This document provides information on various obsessive compulsive related disorders including OCD, BDD, hoarding disorder, excoriation, and trichotillomania. It discusses the group members studying these disorders and lists their defining features. It then covers epidemiology, theories of causation including biological and psychological factors, common comorbidities, and treatments including medications and cognitive behavioral therapy. Brain imaging research suggests abnormalities in circuits involving the orbitofrontal cortex, caudate nucleus, and cingulate gyrus may underlie the disorders.

2. Group members:
• Mahum Azhaar
• Anum Suhail
• Shahtaj Shakir
• Sidra Javed
•Wajeeha Ghani
• Pakeeza Arif
• Soofia Hussain
• S. Amna Burhan

3. •Obsessive Compulsive Disorder
•Body Dysmorphic Disorder
•Hoarding Disorder
•Excoriation
•Trichotillomania

4. It is defined as occurring of unwanted and intrusive thoughts or
distressing images which
are accompanied by compulsive behaviors to neutralize the obsessive
thoughts.

5. Obsessive: Repetitive Thoughts which are distressing,
inappropriate and uncontrollable.
 Order and exactness
 Doubting
 Religious
 Contamination
 Aggressive
 Sexual
 Violence

7. Compulsions: Repetitive overt behaviors or it can be covert
mental rituals.
There are five main primary types of compulsive rituals.
 Cleaning
 Repeated checking,
 Ordering
 Arranging
 Counting

8. The distressing thoughts are usually unacceptable or taboo in
nature (sexual, harming, religious thoughts). Rather than
perform an overt ritual, such people will engage in covert
rituals and mental neutralizing.

9. OCD CYCLE

10.  One recent study found that more than 25% of people in NCS-R
co-morbidity study reported experiencing obsessions or
compulsions at some time of their lives.
 The average lifetime prevalence was 2.3 %.
 British Epidemiology found a gender ratio of 1.4 to 1 (women
to men; Torres et al., 2006)

11.  Depression
 Social phobia, panic disorder, GAD and PTSD
 BDD

13. CAUSAL
FACTORS
Psychological Causal
factors
Cognitive Causal
factors
Biological Causal
factors

15.  Learning Theory (OCD AS LEARNED BEHAVIOR)
 Evolutionary Theory (OCD AND PREPAREDNESS)

16.  Mowrer’s two process theory of avoidance learning(1947) :
According to this theory, neutral stimuli become associated with
frightening thoughts or experience through classical
conditioning and come to elicit anxiety.
 EXAMPLE

17.  This model predicts, then, that exposure to feared objects
or situations should be useful in treating OCD if the
exposure is followed prevention of the rituals, enabling
the person to see that the anxiety will subside naturally in
time without the ritual.
 This indeed the cure of the most effective form of
Behavioral therapy for OCD.

18. They found that for most people with OCD, exposure
to a situation that provoked their obsession did indeed
produce distress, which would continue for a
moderate amount of time and then gradually
dissipate.

19.  We have also enlarged our understanding of Obsessive
Compulsive Disorder by looking at in an evolutionary
context.
 Example

20.  In addition, some theorists have argued that the displacement
activities that many species of animal engage in under
situations of conflict or high arousal resemble the compulsive
rituals seen in Obsessive-Compulsive Disorder.

23.  People with normal and abnormal obsessions differ primarily
in the degree to which the resist their own thoughts.
 The factor contributing to the frequency of obsessive thoughts
and negative moods is the attempt to suppress them.

24.  OCD patients were asked to record their intrusive thoughts in a
diary, both on days when they were told to suppress their
thoughts and on days without instructions to suppress their
thoughts.
 They reported twice as many intrusive thoughts when they tried
to suppress them.

25.  Researches suggest that thought suppressions leads to
more general increase in obsessive compulsive symptoms
just beyond the frequency of obsessions.
 Naturalistic study of people with OCD.

26.  Salkovskis ,Rachman and other cognitive theorists have
distinguished between intrusive thoughts and negative
automatic thoughts and catastrophic appraisal that people have
about experiencing such thoughts.

27.  People with OCD often seems to have an inflated sense of
responsibility.
 This sense of inflated responsibility for the harm they may
cause adds to the “perceived awe fullness of any harmful
consequences and may motivate compulsive behaviors like
washing and checking to reduce the likelihood of the
event.
 Differentiate them from normal people with obsessions
and from the people who have OCD.

29.  The irrational assumption that just because a “bad”
thought presents itself to your mind, then it is undeniably
followed or accompanied by a specific “bad” action. In
other words, thinking something makes it so.
 For some, this fusion is so strong that they believe that
their thoughts actually cause actions to occur.

30.  Attention is drawn to disturbing materials like in
anxiety disorder.
 Suppression of thoughts.
 Have difficulty in blocking out negative and
irrelevant information.

31.  Have low confidence in their memory.

33.  Genetics:
OCD often seems to "run in the family." In fact, almost
half of all cases show a familial pattern. Research studies
report that parents, siblings and children of a person with
OCD have a greater chance of developing OCD than does
someone with no family history of the disorder.

34.  If OCD is "taught" by one family member to another. If this
were the case, though, why do individual family members often
have very different symptoms of OCD?

35. OCD is caused by damage to a specific part of the
brain called the “basal ganglia”

36.  Basal ganglia are strongly inter linked at amygdale to the
limbic system.
 The basal ganglia are associated with a variety of functions
including: control of voluntary motor movements,
procedural learning, routine behaviors or "habits" such as,
eye movements, cognition and emotion

37.  Scientists proposed that any
damage to the basal ganglia might
result in the OCD symptoms.
 The significance of identifying
the basal ganglia is that it shows
that physical damage to a brain
structure results in a
neuropsychological
(mental/emotional) condition.

38.  Researchers learned that two brain structures that communicate
with the basal ganglia are more active in patients with OCD.
 These two structures are known as the orbitofrontal cortex (OFC)
and the anterior cingulate gyrus (ACG).
 Specifically, people with OCD show abnormal activity in
different parts of this circuit including the orbital frontal cortex,
cingulated cortex and caudate nucleus of the basal ganglia.

39.  Modern brain imaging techniques have allowed
researchers to study the activity of specific areas of the
brain. Such studies have shown that people with OCD
have more than usual activity in three areas of the
brain. These are:

40.  This area of the brain acts as a filter for thoughts
coming in from other areas. The caudate nucleus is also
considered to be important in managing habitual and
repetitive behaviors.

41.  The level of activity in the prefrontal orbital cortex is
believed to affect appropriate social behavior.
 Lowered activity or damage in this region is linked to
feeling uninhibited, making bad judgments and feeling a
lack of guilt.
 More activity may therefore cause more worry about social
concerns.

42.  The cingulate gyrus is believed to
contribute the emotional response to
obsessive thoughts. This area of the
brain tells you to perform
compulsions to relieve anxiety.
 This region is highly interconnected
to the prefrontal orbital cortex and
the basal ganglia via a number of
brain cell pathways.

43.  After using the washroom,
you may begin to wash your
hands to remove any harmful
germs you may have
encountered.
 While having a lunch
 Writing something
repeatedly,

44. There are certain cortical and subcortical structures that
are involved in behavior patterns forming a circuit have
abnormally high levels of activity.
The cortico-basal ganglionic thalamic circuit is
normally involved in the preparation of complex sets of
interrelated behavioral responses used in specific
situations like social concerns.
• the primitive urges
regarding sex,
aggression, hygiene
concerns and danger
comes from here
( stuff of obsessions)
Orbital Frontal Cortex
Caudate Nucleus/
Corpus Striatum
• Urges are filtered
here
• Ordinarily filtered
urges are travel
through the circuit
allowing only strong
one to pass onto
thalamus.
Thalamus

45. Theories regarding dysfunction in cortico basal ganglionic thalamus
circuit
BAXTER AND COLLEGUES:
When this circuit is not functioning properly, inappropriate behavioral
responses may occur, including repeated sets of behavior e.g. checking
and cleaning.
-Over activation of the orbital frontal
cortex that combines with a
dysfunctional interaction among the
o Orbital frontal cortex
o Corpus striatum or caudate nucleus
o thalamus The Cortico-striatal-thalamo-cortical
loop is a major site of synaptic
dysfunction

46. • Prevents people with OCD from showing normal
inhibition of sensations, behaviors and thoughts that
would occur if the circuits were functioning
properly.
• The impulses towards aggression sex hygiene and
danger leak through as obsessions and distract
people with OCD from goal oriented behavior
• White matter abnormality
Fear of contamination
Checking (hygiene)

47. Increased activity of serotonin and increased sensitivity of certain brain
structures are involved in OCD symptoms. The drugs that causes a down
regulation of certain serotonin receptors further causing functional decrease in
the availability of serotonin.
• Anafranil (clomipramine) : a tricyclic drug effective in OCD treatment.
Research shows this is because clomipramine has greater effects on the
neurotransmitter SEROTONIN which is strongly implicated in OCD.
• FLUXOERINE (Prozac): an antidepressant drug that has relatively selective
effects on serotonin.
Other neurotransmitters that effect the activity of brain structures related to
OCD are GABA ,GLUTAMATE, dopamine but their role is not yet understood.

48. Treatments For OCD
Medications
Behavioral And Cognitive
Behavioral Treatments

49. A behavioral treatment that combines exposure
and response preventions seems to be the most
effective approach to treat OCD.
 Expose themselves repeatedly to the stimuli
that will provoke their obsessions.
 Following each exposure they are asked not to
engage in the rituals that they ordinarily would
engage to reduce anxiety or distress provoked
by their obsession.

52. BODY DYSMORPHIC DISORDER (BDD), also known
as body dysmorphia or dysmorphic
syndrome (originally dysmorphophobia), is mental illness that
involves belief that one's own appearance is unusually
defective (worthy of hiding or fixing), while one's thoughts
about it are pervasive and intrusive (at least one hour per day)

53.  Severe, the distress of BDD worsens quality of life by
impairing social, occupational, and academic functioning, and
yields social isolation.
 BDD usually involves suicidal ideation and often involves
suicide attempts. BDD is common among psychiatric patients,
whose BDD often remains unrecognized.

54.  People experiencing BDD wish to change or improve some
aspect of their physical appearance—usually hair, nose, skin,
or, particularly in men, body size or musculature
 Relatively common, found in about 1% to 2% of the general
population, BDD is about equally prevalent in women and
men.

55.  Often misdiagnosed, BDD is often thought to be merely major
depressive disorder or social phobia.
 BDD might involve delusions of reference, whereby one
believes, for instance, that passersby are pointing at the flaw.

56. Epidemiology
 Population studies suggest a point prevalence rate of 0.72-
2.4%.International studies suggest that 6-15% of patients
attending cosmetic surgery and dermatology clinics are
estimated to have body dysmorphic disorder (BDD)

57. RESEARCH:
 Neuroimaging suggest weaker connection between
the amygdala and the orbitofrontal cortex (involved in
regulation of emotional arousal).In a cognitive-behavioral
model, BDD arises through interaction of personality factors,
such as introversion and self-consciousness, with early
childhood experiences and social learning. As a group, BDD
cases report high incidence of emotional abuse during
childhood

58. Relationship of OCD and BDD
• People with BDD have prominent obsession such as
reassurance seeking, mirror checking, compare
themselves to others.
• The same neurotransmitter (Serotonin) and the same
set of brain structures are implicated in the two
disorders, and the same kinds of treatment that work
for OCD are also the treatment of choice for BDD.

59. • Western culture has become increasingly focused on “Looks
as every thing” with billions of dollars spent each year on
enhancing appearance through makeup,clothes,plastic surgery
and other means.
• A second reason BDD has been understudied is the most
people with this condition never speak psychological or
psychiatrist treatment.

60. • Part of the reason why people are now seeking treatment is that
starting in the past 15 years the disorder has received a good deal of
media attention.
• It has even been discussed on some daily talk shows, where it is
sometime called “imaginary defect disorder”

61.  Recent Twin Study by Monzani et al(2012)
 Finding:
 Physical appearance as a heritable trait
 Secondly Body Dysmorphic Disorder occurring in
sociocultural context
 Self Schemas:
 MY APPEARANCE IS
 DEFECTIVE

62.  POSSIBILITIES:
Reinforcement V/S Criticism for appearance(Neziroglu et
al 2004)
Empirical evidence tells that BDD patients show baised
attention and interpretation of information relating to
attractiveness( Buhlmann and Wilhelm 2004)

63.  They attend to words like ugly or beautiful more as compared
to other emotional words which are not related to appearance
 Secondly, BDD patients interpret facial expressions as
contemptuous or angry.

64. STUDY DONE ON BDD INDIVIDUALS BY DIDIE ET AL, 2006
Emotional
neglect/abuse
56 to 68%
Physical/Sexual
Abuse/physical
neglect
Approximately
30%
RESULTS:

65.  Studies done by using fmri technology
 One more study by Feusner et al., 2010, 2011
 BDD patients show deficits on task which measures
executive functioning for e.g. manipulating information,
planning and organization which are monitored by prefrontal
brain regions.

66.  SSRI anti depressants like paroxetine and sertraline.
 Cognitive behavioral therapy

68.  Ac qui r e d
 A Re l a t i ve Wi t h
Hoa r di ng I n
Sur r oundi ngs
 Suf f e r e d A Tr a uma Or
Los s
 I nhe r i t ed
 Ge ne t i c Re s e a r c he s
I ndi c a t e Of A Uni que
Pa t t e r n Of
Chr omos ome 14
Wi t hi n Fami l i e s Of
Hoa r di ng Vs Non -
hoa r di ng Re l a t i ve s Of
OCD

69.  De c r e a s e d Cogni t i ve Pr oc e s s Ef f e c t i ng
Ps yc hol ogi c a l Thought Pr oc e s s
 La ck In At t ent i on
 La c k In Memor y
 La c k In De c i s i on Ma ki ng
 La c k In Ca t e gor i z ing Pos s e s s i ons ,

70. Re s e a r c h e r s Br a i n Re g i o n s Ac t i v a t i o n F u n c t i o n
S a n j a y a
S a x e n a
An t e r i o r
Ci n g u l a t e
Co r t e x (ACC)
I n c r e a s e d
Ac t i v a t i o n
L i n k e d To Ri s k
As s e s sme n t ,
Imp o r t a n c e Of
S t imu l i An d
Emo t i o n a l
De c i s i o n s .
Da v i d Ma t a i x -
c o l s
L e f t P r e c e n t r a l
Gy r u s An d
Ri g h t
Or b i t o f r o n t a l
Co r t e x
I n c r e a s e d
Ac t i v a t i o n
De c i s i o n -
ma k i n g ,
R ewa r d
P r o c e s s i n g ,
An d I n h i b i t i o n
An n E t Al . Ve n t r ome d i a l
P r e f r o n t a l
Co r t e x
(VMP FC)
I n c r e a s e d
Ac t i v a t i o n
De c i s i o n
Ma k i n g
To l i n An d
Ki e h l
L e f t L a t e r a l
Or b i t o f r o n t a l
Co r t e x (OFC)
I n c r e a s e d
Ac t i v a t i o n
De c i s i o n -
ma k i n g An d
E x p e c t a t i o n

72.  P SYCHOLOGICAL FACTORS
 To Re d u c e At t r a c t i v e n e s s Be c a u s e Of P s y c h o s e x u a l
Co n f l i c t s
 A Ma l a d a p t i v e Co p i n g Me c h a n i sm
 SOCIAL FACTORS :
 Re p r e s s e d Ra g e Of Ch i l d r e n Ag a i n s t Au t h o r i t a r i a n
P a r e n t s .
NEUROIMAGING F INDINGS
Imp a i r e d Mo t o r I n h i b i t o r y
Co n t r o l - F r o n t o s t r i a t a l Ci r c u i t .
Ci r c u i t I s I n v o l v e d I n Th e
S u p p r e s s i o n Of I n a p p r o p r i a t e
Be h a v i o r s

74.  F a c t # 1 No rma l a n d a d a p t i v e s y s t em o f b o d y
i n d i c a t i n g d a n g e r
 F a c t # 2 C o n s i d e r e d a p ro b l em i f i n d i c a t i n g d a n g e r
wh e n t h e r e i s n o n e .
 L e a r n t h a t wo r r i e s , f e a r a n d p h y s i c a l f e e l i n g s h a v e
a n ame a n x i e t y.

75. Un h e l p f u l me a n i n g t o Ob s e s s i o n s
 T h o u g h t - a c t i o n f u s i o n
 I n f l a t e d r e s p o n s i b i l i t y.
 Me n t a l c o n t r o l f a i l u r e .
 Pe r f e c t i o n i sm.
 I n t o l e r a n c e o f u n c e r t a i n t y.

76. • Build a fear ladder
• Climbing The Fear Ladder – Exposure &
Response Prevention

77.  T O T H E O C D ’ S
 TAKE THAT FIRST STEP!