What are obsessive-compulsive and related disorders?

Obsessive-compulsive and related disorders are characterized by the presence of repetitive and intrusive thoughts or obsessions and/or repetitive or ritualized behaviors. Individuals with these symptoms often feel stuck in repetitive cycles of thoughts and behaviors that are very difficult for them to break out of. A number of different disorders make up this category of mental health concerns and although they share some similarities, they also have important differences that have implications for effective treatment.

The Anxiety Center has the largest concentration of specialists in obsessive-compulsive disorders in the Pacific Northwest. As a result, our treatment team has extensive experience in treating these problems, including working with individuals with very severe symptoms who may need a more intensive treatment approach.

Below are brief descriptions of the types of obsessive-compulsive and related disorders we treat at the Anxiety Center.

Obsessive-compulsive disorder (OCD)

About 1 out of 50 adults in the United States currently has OCD, or about 3 million people; twice that many have had it at some point in their lives. Although OCD was once believed to be untreatable, advances in science over the last few decades have led to the development of very effective treatments. In fact, research indicates that the success rates for treating OCD are often much higher than for many other mental health problems.

People with OCD experience uncontrollable obsessions and/or compulsions (usually both) which they often realize are excessive or unreasonable. Obsessions are recurring thoughts, images, or impulses that are intrusive/unwanted and cause the person considerable anxiety or other forms of distress (i.e., disgust, a “not right” feeling). Common types of obsessions include concerns about germs/contamination, doubts about whether a task was completed (i.e, locking the front door, turning off the lights and the stove), worries about causing harm to oneself or others, unwanted sexual thoughts, concerns about morality or religious issues, urges to do things in a “just right” way (i.e., put thing in certain places, do things in a certain order), and superstitious thoughts (i.e., beliefs that if certain things are not done “right” bad things will happen).

Compulsions, or rituals, are the repetitive behaviors that individuals with OCD typical perform in response to their obsessive thoughts. These behaviors are done in an attempt to get temporary relief from the anxiety and distress caused by obsessions. Compulsions can include both behaviors that others can see, as well as mental rituals that take place in one’s mind. The most common types of compulsions involve repeatedly washing or cleaning one’s hands or other objects, checking things in the environment (i.e., locks, lights, stove), counting, repeating activities until they feel “right,” and rearranging objects until they are in the “right” place. Mental rituals can involve thinking “good” thoughts to cancel out “bad” thoughts, praying, repeating phrases in one’s mind, and spending long periods of time try to analyze situations to feel more certain about them.

Most OCD symptoms begin in childhood and the majority of people with OCD experience more than one type of obsession over time.

Hoarding disorder

Until recently, compulsive hoarding was believed to be a subtype of OCD. However, recent research suggests that although OCD and hoarding share some traits, they are in fact separate problems. Hoarding disorder involves considerable difficulties with getting rid of possessions due to beliefs about needing to save them and/or the distress that is caused by getting rid of them. Hoarding behaviors lead to a build of up clutter in living spaces that makes it difficult to use them for what they were intended. In severe cases, this can lead to unsafe or unsanitary living conditions. Some individuals with hoarding disorder also engage in excessive acquiring of items that are not needed or for which there is not enough space in the home.

Body dysmorphic disorder (BDD)

Individuals with BDD are preoccupied with one or more perceived flaws in their physical appearance that are not observable to others. In short, they do not see their appearance the way others do. These negative beliefs about appearance lead individuals with BDD to engage in a range of compulsive behaviors to try and improve or hide their appearance (i.e., excessive checking of appearance in the mirror, spending excessive amounts of time getting dressed, putting on make-up or styling hair, wearing certain types of clothes to cover up or disguise disliked parts of the body, seeking reassurance from others about physical appearance, skin picking to improve the appearance of skin). However, these efforts rarely succeed in eliminating appearance concerns. Common concerns about appearance in BBD include worries about hair, different parts of the face (i.e., nose, placement of eyes), and skin, however, BDD can focus on any part of the body. Some men with BDD are concerned that their body build is too small and spend considerable time and energy trying to build larger muscles. The body image concerns that are present in BDD exceed the normal levels of concerns that many people experience about their physical appearance and can be quite impairing.

Hair-pulling disorder (trichotillomania)

Hair-pulling disorder, also sometimes referred to as trichotillomania, involves recurrent pulling out of one’s hair. The resulting hair loss from this behavior can be mild (a small area of thin or no hair on the scalp) to severe (no eye lashes or eyebrows, no hair remaining on the scalp). Pulling is often pulled from the scalp or face, but can be pulled from anywhere on the body. Most individuals with hair pulling have made repeated unsuccessful attempts to stop this behavior and are often quite frustrated about trying to manage this behavior. Significant hair loss resulting from hair pulling can lead individuals to avoid certain types of behaviors that would make the hair loss more noticeable (i.e., swimming) and this can often have a very limiting impact on people’s lives.

Skin-picking disorder

Skin-picking disorder involves repeated picking of the skin that results in sores or lesions. Symptoms can range from mild (a few open sores around the cuticles or on the face or extremities) to severe (numerous open sores that pose a risk of infection). Similar to hair pulling, individuals who struggle with these behaviors have often tried, unsuccessfully, to stop picking. In cases in which the picking behaviors are more noticeable (i.e., on the face), individuals may avoid certain types of social interactions due to worries that others will notice places where they have picked. For this reason, some individuals only pick on parts of the body that tend to be covered up by clothing so that others will not notice (i.e,., shoulders, upper arms, top of the back).

Tic disorders

Although not formally considered an obsessive-compulsive or related disorder, tic disorders commonly co-occur with OCD and are also a focus of treatment at the Anxiety Center. Tics disorders can involve motor tics (i.e., eye blinking, neck and head movements, shoulder shrugging, movements of the hands, arms, and legs), vocal tics (i.e., throat clearing, sniffing, grunting, repeating words), or both. There are several different types of tic disorders that vary depending on the types of tics that are present and how long they have lasted. For instance, Tourette’s Disorder involves the presence of both multiple motor tics, as well as at least one vocal tic, that have been persistent off an on for at least a year. Some tics, called complex tics, involve a sequence of motor movements or sounds that can look like purposeful behaviors but are not under the person’s control. Additionally, some of these behaviors can look like OCD-related rituals and a careful assessment is often needed to determine whether the behaviors are tics, OCD, or some combination of both. Tics typically start in childhood and the majority of people who experience tics in childhood will no longer have the symptoms by adulthood.