Obsessive-compulsive disorder

In general

• Stressor
  • internal (in contrast to impulse control disorder) → Alleviation
• Imagine you hold your breath -> the internal urge to breath is here the obsession ("I need air") and the act of breathing is the compulsion ("breathing"), that relieves the stressor
  • Obsessions are...
    • Anxiety provoking
    • internal, intrusive, unwanted, thoughts/preoccupation
  • Compulsions are...
    • anxiety reducing → if suppressed → more anxiety
    • behaviors, rituals

Examples of obsessions and compulsions

• washing hands excessively (they will literally wash of their skin), checking if the door is locked 19x times, doing a certain movement if XY happens -> very irrational and the people know it -> they are very stressed about it since it is functionally disableing for them
  • Dx: it becomes a disorder if it becomes dysfunction (socially, job, ..) → Dx according to clinical criteria: obsessions and compulsions, it needs to be time-consuming (≥ 1 hour/day) or result in significant distress at school/work, not due to something else (medication, mental disorder)
  • DDx: Obsessive compulsive personality disorder, Psychosis, GAD, hoarding disorder, tic disorder, body dysmorphic disorder, trichotillomania
  • Tx:
    • Psychotherapy (CBT) > medication
    • SSRI, generally don´t use benzos
    • redirecting, reducing

Related disorders

• Hoarding: hoards trash
• Body dysmorphic disorder: women occupied with seemingly minor parts of their body, they will often undergo multiple surgeries for that
• Muscle dysphoria: "the male counterpart", but females can have it too
• Trichotillomania: pulls out hair at different times at different parts of the head