Obsessive preoccupations

TCAs. Two tricyclics, clomipramine (Anafranil) and amitriptyline (Elavil), have been studied in AN. The obsessive preoccupation with food and body image pathognomonic of AN led clinicians to study clomipramine first, recognizing its well-documented efficacy for the treatment of OCD. Unfortunately, clomipramine did not successfully improve weight gain. Amitriptyline has been evaluated in AN studies with mixed results. 

The production of obsessive preoccupations with aggression against self or others, often accompanied by a worsening of any preexisting depression. 

Costly chaos as order breaks down, stress begins to take a more serious toll on the parents than on the addicted child who gains freedom as traditional family structure seems to fall apart. For example, while obsessive preoccupation with what the child will or won t do next exhausts parents with anxiety, the child gathers power through increased unpredictability. 

SSRIs are agents of choice in obsessive-compulsive disorder and in the syndromes of impulse dyscontrol or obsessive preoccupations (e.g., compulsive gambling, trichotillomania, bulimia, but usually not anorexia nervosa and body dysmorphic disorder). Despite their hmited benefits, SSRIs offer an important advance in the medical treatment of these often chronic and sometimes incapacitating disorders. The effectiveness of pharmacological treatment for these disorders is greatly enhanced by use of behavioral treatments. 

BDD is an obsessive-compulsive disorder that leads someone to have a preoccupation with what he or she perceives as a flaw in his or her appearance. Most frequently, the head and... 

When a patient with OCD has impaired insight, the distinction between obsession and delusion becomes blurred. We would argue that such a patient is in fact delusional. The with poor insight specifier is therefore the OCD equivalent to the with psychotic features specifier applied to the mood disorders. There may in fact be a continuum of insight in patients with OCD that fluctuates over time. For example, patients with OCD may recognize that their preoccupation with an obsessional idea or compulsive ritual is excessive, yet they may remain insistent that the premise underlying their anxiety is entirely reasonable. 

Generaiized Anxiety Disorder. The obsessions of OCD in some respects resemble the persistent and excessive worry of GAD. However, GAD entails an exaggerated preoccupation regarding real-life concerns, whereas the obsessions of OCD are senseless ego-dystonic thoughts and images. In addition, the obsessions of OCD are typically accompanied by compulsive behaviors that aim to alleviate the anxiety triggered by the obsession. Patients with GAD do not usually engage in compulsive behaviors to relieve tension. 

In addition, patients with body dysmorphic disorder experience a preoccupation with an imagined defect in appearance that leads to repetitive checking behaviors to assess their appearance. The symptoms of body dysmorphic disorder, essentially equivalent to the obsessions and compulsions of OCD, have led some to propose that the former syndrome is not a distinct disorder but a subtype of the latter. Again, a key distinguishing factor is that OCD will typically have been associated with some other nonsomatic obsession during the course of the illness. 

Obsessive-Compulsive Disorder (OCD). Certainly the name suggests that OCD and OCPD are closely related. This is actually somewhat misleading. With OCD, the obsessions are intrusive and distressful (i.e., ego dystonic) thoughts that lead the patient to develop rituals (i.e., compulsions) to alleviate the resultant anxiety. With OCPD, we use the term obsession in a somewhat different way. The OCPD patient is not necessarily prone to obsessions in the form of intrusive thoughts instead, they display a perfectionistic preoccupation with detail that characterizes their obsessionality. Furthermore, this obsessionality is ego-syntonic. Patients with OCPD purposefully harbor these obsessions in an effort to exert control over themselves and their environment. 

In Kanner s 1943 landmark description of 11 autistic children, the repetitive nature of behavior, speech, and modes of social interaction were designated as core clinical elements of the syndrome (Kanner, 1943). Verbal and motor rituals, obsessive questioning, a rigid adherence to routine, a preoccupation with details, and an anxiously obsessive desire for the maintenance of sameness and completeness were all noted. These phenomena remain as core elements in the diagnostic criteria for autistic disorder in DSM-IV. 

A number of clinical reports have described a syndrome of obsessive SSRI-induced suicidality and aggression that seems particular to these drugs, starting with Teicher et al. (1990). These cases bear some similarity to akathisia-driven suicidality, but compulsion toward self-harm is not accompanied by the specific symptoms of akathisia. They summarized, Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment (p. 207). Additional cases and potential mechanisms of action were analyzed by Teicher et al. (1993). 

Obsessive-compulsive personality disorder a pattern of preoccupation with orderliness, perfectionism, and control. 

Suddendorf Many other acknowledged deficits that characterize autism, such as obsession with routine, stereotyped behaviour, preoccupation with parts of an object, echopraxia and echolalia, can hardly be explained as secondary deficits caused by a defect in a presumed social cognition module. Autistic children also have a deficit on creativity tasks. The clinical picture is far more complex than a malfunctioning discrete module for social cognition. 

Obsessions/covert compulsions. These are distressing and driven by anxiety, but can be hard to distinguish from ASD-related restricted preoccupations/need for order. 

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