Tag Archive for: syndrome

Syndrome Series: Obsessive Compulsive Disorder

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obsessive compulsive disorder shoes

What is Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a condition characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent thoughts, urges, or images that are intrusive and unwanted, while compulsions are repetitive behaviors or mental acts that are applied to the obsessions (or other rules) that are rigidly followed.

Types of Obsessions and Compulsions

The types of obsessions and compulsions vary broadly, although there are common themes. Stereotypical OCD symptoms showcased in media are fear of contamination accompanied by compulsive cleaning (seen famously on the TV show Monk). Other common themes include symmetry (organizing, ordering, or counting compulsions), morality (sexual, aggressive, or religious based compulsions), or harm (checking compulsions for fear of harming others). These themes are seen globally across cultures with minor variances.

The performance of the compulsion is done in an attempt to mitigate anxiety or distress associated with the obsession. Individuals with OCD typically have an impending sense of doom if they don’t perform the compulsions, or they may believe something horrific will occur if they do not perform the tasks. The individual with this condition finds distress in their compulsions and obsessions and avoiding the compulsion or obsession can take up a significant amount of time. Because of this, they may avoid of people or certain places in order to avoid a trigger for a compulsion.

Realistically, the action and obsessions are not connected in any significant way. However, the extent that the individual believes this depends on their insight.

Insight

Insight refers to how well the individual recognizes the credibility of their beliefs. They may have good or fair insight in which they realize their disordered beliefs are definitely or most likely untrue; poor insight in which they think their obsessive compulsive beliefs are probably true; or absent insight in which they are completely convinced their disordered beliefs are true.

Prevalence and Transmission

The average age of onset is 19.5 years old, with a quarter of cases starting by the age of 14. Females tend to be affected slightly more than males in adulthood, while males are more affected in childhood. The prevalence in the U.S. is 1.2%, with similar prevalence rates seen globally. There is a 2x rate of familial transmission among first degree relatives with the condition compared to those without first degree relatives with the condition.

First Line Treatments

Treatment options for OCD generally includes psychotherapy and pharmaceuticals. These can be used exclusively or in combination with each other.

Psychotherapy

Cognitive Behavioral Therapy (CBT) is one of the first line treatment options for OCD. CBT is effective in treating OCD by helping the individual become aware of the cognitive distortions present that are leading to their compulsive behavior. Once identified, the clinician can work with the patient to untangle how the obsession and compulsion are not directly related and ultimately remove the desire to complete the compulsion when faced with a trigger.

In addition to standard CBT, there is another type of CBT called Exposure and Response Prevention (ERP) that can be highly effective in the treatment of OCD. With this type of therapy, the client is systematically exposed to gradually increasing levels of the trigger for their compulsions and assisted in learning how to reject the compulsion.

Pharmaceuticals

Mayo clinic reports the following antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD:

  • Clomipramine (Anafranil) for adults and children 10 years and older
  • Fluoxetine (Prozac) for adults and children 7 years and older
  • Fluvoxamine for adults and children 8 years and older
  • Paroxetine (Paxil, Pexeva) for adults only
  • Sertraline (Zoloft) for adults and children 6 years and older

Additional Treatment Options

Other treatment options may be considered if first line treatments fail. These include Deep Brain Stimulation and Transcranial Magnetic Stimulation. These options are typically reserved for cases in which neither first line treatments have been found to be effective, and are generally used in patients over the age of 18. In both these treatment options, different neurological regions of the brain are stimulated using electrodes in order to suppress compulsive thoughts and behaviors.

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REFERENCES:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438#:~:text=Antidepressants%20approved%20by%20the%20U.S.,children%208%20years%20and%20older

Syndrome Series: Schizoid vs. Schizotypal Personality

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man in front of mirror representing schizoid personality

What is Schizoid Personality

Schizoid personality is a cluster A personality disorder found in the DSM-V. Individuals with this disorder are not “almost schizophrenic” as the name may imply. Instead, these are unique individuals that show detachment from socials relationship and severe restriction in range of emotional expression. The DSM classifies it as showing at least four of the following: neither desire or enjoyment of close relationships (including being a part of a family), almost always choosing solitary activities, having little if any interest in sexual experiences with other people, experiencing little pleasure from any activities, lacking close friends or confidants, showing indifference to praise or criticism, and showing emotional coldness, detachment or flattened affectivity.

This pattern of behavior usually emerges in early adulthood. To others, these individuals seem to lack a desire of any form of intimacy or social connectedness. It is not a common condition, with a prevalence rate of 3.1- 4.9% in the U.S. population.

Schizoid vs. Schizotypal Personality

Schizotypal personality is also a cluster A personality disorder. Although the names are similar, there are several key distinctions between Schizoid and Schizotypal personality. While they both have few, if any, close friends or confidants and show constricted affect, the root of these similar attributes is different. Schizotypal personality is associated with a lack of capacity and severe discomfort with close relationships; Schizoid personality is associated with a total lack of interest and indifference to others.

Schizotypal individuals show interpersonal deficits as well as cognitive or perceptual distortions. The DSM requires that these individuals also display at least five of the following: ideas of reference, odd beliefs or magical thinking (i.e., belief in telepathy or clairvoyance, bizarre fantasies), bodily illusions or unusual perceptual experiences, odd thinking and speech (i.e., vague, circumstantial, metaphorical), odd or eccentric behavior, and excessive social anxiety associated with paranoid or suspicious ideation.

Similar to Schizoid, this pattern of behavior also emerges in early adulthood. While Schizoid personality appears detached and cold to others, Schizotypal personality appears as eccentric or odd, and as having apparent discomfort with close relationships. The prevalence rate is similar to Schizoid personality at just under 4% of the U.S. population.

First Line Treatments

Treatment options for either of these disorders generally includes psychotherapy as the primary tool. Some pharmaceutical options may be used as well, but there is no current specific medication used for either disorders.

Psychotherapy

  • Family therapy- Schizoid patients may be seen with family members as a means of the family trying to bridge the apparent gap between them. This type of therapy may be helpful in giving the family members tools and knowledge in how to maintain a manageable relationship with the Schizoid individual, although the patient may not respond. Conversely, Schizotypal patients may benefit from family therapy as a means of building trust and improving communication skills, as well as reducing anxiety around social interaction with their family.
  • Group therapy- For a Schizoid patient, group therapy may prove to be beneficial as it offers them an opportunity to practice social skills in a controlled setting with others that are similar to themselves. If they are responsive, it can provide groundwork for learning how to connect on a social level with others.
  • Supportive therapy- Schizotypal patients can respond positively to supportive therapy as it gives them space to learn adaptive skills and gain encouragement.
  • Modified CBT- Both Schizoid and Schizotypal patients can benefit from modified CBT. CBT is used to address erroneous and/or negative thought patterns, restructure ones perceptions, and change the ensuing behaviors. For a Schizoid patient, this may involve examining their beliefs on the utility of relationships as well as their expectations of how to conduct relationships with others. For a Schizotypal patient, this may involve addressing the negative thought patterns leading to their social anxiety and paranoia, and learning more adaptive skills in social settings.

Pharmaceuticals

There are no current, FDA approved medications for either of these personality disorders. However, some medications may be used in combination with psychotherapy to alleviate symptoms to benefit the patient, such as antidepressants or antianxiety medications.

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REFERENCES:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/schizotypal-personality-disorder/diagnosis-treatment/drc-20353924#:~:text=Treatment%20for%20schizotypal%20personality%20disorder,fit%20for%20their%20personality%20styles.

Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/23030-schizoid-personality-disorder

Syndrome Series: Illness Anxiety Disorder

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artistic design man holding his face due to illness anxiety

What is Illness Anxiety?

Illness Anxiety Disorder is a fairly new condition that was added to the DSM-V under the section of somatic symptom and related disorders. It is the preoccupation with having or acquiring a serious illness, generally in the absence of somatic symptoms. This is accompanied by a high level of anxiety about health, and individuals who have this condition perform excessive health-related behaviors such as checking for abnormalities on the body. . This condition can be care-seeking (where the individual is seeking physician visits, tests, and procedures at an unnecessary rate) or care-avoidant (where the individual avoids physician visits, tests, or procedures in fear of discovering an illness).

Illness Anxiety and Hypochondriasis

Prior to somatic symptom and related disorders being acquired, people fitting these criteria were generally referred to as hypochondriacs. Now, about 75% of those individuals have a somatic symptom disorder diagnosis. The other 25% are diagnosed with illness anxiety. Hypochondriasis is not considered an anxiety disorder and may have somatic symptoms present; illness anxiety is considered an anxiety disorder related to somatic symptom disorders due to the physical checking and specified anxiety related to ones health.

Illness Anxiety Comorbidities

As a newer condition, comorbidities to illness anxiety are not well understood. Currently it is expected that two-thirds of individuals with illness anxiety also are likely to have at least one other major mental health issue. Hypochondriasis is commonly seen to co-occur with anxiety disorders such as generalized anxiety, panic disorder, OCD, as well as depression. Since these conditions share similarities, these could be reasonable comorbidities to be aware of.

First Line Treatments

Treatment options for this condition focus on the ability to manage anxiety symptoms. This can include both psychotherapy and pharmaceutical therapy. The most common psychotherapy used is cognitive behavioral therapy (CBT). Mayo Clinic outlines the following as the goals of CBT in regard to illness anxiety disorder.

Psychotherapy Objectives

  • Identify your fears and beliefs about having a serious medical disease
  • Learn alternate ways to view your body sensations by working to change unhelpful thoughts
  • Become more aware of how your worries affect you and your behavior
  • Change the way you respond to your body sensations and symptoms
  • Learn skills to cope with and tolerate anxiety and stress
  • Reduce avoidance of situations and activities due to physical sensations
  • Reduce behaviors of frequently checking your body for signs of illness and repeatedly seeking reassurance
  • Improve daily functioning at home, at work, in relationships and in social situations
  • Address other mental health disorders, such as depression

Pharmaceuticals

The next option for treatment is selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications work well for anxiety disorders as well as depressive disorders, and have shown efficacy in the treatment of illness anxiety. They also have lower rates of side effects and higher rates of tolerability. They offer safe options for a variety of patients, including patients that are pregnant.

Ready to learn more?

Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!

REFERENCES:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

French JH, Hameed S. Illness Anxiety Disorder. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554399/

Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/diagnosis-treatment/drc-20373787