ocd and related disorderintroduction .pdf

Ocd and related disorders

1. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

2. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

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3. Chapter 13: Impulsivity, Compulsivity, and Addiction
13
ACC
VMPFC
thalamus
thalamus
ventral
striatum
OFC
IMPULSIVITY
impulsive
violence
ADHD
mania
intermittent
explosive
disorder
kleptomania
pyromania
autism
spectrum
Tourette
syndrome
body
dysmorphic
disorder
skin
picking
trichotillomania
OCD
somatization
gambling
internet
paraphilias
hypersexual
drug addiction
gambling
obesity/
binge eating
compulsive
shopping
hypochondriasis
borderline
personality
disorder
antisocial
behavior
COMPULSIVITY
dorsal
striatum
Figure 13-3 Impulsive–compulsive disorder construct. Impulsivity and compulsivity are seen in a wide variety of psychiatric disorders.
Impulsivity can be thought of as the inability to stop the initiation of actions and involves a brain circuit centered on the ventral striatum
and linked to the thalamus, to the ventromedial prefrontal cortex (VMPFC), and to the anterior cingulate cortex (ACC). Compulsivity can
be thought of as the inability to terminate ongoing actions and hypothetically involves a brain circuit centered on the dorsal striatum
and linked to the thalamus and orbitofrontal cortex (OFC). Impulsive acts such as drug use, gambling, and over-eating can eventually
become compulsive due to neuroplastic changes that engage the dorsal habit system and theoretically cause impulses in the ventral
loop to migrate to the dorsal loop.
541
t
Odt
-
-

4. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

mer

5. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

6. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

7. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

Lifetime prevalence means the proportion of individuals in a given population who have experienced a
particular disorder (or condition) at any point in their life up to the time of assessment.
!
Example:
If a study reports that the lifetime prevalence of major depressive disorder is 15%, it means that 15 out of
every 100 people have had at least one episode of major depression at some time in their lives (whether or
not they have it currently).
2
-
NationalCombidity
2 Swey-Replican
w

8. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

9. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

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house
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10. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

D

11. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

The word blasphemous means:
Disrespectful or irreverent toward something considered sacred, especially religious beliefs, deities, or symbols.
More broadly, it can mean offensive speech or actions that show a lack of respect for deeply held values or traditions.
Desecrate means to violate, damage, or show disrespect toward something sacred or highly valued.
In a religious sense, it refers to treating a holy place or object with irreverence (e.g., vandalizing a temple or church).
In a broader sense, it can mean spoiling or ruining something cherished (e.g., “The graffiti desecrated the historic monument”).
2
2
To

12. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

13. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

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14. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

15. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

16. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

17. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

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18. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

19. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

20. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

21. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

22. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

23. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

24. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

25. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

26. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

27. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
Loading…
Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

Loading…
• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
Loading…
BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

It
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.
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.
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28. Medical Disorders Associated with OCD / OCD-like Symptoms
Neurological conditions
Basal ganglia disorders
Huntington’s disease
Sydenham’s chorea (post-streptococcal autoimmune, linked to PANDAS in children)
Tourette’s disorder
Parkinson’s disease
Epilepsy (especially temporal lobe epilepsy)
Head injury / traumatic brain injury (TBI)
Stroke (particularly affecting basal ganglia or frontal lobes)
Brain tumors / space-occupying lesions in frontal-subcortical circuits
Autoimmune / infectious disorders
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection)
Neuropsychiatric lupus (SLE)
Encephalitis (e.g., autoimmune encephalitis, viral encephalitis)
Neurodegenerative disorders
Alzheimer’s disease and other dementias (OCD-like behaviors may emerge)
Wilson’s disease
Metabolic / other medical causes
Hyperthyroidism or hypothyroidism (rare, but can exacerbate OCD symptoms)
Hypoxic brain injury
"
Key mechanism: Most of these conditions disrupt the cortico-striato-thalamo-cortical (CSTC) circuitry, especially the orbitofrontal cortex–basal ganglia–thalamus loop, which is central in OCD pathophysiology.
Key differences
Feature Huntington’s chorea Sydenham’s chorea
Etiology Genetic (CAG repeat, AD inheritance) Autoimmune (post-strep, rheumatic fever)
Onset Adult (30–50 years) Child/adolescent (5–15 years)
Pathology Degeneration of caudate nucleus Autoimmune basal ganglia inflammation
Course Progressive, fatal Self-limiting (weeks–months)
Associated psych symptomsDementia, depression, OCD Emotional lability, OCD, irritability
Treatment Symptomatic (tetrabenazine, antipsychotics, supportive)Antibiotics (penicillin prophylaxis), steroids, symptomatic care

29. INTRODUCTION TO
OBSESSIVE-COMPULSIVE A ND RELATED
DISORDERS(OCRDS) AND IMPULSE-
CONTROL DISORDERS
PRESENTED BY: DR.YUGANTKARI
CHAIRPERSON:DR.GUNJAN MAAM
MODERATOR:DR LOVESH SAINI BOSS
Obsessive-Compulsive Disorder (OCD):

Obsessions

Definition:

•Recurrent and persistent thoughts, urges, or images.

•Experienced as intrusive and unwanted (at some point during the disorder).

•Causes marked anxiety or distress in most individuals.

•The individual attempts to ignore, suppress, or neutralize them with some other thought or
action. may become less intrusive over time as patients get used to them.
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Compulsions

Definition:

•Repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession or
according to rules that must be applied rigidly.

•Aimed at preventing/reducing anxiety or distress; however, not connected realistically with what they
are designed to neutralize/prevent, or are clearly excessive.

• Some patients may have only obsessions or only compulsions, but in most cases both obsessions and
compulsions are present.

•Obsessions or compulsions are time-consuming (>1 hr/day) or cause clinically significant
distress/impairment in socio-occupational functioning or other important areas of functioning.
HISTORY

• The English term OCD derives from Westphal’s description of “zwangsvorstellung” in the late 19th
century, which was translated as “obsession” or “compulsion.”

• Different terms for OCD :-
- Abortive Insanity - Westphal
-Obsessive Compulsive Neurosis – Fenichel

• Pierre Janet in 1903 described 3 stages in the development of OCD - psychasthenia, forced agitations
and stage of obsessions and compulsions, in his highly regarded work ''Les Obsessions et al
Psychasthenie''.

• He described the role of “incompleteness” in OCD patients, as well as symptoms such as tics.

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• Jaspers in 1963 in his phenomenological analysis identified five essential characteristics of
obsessional symptoms:-

a) A nonsensical, meaningless and absurd quality to the thoughts and actions of the obsessive that
is recognized by the obsessive himself.

b) The thoughts and acts having a compelling force.

c) A belief that thoughts and actions can influence events (magical thinking).

d) Need for order.

e) Unacceptable impulses.


• Mayer Gross outlined the boundaries of obsessions with delusions and overvalued ideas.
Recently this issue was reviewed by Kozak and Foa .

•OCD typically starts in childhood or adolescence, persists throughout a person’s life, and
produces substantial impairment in functioning due to the severe and chronic nature of the
illness
Epidemiology

•Lifetime prevalence: 2.3% (National Comorbidity Survey Replication; NCS-R).

•Gender distribution:•Community studies: Females > Males•Clinical context: Females = Males

•Median age of onset: 19 years (NCS-R).

•Childhood onset:
- 25% of cases before age 10.
-More common in males.
-Males more likely to have comorbid tics.

Common Presentations:

A.Contamination/Cleaning:

• Most common presentation.

• have a fear of dirt, germs, toxins, or bodily secretions, such as urine, feces, or semen.
•To manage these fears, individuals often engage in compulsions such as excessive washing or cleaning.

•Avoidance behaviors are also common; individuals may avoid public restrooms, shaking hands, or touching
commonly used surfaces.

•These reactions can be triggered not only by direct contact with perceived contaminants but also by proximity or
simply seeing something they associate with being unclean.

•There may be a sensory experience or perception of feeling unclean, even in the absence of visible
contamination.
•They may experience intrusive fears of potential consequences, such as becoming ill or, in some cases, fears like
unwanted pregnancy.
B. Pathological Doubt/Checking :

• Second most common presentation.

• Individuals experience an intense fear of being responsible for catastrophic events, such as burglary, fire, or job
loss.
• To manage this fear, they engage in compulsions such as repeatedly checking locks, appliances, or documents.
• may also frequently seek reassurance and engage in avoidance behaviors .

C. Intrusive Thoughts (Sexual and Aggressive Obsessions):
• Individuals experience recurrent, distressing intrusive thoughts about committing socially or morally
unacceptable acts, either sexual or aggressive in nature.




•Common examples include a fear of accidentally hitting pedestrians while driving or thoughts of engaging in
inappropriate sexual acts with family members.

•In response to these thoughts, individuals may perform compulsions such as checking (e.g., reviewing actions),
confessing to others, or seeking reassurance to reduce anxiety.

•Avoidance behaviors and may include not driving, avoiding sharp objects, or steering clear of social situations to
prevent feared outcomes.
C.Need for Symmetry / Ordering:

• Individuals with this presentation experience a strong drive to arrange things “perfectly” or
symmetrically.
• They often feel compelled to repeat actions or behaviors until they feel “just right” or balanced.

• This may involve arranging objects in a symmetrical or precise order, balancing movements or
touches, or engaging in magical thinking, such as believing that maintaining symmetry can prevent bad
events.

• In some cases, this presentation may resemble an extreme form of Obsessive-Compulsive Personality
Disorder (OCPD).

E. Somatic Obsessions
•Individuals experience persistent fears of developing serious illnesses or having undetected physical conditions.
•These fears are part of OCD and should be differentiated from Illness Anxiety Disorder (IAD).
•A key distinguishing feature is the presence of other OCD symptoms, such as intrusive thoughts or additional
compulsions.
•Individuals often perform classical compulsions like body checking, repeated self-examinations, or seeking
medical reassurance.
•Unlike IAD, OCD with somatic obsessions typically lacks actual somatic symptoms, focusing more on
obsessive thoughts and mental rituals.

F. Religious Obsessions
•Religious obsessions involve distressing blasphemous thoughts or mental images related to God, holy figures, or
sacred practices.
•Individuals may also experience urges to desecrate religious objects or places, even though these urges are
unwanted and ego-dystonic.
•To reduce the anxiety caused by these thoughts, they may engage in compulsions such as excessive praying,
seeking forgiveness, or mental rituals.
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BODY DYSMORPHIC DISORDER

Definition

• BDD is characterized by persistent preoccupations about one or more perceived defects or flaws in one’s
appearance.

•The defects or flaws appear slight or are not observable to others.

•In response to their appearance concerns, individuals with BDD demonstrate a range of mental acts or
behaviors, including :
-comparing themselves with others,

- checking in the mirror,

-camouflaging their perceived flaws,

- reassurance seeking.
•The most common concerns involve the face and head (e.g., the skin, nose shape and size, hair),

•Causes significant distress or impairment.

•May develop ideas or delusios of reference.

•Only a quarter of BDD patients have reasonable insight, and around one-third have absent insight.
History

• The term dysmorphophobia was introduced more than a century ago by an Italian psychiatrist,
Morselli.

• It derived from the word “dysmorphia,” meaning misshapenness or ugliness.

• The introduction of BDD into the official nomenclature in 1987 helped to increase clinical
awareness of this condition

Epidemiology:

• Point prevalence (US): 1.7–2.4%
• Mean age of onset: Adolescence
• Gender distribution:
• Community studies: Females > Males

•Focus on:

•In male’s focus is on: Hair, penis size, build/muscles.

•In female’s focus is on: Weight, breasts, hips, body hair, legs.
•
•Common in cosmetic surgery and dermatology clinics .




Comorbidities (Lifetime)Depression (75%),Suicidal ideation (80%),OCD (33%).





Course: Typically, chronic
HOARDING DISORDER

Definition:
• Hoarding Disorder is characterized by the persistent and profound difficulty discarding with or parting from
one’s possessions.

•Patients experience a perceived need to save items and significant distress when attempting to discard them.
• This behavior results in the accumulation of a large number of possessions, causing congestion and clutter
in living spaces.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Commonly hoarded items include:-Daily use items,
-Clothes,
-Newspapers,
-Documents,
-Flyers,
-Unusual items (e.g., nails)
•Reasons for hoarding include:

oPerceived utility: Belief that items may be needed in the future.

oEmotional attachment: Strong sentimental value attached to possessions.

oFear of needing items later: Anxiety about potentially requiring the item in the future.

oAvoiding waste: Concern about items being wasted if discarded.

•Associated problems include:

oHealth issues: Risk of “clutter avalanches,” sanitation problems, infestations of rodents and insects.

oSafety concerns: Increased fire hazards, risk of injury from falling objects.

oRelationship problems: Marital conflicts, issues with neighbors or landlords.

oHousing issues: Risk of eviction, difficulty finding suitable accommodation.
Epidemiology:
•The point prevalence of Hoarding Disorder is approximately 1.5%.

•The gender distribution is equal in the general population, but females are more commonly seen in
clinical settings.

•Unlike other OCRDs, the prevalence of Hoarding Disorder increases with age.

•The average age at first clinical visit is around 50 years.

•Patients are often brought to treatment by their children or authorities rather than seeking help
independently.
History
• Freud described hoarding symptoms as a component of OCPD.

• Italian neurologist Giovanni Mingazzini (1893) wrote about obsessive collecting behaviors,
foreshadowing modern understandings of hoarding.
Trichotillomania
(Hair-Pulling Disorder):


• Hair-pulling disorder is a chronic disorder characterized by repetitive hairpulling, leading to variable
hair loss that may be visible to others.

• It is also known as trichotillomania, from the Greek trich (hair) and tillein (to pull or pluck), a term
coined by a French dermatologist Francois Hallopeau in 1889.

• It resembles both obsessive-compulsive and impulse control disorder: increased tension before the
hairpulling leads to the behavior and then subsequent relief or satisfaction.

Clinical Features:

o Patients engage in repeated pulling out of their own hair, resulting in noticeable hair loss.

o There are repeated attempts to stop or decrease the hair-pulling behavior.

o The disorder causes significant distress or impairment in social, occupational, or other important
areas of functioning.

o Common areas affected include the:
-Scalp (most common),
- Eyebrows,
-Eyelashes,
- Pubic hair.
o Hair pulling is typically done using fingers, but some patients may use tweezers or other instruments.

o Trichophagia, or ingestion of pulled hair, occurs in some cases.

o Can lead to formation of trichobezoars (hairballs) in the digestive tract.

o Trichobezoars can cause acute abdominal pain and may require surgical removal.

o Patients often use various camouflage techniques to hide hair loss, such as wearing hats, wigs, or glasses.
Types of Hair Pulling:

oFocused:•Preceded by an urge or increasing tension.

•The patient attempts to resist the urge.

•Tension increases until hair pulling occurs.

•Pulling is followed by a sense of relief or gratification.

oAutomatic:•Occurs without full awareness.

•The patient may not realize they are pulling until after the fact.
Triggers:
•Hair pulling can be triggered by states of:
•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom).


Epidemiology:•The point prevalence of trichotillomania is estimated to be 0.5–2% of the population.

•There is a strong gender disparity, with a female-to-male ratio of 9:1 (some sources
suggest 4:1).

•The age of onset is often around menarche for females.



•The course of the disorder is typically chronic without treatment.
Excoriation (Skin-Picking) Disorder :

Clinical Features:

•Patients engage in recurrent skin picking, resulting in skin lesions.

•There are repeated attempts to decrease or stop the skin-picking behaviour.

•The disorder causes significant distress or impairment in social, occupational, or other important areas of
functioning.

•Common areas affected include the face, hands, fingers, arms, and legs, often involving multiple sites.

•Skin picking is typically done using fingers, but some patients may use tweezers or other instruments.

•The behavior may begin after a skin condition (e.g., acne) but persists even after the condition resolves.
•
• Patients often use various camouflage techniques to conceal lesions, such as makeup or bandages.

•


o Types of Skin Picking:

•Focused:- Preceded by an urge or increasing tension.

-The patient attempts to resist the urge.

- Tension increases until skin picking occurs.

- Picking is followed by a sense of relief, often followed by guilt.

•Automatic:- Occurs without full awareness.

-The patient may not realize they are picking until after the
fact.
Triggers:

•Skin picking can be triggered by states of:•Hyperarousal (e.g., anxiety)

•Hypoarousal (e.g., boredom)


Epidemiology:

•The point prevalence of excoriation disorder is estimated to be 1.4–5.4% of the
population.
•The disorder is more common in females than males.

•The mean age of onset is around 12 years.

course:

•The course of the disorder is typically chronic without treatment.


Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition:

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other
body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and
related disorder predominate in the clinical picture.

•There is evidence from the history, physical examination, or laboratory findings that the disturbance is
the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

•The disturbance does not occur exclusively during the course of a delirium.
Substance/Medication-Induced Obsessive-Compulsive and Related
Disorder:


•Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other
symptoms characteristic of the obsessivecompulsive and related disorders predominate in the clinical
picture.

•There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
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•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

30. Substances and Medications Linked to OCD/OCS
Dopaminergic agents
L-dopa, bromocriptine, pramipexole, ropinirole (used in Parkinson’s disease)
May trigger compulsive behaviors (sometimes classified as “impulse control disorders”), but OCD-like repetitive thoughts/acts have been reported.
Antiepileptics
Levetiracetam, zonisamide, topiramate → rare reports of inducing obsessive–compulsive symptoms.
Atypical antipsychotics (esp. serotonin-dopamine antagonists)
Clozapine, olanzapine, risperidone → paradoxically may worsen or induce OCS in schizophrenia patients.
Stimulants & related substances
Amphetamines, cocaine, MDMA → can lead to repetitive thoughts/behaviors, sometimes mimicking OCD.
Serotonergic agents
Very rarely, some SSRIs at high doses or serotonin agonists (e.g., fenfluramine, LSD, psilocybin) may cause intrusive thought patterns.
Others (case reports / less common)
Cycloserine (an antibiotic, also used in TB)
Methylphenidate (case reports of OCS)

31. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
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•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

32. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU
Psychologicaldisbelfanxiety
Sur
.
Semen
loss
-

33. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

34. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

35. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

36. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU
E
conduct
Do
-
-
disrobis

37. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU
backor
sette
-
showingstrong
delivefor
wanting
tohost
someonesupers
auopen
over
oppite

38. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU
-
>

39. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

40. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

41. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

42. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

43. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU
-
staysaway
fromschoolToutpermissiono
bot

44. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

45. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

46. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
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•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU

47. •There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

•1. The symptoms developed during or soon after substance intoxication or withdrawal or after exposure
to or withdrawal from a medication.

•2. The involved substance/medication is capable of producing the symptoms.
Other Specified Obsessive-Compulsive and Related Disorder:

cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related
disorders diagnostic class.

• 1. Body dysmorphic–like disorder with actual flaws: This is similar to body dysmorphic disorder except that the
defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than
“slight”).

• 2. Body dysmorphic–like disorder without repetitive behaviors: Presentations that meet body dysmorphic
disorder except that the individual has never performed repetitive behaviors or mental acts in response to the
appearance concerns.

• 3. Other body-focused repetitive behavior disorder: Presentations involving recurrent body-focused repetitive
behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) that are
accompanied by repeated attempts to decrease or stop the behaviors.
Loading…
•4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a partner’s perceived
infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity
concerns;

• 5. Olfactory reference disorder (olfactory reference syndrome): This is characterized by the individual’s
persistent preoccupation with the belief that he or she emits a foul or offensive body odor that is
unnoticeable or only slightly noticeable to others; The syndrome is predominant in males and single
persons. The mean age of onset is 25 years of age.

•6. Shubo-kyofu: is similar to body dysmorphic disorder and is characterized by excessive fear of having a
bodily deformity.

•7. Koro: Related to dhat syndrome :an episode of sudden and intense anxiety that the penis in males (or the
vulva and nipples in females) will recede into the body, possibly leading to death.

DSM-IV-TR:
•OCD was classified under Anxiety Disorders.
DSM-5:
•OCD was moved to a new chapter:
• "Obsessive-Compulsive and Related Disorders" (OCRDs)
•This chapter includes:
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD) (moved from Somatoform
Disorders)
• Hoarding Disorder (new diagnosis)
• Trichotillomania (Hair-Pulling Disorder) (moved from Impulse-
Control Disorders)
• Excoriation (Skin-Picking) Disorder (new diagnosis)
• Substance/Medication-Induced OCRD
• OCRD Due to Another Medical Condition
Key changes from DSM IV to DSM V for OCD and Related
Disorders:

DSM-IV-TR:
•No explicit mention of insight levels.
•Compulsions were defined as behaviors or mental acts aimed at reducing distress or preventing a feared
event.
DSM-5:
•Added a specifier for insight:
• With good or fair insight
• With poor insight
• With absent insight/delusional beliefs
•Clarified definitions and examples of compulsions (especially mental rituals).

•Removed the requirement that the person recognize obsessions or compulsions are
excessive/unreasonable.


1. New Chapter Created for OCD and Related Disorders
o ICD-10:
•OCD was classified under:
• F42: Obsessive-Compulsive Disorder
• Located in the Neurotic, stress-related and somatoform disorders chapter

o ICD-11:
•A new diagnostic grouping was created:
• "06: Obsessive-Compulsive and Related Disorders"

Key changes from ICD-10 to ICD-11 for OCD and Related
Disorders



IMPULSE-CONTROL DISORDERS


• Impulse control disorders are a group of psychiatric conditions marked by an inability to resist impulses,
urges, or temptations that may be harmful to oneself or others.

• Individuals often experience mounting tension or arousal before acting on the impulse, followed by relief,
pleasure, or gratification, and sometimes feelings of guilt or remorse afterward


•Oppositional Defiant Disorder:

•A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
•
•1. Often loses temper.
•2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
Argumentative/Defiant Behavior

•4. Often argues with authority figures or, for children and adolescents, with adults.
•5. Often actively defies or refuses to comply with requests from authority figures or with rules.
• 6. Often deliberately annoys others.
•7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness

•8. Has been spiteful or vindictive at least twice within the past 6 months
Prevalence The cross-national prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average prevalence
estimate of around 3.3%.
The disorder appears to be somewhat more prevalent in boys than in girls (1.59:1) prior to adolescence.
Intermittent Explosive Disorder (IED)

•Represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive
behavior .

•Diagnosis of IED should not be given to individuals if the aggressive symptoms are better explained by
another disorder such as disruptive mood regulation disorder, anti-social personality disorder or
borderline personality disorder, delirium, major neurocognitive disorder, personality change due to
another medical condition (aggressive type), substance intoxication or withdrawal, ADHD, conduct
disorder, oppositional defiant disorder, or autism spectrum disorder.

• The age of onset for IED is in adolescence to early adulthood, ranging from 12 to 21 years of age.


• The 1-year prevalence for intermittent explosive disorder in the United States is about 2.6%, with a
lifetime prevalence of 4.0%. .
• In some studies, the prevalence of intermittent explosive disorder is greater in men and boys than in
women and girls;
Pyromania:

•The diagnosis of pyromania requires a pattern of behavior with multiple episodes of deliberate
and purposeful fire setting on multiple occasions.

•There is tension or emotional arousal before the act and relief after the act, similar to OCD and
kleptomania.

•Individuals with pyromania are curious about fires and are fascinated with fire paraphernalia,
institutions, and people affiliated with the fire departments.

• There is pleasure or relief when setting fires, or when watching or engaging in its aftermath.

•In comparison to arson, the fire setting is not done for monetary reasons, to hide a crime,
express a sociopolitical idea, vengeance, or in response to psychosis or judgment that is
impaired by major neurocognitive disorder, intellectual disability, or substance intoxication.
•Prevalence
• The population prevalence of pyromania is not known.
•Fire-setting behavior occurs more often in men than in women (lifetime prevalence 1.7% vs. 0.4%)
Kleptomania :

• Kleptomania is the recurrent failure to resist impulses to steal items even though the items are not
needed for personal use or for their monetary value .

• The individual experiences a rising subjective sense of tension before the theft and feels pleasure,
gratification, or relief when committing the theft.

•The stealing is not committed to express anger or vengeance, is not done in response to a delusion or
hallucination , and is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.

•The thefts are not preplanned and very little attention is given to the consequences of the theft.

•Occasionally the individual may hoard the stolen objects or surreptitiously return them.

•Individuals with kleptomania typically attempt to resist the impulse to steal, and they are aware that
the act is wrong and senseless.

•The individual frequently fears being apprehended and often feels depressed or guilty about the
thefts.

• Its prevalence in the U.S. general population is very rare, at approximately 0.3%– 0.6%.

•Women outnumber men at a ratio of 3:1.
Conduct Disorder :
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal
norms or rules are violated, as manifested by the presence of at least past 6 months:
●Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
•7. Has forced someone into sexual activity.
●Destruction of Property
•8. Has deliberately engaged in fire setting with the intention of causing serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
●Deceitfulness or Theft
•10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
•12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
entering; forgery).
● Serious Violations of Rules.
•13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
•14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once
without returning for a lengthy period.
•15. Is often truant from school, beginning before age 13 years.

● Lack of remorse or guilt,

● lack of empathy,

● Unconcerned about performance,

● Shallow or deficient affect.
Prevalence
•One-year population prevalence estimates in the United States range from 2% to more than 10%, with a median of 4%.
In the United States,
• the lifetime prevalence was found to be 12.0% among men and 7.1% among women.
• Prevalence rates rise from childhood to adolescence.
Key changes from DSM IV to DSM V for Impulse-Control Disorder:

DSM-IV-TR
Impulse-Control Disorders were grouped under:
•"Impulse-Control Disorders Not Elsewhere Classified"
•Included the following:
• Intermittent Explosive Disorder (IED)
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Impulse-Control Disorder NOS
Key Changes in DSM-5:
•New Chapter:
DSM-5 created a dedicated chapter:
"Disruptive, Impulse-Control, and Conduct Disorders"
•Reclassification:
• Gambling Disorder → Moved to Addictive Disorders
• Trichotillomania → Moved to OCRDs
•Refined Diagnostic Criteria:
• Criteria for IED, Kleptomania, and Pyromania were updated for better clinical clarity.
• IED: Now includes both verbal aggression and behavioral outbursts.
Key changes from ICD-10 to ICD-11 for Impulse-Control Disorder:
ICD-10:
•Impulse disorders were listed under:
• F63: Habit and Impulse Disorders
•Included:
• Pathological Gambling (F63.0)
• Pyromania (F63.1)
• Kleptomania (F63.2)
• Trichotillomania (F63.3)
• Other/Unspecified
Key Changes in ICD-11:
•New Categories Created:
• Gambling Disorder → Moved to Addictive Behaviour Disorders (6C50)
• Trichotillomania → Moved to OCRDs (6B22)
•Impulse-Control Disorders Now Include:
• Intermittent Explosive Disorder (6C70)
• Kleptomania (6C71)
• Pyromania (6C72)
•Clearer Diagnostic Criteria introduced for:
• Duration, frequency, and functional impairment
• Differentiation from other disorders (e.g., mood, psychosis)
REFERENCES :
•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry. 12th ed. Philadelphia: Wolters Kluwer; 2021.

•Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th
ed. Philadelphia: Wolters Kluwer; 2017.

•American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

•World Health Organization. International Classification of Diseases for Mortality and Morbidity
Statistics (11th Revision) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 11].
THANK YOU