Module 03 · Anxiety Disorders

Module 9: Obsessive-Compulsive and Related Disorders模块 9：强迫症及相关障碍

3rd edition as of July 2023
截至 2023 年 7 月的第 3 版

Module Overview 模块概述

In Module 9, we will discuss matters related to obsessive-compulsive and related disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), and hoarding. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
在模块 9 中，我们将讨论与强迫症及相关疾病相关的问题，包括其临床表现、流行病学、共病、病因和治疗选择。我们的讨论将包括强迫症（OCD）、体象障碍（BDD）和囤积症。请确保您参考模块 1-3 以了解关键术语的解释（模块 1）、解释心理病理学的各种模型概述（模块 2）以及治疗描述（模块 3）。

Module Outline 模块大纲

Module Learning Outcomes 模块学习成果

Describe how obsessive-compulsive disorders present.
描述强迫症的表现方式。
Describe the epidemiology of obsessive-compulsive disorders.
描述强迫症流行病学。
Describe comorbidity in relation to obsessive-compulsive disorders.
描述与强迫症相关的共病情况。
Describe the etiology of obsessive-compulsive disorders.
描述强迫症的病因。
Describe treatment options for obsessive-compulsive disorders.
描述强迫症的治疗方案。

9.1. Clinical Presentation 9.1. 临床表现

Section Learning Objectives 章节学习目标

Describe how obsessive compulsive disorder presents.
描述强迫症的表现方式。
Describe how body dysmorphic disorder presents.
描述体象障碍如何表现。
Describe how hoarding disorder presents.
描述强迫性囤积症的表现。

9.1.1. Obsessive-Compulsive Disorder 9.1.1. 强迫症

Obsessive-compulsive disorder, more commonly known as OCD, requires the presence of obsessions, compulsions, or both**. Obsessions** are defined as repetitive and persistent thoughts, urges, or images. These obsessions are intrusive, time-consuming (i.e., take more than an hour a day), and unwanted, often causing significant distress or impairment in an individual’s daily functioning. Common obsessions are contamination (dirt on self or objects), errors of uncertainty regarding daily behaviors (locking the door, turning off appliances), thoughts of physical harm or violence, and orderliness, to name a few (Cisler, Adams, et al., 2011; Yadin & Foa, 2009). Often the individual will try to ignore these thoughts, urges, or images. When they are unable to ignore them, the individual will engage in compulsory behaviors to gain temporary relief from the distress or anxiety.
强迫症，通常称为 OCD，需要存在强迫观念、强迫行为或两者兼有。强迫观念被定义为重复和持续的思考、冲动或图像。这些观念是侵扰性的、耗时的（即每天超过一小时），且不受欢迎，常常导致个人在日常生活中出现显著的不适或功能障碍。常见的强迫观念包括污染（自身或物体上的污垢）、对日常行为的不确定性错误（锁门、关闭电器）、对身体伤害或暴力的想法，以及整洁，等等（Cisler，Adams 等，2011；Yadin & Foa，2009）。通常，个人会试图忽略这些想法、冲动或图像。当他们无法忽略时，个人会进行强迫行为以获得暂时的缓解或减轻痛苦和焦虑。

Compulsions are time-consuming, repetitive behaviors or mental acts that an individual performs in response to an obsession. Common examples of compulsions are checking (e.g., repeatedly checking if the stove is turned off even though the first four-times they checked it was), counting (e.g., flicking the lights off and on exactly five times), hand washing, symmetry, fears of harm to self or others, or repeating specific words (APA, 2022). These compulsive behaviors essentially alleviate the anxiety associated with the obsessive thoughts. For example, an individual may feel as though their hands are dirty after using utensils at a restaurant. They may obsess over this thought for some time, impacting their ability to interact with others or complete a specific task. This obsession will ultimately lead to the individual performing a compulsion where they will wash their hands with extremely hot water to rid all the germs, or even wash their hands a specified number of times if they also have a counting compulsion. At this point, the individual’s anxiety should be temporarily relieved.
强迫症是耗时、重复的行为或心理活动，个体在强迫观念的影响下执行。常见的强迫症例子包括检查（例如，反复检查炉子是否关闭，尽管前四次检查时已经关闭了），计数（例如，开关灯五次），洗手，对称，对自身或他人受到伤害的恐惧，或重复特定词语（APA，2022）。这些强迫行为本质上可以缓解与强迫思维相关的焦虑。例如，一个人可能在餐厅使用餐具后觉得手很脏。他们可能会长时间地纠结于这个想法，影响他们与他人互动或完成特定任务的能力。这种痴迷最终会导致个体执行一种强迫行为，他们会用极热的水洗手以去除所有细菌，或者如果他们也有计数强迫症，甚至会洗手指定次数。这时，个体的焦虑应该会暂时缓解。

These obsessions and compulsions are more excessive than the typical “cleanliness” as they consume a large part of the individual’s day. Additionally, they cause significant impairment in one’s daily functioning. Given the example above, an individual with a fear of contamination may refuse to eat at restaurants, or they may bring their utensils from home. The frequency and severity of the obsessions and compulsions varies by patient, with some having mild to moderate symptoms and only spending 1-3 hours a day obsessing or engaging in compulsive behaviors, while other patients present with severe symptoms and have nearly constant intrusive thoughts or compulsions that can become incapacitating (APA, 2022).
这些强迫和冲动比典型的“清洁”更为过度，因为它们占据了个人大量的一天时间。此外，它们会严重损害个人的日常功能。以上述例子为例，一个害怕污染的人可能会拒绝在餐馆吃饭，或者他们可能会从家里带来餐具。强迫和冲动的频率和严重程度因患者而异，有些患者症状轻微到中度，每天只花费 1-3 小时进行强迫或强迫行为，而其他患者则表现出严重症状，几乎持续不断地出现侵入性思维或强迫行为，这可能导致他们无法正常生活（APA，2022）。

9.1.2. Body Dysmorphic Disorder 9.1.2. 体象障碍

**Body dysmorphic disorder **is another obsessive disorder; however, the focus of the obsessions is with perceived defects or flaws in one’s physical appearance. A key feature of these obsessions is that they are *not *observable or appear slight to others. An individual who has a congenital facial defect or a burn victim who is concerned about their scars are ***not ***examples of an individual with body dysmorphic disorder. The obsessions related to one’s appearance can run the spectrum from feeling “unattractive” to “looking hideous.” While any part of the body can be a concern for an individual with body dysmorphic disorder, the most commonly reported areas are skin (acne, wrinkles, skin color), hair (particularly thinning or excessive body hair), and nose (size or shape; APA, 2022). Interestingly, the disorder can occur by proxy meaning the individual is not concerned with their own defects but those of another person, often a spouse or partner but at times, a parent, child, sibling, or stranger.
体象障碍是一种强迫症；然而，强迫的焦点在于对自身外貌感知到的缺陷或瑕疵。这些强迫症的关键特征是它们不可观察或对他人来说显得轻微。患有先天性面部缺陷或烧伤患者担心他们的疤痕的人不是体象障碍个体的例子。与外貌相关的强迫症可以从感觉“不吸引人”到“丑陋”的范围。虽然身体任何部位都可能成为体象障碍个体的关注点，但最常报告的区域是皮肤（痤疮、皱纹、肤色）、头发（尤其是脱发或过多体毛）和鼻子（大小或形状；APA，2022）。有趣的是，这种障碍可以通过代理发生，即个体不是关心自己的缺陷，而是关心他人的缺陷，通常是配偶或伴侣，有时是父母、子女、兄弟姐妹或陌生人。

Due to the distressing nature of the obsessions regarding one’s body, individuals with body dysmorphic disorder also engage in compulsive behaviors that take up a considerable amount of time in their day. For example, they may repeatedly compare their body to other people’s bodies in the general public; frequently look at themselves in the mirror; engage in excessive grooming, which includes using make-up to modify their appearance. Some individuals with body dysmorphic disorder will go as far as having numerous plastic surgeries in attempts to obtain their “perfect” appearance.
由于对身体扭曲的困扰性质，患有体象障碍的人也会进行一些占去他们一天中相当一部分时间的强迫行为。例如，他们可能会反复将他们的身体与公众中其他人的身体进行比较；经常在镜子前照自己；进行过度打扮，包括使用化妆品来改变他们的外貌。一些患有体象障碍的人甚至会进行多次整形手术，试图获得他们所谓的“完美”外观。

While most of us are guilty of engaging in some of these behaviors, to meet criteria for body dysmorphic disorder, one must spend a considerable amount of time preoccupied with their appearance (i.e., on average 3-8 hours a day), as well as display significant impairment in social, occupational, or other areas of functioning. Some individuals excessively tan, change their clothes repeatedly, or compulsively shop such as for beauty products. Camouflaging perceived defects is a common behavior and could involve applying makeup, adjusting a hat or one’s clothes, or covering the forehead or eyes with one’s hair, all to hide or cover the perceived defect or problem area (APA, 2022).
尽管我们大多数人都有参与这些行为中的某些，但要符合体象障碍的诊断标准，一个人必须花费相当多的时间沉迷于自己的外貌（即平均每天 3-8 小时），以及在社会、职业或其他功能领域表现出显著的损害。有些人过度晒黑，反复更换衣物，或强迫性购物，如购买美容产品。掩饰感知到的缺陷是一种常见的行为，可能包括化妆、调整帽子或衣物，或用头发遮盖额头或眼睛，所有这些都是为了隐藏或掩盖感知到的缺陷或问题区域（APA，2022）。

As the DSM-5-TR notes, body dysmorphic disorder has been associated with, “abnormalities in emotion recognition, attention, and executive function, as well as information-processing biases and inaccuracies in interpretation of information and social situations” (APA, 2022, pg. 273). These individuals tend to express a bias for negative and threatening interpretations of facial expressions and situations that would be classified as ambiguous, for instance.
如 DSM-5-TR 所述，体象障碍与“情绪识别、注意力和执行功能异常，以及信息处理偏差和信息及社交情境解释的不准确”有关（APA，2022，第 273 页）。这些个体倾向于对面部表情和被归类为模糊的情况表现出对负面和威胁性解释的偏好，例如。

** 9.1.2.1. Muscle dysmorphia. **While muscle dysmorphia is not a formal diagnosis, it is a common type of BDD, particularly within the male population. Muscle dysmorphia refers to the belief that one’s body is too small or lacks the appropriate amount of muscle definition (Ahmed, Cook, Genen & Schwartz, 2014). While the severity of BDD between individuals with and without muscle dysmorphia appears to be the same, some studies have found higher use of substance abuse (i.e., steroid use), poorer quality of life, and increased reports of suicide attempts in those with muscle dysmorphia (Pope, Pope, Menard, Fay Olivardia, & Philips, 2005). The DSM-5-TR instructs clinicians to specify if body dysmorphic disorder occurs with muscle dysmorphia.
9.1.2.1. 肌肉畸形症。虽然肌肉畸形症不是一个正式的诊断，但它是一种常见的体象障碍（BDD）类型，尤其是在男性人群中。肌肉畸形症是指一个人认为自己身体太小或缺乏适当的肌肉轮廓（Ahmed, Cook, Genen & Schwartz，2014）。尽管肌肉畸形症和非肌肉畸形症患者之间的 BDD 严重程度似乎相同，但一些研究发现，肌肉畸形症患者滥用物质（即使用类固醇）的频率更高，生活质量更差，自杀尝试的报告也更多（Pope, Pope, Menard, Fay Olivardia, & Philips，2005）。DSM-5-TR 指导临床医生在出现肌肉畸形症时明确指出是否存在体象障碍。

** 9.1.2.2. Insight specifiers. **Those diagnosed with body dysmorphic disorder vary in the degree of insight they have about the accuracy of their body dysmorphic disorder beliefs, ranging from good to absent/delusional. On average, insight is poor and at least one-third of those diagnosed with the disorder display absent/delusional insight. Mental health professionals would indicate the degree of insight regarding body dysmorphic disorder beliefs using with good or fair insight, with poor insight, or with absent insight/delusional beliefs. See page 272 of the DSM-5-TR for more information. Note that the insight specifier is used with OCD and hoarding disorders as well.
9.1.2.2. 内在认知说明。患有体象障碍的患者在对其体象障碍信念准确性的内在认知程度上存在差异，从良好到缺失/妄想不等。平均而言，内在认知较差，至少有三分之一的患者表现出缺失/妄想的内在认知。心理健康专业人员会使用“有良好或一般内在认知”、“内在认知差”或“缺失内在认知/妄想信念”来表明对体象障碍信念的内在认知程度。有关更多信息，请参阅 DSM-5-TR 第 272 页。请注意，内在认知说明也用于强迫症和囤积症。

9.1.3. Hoarding Disorder 9.1.3. 贮物狂乱症

In hoarding disorder, the key feature is the persistent over-accumulation of possessions (APA, 2022). While we all obtain items throughout life, individuals with hoarding disorder continue to accumulate items without discarding possessions, regardless of their value or sentiment. This lack of discarding occurs over a long period and is not explained by a recent significant stressor (e.g., lost house in fire, so now keeps everything). For example, last week’s newspaper would likely have no relevance to you or possibly any historical value, but those with hoarding disorder would keep this newspaper despite the lack of value or sentiment.
囤积障碍的关键特征是持续过度积累物品（APA，2022）。虽然我们一生中都会获得物品，但患有囤积障碍的人会继续积累物品而不丢弃，无论其价值或情感如何。这种不丢弃的行为持续了很长时间，并且不是由近期的重要压力因素（例如，房屋失火，因此现在保留一切）所解释。例如，上周的报纸可能对你或可能对任何历史价值都没有相关性，但患有囤积障碍的人会保留这份报纸，尽管其价值或情感不足。

The most commonly hoarded items are newspapers, magazines, clothes, bags, books, mail, and paperwork (APA, 2022). While these items may be stored in attics and garages, individuals with a hoarding disorder also have these items cluttering their living space, sometimes to the extent that they are unable to utilize their furniture because it is covered in stuff. Cognitive factors contributing to the need to hold onto these non-sentimental items are fear of losing valuable information and fear of being wasteful. When asked to “clean out” their house or get rid of these items, individuals with hoarding disorder experience significant distress. Individuals with hoarding disorder display indecisiveness, avoidance, procrastination, perfectionism, difficulty planning and organizing tasks, and are easily distractible.
最常见的囤积物品包括报纸、杂志、衣服、包、书籍、邮件和文件（APA，2022）。虽然这些物品可能被储存在阁楼和车库中，但患有囤积症的人也会让这些物品充斥他们的生活空间，有时甚至到了无法使用家具的程度，因为家具上堆满了东西。导致人们需要保留这些非情感性物品的认知因素包括害怕失去有价值的信息和害怕浪费。当被要求“清理”房屋或丢弃这些物品时，患有囤积症的人会经历极大的痛苦。患有囤积症的人表现出犹豫不决、回避、拖延、完美主义、难以规划和组织任务，并且容易分心。

One’s hoarding behaviors also impacts their daily functioning and causes impairment in social and occupational functioning. It can lead to low quality of life and in extreme cases, place the individual at risk for figure, falling, poor sanitation, and other health risks. Family relationships are often strained and conflict with neighbors and local authorities is common (APA, 2022).
一个人的囤积行为也会影响他们的日常生活功能，并导致社交和职业功能受损。这可能导致生活质量下降，在极端情况下，使个人面临跌倒、卫生状况差和其他健康风险。家庭关系通常紧张，与邻居和当地当局的冲突很常见（APA，2022）。

Key Takeaways 关键要点

You should have learned the following in this section:
您应该在本节中学到了以下内容：

As part of OCD, obsessions are repetitive and persistent thoughts, urges, or images while compulsions are repetitive behaviors or mental acts that an individual performs in response to an obsession.
强迫症（OCD）中，强迫观念是重复和持续的思考、冲动或图像，而强迫行为是个体为了应对强迫观念而重复执行的行为或心理活动。
Body dysmorphic disorder is characterized by obsessions over perceived defects or flaws in one’s physical appearance.
体象障碍以对自身外貌感知到的缺陷或瑕疵的强迫性关注为特征。
Muscle dysmorphia refers to the belief that one’s body is too small or lacks the appropriate amount of muscle definition and is a type of body dysmorphic disorder common to men.
肌肉畸形是指认为自己身体太小或缺乏适当的肌肉轮廓，是一种常见于男性的体象障碍。
Hoarding disorder is characterized by accumulating items without discarding possessions, regardless of their value or sentiment.
囤积症的特点是积累物品而不丢弃财产，无论其价值或情感如何。

Section 9.1 Review Questions
第 9.1 节复习题

Define obsessions and compulsions. Provide a list of examples of each thought/behavior.
定义强迫症和强迫行为。提供每种想法/行为的例子列表。
What is body dysmorphic disorder? Give examples of characteristics that would *not *be consistent with a body dysmorphic disorder diagnosis.
什么是体象障碍？给出一些不符合体象障碍诊断特征的特点示例。
Many of us save items throughout our lifetime that remind us of specific events. How is this different from hoarding?
我们中许多人一生中都会保存一些能让我们想起特定事件的物品。这与囤积有何不同？

9.2. Epidemiology 9.2. 流行病学

Section Learning Objectives 章节学习目标

Describe the epidemiology of OCD.
描述强迫症的流行病学。
Describe the epidemiology of body dysmorphic disorder.
描述体象障碍的流行病学。
Describe the epidemiology of hoarding disorder.
描述囤积障碍的流行病学。

9.2.1. OCD 9.2.1. 强迫症

The prevalence rate for OCD is approximately 1.2% both in the U.S. and worldwide (APA, 2022). Women are diagnosed with OCD more often than males; however, in childhood, boys are diagnosed more frequently than girls (APA, 2022). With respect to gender and symptoms, females are more likely to be diagnosed with cleaning related obsessions and compulsions. In contrast, males are more likely to display symptoms related to forbidden thoughts and symmetry (APA, 2022). The DSM-5-TR reports that the mean age of onset of OCD is 19.5 years with a quarter of cases starting by 14 years of age. Additionally, males have an earlier age of onset (5-15 yrs.) compared to females (20-24 yrs.; Rasmussen & Eisen, 1990).
强迫症（OCD）的患病率在美国和全球大约为 1.2%（APA，2022 年）。女性比男性更容易被诊断为 OCD；然而，在儿童期，男孩比女孩更容易被诊断（APA，2022 年）。在性别和症状方面，女性更容易被诊断为与清洁相关的强迫和冲动。相比之下，男性更可能表现出与禁忌思想和对称性相关的症状（APA，2022 年）。DSM-5-TR 报告称，OCD 的平均发病年龄为 19.5 岁，其中四分之一的患者在 14 岁之前开始发病。此外，与女性（20-24 岁；Rasmussen & Eisen，1990 年）相比，男性的发病年龄更早（5-15 岁）。

9.2.2. Body Dysmorphic Disorder 9.2.2. 体象障碍

The point prevalence rate for body dysmorphic disorder among U.S. adults is 2.4% while outside the U.S., the point prevalence is 1.7% to 2.9%. Gender-based prevalence rates indicate that women are more likely to be diagnosed with body dysmorphic disorder than men, though muscle dysmorphia is diagnosed more frequently in men. Additionally, women are more likely to be preoccupied with weight, breasts, buttocks, legs, hips, and excessive body or facial hair while men have preoccupations with their genitals, body build, and thinning hair (APA, 2022).
美国成年人身体变形障碍的点现患率为 2.4%，而在美国以外，点现患率为 1.7%至 2.9%。基于性别的现患率表明，女性比男性更容易被诊断为身体变形障碍，尽管肌肉变形障碍在男性中更为常见。此外，女性更容易对体重、胸部、臀部、腿部、臀部以及过多的身体或面部毛发感到担忧，而男性则对他们的生殖器、体格和脱发感到担忧（APA，2022）。

9.2.3. Hoarding Disorder 9.2.3. 贮物狂乱症

While national studies on the prevalence rate of hoarding within the U.S. and internationally are not available, community surveys estimate clinically significant hoarding as occurring in 1.5% to 6.0% of the population (APA, 2022; Gilliam & Tolin, 2010). Clinical samples are more highly represented by females than males and older individuals (over the age of 65 years) are three times more likely to be diagnosed with hoarding disorder than younger adults.
尽管美国和国际上关于囤积症患病率的全国性研究尚不可用，但社区调查估计，临床上有意义的囤积症在人口中发生率为 1.5%至 6.0%（APA，2022；Gilliam & Tolin，2010）。临床样本中女性比男性更为突出，65 岁以上的老年人患囤积症的可能性是年轻人的三倍。

Key Takeaways 关键要点

You should have learned the following in this section:
您应该在本节中学到了以下内容：

The prevalence rate for OCD is about 1.2% while body dysmorphic disorder is 2.4% and hoarding is estimated at 1.5% to 6%.
强迫症患病率约为 1.2%，体象障碍为 2.4%，囤积症估计在 1.5%至 6%之间。
In terms of gender, females are more likely to be diagnosed with the three disorders, though in terms of body dysmorphic disorder, males receive the muscle dysmorphia specifier more than females.
就性别而言，女性更容易被诊断出这三种疾病，尽管在体象障碍方面，男性比女性更可能被诊断为肌肉畸形。
Gender differences are also present for symptom presentation in OCD and the area of the body focused on in body dysmorphic disorder.
性别差异也存在于强迫症的症状表现以及体象障碍中身体关注的区域。

Section 9.2 Review Questions
第 9.2 节复习题

What are the key gender differences related to OCD and body dysmorphic disorder?
什么是与强迫症和体象障碍相关的关键性别差异？
How do the prevalence rate of the three disorders compare?
三种疾病的患病率如何比较？

9.3. Comorbidity 9.3. 并发症

Section Learning Objectives 章节学习目标

Describe the comorbidity of OCD.
描述强迫症（OCD）的共病情况。
Describe the comorbidity of body dysmorphic disorder.
描述体象障碍的共病情况。
Describe the comorbidity of hoarding disorder.
描述囤积障碍的共病情况。

9.3.1. OCD 9.3.1. 强迫症

There is a high comorbidity between OCD and other anxiety disorders. Nearly 76% of individuals with OCD will be diagnosed with another anxiety disorder, most commonly panic disorder, social anxiety disorder, generalized anxiety disorder, or a specific phobia. Additionally, due to the nature of OCD and its symptoms, nearly 41% of those with OCD will also be diagnosed with a depressive or bipolar disorder (APA, 2022).
强迫症与其他焦虑障碍的共病率很高。近 76%的强迫症患者将被诊断为另一种焦虑障碍，最常见的是恐慌症、社交焦虑障碍、广泛性焦虑障碍或特定恐惧症。此外，由于强迫症及其症状的性质，近 41%的强迫症患者还将被诊断为抑郁症或双相情感障碍（APA，2022）。

There is a high comorbidity between OCD and tic disorder, particularly in males with an onset of OCD in childhood. Children presenting with early-onset OCD typically have a different presentation of symptoms than traditional OCD. Research has also indicated a strong triad of OCD, tic disorder, and ADHD in children. Due to this psychological disorder triad, it is believed there is a neurobiological mechanism at fault for the development and maintenance of the disorders.
OCD 与抽动障碍的共病率较高，尤其是在儿童期起病的 OCD 男性中。早期发病的儿童 OCD 通常比传统 OCD 有不同症状表现。研究还表明，儿童中存在 OCD、抽动障碍和 ADHD 的强烈三联征。由于这种心理障碍三联征，人们认为存在一种神经生物学机制负责这些疾病的发展和维持。

It should be noted that there are several disorders—schizophrenia, bipolar disorder, eating disorders, body dysmorphic disorder, and Tourette’s disorder – that OCD is much more common in. Therefore, clinicians who have a patient diagnosed with one of the disorders should also routinely assess patients for OCD (APA, 2022).
应注意的是，有几个疾病——精神分裂症、双相情感障碍、进食障碍、体象障碍和妥瑞氏症——在这些疾病中强迫症（OCD）更为常见。因此，对于被诊断为这些疾病之一的患者的临床医生应常规评估患者是否存在 OCD（APA，2022）。

Finally, OCD has a mean rate of lifetime suicide attempts of 14.2%, a mean rate of lifetime suicidal ideation of 44.1%, and a mean rate of current suicidal ideation of 25.9%. Severity of OCD, the symptom dimension of unacceptable thoughts, a history of suicidality, and severity of comorbid depressive and anxiety symptoms are predictors of greater suicide risk (APA, 2022).
最后，强迫症的平均终身自杀尝试率为 14.2%，平均终身自杀意念率为 44.1%，平均当前自杀意念率为 25.9%。强迫症的严重程度、不可接受的思想症状维度、自杀史以及共病抑郁和焦虑症状的严重程度是自杀风险增加的预测因素（APA，2022）。

9.3.2. Body Dysmorphic Disorder 9.3.2. 体象障碍

Major depressive disorder is the most common comorbid psychological disorder with body dysmorphic disorder and typically occurs after the onset of body dysmorphic disorder. Additionally, there are some reports of social anxiety disorder, OCD, and substance-related disorders (likely related to muscle enhancement; APA, 2022). Those with body dysmorphic disorder are four times more likely to have experienced suicidal thoughts and 2.6 times more likely to have made suicide attempts compared to healthy control subjects and those diagnosed with eating disorders, OCD, or any anxiety disorder.
重度抑郁症是最常见的与体象障碍共病的心理障碍，通常在体象障碍发病后出现。此外，还有一些关于社交焦虑障碍、强迫症和物质相关障碍（可能与肌肉增强有关；APA，2022）的报道。患有体象障碍的人比健康对照组以及被诊断为进食障碍、强迫症或任何焦虑障碍的人更有可能经历自杀想法，自杀尝试的可能性是后者的 2.6 倍。

9.3.3. Hoarding Disorder 9.3.3. 贮物狂乱症

Of those diagnosed with hoarding disorder, about 75% have a comorbid mood or anxiety disorder with major depressive disorder, social anxiety disorder, and generalized anxiety disorder being the most common comorbid conditions. Additionally, nearly 20% also meet the criteria for OCD (APA, 2022).
在那些被诊断为囤积障碍的人中，大约 75%患有共病情绪或焦虑障碍，其中重度抑郁症、社交焦虑障碍和广泛性焦虑障碍是最常见的共病情况。此外，近 20%的人也符合强迫症的诊断标准（APA，2022）。

Key Takeaways 关键要点

You should have learned the following in this section:
您应该在本节中学到了以下内容：

OCD is shown to have a high comorbidity with anxiety and depressive disorders as well as tic disorder and ADHD in children.
强迫症与焦虑症、抑郁症以及儿童抽动障碍和 ADHD 的共病率较高。
Body dysmorphic disorder has a high comorbidity with major depressive disorder.
体象障碍与重度抑郁症具有较高的共病率。
Hoarding disorder has a high comorbidity with mood and anxiety disorders.
囤积症与情绪和焦虑障碍的共病率较高。

Section 9.3 Review Questions
第 9.3 节复习题

What are the most common comorbidities for OCD? Be specific.
什么是 OCD 最常见的共病？请具体说明。
This section discussed the OCD triad in children. What two other disorders complete this triad?
本节讨论了儿童强迫症三联征。还有哪两种疾病能完成这个三联征？
Which disorder is body dysmorphic disorder most comorbid with?
哪种疾病与体象障碍最常并发？
What can we say about comorbidities with hoarding disorder?
关于强迫性囤积症的共病，我们能说什么？

9.4. Etiology 9.4. 病因

Section Learning Objectives 章节学习目标

Describe the biological causes of obsessive-compulsive disorders.
描述强迫症的生物原因。
Describe the cognitive causes of obsessive-compulsive disorders.
描述强迫症的认知原因。
Describe the behavioral causes of obsessive-compulsive disorders.
描述强迫症的行为原因。

9.4.1. Biological 9.4.1. 生物

There are a few biological explanations for obsessive-compulsive related disorders, including hereditary transmission, neurotransmitter deficits, and abnormal functioning in brain structures.
有一些强迫症相关疾病的生物学解释，包括遗传传递、神经递质缺乏和大脑结构异常功能。

** 9.4.1.1. Hereditary transmission. **With regards to heritability studies, twin studies routinely support the role of genetics in the development of obsessive-compulsive behaviors, as monozygotic twins have a substantially greater concordance rate (80-87%) than dizygotic twins (47-50%; Carey & Gottesman, 1981; van Grootheest, Cath, Beekman, & Boomsma, 2005). Additionally, first degree relatives of patients diagnosed with OCD are at a 5-fold increase to develop OCD at some point throughout their lifespan (Nestadt, et al., 2000).
9.4.1.1. 遗传传播。关于遗传性研究，双生子研究通常支持遗传在强迫症行为发展中的作用，因为单卵双生子的一致性率（80-87%）显著高于双卵双生子（47-50%；Carey & Gottesman，1981；van Grootheest，Cath，Beekman & Boomsma，2005）。此外，被诊断为强迫症的患者的一级亲属在其一生中患强迫症的风险增加 5 倍（Nestadt 等，2000）。

Interestingly, a study conducted by Nestadt and colleagues (2000) exploring the familial role in the development of obsessive-compulsive disorder found that family members of individuals with OCD had higher rates of both obsessions and compulsions than control families; however, the familial relationship with regards to obsessions were stronger than that of compulsions suggesting that there is a stronger heritability association for obsessions than compulsions.
有趣的是，Nestadt 及其同事（2000 年）进行的一项研究探讨了家族在强迫症发展中的作用，发现患有强迫症个体的家庭成员在强迫和强迫行为方面的发生率高于对照组家庭；然而，在强迫与家族关系方面比强迫行为方面更强，这表明强迫的遗传关联性比强迫行为更强。

This study also found a relationship between age of onset of OCD symptoms and family heritability. Individuals who experienced an earlier age of onset, particularly before age 17, were found to have more first-degree relatives diagnosed with OCD. In fact, after the age of 17, there was no relationship between family diagnoses, suggesting those who develop OCD at an older age may have a different diagnostic origin (Nestadt, et al., 2000).
这项研究还发现，强迫症症状的发病年龄与家族遗传性之间存在关联。研究发现，那些发病年龄较早的人，尤其是 17 岁之前，其一级亲属中患有 OCD 的比例更高。事实上，在 17 岁之后，家庭诊断之间没有发现关联，这表明在较晚年龄发病的 OCD 可能具有不同的诊断起源（Nestadt 等，2000 年）。

Initial studies exploring genetic factors for BDD and hoarding also indicate a hereditary influence; however, environmental factors appear to play a more significant role in the development of these disorders than that of OCD (Ahmed, et al., 2014; Lervolino et al., 2009).
初步研究探讨了 BDD 和囤积症的遗传因素，也表明了遗传影响；然而，环境因素似乎在发展这些疾病方面比 OCD（Ahmed 等，2014；Lervolino 等，2009）起着更重要的作用。

** 9.4.1.2. Neurotransmitters**. Neurotransmitters, particularly serotonin, have been identified as a contributing factor to obsessive and compulsive behaviors. This discovery was made accidentally, when individuals with depression and comorbid OCD were given antidepressant medications clomipramine and fluoxetine—both of which increase levels of serotonin—to mediate symptoms of depression. Not only did these patients report a significant reduction in their depressive symptoms, but also a substantial improvement in their OCD symptoms (Bokor & Anderson, 2014). Antidepressant medications that do not affect serotonin levels are not effective in managing obsessive and compulsive symptoms, thus offering additional support for deficits of serotonin levels as an explanation of obsessive and compulsive behaviors (Sinopoli, Burton, Kronenberg, & Arnold, 2017; Bokor & Anderson, 2014). More recently, there has been some research implicating the involvement of additional neurotransmitters—glutamate, GABA, and dopamine—in the development and maintenance of OCD, although future studies are still needed to draw definitive conclusions (Marinova, Chuang, & Fineberg, 2017).
9.4.1.2. 神经递质。神经递质，尤其是血清素，已被确定为强迫和强迫行为的一个相关因素。这一发现是在偶然情况下做出的，当时患有抑郁症和共病 OCD 的个体被给予抗抑郁药物氯米帕明和氟西汀——这两种药物都能增加血清素水平，以缓解抑郁症的症状。这些患者不仅报告说他们的抑郁症状显著减少，而且他们的 OCD 症状也有显著改善（Bokor & Anderson，2014）。不影响血清素水平的抗抑郁药物在管理强迫和强迫症状方面无效，从而为血清素水平不足作为强迫和强迫行为解释提供了额外的支持（Sinopoli，Burton，Kronenberg，& Arnold，2017；Bokor & Anderson，2014）。最近，有一些研究暗示了其他神经递质——谷氨酸、GABA 和多巴胺——在 OCD 的发展和维持中的作用，尽管还需要未来的研究来得出明确的结论（Marinova，Chuang，& Fineberg，2017）。

** 9.4.1.3. Brain structures.** Seeing as neurotransmitters have direct involvement in the development of obsessive-compulsive behaviors, it’s only logical that brain structures that house these neurotransmitters also likely play a role in symptom development. Neuroimaging studies implicate the brain structures and circuits in the frontal lobe, more specifically, the orbitofrontal cortex, which is located just above each eye (Marsh et al., 2014). This brain region is responsible for mediating strong emotional responses and converts them into behavioral responses. Once the orbitofrontal cortex receives sensory/emotional information via sensory inputs, it transmits this information through impulses. These impulses are then passed on to the caudate nuclei, which filters through the many impulses received, passing along only the strongest impulses to the thalamus. Once the impulses reach the thalamus, the individual essentially reassesses the emotional response and decides whether to act (Beucke et al., 2013). It is believed that individuals with obsessive compulsive behaviors experience overactivity of the orbitofrontal cortex and a lack of filtering in the caudate nuclei, thus causing too many impulses to transfer to the thalamus (Endrass et al., 2011). Further support for this theory has been shown when individuals with OCD experience brain damage to the orbitofrontal cortex or caudate nuclei and experience remission of OCD symptoms (Hofer et al., 2013).
9.4.1.3. 大脑结构。鉴于神经递质直接参与强迫症行为的发展，这些神经递质所在的大脑结构也可能在症状发展中发挥作用。神经影像学研究暗示了额叶中的大脑结构和回路，更具体地说，是位于每个眼睛上方的眶额叶皮层（Marsh 等，2014）。这个大脑区域负责调节强烈的情绪反应，并将它们转化为行为反应。一旦眶额叶皮层通过感官输入接收感官/情绪信息，它就会通过冲动传递这些信息。然后，这些冲动被传递到尾状核，尾状核过滤接收到的许多冲动，只将最强的冲动传递到丘脑。一旦冲动达到丘脑，个体本质上重新评估情绪反应，并决定是否采取行动（Beucke 等，2013）。人们认为，强迫症患者大脑眶额叶皮层过度活跃，尾状核缺乏过滤，从而导致过多冲动传递到丘脑（Endrass 等，2011 年）。当 OCD 患者出现眶额叶皮层或尾状核损伤并经历 OCD 症状缓解时，这一理论得到了进一步支持（Hofer 等，2013 年）。

9.4.2. Cognitive 9.4.2. 认知

Cognitive theorists believe that OCD behaviors occur due to an individual’s distorted thinking and negative cognitive biases. More specifically, individuals with OCD are more likely to overestimate the probability of harm, loss of control, or uncertainty in their life, thus leading them to over-interpret potential negative outcomes of events. Additionally, some research has indicated that those with OCD also experience disconfirmation bias, which causes the individual to seek out evidence of their failure to perform the ritual or compensatory behavior correctly (Sue, Sue, Sue, & Sue, 2017). Finally, individuals with OCD often report the inability to trust themselves and their instincts, and therefore, feel the need to repeat the compulsive behavior multiple times to ensure it is done correctly. These cognitive biases are supported throughout research studies that repeatedly find individuals with OCD experience more intrusive thoughts than those without OCD (Jacob, Larson, & Storch, 2014).
认知理论家认为，强迫症行为是由于个人扭曲的思维和消极的认知偏差引起的。更具体地说，患有强迫症的人更容易高估生活中伤害、失去控制或不确定性的可能性，因此导致他们对事件的潜在负面结果进行过度解读。此外，一些研究表明，患有强迫症的人还经历否认偏差，这导致个人寻求证据来证明他们未能正确执行仪式或补偿行为（Sue, Sue, Sue, & Sue, 2017）。最后，患有强迫症的人经常报告无法信任自己和自己的直觉，因此感到需要多次重复强迫行为以确保其正确执行。这些认知偏差在研究研究中得到支持，这些研究反复发现患有强迫症的人比没有强迫症的人体验到更多的侵扰性思维（Jacob, Larson, & Storch, 2014）。

We have shown that individuals with OCD experience cognitive biases and that these biases contribute to the obsessive and compulsive behaviors, but why do these cognitive biases occur so often? Everyone has times when they have repetitive or intrusive thoughts such as: “Did I shut the oven off after cooking dinner?” or “Did I remember to lock the door before I left home?” Fortunately, most individuals are able to either concede to their thoughts once, or even forgo acknowledging their thoughts after they confidently talk themselves through their actions, ensuring that the behavior in question was or was not completed. Unfortunately, individuals with OCD are unable to neutralize these thoughts without performing a ritual as a way to put themselves at ease. As you will see in more detail in the behavioral section below, the behaviors (compulsions) used to neutralize the thoughts (obsessions) provide temporary relief to the individual. As the individual is continually exposed to the obsession and repeatedly engages in the compulsive behaviors to neutralize their anxiety, the behavior is repeatedly reinforced, thus becoming a compulsion. This theory is supported by studies where individuals with OCD report using more neutralizing strategies and report significant reductions in anxiety after employing these neutralizing techniques (Jacob, Larson, & Storch, 2014; Salkovskis et al., 2003).
我们已经表明，强迫症患者会经历认知偏差，这些偏差导致强迫和强迫性行为，但为什么这些认知偏差会如此频繁地发生？每个人都有重复或侵入性思维的时候，比如：“我做饭后关上烤箱了吗？”或者“我离开家之前记得锁门了吗？”幸运的是，大多数人能够一次或多次承认自己的思维，或者在他们自信地通过自己的行动说服自己后，不再承认自己的思维，确保所讨论的行为已经完成或未完成。不幸的是，强迫症患者无法在不进行仪式的情况下中和这些思维，以此来让自己安心。正如您将在下面的行为部分更详细地看到的那样，用来中和思维（强迫）的行为（强迫行为）为个体提供了暂时的缓解。随着个体不断接触到强迫思维并反复进行强迫行为来中和他们的焦虑，这种行为会反复得到强化，从而成为一种强迫行为。这一理论得到了研究的支持，其中患有强迫症的个人报告称，在采用这些中和策略后，焦虑感显著降低（Jacob, Larson, & Storch, 2014；Salkovskis 等，2003）。

9.4.3. Behavioral 9.4.3. 行为

The behavioral explanation of obsessive compulsive-related disorders focuses on compulsions rather than obsessions. Behaviorists believe that these compulsions begin with and are maintained through operant conditioning. How so? Well, an individual with OCD may experience negative thoughts or anxieties related to an unpleasant event (obsession; the event is a stimulus). These thoughts/anxieties cause significant distress to the individual, and therefore, they seek out some behavior (compulsion; the response) to alleviate these threats (i.e., escape behavior associated with negative reinforcement). This provides temporary relief to the individual, thus reinforcing the compulsive behaviors used to lessen the threat. Over time, the compulsive behaviors are reinforced due to the repeated exposure of the obsession and the temporary relief that comes with engaging in these compulsive behaviors (escape behavior).
行为解释强迫症相关疾病侧重于强迫行为而非强迫观念。行为主义者认为这些强迫行为始于并维持于操作性条件反射。怎么会这样呢？嗯，患有强迫症的人可能会经历与不愉快事件相关的负面想法或焦虑（强迫观念；事件是刺激）。这些想法/焦虑给个人带来极大的困扰，因此，他们会寻求某种行为（强迫行为；反应）来减轻这些威胁（即与负面强化相关的逃避行为）。这为个人提供了暂时的缓解，从而强化了用来减轻威胁的强迫行为。随着时间的推移，由于反复暴露于强迫观念和进行这些强迫行为（逃避行为）所带来的暂时缓解，强迫行为得到强化。

Strong support for this theory is the fact that the behavioral treatment option for OCD- exposure and response prevention, is among the most effective treatments for these disorders. As you will read below, this treatment essentially breaks the patient’s operant conditioning associated with the obsessions and compulsions by preventing the individual from engaging in the compulsive behavior until anxiety is reduced.
强烈支持这一理论的事实是，针对 OCD 的行为治疗选项——暴露和反应预防，是治疗这些疾病中最有效的治疗方法之一。正如您下面将要读到的，这种治疗本质上通过防止个体在焦虑降低之前进行强迫行为，打破了患者与强迫症相关的操作性条件反射。

Key Takeaways 关键要点

You should have learned the following in this section:
您应该在本节中学到了以下内容：

Biological causes of obsessive-compulsive disorders include hereditary transmission, neurotransmitter deficits particularly in relation to serotonin, and abnormal functioning in brain structures.
生物强迫症的原因包括遗传传递、神经递质缺乏，尤其是与血清素相关，以及大脑结构的异常功能。
Cognitive causes of obsessive-compulsive disorders include distorted thinking such as overestimating the probability of harm, loss of control, or uncertainty in their life, and negative cognitive biases such as disconfirmation bias.
认知性强迫症的原因包括扭曲的思维，如过度估计伤害、失去控制或生活中不确定性的可能性，以及负面的认知偏差，如否认偏差。
Behavioral causes of obsessive-compulsive disorders include operant conditioning.
强迫症的行为原因包括操作性条件反射。

Section 9.4 Review Questions
第 9.4 节复习题

What are the biological implications regarding the etiology of OCD and related disorders? What brain structures have been linked to these disorders?
关于强迫症及相关疾病的病因学，有哪些生物学意义？哪些大脑结构与这些疾病有关？
Discuss identified cognitive biases that are related to the development and maintenance of OCD and related disorders?
讨论与强迫症及相关障碍的发展和维持相关的认知偏差？
The behavioral model discusses how respondent conditioning may explain the development and maintenance of these disorders. What type of reinforcement is at work and how?
行为模型讨论了应答条件如何解释这些障碍的发展与维持。起作用的强化类型是什么以及如何起作用？

9.5. Treatment 9.5. 治疗

Section Learning Objectives 章节学习目标

Describe treatment options for OCD.
描述强迫症的治疗方案。
Describe treatment options for body dysmorphic disorder.
描述体象障碍的治疗方案。
Describe treatment options for hoarding disorder.
描述囤积症的治疗方案。

9.5.1. OCD 9.5.1. 强迫症

** 9.5.1.1. Exposure and Response Prevention (ERP). **Treatment of OCD has come a long way in recent years. Among the most effective treatment options is exposure and response prevention (March, Frances, Kahn, & Carpenter, 1997). First developed by psychiatrist Victor Meyer (1966), as you might infer from the name, individuals are repeatedly exposed to their obsession, thus causing anxiety/fears, while simultaneously prevented from engaging in their compulsive behaviors. Exposure sessions are often done in vivo (in real life), via videos, or even imaginary, depending on the type of obsession. For example, a fear that one’s house would burn down if their compulsion was not carried out would obviously be done via imaginary exposure, as it would not be ethical to have a person burn their house down.
9.5.1.1. 暴露和反应预防（ERP）。近年来，强迫症的治疗取得了长足进步。其中最有效的治疗方法之一是暴露和反应预防（March, Frances, Kahn, & Carpenter，1997）。该方法最初由精神病学家维克多·迈耶（1966）开发，正如其名称所暗示的，个体会反复暴露于其强迫观念，从而引起焦虑/恐惧，同时阻止他们进行强迫行为。暴露治疗通常在现实生活中进行，通过视频，甚至想象，具体取决于强迫观念的类型。例如，如果一个人不执行其强迫行为，他们的房子就会烧毁的恐惧显然是通过想象暴露来进行的，因为这不符合道德规范，让一个人烧毁自己的房子。

Prior to beginning the exposure and response prevention exercises, the clinician must teach the patient relaxation techniques for them to engage in during the distress of being exposed to the obsession. Once relaxation techniques are taught, the clinician and patient will develop a hierarchy of obsessions. Treatment will start at those with the lowest amount of distress to ensure the patient has success with treatment, as well as preventing withdrawal of treatment.
在开始暴露和反应预防练习之前，临床医生必须教会病人在面对强迫观念时的放松技巧。一旦教授了放松技巧，临床医生和病人将制定一个强迫观念的等级体系。治疗将从引起最低程度不适的强迫观念开始，以确保病人能够成功接受治疗，同时防止治疗中断。

Within the hierarchy of obsessions, the individual is also gradually exposed to their obsession. For example, an individual obsessed with germs, may first watch a person sneeze on the computer in session. Once anxiety is managed and compulsions refrain at this level of exposure, the individual would move on to being present in the same room as a sick individual, to eventually shaking hands with someone obviously sick, each time preventing them from engaging in their compulsive behavior. Once this level of their hierarchy was managed, they would move on to the next obsession and so forth until the entire list was complete.
在强迫症的等级体系中，个体也逐渐暴露于其强迫症中。例如，一个对细菌有强迫症的人，可能首先会观察一个人在治疗过程中在电脑上打喷嚏。一旦焦虑得到控制，并在这种暴露水平上抑制强迫行为，个体就会继续前进，与生病的个体同处一室，最终与显然生病的人握手，每次都阻止他们进行强迫行为。一旦他们管理了这一级别的等级，他们就会继续前进到下一个强迫症，以此类推，直到整个清单完成。

Treatment outcome for exposure and response prevention is very effective in treating individuals with OCD. In fact, some studies suggest up to an 86% response rate when treatment is completed (Foa et al., 2005). Combination treatments such as ERP with family counseling (utilizing CBT techniques) may increase this response rate even higher (Bolleau, 2011; Krebs & Heyman, 2015). Like most OCD related treatments, the largest barrier to treatment is getting patients to commit to treatment, as the repeated exposures and prevention of compulsive behaviors can be extremely distressing to patients.
治疗暴露和反应预防对治疗强迫症个体非常有效。事实上，一些研究表明，当治疗完成时，响应率可高达 86%（Foa 等人，2005 年）。如 ERP 与家庭咨询（利用 CBT 技术）相结合的治疗可能进一步提高这一响应率（Bolleau，2011；Krebs & Heyman，2015）。与大多数与 OCD 相关的治疗方法一样，治疗的最大障碍是让患者承诺治疗，因为重复的暴露和预防强迫行为可能对病人造成极大的痛苦。

** 9.5.1.2. Psychopharmacology. **There has been minimal support for the treatment of OCD with medication alone. This is likely due to the temporary resolution of symptoms during medication use. Among the most effective medications are those that inhibit the reuptake of serotonin, clomipramine and SSRIs. Reportedly, up to 60% of patients show improvement in symptoms while taking these medications; however, symptoms are quick to return when medications are discontinued (Dougherty, Rauch, & Jenike, 2002). While there has been some promise in a combined treatment option of exposure and response prevention and SSRIs, these findings were not superior to exposure and response prevention alone, suggesting that the inclusion of medication in treatment does not provide an added benefit (Foa et al., 2005).
9.5.1.2. 精神药理学。单独使用药物治疗强迫症的支持非常有限。这可能是由于在用药期间症状的暂时缓解。其中最有效的药物是抑制血清素再摄取的药物，如氯米帕明和 SSRIs。据报道，在服用这些药物时，高达 60%的患者症状有所改善；然而，当停止用药时，症状很快就会复发（Dougherty, Rauch, & Jenike，2002）。虽然暴露和反应预防与 SSRIs 联合治疗有一些希望，但这些发现并不优于单独的暴露和反应预防，这表明在治疗中加入药物并不提供额外的益处（Foa 等，2005）。

9.5.2. Body Dysmorphic Disorder 9.5.2. 体象障碍

Seeing as though there are strong similarities between OCD and body dysmorphic disorder, it should not come as a surprise that the only two effective treatments for body dysmorphic disorder are those that are effective in OCD. Exposure and response prevention has been successful in treating symptoms of body dysmorphic disorder, as patients are repeatedly exposed to their body imperfections/obsessions and prevented from engaging in compulsions used to reduce their anxiety. (Veale, Gournay, et al., 1996; Wilhelm, Otto, Lohr, & Deckersbach, 1999). The other treatment option, psychopharmacology, has also been shown to reduce symptoms in patients with body dysmorphic disorder. Similar to OCD, medications such as clomipramine and SSRIs are generally prescribed. While these are effective in reducing body dysmorphic disorder symptoms, once medication is discontinued, symptoms resume nearly immediately suggesting this is not an effective long-term treatment option for those with body dysmorphic disorder.
鉴于强迫症和体象障碍之间存在强烈相似性，因此，仅有的两种有效的体象障碍治疗方法都是对强迫症有效的治疗方法，这并不令人惊讶。暴露和反应预防在治疗体象障碍症状方面已取得成功，因为患者反复接触他们的身体缺陷/强迫观念，并防止他们进行减少焦虑的强迫行为。（Veale, Gournay 等，1996；Wilhelm, Otto, Lohr 和 Deckersbach，1999）。另一种治疗方法，心理药理学，也已证明可以减轻体象障碍患者的症状。与强迫症相似，通常处方使用氯米帕明和 SSRI 类药物。虽然这些药物在减少体象障碍症状方面有效，但一旦停止用药，症状几乎立即恢复，这表明这不是体象障碍患者有效的长期治疗选择。

Treatment of body dysmorphic disorder appears to be difficult, with one study finding that only 9% of participants had full remission at a 1-year follow-up, and 21% reported partial remission (Phillips, Pagano, Menard & Stout, 2006). A more recent finding reported more promising findings, with 76% of participants reporting full remission over 8 years (Bjornsson, Dyck, et al., 2011).
治疗体象障碍似乎很困难，一项研究发现，在 1 年随访中，只有 9%的参与者完全缓解，21%报告部分缓解（菲利普斯、帕加诺、梅纳德和斯塔特，2006 年）。一项更近期的发现报告了更有希望的结果，8 年内有 76%的参与者报告完全缓解（比约恩松、迪克等，2011 年）。

** 9.5.2.1. Plastic surgery and medical treatments. **Many individuals with body dysmorphic disorder seek out plastic surgery to attempt to correct their deficits. Phillips and colleagues (2001) evaluated treatments of patients with body dysmorphic disorder and found that 76.4% of the patients reported some form of plastic surgery or medical treatment, with dermatology treatment the most reported (45%) followed by plastic surgery (23%). The problem with this type of treatment is that the individual is rarely satisfied with the outcome of the procedure, thus leading them to seek out additional surgeries on the same defect (Phillips et al., 2001). Therefore, it is important that medical professionals thoroughly screen patients for psychological distress before completing any medical treatment.
9.5.2.1. 美容外科和医疗治疗。许多患有体象障碍的人寻求美容外科手术来尝试纠正他们的缺陷。菲利普斯及其同事（2001 年）评估了体象障碍患者的治疗方法，发现 76.4%的患者报告过某种形式的整形外科手术或医疗治疗，其中皮肤科治疗报告最多（45%），其次是整形外科手术（23%）。这种治疗的问题在于，个体很少对手术结果感到满意，因此导致他们寻求对同一缺陷进行额外的手术（菲利普斯等，2001 年）。因此，在完成任何医疗治疗之前，医疗专业人员彻底筛查患者的心理压力非常重要。

9.5.3. Hoarding Disorder 9.5.3. 贮物狂乱症

Recent research has concluded that unlike OCD, many individuals with hoarding disorder do not experience intrusive thoughts, nor do they experience urges to perform rituals. Because of this difference, treatment for hoarding disorder has moved away from exposure and response prevention, and more toward a traditional cognitive-behavioral approach.
近期研究表明，与强迫症不同，许多有囤积症的人没有侵入性思维，也没有进行仪式行为的冲动。正因为这种差异，囤积症的治疗已从暴露和反应预防转向了更传统的认知行为疗法。

Frost and Hartl (1996) believed that individuals with hoarding disorder engage in complex decision-making processes, overanalyzing the value and worth of possessions, thus leading to hoarding the object as opposed to discarding it. Therefore, in addition to having the individual engage in exposure treatment, an added component of cognitive restructuring and motivational interviewing are added to address the complex-decision making that is involved in maintaining unnecessary possessions. By discussing motives for keeping items, as well as fears that may be associated with discarding items, clinicians can assist patients in their cognitive processes to ultimately determine the item’s actual worth (Williams & Viscusi, 2016). Unfortunately, due to the distressing nature of having to discard their possessions, many individuals in treatment for hoarding disorder prematurely end treatment, thus never reaching remission of symptoms (Mancebo, Eisen, Sibrava, Dyck, & Rasmussen, 2011).
Frost 和 Hartl（1996）认为，患有囤积症的人会参与复杂的决策过程，过度分析物品的价值和意义，因此导致囤积物品而不是丢弃它。因此，除了让个体参与暴露疗法外，还增加了认知重构和动机访谈的附加成分，以解决维持不必要的物品所涉及的复杂决策。通过讨论保留物品的动机以及与丢弃物品相关的恐惧，临床医生可以帮助患者在认知过程中最终确定物品的实际价值（Williams & Viscusi，2016）。不幸的是，由于丢弃物品的痛苦性质，许多正在接受囤积症治疗的人过早结束治疗，因此从未达到症状缓解（Mancebo，Eisen，Sibrava，Dyck 和 Rasmussen，2011）。

Key Takeaways 关键要点

You should have learned the following in this section:
您应该在本节中学到了以下内容：

Treatment options for OCD include exposure and response prevention, as well as SSRIs though the drug does not provide an added benefit in treatment.
强迫症的治疗方案包括暴露和反应预防，以及选择性 5-羟色胺再摄取抑制剂（SSRIs），尽管该药物在治疗中并不提供额外的益处。
Treatment options for body dysmorphic disorder include exposure and response prevention and drugs clomipramine and SSRIs.
治疗体象障碍的治疗方案包括暴露和反应预防以及氯米帕明和选择性 5-羟色胺再摄取抑制剂（SSRIs）。
Treatment options for hoarding disorder include exposure treatment, cognitive restructuring, and motivational interviewing.
治疗囤积症的方法包括暴露疗法、认知重构和动机访谈。

Section 9.5 Review Questions
第 9.5 节复习题

Discuss the various types of treatments for OCD. Which treatment option has the best outcome?
讨论强迫症的各种治疗方法。哪种治疗方案效果最佳？
What are the different components of Exposure and Response Prevention? How do they work together to reduce OCD symptoms?
什么是暴露和预防反应的不同组成部分？它们如何共同作用以减少强迫症症状？
What are the most effective treatment approaches for body dysmorphic disorder?
什么是治疗体象障碍最有效的方法？
According to Frost and Hartl (1996) what are the main components that contribute to the maintenance of hoarding disorder?
根据 Frost 和 Hartl（1996）的研究，维持囤积障碍的主要成分有哪些？

Module Recap 模块总结

As in all modules past, we have discussed the clinical presentation, epidemiology, comorbidity, etiology, and treatment options for a specific class of disorders – obsessive compulsive and related disorders.
与所有过往模块一样，我们讨论了特定类别疾病（强迫症及相关疾病）的临床表现、流行病学、合并症、病因和治疗选择。

3rd edition 第 3 版

Source: https://opentext.wsu.edu/abnormal-psych/chapter/module-9-obsessive-compulsive-and-related-disorders/