Disorders We Treat

OCD consists of two components: obsessions and compulsions. Obsessions are the cognitive component – these are typically in the form of thoughts, images or impulses that are unwanted, repetitive and intrusive in nature. These "sticky" thoughts are hard to set aside and get out of one's mind. They trigger an anxiety response. People with OCD then engage in behaviours or compulsions in an attempt to get rid of their anxiety.

OCD can be treated using an evidence-based approach called Cognitive Behaviour Therapy (CBT) as well as psychiatric medication. Exposure Response Prevention (ERP) is a significant component of CBT that is used to help individuals with OCD overcome their obsessions and compulsions. During ERP, individuals will learn to expose themselves to their obsessions, without engaging in their typical rituals/compulsions. Although this is anxiety-provoking and distressing, it has been found to be one of the most effective ways to overcome this illness. When we do not engage in rituals in the face of our obsessions we are able to learn that nothing dangerous happens and that our anxiety often gradually declines on its own. CBT will also provide you with skills to challenge the catastrophic thoughts you often experience when faced with an obsession and learn that there may be other ways of thinking about these situations. Finally, it can often be helpful to learn how to tolerate the distress you will experience with ERP and begin to move forward with your goals and values despite how you are feeling.

Individuals experiencing symptoms of OCD often benefit from drugs that increase the release of serotonin available to transmit messages to the brain. The main medications that do this are known as serotonin reuptake inhibitors (SRI), these medications are commonly used to treat OCD. For more information regarding the available treatment at the Thompson Centre, please see our Sunnybrook Outpatient OCD Services or Intensive Treatment Services.

OCD is a psychiatric illness, and like any type of illness, there is a gradual and ongoing recovery process. We do know that CBT tends to wax and wane over the course of one's life and will often increase with respect to severity of symptoms if left untreated. We do know that CBT and medication management is effective in reducing symptoms of OCD; however, success with reducing symptoms depends on each individual person and their present circumstances. Finally, when undergoing a treatment such as CBT and the exposure work you will do, there is often a lot of independent work that you will eventually be doing in treatment (some exposure with support and some independent). This will be critical to your success in overcoming your symptoms. It is often found that the greater effort that is put in, the more benefit an individual has from this treatment.

To learn more about Hair Pulling (Trichotillomania) and Skin Picking Disorder please see our Patient Hub.

Additional resources are available in our Patient Hub.

People with BDD are overly concerned about an imagined or minor flaw in their appearance. The focus of concern is often the face and head, but other body parts can become a focus. While most people would probably like to change one or two aspects of their appearance, people with BDD are very preoccupied with these issues. They feel intense distress as a result. For many, the concern can cause serious impairment in their day-to-day lives. BDD is considered by mental health professionals to be in the same category of conditions as OCD, due to their similarity. For example, BDD involves intrusive and recurrent thoughts about one's appearance as well as compulsive behaviours to ease the distress of these thoughts. A person may be very concerned by the shape or size of their nose and repetitively check mirrors, ask for reassurance, or consult with cosmetic surgeons in attempts to relieve their distress. Like the compulsions in OCD, these behaviours may provide short-term relief (e.g. "my nose doesn't look too bad in that mirror") but make things worse in the long run (e.g. increased need to check mirrors).

Like OCD, medication and CBT are both used to treat BDD. In general, the same types of medications are used for OCD and BDD (e.g. selective serotonin reuptake inhibitors and sometimes augmentation with an antipsychotic). In CBT for BDD, strategies target the unhelpful beliefs about appearance and the avoidance or ritualistic behaviours. Some of these strategies include exposure and response prevention, cognitive restructuring, and perceptual re-training. Benefits of CBT for BDD could be but is not limited to:

• Confronting negative thoughts associated with your body image
• Learning strategies to reduce rituals and reassurance seeking
• Improve decision-making, social engagement, and motivation for change

For more information regarding the available treatment at the Thompson Centre, please see our Sunnybrook Outpatient OCD Services or Intensive Treatment Services.

BDD can be treated with medication and CBT. Just like OCD, there is a gradual and ongoing recovery process. Success with reducing symptoms depends on each individual person and their present circumstances.

To find additional support with managing BDD please see our Patient Hub.

Additional resources are available in our Patient Hub.

Hair pulling (Trichotillomania) and skin picking (Excoriation) are also known as Body Focused Repetitive Behaviours or BFRBs. These conditions are now recognized as closely related to OCD. In these disorders, individuals repeatedly pull hair or pick at their skin despite repeated efforts to stop. These behaviours may occur outside a person's awareness and are often worsened by both stress and boredom. They are best understood as repetitive self-soothing/stimulating and grooming behaviours. Over time they can cause significant distress or impairment in a person's ability to function. Many people with these disorders experience shame and embarrassment because these are disorders of secrecy; people are often unaware that they are among the most common mental disorders with estimates in the range of 5% of the population.

The mainstay of treatment is a version of CBT called the comprehensive behavioural model. It teaches strategies in 5 domains:

1. Finding sensory substitutes
2. Addressing negative thinking
3. Skills to regulate emotions
4. Gaining awareness into when the behaviours are happening and motor substitutes
5. Adjusting elements in the environment to make the behaviour less likely

Steps to destigmatize these conditions and help people accept themselves for who they is an important aspect of the treatment.

For more information regarding the available treatment at the Thompson Centre, please see our Sunnybrook Outpatient OCD Services or Intensive Treatment Services.

To learn more about Hair Pulling and Skin Picking please see our Patient Hub.

Where can I find additional resources?

Additional resources are available in our Patient Hub.

People with hoarding disorder have trouble with stuff. They acquire too much stuff and/or have trouble getting rid of it. The types of things that people hoard can vary but are often perceived as potentially useful in the future, valuable or as having sentimental value. Like all the disorders described here, saving and collecting occurs on a continuum. Most people save some items that they consider useful or sentimental but when a space becomes cluttered enough to compromise intended use (e.g. unable to sit on a couch in the living room due to clutter) or the person is unable to maintain a safe environment for themselves and others, a diagnosis and treatment may be warranted. Potential risks of hoarding include fires, falls, blocked entrances and exits, infestation with rodents and insects, lung disease, and inability to maintain good hygiene. Hoarding shares some similar features with OCD: some people describe obsessional thinking about their belongings and a compulsive need to acquire items. Also, the distress felt when having to resist acquiring or when discarding items is considered similar to the anxiety in OCD. However, the thoughts are not typically described as intrusive or distressing and the behaviour is not ritualistic and is often considered pleasurable.

Hoarding can be treated with medication management and CBT. Currently, there is inconsistent evidence for the role of medications, particularly SSRIs in the treatment of hoarding. In general, for people who do respond, the responses to SSRIs are poorer than those with OCD alone. The current medication approach is to attempt a trial of SSRI in conjunction with CBT, which is very helpful for hoarding.

Benefits of CBT for hoarding could be but is not limited to:

• Confronting hoarding related beliefs related to keeping and saving items
• Learning strategies to prevent the need to keep items, dispose items, and decluttering home
• Improve decision-making, social engagement, and motivation for change

For more information regarding the available treatment at the Thompson Centre, please see our Sunnybrook Outpatient OCD Services, or Intensive Treatment Services.

Just like OCD, there is a gradual and ongoing recovery process. Success with reducing symptoms depends on each individual person and there present circumstances.

To learn more about hoarding please see our Patient Hub.

Additional resources are available in our Patient Hub.