Disorders related to OCD

 

​Most of us have something we don't like about our appearance — a crooked nose, an uneven smile, or ears that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day.

They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Body Dysmorphic Disorder (BDD)

 

Characteristics of BDD

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose or chest.  In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally.

This disorder is prevalent  - about one in 100 people suffers from this ailment.

Symptoms

People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

BDD sufferers may perform some type of ritualistic behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief. Examples are listed below:

•             camouflaging (with body position, clothing, makeup, hair, hats)

•             comparing body part to others' appearance

•             checking in a mirror

•             avoiding mirrors

•             skin picking

•             excessive grooming

•             excessive exercise

•             changing clothes excessively

  

BDD and Other Mental Health Disorders

People with BDD commonly also suffer from obsessive-compulsive disorder (OCD) and depression. BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD.

Treatment

To get an accurate diagnosis and appropriate treatment, a physician conducts a careful evaluation of patient's  concerns with their appearance. If your child is preoccupied with appearance so that it interferes with concentration in school or if behaviors listed above appear, talk to a mental health professional.

Effective treatments are available to help BDD sufferers live full, productive lives.

•             Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones.

•             Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results.

Hypochondriasis or Illness Anxiety Disorder

People with hypochondriasis misinterpret benign physical sensations as evidence that they have a serious illness. They are not faking their symptoms, and their anxiety about them is real. Sensations they focus on are a rapid heartbeat, stomach rumblings, sweating, or dizziness on standing up. They may become highly concerned about minor physical problems such as an occasional cough or a temporary condition such as ringing in the ears (tinnitus).

Reassuring people with hypochondriasis that these symptoms are not signs of a serious disease usually does not help. Moreover, because they do not have the condition they fear they have, their problem does not respond to routine medical treatment. In fact, medical treatment often leads to undesirable side effects and new symptoms.

Unless it is treated, hypochondriasis is generally a lifelong problem; however, most people with this disorder refuse referral to a mental health professional. They may see such a referral as a suggestion that they are imagining or fabricating their symptoms. They may also believe that their physician is trying to get rid of them by sending them to another professional.

Most people with hypochondriasis have received a great deal of medical care without resolution of their symptoms or their anxiety. They are frustrated with their past care and their past physicians, and often their physicians are frustrated with them.

 

Treatment

Satisfactory care for people with hypochondriasis begins with a trusting relationship with a physician that can be maintained over time. Patients should visit the physician's office for medical care on a regular schedule, even when they are not experiencing symptoms. The patient and the physician should agree on the frequency of visits. Laboratory studies, diagnostic tests, and surgery should not be done unless they are clearly needed.

Some patients find it helpful when a physician explains to them that they are exceptionally sensitive to normal fluctuations in bodily functioning. However, because patients with hypochondriasis are as likely as other patients to develop a physical illness that requires treatment, the physician must remain open and attentive to the possibility of medical causes for the symptoms.

People with hypochondriasis can be helped by a mental health professional if they can be persuaded to see one. A variety of psychotherapies, including cognitive-behavioral therapy, can be effective.

About two-thirds of people with hypochondriasis also have other psychiatric disorders, such as major depression, panic disorder, obsessive-compulsive disorder.  A patient with hypochondriasis should receive a careful assessment so that any other psychiatric conditions can be identified and treated; such treatment often lessens or eliminates the hypochondriacal symptoms and helps the patient's other psychiatric disorders as well.

When a person with hypochondriasis obtains treatment from a physician who understands that it is a real and chronic disorder, the two can work together to increase the patient's ability to tolerate and cope with symptoms. The goal of treatment should be to maximize day-to-day functioning, much as it is in the care of chronic physical illnesses.

Tourette Syndrome (TS)

Tourette Syndrome (TS) is a neuro-psychiatric  disorder characterized by sudden rapid, involuntary movements called tics, which occur repeatedly.

In most instances TS starts in childhood, and for about half of children with TS, the condition continues into adulthood. In most cases TS is also linked to other behaviors, most often OCD and Attention Deficit Disorder (ADD).

Symptoms can include bouts of motor and vocal tics and the focus of these tics tends to wax and wane over time. Typically tics increase as a result of stress or tension, and may decrease when relaxed or absorbed in a task. However, symptoms are an individual phenomenon, with people exhibiting many different symptoms, perhaps over the course of their lifetime.  Tics are experienced as an irresistible urge (as, for example, in a sneeze) and must eventually be expressed. Many people try and suppress their tics until they can find a secluded spot in which to release them.  Even then, the feeling of relief tends to be only momentary.

Two categories of tic have been identified, namely simple and complex tics.  The simple type includes eye blinking, head and limb jerking, shoulder shrugging and grimacing (motor tics); plus sniffing, grunting, throat clearing and yelping (vocal tics).  Complex motor tics include jumping, smelling, touching rituals, and self-injurious behaviour.  Coprolalia (vocalising offensive words and phrases), Echophenomena (repeating a sound) and Echolalia (repeating a word or phrase just heard) constitute complex vocal tics.

The range of tics, or tic-like symptoms that characterise TS, is very broad and they can exist in different combinations.  For a diagnosis of TS to be made, the onset of symptoms must be before the age of 18 years.

There are a number of additional behaviors thought to be associated with TS, although they are not necessary in order for a diagnosis to be established.  Specifically, they include Obsessive Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD).  In addition, some studies suggest a link between TS and Learning Disabilities (eg reading and writing difficulties, perceptual problems).

In terms of cause, genetic studies show that TS is inherited as a gene or genes. Gender also influences the expression of the gene, with the incidence of TS being at least 3 to 4 times higher in males than in females.  

Importantly,  not everyone with TS experiences symptoms severe enough to require medical attention and most people with tic disorders tend to improve in adulthood.

 

 

Tourette Syndrome and OCD

The clustering of OCD and TS within families suggests a common inherited factor, with TS often being complicated by co-morbid OCD. The estimated incidence of this ranges from 35% to 50%.  The incidence of TS in OCD is lower (5% to 7%).  A distinction can be made between tic-related and non-tic-related OCD.

The most striking similarity between TS and OCD is that both are characterized by apparently senseless repetitive behaviors.  Motor tics in TS are often described as ‘irresistible’, as although they can be delayed, they must ultimately be performed.  Once the tic has been performed, until it feels ‘just right’, a sense of relief is then experienced.  This type of phenomenon also occurs with obsessions and compulsions.

OCD with co-morbid tics appears to respond differently to treatment compared with non-tic-related OCD.  In addition to anti-obsessional drugs (eg SSRIs such as Fluvoxamine and Paroxetine), individuals with TS seem to respond better to a combination of SSRI and neuroleptic treatment (eg,  Risperidone, Halidol).

Current theory suggests that immunological alterations may have occurred in individuals with OCD, either through haemolytic streptococcal or viral infections during childhood. An antigen has been shown to be stable in different populations  over time, and is present in individuals with childhood OCD, Tourettes Syndrome, chronic tic disorder and autism.  It is possible that the antigen could be linked to the motor component of the various disorders. However, much further research is required in this area, and it is probable that there aremultiple factors that have the ability to trigger OCD symptoms according to individual vulnerability, with genetically-based theory and exposure to infection being two of the likely contributors.