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Types of Treatment for Obsessive-Compulsive and Related Disorders

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C. E. Zupanick, Psy.D.

Most people are somewhat familiar with the obsessive-compulsive disorder (OCD). Many celebrities have publically discussed their struggles and triumphs with OCD. Likewise, many fictional characters in theatre, movies, television, and books are cast as people with OCD. While this publicity has raised public awareness, it has also created an inaccurate, and at times, insensitive portrayal of the disorder.

therapist and patientWhile OCD may be fairly well known, the other disorders in the obsessive-compulsive spectrum are less well-known. Five disorders in the obsessive-compulsive spectrum form a single diagnostic category called obsessive-compulsive and related disorders (OCRDs). We have previously reviewed the signs and symptoms of each disorder:

1. obsessive-compulsive disorder;
2. body dysmorphic disorder;
3. hoarding disorder;
4. trichotillomania (hair-pulling); and,
5. excoriation (skin-picking).

Many years of research have demonstrated the similarities between OCD and the other four disorders. This formed the rationale to cluster these five disorders together into single category. The disorders in this OCRDs category share similar symptoms, have a similar age of onset, similar progression and course, co-occur together frequently, have similar family histories, and share similar treatment response. Genetic and biological studies further support a relationship between these disorders.

To illustrate the relationship among the disorders in the OCRDs category, let's consider the similarities between obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). People with BDD and OCD both experience repetitive intrusive thoughts. These thoughts cause anxiety and distress. Both conditions also include repetitive behaviors that are difficult to control. A high portion of people with BDD also have OCD; with comorbidity rates around 33%. Both BDD and OCD are rather chronic conditions. People with BDD are more likely to have a first-degree relative with OCD than people without either disorder. People with BDD and OCD respond similarly to medications and psychotherapy. Although BDD also shares similarities with social anxiety and depression, it has more in common with OCD.

There are many benefits of placing these five disorders into a single category. First, it helps clinicians to identify disorders that might otherwise be overlooked. For example, a therapist is more likely to ask about appearance obsessions (common in BDD) if the patient has already met the diagnostic criteria for OCD. This is because both disorders are in the same category, are highly related, and tend to co-occur. This prompts the clinician to inquire about topics that patients are unlikely to self-report such as body obsessions or hoarding behaviors.

Another benefit of grouping these disorders together is that it improves treatment outcomes. Because there is considerable symptom overlap among these disorders, the basic treatment strategy is similar for each disorder. However, each disorder requires some specific treatment techniques to be most effective. For instance, BDD and hoarding disorder are challenging and serious conditions. Their similarity to OCD helps clinicians develop a treatment plan that involves targeting the inaccurate beliefs of each disorder, along with exposure exercises to address compulsive behaviors specific to each disorder.

Fortunately, there are several highly effective treatments for OCRDs. Therapists pick and choose among these various treatments to form an individualized treatment plan. The specific combination of treatments in the treatment plan will depend upon a host of many factors:

1) the unique characteristics and preferences of each person; 2) their social support system and living environment; 3) their degree of insight into their disorder and symptoms; 4) their motivation for treatment and recovery; 5) the specific OCRD; 6) the presence of co-occurring mental or physical disorders; and, 7) previous treatment attempts and their outcomes.

In this section, we will review and describe the menu of effective treatment options available for OCRDs. Then, in the section that follows, we will discuss the usual and customary treatment approach for each specific OCRDs.