Obsessive-Compulsive Related Disorders

Body Dysmorphic Disorder (BDD):

BDD is an OCD-related disorder in which an individual becomes excessively preoccupied with perceived flaws or defects, typically about a specific aspect of their physical appearance. These flaws are often minor or not observable to others, but they seem very significant and distressing to the person with BDD.

• Individuals with BDD spend a lot of time dwelling and ruminating about their perceived flaws, which can involve any part of the body but most frequently focused on the skin, hair, nose, and other facial features.

• This preoccupation causes significant distress and can interfere with daily functioning. People with BDD may avoid social activities, have difficulties at work or school, and struggle with relationships.

• To cope with their distress, individuals with BDD may engage in compulsive, repetitive behaviors, such as mirror checking, excessive grooming, skin picking, or seeking reassurance from others.

• Some people with BDD may avoid mirrors or social interactions to avoid dealing with their perceived flaws.

• In an attempt to fix their perceived flaws, individuals with BDD might seek medical or cosmetic procedures. However, these treatments rarely provide relief and can sometimes worsen the disorder.

• BDD is not about vanity. It is a potentially severe mental health condition that can lead to significant impairment and distress.

• Evidence-based treatments for BDD include cognitive-behavioral therapy (CBT) and medication, particularly selective serotonin reuptake inhibitors (SSRIs). These treatments can help reduce the preoccupied thoughts and compulsive behaviors associated with the disorder.

Hoarding Disorder:

Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. This behavior leads to the overwhelming accumulation of many items, which can clutter living spaces and make them difficult to use.

• Individuals with hoarding disorder have a strong urge to save items and experience distress at the thought of getting rid of possessions, including newspapers, clothes, storage containers, and even items perceived as trash by others.

• The excessive accumulation of items leads to cluttered living and work spaces, making areas like kitchens, bathrooms, and bedrooms unusable. This can interfere with the normal use of living spaces and impact daily functioning.

• Hoarding disorder causes significant distress or impairment in social, occupational, or other important areas of functioning, leading to difficulties in maintaining relationships or work responsibilities.

• Excessive clutter can pose health and safety risks, including fire hazards, fall risks, and unsanitary living conditions. This can impact both the individual and others living in the same space.

• People with hoarding disorder have varying levels of insight into their condition. Some may recognize their behavior as problematic, while others may not see it as an issue, minimize its impact, or be seemingly blind to the clutter.

• There is often a strong, even pathological, emotional attachment to the hoarded items. Individuals with hoarding disorder may feel that these items are potentially needed for future use or have sentimental value, even if, objectively, they are not useful or valuable.

• Variations of cognitive-behavioral therapy (CBT) is an effective treatment for hoarding disorder. It helps individuals challenge their beliefs about possessions, develop decision-making skills, and develop distress tolerance associated with discarding items. Medication, particularly selective serotonin reuptake inhibitors (SSRIs), may also be helpful.

Excoriation Disorder:

Excoriation disorder, also known as skin picking disorder, sometimes referred to as dermatillomania, is a mental health condition characterized by the recurrent and compulsive picking at one's skin, leading to tissue damage, infection, or, more seriously, anaphylactic shock.

• Individuals with excoriation disorder repeatedly pick at their skin, which can result in sores, scars, and other skin lesions, which generates a further cycle of picking. The picking can occur on any part of the body but is commonly focused on the face, arms, and hands.

• People with this disorder often make repeated attempts to reduce or stop their skin picking but are unable to do so despite their efforts.

• The skin-picking behavior causes significant distress or impairment in social, occupational, or other important areas of functioning, including feelings of shame, embarrassment, and social withdrawal due to visible skin damage.

• Skin picking can be triggered by various factors, including stress, anxiety, boredom, or perceived imperfections or irregularities in the skin.

• Individuals with excoriation disorder may use tools like tweezers, pins, or other objects to pick at their skin, which can exacerbate the damage.

• Skin picking is not better explained by another medical condition (e.g., scabies or other infestations) or by using substances such as cocaine or methamphetamine.

• Evidence-based treatments for excoriation disorder include CBT, particularly habit reversal training (HRT), which helps individuals recognize and develop competing strategies to change their skin-picking behaviors. Stress management and relaxation training may also be helpful. In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) may also be beneficial.

Trichotillomania:

Trichotillomania, or hair-pulling disorder, is characterized by the recurrent, irresistible urge to pull out one's hair. This behavior can lead to noticeable hair loss and significant distress or impairment in daily functioning.

• Individuals with trichotillomania repeatedly pull hair from their scalp, eyebrows, eyelashes, or other parts of their body. This behavior can result in noticeable hair loss and bald patches.

• People with this disorder often make repeated attempts to decrease or stop their hair-pulling behavior but find it difficult to control the urge.

• Hair-pulling behavior causes significant distress or impairment in social, occupational, or other important areas of functioning. Individuals may feel embarrassed or ashamed about their hair loss, leading to social withdrawal or avoidance of worthwhile activities.

• Hair pulling can be triggered by various factors, including stress, anger, anxiety, boredom, or a need to achieve a sense of relief or gratification. Some individuals may pull their hair consciously in response to specific cues, others may do it automatically without much awareness or a combination of both factors.

• Individuals with trichotillomania may engage in specific rituals or compulsive behaviors related to hair pulling, such as examining the hair root, manipulating or biting the hair, swallowing hair, or pulling hair from particular locations in a symmetrical or patterned way.

• Hair-pulling behavior is not better explained by another medical or dermatological condition (such as alopecia) or substance use.

• Evidence-based treatments for trichotillomania include CBT, particularly habit reversal training (HRT), which helps individuals recognize and develop competing strategies, using effective stimulus control methods to change their hair-pulling behaviors. In some cases, medications such as selective serotonin reuptake inhibitors (SSRIs) may also be helpful.

Anxiety Disorders

Social Anxiety Disorder (SAD):

SAD, also known as social phobia, is an anxiety disorder characterized by an intense and persistent fear of social or performance situations in which the person may be scrutinized or judged by others.

• People with SAD experience significant anxiety and distress in social situations, often fearing embarrassment or humiliation.

• The anxiety in SAD is typically focused on specific situations or activities, such as public speaking, eating in front of others, or attending parties.

• While avoidance of feared situations is common in SAD, it tends to be more specific to certain triggers rather than a general pattern of social avoidance.

Panic Disorder:

Panic disorder is characterized by recurrent, often unexpected panic attacks. These attacks are sudden periods of intense feelings of fear or discomfort that peak within minutes, lasting 5-30 minutes, and are accompanied by physical and cognitive symptoms. Panic attacks involve a sudden surge of intense fear or discomfort that reaches its peak within minutes. Symptoms can include a pounding heart, sweating, trembling, rapid breathing, shortness of breath, tight chest, nausea, dizziness, chills, hot flashes, numbness, and feelings of unreality or detachment.

• Panic attacks in panic disorder occur unexpectedly and without an obvious cue. This unpredictability can lead to significant anxiety about having future attacks.

• Individuals with panic disorder worry about having more panic attacks or about the potential consequences of the attacks (e.g., losing control or having a heart attack, embarrassment). This concern can lead to significant alterations in behavior to prevent future panic attacks.

• The fear of having panic attacks and avoidance behaviors can significantly impact a person's life functioning, affecting their ability to work, interact socially, and do routine activities.

• During a panic attack, people may feel a sense of impending doom or fear of dying or going crazy. The physical symptoms are often so intense that individuals may seek emergency medical care, thinking they are having a heart attack or other serious medical issues.

• Panic disorder is diagnosed when a person experiences recurrent, unexpected panic attacks and at least one month of persistent concern or worry about additional attacks or significant behavioral changes related to the attacks.

• Effective treatments for panic disorder include CBT, which helps individuals understand and change their beliefs and behaviors related to panic attacks. Exposure-based therapy can help people gradually face and reduce their fear of panic attacks.

• Various medications, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, can also help manage symptoms.

Agoraphobia:

Agoraphobia is an intense fear and anxiety of being in situations or places where escape might be difficult, or help might not be available should a panic attack or other incapacitating symptoms arise. This fear can lead to significant avoidance of various perceived threatening environments and situations associated with panic, severely impacting daily functioning.

• People with agoraphobia fear situations where they perceive it would be difficult to escape or get help, including being outside the home alone, being in a crowd or standing in line, using public transportation, being in open spaces (like parking lots or bridges), and being in enclosed spaces (e.g., elevators, stores, stadiums, theaters).

• To manage their anxiety, individuals with agoraphobia often avoid the situations associated with perceived threat. This avoidance can become pervasive, leading to becoming housebound or only able to leave their safe space when accompanied by someone they trust.

• The fear experienced in agoraphobia is often related to the concern that they might experience panic-like symptoms (such as dizziness, feeling faint, rapid heart rate, or difficulty breathing) and be unable to escape or get help.

• Agoraphobia can significantly interfere with a person's ability to perform daily activities, maintain employment, and engage in social relationships. The avoidance behavior and anxiety can lead to a reduced quality of life.

• Evidence-based treatments for agoraphobia include CBT, which helps individuals confront and reduce their anxiety through gradual exposure to the feared situations. CBT also works to change the thought patterns that contribute to their anxiety.

• Medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), can also help manage symptoms of agoraphobia.

Generalized Anxiety Disorder:

GAD is a mental health condition characterized by persistent, excessive, and uncontrollable worry about various aspects of daily life. This chronic anxiety can significantly interfere with a person's ability to function in everyday activities.

• People with GAD experience intense and persistent worry about a variety of topics, such as health, work, finances, family, or minor matters like household chores or appointments. This worry is often disproportionate to the actual situation and difficult to control.

• The anxiety and worry occur more days than not for at least six months, and the person finds it challenging to control the worry.

• GAD is often accompanied by physical symptoms, including restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbances (difficulty falling or staying asleep, or restless and unsatisfying sleep).

• The anxiety and physical symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This can affect a person's ability to work, maintain relationships, and carry out everyday activities.

• The symptoms of GAD are not attributable to the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition, and they are not better explained by another mental disorder (e.g., panic disorder, social anxiety disorder, obsessive-compulsive disorder).

• Evidence-based treatments for GAD, including CBT, which helps individuals identify, understand, and change patterns of thinking and behavior that contribute to their anxiety. CBT often involves techniques like cognitive restructuring, relaxation training, and exposure therapy.

• Medications, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and the sparing use of benzodiazepines, can also help manage symptoms. These medications are often used in conjunction with therapy for best results.

Specific Phobia:

A specific phobia is an intense, irrational fear of a specific object, situation, or activity that is generally not harmful. This fear leads to avoidance behavior and can significantly impact a person's daily life. Here are the key aspects of specific phobias:

• Individuals with a specific phobia experience an immediate and intense fear when exposed or perceived to be exposed to the phobic object or situation. The fear is out of proportion to the actual threat posed.

• People with specific phobias vigorously avoid the feared object or situation. This avoidance can interfere with their daily activities and responsibilities.

• Exposure to the phobic stimulus can cue physiological symptoms similar to panic.

• There are several types of specific phobias, commonly categorized into five groups:

  • Animal Type: Fear of animals or insects (e.g., spiders, snakes, roaches).

  • Natural Environment Type: Fear of natural phenomena (e.g., heights, storms, water).

  • Blood-Injection-Injury Type: Fear of blood, injections, or medical procedures (may cause fainting).

  • Situational Type: Fear of specific situations (e.g., flying, driving, elevators, enclosed spaces).

  • Other Type: Any other phobias that do not fit into the above categories (e.g., fear of choking, vomiting, loud noises).

• The intense fear and avoidance behaviors can lead to significant distress and impair a person's ability to function in various areas of life, including work, school, and social interactions.

• A specific phobia is diagnosed when the fear and avoidance behaviors are persistent, typically lasting six months or more. and cause significant distress or impairment in daily functioning.

• Evidence-based treatments for specific phobias include CBT, particularly exposure therapy. In exposure therapy, individuals are gradually and systematically exposed to the feared object or situation in a controlled manner, helping them to reduce their fear response over time.

• Other therapeutic techniques, such as relaxation training and cognitive restructuring, can also be beneficial. Medications like beta-blockers or benzodiazepines may be used to manage acute anxiety symptoms, but they are generally not considered long-term solutions.