Obsessive-Compulsive Spectrum Disorders (OCSDs) Part IIMatthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.2) Hypochondriasis
In the current edition of the DSM (DSM-IV-R, 2000), this disorder is not included in the category of anxiety disorders; instead, it is included in the category called, "somatoform disorders." Hypochondriasis is an excessive fear of having, or potentially having, a medical condition based on a misinterpretation, or exaggeration of bodily symptoms and cues. This worry continues even after medical evaluations and assurances have been provided. The main concerns of someone with Hypochondriasis are pain, having a serious medical illness (such as AIDS), and gastrointestinal issues. Treatment for this disorder is found in the treatment section.
3) Trichotillomania
In the current edition of the DSM (DSM-IV-R, 2000), this disorder is not included in the category of anxiety disorders; instead, it is included in a category called, "impulse-control disorders not elsewhere classified." The characteristic feature of Trichotillomania is repeated hair pulling that leads to a visible loss of hair. It begins with an urge, or a feeling of tension, that is experienced just before pulling, or when attempting to refrain from pulling. Feelings of pleasure, gratification, or relief are associated with hair pulling. Oftentimes, hair pulling can be followed by looking at the hair root, pulling the hair between their teeth, or eating the hair. Though it is currently classified as an impulse-control disorder, many researchers now believe that Trichotillomania fits into the OCSDs category. Treatment is discussed here.
4) Tourette's disorder
In the current edition of the DSM (DSM-IV-R, 2000), this disorder is not included in the category of anxiety disorders; instead it is included in a category called, "disorders usually first diagnosed in infancy, childhood, or adolescence." Tourette's disorder is characterized by multiple "tics" which are stereotypic, rapid, non-rhythmic vocalizations or movements. Motor tics usually involve the head, torso, and limbs such as eye blinking, retracing steps, or twirling while walking. Vocal tics include various words or sounds such as clicks, grunts, barks, sniffs, snorts, etc. Though the use of profanity (known as coprolalia) is most often associated with this disorder, only 10% of individuals with Tourette's experience this particular symptom (APA, 2000). Tics must endure for one year and may occur every day, or intermittently. The gap between episodes cannot exceed three months in order to meet diagnostic criteria. Onset is always before the age of 18. OCD and Tourette's commonly co-occur (occur together) and it is believed they have a common genetic pathway. Treatment for Tourette's is found in the treatment section.
5) Hoarding
The previous four examples of the Obsessive-Compulsive Spectrum Disorders are included in the most recent version of the DSM (DSM-IV-R); but, as mentioned, they are not currently categorized as anxiety disorders. However, Hoarding is not listed at all in DSM-IV-TR. Nonetheless, Hoarding has received a great deal of attention lately, and it is anticipated that it will be included in the upcoming DSM-V. In the current diagnostic system (DSM-IV-R) Hoarding would usually be diagnosed as Anxiety Disorder Not Otherwise Specified.
Hoarding refers to acquiring and saving items that have little or no value, and having a difficult time getting rid of these worthless possessions, even when it would be advantageous to do so. Symptoms might include an aversion to disposing of these items; becoming highly anxious when attempting to make decisions about whether to keep, or dispose of an item; obsessively thinking about their possessions; and disorganization and excessive clutter in the location where these items are stored (usually at home). As with other anxiety disorders, individuals that hoard experience functional impairments including conflict with family members over the amount, and disorganization of their possessions; the loss of functional space in their home; health or safety hazards that result from hoarding; and financial troubles. You may also wish to review an interview with an expert on Hoarding Disorder, Gail Sketeke.
People often confuse hoarding with collecting, but they are not the same. Collectors take great delight in displaying their items, and their collections are usually exceptionally well-organized, and maintained. Collectors enjoy showing off their prized collections, and speak about their collection with a sense of pride. A good example is Jay Leno's well-known, car collection. He takes great pride in his car collection, he often talks about his cars, and he frequently shows video clips of his garage where his collection is housed. On the other hand, people who hoard are embarrassed, and dislike having people come to their homes due to their embarrassment over their disorganization and clutter.
Much of the scientific literature suggests that hoarding is related to OCD; however, not everybody who hoards has OCD and visa versa. It is estimated that roughly one-quarter to one-third of those with OCD may have hoarding symptoms as well (Neziroglu, Bubrick, & Yaryura-Tobias, 2004). Treatment for Hoarding Disorder is found here.
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