Conditions We Treat
We treat all forms of OCD and OCD Spectrum Disorders, including Body Dysmorphic Disorder, hair pulling or trichotillomania (TTM), and skin picking. The obsessive concerns (fear, disgust, aversion, doubt) that we treat range span a wide range of themes, such as morality or spirituality (scrupulosity), health, and safety of self or others. Compulsions that are the focus of treatment include many forms of checking, cleaning, ordering or arranging, as well as avoidance of certain places or activities. Conditions may be longstanding, or they may appear suddenly at any time in the lifespan (e.g., post-partum concerns about harming one's child). We also treat conditions when they co-occur with the OCD, such as depression, social anxiety, or other anxiety disorders. We no longer treat hoarding.
Before treatment can begin, it is important to make an accurate diagnosis. If you're not sure if you or a loved one has OCD, you might want to look at our OCD screening self-test or our Child OCD screening test. Please note that these are only guides; they cannot provide a diagnosis. There are numerous conditions that overlap but are treated quite differently.
If you are considering treatment at AustinOCD, we recommend that you make an appointment for an assessment. We typically begin by having you fill out an assessment packet that will save time in the evaluation process. Determining the appropriate type of treatment depends on a thorough evaluation of the individual's strengths as well as needs. In addition to making an accurate diagnosis (or diagnoses, if there are multiple problems), we would want to know what treatments or strategies have been tried, what has been found helpful, and what has not. Also, important non-clinical factors such as distance from our center and financial resources need to be considered. See also Advice on Getting Help.
Obsessions and Compulsions
OCD is a neurobiological disorder characterized by obsessions or compulsions (usually both). Obsessions are repetitive, involuntary, unwanted, intrusive thoughts or images that increase anxiety. Compulsions are repetitive, voluntary behaviors that temporarily reduce anxiety. Common obsessions are excessive fears of dirt or germs, or that harm may come to oneself or loved ones either through some impulsive action or failure to exercise sufficient care. Common compulsions are excessive washing, cleaning, or checking. Performing these compulsive or ritual behaviors may reduce anxiety temporarily, but the obsessions invariably return.
Sometimes people with OCD experience only obsessions without any noticeable compulsions (although in many cases there may be mental compulsions, such as thinking a "good" thought, silently repeating a special phrase, or avoiding situations that might trigger obsessive thoughts). In other cases, there may be compulsions without any identifiable obsessions except a vague feeling of dread or the feeling that something is "just not right" until the ritual behavior is performed.
Clinically significant OCD affects 2 to 4% of adults, and 1 to 2% of children. Many other people have "sub-clinical" OCD traits, which don't significantly interfere with their lives. People with OCD are often successful at hiding their compulsive behaviors from others for years.
OCD symptoms often "wax and wane" over a lifetime, and they can even change form dramatically over the years, e.g., from checking to washing to ordering to hoarding. No one is able to cure OCD yet, but we do have effective treatments to help people control it, so that it becomes more of a minor annoyance than a major problem.
No one knows what causes OCD. We do know that certain nerve pathways in the brain are overactive in OCD, and that when these pathways are "calmed," either with cognitive-behavioral therapy (CBT), medication, or psychosurgery, symptoms are reduced. In some cases, called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), we believe that the antibodies created by the body to fight a streptococcus infection (e.g., a strep throat) can actually attack part of the brain, resulting in OCD, often literally overnight.
We also believe there is a genetic component to OCD, that is, it tends to run in families. Interestingly, however, family members may have completely different types of OCD. For example, a parent may have contamination or hoarding symptoms, and their child could have symmetry or harm obsessions. This observation supports the idea of a genetic link rather than symptoms being taught or modeled.
Two old notions about the cause of OCD have been thoroughly laid to rest. The first is that OCD symptoms can result from faulty parenting (such as overly strict toilet training). The second is that OCD symptoms represent unconscious conflicts, guilt feelings, or a need for control. There is simply no evidence for either of these ideas, but countless patients and their parents over the years have been misled into thinking that their OCD is somehow their fault. One especially cruel example of this is when new mothers have been told, authoritatively but erroneously, that their fears of harming their baby are a result of unconscious anger or other negative feelings toward their child.
Related Conditions - OCD Spectrum Disorders
OCD spectrum disorders are similar to OCD but also have significant differences, and they are treated somewhat differently. The most common OCD spectrum disorders are Body Dysmorphic Disorder (BDD), hair pulling (trichotillomania), skin picking, and hoarding. The treatment of choice for OCD spectrum disorders is behavior therapy or cognitive-behavioral therapy. The medications that are used to help treat OCD can also be helpful for OCD spectrum disorders, but they are often less effective than with OCD.
Body Dysmorphic Disorder (BDD) is the OCD spectrum disorder most similar to OCD. It is characterized by a preoccupation with perceived defects in one's physical appearance and a conviction that these defects (which in reality are minor or even nonexistent) make the person look disfigured. Obsessions of ugliness are usually accompanied by extensive makeup rituals, excessive looking in mirrors, or sometimes avoidance of mirrors altogether. As with other forms of OCD, reassurance has either no effect at all or only a temporary effect. Either way, reassurance is not helpful and should be avoided.
Hair pulling, or trichotillomania (TTM) is the compulsive pulling out of one's own hair, most commonly from the head, but eyebrows, eyelashes, and beard hairs are also preferred targets. The pubic area is also fairly common, followed by legs. Other areas are relatively rare. Hair pulling is often accompanied by nibbling at the hair roots or eating the hairs. It affects more females than males, and usually starts in childhood or adolescence.
Skin picking is considered by many to be more a behavior than a diagnosis, though it too has a fancy name, "neurotic excoriation." It is similar to compulsive nail biting ("onychophagia"!) and hair pulling in a number of ways. They may be related neurologically as normal grooming behaviors gone haywire, and they often occur most frequently both in times of stress (high stimulation) and boredom (low stimulation).
The following are not usually the sole focus of treatment at AustinOCD, but can be addressed if they are also part of the individual's overall symptom picture. (Try not to diagnose yourself from these brief descriptions. Professional skill is usually needed to differentiate the perfectionism seen in OCD, for example, from the perfectionism seen in OCPD.)
Obsessive-Compulsive Personality Disorder (OCPD). Despite the similarity in names, OCPD is an entirely different disorder from OCD. People with OCPD typically do not have obsessions or compulsions, although they may have rigid behavior patterns. OCPD is characterized by a preoccupation with rules (for others' as well as one's own behavior), perfectionism, and rigidity. OCPD can be difficult to treat, and, as with other personality disorders, may make treating concurrent OCD more difficult. On the other hand, treating the OCD can also help reduce the OCPD symptoms. Individuals with OCPD tend to see any difficulties they encounter as resulting from others' problems, not their own, so they may not recognize difficulties their own behavior is causing, and thus they may be less motivated to change their own behaviors. Many people with OCPD are very distressed, however, and they often do seek psychological treatment.
Impulse Control Disorders. Other disorders that have may appear to have some similarity to OCD are: compulsive stealing (kleptomania), compulsive shopping, compulsive gambling, and compulsive sexual activity. However, performing these behaviors is typically pleasurable, whereas performing OCD compulsions is not pleasurable and is done to reduce anxiety. These behaviors are considered impulsive rather than compulsive and are designated Impulse Control Disorders, are treated somewhat differently. They can co-occur with OCD, however, and if so can also be addressed in treatment at AustinOCD.Hoarding is defined as the excessive acquisition and inability to discard a large number of items even though they appear (to others) to have little or no value. This results in cluttered living spaces that can no longer be used for the purposes that they were originally designed, such as sitting on a chair, cooking on a stove, or eating at a kitchen table. People with this chronic pattern of cluttering their home and other environments also often report problems with procrastination, perfectionism, underachievement, and chronic disorganization. Although there was little scientific research on "compulsive hoarding" before the 1990's, there has since been much more interest among researchers and therapists, as well as greatly increased coverage in the media. At this time it is not certain that hoarding is an OCD-spectrum disorder; it is currently not listed in the Diagnostic and Statistical Manual (DSM-IV). Originally believed to be resistant to treatment, more people are now beginning to overcome their problematic behaviors through cognitive-behavioral therapy strategies adapted for this disorder, with therapy sessions often taking place in the person's home. We generally do not treat hoarding except in those cases where OCD is the primary diagnosis. We do not treat animal hoarding.
See Treatment at AustinOCD for a discussion of our approach and the types of treatment we offer.