advertisement

OCD

Skin-picking_408299aThe essential feature of excoriation (skin-picking) disorder is recurrent picking at one’s own skin. The most commonly picked areas are the face, arms, and hands, but many individuals pick from multiple sites.

In addition to skin picking, skin rubbing, squeezing, lancing, and biting are also common. Most individuals pick with their fingernails, although many use tweezers, pins, or other objects.

Diagnostic criteria includes:

  • Repeated attempts to decrease or stop skin picking.
  • The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).
  • The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypic movement disorder, or non-suicidal self-harm).

Individuals with excoriation disorder often spend significant amounts of time on their picking behavior, sometimes several hours per day. Skin picking may endure for months or years.

 

This is a new disorder added to the updated DSM-5 (2013).

Excoriation (Skin-Picking) Disorder

OCD

Hoarding Disorder SymptomsThe main feature of hoarding disorder is a person’s irrational, persistent difficulty in discarding or parting with possessions — regardless of their actual value. This is a long-standing difficulty, not just something related to a one-time circumstance (such as having difficulty discarding property  you inherited from a loved one). Discarding means that the person can’t seem to give away, throw away, recycle, or sell things they no longer need (or sometimes, even want).

There are many reasons people give for not wanting to discard or part with things in hoarding disorder. Some feel they are just being frugal and don’t want to be wasteful. Others have a sentimental attachment to their things, regardless of whether there is any actual history or sentiment that ordinarily one might have (such as a collection of old newspapers or magazines). Still others fear there is “important information” in the things that could be discarded, and they just need to “go through” them all to ensure that information is removed.

The inherent value of an object is not important in the definition of this disorder; people with hoarding disorder will keep many invaluable things alongside of valuable objects. People with this disorder make a conscious effort to save things; it is not the result of simply passive accumulation of stuff (due to, for instance, depression and the lack of energy to deal with organizing and getting rid of items that are no longer needed).

When faced with the prospect of discarding or parting with their things, a person with hoarding disorder will experience distress.

Last, a person with this disorder will usually collect so many things over a long period of time, that the actual use of any given item or even the person’s normal living space is next to impossible. The clutter collected over time impedes the person from living in their apartment or home in a normal manner. For instance, their bed may be so full of collected clothes or newspapers, they sleep on the floor; kitchen counters are so full of things, there is no place to prepare and cook food.

It is estimated that hoarding disorder affects somewhere between 2 and 6 percent of the population.

Specific Symptoms of Hoarding Disorder

1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

2. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities).

4. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment safe for oneself or others).

5. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

6. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, etc.).

Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. (Approximately 80 – 90 percent of individuals with hoarding disorder display this trait.)

Specify if:

With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

 

This disorder is new to the DSM-5. Code: 300.3 (F42)

Hoarding Disorder Symptoms

OCD

Trichotillomania is primarily characterized by the recurrent pulling out of one’s own hair. Hair pulling may occur from any region of the body — such as your scalp, eyelids or eyebrows. Less common areas where trichotillomania occurs includes pulling out facial hair, pulling out hair from your arms, legs, armpits, or pubic hair. Hair pulling sites may vary over time.

The prevalence of this disorder is approximately 1 – 2 percent of the population. It occurs more frequently in females than males (10:1 ratio).

Specific Symptoms of Trichotillomania

1. Recurrent pulling out of one’s hair resulting in noticeable hair loss.

2. Repeated attempts to decrease or stop the hair pulling.

3. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. The disturbance is not better accounted for by another mental disorder (such as trying to improve a perceived defect or flaw in body dysmorphic disorder) and is not due to a general medical condition (e.g., a dermatological condition).

 

Updated for DSM-5. Code: 312.39 (F63.2)

Trichotillomania Symptoms

OCD

Body dysmorphic disorder is a mental disorder characterized by a preoccupation with a defect in the person’s physical appearance. The defect is either imagined, or, if a slight physical anomaly is present, the individual’s concern is markedly excessive. The preoccupation must cause significant distress or impairment in social, occupational, or other important areas of functioning. Last, the preoccupation cannot be better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).

Complaints commonly involve imagined or slight flaws of the face or head such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion, swelling, facial asymmetry or disproportion, or excessive facial hair. Other common preoccupations include the shape, size, or some other aspect of the nose, eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw, chin, cheeks, or head. However, any other body part may be the focus of concern (e.g., the genitals, breasts, buttocks, abdomen, arms, hands, feet, legs, hips, shoulders, spine, larger body regions, or overall body size).

The preoccupation may simultaneously focus on several body parts. Although the complaint is often specific (e.g., a “crooked” lip or a “bumpy” nose), it is sometimes vague (e.g., a “falling” face or “inadequately firm” eyes). Because of embarrassment over their concerns, some individuals with body dysmorphic disorder avoid describing their “defects” in detail and may instead refer only to their general ugliness.

Most individuals with this disorder experience marked distress over their supposed deformity, often describing their preoccupations as “intensely painful,” “tormenting,” or “devastating.” Most find their preoccupations difficult to control, and they may make little or no attempt to resist them. As a result, they often spend hours a day thinking about their “defect,” to the point where these thoughts may dominate their lives. Significant impairment in many areas of functioning generally occurs. Feelings of self-consciousness about their “defect” may lead to avoidance of work or public situations.

Specific Symptoms of Body Dysmorphic Disorder

Body Dysmorphic Disorder Symptoms