Related Disorders

These disorders are listed seperately to Anxiety Disorders in DSM-V but are discussed here

as many of the same principles apply to management.

Obsessive-Compulsive and Related Disorders

Obsessive-Compulsive Disorder

This refers to the situation when obsessions (intrusive troubling thoughts) and compulsions (repetitive behaviours aimed at reducing the anxiety caused by the obsessions) cause a person distress or interfere with their daily activities. Obsessive-compulsive disorder also has the following features: • The obsessions and compulsions are not viewed as being under the control of outside persons or influences, • They are repetitive and excessive, • They are often purposeless and not inherently enjoyable (temporary relief of tension/anxiety doesn’t count as enjoyment), • The person may try to resist them (may not occur with long standing symptoms), • Interference with the person’s compulsions causes him or her distress, which may be associated with aggression. It can be particularly difficult to differentiate between compulsions, repetitive movements (tics or stereotypies) and the repetitive behaviours in autism. The diagnosis can be clarified by considering the onset of symptoms; however people with Autism Spectrum Disorders are at increased risk of co- morbid Obsessive Compulsive Disorder Other disorders in this category include body dysmorphic disorder, trichotillomania (hair-pulling), excoriation disorder (skin-picking) and hoarding disorder.

Trauma and Stressor-related Disorders

Post Traumatic Stress Disorder (PTSD)

DSM criteria require exposure to a significant traumatic event and that this causes significant problems for the person’s ability to function, lasting more than one month. The person’s response is divided into four clusters: re-experiencing, avoidance, negative cognitions and mood, and arousal, but the person may have symptoms from any cluster. The traumatic event may be “re-experienced” with recurrent, intrusive and distressing recollections, dreams or flashbacks. In the “avoidance” cluster the person avoids reminders such as people or places which may be connected with the event and may be intensely distressed when exposed to reminders. “Negative cognitions and mood” covers many responses, such as a preoccupation with blame, social withdrawal, anhedonia or memory problems. In the “arousal” cluster they may present with insomnia, irritability, angry outbursts, poor concentration, hyper vigilance and a marked startle response. People with ID are more likely to experience traumatic events, and it is likely that PTSD in people with ID, particularly people with little or no verbal ability, will present with behavioural disturbance.

Acute Stress Disorder

This is described as a syndrome very similar to PTSD but occuring more than two days, and less than one month following the trigger event.

Adjustment Disorder

This category may be viewed as a response to a life stress, whether traumatic or not. People with an adjustment disorder may have symptoms such as depressed mood, anxiety symptoms or disturbed behaviour, but do not meet the criteria for another disorder.