Obsessive Compulsive Disorder vs Adjustment Disorder

Obsessive Compulsive Disorder vs Adjustment Disorder

            OCD is chgracterized by the presence of obsesioins and/or compulsions. In OCD, obsessions are recurring thoughts that may cause anxiety, while compulsions are repeated actions or mental activities that are done in response to an addiction or according to laws that must be followed(Seibell,2014).

            Adjustment disorder is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressors occurring within 3 months of the onset of the stressor causing significant impairment in social, occupational, or other important ares of functioning(Patra, 2013).

Difference between an adjustment disorder

            OCD differs from adjustment disorder in that the obsessive behaviors cause distress and compulsive behaviors are acts performed in an attempt to decrease their anxiety(Seibell,2014). OCD creates a vicious loop in which OCD worsens every time a compulsive activity or a mental act is performed, leading to an intensification of obsessions and compulsion(Ex.skin picking, Trichotillomania,fear of contamination-excessive hand washing). 

             In patients with adjustment disorders, the stress-response is situational leading to difficulties adjusting after a stressful event at a level disproportionate to the severity or intensity of the stressor(Patra, 2013). These symptoms are characterised by stress responses that are out of step with socially or culturally expected reactions to the stressor and/or which cause marked distress and impairment in daily functioning(Patra, 2013).Good examples are subjective distress and emotional disturbance, such as significant life changes, stressful life events, serious physical illness, or possibility of serious illness: (ex. cancer, death in family ,move).

Diagnostic criteria for OCD

            According to American Psychiatric Association(2013), the diagnostic criteria for what constitutes OCD are that obsessive thoughts are distracting and unwelcome, causing the person to conduct repetitive behaviors that “are intended to prevent or reduce anxiety or distress, or to prevent some dreaded event or situation”. The DSM-5 also notes that other diagnostic criteria include that “obsessions or compulsions are time-consuming or cause significant distress/disruption in social, occupational or other important areas of functioning,” that obsessive-compulsive symptoms are not triggered by the physiological effects of a drug or a medical condition, and that the symptoms are synthesized(American Psychiatric Association,2013).

Psychotherapy and Psychopharmacologic treatment for OCD

            The mainstays of treatment in OCD includes cognitive-behavioral therapy in the form of exposure and response prevention (ERP) and serotonin reuptake inhibiting medications and a tricyclic antidepressant depending on illness severity(Seibell,2014). Treatment with a skilled cognitive-behavioral/ERP can help patients make significant gains overall in level of functioning and quality of life(Seibell,2014). Medication management includes FDA approved medications for treatment of OCD are SSRIs, that include fluoxetine, fluvoxamine, paroxetine,sertraline and clomipramine, a tricyclic.However, Clomipramine has a higher side-effect burden than SSRIs. Therefore, an SSRI is recommended as first-line pharmacological treatment and has similar efficacy(Seibell,2014).

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Patra, B. N., & Sarkar, S. (2013). Adjustment disorder: current diagnostic status. Indian journal of psychological medicine, 35(1), 4–9. https://doi.org/10.4103/0253-7176.112193

Seibell, P. J., & Hollander, E. (2014). Management of obsessive-compulsive disorder. F1000prime reports, 6, 68. https://doi.org/10.12703/P6-68

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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