CHAPTER 5 - Anxiety, Trauma- and An intense discomfort that reaches a peak within

Stressor-Related, and Obsessive-Compulsive minutes, and during which time four (or more) of the
and Related Disorders following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart
The Complexity of Anxiety Disorders rate
An emotion implicated in both biological and 2. Sweating
psychological 3. Trembling or shaking
Panic attack - occurs when we fear something 4. Sensations of shortness of breath or smothering
Anxiety - negative mood state characterized by 5. Feeling of choking
bodily symptoms of physical tension/apprehension 6. Chest pain or discomfort
about the future 7. Nausea or abdominal distress
- In humans, it is: 8. Feeling dizzy, unsteady, lightheaded, or faint
○ A subjective sense of unease 9. Chills or heat sensations
○ A set of behaviors 10. Paresthesias (numbness or tingling sensational)
○ Physiological response originating from the brain - 11. Derealization (feelings of unreality) or
reflected in elevated heart rate - muscle tension depersonalization (being detached from oneself)
- Closely related to depression 12. Fear of losing control or going crazy
- Psychologists have known that we perform better 13. Fear of dying
when we are a little anxious
- Things could go wrong Biological Contributions
- Future-oriented mood state - Increasing evidence shows that we inherit a
- Unpredictable or uncontrollable upcoming events tendency to be tense, uptight, and anxious
- Negative affect - No single gene seems to cause anxiety or panic or
- Somatic symptoms of tension any other psychiatric disorder
Fear - immediate alarm reaction to danger - Anxiety is associated with specific brain circuits and
- Protects us by activating a massive response from neurotransmitters systems
the Autonomic Nervous - GABA-benzodiazepine system; noradrenergic
System (ANS) system; serotonergic neurotransmitter system is
○ Increased heart rate and blood pressure associated with increased anxiety
○ Subjective sense of terror - Controcotropin-releasing factor. the central to the
○ Flight or fight response expression of anxiety (and depression) CRF
- Immediate emotional reaction - Hypothalamic-pituitary-adrenocortic al (HPA) has
- Negative affect wide-ranging effects on areas of the brain implicated
- Strong sympathetic nervous system arousal in anxiety
Panic attack - an abrupt experience of intense - Limbic system; emotional brain
fear or acute discomfort; accompanied by physical - Hippocampus and amygdala
symptoms: - Locus coeruleus (brain stem)
- Heart palpitations - Prefrontal cortex
- Chest pain - Dopaminergic neurotransmitter system
- Shortness of breath Limbic system
- Dizziness - Brain stem and the cortex
Fear and anxiety reactions differ psychologically and Behavioral inhibition systems (BIS)
physiologically - Activated by signals from the brain stem of
(2) Basic types of panic attacks unexpected events
- Fear occurring at an inappropriate time - Major changes in body functioning that might signal
Expected (cued) panic attacks danger
Unexpected (uncued) panic attacks - When activated, we freeze, experience anxiety, and
apprehensively evaluate the situation to confirm that
Diagnostic Criteria for Panic Attack: danger is present
- fight/flight system (FFS) months about a number of events or activities (such
as work or school performance)
Psychological Contributions B. The individual finds it difficult to control the worry
- Behavioral theorists. a product of early classical C. The anxiety and worry are associated with at least
conditioning, modeling, or other forms of learning three (or more) of the following six symptoms (with at
- Anxiety sensitivity. to determine who or who will least some symptoms present for more days than not
not experience problems with anxiety under certain for the past 6 months)
stressful conditions Note: Only one item is required in children.
- A strong fear response initially occurs 1. Restlessness or feeling keyed up or on edge
during extreme stress or perhaps as a result of a 2. Benign easily fatigued
dangerous situation in the environment 3. Difficulty concentrating or mind going blank
Social Contributions 4. Irritability
- Stressful life events trigger our biological and 5. Muscle tension
psychological vulnerabilities to anxiety 6. Sleep disturbance (difficulty falling or staying asleep
- E.g. marriage, divorce, difficulties at work, death of a or restless, unsatisfying sleep)
loved one, pressure at school, etc. D. The anxiety, worry, or physical symptoms cause
- Headaches, hypertension, or any emotional clinically significant distress or impairment in social,
reactions such as panic attacks. occupational, or other important areas of functioning
E. The disturbance is not due to the direct
An Integrated Model physiological effects of a substance (e.g. drug of
Triple vulnerability theory abuse, a medication) or a general medical condition
- Theory of the development of anxiety (e.g., hyperthyroidism)
Generalized biological vulnerability F. The disturbance is not better explained by another
- First vulnerability mental disorder (e.g., anxiety or worry about having
- The tendency to be uptight or high-strung might be panic attacks in panic disorder, negative evaluation in
inherited social anxiety disorder)
- Heritable contribution to negative affect Causes
Generalized psychological vulnerability - Stressful events
- Second vulnerability - Anxious apprehension
- Grow up believing the world is - Worry process
dangerous and out of control and you - Intense cognitive processing
might not be able to cope when things go wrong - Avoidance of imagery
based on your early experiences - Inadequate problem solving skills
- Senses that events are uncontrollable - Restricted autonomic response
Specific psychological vulnerability Treatment
- Learning from early experience such as taught by - Drug; benzodiazepines
patients - Psychological; encouraging, CBT
- Physical sensations are potentially dangerous
Panic Disorder and Agoraphobia
Anxiety Disorders Agoraphobia - fear and avoidance of situations in
- Generalized anxiety disorder, panic disorder, which a person feels unsafe or unable to escape to
agoraphobia, specific phobia, and social anxiety get home or to a hospital in the event of a developing
disorder panic
Typical situations:
Generalized Anxiety Disorder - Shopping malls
Diagnostic Criteria for Generalized Anxiety Disorder - Cars, buses, trains, subways
A. Excessive anxiety and worry(apprehensive - Wide streets, tunnels
expectation), occurring more than not for at least 6 - Restaurants, theaters
- Being far from home or staying at home alone
- Waiting in line (supermarkets, stores) E. The fear or anxiety is out of proportion to the
- Crowds actual danger posed by the
- Planes agoraphobic situations, and to the sociocultural
- Elevators or escalators context.
Interoceptive daily activities typically avoided: F. The fear, anxiety or avoidance is persistent, typically
- Running up flights of stairs lasting for 6 months or more.
- Walking outside in intense heat G. The fear, anxiety or avoidance causes clinically
- Having showers with the doors and windows closed significant distress or impairment in social,
- Hot, stuffy stores or shopping malls occupational or other important areas of functioning.
- Lifting heavy objects H. If another medical condition (e.g., inflammatory
- Dancing bowel disease, Parkinson’s disease) is present, the
- Eating chocolate fear, anxiety or avoidance is clearly excessive.
- Sports I. The fear, anxiety or avoidance is not better
Diagnostic Criteria for Panic Disorder explained by the symptoms of another mental
A. Recurrent unexpected panic attacks are present. disorder, e.g., the symptoms are not confined to
B. At least one of the attacks has been followed by 1 specific phobia, situational type; do not involve only
month or more of one or both of the following: social situations (as in social anxiety disorder) and are
(a) Persistent concern or worry about additional panic not related exclusively to obsessions (as in obsessive-
attacks or their consequences (e.g., losing control, compulsive disorder), perceived deficits or flaws in
having a heart attack, <going crazy=) physical appearance (as in body dysmorphic
(b) A significant maladaptive change in behavior disorder), reminders of traumatic events (as in
related to the attacks (e.g., behaviors designed to posttraumatic stress disorder), or fear of separation
avoid having panic attacks, such as avoidance of (as in separation anxiety disorder)
exercise or unfamiliar situations). Causes
C. The disturbance is not attributable to the - Agoraphobia often develops after a person has
physiological effects of a substance (e.g., a drug of unexpected panic attacks
abuse, a medication) or another medical condition - Stress due to life events
(e.g., hyperthyroidism, cardiopulmonary disorders). - False alarm; learned alarm
D. The disturbance is not better explained Treatment
by another mental disorder (e.g., panic attacks do not Medication.
occur only in response to feared social situations, as in - High-potency benzodiazepines
social anxiety disorder). - Selective-serotonin reuptake inhibitors (SSRIs)
Diagnostic Criteria for Agoraphobia - Serotonin-norepinephrine reuptake inhibitors
A. Marked fear or anxiety about two or more of the (SNRIs)
following five situations: Public transportation, open
spaces, enclosed places, standing in line or being in a Psychological Intervention.
crowd, being outside the home alone. - Exposure exercises with anxiety-reducing coping
B. The individual fears or avoids these situations due mechanisms (relaxation, breathing retraining)
to thoughts that escape might be difficult or help - Panic control treatment (PCT)
might not be available in the event of developing
panic-like symptoms or other incapacitating or Specific Phobia
embarrassing symptoms (e.g., fear of falling in the Specific Phobia - is an irrational fear of a specific
elderly, fear of incontinence). object or situation that markedly interferes with an
C. The agoraphobic situations almost always provoke individual’s ability to function.
fear or anxiety. Diagnostic criteria for Specific Phobia
D. The agoraphobic situations are actively avoided, A. Marked fear or anxiety about a specific object or
require the presence of a companion, or are endured situation (e.g., flying, heights, animals, receiving an
with intense fear or anxiety. injection, seeing blood).
B. The phobic object or situation almost always happen to the children themselves that will separate
provokes immediate fear or anxiety. Note: In them from their parents
children, the anxiety may be expressed by crying, - E.g. they will be lost, kidnapped, killed, or hurt in an
tantrums, freezing, or clinging. accident
C. The phobic object or situation is actively avoided
or endured with intense fear or anxiety. Social Anxiety Disorder (Social Phobia)
D. The fear or anxiety is out of proportion to the Diagnostic Criteria for Social Anxiety
actual danger posed by the specific object or Disorder (SAD)
situation, and to the sociocultural context. A. Marked fear or anxiety about one or more social
E. The fear, anxiety or avoidance is persistent, situations in which the person is exposed to possible
typically lasting for 6 months or more. scrutiny by others.
F. The fear, anxiety or avoidance causes clinically - Examples include social interactions (e.g., having a
significant distress or impairment in social, conversation; meeting unfamiliar people), being
occupational or other important areas of functioning. observed (e.g., eating or drinking), or performing in
G. The disturbance is not better explained by the front of others (e.g., giving a speech)
symptoms of another mental disorder, including fear, Note: In children, the anxiety must occur in peer
anxiety and avoidance of: situations associated with settings and not just in interactions with adults.
panic-like symptoms or other incapacitating B. The individual fears that he or she will act in a way,
symptoms (as in agoraphobia); objects or situations or show anxiety symptoms, that will be negatively
related to obsessions (as in obsessive-compulsive evaluated (i.e., will be humiliating, embarrassing, lead
disorder); reminders of traumatic events (as in to rejection, or offend others).
posttraumatic stress disorder); separation from home C. The social situations almost always
or attachment figures (as in separation anxiety provoke fear or anxiety.
disorder); or social situations (as in social anxiety Note: in children, the fear or anxiety may be
disorder) expressed by crying, tantrums, freezing, clinging,
Specify type: shrinking, or failing to speak in social situations.
1. Animal D. The social situations are avoided or endured with
2. Natural environment (e.g., heights, storms, and intense fear or anxiety.
water) E. The fear or anxiety is out of proportion to the
l

3. Blood–injection–injury actual threat posed by the social situation, and to the

4. Situational (e.g., planes, elevators, or enclosed sociocultural context.
places) F. The fear, anxiety or avoidance is persistent,
5. Other (e.g., phobic avoidance of situations that may typically lasting for 6 months or more.
lead to choking, G. The fear, anxiety or avoidance causes clinically
vomiting, or contracting an illness; or in children, significant distress or impairment in social,
avoidance of loud sounds or costumed characters) occupational or other important areas of functioning.
Causes H. The fear, anxiety or avoidance is not attributable to
- Direct experience the effects of a substance (e.g., a drug of abuse, a
- Experiencing a false alarm medication) or another medical condition.
- Observing someone else experiencing severe fear I. The fear, anxiety or avoidance is not better
- Being told about danger explained by the symptoms of another mental
Treatment disorder, such as panic disorder (e.g., anxiety about
- Exposure-based exercise having a panic attack) or separation anxiety disorder
(e.g., fear of being away from home or a close
Separation Anxiety Disorder relative).
Separation anxiety disorder is characterized by J. If another medical condition (e.g., stuttering,
children’s unrealistic and persistent worry that Parkinson’s disease, obesity, disfigurement from
something will happen to their parents or other burns or injury) is present, the fear, anxiety or
important people in their life or that something will avoidance is clearly unrelated or is excessive.
Specify if: Performance only: If the fear is restricted 2. Recurrent distressing dreams in which the content
to speaking or performing in public. and/or affect of the dream are related to the
Causes traumatic event(s).
- Biological tendency to be socially Note: In children, there may be frightening dreams
inhibited without recognizable content.
- Stressful events 3. Dissociative reactions (e.g., flashbacks) in which the
- panic attacks in social situations individual feels or acts as if the traumatic event(s)
Treatment were
- Cognitive therapy recurring. (Such reactions occur on a continuum, with
- Interpersonal psychotherapy (IPT) the most extreme expression being a complete loss of
- CBT awareness of present surroundings.)
- Drug. SSRI drug Prozac Note: In young children, trauma specific reenactment
- Self-exposure may occur in play.
Trauma- and Stressor-Related Disorders 4. Intense or prolonged psychological distress at
- Happens after a relatively stressful life event exposure to internal or external cues that symbolize
Posttraumatic Stress Disorder or
Posttraumatic Stress Disorder (PTSD) - resemble an aspect of the traumatic event(s).
exposure to a traumatic event during which an 5. Marked physiological reactions to internal or
individual experiences or witnesses death or external cues that symbolize or resemble an aspect of
threatened death, actual or threatened serious injury, the traumatic event(s).
or actual or threatened sexual violation C. Persistent avoidance of stimuli associated with the
Diagnostic Criteria for Posttraumatic Stress Disorder traumatic event(s), beginning after the traumatic
A. Exposure to actual or threatened death, serious event(s)occurred, as evidenced by one or both of the
injury, or sexual violence in one (or more) of the following:
following ways: 1. Avoidance of or efforts to avoid distressing
1. Directly experiencing the traumatic event(s). memories, thoughts, feelings, or conversations about
2. Witnessing, in person, the event(s) as they occurred or closely associated with the traumatic
to others. event(s).
3. Learning that the event(s) occurred to a close 2. Avoidance of or efforts to avoid external
relative or close friend. In cases of actual reminders (people, places, conversations, activities,
or threatened death of a family member or friend, the objects, situations) that arouse distressing memories,
event(s) must have been violent or accidental. thoughts, or feelings about or closely associated with
4. Experiencing repeated or extreme exposure to the traumatic event(s).
aversive details of the traumatic event(s) (e.g., first D. Negative alterations in cognitions and mood
responders collecting human remains; police officers associated with the traumatic event(s), beginning or
repeatedly exposed to details of child abuse). worsening after the traumatic event(s) occurred, as
Note: Criterion A4 does not apply to exposure evidenced by two (or more) of the following:
through electronic media, television, movies, or 1. Inability to remember an important aspect of the
pictures, unless this exposure is work related. traumatic event(s) (typically due to dissociative
B. Presence of one (or more) of the following amnesia and not to other factors such as head injury,
intrusion symptoms associated with the traumatic alcohol, or drugs).
event(s), beginning after the traumatic event(s) 2. Persistent and exaggerated negative beliefs or
occurred: expectations about oneself, others, or the world (e.g.,
1. Recurrent, involuntary and intrusive distressing <I am bad,= <no one can be trusted,=
memories of the traumatic event(s). <the world is completely dangerous,= <My whole
Note: In young children, repetitive play may occur in nervous system is permanently ruined=).
which themes or aspects of the traumatic event(s) are 3. Persistent distorted cognitions about the cause or
expressed. consequences of the traumatic event(s) that lead the
individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, - Process the intense emotions
horror, anger, guilt, or shame). - Develop effective coping procedures to overcome
5. Markedly diminished interest
14 - Catharsis. Arranging the reexposure so that it will be
or participation in significant activities. therapeutic rather than traumatic
6. Feelings of detachment or estrangement from - Imaginal exposure. Exposure practices
others. - Cognitive therapy. CBT
7. Persistent inability to experience positive - Drugs. SSRIs (prozac, paxil)
emotions
(e.g., inability to experience happiness, satisfaction, or Obsessive-Compulsive and Related Disorders
loving feelings). ● Person that has been diagnosed with anxiety and its
E. Marked alterations in arousal and reactivity related disorders that needs hospitalization is likely to
associated with the traumatic event(s), beginning or have obsessive- compulsive disorder (OCD).
worsening after the traumatic event(s) occurred, as ● Psychosurgery- neurosurgery for a psychological
evidenced by two (or more) of the following: disorder.
1. Irritable behavior and angry outbursts (with little ● Px that is referred to psychosurgery because
or no provocation) typically expressed as verbal or psychological and pharmacological treatment failed,
physical aggression toward people or objects. probably has OCD.
2. Reckless or self-destructive behavior. ● Uncommon with Px with OCD = severe generalized
3. Hypervigilance. anxiety, recurrent panic attacks, debilitating
4. Exaggerated startle response. avoidance,
5. Problems with concentration. and major depression, all occurring simultaneously
F. Sleep disturbance (e.g., difficulty falling or staying with
asleep or restless sleep). Duration of the disturbance obsessive-compulsive symptoms.
(Criteria B, C, D and E) is more than one month. ● When Px with OCD seems hopeless with the
G. The disturbance causes clinically significant scientific treatments they often try magic and rituals.
distress or impairment in social, occupational, or Clinical Description
other important areas of functioning. ● In anxiety disorder, the harm with the Px is with
H. The disturbance is not attributable to the external objects or situations. WHILE in OCD the
physiological effects of a substance (e.g., medication, danger is on, thought, image, or impulse.
alcohol) or another medical condition. ● Obsessions- intrusive, nonsensical thoughts, images
Specify if: With delayed expression: If the full or urges that a Px tries to resist or eliminate.
diagnostic criteria are not met until at least 6 ● Compulsions- thoughts, actions to suppress the
months after the event (although it is understood obsessions and give relief.
that onset and expression of some symptoms may be Types of Obsessions and Compulsions
immediate). ● The four major types of obsessions is associated
Specify whether: With Dissociative with a pattern of compulsive behavior.
Symptoms: The individual’s symptoms meet the
criteria for posttraumatic stress disorder, and in DSM 5: Diagnostic Criteria for Obsessive
addition, in response to the stressor, the individual Compulsive Disorder
experiences persistent or recurrent symptoms of A. Presence of obsessions, compulsions or both:
either depersonalization or derealization. Obsessions are defined by 1 and 2:
Causes 1. Recurrent and persistent thoughts, urges, or images
- In terms of the precipitating event: Someone that are experienced, at some time during the
personally experiences a trauma and develops a disturbance, as intrusive and inappropriate and that in
disorder. most individuals cause marked anxiety or distress
- Biological, psychological, and social factors 2. The individual attempts to ignore or suppress such
Treatment thoughts, impulses, or images, or to neutralize them
Psychological. with some other thought or action
- Face the original trauma Compulsions are defined by 1 and 2:
1. Repetitive behaviors (e.g., handwashing, ordering, probably not true or that they may or may not be
checking) or mental acts (e.g., praying, counting, true.
repeating words silently) that the individual feels - With poor insight: The individual thinks obsessive-
driven to perform in response to an obsession, or compulsive disorder beliefs are probably true.
according to rules that must be applied rigidly - With absent insight/delusional: the person is
2. The behaviors or mental acts are aimed at completely convinced that obsessive-compulsive
preventing or reducing distress or preventing some disorder beliefs are true.
dreaded event or situation; however, these behaviors Specify if:
or mental acts either are not connected in a realistic Tic-related: The individual has a current or past
way with what they are designed to neutralize or history of a tic disorder.
prevent or are clearly excessive.
B. The obsessions or compulsions are time-consuming Types of Obsessions and Associated
(e.g., take more than 1 hour per day), or cause
clinically significant distress or impairment in social,
occupational
or other important areas of functioning.
C. The disturbance is not due to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the
symptoms of another mental disorder (e.g., excessive
worries, as in generalized anxiety disorder, or
preoccupation with appearance, as in body
dysmorphic disorder).
Specify if:
- With good or fair insight: the individual recognizes
that obsessive-compulsive disorder beliefs are
definitely or

● Symmetry- keeping things in perfect order or doing

something in a specific way. For example: Richard
thought that if he did not eat in a certain way he
might become possessed. If he didn’t take small steps
and look back, some disaster might happen to his
family.
● On rare occasions, Px children will have compulsions - found essentially similar types and proportions of
but no obsessions. For example: An 8-year-old child obsessions and compulsions, as did studies from
who Canada, Finland, Taiwan, Africa, Puerto Rico, Korea,
felt compelled to undress, put on his pajamas, and and New Zealand
turn down the covers in a time-consuming fashion
each night; he always repeated the ritual three times. Body Dysmorphic Disorder
He could give no particular reason for his behavior; he ● Body Dysmorphic Disorder (BDD)- people fantasize
simply had to do it. about improving something, but some relatively
normal-looking people think they are so ugly they
Tic Disorder and OCD refuse to interact with others or otherwise function
● Tic disorder- involuntary movement (sudden jerking normally for fear that people will laugh at their
of limbs) ugliness.
● Tourette’s disorder- more complex tics with ● People with BDD complain of persistent, intrusive,
involuntary vocalizations and horrible thoughts about their appearance, and
● The obsessions in tic-related OCD are almost always they engage in such compulsive behaviors as
related to symmetry. repeatedly looking in mirrors to check their physical
● <PANDAS=- as Pediatric AutoimmuNe Disorder features.
Associated with Streptococcal infection ● Dysmorphophobia- fear of ugliness
- One small group of children presenting OCD and tics - For decades people with BDD have been
suggest that these problems occurred after strep misdiagnosed with this phobia.
throat. - Represent a psychotic delusional state because the
- More likely to be male, has fever, or sore throat. affected individuals were unable to realize, even for a
- Full remission of symptoms during antibiotic fleeting moment, that their ideas were irrational.
therapy. ● UNCOMMON- For people with BDD to be seen in
- Noticeable clumsiness mental health clinics because they often tend to seek
- Past streptococcal infections plastic surgeons and dermatologists
- Revised and broadened under the umbrella term ● MEN- focus on body build, genitals, and thinning
hair and tend to have more severe BDD.
Pediatric Auto-immune Neuropsychiatric Syndrome ● WOMEN- focus on more varied body areas and are
Statistics more likely to also have an eating disorder.
● Estimates of the lifetime prevalence of OCD range ● Common consequences of BDD are depression and
from 1.6% to 2.3% substance abuse.
● Obsessions and compulsions are in continuum, just ● Psychopathology of BDD- reacting to a
like anxiety disorder. <deformity=that others cannot perceive.
● <Normal= - Intrusive and distressing thoughts are ● People that conform with their culture such as
common in nonclinical individuals. altering facial features do not have BDD.
- 13% of a <normal= community sample of people had Diagnostic Criteria for Body Dysmorphic Disorder
moderate levels of obsessions or compulsions that A. Preoccupation with one or more defects or flaws in
were not severe enough to meet diagnostic criteria physical appearance that are not observable or
for OCD. appear slight to others.
● OCD (mid-adolescents) sex ratio 1(female):1(male) B. At some point during the course of the disorder,
patients. the individual has performed repetitive behaviors
● OCD develops becomes chronic. (e.g., mirror checking, excessive grooming, skin
● Arabia and Egypt picking, reassurance seeking) or mental acts (e.g.,
- obsessions are primarily related to religious comparing his or her appearance with that of others)
practices, in response to the appearance concerns.
specifically the Muslim emphasis on cleanliness. C. The preoccupation causes clinically significant
● England, Hong Kong, India, Egypt, Japan, and distress or impairment in social, occupational, or
Norway other important areas of functioning.
D. The appearance preoccupation is not better ● genetic influence.
explained by concerns with body fat or weight in an ● Both disorders were classified under impulse
individual whose symptoms meet diagnostic criteria control disorders, often co-occur with OCD and BDD.
for an eating disorder. ● these behaviors tend to relieve tension.
Specify if: ● Treatment: habit reversal training.
With good or fair insight: The individual recognizes ● Substitute different behavior such as chewing gum
that the body dysmorphic disorder beliefs are or other reasonably pleasurable but harmless
definitely or probably not true or that they may or behavior.
may not be true. ● serotonin reuptake inhibitors.
With poor insight: The individual thinks that the body ● Repetitive and compulsive hair pulling resulting in
dysmorphic disorder beliefs are probably true. significant noticeable loss of hair or repetitive and
With absent insight/delusional beliefs: the compulsive picking of the skin leading to tissue
individual is completely convinced that the body damage characterize trichotillomania and excoriation
dysmorphic disorder beliefs are true. disorders respectively.
With muscle dysmorphia: The individual is
preoccupied with the idea that his or her body build is
too small or insufficiently muscular.
This specifier is used even if an individual is
preoccupied with other body areas, which is often the
case.

Other Obsessive-Compulsive and Related Disorders

Hoarding Disorder
● fear of discarding things due to thoughts of urgently
needing it.
● nearly equal number of men and women.
● excessive acquisition of things, difficulty discarding
anything, living w/ excessive clutter under conditions
best characterized as gross disorganization.
● Hoarding disorder is characterized by excessive
acquisition of things, difficulty discarding anything,
and
living with excessive clutter under conditions best
characterized as gross disorganization.
● Treatment approaches are similar to those for OCD
but are less successful.
Excoriation
● repetitive and compulsive picking of the skin leading
to tissue damage.
● require medication.
● there is a significant embarrassment, distress, and
impairment in terms of social and work functioning.
● female disorder
Trichotillomania
● urge to pull own hair including scalp, eyebrows, and
arms.
● Results in noticeable hair loss, distress, and
significant social impairments.
● female more than male