In this video I describe some symptoms and prevalence of several disorders in the Obsessive-Compulsive Related Disorders category of the DSM-5. These include Obsessive-Compulsive Disorder (OCD), Hoarding Disorder, and Body Dysmorphic Disorder. Please note that the symptoms described in this video are not comprehensive and there are other symptoms involved in diagnosis for each of these disorders.
Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of obsessive-compulsive and related disorders in the DSM-5 and so we’ll start with obsessive-compulsive disorder. Obsessive-compulsive disorder or OCD has two main characteristic symptoms and these are obsessions and compulsions. So obsessions refers to recurrent unwanted and intrusive thoughts that the patient keeps having and compulsions refers to repetitive behaviors that the patient keeps engaging in. So the obsessions that are common in OCD are thoughts related to contamination, like feeling that one’s hands are contaminated and need to be cleaned, or fears about harming others that if, if the person doesn’t do something then loved ones will be harmed or even killed, or thoughts related to the need for symmetry and balance.
The estimated prevalence in the DSM-5 for OCD is about 2% and it’s roughly equal for males and females and it’s often comorbid with depression. Now another part of OCD is that the patients who suffer from this often know that their compulsions are irrational. So they know that they’ve just washed their hands recently and rationally they shouldn’t need to wash their hands again or they know that turning a light switch on you know a set number of times, like maybe they always turn the switch four or five times, they may rationally know that of course that shouldn’t do anything, that shouldn’t matter, that might not protect their loved ones from harm or something, but they still engage in this behavior, right? They feel that they don’t have full control over this. And so one way we could think about this is to imagine a thought that you may have had before that your hands are contaminated.
This is something we’ve all experienced before; you touched something that you know is dirty or that might have something on it that you don’t want on your hands and so you have this little bit of anxiety that comes along with that, that you need to wash your hands. You’ve touched something disgusting or maybe you’ve been handling raw meat or something, you think “I really need to wash my hands” and so there’s a little bit of anxiety until you wash your hands. And that’s normal, we all experience that. But then could imagine that you wash your hands and very soon after you’ve washed your hands that thought comes back; that your hands are still contaminated, that maybe you didn’t do a good job cleaning them or maybe, maybe they’re actually contaminated again. And you might rationally know that that’s not the case but you might still feel some anxiety related to that. Maybe, you know what, maybe if I if I wash my hands again, I’ll feel better, right? It will reduce the anxiety and this is sort of what it’s like for somebody who’s suffering from OCD. They might rationally know that this behavior isn’t needed but it reduces their anxiety when they engage in the compulsive behavior and so they’ll wash their hands again or they’ll maybe wash their hands with, with hotter water or use more soap or or maybe use a stronger sort of cleansing material to wash their hands. And what happens is they keep having this anxiety come back.
Similarly we all have some experience of, you know, wondering whether we left the iron on or the oven on when we’re out, you know? We think “did I leave that on?” and this causes a little bit of anxiety. And you know maybe we check, you know, you’re on your way out the door and you think “I should probably check the oven”, maybe “I need to unplug the curling iron” or something that might be dangerous and you check and then you could imagine just as you left if that thought came back. You know, “well I know I just checked but did I turn it off or maybe I accidentally turned it back on” right? And that might cause even more anxiety and so you could see how it’s possible for somebody to get stuck in these sort of loops where they’re feeling anxiety related to this obsessive thought and they’re not really feeling in control of the thought, it’s intrusive right? It keeps coming back to them even though they actually know that they just did something that should take care of it. And I hope that gives you a little bit more insight into what it’s like to suffer from this disorder.
Okay, so let’s look at another disorder in this category and this is hoarding disorder. This is another disorder like OCD that did get some exposure in popular media you may have heard of this or seen TV shows showing people with hoarding disorder. And this used to be considered a type of obsessive compulsive disorder in the DSM-IV, but in the DSM-5 it was now given its own disorder of label. So it’s not considered to be a type of OCD anymore and this refers to a difficulty parting with personal possessions, even if they’re worthless. So somebody is hoarding lots of items they experienced a great deal of anxiety or stress in trying to part with those items.
Now it’s important to note that this difficulty in parting with possessions is not due to obsessive thoughts, it’s not due to brain injury, or autism, or a lack of energy. So if somebody feels they just don’t have the energy to, you know, clean out the attic or something or or clean out their living space then that wouldn’t necessarily be considered to be a hoarding disorder. Okay so often this accumulation of things, this clutter, impairs the person’s ability to function socially or even occupationally and it also can create an unsafe living environment. And so it represents a bit of danger to the patient in some cases.
Now in most cases about 80 to 90% of people who have hoarding disorder show what’s called excessive acquisition, that means that they will acquire things that they do not have space for that they cannot possibly fit into their home. So often there will be a very little space where they’re living and just, you know, packed to the ceiling with with piles of things that they just can’t bring themselves to give away. It causes a great deal of anxiety to them try to part with these possessions.
Another type of hoarding disorder that is seen is animal hoarding and this is where people will take in pets that they cannot possibly care for, that they can’t provide minimal standards of nutrition and care and grooming for these animals and yet they take them in. They try to take these animals as pets.
Now the estimated prevalence for hoarding disorder is about 2 to 6% and it’s also roughly equal between males and females, although it’s much more common in older populations. So it’s 3 times more common and people in the age range of 55 to 94 and in 75% of cases of hoarding disorder we see that it’s comorbid with a mood disorder like depression or an anxiety disorder.
Ok so the last disorder that we’ll look at in the obsessive-compulsive and related disorders category is called body dysmorphic disorder and this was formerly known as dysmorphophobia but now it has this new label bought body dysmorphic disorder and this refers to a preoccupation with perceived flaws or defects in one’s physical appearance.
And it’s important that these flaws or defects are things that are very slight; they’re often not noticeable to others. So this is not the case where somebody actually has some disfigurement or some terrible scarring or something but they have some minor flaw. But they are preoccupied with this, they can’t stop thinking about it and so often this is in the form of skin issues like scars or wrinkles, but it can apply to other aspects of physical appearance; hair, teeth, facial features, or areas of the body, and some of these symptoms of body dysmorphic disorder include intrusive thoughts related to this perceived flaw. The person keeps thinking about this right? They have these unwanted and recurrent thoughts about this flaw and they also might have some repetitive behaviors and so these could include things like constantly checking a mirror to look at this perceived flaw and see how it looks, or repetitive grooming behaviors that are designed to maybe hide this flaw or conceal it, or constant reassurance seeking where they might repeatedly be asking friends or family or loved ones about this flaw and how it looks and, you know, is it noticeable in this condition or is it noticeable in this lighting or something like that.
And patients who receive this diagnosis also often have distorted thoughts about this perceived flaw so they might have this tendency to exaggerate or catastrophize this perceived flaw by saying that they feel that they’re deformed or, you know, in the extreme cases that you know “I’m a monster” right? “I’m hideous to look at” because of this minor flaw.
Now the estimated prevalence of body dysmorphic disorder is about 2.4% in the United States and it’s slightly more common in females than males. Now you might expect that this body dysmorphic disorder would be very common in people who are seeking cosmetic surgery but the estimate in the DSM-5 is that only about 7-8% of people who undergo cosmetic surgery actually meet the diagnostic criteria for this body dysmorphic disorder. So that suggests that many people who are seeking or have had cosmetic surgery are not going to meet the diagnosis for this body dysmorphic disorder and it’s often comorbid with major depressive disorder.
Okay so those are a few disorders in the obsessive-compulsive and related disorders category of the DSM-5. I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!
