Related Disorders
Comorbid disorders are other psychiatric disorders that tend to accompany OCD. By far the most common is major depression. People with OCD are also more likely than people without OCD to have phobias, Tourette's Disorder (formerly Tourette's Syndrome) and other tic disorders, eating disorders, alcohol abuse or dependence, or panic disorder.
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, hair pulling (trichotillomania), skin picking, and hoarding. The treatment of choice for OCD spectrum disorders is behavior therapy or cognitive behavior 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.
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).
Hoarding can be difficult to treat, especially if the hoarder is not motivated to change his or her behavior. Often family members are the ones most negatively affected by hoarding. Items hoarded can be old newspapers and magazines, scraps of paper, out-of-style clothing that no longer fits, and even animals. Treatment needs to address not only the delicate issue of the person becoming able to part with what they may see as their treasured possessions, but also cutting down on the acquisition of new material.
Other disorders that 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, designated Impulse Control Disorders, are treated somewhat differently.
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 lack of emotional warmth. OCPD is difficult to treat, because, as with all personality disorders, individuals with OCPD tend to see any difficulties they encounter as resulting from others' problems, not their own.