1.1%-1.8%).
• Females are affected at a slightly higher rate than
males in adulthood, although males are more
commonly affected in childhood.
Obsessive-Compulsive Disorder
6. Development and Course
• In the United States, the mean age at onset of OCD
is 19.5 years, and 25% of cases start by age 14 years.
Onset after age 35 years is unusual but does occur.
• Males have an earlier age at onset than females:
nearly 25% of males have onset before age 10 years.
The onset of symptoms is typically gradual;
however, acute onset has also been reported.
Obsessive-Compulsive Disorder
7. Development and Course
• Compulsions are more easily diagnosed in children
than obsessions are because compulsions are
observable. However, most children have both
obsessions and compulsions (as do most adults).
• The pattern of symptoms in adults can be stable
over time, but it is more variable in children.
Obsessive-Compulsive Disorder
8. Diagnostic Criteria
Criterion A
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images
that are experienced, at some time during the
disturbance, as intrusive and unwanted, and that in
most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such
thoughts, urges, or images, or to neutralize them
with some other thought or action (i.e., by
performing a compulsion).
Obsessive-Compulsive Disorder
9. Diagnostic Criteria
Criterion A
Common Obsessions:
• Scared of dirt or germs
• Dread of bodily waste or fluids
• Overly concerned with order and balance
(symmetry) of things
• Worry that a task was not fulfilled properly despite
knowing the contrary
• Fear of bad or sinful thoughts
Obsessive-Compulsive Disorder
10. Diagnostic Criteria
Criterion A
Common Obsessions:
• Preoccupation with thoughts about certain sounds,
images, words or numbers
• Craving for constant reassurance
• Afraid of harming a family member or friend
Obsessive-Compulsive Disorder
11. Diagnostic Criteria
Criterion A
Compulsions are defined by (1) and (2):
1. Repetitive behaviors or mental acts that the
individual feels driven to perform in response to an
obsession or according to rules that must be applied
rigidly.
Obsessive-Compulsive Disorder
12. Diagnostic Criteria
Criterion A
Compulsions are defined by (1) and (2):
2.The behaviors or mental acts are aimed at
preventing or reducing anxiety or distress, or
preventing some dreaded event or situation;
however, these behaviors or mental acts are not
connected in a realistic way with what they are
designed to neutralize or prevent, or are clearly
excessive.
Obsessive-Compulsive Disorder
13. Diagnostic Criteria
Criterion A
Common Compulsions:
• Excessive washing of hands, showering, brushing
teeth and cleaning
• Repeatedly checking door locks, furniture and
appliances to make sure they have been properly
closed or turned off
• Repeating actions such as turning on and turning off
the lights, going in and out of a door, sitting down
and getting up from a chair, or touching specific
objects several times
Obsessive-Compulsive Disorder
14. Diagnostic Criteria
Criterion A
Common Compulsions:
• Organizing or lining up items in certain ways
• Counting to a certain number over and over again
• Not discarding old newspapers, mail or containers
even though they are no longer needed
• Seeking for constant approval and reassurance
Obsessive-Compulsive Disorder
15. Diagnostic Criteria
Criterion B
The obsessions or compulsions are time-consuming
(e.g., take more than 1 hour per day) or cause clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.
Criterion C
The obsessive-compulsive symptoms are not
attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another
medical condition.
Obsessive-Compulsive Disorder
16. Diagnostic Criteria
Criterion D
The disturbance is not better explained by the
symptoms of another mental disorder.
• excessive worries (generalized anxiety disorder)
• preoccupation with appearance (body dysmorphic
disorder)
• difficulty discarding or parting with possessions
(hoarding disorder)
• hair pulling (trichotillomania), etc.
Obsessive-Compulsive Disorder
17. Specifiers
• With good or fair insight: The individual recognizes
that obsessive-compulsive disorder beliefs are
definitely or probably not true or that they may or
may not be true.
• With poor insight:The individual thinks obsessive-
compulsive disorder beliefs are probably true.
• With absent insight/delusional beliefs: The
individual is completely convinced that obsessive-
compulsive disorder beliefs are true.
• Tic-related: The individual has a current or past
history of a tic disorder.
Obsessive-Compulsive Disorder
19. Risk and Prognostic Factor
• Temperamental: Greater internalizing symptoms,
higher negative emotionality, and behavioral
inhibition in childhood are possible temperamental
risk factors.
• Environmental: Physical and sexual abuse in
childhood and other stressful or traumatic events
have been associated with an increased risk for
developing OCD.
Obsessive-Compulsive Disorder
20. Risk and Prognostic Factor
• Genetic and physiological: The rate of OCD among
first-degree relatives of adults with OCD is
approximately two times that among first-degree
relatives of those without the disorder; the rate first-
degree relatives of individuals with onset of OCD in
childhood or adolescence is increased 10-fold.
Familial transmission is due in part to genetic factors.
Dysfunction in the orbitofrontal cortex, anterior
cingulate cortex, and striatum have been most
strongly implicated.
Obsessive-Compulsive Disorder
21. Treatment
Medications:
• Serotonin Reuptake Inhibitors (SRIs) are the most
commonly used medications for the obsessive-
compulsive and related disorders. SRIs ware initially
developed as antidepressant, but it is well established
that they are effective in the treatment of OCD
(Steketee & Barlow, 2004) and BDD (Hollander, et al.,
1999)
Obsessive-Compulsive Disorder
22. Treatment
Medications:
• Clomipramine, the most commonly prescribed SRI
for OCD
• “Selective” Serotonin Reuptake Inhibitors (SSRIs)
are a newer class of SRIs that have fewer side effects
Obsessive-Compulsive Disorder
23. Treatment
Psychotherapy:
• Exposure & Response Prevention (ERP) is the most
widely used psychological treatment for OCD.This is
a type of cognitive-behavioral therapy where the
therapist helps the patient face situations that bring
out their fear, anxious thoughts and obsessions.The
therapist encourages the patient to suppress the
need to perform the rituals that normally help the
individual control his distress.
Obsessive-Compulsive Disorder
24. Body Dysmorphic Disorder
Key Features:
• Preoccupation with an imagined flaw in one’s
appearance
• Excessive repetitive behaviors or acts regarding
appearance (e.g., checking appearance, seeking
reassurance)
Body Dysmorphic Disorder
25. Important Facts about BDD
• Formerly known as Dysmorphophobia
• Although people with BDD may appear attractive to
others, they perceive themselves as ugly or even
“monstrous” in their appearance (Phillips, 2006)
• Women tend to focus on their skin, hips, breasts, and
legs, whereas men are more likely to focus on their
height, penis size, or body hair (Perugi, et al., 1997)
• While many spend hours a day checking their
appearance, some try to avoid being reminded of
their perceived flaws by avoiding mirrors, reflective
surfaces, or bright lights (Albertini & Phillips, 1999)
Body Dysmorphic Disorder
26. Important Facts about BDD
• In cross-sectional/retrospective studies, 45%–70% of
the patients reported a history of suicidal ideation
attributed primarily to BDD. Reported rates of past
suicide attempts are 22%–24% (Phillips & Menard,
2006)
• BDD occurs slightly more often in women than in
men, but even among women it is relatively rare, with
a prevalence of less 2% (Rief et al., 2006)
• Among women seeking plastic surgery, however,
about 5% to 7% meet the diagnostic criteria for this
disorder (Mundo et al., 2001)
Body Dysmorphic Disorder
27. Important Facts about BDD
• Among college students, concerns about body
appearance appear to be more common in America
than in Europe
• As many as 74% of American students report at least
some concern about their body image, with women
being more likely than men to report dissatisfaction
(Bohne, 2002)
• Robert Pattinson, Hayden Panettiere, AndyWarhol,
Franz Kafka, Sylvia Plath, Shirley Manson, Michael
Jackson are all celebrities who have lived with BDD
Body Dysmorphic Disorder
28. Prevalence
• The point prevalence among U.S. adults is 2.4% (2.5%
in females and 2.2% in males). Outside the United
States (i.e., Germany), current prevalence is
approximately 1.7%-1,8%, with a gender distribution
similar to that in the United States.
• The current prevalence is 9%-15% among
dermatology patients, 7%-8% among U.S. cosmetic
surgery patients, 3%- 16% among international
cosmetic surgery patients (most studies), 8% among
adult orthodontia patients, and 10% among patients
presenting for oral or maxillofacial surgery.
Body Dysmorphic Disorder
29. Development and Course
• The mean age at disorder onset is 16-17 years, the
median age at onset is 15 years, and the most
common age at onset is 12-13 years.Two-thirds of
individuals have disorder onset before age 18.
• Subclinical body dysmorphic disorder symptoms
begin, on average, at age 12 or 13 years.
• Subclinical concerns usually evolve gradually to the
full disorder, although some individuals experience
abrupt onset of body dysmorphic disorder.
Body Dysmorphic Disorder
30. Development and Course
• The disorder's clinical features appear largely similar
in children/adolescents and adults.
• Body dysmorphic disorder occurs in the elderly, but
little is known about the disorder in this age group.
Individuals with disorder onset before age 18 years
are more likely to attempt suicide, have more
comorbidity, and have gradual (rather than acute)
disorder onset than those with adult-onset body
dysmorphic disorder.
Body Dysmorphic Disorder
31. Diagnostic Criteria
Criterion A
Preoccupation with one or more perceived defects or
flaws in physical appearance that are not observable
or appear slight to others.
Criterion B
At some point during the course of the disorder, the
individual has performed repetitive behaviors (e.g.,
mirror checking, excessive grooming, skin picking,
reassurance seeking) or mental acts (e.g., comparing
his or her appearance with that of others) in response
to the appearance concerns.
Body Dysmorphic Disorder
32. Diagnostic Criteria
Criterion C
The preoccupation causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
Criterion D
The appearance preoccupation is not better
explained by concerns with body fat or weight in an
individual whose symptoms meet diagnostic criteria
for an eating disorder.
Body Dysmorphic Disorder
33. Specifiers
• With muscle dysmorphia: The individual is
preoccupied with the idea that his or her body build is
too small or insufficiently muscular.This specifier is
used even if the individual is preoccupied with other
body areas, which is often the case.
• Indicate degree of insight regarding body
dysmorphic disorder beliefs (e.g., “I look ugly” or “I
look deformed”).
Body Dysmorphic Disorder
34. Specifiers
• With good or fair insight: The individual recognizes
that the body dysmorphic disorder beliefs are
definitely or probably not true or that they may or
may not be true.
• With poor insight: The individual thinks that the
body dysmorphic disorder beliefs are probably true.
• With absent insight/delusional beliefs: The
individual is completely convinced that the body
dysmorphic disorder beliefs are true.
Body Dysmorphic Disorder
35. Risk and Prognostic Factors
• Environmental: Body dysmorphic disorder has been
associated with high rates of childhood neglect and
abuse.
• Genetic and physiological: The prevalence of body
dysmorphic disorder is elevated in first-degree
relatives of individuals with obsessive-compulsive
disorder (OCD).
Body Dysmorphic Disorder
