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

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. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Advertisements

Nonsuicidal Self Injury – Cutting to stop pain

By David Joel Miller

What is cutting – Non-suicidal Self-Injury?

Cutting

Non-Suicidal Self-Injury
Photo courtesy of Pixabay.com

Non-suicidal self-injury often called cutting, is another of those troubling conditions that send people to hospitals, physical and mental hospitals. Intentional self-burning, head banging, hair pulling, hitting yourself and repetitive skin picking are other examples of this thing we call Non-suicidal self-injury. Non-suicidal self-injury causes a lot of suffering for those who do it and for those around them, and yet this problem, like anger, does not get the recognition of a separate diagnosis. FYI Hair pulling has gotten its own diagnosis called Trichotillomania.

Deliberate self-injury is a behavior. Like many behaviors, it can be misunderstood. If someone waves at you, they may be calling you over, they may be telling you to get away from where you are or it may be a way to say hello. It might even have another meaning. Self-injury is like that, a behavior, which may have different meanings.

Non-suicidal self-injury is a condition that has been researched and has been proposed for inclusion in the DSM as a recognizable mental illness. Currently, it is not a “stand-alone diagnosis.” Non-suicidal self-injury is listed in the back of the DSM-5 as a “condition for further study.”

If someone engages in non-suicidal self-injury, the kind we think is a mental illness, the most likely way it gets categorized is as a symptom of Borderline Personality Disorder. Sometimes it is a symptom of Borderline Personality Disorder or Borderline traits, sometimes not. Borderline Personality disorder is the only mental health condition that lists both suicide and Nonsuicidal self-injury as symptoms despite the high or increased rates of self-harm in other disorders like depression, bipolar and alcohol use disorders. First, the things Nonsuicidal self-injury is not and then what we or I think it is.

What Non-suicidal self-injury is not.

Non-suicidal self-injury is not simply a teen thing.

The kind of thing we mean when we talk about Non-suicidal self-injury, the one that gets diagnosed and treated is not a fad or a rite of passage. I know there are those who cut, tattoo or brand themselves because they want to scar their body to look cool or to impress their friends. This is not what we are talking about when we say Non-suicidal self-injury – the disease.

Nonsuicidal self-injury is not a request for attention.

Yes, some people do this behavior to get noticed or to get something they want. One way to differentiate this is to ask where they self-injury. Most people who seek attention cut in places that are clearly visible. Those who do it as a result of an emotional or mental issue cut or otherwise self-injure in places that are not visible, the stomach or the thighs and they often wear long sleeves, even in the heat of the summer, to cover the cuts. The distinction is that those who develop the illness Non-suicidal self-injury often try to hide their cutting.

What Nonsuicidal self-injury is.

A way to cope with emotional pain.

Transforming emotional pain into physical pain can seem like a way to escape that emotional pain. While it does work, at least some of the time it is not a desirable way to cope. Good coping mechanisms need to be not only effective but safe also. Treatments for Non-suicidal self-injury include lots of learning and practice of alternative coping skills sometimes referred to as recovery tools.

A way to cope with dissociation

Some people report they self-harm to feel or to feel real. This numbing out is a symptom of dissociation and related disorders. Dissociation is not always recognized for what it is. Dissociation needs treatment for what it is not just for the behaviors like anger or cutting.

If you live in chronic emotional numbness then the only time you may be able to feel anything is when you substitute physical pain for the constant numbing emotional hurts.

Non-suicidal self-injury is a way to regulate emotions.

Some people have difficulty regulating their emotions. They may have suffered traumas, grown up in a dysfunctional home or have personality characteristics that make them more prone to be overloaded with emotions. Take a look at the post Emotional Avalanches and Feelings Landslides which discusses how people can be suddenly swept away by feelings floods.

Cutting or other types of non-suicidal self-injury is one way some people cope with these feelings avalanches. Violent outburst is another way. The topic of violent outbursts and emotional regulation is covered in the series on “Anger Management.”

Rumination plays a major role in depression, anxiety, and anger as well as in causing emotional landslides.

Some of the links above may not be active yet. The bold-underlined terms mean that a post is up or will be coming shortly. I will try to get the links in here as the new articles post. If any links (the ones in blue) do not work let me know and I will work on fixing them.

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.

Hair Pulling is a mental illness- trichotillomania.

By David Joel Miller.

Hair-Pulling Disorder – Trichotillomania.

Bird without Feathers

Bird without Feathers

Yes Hair-Pulling Disorder, the repetitive uncontrolled kind of hair pulling is a mental health issue. Humans are not the only creatures who resort to this kind of self-mutilation when under stress. Caged animals, especially birds do this when stressed also.

Hair-pulling Disorder sounds like an odd problem to have at first glance unless you or someone you know has had this disorder and then it takes on huge importance.

The way we understand this one has been changing. This is in flux and will take some time to sort out.

In the past, as reflected in the DSM-4 this was seen as a form of impulse control disorder. Much of the way it was treated in the past was behavioral. The focus was on the behavior and not the meaning or function it had for the person pulling the hair.

As an impulse control disorder, it was in with Pathological Gambling and Intermittent Explosive Disorder. Hair pulling was for sure different than compulsive gambling but most people who had to treat clients with this problem didn’t know what else to do with it.

In the new DSM-5, when all the professionals switch to the DSM-5, this disorder will move to the section on Obsessive Compulsive Disorders. This will put it more in the class of disorders with Hoarding and Body Dysmorphic Disorder. We are seeing that obsessions and compulsions are more driven than chosen behaviors.

This change in thinking makes a whole lot of difference in how it might get treated and it makes even more of a change in how the person who has the problem might react to that treatment.

Behavioral treatment is focused on the behavior and interrupting that behavior. So grandma might have used a treatment that consisted of slapping that hand each time the young person reached for the hair. The idea was that stop the behavior and you had the problem cured.

If we see this as OCD behavior, then this is not something the person is consciously doing. The behavior is functioning to reduce tension and there is this overwhelming need to do it. This would not be something that the person thought about beforehand and no amount of slaps or yells will change anything.

You might as well yell at someone for yawning. Once they yawn it is over. Besides we think yawning is about physical sensations, not inappropriate behavior. Despite that feeling, we still can get annoyed at people who yawn and we all try to stifle the yawn from time to time.

But if you got smacked for each and every yawn eventually you might give up and just avoid the person slapping you or you might feel that you were a bad person for not being able to control this sensation and you could punish yourself in some way.

So if this is a form of OCD we would want to know what the function of the behavior was. What anxiety or tension is the person trying to relieve by hair pulling? Reduce that tension; treat the anxiety and the hair pulling stops on its own.

Young women are ten times more likely to get this diagnosis than young men. We do not mind seeing young men with very little hair but a young girl with bald spots, that gets noticed.

People who have Hair-Pulling Disorder (Trichotillomania) are also at higher than average risk to do others self-injurious behaviors. Someone with hair pulling disorder might also pick at their skin excessively, technically called excoriation, or they might nail-bite excessively.

There are also likely to become depressed and or develop another anxiety disorder.

So if you or someone you know is finding their life messed up because they are constantly pulling out hair, they develop bald spots for which there is no known medical cause and when they try to stop find they can’t, consider professional treatment.

Yes, absolutely Hair-Pulling Disorder (Trichotillomania) is a real mental illness of the obsessive-compulsive disorder type.

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.