Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) is characterized by obsessions (intrusive or unwanted thoughts) and/or compulsions (behaviors that aim to rid oneself of the obsessions and/or decrease distress). Disorders related to OCD include:
Obsessive compulsive disorder (OCD) is characterized by obsessions (intrusive or unwanted thoughts) and/or compulsions (behaviors that aim to rid oneself of the obsessions and/or decrease distress). Disorders related to OCD include:
- Tic Disorders, including Tourette Syndrome
- Some Impulse Control Disorders
- Body-focused Repetitive Behaviors, including trichotillomania and dermotillomania (excoriation disorder)
- Hoarding Disorder
- PANDAS/PANS
- Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD)*
Body Dysmorphic Disorder involves persistent and intrusive thoughts regarding a perceived or small imperfection or flaw with one’s body. It can involve any of the various body parts, and affects approximately 1.7-2.4% of the population. BDD typically develops in adolescents and teenagers and affects men and women equally. The DSM-V categorizes BDD as an obsessive compulsive and related disorder. Treatment for BDD can include cognitive behavioral therapy and antidepressants including selective serotonin reuptake inhibitors.
Diagnostic Criteria
Preoccupation with appearance:
Preoccupation with one or more perceived defects in physical appearance that others cannot see or appear to be slight
Repetitive behaviors or mental acts:
In response to worry about appearance, individual has performed repetitive behaviors or mental acts.
Repetitive behaviors may include excessive grooming, checking mirror, skin seeking, reassurance seeking or changing clothing.
Mental acts may include comparing physical appearance to others.
Preoccupation must cause clinically significant distress or impairment in social, occupational or other areas of functioning and must not be able to be better explained by an eating disorder. Individual must not meet criteria for an eating disorder.
Specifying Subgroups include the following:
Muscle dysmorphia:
Preoccupation that body is not muscular enough. Individuals may also be preoccupied with other areas of the body and still have this specifier.
Insight:
Degree of insight individual has about their dysmorphic disorder beliefs. Good or fair insight describes individuals who understand their beliefs are either not true or they may not be true; poor insight describes individuals who think their beliefs are probably true; absent insight/delusional beliefs describe individuals who are completely convinced their beliefs are true.
Differential Diagnoses include: Obsessive compulsive disorder, eating disorder, social anxiety disorder, major depressive disorder, excoriation disorder, and generalized anxiety disorder.
Body Dysmorphic Disorder involves persistent and intrusive thoughts regarding a perceived or small imperfection or flaw with one’s body. It can involve any of the various body parts, and affects approximately 1.7-2.4% of the population. BDD typically develops in adolescents and teenagers and affects men and women equally. The DSM-V categorizes BDD as an obsessive compulsive and related disorder. Treatment for BDD can include cognitive behavioral therapy and antidepressants including selective serotonin reuptake inhibitors.
Diagnostic Criteria
Preoccupation with appearance:
Preoccupation with one or more perceived defects in physical appearance that others cannot see or appear to be slight
Repetitive behaviors or mental acts:
In response to worry about appearance, individual has performed repetitive behaviors or mental acts.
Repetitive behaviors may include excessive grooming, checking mirror, skin seeking, reassurance seeking or changing clothing.
Mental acts may include comparing physical appearance to others.
Preoccupation must cause clinically significant distress or impairment in social, occupational or other areas of functioning and must not be able to be better explained by an eating disorder. Individual must not meet criteria for an eating disorder.
Specifying Subgroups include the following:
Muscle dysmorphia:
Preoccupation that body is not muscular enough. Individuals may also be preoccupied with other areas of the body and still have this specifier.
Insight:
Degree of insight individual has about their dysmorphic disorder beliefs. Good or fair insight describes individuals who understand their beliefs are either not true or they may not be true; poor insight describes individuals who think their beliefs are probably true; absent insight/delusional beliefs describe individuals who are completely convinced their beliefs are true.
Differential Diagnoses include: Obsessive compulsive disorder, eating disorder, social anxiety disorder, major depressive disorder, excoriation disorder, and generalized anxiety disorder.
Trichotillomania**
Trichotillomania is characterized in the DSM-V as a stereotypic movement disorder (SMD) that involves recurrent, irresistible urges to pull out hair from one's scalp, eyebrows or other areas of the body. The recurrent hair-pulling results in noticeable hair loss and is associated with clinically significant distress or impairment. The disorder impacts approximately 0.6% of the population, with an average age of onset of 13.1 years. There is a female predominance. Family history is thought to be a risk factor. Trichotillomania is often comorbid with anxiety, mood disorders, and obsessive-compulsive disorder.
DSM-V Criteria (these are criteria for OCD, as this body-focused disorder falls under these criteria):
DSM-V Criteria (these are criteria for OCD, as this body-focused disorder falls under these criteria):
- Presence of obsessions, compulsions, or both
- 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
- 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
- The disturbance is not better explained by the symptoms of another psychiatric disorder
Assessment & Screening Tools
OCD
Tics/Tourette's
Body Dysmorphic Disorder
Trichotillomania
PANDAS/PANS
Hoarding Disorder
- Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
- Repetitive Thoughts and Behaviors (Adapted from C-FOCI)
- Nonsuicidal Self-Injury - Severity
Tics/Tourette's
- Massachusetts General Hair-Pulling Scale Trichotillomania Scale for Children
- PUTS Scale
Body Dysmorphic Disorder
- Body Dysmorphic Disorder Questionnaire for Adolescents (BDDQ)
- Body Dysmorphic Disorder Examination (BDDE)
- Body Image Disturbance Questionnaire (BIDQ) ($, validated for use in research only)
- Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS), modified for BDD (for adolescents)
- BDD Diagnostic Module (adapted for use in pediatric population, unvalidated)
Trichotillomania
- Trichotillomania Scale for Children (see pg. 344
- The National Institute of Mental Health - Trichotillomania Impairment Scale
- Milwaukee Inventory of Subtypes of Trichotillomania (child version)
- The Hairpulling Distress and Impairment Scale
PANDAS/PANS
- Symptom Scales
Hoarding Disorder
- Structured Interview for Hoarding Disorder (Pertusa, 2013) (not validated in children/adolescents)
- Hoarding Assessment Tool (Steketee & Frost, 2007) (not validated in children/adolescents)
- Hoarding Rating Scale self report tool (Tolin, Frost & Steketee, 2010) (not validated in children/adolescents)
Position Papers & Practice Parameters
- AACAP's Practice Parameter for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder (includes section on Tic Disorders)
- National Institute for Health and Care Excellence (UK's NICE) Clinical Guidelines for BDD (2005, update pending as of 2/2019)
-
Self-inflicted Lesions in Dermatology: Terminology and Classification - A Position Paper from the European Society for Dermatology and Psychiatry (ESDaP)
- Expert Consensus Treatment Guidelines on Body-Focused Repetitive Behaviors: Hair Pulling, Skin Picking, and Related Disorders (TLC Foundation for Body-Focused Repetitive Behaviors) (2016)
Articles
- A meta-analysis of CBT and medication for child obsessive-compulsive disorder: moderators of treatment efficacy, response, and remission (McGuire, Piacentini, Lewin, et al, 2015)
- Obsessive-compulsive disorder in children and adolescents (Krebs & Heyman, 2015)
- Childhood obsessive-compulsive disorder (Sarvet, 2013)
- A review of obsessive-compulsive disorder in children and adolescents (Boileau, 2011)
- Assessment and differential diagnosis of body dysmorphic disorder (Phillips & Feusner, 2010)
- Clinical Characteristics of Pediatric Trichotillomania: Comparisons with Obsessive–Compulsive and Tic Disorders (Rozenman, et al, 2016)
- Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders (Woods & Houghton, 2015)
Resources
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Organizations
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*BDD content originally curated by Kaley Cucci, BSN, RN and Stephanie Walker, BSN, RN
**Trichotillomania content originally curated by Krista Van Baren, BSN, RN, CPN and Amber Misra, MSN, APRN, PHN, PCNS-BC
**Trichotillomania content originally curated by Krista Van Baren, BSN, RN, CPN and Amber Misra, MSN, APRN, PHN, PCNS-BC