Obsessive-Compulsive and Related Disorders
The tandem defining features of these disorders are the experience of recurring and intrusive thoughts or urges and the presence of excessively repetitive or ritualized behaviors. The repetitive or ritualized behaviors usually serve to reduce discomfort caused by the intrusive thoughts or urges. Each of the disorders described below can have a dramatic and adverse impact on a person’s life. The good news is that there are effective treatments that have helped many people address and manage their symptoms. There are similarities in the treatments for obsessive-compulsive disorders, but each disorder requires slight modifications and a tailored and individual approach to therapy.
Obsessive-Compulsive Disorder (OCD)
Individuals with OCD experience obsessions (persistently recurring and highly distressing intrusive thoughts) and/or engage in compulsions (seemingly uncontrollable repetitive behaviors that are driven by the perception that completing them is the only way to decrease the distress and anxiety caused by the obsession). The form that obsessions and compulsions may take is unlimited. The most common forms of obsessions include thoughts related to germs or contamination of some kind (e.g., chemicals), doubts that something important was completed (e.g., locking a door), unwanted sexual thoughts, or thoughts or urges to harm someone (e.g., one’s child or oneself). Common compulsions include using mental rituals to get rid of “bad” thoughts, washing excessively, checking something repeatedly, and seeking reassurance over and over again. There is an abundant amount of research that persuasively suggests the “gold-standard” treatment for OCD is Exposure and Response Prevention (ERP or ExRP). I have been certified as a treatment provider by the International OCD Foundation and have provided ERP extensively.
People with hoarding disorder excessively acquire and save possessions and this leads to a tremendous amount of clutter in one’s living space. The clutter may ultimately interfere with their functioning or pose a health and safety risk. Treatment for hoarding disorder is often helpful and may require visits to the person’s home. As with all of the problems described here, each hoarding disorder treatment plan is unique. I was trained in the treatment of hoarding disorder by Travis Osborne, PhD who, as an expert psychologist, has been featured on the program Hoarding: Buried Alive.
Body Dysmorphic Disorder (BDD)
Body dysmorphic disorder is characterized by a profound preoccupation with self-perceived flaws in one’s appearance that are usually not (or are minimally) observable by other people. The skin, hair, and nose are the most common focus for people with this disorder although any part of the body may be identified. The distress caused by the self-perceived defect(s) may lead a person to spend an excessive amount of time and effort engaging in behaviors that are intended to check on (e.g., mirror checking, reassurance-seeking), hide, or improve appearance (e.g. excessive grooming, surgical procedures).
Trichotillomania (Hair-Pulling Disorder)
Hair-pulling disorder is a problem in which a person pulls out their own hair repeatedly and this results in hair loss. Hair may be pulled from any area of the body and it is common for a person with this disorder to pull hair from their scalp, from around their eyes, or from their pubic region. People may go to extreme lengths to hide evidence of a hair-pulling problem and their efforts to stop pulling have thus far been unsuccessful.
Excoriation Disorder (Skin-Picking Disorder)
Skin-picking disorder involves the recurrent picking of one’s flesh that results in or exacerbates sores, wounds, or lesions. Efforts to stop picking have been unsuccessful. It is common for people who pick their skin to try and cover up the damage with clothing or to specifically pick skin on areas of the body that are typically covered.