Incompleteness and Harm Avoidance in OCD

Author(s):  
Stefano Pallanti ◽  
Jennifer Barnes ◽  
Christopher Pittenger ◽  
Jane Eisen

Obsessive-compulsive disorder (OCD) has been traditionally linked with the motivational dimension of harm avoidance (HA). However, there is increasing evidence for the involvement of a second core dimension, referred to as Incompleteness (INC) or “not just right experiences” (NJREs), in a substantial fraction of patients. INC-driven compulsions are typically driven by feelings of discomfort or tension, rather than by anxiety. Appreciation of the importance of INC in OCD is one of the factors that motivated the movement of OCD out of the Anxiety Disorders chapter and into its own grouping in the latest edition of the Diagnostic and Statistical Manual (DSM-5). Both dimensions seem to contribute to OCD symptomatology, thus representing core features underlying the disorder. In this chapter, the differential roles and neural substrates of HA and INC are discussed, together with the consequent theoretical and clinical implications.

Author(s):  
Dennis C. Daley ◽  
Antoine Douaihy

Co-occurring disorders (CODs) refers to the occurrence of both a substance use disorder (SUD) and a psychiatric disorder, such as mood disorder, anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, eating disorder, antisocial personality disorder, and borderline personality disorder. This chapter reviews the prevalence, patterns, and effects of CODs. Next, the relationships between psychiatric disorders and SUDs, challenges for practitioners, and types and causes of psychiatric disorders are discussed. The chapter continues with the process of conducting a comprehensive and thorough assessment using the format of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The authors also discuss the importance of conveying assessment findings to the client and/or family and concerned significant others, as well as getting the client to accept help.


2020 ◽  
Vol 10 (2) ◽  
pp. 44-48 ◽  
Author(s):  
Carly A. Kempf ◽  
Kimberly A. Ehrhard ◽  
Steven C. Stoner

Abstract Introduction The use of smartphones throughout the United States continues to rise. Although smartphones have increased our capacity to access information, there is concern if excessive use may impact mental health. The purpose of this study was to examine whether a relationship exists between smartphone use and the presence of obsessive-compulsive symptoms (OCS) or behaviors. Methods A 33-item online survey was developed with 19 items relating to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for obsessive-compulsive disorder (OCD). A survey response was considered positive for possible OCS if participants answered at least 3 questions as Most of the time or All of the time for the OCD-related questions structured around the DSM-5 criteria for OCD while also using their smartphone for greater than 2 or more hours per day. Results A total of 308 of 550 subjects identified spending 2 or more hours on their smartphone per day and also answered positively on 3 or more questions designed to identify OCS. A statistically significant difference was discovered between those who used their smartphone for 2 or more hours per day and those who met 3 or more positive criteria for OCS compared to those who used their smartphone less than 2 hours per day (P < .00001). Discussion The results of this study demonstrate a possible relationship between smartphone use and OCS. Additional research needs to be conducted to further investigate these results to determine their significance in clinical practice.


2018 ◽  
Vol 31 (2) ◽  
pp. e000012
Author(s):  
Balaswamy Reddy ◽  
Soumitra Das ◽  
Srinivas Guruprasad

There is some evidence consistently linking the occurrence of de novo obsessive-compulsive disorder (OCD) with clozapine. This skin-picking disorder is also known as impulsive-compulsive disorder-unspecified which with an increasing convergence with OCD has been placed in the current Diagnostic and statistical manual of mental disorders-fifth edition by American Psychiatric Association (DSM-5), in the category of the obsessive-compulsive and related disorders. To the best of our knowledge, there is no literature relating antipsychotics like clozapine with the occurrence of skin-picking behaviour. In this article, we present a case in whom skin-picking behaviour emerged during the upward dose titration of clozapine and was successfully treated with escitalopram.


CNS Spectrums ◽  
2018 ◽  
Vol 24 (04) ◽  
pp. 390-394 ◽  
Author(s):  
Verinder Sharma ◽  
Minakshi Doobay

IntroductionLamotrigine is a commonly used drug in the treatment of bipolar disorder. Although there are reports of its effectiveness in the management of bipolar disorder and comorbid obsessive-compulsive disorder (OCD), lamotrigine has also been associated with obsessionality in patients with bipolar disorder.MethodsCharts of 8 patients with bipolar disorder who had de novo onset of obsessions and compulsions after the use of lamotrigine were reviewed. The Naranjo scale was used to assess the likelihood of patients developing OCD due to lamotrigine use.ResultsTwo to 8 months after the initiation of lamotrigine, patients with no such prior history developed obsessions and compulsions meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for medication-induced OCD. In all except 1 patient, the symptoms resolved within a month of lamotrigine discontinuation.ConclusionsSome patients with bipolar disorder may develop OCD after initiation of lamotrigine. Due to the inherent limitations of a case series, the findings should be interpreted with caution.


2017 ◽  
Author(s):  
Christine Lochner ◽  
Dan Stein ◽  
Eileen Thomas

Hoarding disorder is characterized by an obsessive need to acquire, collect, or keep possessions and difficulty in organizing and discarding, resulting in accumulation of clutter, which elicits great concern from family and friends. Functioning is usually impaired in a variety of domains. Obsessive-compulsive disorder is the disorder most closely associated with hoarding. Overvalued ideation regarding the value or usefulness of possessions may make it impossible for individuals to discard items. This review contains 1 table, and 22 references. Key words: clutter, diagnostic and statistical manual, etiology, hoarding, obsessive-compulsive and related disorder


CNS Spectrums ◽  
2004 ◽  
Vol 9 (9) ◽  
pp. 14-16
Author(s):  
Teresa A. Pigott

Key Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessive-compulsive disorder (OCD) include the presence of either obsessions or compulsions, some recognition by the individual that their symptoms are excessive or irrational (except in children), duration of at least 1 hour/day, and association with marked distress or functional impairment. OCD patients report that somatic, religious, and sexual obsessions as well as those concerning contamination, aggression, symmetry, and hoarding are most common. The most frequent compulsions reported in OCD patients involve checking, cleaning, counting, repeating, and hoarding behaviors. Factor analyses of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom checklist have also identified five primary symptom dimensions: aggression/checking; contamination/cleaning; symmetry/repeating, counting, or ordering rituals; hoarding; and a sexual/religious symptom dimension.Results from a large, 2-year prospective study suggest that symptoms of adult OCD are much more stable than previously thought, with any changes more likely to occur within, rather than between the symptom dimensions. Prevalence estimates based on the Epidemiologic Catchment Area survey and the Cross-National OCD Collaborative Group study indicate a worldwide lifetime prevalence rate for OCD of 2% to 3%. Females have a slightly higher risk (1.5 times) for OCD (Slide I). OCD onset is relatively early, generally during adolescence or young adulthood. The clinical course of OCD is generally chronic and complicated by comorbidities.


Author(s):  
David Mataix-Cols ◽  
Odile A. van den Heuvel

Obsessive-compulsive disorder (OCD) shares features and often co-occurs with other anxiety disorders, as well as with other psychiatric conditions classified elsewhere in the Diagnostic and Statistical Manual (DSM-IV), the so-called “OCD spectrum disorders.” Neurobiologically, it is unclear how all these disorders relate to one another. The picture is further complicated by the clinical heterogeneity of OCD. This chapter will review the literature on the common and distinct neural correlates of OCD vis-à-vis other anxiety and “OCD spectrum” disorders. Furthermore, the question of whether partially distinct neural systems subserve the different symptom dimensions of OCD will be examined. Particular attention will be paid to hoarding, which is emerging as a distinct entity from OCD. Finally, new insights from cognitive and affective neuroscience will be reviewed before concluding with a summary and recommendations for future research.


2018 ◽  
Vol 67 (2) ◽  
pp. 135-139
Author(s):  
Liliana Silva ◽  
Pedro Morgado

RESUMO A síndrome de koro é uma síndrome psiquiátrica ligada à cultura, que se caracteriza por um episódio de ansiedade súbito e intenso relacionado com a crença de que o pênis (nas mulheres, mamilos e grandes lábios) estar a retrair-se para o interior do organismo, podendo conduzir à impotência, esterilidade e, eventualmente, morte. É mais frequente nos países do Sudoeste Asiático e no sexo masculino. No Ocidente é rara, embora existam descrições de koro-like secundárias a perturbações neurológicas, psiquiátricas ou orgânicas. No Diagnostic and Statistical Manual of Mental Disorders-5 é classificada como um “Transtorno Obsessivo-Compulsivo e transtornos relacionados com outra especificação”. Este artigo descreve um caso raro de um doente com síndrome de koro secundária a um transtorno obsessivo-compulsivo. Neste artigo, apresenta-se a descrição de um caso clínico e revisão bibliográfica, com base na pesquisa de artigos publicados, desde 2000, no PubMed, com as palavras-chave: “koro syndrome”, “obsessive-compulsive disorder” e “koro-like symptoms”. Analisaram-se alguns artigos anteriores ao ano 2000 para contextualização histórica. Doente com síndrome de koro secundária a transtorno obsessivo-compulsivo, com boa resposta à terapia farmacológica associada à terapia cognitivo-comportamental. O conhecimento desse diagnóstico e da sua gestão clínica é importante para identificar as condições subjacentes e otimizar o tratamento.


2017 ◽  
Author(s):  
Christine Lochner ◽  
Dan Stein ◽  
Eileen Thomas

Body dysmorphic disorder requires obsessional thoughts regarding a perceived defect in appearance and/or compulsive behavior that develop in response to those thoughts. Individuals experience clinically significant impairment because of their appearance concerns. Body dysmorphic disorder and obsessive-compulsive disorder have many similarities, including phenomenologic features, comorbidities, and underlying pathophysiology. Insight into the excessiveness or irrationality of their beliefs varies from good to delusional. Many individuals with body dysmorphic disorder present with comorbid suicidal ideation and substance use disorders. This review contains 1 table, and 30 references. Key words: body dysmorphic disorder, diagnostic and statistical manual, obsessive-compulsive and related disorder


CNS Spectrums ◽  
2009 ◽  
Vol 14 (8) ◽  
pp. 415-418 ◽  
Author(s):  
Lieuwe de Haan ◽  
Christine Dudek-Hodge ◽  
Yolanda Verhoeven ◽  
Damiaan Denys

ABSTRACTIntroduction: The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia and related disorders has been increasingly recognized. However, the rate of psychosis comorbidity in OCD patients has yet to be systematically evaluated.Methods: The prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychotic disorders was evaluated in 757 subjects consecutively referred to a specialised diagnostic and treatment facility for OCD. Demographic and clinical characteristics were assessed.Results: Thirteen OCD patients (1.7%) also met the DSM-IV criteria for a psychotic disorder. We found no significant differences in clinical characteristic between OCD patients with and without a psychotic disorder, although patients with OCD and a psychotic disorder more likely used illicit substances and more likely were male.Conclusion: Relatively few patients referred to a specialized treatment OCD center suffer from a psychotic disorder.


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