WIXLIB

Trichotillomania (also known as Hair-Pulling Disorder)Jasmine first started pulling her hair in her teens,and over time she noticed that the hair had notgrown back. She was very embarrassed by herbald spot, and started wearing hats all the timeto cover it up. Jasmine also started avoidingsocial situations because of her appearance butstill could not stop.Trichotillomania involves recurrent hair pulling,resulting in noticeable hair loss. People withcompulsive hair pulling may pull hair from anypart of their body, including the scalp, eyebrows,eyelashes, pubic area, and legs. Severity rangesbroadly: for some, thinning areas are visible onlyupon close inspection, while others pull to thepoint of baldness. For some, the urge to pull canbe managed with simple tools like relaxation andincreased awareness. For others, the urge can beso strong at times that it feels impossible to resist.tension which are relieved after pulling. For others,Many people wear wigs, hats, or scarves to disguisepulling seems to happen automatically with littlethe hair loss on their scalp, while others may useawareness and no sense of tension or relief.make-up or false eyelashes for hair loss in otherareas. The repetitive nature of pulling seems similarto compulsions in OCD. However, the pulling isusually done for different reasons. For some, theTrichotillomania (Hair-pulling Disorder):compulsive hair pulling to the point ofnoticeable hair loss.need to pull happens in response to feelings of7

Excoriation (Skin-Picking) Disorder(also known as Dermatillomania; pathological skin picking, neurotic/ psychogenic excoriation)Ahmed began picking at a spot on his arm where he felt there might be a small bump. Overtime he found himself picking at any irregularity or bump on his skin, resulting in scarring anddiscolouration. This impact on his appearance made it hard for Ahmed to wear short sleeves, or feelcomfortable in social settings in warmer weather.Hair-pulling and skin-picking disorders fall under anExcoriation (Skin-Picking) Disorder:compulsive skin-picking resulting innoticeable damage to the skin.umbrella of similar behaviours called Body-FocusedRepetitive Behaviours (BFRBs). Other BFRBsinclude compulsive nose-picking, cheek-biting, andnail-biting.Similar to hair pulling, skin picking is thought to becompulsive when it becomes recurrent and results innoticeable scarring and/or damage to the skin.People with compulsive skin picking will makerepeated efforts to stop or reduce their picking, andare significantly distressed by their behaviour. Skinpicking can occur on any part of the body, includingthe face, scalp, lips, and legs. While it is often donein response to a perceived imperfection, this is notalways the case. Regardless, compulsive pickingresults in pain and damage to the skin.8Body-focused Repetitive Behaviours(BFRB): repetitive behaviours that causedamage to one’s appearance and/or physicalinjury

Hoarding DisorderRaoul found it hard to throw things away, especially papers. He worried that he might throw awaysomething that he would need at a later time. He had collected so much paper that there was noroom for anyone else in his apartment. He knew that it was a fire hazard and could no longer use hisbedroom, but still could not bring himself to throw things away.People with hoarding disorder have trouble withand exits, infestation with rodents and insects, lungstuff. They acquire too much stuff and/or havedisease, and inability to maintain good hygeine.trouble getting rid of it. The types of things thatHoarding shares some similar features with OCD:people hoard can vary but are often perceived assome people describe obsessional thinking aboutpotentially useful in the future, valuable or as havingtheir belongings and a compulsive need to acquiresentimental value. Like all the disorders describeditems. Also, the distress felt when having to resisthere, saving and collecting occurs on a continuum.acquiring or when discarding items is consideredMost people save some items that they considersimilar to the anxiety in OCD. However, theuseful or sentimental but when a space becomesthoughts are not typically described as intrusive orcluttered enough to compromise intended usedistressing and the behaviour is not ritualistic and is(e.g. unable to sit on couch in living room due tooften considered pleasurable.clutter) or the person is unable to maintain a safeenvironment for themselves and others, a diagnosisand treatment may be warranted. Potential risksof hoarding include fires, falls, blocked entrancesHoarding Disorder (HD): persistentdifficulty getting rid of possessions becauseof a perceived need to save them.9

How Do We Know it’s OCD? Assessment & DiagnosisEveryone will have upsetting thoughts and manysevere anxiety. Sometimes individuals dealing withpeople have certain ways of doing things. For most,depression will become intensely preoccupied withthese thoughts and behaviours are not a problem.thoughts regarding their past failures. AccurateWhat makes someone with OCD different?assessment is important because it helps guidesAssessment and diagnosis of OCD involves makingtreatment. Different challenges require differentthe distinction between normal thoughts andsolutions. It is also important to note that OCDbehaviours and a diagnosable condition. The bigcan also occur at the same time as other disorders.distinctions are the amount of time occupied bySometimes a clinician may determine that oneobsessions and compulsions, the degree of distress,problem is “primary” which may mean it needs to beand/or the level of impairment (e.g. difficultytreated first before other disorders can be addressed.attending work or school, or inability to socialize).As mentioned, OCD is similar to other disordersThe American Psychiatric Association (APA) definesin some ways. Below is a list of disorders that areOCD in the following way:commonly confused with, or can occur at the sameThe presence of obsessions and/or compulsionstime as OCD. It may be useful to talk to yourwhich occupy more than one hour per day, causehealthcare provider about the differences in moremarked distress OR significantly interfere withdetail to make sure you find the right help.functioning.Common Anxiety Disorders Obsessions ·· persistent unwanted thoughts, images, orimpulsesPanic disorder (fear of recurrent, unexpectedpanic attacks) Agoraphobia (fear of specific situations suchas buses or trains, crowded places or of leavinghome alone) Generalized Anxiety Disorder (excessive worryabout real-life concerns, e.g. health or money) Social Phobia (fear of scrutiny, humiliation orembarrassment in social situations) Specific Phobia (fear of a particular object orsituation, such as heights or snakes) Post-traumatic Stress Disorder (the re-experienceof fear following a traumatic event) Anxiety disorder due to a general medicalcondition (anxiety symptoms are directly relatedto a medical condition; can be ruled out byphysician’s exam) Substance-induced anxiety disorder (anxietydirectly related to the effects of a substance, suchas cocaine)·· Intrusive, uncontrollable/excessive·· provoke anxiety Compulsions·· repetitive behaviours or mental acts·· performed in response to an obsession, or inritualistic fashion·· intended to reduce discomfort or preventfeared eventMental health professionals use specific interviewstrategies and questionnaires to determine whetheror not a person has OCD. Clinicians are carefulto ensure that a person’s symptoms are not betteraccounted for by a different problem, cliniciansare careful to “rule out” other possibilities. Forexample, many anxiety disorders have similarities:fear of specific situations or things; avoidance;10

Differentiating OCD from Other DisordersObsessive-Compulsive PersonalityDisorder (OCPD)DepressionObsessive Compulsive Personality Disorder andin OCD: a depressed person is likely to ruminateOCD are two different conditions with similarabout past mistakes and perceived failures whereas anames. A diagnosis of OCPD describes personalityperson with OCD typically fears things that couldtraits such as extreme perfectionism, indecision,happen in the future. Another important differenceor rigidity with details or rules. People withis that people with depression often brood over theirOCPD are often highly devoted to work and canemotional state as a way to understand it better,become “workaholics”. Other features of OCPDwhereas people with OCD usually try to avoid orinclude being excessively meticulous and difficultyneutralize recurrent thoughts.Thoughts in depression are different than thoseexperiencing affection or enjoyment with others.While many people with OCD report having one ortwo of these traits, a person who has five or more ofthese traits will warrant a diagnosis of OCPD. Thereare important differences between the two diagnoses,particularly in terms of treatment.11

How Do People Get OCD?Like most psychiatric conditions, research indicatesa combination of biological, psychological, andthat there is no single cause of OCD. Instead,sociocultural factors.most experts agree that OCD is likely caused byChanges in Brain ChemistryNeurons: cells in the brainother related disorders. Serotonin, for example, is aneurotransmitter that is important in the regulationNeurotransmitter: a chemical in the brainthat helps transmit signals from one neuronto anotherof mood and impulse control. It also affects memorySerotonin, dopamine, glutamate: naturallyoccuring neurotransmitters in the braincertain brain areas and the development of OCD,and learning processes. There seems to be a linkbetween decreased levels of available serotonin inas well as other conditions such as depression andanxiety disorders. The antidepressant medicationsChemical messengers in the brain, known asused to treat OCD work by raising the level of thisneurotransmitters, transmit signals between brainmessenger in the brain. Dopamine is an importantcells (neurons). These signals are the biologicalneurotransmitter for the reward systems in the brain,basis in the brain for most of our experiences,and has also been linked to OCD, and similarlylike mood, sleep, memory and learning. Someantipsychotic medications which affect dopamineof these neurotransmitters are believed to play acan also sometimes be helpful to OCD. Anotherlarge role in the development of OCD, hoarding,major neurotransmitter, glutamate, is now beingtrichotillomania, compulsive skin picking, andinvestigated in its role in the development of OCD.12

Changes in Brain ActivityThe prefrontal cortex is another structure implicatedin OCD. It is involved in regulating appropriatesocial behavior. Diminished activity in this area canlead to poor impulse control, impaired judgmentand lack of remorse. Increased activity may thereforebe related to increased worry about social andmoral concerns, such as meticulousness, cleanlinessand fears of being inappropriate, all of which areamplified in OCD.Researchers and clinicians are able to study the levelsof brain activity, or metabolism, with advancedimaging techniques such as Positron EmissionTomography (PET), Single Photon EmissionComputed Tomography (SPECT) and functionalMagnetic Resonance Imaging (fMRI). Such studieshave consistently shown that individuals with OCDhave increased levels of activity in three areas of thebrain: the basal ganglia, prefrontal cortex, andcingulate gyrus.The caudate nucleus is a deep brain structure locatedin the basal ganglia. It is believed to act as a filter,Positron Emission Tomography (PET):A brain imaging technique that producesa three-dimensional images of chemicalchanges in the brainSingle Photon Emission ComputedTomography (SPECT): similar to PETscans, SPECT is a brain imaging techniquethat can give information about blood flowand chemical reactions.functional Magnetic Resonance Imaging(fMRI): measures brain activity by lookingat changes in blood flow in the brain.screening messages that it receives from other areasof the brain. It also regulates habitual and repetitiveThe cingulate gyrus helps regulate emotion. It isbehaviors, such as those observed in OCD andalso involved in predicting and avoiding negativerelated disorders. Interestingly, the increased level ofoutcomes, and recognizing errors. In OCD,brain activity in this area normalizes in individualsincreased activity in this brain regionmay be relatedafter successful treatment of OCD, either withto the emotions triggered by obsessive thoughts andmedications or cognitive behavior therapy. Thistofeelings that one has made a mistake or not donedemonstrates that changes in ‘thinking’ that occur insomething correctly. This area is well connected totherapy can alter physical functions in the brain.the prefrontal cortex and basal ganglia via a numberof brain circuits.13

Genetic Factors in OCDTourette’s Syndrome (TS): a neurologicaldisorder characterized by tics. Tics arerepetitive, involuntary, and suddenmovements and/or vocalizations.There is a lot of interest in the exact genes involvedin OCD. Such potential gene ‘candidates’ mayinclude genes that are involved in the regulation ofserotonin and other brain chemicals. At this pointin time, although changes in specific genes havebeen identified that may contribute to the risk ofIt is widely agreed that OCD and its relatedthe illness, the effect of of these variants is too smalldisorders can run in families. Almost half of all casesto be clinically helpful. However in the near futuredemonstrate this pattern. Studies show a highergene testing may be able to help better predict thelikelihood that close relatives of a person with OCDfuture course of the illness, or response to treatment.(e.g. parents, siblings or children) have or willdevelop the disorder at some point in their lifetimes.Although OCD symptoms can be ‘learned’ fromaffected family members, relatives with OCD oftenhave different obsessions and compulsions.There is also a relationship between OCD andTourette’s syndrome (TS). Family members ofindividuals with TS often show higher rates ofOCD than the general population, also suggesting agenetic relationship between these disorders.Other Possible CausesIn a minority of children, the development of Groupof OCD symptoms, suggesting that variations inA Streptocococcal infection (‘strep throat’) has beenhormone levels may play a role.associated with the onset or worsening of OCDOCD symptoms that develop quickly after asymptoms. In these cases, OCD or TS symptomsdevelop very abruptly after infection. Some scientistsbelieve this may be an autoimmune response, wherethe body mounts an immune response by attackingthe basal ganglia in the brain. There is currently noevidence that this, or other infectious agents, play arole in the development of OCD in adulthood.For some women, premenstrual and postpartumperiods can lead to the development or worsening14traumatic event have been observed in certain cases.This suggests that stress can contribute to the onsetof OCD symptoms.There have been small studies showing that damageto the brain, such as stroke or traumatic brain injury,in certain areas can also give rise to new OCDsymptoms.

Psychological FactorsCognitive Theorymay start to avoid being alone with their child, orCognitive (i.e. thought processes) theory focusesmust think “good thoughts” to counter the “badmainly on the thoughts in OCD, instead of thethoughts”.behaviours. It is based on the idea that thoughtsCognitive theorists have identified several patternsimpact how we feel. In OCD, this theory suggestsof beliefs that are common in OCD. Theythat people with OCD misinterpret their thoughts.may contribute to the ways people with OCDIt is not the obsession itself that is the problem, it ismisinterpret their thoughts.the way the obsession is interpreted. Over-inflated sense of responsibility: the beliefthat you are solely responsible for preventingharm to others. Exaggerated sense of threat: a tendency tooverestimate the likelihood of danger Over-importance of thoughts: thoughts arevery important and must be controlled Thought-action fusion: just having a thoughtincreases the chances that it will come true and/or that I will act on itspecial attention. The importance of the thought gets Perfectionism: mistakes are unacceptableexaggerated, which causes the person to feel anxious. Intolerance of Uncertainty: a need for 100%certainty about a given situationResearch shows that most people without OCDhave thoughts, urges, or images similar to theones reported by people with OCD. Intrusive anddisturbing thoughts (e.g. harming a loved one orleaving the stove on and starting a fire) are normaland common. However, for most people, thesethoughts don’t become a problem because they don’tget any special attention; they are easily shruggedoff. For people with OCD however, the thought getsThis leads them to react to the thought as thoughit were an actual threat. They might think, “SinceI had that thought of hurting my child, I must bea dangerous person”. This interpretation can causeintense anxiety, disgust, and guilt. Once thoughtsbecome interpreted in such a way, people with OCDwill try to reduce or eliminate that distress by doingcompulsions or by avoidingsituations that triggerIn cognitive therapy (discussed more in Treatmentsection), people learn to think in more rational andbalanced ways. Cognitive therapy is not about tryingto think only good thoughts or to assume there areno dangers in the world; it is about using skills thathelp us look at situations based on facts, not fear.the disturbing thoughts. In this example, a person15

Behavioural TheorySocial and Cultural FactorsUnlike cognitive therapy, which looks at thoughs,Research on OCD in different cultural groupsbehaviour therapy focuses on the behaviours insuggests that there are no big differences acrossOCD. According to behaviour theory OCD makescultures, age, or between genders. Instead, OCDconnections between certain situations and fear (e.g.symptoms often seem related to the things we valuepublic bathroom anxiety). In order to reduce thatmost or that are particularly relevant in our lives.fear, the person learns to avoid those situations orFor example, obsessions about harming one’s baby isdo rituals. A link is formed between the compulsioncommon amongst new parents with OCD. Similarly,and feeling better. The more someone avoids orindividuals raised in religious homes may developritualizes in response to this fear, the stronger thatobsessions that seem to contradict one’s religiouslink becomes. The stronger this connection, thebeliefs (e.g. sexual thoughts about Jesus Christ).more likely a person is to continue their avoidanceor rituals because they don’t

4. Obsessive-Compulsive disorder is common: about 2.5% of the population or 1 adult in 40 are afflicted, which makes it abo