Obsessive-Compulsive and Related Disorders.

By David Joel Miller.

Obsessive-Compulsive Related Disorders.

Obsessive-Compulsive and Related Disorders.
Photo courtesy of Pixabay.com

Obsessive-compulsive is a label that is frequently misused. Most people, when they say they are obsessive-compulsive, mean that they have strong preferences for the way they want the thing to be done. In the mental health field, what we mean by Obsessive-Compulsive Related Disorders are a group of disorders which seriously interfere with a person’s relationships, their ability to work, cause them distress, or prevent them from engaging in other important activities.

A personal story about compulsions to illustrate this difference.

I have a preferred breakfast meal. It comes frozen and is relatively inexpensive. Each week when I do the grocery shopping, I buy enough for the following week. I tend to eat this meal every day. Should I end up traveling, or get behind schedule I’m open to eating something else.

Someone with OCD or a related disorder might feel that their failure to eat the required breakfast, could cause their day to be ruined. They might believe, even though they know it is illogical, that their failure to eat the required breakfast, in a specific order, could result in someone starving to death, or harm coming to a family member. These beliefs that their actions or inactions, can cause harm results in an overwhelming compulsion to perform actions.

I have used an extremely exaggerated example here, but I hope you can see the difference between an extremely strong preference and a compulsion. A compulsion is something you feel forced to do even when it makes no sense. It is as if the person with OCD is being controlled by an outside force.

Defining obsessions and compulsions.

Obsessions are persistent, unwanted, and intrusive thoughts, urges, or pictures that you can’t get out of your head. Compulsions are the things people feel required to do to reduce the tension caused by the obsessions. These behaviors are often done a specific number of times. Compulsions may involve inflexible rules which must be obeyed to prevent something bad happening. Some Obsessive-Compulsive Related Disorders involve self-injury, like hair pulling or skin picking, which continues despite efforts reduce or stop the behavior.

Classifying Obsessive-Compulsive Related Disorders.

In the past, Obsessive-Compulsive Related Disorders were scattered throughout the diagnostic manual. Some of these disorders were in the chapter on anxiety; some were mixed in with impulse control disorders, others were under somatoform disorders. A few were not even recognized as mental illnesses in the past. In the most recent DSM-5, these issues were brought together in a single Obsessive-Compulsive and Related Disorders chapter.

Sometimes it’s hard for professionals to diagnose which disorder a person has. It is possible for one person to have several of the Obsessive-Compulsive Related Disorders. Many people with Obsessive-Compulsive Related Disorders also have anxiety disorders, trauma and stressor-related disorders and some form of depression.

OCD leads the Obsessive-Compulsive Related Disorders parade.

Among the Obsessive-Compulsive Related Disorders, the best-known disorder is Obsessive-Compulsive Disorder, a serious mental health issue which is estimated to affect between 1% and 2% of the population worldwide.

Other Obsessive-Compulsive Related Disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, (hair pulling), and excoriation (skin picking). All of these disorders significantly interfere with people’s lives. Symptoms in these disorders recur, despite repeated efforts to control or stop the Obsessive-Compulsive Related Behaviors.

Substances and medications can cause, or induce, Obsessive-Compulsive Related Disorders. Some medical conditions can also cause obsessive-compulsive behaviors. In the DSM-5 they are also seven other conditions lumped together under the heading Other Specified Obsessive-Compulsive Disorders. One of those conditions is Obsessional Jealousy. This is one of the few times jealousy counts as a symptom of a mental health disorder. More on Obsessional Jealousy in a future post.

Treatment for Obsessive-Compulsive Related Disorders.

The primary treatment for Obsessive-Compulsive Disorder (OCD) is exposure and response prevention therapy. While exposure and response prevention therapy has some similarities to systematic desensitization, which is used to treat specific phobias, relatively few therapists are trained in exposure and response prevention therapy.

One resource you may want to consult is the WordPress blog ocdtalk.  http://ocdtalk.wordpress.com/

For more information on Obsessive-Compulsive and Related Disorders see:

Obsessive-Compulsive Related Disorders category

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania, (hair pulling)

Excoriation (skin picking)

Obsessive-Compulsive Personality Disorder

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Ugly nose and face or Body Dysmorphic Disorder

By David Joel Miller

Can someone be too ugly to get a job or be loved?

Ugly Bird

Ugly Bird (Sorry Mr. Bird)
Photo courtesy of Flickr (YuvalH)

There is a group of people in our society who believe very deeply that there is something wrong with their body which makes them so ugly that no employer will hire them and no other person could stand to be in a relationship with them. They often seek medical help to change their appearance but that help rarely results in them feeling acceptable.

There is a range of appearances. Some people are frankly better looking than others. We value celebrities based on their looks. So how far from that ideal level of beauty do you need to fall before you conclude that you are ugly and no one can possibly love or accept you?

Some people believe that they are ugly even when others around them cannot see the “flaw” that makes them believe they are undesirable. This belief that your body is flawed in some way, while others do not see the flaw is called Body Dysmorphic Disorder.

Body Dysmorphic Disorder can center on beliefs that any part of your body is defective but the most common things that are the focus of this belief are the skin, hair, and nose. Stomach, weight, breasts or chest and eyes also cause significant numbers of people to feel badly about themselves.

Researchers believe that the prevalence of Body Dysmorphic Disorder is greatly underestimated. The number of people who suffer from this emotional problem is probably far greater than our statistics are reporting. Estimates of the number of people in the United States with Body Dysmorphic Disorder range from 2 million to in excess of 15 million people. The number of cases you see depends on where you look.

Most people with Body Dysmorphic Disorder do not come to mental health systems because of their excessive focus on their appearance. They often first present at a plastic surgeons office requesting an operation to change that part of them that they feel is making them ugly.

Annual expenditures for plastic surgery surpassed 10 billion dollars in 2008. This was an almost 900% increase over 1992 and this figure continues to grow. Unfortunately people with Body Dysmorphic Disorder are most likely to feel that their operation was “botched” and as a result sue the doctor or request a second or third operation. One study reported that 44% of plastic surgery patients were repeat clients. Some clearly were happy with the results and having more done but those with Body Dysmorphic Disorder are likely to undergo repeated operations because the problem lies in their thinking that they are ugly rather than in any particular objective problem with their looks.

So how does this Body Dysmorphic Disorder manifest in those who have the disorder? Suffers typically spend 3 to 5 hours per day looking at themselves in the mirror. They are highly sensitive to minor flaws in people and can spot defects in others readily. Many become housebound, afraid to go out and socialize because they believe that they are so ugly no one will like them. A deficit in social skills predisposes them to believe that their lack of friends and romantic partners is the result of their appearance rather than their lack of social skills.

Since those with Body Dysmorphic Disorder blame their lack of friends and jobs on their appearance they are unlikely to present for counseling or therapy. One way they enter treatment with a mental health professional is when their depression, anxiety or other emotional problem brings them to the notice of the mental health system.

Almost half of those with Body Dysmorphic Disorder have been hospitalized in a psychiatric hospital. As many as 82% have had thoughts of suicide and one in four is likely to have attempted suicide. Most are young, single and unemployed. They frequently have eating disorders, Obsessive Compulsive Disorder or another psychiatric problem in addition to the Body Dysmorphic Disorder. Skin picking and religious or sexual preoccupation are also common. Many go on to develop Avoidant Personality Disorder.

They are also at risk to miss many days of work or school and many social events as a result of their feelings that they are physically ugly. Many of those with Body Dysmorphic Disorder drop out of school to avoid being seen by others.

Body Dysmorphic Disorder frequently begins in early teen years and gets progressively worse. The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. Those with the disorder will cover their faces in various ways, spend excessive amounts on clothing or cosmetics or resort to extreme methods to try to alter their appearance.  Frequently those with Body Dysmorphic Disorder have been teased or bullied.

The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. The DSM-5 tells us that the most common age for onset of Body Dysmorphic Disorder is 12 to 13 years old.

This disorder is not restricted to females. Many young men develop the notion that they need to have huge bulging muscles to be acceptable and develop a related condition called Muscle Dysmorphic Disorder. Males are also at risk to believe that their genitals are too small resulting in avoiding dating and sexual relationships.

Those with Body Dysmorphic Disorder may also show up in weight loss groups where despite their low to normal body weight they will be focused on changing the shape of one part of their body that they see as defective.

Our understanding of Body Dysmorphic Disorder continues to change. In the DSM-4 Body Dysmorphic Disorder was included in the section on somatoform disorders, those disorders where emotions make you sick or make you illness worse. In the new DSM-5 Body Dysmorphic Disorder is included in the Obsessive Compulsive disorders because of the time people with this disorder spend on concerns about their appearance.

There are effective treatments for Body Dysmorphic Disorder. The difficult part is getting those with the disorder to come for treatment. Since they firmly believe that their problems are the result of some physical defect they do not see how counseling can help them, and will often insist that they are not “crazy” or “mental.”

Treatment of other issues, depression, anxiety and suicidal thoughts and actions are often the first step in engaging those with Body Dysmorphic Disorder in treatment. Cognitive Behavioral Therapy, Antidepressant medications, Narrative therapy and skills training are all thought to be effective in treating Body Dysmorphic Disorder.

So if you or someone you know has no friends, no romantic partner or no job and you think this may be because of looks, consider working with a counselor on your social skills, career counseling and self-esteem before you conclude that the problem is your looks.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.