- Cognitive Behavioral Therapy
- Medications
- Neurosurgery

Treatments of OCD

- OCD and Tourette's syndrome are often comorbid (occurring together)
- Both disorders have abnormalities of the basal ganglia
- Tourette's syndrome treatment is focused on adjusting dopamine in the brain while treatment for OCD focuses on serotonin in the brain


Comorbidity of Obsessive Compulsive Disorder

Bhandari, S. (2020, September 4). OCD: Types, Symptoms, Causes, Diagnosis, Treatment, and Related Conditions. WebMD. https://www.webmd.com/mental-health/obsessive-compulsive-disorder. 

OCD WebMD

U.S. Department of Health and Human Services. (2019, October). Obsessive-Compulsive Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/. 

OCD NIMH

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that raises their level of anxiety and drive them to perform certain ritual or actions (compulsions) that serves to lower their anxiety about their thoughts. The compulsive behaviors can significantly interfere with a person’s daily activities and social interactions. Some people with OCD have faced psychological distress and worse "symptoms" in the wake of the pandemic.

Obsessive-Compulsive Disorder (and COVID-19)

Sexual minorities experience unique stress in the form of external discrimination, microaggressions, internalized stigma and homophobia, social rejection, and identity discomfort and concealment. The accumulation of these identity-based stressors is believed to explain the increased incidence of OCD in this population and have an effect on the content of their obsessive thoughts and types of compulsions.

Obsessive-Compulsive Symptoms in Sexual Minorities

Many studies reveal conflicting information regarding the associations between traumatic experiences and OCD or hoarding symptoms. Previous studies have found a plethora of information regarding differences and similarities between the trauma experiences of those with OCD and those with hoarding symptoms. It is still unclear exactly what types of traumatic events are associated with each, if any, the association between the time a traumatic event occurred and symptom development (i.e., prior to the onset or after the onset of symptoms), and how many traumatic events these individuals with these disorders have experienced or may experience in the future. A study in 2014 sought to answer these questions.

The Links between Traumatic Events and OCD and/or Hoarding Symptoms

Obsessive Compulsive Disorder and Obsessive-Compulsive Personality Disorder Comparison 

Reference for Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder Comparison

Mathes, B.M., Morabito, D.M. & Schmidt, N.B. Epidemiological and Clinical Gender Differences in OCD. Curr Psychiatry Rep 21, 36 (2019). https://doi.org/10.1007/s11920-019-1015-2

Reference for “ Epidemiological and Clinical Gender Differences in OCD”

In the context of Obsessive-Compulsive Disorder, obsessions are defined as persistent, unintentional, and unwanted thoughts that are highly intrusive, unpleasant, and cause significant distress. These are distinct from everyday worries, like concerns about job security, or occasional unwanted thoughts, such as recalling an awkward comment. Individuals with OCD typically recognize that their obsessive thoughts are irrational but experience extreme difficulty in suppressing or ignoring them.

Characteristics of Obsessions in OCD

In the context of Obsessive-Compulsive Disorder, compulsions are defined as repetitive, ritualistic actions or mental acts performed to alleviate the distress caused by obsessions or to prevent a feared outcome. These acts are not inherently pleasurable and often lack a realistic connection to the problem they are intended to address.

Characteristics of Compulsions in OCD

When obsessive-compulsive disorder is not treated, it typically becomes a chronic, long-term condition. This can lead to persistent psychological and interpersonal difficulties throughout an individual's life.

Chronicity of Untreated OCD

Body Dysmorphic Disorder (BDD) is a condition where an individual is intensely preoccupied with a perceived flaw in their physical appearance, which is often nonexistent or barely perceptible to others. This preoccupation can cause the person to believe they are unattractive, ugly, or deformed. The intense focus on these imagined defects leads to repetitive, ritualistic behaviors and mental acts. These compulsions can include constantly checking one's appearance in the mirror, attempting to conceal the perceived flaw, making comparisons to others, and in some cases, seeking cosmetic surgery.

Body Dysmorphic Disorder (BDD)

A student, Alex, keeps the pens, books, and laptop on their desk in perfect alignment, straightening them multiple times a day. Which of the following additional details would be most critical in determining whether this behavior is a symptom of obsessive-compulsive disorder (OCD) rather than simply a personality trait?

Many people use the word "obsession" or refer to OCD in a casual manner in everyday conversation, which can be insensitive to people experiencing OCD.

Casual Misuse of OCD-Related Language

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions. Obsessions are defined as intrusive and unwanted thoughts, mental images, fears, sensations, or urges. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform, often in response to an obsession. These cycles of obsessions and compulsions are typically distressing, time-consuming, and can significantly disrupt a person's daily activities.

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- Depression
- Obsessive-Compulsive Disorder
- Hoarding Disorder
- Post-traumatic Stress Disorder
- Anxiety/ Panic Disorders
- Social Anxiety Disorder
- Body dysmorphic disorder
- Schizophrenia 
- Borderline Personality Disorder

Mental Disorders Affected By The Covid-19 Pandemic

- Physiological or emotional numbing
- Sensory impairments feelings of disembodiment
- Distorted experience of time
- Feeling as if one is in a dream
- Visual perceptual distortions
- An unreal/absent sense of self
- May hear voices (dissociative episodes; distinct from the auditory hallucinations experienced in psychosis)
- DON’T have psychosis and HAVE intact reality testing
- Symptoms often overlap with both anxiety and other dissociative disorders (PTSD or panic disorder, OCD, depression, schizophrenia)

Depersonalization-Derealization Disorder Symptoms

List of Other Recognized Anxiety Disorders

Several mental and physical health conditions are commonly comorbid with ARFID, and may potentially contribute to its symptoms: 

- Attention-deficit/hyperactivity disorder
- Autism spectrum disorder 
- Internet gaming disorder
- Anxiety disorders 
- Abdominal pain or other somatic issues
- Drug use

Avoidant/Restrictive Food Intake Disorder (ARFID) Comorbid Conditions

Breedlove, S. & Watson, N. (2017). Behavioral neuroscience, eighth edition. Oxford University Press.

Behavioral Neuroscience 8th Edition

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

The COVID-19 pandemic and ensuing isolation measures has had negative psychological impact on the general population of China, measured by mean levels of stress, depression and anxiety. Authors conducted a cross-sectional study (Jan. 31 - Feb. 2) (n=1210, from 194 cities) using an online questionnaire disseminated to university students who were encouraged to pass it along. Overall, 75.5% of respondents reported psychological impacts resulting from the pandemic. Women, students, presentation of various symptoms (ex: dizziness, coryza), and low reported health-status are high risk-factors for worsened mental health. Identifying populations vulnerable to psychological distress, and factors favouring psychological health, provide insight for the formulation of psychological interventions.

Psychological response to the first wave of COVID-19 in China (stress, depression and anxiety)

Hoarding disorder is characterized by a persistent difficulty in discarding or parting with possessions, regardless of their actual value. This behavior frequently results in the accumulation of items that clutter and congest the individual's living area.

Hoarding Disorder

Schizophrenia is a severe psychological disorder that leads to a profound breakdown in an individual's ability to function, often necessitating hospitalization. It is characterized by significant disruptions in thought, perception, emotion, and behavior, including symptoms like hallucinations, delusions, incoherent thinking, bizarre actions, flat emotions, and a lack of motivation for basic activities. It is important to distinguish schizophrenia from dissociative identity disorder ('split personality'), as the term 'schizophrenia' refers to a 'splitting of psychic functions,' not a divided personality.

Schizophrenia

- Factors increasing anxiety
- Protective factors against anxiety

Areas impact between COVID and Anxiety/Panic Disorders

Post-traumatic Stress Disorder (PTSD) is a condition where an individual experiences a collection of persistent symptoms following a traumatic or profoundly stressful event, such as combat, sexual assault, or a natural disaster. For a diagnosis, these symptoms must last for at least one month. The traumatic event can be witnessed firsthand or secondhand. Historically, PTSD was referred to by terms like 'shell shock' and 'combat neurosis' due to its frequent association with war, but it is now recognized as affecting a wider population.

Post-traumatic Stress Disorder (PTSD)

Laura J. Dixon, Sara M. Witcraft & Mary J. Schadegg (2023) COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic, Journal of American College Health, 71:4, 1152-1160, https://doi.org/10.1080/07448481.2021.1923504 

The Effects of COVID-19 on Anxiety-Related Mental Health Concerns

DDD manifests as a pervasive disruption of self-awareness at its most basic level (what it feels like to be an entity; to exist). Other dissociative disorders/conditions usually impair identity at levels involving autobiographical memory, self-narratives, and personality.

Depersonalization-Derealization Disorder (DDD) vs. Other Dissociative Disorders

Generally speaking, depression is an overall feeling of sadness. More specifically, those with depression tend to experience several things such as: an increase or decrease in weight, troubles with concentration, feelings of meaninglessness or worthlessness, thoughts of death or suicide, and so on. 

Depression

- Derealization
- Anomalous subjective recall
- Emotional numbing
- Feelings of disembodiment

Experiential Components of DDD

Generalized Anxiety Disorder (GAD) is characterized by a persistent and relatively continuous state of excessive, uncontrollable, and often pointless worry and apprehension. Individuals with this disorder typically worry about routine, everyday matters, such as health, finances, or the safety of family members, without any justified reason. For a diagnosis, this diffuse worrying must occur more days than not for a period of at least six months, not be attributable to another disorder, and be accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep difficulties.

Generalized Anxiety Disorder

This disorder is hallmarked by the experience of multiple, unexpected panic attacks. These attacks are often associated with intense fear that occurs quickly. Generally, this diagnosis is applied if you have had four or more panic attacks, and fear their reocurrence. Having one panic attack, is not a panic disorder. Worry over panic attacks and avoidance of situations, places, etc. that are associated with panic attacks can lead to further problems. 

Recurrent panic attacks may show temporal lobe abnormalities. Those who suffer from panic disorder typically have lower temporal lobe volumes. These attacks can occur unexpectedly or by a trigger. 



Panic Disorder

The term 'phobia' originates from the Greek word for fear. A phobic disorder is defined by an intense, persistent, and irrational fear of a particular object, activity, or situation. This overwhelming fear compels the individual to actively avoid the source of their phobia. Exposure to the phobic stimulus results in significant distress and dysfunction, even when the person intellectually understands that their fear is excessive. Phobic disorders are generally categorized into three types: specific phobias, agoraphobia, and social phobia.

Phobic Disorder

https://books.google.co.in/books?hl=en&lr=&id=AbYwDwAAQBAJ&oi=fnd&pg=PA2&dq=hypochondria&ots=wBYJuZQSsU&sig=teQPxyaj2KUQ0DsgOF1f8rEyrlQ&redir_esc=y#v=onepage&q=hypochondria&f=false

Hypochondriasis: Illness Anxiety Disorder and Somatic Symptom Disorder

Hypochondriasis, commonly known as hypochondria was considered a disorder where an individual believes that they have illnesses or symptoms of diseases, even when they did not. It caused anxiety and distress for patients, and potentially impeded their day-to-day functioning. However, in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), hypochondria itself was declassified as a separate disorder and instead was considered a symptom or manifestation that occurred in two different disorders. Certain characteristic features of hypochondriasis were classified under Illness Anxiety Disorder and more severe manifestations under Somatic Symptom Disorder. These disorders are both largely characterized by the preoccupation over certain undiagnosed or unexplained symptoms that persist in the individual. 

Hypochondriasis 

References  for Associations between Hoarding Disorder and  Obsessive Compulsive Disorder

Anxiety disorders are characterized by features of excessive fear and anxiety, as well as related behavioral disturbances. These symptoms are often not temporary and linger beyond typical expectations. Excessiveness of these symptoms is clinician diagnosed with cultural contexts taken into consideration.

Anxiety Disorders

Autism Spectrum Disorder is a neurodevelopmental disorder that affects communication and behavior. It displays symptoms such as impaired communication, lack or impairment in social skills and interactions, and repeated patterns of behaviors that interfere with an individual's ability to cognitively function. These symptoms are almost always present in early development, and are considered to be on a 'spectrum' because of the differences in severity of these symptoms.


Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. Boys tend to be diagnosed more often than girls by approximately 4x. There is also an overrepresentation of transgender or gender nonconforming people with ASD.

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