Welcome back. I am so happy to have you here with me today to talk about mindfully tending to feelings of anger and resentment.
Sometimes when we have relentless anxiety and intrusive thoughts, anger can feel like the only emotion we can access.
(more…)
Unlike OCD which is classed as an anxiety disorder, skin-picking disorder (excoriation or dermatillomania) is known as a body-focused repetitive behavior.
Skin-picking disorder may also be known as a body-focused repetitive behavior. It may also be called an impulse control disorder due to an excessive and ongoing urge to perform the skin-picking act. And in other occasions may be named an ‘obsessive-compulsive spectrum disorder’ due to the features that overlap with OCD.
While skin-picking disorder and OCD are two separate conditions, people with skin-picking disorder are more likely to have OCD or OC spectrum disorders such as hair pulling, BDD, and tic disorders.
This is because of the urge to engage in those repetitive ritualistic behaviors that offer relief either from intrusive and unwanted thoughts, or negative feelings or emotions.
Let’s get into the differences between these two disorders…
Content
OCD is a mental illness characterized by obsessive and unwanted thoughts or urges followed by repetitive physical or mental compulsions done to reduce the resulting anxiety.
It’s important to differentiate between everyday, low-frequency anxiety that many people will experience and disordered anxiety, brought on by these intrusive thoughts.
An intrusive thought may look something like this:
“If I don’t do X, then catastrophe Y will happen”
“What if this catastrophe occurs?”
When these thoughts arise, someone with OCD feels compelled to solve for the uncertainty and anxiety that arises. This is why OCD is sometimes known as the ‘doubting disorder’.
OCD is egodystonic in nature which means the obsessions experienced by the sufferer goes against their values.
Unsurprisingly, when a disturbing thought arises, the uncertainty surrounding it can feel unbearable.
The OCD sufferer may find themselves ruminating on what this thought must mean about them and try to ‘figure it out’.
Why did I have this thought?
What does it mean about me?
What might happen if I don’t do something about it?
In an attempt to alleviate the uncertainty and anxiety brought about by this unwanted thought, the sufferer performs compulsions that offer short-term relief.
For example, someone with postpartum OCD may fear that their newborn child will stop breathing in their sleep. The compulsion might be to check on their baby at regular intervals which in turn disrupts their own sleep and has a greater knock-on effect to their mental and physical health.
Another example may be someone with contamination OCD. They may fear intrusive thoughts such as, “What if I catch a disease?” or “What if I get sick and die?”.
The compulsion in this example might be to excessively wash their hands and wipe down objects before touching them.
The disordered anxiety suffered by those with OCD can consume all aspects of their life.
Social gatherings may be avoided, relationships become strained, and work or school can become difficult to focus on. OCD can be very scary, especially if obsessions are violent in nature, but it is treatable and manageable with the right help.
Click here to sign up for our weekly newsletter and receive immediate access to the 6-part mental compulsions audio series to help you resist the urge to engage in mental rituals (PDF worksheets included)
Skin picking disorder or excoriation is characterized by the habitual picking of skin, commonly around your nails, pimples, or blemishes.
People with dermatillomania may also create open sores by compulsively touching or picking at the skin, even if there is nothing there to pick at.
We’re all guilty of occasionally picking at our skin, but it becomes a disordered condition when it is near-constant and causes bleeding, open sores, or scars.
Although, to the untrained eye, skin picking may not seem overly distressing or a source for concern, those with excoriation disorder often find themselves trapped in a difficult cycle to break.
People may pick at their skin for a variety of reasons including boredom, anxiety, increased stress, or to cope with negative emotions.
While skin picking offers an initial burst of relief, it often follows with intense feelings of guilt or shame. Someone with excoriation disorder could spend hours each day picking their skin, thinking about picking their skin or trying to resist the urge to pick their skin.
It could be very easy for an observer to label this as an insignificant ‘bad habit’ but for the sufferer, skin picking can lead to greater implications that impact their quality of life.
It is not uncommon for those with excoriation disorder to avoid social events, isolate themselves from loved ones, have difficulty managing their condition at work, and fall into episodes of depression due to feeling ‘out of control’.
There are similarities between the symptoms of skin picking and OCD but they are not the same.
They are, however, both categorized as obsessive-compulsive and related disorders under the DSM-V (Diagnostic Statistical Manual) due to their overlapping features and the frequency with which they are simultaneously diagnosed within individuals.
It is the compulsive need to pick that lands this particular disorder in with other obsessive-compulsive and related disorders.
Medical reviewers have even found that those who suffer from skin-picking disorder are more likely to also have OCD compared to those without.
For those with skin-picking disorder, the act of excessively picking skin is often done to alleviate the constant urge to pick or touch the skin.
Similar tools are used with sufferers of OCD in that compulsive and ritualistic behavior is used to diffuse the uncertainty and anxiety felt by obsessive thoughts.
However, a skin-picking disorder focuses purely on picking scabs, spots, and scars, and can occur without comorbid OCD. You can receive an excoriation diagnosis without also receiving an OCD diagnosis.
With OCD, there is a wider range of compulsive ritualistic behaviors as a result of intrusive and obsessive thoughts. For example, some compulsive rituals might include:
The urge to pick may be an obsessive-compulsive behavior but it is not, in isolation, a symptom of OCD.
Skin picking becomes a problem when it begins to affect your daily life.
If skin-picking behavior gets to the point that it is near-constant, affecting your ability to see friends or carry out your responsibilities at work and school, this may be the time to seek a medical assessment to see if you are dealing with excoriation disorder.
Someone with a skin-picking disorder can develop damage to areas of their body that are easily seen by those around them. Scars and skin damage to the face are incredibly common and can leave the sufferer feeling embarrassed and ashamed.
This is not a disorder to be taken lightly despite how minor it may appear to someone with little knowledge of the condition.
While people with dermatillomania may not want to stop picking their skin, they don’t like the consequences of doing so and they feel very controlled by these urges. They feel as though they have little control over this strong urge and they feel like they have to pick.
There’s a reason that disorders such as this are often accompanied by high levels of anxiety, stress, and depression. It’s because it can be psychologically and emotionally difficult to manage day-to-day life.
It’s important to know that skin picking can be treated and managed so if you suspect you might be struggling with this condition, seek appropriate support from a mental health professional.
Both OCD and excoriation disorder – together or separately – can be treated effectively.
OCDLA created a simple and clear classification of dermatillomania to help us understand when skin picking becomes a problem. Because let’s face it, we all pick! But when does it start to matter?
“A” is something almost anyone would pick.
Something that anyone would feel inclined to pick might be some dry skin hanging from your arm or elbow, a scab that’s mostly fallen off, or a full spot on your chin that’s ready to burst!
“B” is a bump, pimple, or scab.
This is something that only a skin picker would pick at. At this stage, there is very little there to actually pick unlike the things noted in the “A” category. But a skin picker may feel for little bumps or potential spots and begin to pick.
Everything in the “B” category has the potential to turn into something from the “A” category or would disappear if left alone. But a skin picker will pick at these things and make them worse which ultimately causes high levels of distress and skin damage.
Those with skin-picking disorder may contribute at least 50% of their skin-picking to this category.
“C” stands for create.
Only someone with dermatillomania will find themself in band C. In this category, the sufferer does not pick at anything real per se, they pick at seemingly healthy skin and therefore create something such as a cut or blemish that was not there before.
In this category, the picker does not pick at anything apparent on their skin. Instead, they create skin damage through the act of picking at healthy skin.
The exact causes of excoriation disorder, like causes of OCD, are unknown. But there are a few factors that can trigger people to pick at their skin.
Research suggests that the disorder may be linked to genetics. A study from 2012 found that out of 60 people with excoriation disorder, 28.3% had close family members who shared the same disorder.
(OCD) and body dysmorphic disorder (BDD), two types of obsessive-compulsive and related disorders, are also more common in people with skin picking disorder than in those without the disorder.
Research figures highlight that 28% of those with BDD also have excoriation or skin-picking disorder.
| Two types of skin picking: Automatic: This type of skin picking is more habitual and can be done without a person knowing they’re even doing it. Within this type of skin picking, the person may be seen running their fingers over their skin to check for any areas that feel different and could be a focus area for skin picking. This behavior is also known as ‘scanning’ and can be described as being in a trance-like state. In this trance-like state, they can lose track of time completely and fall into trance-like behaviors when they are picking. Focused: This type of skin picking is more intentional, and an episode can last four extended periods of time, leading to greater skin damage. |
There are several symptoms of skin-picking disorder:
Common areas of focus such as the face where acne may be present are typical, and moles or freckles are targeted in an attempt to remove what is considered a blemish.
People with skin picking disorder will exhibit behaviors absent-mindedly, scanning for areas without much thought, but they can also have focused “sessions” where specific areas are targeted with picking lasting for hours at a time.
This is the more severe behavior trait and in some cases can result in surgery.
Diagnosing excoriation disorder requires a physical exam from a healthcare professional and some questions about any skin-picking behaviors to try and figure out if a skin-picking habit has crossed into a disorder.
Diagnosing this condition requires meeting all five of the following criteria:
OCD is a long-term condition and the treatment for OCD will reflect this. The most effective treatments are psychotherapy and medication.
Cognitive behavioral therapy or CBT is used for many psychological problems, including OCD. Exposure and response prevention (ERP), is a type of CBT that involves gradual exposure to obsessions while resisting the urge to perform compulsive behaviors as a coping tool. The aim is to help teach your brain that you are capable of managing anxiety and uncertainty without the use of these coping mechanisms.
Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are designed to increase the levels of serotonin in the brain. These are often prescribed alongside psychotherapy.
Medication should only be taken if prescribed by a mental health professional. Please seek medical assistance and effective medication treatment that is tailored to you and your needs.
Medication isn’t used to treat excoriation disorder, treating skin-picking disorder follows two main kinds of psychotherapy…
As with OCD, CBT has been shown to be effective at treating excoriation disorder by helping to change how their relationship and response to stressful or overly emotional situations. More specifically, a technique called habit reversal training is used to help identify what causes these urges and develop alternative, less harmful behaviors.
Making changes to your surroundings and limiting the opportunity to act on urges to pick is also effective.
This is known as stimulus control and a therapist will work with you to make it harder to act on these urges. Wearing gloves or band-aids can help by reducing the opportunities to pick and other changes, such as removing mirrors or covering reflective surfaces, limits exposure to face acne or other blemishes that may usually trigger the urge to pick.
We discuss:
This is Your Anxiety Toolkit – Episode 318, and welcome 2023.
Welcome back, guys. Happy 2023. Happy New Year. I want you to imagine you and I are sitting down at a table and we both have the most wonderful, warm tea or coffee or water or whatever it is that you enjoy, and we are going to have a talk. You’re not getting a talking too, I’m not saying that. But I want you to imagine that I’m standing in front of you or sitting in front of you and we’ve got eyes locked, and I am dead serious in what I’m talking to you about because I believe it to be the most important thing you need for 2023. I really, really do.
So, let’s talk. Okay, you’ve got your tea. I’ve got my tea. Let’s do this. Okay.
(more…)
Trichotillomania – also known as the ‘hair-pulling’ disorder – is categorized as the repetitive and uncontrollable urge to pull hair from your body. While some confuse it with OCD, it is in fact a separate condition.
While hair can be pulled from any part of your body with this condition the most common areas include the scalp, eyelashes, eyebrows, arms, pubic hair, and armpits.
Hair pulling is a real mental health condition and can lead to feelings of low self-esteem and a lack of self-confidence.
Obsessive-compulsive disorder (OCD) and bipolar disorder share many symptoms but there is also a key distinction between the two.
OCD is an anxiety disorder characterized by disturbing and unwanted obsessions in the form of thoughts, images, urges, feelings, or sensations. This is followed by repetitive ritualistic behaviors done with the aim to alleviate the uncertainty and anxiety caused by these obsessions.
Bipolar disorder is a mood disorder that is characterized by extreme changes in mood, thoughts, and behavior.
The relationship between the two has been the subject of numerous studies and research carried out in 2015 found that those with bipolar disorder are more likely to exhibit symptoms of OCD, compared to those with no diagnosed mental health illness.
This does not mean that having one guarantees you will have the other.
However, the statistics show that anywhere up to 20% of those living with bipolar show lifetime comorbidity with OCD.
In order to receive accurate medical advice, diagnosis, or treatment, it is important to first identify the characteristics of each.
Content
There are two core components of OCD, obsessions, and compulsions.
The OCD cycle begins when the sufferer is triggered by an obsession and intrusive thoughts. These obsessions are very sticky and difficult to shake for an OCD sufferer precisely because they go against their values.
When those obsessions arise, the sufferer feels the need for certainty.
Instead, they doubt themselves. They can find themselves trapped in a loop of rumination:
These intrusive thoughts can be torturous and painful to live with for someone with OCD. This is why the sufferer then engages in compulsions.
Compulsions are the repetitive, ritualistic behaviors we then do in order to gain some sense of certainty (if only for a short while) and find relief from the anxiety.
The most overplayed representation of OCD in pop culture and media is the need to excessively wash hands or clean. But there are a vast array of subtypes that cover a great deal of context beyond contamination OCD – there is simply a lack of education and understanding at this time (although that’s changing!).
Examples of other OCD subtypes can include:
It is often difficult for those not suffering from OCD to recognize the link that a compulsive action has to an intrusive thought and not all compulsions are visible to others.
Bipolar disorder is a chronic mood disorder that causes sufferers to experience severe changes in mood, activity levels, energy, and concentration.
People with bipolar disorder will have emotional highs (mania) where they experience feelings of extreme euphoria. And in contrast, extreme emotional lows leave them feeling lethargic, sad, and oftentimes, hopeless.
The severe shift in mood is known as an episode.
As with all mood disorders, an individual’s mood doesn’t necessarily match their circumstances and it will have a detrimental effect on a person’s ability to complete day-to-day functions.
Bipolar disorder is usually diagnosed in adolescence but it can occur at any age with symptoms varying over time and from person to person.
Mania refers to an episode of extreme emotional highs that lasts for a week or more.
Hypomania is the milder of the two, lasting for only a few days and although the symptoms experienced are similar, hypomania is considered the more manageable of the two as the episodes are shorter-lived.
Although mania/hypomania represents the ‘highs’ of bipolar disorder, this isn’t to be confused with ‘feel-goods’. The highs are just as detrimental to a sufferer’s day-to-day life as the lows are.
Episodes of mania or hypomania can be identified by feelings of:
Experiencing these feelings during a manic episode leads to changes in behavior such as:
The contrast to mania and hypomania is depression.
Depressive episodes can last anywhere from a couple of weeks to months at a time and are as equally disruptive as the mania.
The swing from high to low moods can be considerably jarring and leave the sufferer feeling like they have no control.
Depressive episodes leave individuals feeling:
The behavioral changes might look as follows:
These episodes of mania/hypomania and depression can shift very quickly from one to the other or even occur at the same time. This results in unpredictable behavior and confusion, not only in its sufferers but for those around them.
Feeling recklessly impulsive and confident while hopelessly dejected can be difficult to explain and may cause individuals to act erratically.
Mixed episodes can also last from weeks to months and the prevailing evidence from medical reviewers shows that those who suffer mixed episodes are at a greater risk of attempting suicide compared to those who suffer episodes in isolation.
Bipolar disorder is broken down into multiple categories for diagnosis:
The symptoms shared by both OCD and bipolar disorder include:
There is a clear overlap and someone with OCD can exhibit symptoms of bipolar disorder without a specific bipolar disorder diagnosis (and vice versa), though these may only be experienced during periods of mania or depression.
Symptoms that are caused by OCD but not bipolar disorder include:
Symptoms that are caused by bipolar disorder but not OCD include:
To the untrained eye, a person suffering from obsessions and compulsions associated with OCD may appear to be having a bipolar episode. However, this is why it’s very important to receive a thorough assessment so that you can are treatment for the correct disorder.
If someone with OCD is having racing intrusive thoughts or performing repetitive ritualistic compulsions, it can be common for them to be misunderstood as having bipolar disorder.
If you suspect yourself of having one or the other, or both, you must be thoroughly assessed so that an appropriate treatment plan can be made for you. For someone living with both OCD and bipolar disorder, it is imperative that their bipolar be treated before they begin treatment for OCD as it will affect their OCD recovery.
If you feel like your symptoms are better understood as obsessions and compulsions and you would like to have a thorough assessment from someone from our team to receive the correct diagnosis and treatment, please submit a submission form HERE (for those based in California).
Living with OCD or bipolar disorder independently from each other can be challenging. If you are experiencing both it may bring some additional challenges.
It is completely understandable, therefore, that someone would feel overwhelmed when faced with a life of both.
The good news is there are science-based treatment modalities for both OCD and Bipolar disorder. Thanks to many years of research, we also have medications that are proving to be highly effective for those managing both OCD and Bipolar disorder.
Please speak with your medical professionals to determine a medication plan that will be helpful for you.
The more knowledge and understanding you have, the better equipped you will be to manage both.
OCD symptoms can exacerbate depressive episodes and increase the severity of bipolar symptoms.
The fear and uncertainty triggered by those obsessions can, during a bipolar depressive episode, only add to the feelings of hopelessness and despair felt by the sufferer. It feels like another thing to manage and another thing that they don’t feel able to deal with.
The uncertainty and self-doubt that arise during the OCD cycle contribute to great doubt and uncertainty surrounding bipolar symptoms.
Rumination (repetitive and unhelpful ‘problem-solving’ thoughts) is a symptom of each and when experienced as a result of OCD, it can cross over and latch on to bipolar symptoms as well.
It is essential that the person with bipolar has been assessed by a medical professional to make sure the symptoms of bipolar disorder are treated before they begin treatment for OCD.
During a depressive episode brought on by bipolar disorder, negative thoughts and low emotions as a result of OCD are increased.
Anxiety levels are also heightened with the introduction of bipolar disorder which can lead to increased obsessive thoughts and subsequent compulsions.
That said, there is evidence to suggest checking compulsions are reduced compared to someone with OCD in isolation and theories suggest that OCD symptoms are less severe during mania/hypomania episodes and heighten during depressive episodes.
Currently, scientists are not sure where the connection lies between the two conditions. However, there are some things that we can consider…
Genetics: Like OCD, there could be a genetic factor involved in the onset of bipolar disorder. Research suggests that there are a number of genes shared by both disorders. While this is not definitive, it is something that researchers continue to explore.
Intrusive thoughts and obsessive thinking: Intrusive thoughts and some form of negative obsessive thinking feature heavily in both disorders and this could be down to a commonality between the two.
Anxiety: As with obsessive thinking, anxiety and anxious thoughts appear with both conditions. This could also be a commonality that connects the two conditions.
When you’re in the middle of living with not only one condition but two simultaneously, it’s not difficult to see why someone may begin to lose hope. But there is hope. The saving grace is that extensive research has been conducted on the most effective treatment for OCD and bipolar individually, as well as in co-occurrence.
Treatment for bipolar disorder needs to be long-term. It is a chronic illness and should therefore be carried out even during episode-free periods.
Mood stabilizers will typically be introduced to control symptoms fast and are sometimes used in conjunction with other medication to be most effective.
Antidepressants can sometimes be used as a medication for bipolar disorder however, in many cases they contribute to cases of mania and hypomania. Because of this, certain mood stabilizers tend to be the first option.
This should not be taken as medication advice, please speak to your medical professional to receive the appropriate medication plan for you.
A form of talking therapy will take place alongside the use of mood stabilizers. The type of therapy will depend on what best suits you and your needs. There are many different types of psychotherapy available, including:
As with bipolar disorder, Treatments for OCD need to be long-term to reflect the long-term nature of the condition.
Cognitive Behavioral Therapy (CBT) is used for many psychological problems, including OCD. Exposure and response prevention (ERP), a type of CBT, involves the gradual exposure to obsessions whilst resisting the urge to engage in compulsive behaviors as a coping tool. This method of treatment is designed to help you change your relationships and respond to those obsessions.
Typically a form of antidepressant known as selective serotonin reuptake inhibitors (SSRIs) are shown to be helpful when prescribed alongside psychotherapy.
Medication should only be taken if prescribed by a mental health professional.
The treatment of bipolar disorder takes precedence when both disorders are being treated together. It’s important that a person’s mood is stabilized before treatment for OCD begins. This follows research suggesting OCD treatment is ineffective if symptoms of bipolar disorder are not dealt with first.
The psychological treatments listed above for each disorder remain effective but due to the heightened risk of substance abuse, self-harm, and erratic behavior in those diagnosed with both, closer monitoring is required.
It is important to ensure that you seek assistance from a specialist who is highly qualified in both disorders, as having the two together can contribute to complications in therapy if you aren’t under the correct guidance.
We have a qualified team of elite clinicians based in California, who can assess and treat OCD. We are able to rule out Bipolar disorder however if you have additional bipolar symptoms we would refer you to specialists who come highly recommended in the treatment of Bipolar disorder.
We will be able to treat your OCD in conjunction with any other bipolar treatment you receive elsewhere.
If you would like to see how we might be able to help you with an appropriate assessment, please submit an inquiry form here.
Welcome back, everybody. I am thrilled, thrilled, thrilled to have you here again, finishing out the year so strong. In this episode, we planned perfectly for this week because my guess is that you’re starting to make New Year’s resolutions or make New Year’s goals, and we wanted to talk, myself and the amazing guests that we have this week, about how you can change your habits in the most compassionate and effective way..
(more…)
In this podcast:
Compulsive hoarding used to be considered a type of OCD.
Some have estimated that up to 1 in 4 with OCD also struggle with compulsive hoarding. And up to 1 in 5 compulsive hoarders have non-hoarding OCD symptoms.
Like many other comorbidities (such as OCD and depression, or OCD and BDD), there is a distinct overlap between the two disorders.
You can be diagnosed with hoarding disorder without an OCD diagnosis. A hoarding disorder with an OCD diagnosis is known as hoarding OCD.
Like many OCD subtypes (and mental health disorders in general) hoarding and hoarding OCD are greatly misunderstood. Both hoarding and hoarding OCD are great sources of pain and stress; they are not enjoyable and they do not bring pleasure to one’s life.
It can have a huge impact on quality of life which, to those who do not understand the disorder, can appear as a way of living that the sufferer may even enjoy.
This is simply not true.
Let’s look at OCD and hoarding separately and together to understand the differences between the two.
Content
People with OCD will suffer from obsessions in the form of thoughts, images, feelings, urges, or sensations. Intrusive thoughts will pop into their head, causing an immense amount of stress and discomfort.
These unwanted and intrusive thoughts are disturbing or fearful in nature and conjure tortuous feelings of uncertainty and distress.
These intrusive thoughts are constant, persistent, and all-consuming and the sufferer will try desperately to alleviate their distress.
This distress leads to a physical or mental compulsion; a ritualistic behavior aimed at soothing the anxiety and uncertainty brought on by distressing thoughts.
Anxiety felt around any uncertainty and thoughts of “what if?” brings with it cravings and urges for certainty.
We do compulsions to try to solve that uncertainty and mitigate any potential consequences of not addressing the obsessions.
In doing this, our brain learns that the physical or mental ritual is needed in order to navigate the uncertainty and anxiety. We learn that we cannot tolerate those feelings without doing compulsive behaviors.
But, the relief this offers is only fleeting and allows OCD to thrive. This is known as the OCD cycle and it acts to perpetuate long-term feelings of distress.
Click here to sign up for our weekly newsletter and receive immediate access to the 6-part mental compulsions audio series to help you resist the urge to engage in mental rituals (PDF worksheets included)
Hoarding is characterized by the persistent gathering and saving of an excessive number of objects. The ‘excessive’ part comes into play as the sheer volume is unmanageable, storage is chaotic and the behavior has a detrimental effect on everyday life.
The items will likely have no monetary value and will create clutter to the point that access to a person’s home is compromised.
People who experience hoarding feel greatly distressed at the thought of discarding the items they have hoarded.
When is hoarding considered a problem?
Hoarding is considered a problem when:
Individuals with hoarding disorder might save items because:
| Often, someone with hoarding OCD has a fear of contamination. Contamination fears are not the only type of obsession in hoarding OCD, but it is very common. |
Collectors will typically take great joy in organizing or filing their collection for admiration.
The presentation will be neat – think stamps in a scrapbook – and the collection will be carefully considered and follow a theme. Collections can be large but they are not disorderly and their existence does cause a detrimental effect on lives.
Hoarding is impulsive and follows no discernible theme. Presentation, in order to admire, isn’t considered and the clutter can often be a source of embarrassment or shame.
A collector will have the presence of mind to budget money and space for their items, whereas the impulsivity of individuals with hoarding disorder means that their items can cause financial strain or debt.
Here are some key signs to look out for when identifying hoarding disorder:
The best way to differentiate between hoarding OCD and hoarding disorder comes down to the reason why the sufferer is hoarding.
For a long time, hoarding disorder was considered to be a part of OCD. In recent years, hoarding disorder has been given its own diagnosis and what separates the two is mainly down to the reasons for the compulsive behavior.
Individuals with hoarding disorder accumulate items because they perceive them to be valuable, and unique or believe that one day they will have a use for them.
Distress is experienced when faced with the prospect of throwing possessions away because of this perceived value.
Whereas hoarding OCD is an unwanted behavior done in response to an obsessive thought.
For those with hoarding OCD, the accumulation and retention of objects are often very stressful as they find themselves ruminating on the potential consequences of what might happen if they were to get rid of said items.
| A helpful distinction between hoarding OCD and hoarding disorder is that those with hoarding disorder hang on to items they feel are valuable and feel distressed at the idea of getting rid of them. Whereas hoarding OCD, people are holding onto items because they fear what will happen if they don’t. |
Hoarding OCD obsessions could sound like:
Hoarding compulsions might look like:
Cognitive behavioral therapy (CBT) with exposure response prevention (ERP), is the gold-standard treatment for OCD disorders, including hoarding OCD.
Through repeated exposure to obsessive thoughts, wilfully tolerating the anxiety and uncertainty, and resisting the urge to do compulsions (hoarding in this instance) we teach our brain that we are capable of navigating the uncertainty without those safety behaviors.
Falling into an OCD cycle is all too easy but by changing our response to those obsessions we provide our brains with new tools that can be used to soothe our anxieties, away from the detrimental and compulsive behavior we may have exhibited in the past.
ERP works by gradually exposing yourself to your obsessions and taking small steps toward changing how you think and behave toward them.
With hoarding OCD in mind, you will work closely with your therapist to break away from your compulsions, for example, going to a grocery store and only buying one item instead of multiples.
With your therapist, you’ll first come up with a hierarchy of exposures you are willing to do and be given education on how to reduce compulsions such as mental compulsions, avoidance compulsions, reassurance compulsions, and hoarding compulsions.
You will also discuss your feared outcome and address ways in which you can expose yourself to those fears.
Along with exposure to only accumulating one item at a time, the therapist and client will also work at exposing the client to getting rid of the hoarded items in the house. This is done in a step-by-step manner where the client themselves get to choose what they are willing to get rid of.
When the degree of clutter is so much, the client and therapist may consider the option of hiring cleaners to discard the items to help the client maintain a degree of safety in their home, if they are unable to do it at a pace that reduces the safety risk.
The aim is to become more comfortable with obsessive thoughts, to identify them, and break away from the compulsive, ritualistic behavior that follows.
If we familiarize ourselves with uncertainty and discomfort, we’re far less likely to fear it. And if we no longer feel apprehensive in the face of the unknown, we’re far more likely to live full and satisfying lives.
SUMMARY:
