Obsessive Compulsive Disorder (OCD) and Related Disorders Treatment in New York
What are OCD and OCD-Related Disorders?
The hallmark of Obsessive Compulsive Disorder (OCD) is the pairing of recurring unwanted thoughts (Obsessions) with repetitive thoughts or behaviors (Compulsions) that are meant to ease the distress caused by the obsessions. This creates a harmful cycle that takes up tremendous time and energy. OCD can involve preoccupations with contamination, loss of control, harm, sexual thoughts, relationships, superstitious beliefs, and more.
There are a number of OCD-Related Disorders including Body Dysmorphic Disorder (BDD), Hoarding Disorder, and Body Focused Repetitive Behaviors (BFRBs) such as Excoriation Disorder (Skin Picking) and Trichotillomania (Hair Pulling), to name a few. These disorders share some common characteristics with OCD but are differentiated from OCD in important, specific ways.
What are examples of OCD Obsessions and Compulsions?
While individual obsessions and compulsions can vary greatly, there are a number of common ones.
Common OCD Obsessions
Unclean substances (i.e., contaminants)
Dirt (examples: soil, grime, or residue)
Germs/disease (examples: the flue, HIV, and COVID-19)
Bodily fluids or excretions (examples: urine and feces)
Chemicals (examples: household cleaners and solvents)
Environmental contaminants (examples: asbestos, lead paint, and radiation)
Includes fear of self-contamination as well as contaminating another
Harm
Fear of being the cause of a terrible event (examples: burglary or fire)
Fear of causing harming to others due to negligence (example: spilling water that might cause someone to slip)
Organization or Perfectionism
Need for things to be “just right”
Concern about evenness, sameness, or exactness
Concern with needing to know or remember things
Fear of losing or forgetting important items or information when throwing something out
Indecisiveness
Unwanted sexual thoughts
Forbidden or perverse sexual thoughts or images
Forbidden or perverse sexual impulses about others
Sexual thoughts that involve children or incest
Obsessions about homosexuality
Obsessions about having aggressive sexual behavior towards others
Loss of control
Fear of stealing things
Fear of saying obscenities or insults
Fear of violent or horrific images in one’s mind
Fear of acting on an impulse to harm oneself or others
Obsessions that are religious in nature
Concern with offending God
Fear of committing blasphemy
Obsession with morality (i.e., what is “right” versus what is “wrong”)
Other Obsessions
Concern with getting a physical illness or disease (not by contamination, e.g., cancer)
Superstitious ideas about lucky/unlucky numbers, certain colors
Common OCD Compulsions
Washing and Cleaning
Washing one’s hands excessively or in a particular order of operations
Excessive showering, bathing, tooth-brushing, grooming , or other bathroom routines
Excessively cleaning household items
Doing other things to prevent or remove contact with contaminants (example: wearing gloves to clean the toilet)
Checking
Checking that you did not and will not harm yourself or others
Checking that nothing terrible happened
Excessively checking that you did not make a mistake
Checking often the condition of parts of your body
Repeating
Rereading or rewriting things
Repeating routine activities (examples: going in or out of doors several times)
Repeating body movements (examples: tapping or touching)
Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” or “safe” number)
Mental Compulsions
Performing a mental review of events to prevent harm to oneself others
Praying to prevent harm to oneself others, or to prevent terrible consequences
Counting while performing a task to end on a number that is “good,” “right,” or “safe”
“Cancelling” or “undoing” (example: replacing a “bad” word with a “good” word in order to cancel it out)
Other Compulsions
Obsessively putting things in order or arranging things until it “feels right”
Asking for constant reassurance
Avoiding situations that might trigger your obsessions
OCD Subsets
Child and Adolescent OCD
OCD usually begins in childhood or adolescence and is in fact one of the most common psychiatric illnesses affecting children. The particular intrusive thoughts experienced can vary by age but any of the following subsets, or any of the above-listed obsessions and compulsions, can be experienced by young people. Like adults, children and adolescents with OCD have repetitive thoughts or images that they can’t control, and the anxiety caused by these thoughts leads to impulses or actions that are distressing, time-consuming or limiting to normal functioning.
Harm OCD
Individuals with this type of OCD experience aggressive, intrusive thoughts of doing violence to someone, as well as the compulsive, coping response. An individual with Harm OCD feels as if they cannot trust their own ability not to do harm to another and the compulsive act is intended to assure themselves that they will not follow through on the harmful action. They often worry that the very thought of harming another is meaningful.
Pure/Purely Obsessional OCD/”Pure-O” OCD
Pure Obsessional OCD is a form of OCD where the individual experiences intrusive, unwanted, and uncontrollable thoughts (or obsessions). It is primarily cognitive (i.e., mental or internal) in nature. While someone experiencing Pure Obsession OCD may not engage in obvious, external behaviors related to their intrusive thoughts, such as hand-washing or counting, the disorder is instead accompanied by “hidden” mental rituals.
Although sometimes understood as a less severe form of OCD by others, for those who experience Pure Obsession OCD, the obsessions can be very disruptive to their lives and incredibly distressing.
Homosexual OCD (HOCD)/Sexual Orientation OCD (SO-OCD)/Gay OCD
This type of OCD is marked by intrusive thoughts about one’s sexual orientation. It is not one’s sexual orientation itself that causes distress but rather the overactive questioning and doubt involved in experiencing the intrusive thoughts, along with the compulsive actions that individuals undertake to check their “real” feelings. For example, an individual with HOCD might observe themselves for evidence of “looking” or “acting” like someone who is either gay or straight. The individual may compulsive review and analyze past interactions with others to see if they have “acted like a gay or straight person.”
Relationship OCD (ROCD)
Relationship OCD pertains to intrusive thoughts specifically focused on one’s intimate relationships. Having questioning thoughts and doubts about relationships is a common experience, however, when these worries or doubts are uncontrolled, distressing, and cause significant impairment to one’s life, this is a sign that ROCD may be at play. Relationship OCD includes both intrusive thoughts (“Is he the right one?” “Are my feelings of love for her strong enough?”) and actions such as constantly checking if one thinks about their partner enough.
Postpartum OCD
Similar to Harm OCD, Postpartum OCD sufferers struggle with repetitive intrusive thoughts centered around harm to one’s baby. An individual may obsess about their baby getting hurt or may even obsess about being afraid of somehow hurting their baby themself.
Scrupulosity OCD
This type of OCD is the name for the above-mentioned obsessions that are religious or moral in nature. Questioning of one’s morality from time to time (“Did I make a fair decision?”) is a common human experience. Likewise, it can be common for individuals to question their religious beliefs and attitudes. Scrupulosity OCD, however, is a pathological (uncontrollable) guilt or anxiety about moral, ethical, or religious issues and causes distress and dysfunction in the life of the sufferer.
Tourettes Syndrome (TS) and Tics
Tourette syndrome is a neurological disorder characterized by sudden, repetitive, rapid, and unwanted movements or vocal sounds called tics. TS is one of a group of disorders of the developing nervous system called tic disorders.
What are examples of OCD-Related Disorders?
Sharing some common characteristics with OCD, these disorders are different in specific and important ways.
Body Dysmorphic Disorder (BDD)
Dirt (examples: soil, grime, or residue)
Germs/disease (examples: the flue, HIV, and COVID-19)
Bodily fluids or excretions (examples: urine and feces)
Chemicals (examples: household cleaners and solvents)
Environmental contaminants (examples: asbestos, lead paint, and radiation)
Includes fear of self-contamination as well as contaminating another
Emetophobia
Fears related to vomiting
Includes fears of situations that might lead to vomiting (such as food poisoning, motion sickness, etc.)
Individuals will avoid experiences and situations where they suspect vomiting may occur (travel for work, social events where alcohol may be present, and even pregnancy)
Typically, only few “safe” foods are eaten and general intake of food may be severely restricted
Hyper-vigilance and hyper-reactivity in response to someone burping, coughing, looking pale, or even people placing their hand on their stomach
Hoarding
An individual acquires an excessive number of items and stores them in in a haphazard manner
Items may have little or no monetary value, such as junk mail and carrier bags, or items they intend to reuse or repair
Individual may find it hard to categorize or organize items
They have difficulty with decision-making and struggle to manage everyday tasks
Individuals become extremely attached to their items and will refuse to allow anyone to remove, borrow, or even touch an item
Misophonia
Hypersensitivity to the presence (or anticipation) of a specific sound that may be accompanied by hyper- arousal, irritation, anger/outbursts, or fear
Avoidance of sound triggers or stimuli associated with specific sounds.
Sensitivity and autonomic responses results in significant distress or impairment
Olfactory Reference Syndrome (ORS)
Also known as olfactory reference disorder, an often severe condition
Individuals believe they smell bad, but in reality, they don't
Habits include smelling oneself, excessive showering, changing clothes, brushing teeth, laundering clothes, seeking reassurance about one’s body oder, and avoiding certain foods
Individuals may also compare their body oder to that of others
Body Focused Repetitive Behaviors (See below)
Body Focused Repetitive Behaviors (BFRB)
Body Focused Repetitive Behaviors (BFRBs) include any repetitive self-grooming behavior that can lead to physical damage to the body. These behaviors include biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails. Individuals have unsuccessfully attempted to stop or decrease these behaviors multiple times.
Excoriation (Skin Picking)
Picking of the skin to the extent that it causes noticeable tissue damage
Individuals show marked distress or impairment in daily functioning
Behaviors can including touching, rubbing, scratching, and picking at or digging into the skin
Behaviors are an attempt to improve imperfections, remove rough patches/scabs or smooth areas
Typically begins in early adolescence but can begin at any age
Trichotillomania (TTM or “trich”) (Hair Pulling)
Characterized by the repetitive pulling out of one's hair
Like other BFRBs, hair pulling includes self-grooming behaviors which result in damage to the body
Not limited to the scalp: can occur on any part of the body that grows hair
Other Types of BFRBs
Onychophagia (Nail Biting) and Onychotillomania (Nail Picking)
Mouth-related biting/chewy including cheeks, lips, and tongue
Hair-related behaviors including hair cutting and hair eating
Dermatophagia (Skin Biting)
How we treat OCD and OCD-Related Disorders at City Center Psychotherapy
At City Center, we treat OCD and OCD-Related Disorders with an effective, evidence-based therapy called Exposure and Response Prevention (ERP). ERP involves a combination of exposing clients to situations that trigger their anxiety—but at a tolerable level—and helping them refrain from their paired response or ritual.
By exposing individuals in a controlled manner to the situations or items that induce anxiety, while simultaneously disallowing the individual to use a coping mechanism (avoidance, ritualization, or escape, for example), overtime the anxiety reduces. ERP is considered the gold-standard treatment for OCD and OCD-Related Disorders. You can read more about ERP therapy here.
Meet Andrea.
Andrea began therapy when she realized how her checking OCD was impacting her son. She had an overwhelming fear of something bad happening as a result of her carelessness. She spent hours each day checking locks, ensuring the stove was turned off, and making sure her son was safe. Andrea’s son became angry with her constant checking and their time together felt strained. Using Exposure and Response Prevention, we helped Andrea spend extended periods of time resisting her urge to check that her house and her son were safe. After a few months of treatment, her compulsions faded away and left her with a lot of extra time to devote to building a better relationship with her son.
Client names, photos, and other identifying details have been changed to maintain confidentiality.
What are the steps to begin OCD therapy?
At City Center Psychotherapy, we’re here to help. Contact us today to hear more about treatment options in New York and how to get started.