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CH5 Anxiety Trauma and Stressor Related and Obsessive
Compulsive and Related Disorders
Psychology (Far Eastern University)
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CHAPTER 5 - Anxiety, Trauma- and
Stressor-Related, and Obsessive-Compulsive
and Related Disorders
The Complexity of Anxiety Disorders
An emotion implicated in both biological and
psychological
Panic attack - occurs when we fear something
Anxiety - negative mood state characterized by
bodily symptoms of physical
tension/apprehension about the future
- In humans, it is:
○ A subjective sense of unease
○ A set of behaviors
○ Physiological response
originating from the brain reflected in elevated heart rate muscle tension
- Closely related to depression
- Psychologists have known that we
perform better when we are a little
anxious
- Things could go wrong
- Future-oriented mood state
- Unpredictable or uncontrollable
upcoming events
- Negative affect
- Somatic symptoms of tension
Fear - immediate alarm reaction to danger
- Protects us by activating a massive
response from the Autonomic Nervous
System (ANS)
○ Increased heart rate and blood
pressure
○ Subjective sense of terror
○ Flight or fight response
- Immediate emotional reaction
- Negative affect
- Strong sympathetic nervous system
arousal
Panic attack - an abrupt experience of intense
fear or acute discomfort; accompanied by
physical symptoms:
- Heart palpitations
- Chest pain
- Shortness of breath
- Dizziness
Fear and anxiety reactions differ
psychologically and physiologically
(2) Basic types of panic attacks
- Fear occurring at an inappropriate time
Expected (cued) panic attacks
Unexpected (uncued) panic attacks
Diagnostic Criteria for Panic Attack:
An intense discomfort that reaches a peak
within minutes, and during which time four (or
more) of the following symptoms occur:
1. Palpitations, pounding heart, or
accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or
smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or
faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling
sensational)
11. Derealization (feelings of unreality) or
depersonalization (being detached from
oneself)
12. Fear of losing control or going crazy
13. Fear of dying
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Biological Contributions
- Increasing evidence shows that we
inherit a tendency to be tense, uptight,
and anxious
- No single gene seems to cause anxiety
or panic or any other psychiatric
disorder
- Anxiety is associated with specific brain
circuits and neurotransmitters systems
- GABA-benzodiazepine system;
noradrenergic system; serotonergic
neurotransmitter system is associated
with increased anxiety
- Controcotropin-releasing factor. the
central to the expression of anxiety (and
depression)
CRF
-
-
Hypothalamic-pituitary-adrenocortic
al (HPA) has wide-ranging effects on
areas of the brain implicated in anxiety
Limbic system; emotional brain
- Hippocampus and amygdala
Locus coeruleus (brain stem)
Prefrontal cortex
Dopaminergic neurotransmitter system
Psychological Contributions
- Behavioral theorists. a product of early
classical conditioning, modeling, or
other forms of learning
- Anxiety sensitivity. to determine who
or who will not experience problems
with anxiety under certain stressful
conditions
- A strong fear response initially occurs
during extreme stress or perhaps as a
result of a dangerous situation in the
environment
Social Contributions
- Stressful life events trigger our
biological and psychological
vulnerabilities to anxiety
- E.g. marriage, divorce, difficulties at
work, death of a loved one, pressure at
school, etc.
- Headaches, hypertension, or any
emotional reactions such as panic
attacks.
An Integrated Model
Limbic system
- Brain stem and the cortex
Triple vulnerability theory
- Theory of the development of anxiety
Behavioral inhibition systems (BIS)
- Activated by signals from the brain stem
of unexpected events
- Major changes in body functioning that
might signal danger
- When activated, we freeze, experience
anxiety, and apprehensively evaluate the
situation to confirm that danger is
present
- fight/flight system (FFS)
Generalized biological vulnerability
- First vulnerability
- The tendency to be uptight or
high-strung might be inherited
- Heritable contribution to negative affect
Generalized psychological vulnerability
- Second vulnerability
- Grow up believing the world is
dangerous and out of control and you
might not be able to cope when things
go wrong based on your early
experiences
- Senses that events are uncontrollable
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Specific psychological vulnerability
- Learning from early experience such as
taught by patients
- Physical sensations are potentially
dangerous
Anxiety Disorders
- Generalized anxiety disorder, panic
disorder, agoraphobia, specific phobia,
and social anxiety disorder
Generalized Anxiety Disorder
Diagnostic Criteria for Generalized Anxiety
Disorder
A. Excessive anxiety and worry
(apprehensive expectation), occurring
more than not for at least 6 months
about a number of events or activities
(such as work or school performance)
B. The individual finds it difficult to
control the worry
C. The anxiety and worry are associated
with at least three (or more) of the
following six symptoms (with at least
some symptoms present for more days
than not for the past 6 months)
D. The anxiety, worry, or physical
symptoms cause clinically significant
distress or impairment in social,
occupational, or other important
areas of functioning
E. The disturbance is not due to the direct
physiological effects of a substance
(e.g. drug of abuse, a medication) or a
general medical condition (e.g.,
hyperthyroidism)
F. The disturbance is not better explained
by another mental disorder (e.g.,
anxiety or worry about having panic
attacks in panic disorder, negative
evaluation in social anxiety disorder)
Causes
- Stressful events
- Anxious apprehension
- Worry process
- Intense cognitive processing
- Avoidance of imagery
- Inadequate problem solving skills
- Restricted autonomic response
Treatment
- Drug; benzodiazepines
- Psychological; encouraging, CBT
Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on
edge
2. Benign easily fatigued
3. Difficulty concentrating or mind going
blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or
staying asleep or restless, unsatisfying
sleep)
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Panic Disorder and Agoraphobia
Agoraphobia - fear and avoidance of situations
in which a person feels unsafe or unable to
escape to get home or to a hospital in the event
of a developing panic
Typical situations:
- Shopping malls
- Cars, buses, trains, subways
- Wide streets, tunnels
- Restaurants, theaters
- Being far from home or staying at home
alone
- Waiting in line (supermarkets, stores)
- Crowds
- Planes
- Elevators or escalators
Interoceptive daily activities typically
avoided:
- Running up flights of stairs
- Walking outside in intense heat
- Having showers with the doors and
windows closed
- Hot, stuffy stores or shopping malls
- Lifting heavy objects
- Dancing
- Eating chocolate
- Sports
Diagnostic Criteria for Panic Disorder
A. Recurrent unexpected panic attacks are
present.
B. At least one of the attacks has been
followed by 1 month or more of one or
both of the following:
(a) Persistent concern or
worry about additional panic
attacks or their consequences
(e.g., losing control, having a
heart attack, <going crazy=)
(b) A significant maladaptive
change in behavior related to
the attacks (e.g., behaviors
designed to avoid having panic
attacks, such as avoidance of
exercise or unfamiliar
situations).
C. The disturbance is not attributable to
the physiological effects of a substance
(e.g., a drug of abuse, a medication) or
another medical condition (e.g.,
hyperthyroidism, cardiopulmonary
disorders).
D. The disturbance is not better explained
by another mental disorder (e.g.,
panic attacks do not occur only in
response to feared social situations, as in
social anxiety disorder).
Diagnostic Criteria for Agoraphobia
A. Marked fear or anxiety about two or
more of the following five situations:
Public transportation, open spaces,
enclosed places, standing in line or
being in a crowd, being outside the
home alone.
B. The individual fears or avoids these
situations due to thoughts that escape
might be difficult or help might not be
available in the event of developing
panic-like symptoms or other
incapacitating or embarrassing
symptoms (e.g., fear of falling in the
elderly, fear of incontinence).
C. The agoraphobic situations almost
always provoke fear or anxiety.
D. The agoraphobic situations are actively
avoided, require the presence of a
companion, or are endured with
intense fear or anxiety.
E. The fear or anxiety is out of proportion
to the actual danger posed by the
agoraphobic situations, and to the
sociocultural context.
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F. The fear, anxiety or avoidance is
persistent, typically lasting for 6
months or more.
G. The fear, anxiety or avoidance causes
clinically significant distress or
impairment in social, occupational or
other important areas of functioning.
H. If another medical condition (e.g.,
inflammatory bowel disease,
Parkinson’s disease) is present, the fear,
anxiety or avoidance is clearly
excessive.
I. The fear, anxiety or avoidance is not
better explained by the symptoms of
another mental disorder, e.g., the
symptoms are not confined to specific
phobia, situational type; do not involve
only social situations (as in social
anxiety disorder) and are not related
exclusively to obsessions (as in
obsessive-compulsive disorder),
perceived deficits or flaws in physical
appearance (as in body dysmorphic
disorder), reminders of traumatic
events (as in posttraumatic stress
disorder), or fear of separation (as in
separation anxiety disorder)
Causes
- Agoraphobia often develops after a
person has unexpected panic attacks
- Stress due to life events
- False alarm; learned alarm
Treatment
Medication.
- High-potency benzodiazepines
- Selective-serotonin reuptake inhibitors
(SSRIs)
- Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
Psychological Intervention.
- Exposure exercises with
anxiety-reducing coping mechanisms
(relaxation, breathing retraining)
- Panic control treatment (PCT)
Specific Phobia
Specific Phobia - is an irrational fear of a
specific object or situation that markedly
interferes with an individual’s ability to
function.
Diagnostic criteria for Specific Phobia
A. Marked fear or anxiety about a
specific object or situation (e.g., flying,
heights, animals, receiving an injection,
seeing blood).
B. The phobic object or situation almost
always provokes immediate fear or
anxiety. Note: In children, the anxiety
may be expressed by crying, tantrums,
freezing, or clinging.
C. The phobic object or situation is
actively avoided or endured with
intense fear or anxiety.
D. The fear or anxiety is out of proportion
to the actual danger posed by the
specific object or situation, and to the
sociocultural context.
E. The fear, anxiety or avoidance is
persistent, typically lasting for 6
months or more.
F. The fear, anxiety or avoidance causes
clinically significant distress or
impairment in social, occupational or
other important areas of functioning.
G. The disturbance is not better explained
by the symptoms of another mental
disorder, including fear, anxiety and
avoidance of: situations associated
with panic-like symptoms or other
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incapacitating symptoms (as in
agoraphobia); objects or situations
related to obsessions (as in
obsessive-compulsive disorder);
reminders of traumatic events (as in
posttraumatic stress disorder);
separation from home or attachment
figures (as in separation anxiety
disorder); or social situations (as in
social anxiety disorder)
Specify type:
1. Animal
2. Natural environment (e.g., heights,
storms, and water)
3. Blood–injection–injury
4. Situational (e.g., planes, elevators, or
enclosed places)
5. Other (e.g., phobic avoidance of
situations that may lead to choking,
vomiting, or contracting an illness; or in
children, avoidance of loud sounds or
costumed characters)
Causes
- Direct experience
- Experiencing a false alarm
- Observing someone else experiencing
severe fear
- Being told about danger
Treatment
- Exposure-based exercise
Separation Anxiety Disorder
Separation anxiety disorder is characterized by
children’s unrealistic and persistent worry
that something will happen to their parents or
other important people in their life or that
something will happen to the children
themselves that will separate them from their
parents
- E.g. they will be lost, kidnapped, killed,
or hurt in an accident
Social Anxiety Disorder (Social Phobia)
Diagnostic Criteria for Social Anxiety
Disorder (SAD)
A. Marked fear or anxiety about one or
more social situations in which the
person is exposed to possible scrutiny
by others.
- Examples include social
interactions (e.g., having a
conversation; meeting
unfamiliar people), being
observed (e.g., eating or
drinking), or performing in
front of others (e.g., giving a
speech)
Note: In children, the anxiety must occur in
peer settings and not just in interactions with
adults.
B. The individual fears that he or she will
act in a way, or show anxiety
symptoms, that will be negatively
evaluated (i.e., will be humiliating,
embarrassing, lead to rejection, or
offend others).
C. The social situations almost always
provoke fear or anxiety.
Note: in children, the fear or anxiety may be
expressed by crying, tantrums, freezing,
clinging, shrinking, or failing to speak in
social situations.
D. The social situations are avoided or
endured with intense fear or anxiety.
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E. The fear or anxiety is out of
proportion to the actual threat posed
by the social situation, and to the
sociocultural context.
F. The fear, anxiety or avoidance is
persistent, typically lasting for 6
months or more.
G. The fear, anxiety or avoidance causes
clinically significant distress or
impairment in social, occupational or
other important areas of functioning.
H. The fear, anxiety or avoidance is not
attributable to the effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition.
I. The fear, anxiety or avoidance is not
better explained by the symptoms of
another mental disorder, such as panic
disorder (e.g., anxiety about having a
panic attack) or separation anxiety
disorder (e.g., fear of being away from
home or a close relative).
J. If another medical condition (e.g.,
stuttering, Parkinson’s disease, obesity,
disfigurement from burns or injury) is
present, the fear, anxiety or avoidance
is clearly unrelated or is excessive.
Specify if: Performance only: If the fear is
restricted to speaking or performing in public.
Causes
- Biological tendency to be socially
inhibited
- Stressful events
- panic attacks in social situations
Treatment
- Cognitive therapy
- Interpersonal psychotherapy (IPT)
- CBT
- Drug. SSRI drug Prozac
- Self-exposure
Trauma- and Stressor-Related Disorders
- Happens after a relatively stressful life
event
Posttraumatic Stress Disorder
Posttraumatic Stress Disorder (PTSD) exposure to a traumatic event during which an
individual experiences or witnesses death or
threatened death, actual or threatened serious
injury, or actual or threatened sexual violation
Diagnostic Criteria for Posttraumatic Stress
Disorder
A. Exposure to actual or threatened death,
serious injury, or sexual violence in one
(or more) of the following ways:
1. Directly experiencing the
traumatic event(s).
2. Witnessing, in person, the
event(s) as they occurred to
others.
3. Learning that the event(s)
occurred to a close relative or
close friend. In cases of actual
or threatened death of a family
member or friend, the event(s)
must have been violent or
accidental.
4. Experiencing repeated or
extreme exposure to aversive
details of the traumatic event(s)
(e.g., first responders collecting
human remains; police officers
repeatedly exposed to details of
child abuse).
Note: Criterion A4 does not apply to exposure
through electronic media, television, movies, or
pictures, unless this exposure is work related.
B. Presence of one (or more) of the
following intrusion symptoms
associated with the traumatic event(s),
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beginning after the traumatic event(s)
occurred:
1. Recurrent, involuntary and
intrusive distressing memories
of the traumatic event(s).
Note: In young children,
repetitive play may occur in
which themes or aspects of the
traumatic event(s) are
expressed.
2. Recurrent distressing dreams
in which the content and/or
affect of the dream are related to
the traumatic event(s).
Note: In children, there may be
frightening dreams without
recognizable content.
3. Dissociative reactions (e.g.,
flashbacks) in which the
individual feels or acts as if the
traumatic event(s) were
recurring. (Such reactions occur
on a continuum, with the most
extreme expression being a
complete loss of awareness of
present surroundings.)
Note: In young children,
traumaspecific reenactment may
occur in play.
4. Intense or prolonged
psychological distress at
exposure to internal or
external cues that symbolize or
resemble an aspect of the
traumatic event(s).
5. Marked physiological
reactions to internal or
external cues that symbolize or
resemble an aspect of the
traumatic event(s).
C. Persistent avoidance of stimuli
associated with the traumatic event(s),
beginning after the traumatic event(s)
occurred, as evidenced by one or both of
the following:
1. Avoidance of or efforts to
avoid distressing memories,
thoughts, feelings, or
conversations about or closely
associated with the traumatic
event(s).
2. Avoidance of or efforts to
avoid external reminders
(people, places, conversations,
activities, objects, situations)
that arouse distressing
memories, thoughts, or feelings
about or closely associated with
the traumatic event(s).
D. Negative alterations in cognitions and
mood associated with the traumatic
event(s), beginning or worsening after
the traumatic event(s) occurred, as
evidenced by two (or more) of the
following:
1. Inability to remember an
important aspect of the
traumatic event(s) (typically
due to dissociative amnesia and
not to other factors such as head
injury, alcohol, or drugs).
2. Persistent and exaggerated
negative beliefs or
expectations about oneself,
others, or the world (e.g., <I am
bad,= <no one can be trusted,=
<the world is completely
dangerous,= <My whole nervous
system is permanently ruined=).
3. Persistent distorted cognitions
about the cause or consequences
of the traumatic event(s) that
lead the individual to blame
himself/herself or others.
4. Persistent negative emotional
state (e.g., fear, horror, anger,
guilt, or shame).
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E.
F.
G.
H.
5. Markedly diminished interest
or participation in significant
activities.
6. Feelings of detachment or
estrangement from others.
7. Persistent inability to
experience positive emotions
(e.g., inability to experience
happiness, satisfaction, or
loving feelings).
Marked alterations in arousal and
reactivity associated with the
traumatic event(s), beginning or
worsening after the traumatic event(s)
occurred, as evidenced by two (or more)
of the following:
1. Irritable behavior and angry
outbursts (with little or no
provocation) typically expressed
as verbal or physical aggression
toward people or objects.
2. Reckless or self-destructive
behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
Sleep disturbance (e.g., difficulty
falling or staying asleep or restless
sleep). Duration of the disturbance
(Criteria B, C, D and E) is more than
one month.
The disturbance causes clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning.
The disturbance is not attributable to
the physiological effects of a substance
(e.g., medication, alcohol) or another
medical condition.
understood that onset and expression of some
symptoms may be immediate).
Specify whether: With Dissociative
Symptoms: The individual’s symptoms meet
the criteria for posttraumatic stress disorder,
and in addition, in response to the stressor, the
individual experiences persistent or recurrent
symptoms of either depersonalization or
derealization.
Causes
- In terms of the precipitating event:
Someone personally experiences a
trauma and develops a disorder.
- Biological, psychological, and social
factors
Treatment
Psychological.
- Face the original trauma
- Process the intense emotions
- Develop effective coping procedures to
overcome
- Catharsis. Arranging the reexposure so
that it will be therapeutic rather than
traumatic
- Imaginal exposure. Exposure practices
- Cognitive therapy. CBT
- Drugs. SSRIs (prozac, paxil)
Specify if: With delayed expression: If the full
diagnostic criteria are not met until at least 6
months after the event (although it is
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Obsessive-Compulsive and Related Disorders
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Person that has been diagnosed with
anxiety and its related disorders that
needs hospitalization is likely to have
obsessive- compulsive disorder (OCD).
Psychosurgery- neurosurgery for a
psychological disorder.
Px that is referred to psychosurgery
because psychological and
pharmacological treatment failed,
probably has OCD.
Uncommon with Px with OCD =
severe generalized anxiety, recurrent
panic attacks, debilitating avoidance,
and major depression, all occurring
simultaneously with
obsessive-compulsive symptoms.
When Px with OCD seems hopeless
with the scientific treatments they often
try magic and rituals.
Clinical Description
In anxiety disorder, the harm with the Px
is with external objects or situations
WHILE in OCD the danger is on,
thought, image, or impulse.
Obsessions- intrusive, nonsensical
thoughts, images or urges that a Px tries
to resist or eliminate.
Compulsions- thoughts, actions to
suppress the obsessions and give relief.
Types of Obsessions and Compulsions
The four major types of obsessions is
associated with a pattern of compulsive
behavior.
DSM 5: Diagnostic Criteria for ObsessiveCompulsive Disorder
A. Presence of obsessions, compulsions or both:
Obsessions are defined by 1 and 2:
1. Recurrent and persistent thoughts, urges, or
images that are experienced, at some time during
the disturbance, as intrusive and inappropriate
and that in most individuals cause marked
anxiety or distress
2. The individual attempts to ignore or suppress
such thoughts, impulses, or images, or to
neutralize them with some other thought or
action
Compulsions are defined by 1 and 2:
1. Repetitive behaviors (e.g., handwashing,
ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the
individual feels driven to perform in response to
an obsession, or according to rules that must be
applied rigidly
2. The behaviors or mental acts are aimed at
preventing or reducing distress or preventing
some dreaded event or situation; however, these
behaviors or mental acts either are not connected
in a realistic way with what they are designed to
neutralize or prevent or are clearly excessive.
B. 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.
C. The disturbance is not due to the direct
physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical
condition.
D. The disturbance is not better explained by the
symptoms of another mental disorder (e.g.,
excessive worries, as in generalized anxiety
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disorder, or preoccupation with appearance, as in
body dysmorphic disorder).
Specify if:
- With good or fair insight: the individual
recognizes that obsessive-compulsive
disorder beliefs are definitely or
probably not true or that they may or
may not be true.
-
With poor insight: The individual thinks
obsessive- compulsive disorder beliefs
are probably true.
With absent insight/delusional: the
person is completely convinced that
obsessive-compulsive disorder beliefs
are true.
Specify if:
Tic-related: The individual has a current or past
history of a
tic disorder.
(aggressiv
e/
sexual/reli
gious)
others
Cleaning/
contamina
tion
- Germs
- Fear of
germ or
contaminant
- Repetitive or
excessive
washing
- Fears of
throwing
anything
away
Collecting/savi
ng
objects with
little
or no actual or
sentimental
value
such as food
wrappings
- Fears of
offending
God
-
Types of Obsessions and Associated
Compulsions
Symptom
Subtype
Obsession
Compulsion
Symmetry
/
exactness/
<just
right=
- Needing
things to be
symmetrical
/ aligned
just so
- Putting things
in a
certain order
- Repeating
rituals
- Urges to
do things
over and
over until
they feel
<just right=
Forbidden
thoughts
or actions
- Fears,
urges to
harm self or
- Checking
- Avoidance
Hoarding
●
●
- Repeated
requests for
reassurance
- Using gloves,
masks to do
daily
tasks
Symmetry- keeping things in perfect
order or doing something in a specific
way.
For example: Richard thought that if he
did not eat in a certain way
he might become possessed. If he didn’t
take small steps and look
back, some disaster might happen to his
family.
On rare occasions, Px children will have
compulsions but no obsessions.
For example: An 8-year-old child who
felt compelled to undress, put on his
pajamas, and turn down the covers in a
time-consuming fashion each night; he
always repeated the ritual three times.
He could give no particular reason for
his behavior; he simply had to do it.
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Tic Disorder and OCD
● Tic disorder- involuntary movement
(sudden jerking of limbs)
● Tourette’s disorder- more complex tics
with involuntary vocalizations
● The obsessions in tic-related OCD are
almost always related to symmetry.
● <PANDAS=- as Pediatric AutoimmuNe
Disorder Associated with Streptococcal
infection
- One small group of children
presenting OCD and tics
suggest that these problems
occurred after strep throat.
- More likely to be male, has
fever, or sore throat.
- Full remission of symptoms
during antibiotic therapy.
- Noticeable clumsiness
- Past streptococcal infections
- Revised and broadened under
the umbrella term Pediatric
Auto-immune Neuropsychiatric
Syndrome
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Statistics
Estimates of the lifetime prevalence of
OCD range from 1.6% to 2.3%
Obsessions and compulsions are in
continuum, just like anxiety disorder.
<Normal= - Intrusive and distressing
thoughts are common in nonclinical
individuals.
- 13% of a <normal= community
sample of people had moderate
levels of obsessions or
compulsions that were not
severe enough to meet
diagnostic criteria for OCD.
OCD (mid-adolescents) sex ratio
1(female):1(male) patients.
OCD develops becomes chronic.
Arabia and Egypt
-
●
obsessions are primarily related
to religious practices,
specifically the Muslim
emphasis on cleanliness.
England, Hong Kong, India, Egypt,
Japan, and Norway
- found essentially similar types
and proportions of obsessions
and compulsions, as did studies
from Canada, Finland, Taiwan,
Africa, Puerto Rico, Korea, and
New Zealand
Body Dysmorphic Disorder
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Body Dysmorphic Disorder (BDD)people fantasize about improving
something, but some relatively
normal-looking people think they are so
ugly they refuse to interact with others
or otherwise function normally for fear
that people will laugh at their ugliness.
People with BDD complain of
persistent, intrusive, and horrible
thoughts about their appearance, and
they engage in such compulsive
behaviors as repeatedly looking in
mirrors to check their physical features.
Dysmorphophobia- fear of ugliness
- For decades people with BDD
have been misdiagnosed with
this phobia.
- Represent a psychotic
delusional state because the
affected individuals were unable
to realize, even for a fleeting
moment, that their ideas were
irrational.
UNCOMMON- For people with BDD
to be seen in mental health clinics
because they often tend to seek plastic
surgeons and dermatologists
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MEN- focus on body build, genitals, and
thinning hair and tend to have more
severe BDD.
WOMEN- focus on more varied body
areas and are more likely to also have an
eating disorder.
Common consequences of BDD are
depression and substance abuse.
Psychopathology of BDD- reacting to a
<deformity= that others cannot perceive.
People that conform with their culture
such as altering facial features do not
have BDD.
Diagnostic Criteria for Body Dysmorphic
Disorder
A. Preoccupation with one or more defects or
flaws in physical appearance that are not
observable or appear slight to others.
B. At some point during the course of the
disorder, the individual has performed repetitive
behaviors (e.g., mirror checking, excessive
grooming, skin picking, reassurance seeking) or
mental acts (e.g., comparing his or her
appearance with that of others) in response
to the appearance concerns.
C. The preoccupation causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
D. The appearance preoccupation is not better
explained by concerns with body fat or weight in
an individual whose symptoms meet diagnostic
criteria for an eating disorder.
Specify if:
With good or fair insight: The individual
recognizes that the body dysmorphic disorder
beliefs are definitely or probably not true or that
they may or may not be true.
With poor insight: The individual thinks that
the body dysmorphic disorder beliefs are
probably true.
With absent insight/delusional beliefs: the
individual is completely convinced that the body
dysmorphic disorder beliefs are true.
With muscle dysmorphia: The individual is
preoccupied with the idea that his or her body
build is too small or insufficiently muscular.
This specifier is used even if an individual is
preoccupied with other body areas, which is
often the case.
Other Obsessive-Compulsive and Related
Disorders
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Hoarding Disorder
fear of discarding things due to thoughts
of urgently needing it.
nearly equal number of men and
women.
excessive acquisition of things,
difficulty discarding anything, living w/
excessive clutter under conditions best
characterized as gross disorganization.
Hoarding disorder is characterized by
excessive acquisition of things,
difficulty discarding anything, and
living with excessive clutter under
conditions best characterized as gross
disorganization.
Treatment approaches are similar to
those for OCD but are less successful.
Excoriation
repetitive and compulsive picking of
the skin leading to tissue damage.
require medication.
there is a significant embarrassment,
distress, and impairment in terms of
social and work functioning.
female disorder
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Trichotillomania
urge to pull own hair including scalp,
eyebrows, and arms.
Results in noticeable hair loss, distress,
and significant social impairments.
female more than male
genetic influence.
Both disorders were classified under
impulse control disorders, often co
occur with OCD and BDD.
these behaviors tend to relieve tension.
Treatment: habit reversal training.
Substitute different behavior such as
chewing gum or other reasonably
pleasurable but harmless behavior.
serotonin reuptake inhibitors.
Repetitive and compulsive hair pulling
resulting in significant noticeable loss of
hair or repetitive and compulsive
picking of the skin leading to tissue
damage characterize trichotillomania
and excoriation disorders respectively.
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