Obsessive-Compulsive and Related Disorders
EBTCS has been a leader in the Pacific Northwest for OCD care for over 20 years
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, including obsessive-compulsive disorder (OCD), body-focused repetitive behaviors (e.g., hair pulling, skin picking), hoarding disorder, body dysmorphic disorder, and tic disorders. Although these problems share some similarities, they also have important differences that have implications for effective treatment. This is why working with providers who specialize in these conditions is so important.
All of these problems can occur across the lifespan, with many first starting in childhood or adolescence. Our Child Anxiety Center and Anxiety Center have the largest concentration of specialists in obsessive-compulsive and related disorders in the Pacific Northwest. As a result, our treatment teams have extensive experience in treating these problems, including working with youth and adults with very severe symptoms who may need a more intensive treatment approach.
About 1 out of 50 adults in the United States currently has Obsessive-Compulsive Disorder (OCD), or about 3 million people; twice that many have had it at some point in their lives.
Obsessive-Compulsive Disorder (OCD)
OCD is not about preferences, perfectionism, or being “particular.” It is a disorder of intrusive fear and learned relief behaviors.
OCD affects an estimated 2% of children, adolescents, and adults and often begins earlier than many people realize. It can be profoundly disruptive — not because individuals want to engage in compulsions, but because the anxiety feels unbearable without them.
Common signs of OCD
- Intrusive, unwanted thoughts, images, or urges
- Repetitive behaviors or mental rituals performed to reduce distress
- Excessive checking, washing, reassurance-seeking, or repeating
- Intense discomfort when things don’t feel “just right”
- Significant distress even when the person knows fears are irrational
People with OCD are often highly aware that their fears don’t make sense — which can increase shame and confusion.
What families are often relieved to learn
OCD is highly treatable when addressed with the correct approach. Decades of research demonstrate that Exposure and Response Prevention (ERP) — a specialized form of CBT — is the first-line treatment and leads to substantial improvement for most people and is the primary treatment for both youth and adults with OCD.
Why expertise is critical
General therapy approaches are often ineffective for OCD and can unintentionally make symptoms worse. Effective treatment requires clinicians who are specifically trained in ERP and understand how OCD presents differently across development.
With specialized care, most people experience dramatic reductions in symptoms and are able to re-engage fully in school, work, relationships, and daily life.
Body-Focused Repetitive Behaviors (BFRBs)
BFRBs are not habits — they are urge-driven behaviors with identifiable treatment pathways.
Repeated hair pulling, skin picking, nail biting, and related behaviors are often linked to anxiety, sensory needs, or emotional regulation difficulties.
What families often notice
- Repeated attempts to stop that don’t last
- Shame or secrecy around behaviors
- Increased urges during stress or boredom
- Avoidance of situations in which the behaviors or their effects are obvious
What helps
Specialized behavioral treatments such as Habit Reversal Training and Stimulus Control (ComB) can help children, adolescents and adults with these behaviors understand triggers, develop alternative responses, and reduce symptoms without blame or punishment.
Body Dysmorphic Disorder (BDD)
BDD is not vanity. It is a distressing condition involving how the brain processes appearance-related thoughts.
BDD often emerges in adolescence, a time when body image naturally becomes more salient. For some people, however, perceived flaws become consuming and distressing.
Common patterns include
- Excessive mirror checking or avoidance
- Repeated reassurance-seeking about appearance
- Spending hours grooming or changing clothes
- Attempts to hide or “fix” perceived flaws
- Skin picking, hair pulling or other appearance-focused behaviors
- Avoiding situations due to concerns about appearance
These behaviors rarely reduce distress and often intensify over time.
What helps
BDD responds best to specialized CBT approaches that address compulsive behaviors and distorted perceptions of appearance. With appropriate treatment, youth and adults with BDD can experience meaningful relief and return attention to school, work, friendships, and working toward goals.
Hoarding Disorder
Hoarding is not just about having too many things, but having an attachment to things that can make it feel nearly impossible to let go of them.
Until fairly recently, 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.
Common symptoms include:
- Significant clutter in living spaces
- Strong urges to keep possessions
- Significant difficulty getting rid of things
- Emotional upset when others try to get rid of their belongings
- Excessive acquiring of items (in some people)
What helps
New research has indicated that a specific form of CBT is effective in helping people with hoarding learn how to let go of unneeded belongings and develop new ways of relating to their possessions. Treatment can also help decrease acquiring behaviors and build new habits needed to keep living spaces more organized in the long-term.
Tics and Tourette Syndrome
Tic disorders affect approximately 1 in 100 school-aged children and typically show up in childhood or teen years. While many tics are temporary, others persist and can cause distress or interfere with functioning and can persist into adulthood.
Tic 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. Some tics are also quite complex and can look like volunary movement patterns.
Important facts about tics
- Tics are involuntary, not intentional
- Stress and anxiety often worsen symptoms
- Tics often vary across different situations and contexts
- Evidence-based behavioral treatments can significantly reduce tic severity
When anxiety or emotional dysregulation co-occur, coordinated treatment improves outcomes.
Treatments We Provide
Over the past 40 years, there have been major breakthroughs in the treatment of OCD and related conditions. The providers in our Anxiety Center and Child Anxiety Center make it a priority to stay current with the latest research developments so that we can offer the most effective, evidence-based care. This means the support we provide is always evolving — improving alongside the science of treating OCD and related conditions.
Click on each tab to learn more about the proven treatments we offer.
Exposure Therapy/ERP
Exposure therapy is generally considered the most important component of treatment for anxiety-related problems. Exposure involves facing one’s fears in incremental steps until they are experienced as less scary and more tolerable. This process helps people decrease avoidance behaviors that often lead to life “shrinking” and participate more fully in their lives.
A specific kind of exposure therapy – exposure and response prevention (ERP) – is used to treat obsessive-compulsive disorder (OCD). In ERP, clients not only face their fears, but also learn to stop the rituals and compulsions that maintain OCD. ERP is the gold-standard behavioral treatment for children, teens, and adults with OCD.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) and behavior therapy emphasize the connections between thoughts, physical sensations, and behaviors in the maintenance of anxiety-related problems. These forms of therapy are present-focused and involve helping clients understand the nature of their symptoms and what is maintaining them, as well as teaching them tools for how to break out of unhelpful symptom patterns. CBT is often used in the treatment of body dysmorphic disorder and hoarding disorder.
Habit Reversal Training and ComB
Habit reversal training (HRT) and ComB are the primary evidence-based treatments for body-focused repetitive behaviors (i.e., hair pulling, skin picking, nail biting).
These treatments involve assisting individuals in identifying and implementing behaviors and strategies that make it more difficult to do the target behaviors (i.e., pulling hair, picking skin), as well as making changes to the environment to reduce the likelihood that these behaviors will occur.
Clients are often surprised to learn how many types of situations and factors (i.e., emotions, thoughts, physical sensations) can trigger these behaviors and how much control they can gain over these behaviors. Other coping skills (i.e., relaxation skills, strategies for managing strong emotions, cognitive therapy skills) are also often a part of these treatments.
Comprehensive Behavioral Treatment of Tics (CBIT)
CBIT is a treatment is a form of habit reversal training and stimulus control that was developed specifically for tic disorders. Through treatment, individuals learn how to recognize when their tics are about to occur, and what conditions tend to trigger them, and to implement responses that decrease their tic behaviors. For young children with tic disorders, parents are often heavily involved in helping to implement the treatment.
Standard Outpatient Therapy
Our team of expert clinicians provide treatment for OCD and related disorders in children, teens, and adults. We strive to offer evidence-based treatment protocols so that you can be assured you are receiving treatment that works.
Anxiety and OCD Intensive Treatment Programs
We provide intensive treatment services for children, teens, and adults with severe OCD and other anxiety disorders. The goal of intensive treatment is to provide focused, highly structured and individualized therapy multiple days per week.
Intensive treatment is appropriate when someone cannot function optimally in their daily life (i.e, cannot attend school, go to work, or participate in social or family activities). Intensive services may also be appropriate when standard outpatient treatment is not working and a higher level of care is needed.
Consultation
Our expert clinicians provide consultation services for individuals considering care at EBTCS as well as for mental health providers seeking guidance. These consultations can help clarify fit and next steps without requiring a treatment commitment.
We offer one-time or ongoing consultations to support treatment planning, clarify diagnoses, or determine the right level of care. Whether you are exploring services for yourself or consulting on behalf of a client, our team provides tailored, expert input.
For more information, call 206-374-0109 or contact us below.
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1200 5th Avenue, Suite 800 Seattle, WA 98101