Obsessive-Compulsive and Related Disorders

Abstract

Obsessive-compulsive and related disorders (OCRD) are a new category of psychiatric disorders that first appeared in the Diagnostic and Statistical Manual of Mental Disorders 5. The OCRD that are covered in this chapter include body dysmorphic disorder (BDD), hoarding disorder (HD), hair-pulling disorder (HPD), and skin-picking disorder (SPD). While these disorders are all related to OCD, there are differences between them in their presentations and treatment protocols. However, the OCRD do have one specific trait in common: patients with OCRD are more likely to present to their primary care physician (or other medical specialists) rather than a psychiatrist. In addition, they rarely complain of mental illnesses, but instead seek other medical or surgical interventions. For this reason, this is imperative that physicians become familiar with these disorders that—unless they are early in their careers—may not have been discussed in medical school or on psychiatric rotations. These disorders can cause serious medical sequelae, have serious social consequences, and have significant rates of morbidity and mortality. The diagnosis and presentation of these disorders will be discussed, including how these patients typically present in medical, non-psychiatric settings. Guidelines on appropriate screening and referral are given for all of the disorders separately. Treatment protocols are discussed for all of the disorders, so that primary care physicians have the ability and tools to know what (if any) medications need to be prescribed and what psychotherapy resources their patients need to be referred to. The basic principles for the pharmacotherapy of the disorders are presented as well as side effect management of medications. Basic algorithms regarding diagnosis and treatment in the primary care setting for all of the disorders are presented as well.