Exam 7: Obsessive-Compulsive and Related Disorders

Nineteen year-old Marjorie Benton was referred to the social worker by her dermatologist. Marjorie admits to picking at her skin to the point that she has scabs and scars from previous picking. She started when she was in her teens and had acne. Marjorie has made repeated attempts to stop but thus far has been unsuccessful. Marjorie's most likely diagnosis is:

In body dysmorphic disorder, plastic surgery is usually seen as beneficial in lessening symptoms.

This diagnosis is characterized by the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair. It is:

Although those with trichotillomania often carry out their behaviors when others are not looking, they will usually admit to these behaviors when asked.

Which of the following best characterizes the compulsive behaviors seen in obsessive-compulsive disorder OCD)?

Individuals with excoriation disorder usually pick their skin out of anxiety or boredom.

Matt Wilcock just renewed his gym membership for the coming year and feels this is one of his best investments. You see, he works out regularly because he wants to look more muscular. Despite the reality that his friends tell him he looks great, Matt believes he looks skinny and that his friends are making fun of him behind his back. He continues to exercise excessively in order to increase his muscle mass and recently started taking anabolic steroids. Matt does not think any of this is working and he remains dissatisfied with his appearance. When his friends try to reassure him that he looks fine, Matt believes, "I just need to work harder at pumping up." What is the most likely diagnosis for Matt?

Moses Freeman is considered by most of his friends to be a very attractive man. He is physically trim, stands about six feet tall, weighs almost two hundred pounds and works out regularly at a neighborhood gym. He watches his diet and mainly eats low fat and high fiber foods. According to him, everything would be fine except for "excessive body hair." Although his friends describe him as "normal," Moses always hides his body. For example, Moses wears long sleeved shirts, even when working out at the gym. In addition, he avoids going to places where his body would be uncovered, such as the beach. Moses is obsessed with how ugly his body hair is despite his friends' reassurance that he looks fine. Moses wants to have his hair surgically removed. What disorder does Moses most likely illustrate?

The majority of individuals with hoarding disorder also display excessive acquisition in which they collect, buy or even steal objects that are not needed and for which there is no space.

Individuals with trichotillomania will pull hair out of anxiety or boredom as the behavior provides a distraction, pleasure, or a relief from anxiety

Those with a preoccupation with a perceived body flaw, which of the following behaviors would help toward confirming a diagnosis of body dysmorphic disorder?

Some people have thoughts or impulses that are not simply worries about real life issues. This is the person makes attempts to ignore, suppress, or neutralize his or her thoughts by performing some other thought or action. These attempts include recurrent thoughts, impulses, or images that the individual experiences as intrusive, inappropriate, irrational, and cause them marked anxiety and/or distress. This behavior is known as:

Excoriation disorder has a worse course when it begins in late adulthood or old age.

Match each term with the appropriate definition: Term: Definition: a) Insight specifier \_\_\_ Characterizes people who have difficulty discarding items they have accumulated b) Hoarding disorder \_\_\_ to acknowledge that persons with this disorder can have a range of insight into the irrationality of their behaviors c) Body dysmorphic disorder with muscle dysmorphia \_\_\_ Includes recurrent thoughts and repetitive behaviors d) Body dysmorphic \_\_\_ Characterized by preoccupations with a disorder perceived body flaw e) Obsessive compulsive disorder \_\_\_ characterizes the individual, usually male, who is preoccupied with the idea that his body build is too small or not sufficiently muscular Koro \_\_\_ an intense anxiety that the penis will recede into the body (in females, the belief is about the vulva or nipples) $\quad$

Skin-picking behavior seen in trichotillomania tends to wax and wane in severity throughout the individual's life.

Skin picking to fix imaginary defects in one's appearance would more likely suggest the diagnosis of body dysmorphic disorder.

All of the following disorders are classified as obsessive-compulsive and related disorders except:

In making the diagnosis of body dysmorphic disorder, only one body part will be "defective;" that is, the individual never experiences multiple "defects."

Kathy Gilmour was referred to the social worker by her family physician due to excessive handwashing. She takes no medications other than an antibiotic ointment to reduce the possibility of infection - her hands are washed to the extent she has open sores. Kathy admits to spending up to 4 hours a day washing her hands. Sometimes she spends more time washing if she feels the washing has not been done "right'" What is the most likely diagnosis for Kathy?