Fact vs. fiction: Understanding OCD and related conditions

You may hear the term “OCD” used loosely and sometimes jokingly throughout daily life and in pop culture. But for millions of Americans, obsessive-compulsive disorder is hardly a joke – if left untreated, it can have a debilitating impact on many aspects of life.

“The nature of OCD is characterized by intrusive, unwanted and distressing thoughts, images or impulses. The individual engages in ritualistic behaviors – both overt and covert – to reduce distress and to prevent the feared outcome from taking place,” said Dr. Eric Storch, a psychologist with Baylor College of Medicine.

Repetitive behavior in and of itself is not OCD. Being “obsessed” with something is also not OCD. For example, a teen being focused on video games may think of them often but this would not be characteristic of OCD.

Alternatively, addictive behaviors, such as gambling or gaming for pleasure, are not OCD.

What are OCD-related disorders?

Storch says there are several psychological conditions that involve OCD-like symptoms, but the foci are different. These conditions include:

Trichotillomania (hair pulling disorder): This condition is characterized by impairing hairpulling behaviors. The pattern keeps repeating itself and can result in significant hair loss.

Skin picking disorder: This is similar to trichotillomania, but the focus is on problematic skin picking. Sometimes, it’s an attempt to make skin unblemished or perfect.

Hoarding disorder: Hoarding involves the problematic acquisition of items, which causes clutter and has a corresponding difficulty in organizing or discarding the items. In its most extreme examples, it can involve animal hoarding or significant clutter that increases risks of accidents.

Tourette syndrome: Tourette syndrome and chronic tic disorder are characterized by vocal and/or motor tics that have been present for more than a year. Tics can range in type and severity from very mild to quite severe. As many as 50% of individuals with Tourette syndrome develop OCD-like symptoms.

Body dysmorphic disorder (BDD): This condition involves obsessive thoughts about perceived flaws in appearance that actually appear minimal or non-existent to others. Individuals with BDD engage in repetitive or unhelpful behaviors in an attempt to hide their appearance flaws from others.

Does treatment differ based on condition?

For disorders that have a central anxiety component, Storch says cognitive behavioral therapy with exposure and response prevention is an effective form of psychotherapy. This specific type of therapy focuses on exposing the person to the potential of the feared outcome happening without them doing safety or checking behaviors. Additionally, antidepressant medications have shown effectiveness.

“When the person confronts the potential trigger without ritualizing, there is usually a gradual reduction in distress, and they discover that the thing they fear happening actually does not happen and they can cope effectively with it.”

For trichotillomania, skin picking disorder, or Tourette syndrome, Storch says the most effective intervention is a form of cognitive behavioral therapy called habit reversal training, which involves developing behaviors that actively compete with the person’s tics or body-focused repetitive behavior.

How to help a loved one

There can be a long duration between the time OCD symptoms come about and eventually finding the right help.

“We aim to support your loved one in a way that is consistent with the treatment model, which includes gradually taking away behaviors that are accommodating in the short term but problematic in the long term.”

Being hostile or critical of someone with OCD is not helpful. “Telling someone to ‘stop it’ isn’t going to do the trick. Rather, supporting the person the same way that one would support a loved one with a medical condition is the best approach. This may involve learning how to help a loved one deal with triggers, encouraging them to access appropriate care, and serving as a supporter.”

Dr. Storch is a professor and McIngvale Presidential Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor.

Additional Resources

Learn more about the Obsessive Compulsive Disorder Program at the Baylor Psychiatry Clinic or call 713-798-3080.

See resources from the International OCD Foundation.

More than appearance concerns: What is body dysmorphic disorder?

-By Nicole Blanton