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OCD

Disclaimer: this page is for information purposes and gives a quick outline of OCD to encourage people to attend groups or discuss with others. It is not meant to diagnose anyone, or be definitive (such a thing doesn't exist), please see a Doctor and from our point of view talking about symptoms is more important than labels, which can nevertheless help individuals or others understand the world. 

OCD and OCD Spectrum related disorders

Obsessive Compulsive Disorder is a form of anxiety. Rather like PTSD mentioned on another page, in the DSM-5 it was given it's own section Obsessive Compulsive and related disorders [1]. Some sources regard these as completely separate but similar, others call it an OCD spectrum. These are OCD, trichotillomania, dermatillomania, body dysmorphia sometimes shorted to BDD, health anxiety and hoarding disorder. We regard OCD as having huge overlaps in symptoms with other forms of anxiety, so people may find it useful attending our groups, as many members have done. 

OCD

Obsessive Compulsive disorder is an extremely varied condition on what the subject matter is, which can vary from mild to extremely severe. In popular culture for many years there has been an awareness that OCD can be linked to hand washing and checking of devices or appliances such as doors, taps and cookers. This only really scratches the surface and the obsessions and compulsions can be about almost anything. As the public have become more aware of it, there has been slight scepticism about what OCD actually is, in actual fact although they sound very stereotypical many cases of OCD are in fact to do with cleanliness, fear of contamination, fear of damage by failure to act, slowness, fear of one's actions on others such as abusing someone and symmetry.  

There are obsessions which are very intrusive thoughts and these are linked to the compulsions to check or do something. The compulsion does not have to be a physically highly noticeable action and may be unnoticeable to some other people. The ways of classifying OCD above have existed a long time and Primarily (or actually predominantly) obsessional obssessive compulsive disorder has been a part of OCD literature for YBOCS-SC which led to a lot of discussion when DSM-5 was written. This started being called purely obsessional OCD and then Pure O started to be used widely. This is not generally used as widely as people think it is away from online communities and many regard it as unhelpful whilst the person themselves may understandly feel it is useful and prefer calling it that. There is agreement - Pure O is part of OCD, it's just it's an extremely varied condition. For a referenced article see OCD UK [2]

Everyone gets intrusive thoughts, even people without anxiety, but the difference is these are occasional and may go after some minutes or a few hours. With OCD the obsessions cannot be separated from the compulsions and the behaviour may repeat dozens or more times per day. Similarly a lot of people have small rituals but they do not cause emotional distress and can be undone quite easily. OCD symptoms  also has broad similarity to two personality disorders (and some people who have OCD have one or both of these).  

Trichotillomania

In 2019 this is usually just called Trich, but is sometimes called hair pulling disorder. In the US the topic is more discussed than here, but estimates range between 2.5 and 11 million Americans have the condition (population 330 million). The condition is more common in teenagers and in girls than boys [3]. The pulling is normally hair, but can be eyebrows and eyelashes. Due to the level of distress of hair loss the hair pulling can be in more concealed areas at the back of the head or neck, which can be problematic for a number of reasons including not feeling the act of hair pulling. Trichophagia is a less understood rare variant where the person with trich eats their own hair and can be life threatening [3]. The disorder has a huge amount of stigma but there are treatments that can work if someone is able to seek help through specialist habit reversal training [3].

Beckie J Brown is a youtuber in the trichster community who has a popular channel. A video from ten years ago explains the condition https://www.youtube.com/watch?v=CiBIXMBEqgE

Dermatillomania

This is also called skin picking disorder or more formally excoriation. This is compulsions with picking at skin that become rituals or habitual. It can also be healed areas usually on easy to access areas like legs, arms, face, neck and scalp. After picking there is a temporary sense of relief. As there is repeated picking the area can become damaged with 'lesions'. As with other OCD spectrum disorders it is recurrent and attempts to manage it have not been successful resulting in distress affecting every day life, marking out a clear difference with just an itch or repeated skin picking. It is distinguished from picking related to substance abuse and other causes [1]. 

Body Dysmorphia

This is sometimes abbreviated to BDD online. This is a condition different from eating disorders related to internal perceptions of imperfections with bodily appearance. It is contrary to myth equally prevalent in men and women. In men a subtype called muscle dysmorphia is currently getting a lot of publicity, but for men and women features relating to the face and skin are common including nose and chin. Often someone with body dysmorphia will have more than one area of the body that is distressing to them. The issue is a difficult issue to discuss due to the stigma, but some patients will seek out surgery to the body e.g. nose to change theappearance on the false belief that it is unusual. It is believed that 2% of the population has the condition, although other estimates go from 0.7% to 2.4% [3].

This is an old BBC article from 2015 about body dysmorphic disorder.

If you have iplayer and a tv licence the BBC has a documentary on body dysmorphia called Ugly Me: my life with body dysmorphia . Caution on content.

Health Anxiety

Was previously called hypochondria, but is rarely referred to now due to the huge amount of stigma around it. These can be very intrusive thoughts about getting ill, or failing to get better from a minor illness, spending large amount of time doing checking behaviours such as tapping or mentally thinking or checking bodily sensations. Someone could be in their teens, 20s or 30s and have this. The symptoms of health anxiety can often be misunderstood for a seperate physical illness which treatment is sort or even carried out unnecessarily. Even after a thorough investigation and reassurance from doctors a patient might still think something is missing. Awareness of overreading physical symptoms and seeing their doctor can put a stigma and strain on medical and family relationships. Appropriate Cognitive Behavioural Therapy is believed to be very effective for health anxiety and a large study of patients with very severe health anxiety symptoms (Tyrer et al. 2017) suggested the effects can last years after [4]

Hoarding Disorder

Is a poorly understood disorder as less research had been done on it until 2013 and was not listed separately from OCD until the DSM-5 and ICD-10 did not list it separately until a later revision. It was frequently diagnosed as OCD for the lack of differentiation [3]. It is a 'persistent difficulty' discarding items to save them or stop distress where their accumulation hinders living areas and causes the patient a lot of distress. There are different levels of insight from good, fair, poor to absent insight/delusional beliefs [1]. Treatment is via adapted exposure therapy where the patient builds up a relationship with the therapist and a series of rules are agreed to stop the accumulation of more items and slowly reducing those hoarded. Strategies include limited touching and the patient not seeing the items once discarded [3]. In the UK hoarding disorder is also treated with CBT [5].

References

[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-5 by V.A. Arlington, published by the AMA, 5th edition, 2013. 

[2] Does Pure O Exist? OCD UK https://www.ocduk.org/ocd/pure-o/

[3] Obsessive Compulsive Disorders: All you want to know about OCD for people living with OCD, carers and clinicians by Lynne Drummond, Royal Society of Psychiatrists, Cambridge University Press, 2018. ISBN 978-1-911-62375-5

[4] Tyrer et al, 2017. National Institute for Health Research, Health Technology Assessment, Volume 21, issue 50. https://doi.org/10.3310/hta21500

[5] Hoarding disorder - NHS, published by the NHS https://www.nhs.uk/conditions/hoarding-disorder/