ObsessiveCompulsive related disorders DSM 5 Obsessive compulsive disorder

Obsessive-Compulsive & related disorders (DSM 5)

• • • Obsessive – compulsive disorder Body dysmorphic disorder Hoarding disorder Trichotillomania (hair pulling) disorder Excoriation (skin picking) disorder

Obsessive Compulsive disorder • A. Presence of obsessions, compulsions, or both: • Obsessions are defined by: – The preoccupation with recurrent and persistent ideas , impulses or images that are experienced as being intrusive, senseless and inappropriate and cause marked anxiety (obsession). • Not excessive worry about daily life problems. • The individual tries to cope with it by ignoring or suppressing thoughts or images or replace it with another thought. • The person recognizes that the thoughts and images are of ones own mind not imposed on him. 5

OCD • Compulsions are defined by (1) and (2): – 1. Repetitive behaviors (e. g. , hand washing, 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. If the person does not carry the act a panic anxiety attack may occur – 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts 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 timeconsuming (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. Exclude physiological disorders • D. Exclude any other psychiatric disorders

OCD • • Checking ……………. . 63% Washing …………………. …. …… 50% Contamination……………. 45% Doubting……………. …. . 42% Body fears………. . . . . 36% Counting…………. 36% Insisting on symmetry………. . 31% aggressive behaviors ………. . 28%

Body Dysmorphic Disorder • A. Preoccupation with some imagined defect in appearance in a normal-appearing person. If a slight physical anomaly is present, the person’s concern is grossly excessive. • 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.

Body Dysmorphic Disorder • 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

Body Dysmorphic Disorder • The belief in the defect is not of delusional intensity ( the person can acknowledge the possibility that the appearance of the defect is being exaggerated and that it is not a defect at all ). • Occurrence does not occur only during the course of Anorexia Nervosa or trans-sexualism.

Dissociative Disorders- DSM 5

Dissociative identity disorder • A. Disruption of identity characterized by two or more distinct personality states. This involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and sensorymotor functioning.

Dissociative identity disorder • B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting • C. The symptoms cause clinically significant distress or impairment in important areas of functioning. • D. Religious practice is omitted, as is normal fantasy play in children. • E. Physiological effects from a substance are omitted. (DSM-5 2013 )

Dissociative amnesia • A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting or neurophysiological damage or toxicity that prevent from memory storage or retrieval. Because in dissociative amnesia the memory is already stored and is reversal

Dissociative amnesia • Localized Amnesia – The inability to recall events occurring few hours after an accident • Selective amnesia – The inability to remember certain details associated with a traumatic event for a specific period of time • Systematized – Inability to remember events related to specific category of information such family members or places. (forgetting childhood experiences, or all memories related to one’s own family) • Generalized – Loss of memory about one’s own identity, they wonder in the street not knowing who they are and might be found by the police

Dissociative amnesia • B. The symptoms cause clinically significant distress or impairment in important areas of functioning. • C. The disturbance is not attributed to Physiological effects from a substance (drug abuse or medication) or neurological medical condition (brain injury) • D. the disturbance is not explained by other dissociative disorders, PTSD, ASD, somatic symptoms disorder • Duration of disturbance usually for 12 months and more in females than males • Common suicidal risk specially when amnesia remits and the person remembers all aspects of trauma

Depersonalization/Derealization Disorder • A. The presence of persistent or recurrent experiences of depersonalization, derealization or both – 1. depersonalization: experience of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, body, or actions, (perceptual alteration, distorted sense of time, emotional numbness) – 2. Derealization: experiences of unreality or detachment with respect to surrounding (individuals, objects are experienced unreal, dreamlike, foggy, lifless or visually distorted)

Depersonalization/Derealization Disorder • B. During the disturbance the reality testing remains intact • C. The symptoms cause clinically significant impairment to social, occupational and other important areas of functioning • D. exclude physiological effects of substances (drug abuse or medication) and medical conditions • E. The disturbance is not explained by other mental disorders