Brain Structure And Functioning
Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but such a connection is not clear. Some people with OCD have areas of unusually high activity in their brain, or low levels of the chemical serotonin, which is a neurotransmitter that some nerve cells use to communicate with each other, and is thought to be involved in regulating many functions, influencing emotions, mood, memory, and sleep.
What Is Major Depression
The Diagnostic and Statistical Manual of Mental Disorders IV classifies MDD as a mood disorder, which relates to disorders that exhibit extreme ranges in mood. In MDD, mood extremes can include a loss of energy, sadness, anhedonia , thoughts of suicide, and a general impairment of sleep, concentration, attentiveness, or decision making. MDD diagnosis requires a major depressive episode , defined as a discrete and pervasive period of these symptoms however, heterogeneity exists in the context in which MDEs occur, and the specific symptoms inherent in each may differ, suggesting that considerable heterogeneity may exist in the underlying architecture of the DSM-IV classification of MDD. For example, up until puberty the rates of MDD are relatively equivalent between males and females, after which rates for females double or triple . Postpartum depression is a specific class of female-specific mood disorder where MDE occurs within 4 weeks of giving birth. The onset of MDD after the age of 50 to 60 has been termed late-life depression . These separate classes of depression may share common genetic and environmental foundations to confer risk, but they may also have distinct etiologies resulting in their different presentation. Where applicable throughout the chapter, evidence to this effect will be highlighted.
Differentiating Symptoms Of Ocd From Those Of Other Disorders
It is important to distinguish the absent insight and delusional beliefs of OCD from the delusions present in psychotic disorders, as OCD may closely resemble psychosis. The major feature distinguishing the absent insight/delusional beliefs of OCD from schizophrenia is that the OCD compulsion is performed in an effort to reduce anxiety provoked by a thought, image, or impulse. The presence of hallucinations, disorganized speech, and affective flattening should alert the clinician to the likelihood of schizophrenia rather than OCD. In addition, although patients with OCD may have difficulty fully verbalizing the phenomenology of their obsessions and compulsions, disorganized speech will not be present. There is some co-occurrence of OCD and schizophrenia, with one study estimating that approximately 12% of patients with schizophrenia have comorbid OCD .
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Integrating Neuropsychological Models With Treatment Models
Based on these and other emerging findings, it is possible to draw inferences about the neuropsychological mechanisms underpinning the response to standard treatments in disorders such as OCD . Increased stress is known to induce a tendency to form habits . It has therefore been suggested that SSRIs may act in OCD by restraining anxiety and reducing the effects of punishment, thereby helping the OCD patient to switch from habitual towards goal-directed behavior and indirectly attenuating the need to perform compulsions . This effect of SSRI could also enhance the capacity to benefit from CBT with ERP . The finding from a non-randomized study that goal-directed learning under both reward and punishment conditions was enhanced in OCD patients receiving SSRI provides some support for this hypothesis. Further support is derived from more recent findings in healthy volunteers that acute tryptophan depletion, which reduces serotonin transmission, induced a shift from goal-directed to habitual responding on a slips-of-action test and also had a deleterious effect on model-based learning .
Insight And Overvalued Ideation
The DSM-5 identifies a continuum for the level of insight in OCD, ranging from good insight to no insight . Good or fair insight is characterized by the acknowledgment that obsessivecompulsive beliefs are not or may not be true, while poor insight, in the middle of the continuum, is characterized by the belief that obsessivecompulsive beliefs are probably true. The absence of insight altogether, in which the individual is completely convinced that their beliefs are true, is also identified as a delusional thought pattern, and occurs in about 4% of people with OCD. When cases of OCD with no insight become severe, affected individuals have an unshakable belief in the reality of their delusions, which can make their cases difficult to differentiate from psychotic disorders.
Historically, OVI has been thought to be linked to poorer treatment outcome in patients with OCD, but it is currently considered a poor indicator of prognosis. The Overvalued Ideas Scale has been developed as a reliable quantitative method of measuring levels of OVI in patients with OCD, and research has suggested that overvalued ideas are more stable for those with more extreme OVIS scores.
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Symptoms And Treatment For Obsessive
Obsessive-compulsive personality disorder is not the same as obsessive compulsive disorder . This illness is characterized by a preoccupation with organization, perfectionism, and controlboth mental and interpersonalat the expense of flexibility and efficiency, while OCD is characterized by obsessions and compulsions.
Individuals who suffer from obsessive-compulsive personality disorder seek to uphold a feeling of control through their meticulous attention to rules, details, procedures, instructions, schedules, or lists and to an extent where the activity becomes pointless. They are very careful in all of their actions and are always checking for possible mistakes. These individuals often dont realize that these tendencies affect others to the point of inconveniencing them and/or annoying them. For example, when someone with obsessive-compulsive personality disorder loses an important list detailing objectives for the day, he or she will spend an excessive amount of time trying to find it instead of taking a moment to simply recreate the list and begin tackling the tasks. This can result in missed deadlines, which affect business partners and coworkers.
Symmetry Obsessions With Ordering Arranging And Counting Compulsions
When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are “just right.” For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color.
This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example, you might think, “If I arrange my desk perfectly, my husband wont die in a car accident.” However, this is not always the case.
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Ocd And Associated Comorbidities
In their lifetime, 90% of people with OCD meet criteria for at least one other psychiatric diagnosis, which means those with OCD should be monitored for comorbidities and suicide risk. The most common comorbid diagnoses are:
Anxiety disorders, including panic disorder, social phobia, specific phobias, and posttraumatic stress disorder
Mood disorders, particularly major depressive disorder
Impulse control disorders
Substance use disorders
The risk of suicide in persons with OCD is significant. In one community survey, 63% of those with the disorder had experienced suicidal thoughts, and 26% had attempted suicide.
Also important to keep in mind are conditions that may be misdiagnosed as OCD. These include:
Ocd Symptoms And Misconceptions
The most prevailing misconception about OCD is that the only symptom is obsessive cleanliness or arrangement of objects. While such actions may be a sign of OCD, there are others as well.
Here are common obsessions and their associated compulsive behaviors:
Aggression: Watching news reports or shows about violent crimes, asking for reassurance about being a good person
Contamination: Washing and cleaning rituals related to germs but also concerned about being “contaminated” by immoral people
Doubt: Fear of doing things incorrectly leads to performing actions repeatedly, and in a specific order
Immorality or excessive religion fixation: Constantly praying, talking about religion, asking for forgiveness, anxiety about the afterlife
Self-control: Due to fear of making inappropriate comments or actions in public creates avoidance of social situations.
Sexual: Avoids situations that trigger sexual thoughts, particularly around sexual deviation or acting sexually inappropriate
Superstition: Counting excessively, avoiding certain numbers or colors.
Symmetry: Ordering items in a balanced or exact way
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What Are The Symptoms Of Obsessive
The symptoms of OCD are obsessions and compulsions that interfere with normal activities. For example, symptoms may often prevent you from getting to work on time. Or you may have trouble getting ready for bed in a reasonable amount of time. A person with OCD may know they have a problem but cant stop.
Disorders Of Compulsivity: A Common Bias Toward Learning Habits
tested a trans-diagnostic group of subjects with diagnoses involving both natural reward , artificial reward , and OCD and compared them with healthy controls. The results showed a common bias across all these disorders away from model-based learning. In addition, the habit formation bias was associated with lower grey matter volumes in the caudate and medial orbitofrontal cortex on structural MRI.
The findings suggested that dysfunction in a neurocomputational mechanism favoring model-free habit learning may underlie the repetitive behaviors that ultimately dominate in diverse disorders involving compulsion. In a further study that compared performance on the two-step task under conditions of reward and loss, OCD subjects compared with healthy volunteers were less goal orientated and more habitual to reward outcomes with a shift towards greater model-based and lower habitual choices to loss outcomes. These results highlight the importance of motivation for learning processes in OCD and suggest that distinct clinical strategies based on reward valence may be warranted.
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Who Is At Risk Of Developing Obsessive
As previously mentioned, making an obsessive-compulsive personality disorder diagnosis can be quite tricky. Clinicians should not only discount a small degree of perfectionism but also behaviors that reflect customs, habits, and styles that may be attributed to the individuals culture, as certain cultures place greater emphasis on work and productivity. Additionally, a few other disorder possibilities should be considered and assessed, such as obsessive-compulsive disorder, hoarding disorder, and other personality disorders, which all share certain symptoms and/or characteristics.
When it comes to sex, it appears that obsessive-compulsive personality disorder is diagnosed about twice as often among males. So, other than males possibly having a higher risk of developing obsessive-compulsive personality disorder, there are not any additional risk factors for this mental illness.
When Should I Talk To My Healthcare Provider About Obsessive
Talk to your healthcare provider if you have obsessions or compulsions. Make sure to mention:
- How often you have symptoms.
- How long they last.
- Whether they make you late for work or social activities.
- Whether you avoid social situations because of anxiety.
- Whether you are using drugs or alcohol to cope.
- Be honest with your healthcare provider about how the symptoms influence your life. Treatments are more effective when your provider understands how the condition affects you.
A note from Cleveland Clinic
OCD doesnt go away by itself, so talk to your healthcare provider about your symptoms. Be honest about any obsessions and compulsions and how theyre affecting your life. CBT and medications can help control your symptoms, so you can work, enjoy social activities and feel more productive.
Last reviewed by a Cleveland Clinic medical professional on 12/31/2020.
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Other Disorders And Conditions
A diagnosis of OCPD is common with anxiety disorders, substance use disorders, and mood disorders. OCPD is also highly comorbid with Cluster Apersonality disorders,especially paranoid and schizotypal personality disorders.
OCPD is also linked to hypochondriasis, with some studies estimating a rate of co-occurrence as high as 55.7%.
Moreover, OCPD has been found to be very common among some medical conditions, including Parkinson’s disease and the hypermobile subtype of Ehler-Danlos syndrome. The latter may be explained by the need for control that arises from musculoskeletal problems and the associated features that arise early in life, whilst the former can be explained by dysfunctions in the fronto-basal ganglia circuitry.
Ocd Refractory To Initial Pharmacological Management
The APA practice guidelines provide additional treatment strategies based on the response to the initial medication trial. For those with moderate response, defined as a clinically significant, but inadequate, response after a 12-week trial of the initial medication, augmentation with a second-generation antipsychotic drug is recommended. This recommendation is supported by meta-analytic data , and approximately one-third to one-half of patients will respond to this augmentation strategy . It is recommended that the length of a trial of augmentation with an atypical antipsychotic drug be in the range of 28 weeks.
Currently, insufficient data are available to determine which member of this class of medications possesses superior efficacy, although at least one randomized controlled trial has shown efficacy for haloperidol, risperidone, quetiapine, olanzapine, and aripiprazole . No RCTs exist that have examined the efficacy of ziprasidone. Of the newer atypical antipsychotic drugs asenapine, lurasidone, iloperidone, and paliperidone, only paliperidone has been examined in a double-blind, placebo-controlled trial, with a nonsignificant trend toward improvement in OCD symptoms .
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Symptoms Of Ocd Subtypes
Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.
The five main subtypes of OCD are:
Obsessive Compulsive And Related Disorders: Comparing Dsm
Published online by Cambridge University Press: 12 July 2016
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Naomi Fineberg
- Affiliation:Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UKDepartment of Postgraduate Medicine, University of Hertfordshire, Hatfield, UKDepartment of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
- Stefano Pallanti*
- Affiliation:Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, ItalyDepartment of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, California, USADepartment of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
- *Address for correspondence: Stefano Pallanti, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Via delle Gore 2H, 50134 Firenze, Italy.
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What Are The Specifications For A Dsm
Listed below are the specifications for a DSM-V diagnosis:
- Your obsessions or compulsions must be laborious or trigger significant emotional distress or psychological impairment in your personal, social, or work lives, cause problems in your relationships, and/or disrupt your daily functioning. Drugs, alcohol or an unrelated health condition must not contribute to your OCD symptoms
- Your symptoms cannot be explained by another mental disorder like:
- Unwarranted worries )
- Cyclical patterns of behavior
Harm Obsessions With Checking Compulsions
If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others. You use checking rituals to relieve your distress.
For example, you might imagine your house burning down and then repeatedly drive by your house to make sure that there is no fire. Or, you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.
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Diagnostic And Statistical Manual Of Mental Disorders And Ocd
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides clinicians with official definitions of, and criteria for, diagnosing mental disorders.
There have been six revisions since it was first published in 1952, the last major revision was DSM-5, published in May 2013, superseding DSM-IV, which was published in 1994 and revised in 2000.
Significantly, in DSM-5 there was a significant and controversial change to where OCD was listed. The previous edition of the DSM categorised Obsessive-Compulsive-Disorder under Anxiety Disorders. However, some experts controversially suggested that the revised edition of the DSM remove OCD from this category and group it with loosely related conditions under the heading of Obsessive-Compulsive and Related Disorders, which is what they did indeed do for DSM-5.
For this reason, the question of where OCD should be located in the diagnostic system has been met with some controversy and received attention and generated debate.
On this page we will try and summarise what the DSM manual says about OCD and under which category they list it.
DSM-5 CategorisationObsessive-Compulsive and Related Disorders
In the preceding chapter about Obsessive-Compulsive and Related Disorders the DSM-5 makes the following comments before its formal clinical classification:
What Causes Obsessive
Scientists dont understand exactly what causes OCD. Certain factors or events may increase a persons chances of developing the condition, or cause an episode of OCD:
- Changes in living situation, such as moving, getting married or divorced, or starting a new school or job.
- Death of a loved one or other emotional trauma.
- History of abuse.
- Low levels of serotonin, a natural substance in the brain that maintains mental balance.
- Overactivity in areas the brain.
- Problems at work or school.
- Problems with an important relationship.
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How Is Ocd Diagnosed
There is no medical test for diagnosing OCD. Generally, a healthcare provider makes the diagnosis after asking you questions touching on the symptoms you have been experiencing.
The provider will use a criterion outlined in the Diagnostic Statistical Manual of Mental Disorders, 5th Edition, DSM 5.
While most of us tend to use the terms obsessed,obsessing, and OCD so casually in our daily conversations, OCD is diagnosed based on specific factors under DSM 5. For one to be diagnosed with OCD, they must fulfill the following conditions:
- You have obsessions, compulsions, or both.
- Your obsessions or compulsions cause emotional distress, discomfort and affect your participation in work responsibilities, social activities, or other life events.
- Your obsessions/compulsions take up a lot of your time.
- The symptoms are not caused by drugs, alcohol, another medical condition, or medications.
- The symptoms arent explained by another mental health disorder such as eating disorder or generalized anxiety disorder.