Adults and Aging Discussion Paper

Diagnostic Criteria for OCD (DSM-5)

Obsessive-Compulsive Disorder is defined by the occurrence of obsession and/or obligations that cause significant distress, require an extensive period, and disrupt daily activities (Bruce et al., 2018). The DSM 5-TR diagnostic criteria for OCD include “obsessions, compulsions, skin picking, other body-focused repetitive behaviors, and symptoms characteristic of obsessive-compulsive disorders.”(Moreno-Amador et al., 2023). The symptoms should not be related to any medical condition induced by a medication or substance. Also, for the diagnosis of OCD, the symptoms should not occur during delirium, and the disturbance should be causing significant distress in the patient’s social, occupational, and other aspects of functioning. Adults and Aging Discussion Paper

Clinical Features and Example

I observed a client who met the criteria for OCD. This client had obsessions related to contamination fears. They were preoccupied with the idea that touching everyday objects, such as doorknobs or public restroom surfaces, would lead to contamination and disease. These obsessions caused the client significant distress. To reduce this distress, the client engaged in repetitive handwashing rituals, often spending hours each day cleaning their hands and avoiding touching objects they considered “contaminated.” These compulsions interfered with the client’s daily life, making it difficult for them to work or maintain social relationships.

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Treatment

Evidence-Based Psychotherapy

Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is considered the most effective psychotherapy for OCD (Reid et al., 2021). ERP involves gradually exposing the individual to their feared obsessions and preventing the associated compulsive behaviors, which helps the person learn to tolerate the anxiety and reduce the need for compulsions. Adults and Aging Discussion Paper

Psychopharmacological Treatment

Selective serotonin reuptake inhibitors (SSRIs), which may include fluoxetine, fluvoxamine, or sertraline, are primarily used in treating OCD (Kotapati et al., 2019). In more severe cases, clomipramine, a tricyclic antidepressant, may be prescribed. These medications help regulate serotonin levels in the brain.

Differential Diagnoses for OCD

Generalized Anxiety Disorder

GAD is defined as excessive worry about various aspects of life (Hebert et al., 2019). While individuals with OCD may worry about their obsessions, the critical difference is the presence of compulsions in OCD that are not typically seen in GAD. Adults and Aging Discussion Paper

Body Dysmorphic Disorder

BDD is the preoccupation with perceived defects in one’s appearance, leading to repetitive behaviors or mental acts to address these concerns. While there may be similarities to OCD, the focus in BDD is on appearance, whereas OCD can involve various obsessions and compulsions.

References

Bruce, S. L., Ching, T. H., & Williams, M. T. (2018). Pedophilia-themed obsessive–compulsive disorder: Assessment, differential diagnosis, and treatment with exposure and response prevention. Archives of sexual behavior, 47, 389-402. https://doi.org/10.1007/s10508-017-1031-4

Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436. https://doi.org/10.1016/j.cbpra.2018.07.007

Kotapati, V. P., Khan, A. M., Dar, S., Begum, G., Bachu, R., Adnan, M., … & Ahmed, R. A. (2019). The effectiveness of selective serotonin reuptake inhibitors for treatment of obsessive-compulsive disorder in adolescents and children: a systematic review and meta-analysis. Frontiers in psychiatry, 10, 523. https://doi.org/10.3389/fpsyt.2019.00523

Moreno-Amador, B., Piqueras, J. A., Rodríguez-Jiménez, T., Martínez-González, A. E., & Cervin, M. (2023). Measuring symptoms of obsessive-compulsive and related disorders using a single-dimensional self-report scale. Frontiers in psychiatry, 14, 958015. https://doi.org/10.3389/fpsyt.2023.958015

Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. A. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive psychiatry, 106, 152223. Adults and Aging Discussion Paper 

Select one disorder from the list of disorders on this unit readings.

OCD
PTSD
Dissociative Disorders
Gender Dysphoria
Somatic Symptom Disorder
Sleep Disorder
Eating Disorder
Your response should include the following regarding your selected disorder:

Explain the diagnostic criteria for your selected disorder.
Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your selected disorder.
List two differential diagnosis for the disorder selected
Support your rationale with references from your reading resources or other evidence-based academic resources. Adults and Aging Discussion Paper