Obsessive Compulsive Disorders (OCD)

All OCD disorders are treated with serotonergic agents (SSRIs > Clomipramine) and CBT.

OBSESSIVE COMPULSIVE DISORDER - The patient’s brain forces them to have certain obsessions which induce a lot of anxiety, and the patient calms those thoughts by performing compulsions (aka rituals) to relieve that anxiety. Ha ha it’s obsessive-compulsive. Most patients have just 1 obsession and 1 compulsion. Common obsessions are safety, contamination and symmetry. It’s thought that the cause of OCD is a serotonin-mediated hyperactive loop of thought in the brain (for example, a thought loop responsible for thinking about symmetry). Patients have to undertake specific behaviors (touching an object with both hands) so that they can break this loop. A lot of us have some internal dialog about safety and cleanliness. But, the diagnosis of OCD requires that these thoughts and behaviors impair their ability to live a normal life. To get technical on you, they need to spend at least 1 hour a day obsessing and/or compulsing. OCD is an ego-dystonic disorder, which means that patients have insight into their disease. The treatment consists of CBT and an SSRI (remember how the hyperactive loop was driven by serotonin?). Fluvoxamine is an SSRI that can only be used for OCD. One of the TCAs, Clomipramine, works too.

Important distinction! OCD involves rituals. Obsessive Compulsive Personality Disorder (OCPD) is a very similar condition that does NOT involve rituals. OCPD also lacks insight into this semi-harmful pattern of behavior. See Personality Disorder section.

BODY DYSMORPHIC DISORDER - a preoccupation and disgust focusing on ONE part of the body, and this body part is often one that’s classically associated with beauty (skin, hair, nose, ears, breasts). In reality, this body part is relatively normal, but it seems hideous to the patient. This obsession compels them to get plastic surgery or avoid social interactions. They have MORE INSIGHT than someone with a delusional disorder. Treat with an SSRI. BDD is more common in females. In males, BDD often takes on the form of obsessing about the size of their muscles. Hence its name, Muscle Dysphoria. 

HOARDING DISORDER - they hoard. Insight is usually poor. 

TRICHOTILLOMANIA - hair pulling compulsion. It can lead to hair thinning. Be aware that a lot of these patients eat their hair after they pluck it. In humans, a hairball is called a bezoar, and it can get nasty if it isn’t treated.

EXCORIATION DISORDER - skin picking disorder. They pick their skin so hard that they create scabs. Often seen with meth use or anxiety disorders. Be on the lookout for cellulitis.