Body Dysmorphia: Definition, Symptoms, Causes, Treatment

Body dysmorphic disorder (BDD), also called body dysmorphia, is a mental health condition that involves an overwhelming preoccupation with one’s body and appearance. Someone with BDD may focus excessively on minor physical flaws or worry about perceived flaws that others don’t notice.

Person with body dysmorphia checking appearance in mirror

Person with body dysmorphia checking appearance in mirror

NickyLloyd / Getty Images


In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BDD is listed within the category of obsessive-compulsive and related disorders. This means it involves both obsessions (intrusive, persistent thoughts) and compulsions (actions that someone performs repeatedly in an attempt to reduce anxiety).

Learn more about body dysmorphia, including symptoms, causes, and available treatment options.

Prevalence of Body Dysmorphic Disorder

Estimates suggest that up to 4% of the U.S. population meets the diagnostic criteria for body dysmorphic disorder. It is most common among people age 15–30.

Symptoms

People with body dysmorphia worry excessively about minor or nonexistent flaws in their body and/or face. To “fix” those flaws, they may go to extreme lengths, such as drastically altering their looks with plastic surgery

Research suggests that people with BDD often spend three to eight hours a day worrying about their perceived physical imperfections. Any body part may become a target for these worries. However, people with body dysmorphia are most likely to worry about their skin, nose, or hair. 

Common symptoms of body dysmorphia include:

  • Extreme preoccupation with physical flaws that are either very minor or imagined
  • Spending an excessive amount of time covering perceived flaws with makeup, different outfits, or new hairstyles
  • Buying products or getting plastic surgery to alter one’s appearance
  • Checking the mirror excessively or avoiding mirrors 
  • Trying to hide certain body parts with clothing or accessories
  • Repetitive behaviors, such as picking at their skin
  • Needing constant reassurance from others about physical appearance
  • Worrying excessively about appearing “ugly” or unattractive
  • Constantly comparing one’s looks to others

Someone with body dysmorphia may feel so consumed with thoughts about their looks that they neglect other areas of their life. They may even avoid school, social events, dating, or work out of fear of being judged for their looks. 

When left untreated, BDD can lead to serious negative consequences. Over half of people with BDD are unmarried, and over 20% of people with body dysmorphia are unemployed. Around 20% of people with BDD are so distressed by their appearance that they attempt suicide.

Diagnosis

If you think you may have BDD, talk to your healthcare provider. They can refer you to a mental health specialist who can make a diagnosis using the criteria in the DSM-5. If your worries about your looks are focused more on your body weight or size, you may be diagnosed with an eating disorder instead.

To be diagnosed with body dysmorphia, the preoccupation with your appearance must negatively affect your life and/or cause significant emotional distress. Your healthcare provider may also specify whether you have muscle dysmorphia, a type of body dysmorphia that involves worrying about appearing “too small” or not muscular enough.

During the diagnostic process, your mental health specialist may specify whether you have good, fair, or poor insight into your BDD symptoms.

According to the DSM-5, some people with body dysmorphic disorder have “good” insight, which means they are aware that their beliefs about their body are not true. People with “fair” or “poor” insight aren’t aware that their worries are excessive or not based in reality.

Causes

The exact cause of body dysmorphia is unknown. Researchers believe that several factors may contribute to the development of BDD, including:

  • Genetics: In some cases, BDD may be inherited. According to twin studies, genetic factors account for about 44% of the variance in body dysmorphic disorder symptoms. 
  • Trauma: People with a history of trauma have a higher chance of developing body dysmorphia. Many people with BDD report having been bullied by peers at school, and up to 79% of people with body dysmorphia experienced childhood abuse.
  • Personality traits: People with certain personality traits, such as perfectionism and sensitivity to aesthetics, are more likely to develop body dysmorphia.
  • Comorbid conditions: Many people with BDD have at least one other mental health condition at the same time. It’s especially common for someone with body dysmorphia to have obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), or an eating disorder, such as anorexia nervosa (AN).

Treatment

Treatment for body dysmorphia usually involves psychotherapy (talk therapy) and/or medication. Research suggests that the following approaches are effective in treating people with BDD:

  • Cognitive behavioral therapy (CBT): CBT can help people with BDD learn to manage their anxiety and depression, gain insight into their beliefs, and resist the urge to perform compulsive behaviors. 
  • Selective serotonin reuptake inhibitors (SSRIs): Studies indicate that certain antidepressants, such as SSRIs, have been shown to be 53% to 70% effective in treating BDD. Many people with body dysmorphia have to take SSRIs on a long-term basis to reduce their symptoms.

Coping

If you have BDD, it’s important to build your self-esteem and reach out to others for support. In addition to seeking professional treatment, here are some ways to cope with the symptoms of body dysmorphia:

  • Joining an online or in-person peer support group for people with BDD
  • Spending time with loved ones 
  • Practicing mindfulness techniques, such as meditation
  • Managing stress with relaxation techniques, such as deep breathing exercises
  • Writing your thoughts in a journal
  • Using positive affirmation statements to build your confidence
  • Participating in a new hobby or learning a new skill

Summary

Body dysmorphic disorder (BDD), is a mental health disorder that involves an extreme preoccupation with minor or imagined flaws in one’s physical appearance. People with BDD feel overwhelmed by negative thoughts about their body or face. They may spend excessive amounts of time and/or money in attempts to conceal their imperfections or “fix” the way they look. 

Researchers believe that BDD is caused by a combination of genetic and environmental factors. Many people with BDD have been bullied about their looks. A history of trauma, such as child abuse, also increases the likelihood of developing BDD. Treatment for BDD typically involves psychotherapy, medication, or both.

A Word From Verywell

If you worry excessively about your looks, you’re not alone. Body dymorphia is common, especially among young adults. Many people have low self-esteem and body image concerns. Talk to your healthcare provider about your options for treatment, support, and empowerment.

Frequently Asked Questions

  • Many people are insecure about their looks. However, people with body dysmorphia are so concerned with certain aspects of their appearance that it interferes with their everyday life.

    They may take extreme steps to change or hide particular body parts. They may also avoid going out at all because of their imagined physical flaws.

  • You may have body dysmorphic disorder if you are excessively preoccupied with minor or imagined flaws in your body and/or face. You may also perform repetitive actions, such as comparing yourself to others or grooming excessively, to address your perceived imperfections. Talk to your healthcare provider if you feel consumed or overwhelmed by negative thoughts about your appearance.

  • Body dysmorphic disorder is a fairly common mental health condition. According to estimates, between 0.6% to 4% of the population has body dysmorphia. It is even more common among people who get plastic surgery or visit a dermatologist regularly.

  • Research suggests that both biological and environmental factors contribute to the development of body dysmorphia. A history of trauma, including bullying and/or abuse, significantly increases the likelihood that someone will develop BDD. Twin studies indicate that genetics also plays a role, accounting for up to 44% of BDD cases.

  • If your friend or family member has body dysmorphic disorder, try to be an empathetic listener. Help to build their self-esteem and confidence by offering support and companionship.

    If your loved one is open to professional help, reach out to a healthcare provider or support group. Remember to set boundaries and prioritize self-care to keep your communication healthy and effective.

What Is OCD? Symptoms, Treatment And More

When someone is suffering from obsessive-compulsive disorder, they often have repetitive and unwanted thoughts—called obsessions—of a disturbing nature. These obsessions are often unrealistic or irrational and are recognizable as such to the individual, but still trigger intense feelings of anxiety or distress. Obsessions are often, but not always, accompanied by strong, uncomfortable urges to perform certain behaviors, called compulsions. These behaviors can temporarily relieve the distressing feelings but over time, can begin to take over the person’s day, as some of these compulsions are repetitive and involve elaborate rituals that can take a long time and cut into their ability to tend to their responsibilities or engage socially.

At the heart of these obsessions and compulsions is doubt. “Doubt is a hallmark of OCD and it overrides any sense of logic or intelligence an individual might have,” says Holly Schiff, Psy.D., a licensed clinical psychologist based in Greenwich, Connecticut. “The cause for this doubt comes from the fact that OCD makes you obsess over certain thoughts—in this case doubting if you did something or not, and therefore, in order to get safety, security and certainty, you will obsessively repeat the action.”

Symptoms of OCD

The chief symptom associated with OCD is a person experiencing obsessions and/or compulsions. People with OCD find it difficult to manage their obsessive thinking which can wreak havoc on their ability to manage other tasks effectively. Those who experience the compulsion symptoms will have great difficulty resisting the urge to perform these compulsions. These symptoms can ultimately impact their work, education or relationships with others.

Below, we’ve listed some of the more common obsessive thoughts and compulsive actions, according to the Mental Health Foundation.

Common obsessions in OCD:

  • Fear of dirt
  • Fear of germs
  • Fear of harm (such as what might happen if the stove is left turned on or door left unlocked)
  • Placing items in an exact order, facing the same way or matching in some other fashion
  • Excessive need for orderliness
  • Anxiety over unwelcome thoughts including anger or sexual or religious content
  • Anxiety over unwelcome thoughts relating to harming oneself or others
  • Anxiety over unwelcome thoughts relating to inappropriate behavior

Common compulsions in OCD:

  • Ritualized and extensive cleaning
  • Repetitive acts (like checking stoves or locked doors)
  • Ordering and arranging
  • Repeating mantras or phrases
  • Mental rituals
  • Repeating words, phrases or prayers

“OCD symptoms can be similar to those of other mental illnesses, like obsessive-compulsive personality disorder, anxiety disorders, depression, autism spectrum disorders or schizophrenia,” says Dr. Schiff. Each person suffering from OCD may have a unique mix of symptoms that stems from personal experience, stressful events and even trauma.

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How to recognise the symptoms of anxiety and get help

Many people will be familiar with the dry mouth, intrusive thoughts, and fluttering heart and stomach that are the hallmarks of anxiety. Often a temporary, and completely natural reaction to threat, these responses can be helpful in certain situations, sharpening the mind and sending blood to where it is needed faster.

But whereas stress usually resolves once a concern has passed, anxiety persists and is often disproportionate to the challenge faced. If it continues for months, and starts to interfere with everyday activities, an anxiety disorder may be diagnosed.

Even before the Covid-19 pandemic, an estimated five in every 100 people in England were experiencing regular or uncontrollable worries about multiple things in their lives – a condition known as generalised anxiety disorder (GAD).

The introduction of the first UK lockdown in March 2020 saw the prevalence of generalised anxiety among the general population soar to 31% according to one recent study, as a consequence of social isolation, uncertainty about the future and the perceived threat of illness or death many people felt. This is a challenge that “cannot be undone overnight”, according to the study’s lead author Dr Gemma Taylor of the University of Bath. A separate study, conducted in the summer of 2021, found that a fifth of participants continued to suffer from what the researchers called “Covid-19 Anxiety Syndrome” – a heightened state of worry, excessive symptom checking and avoidance of public spaces due to fears about contamination.

A diagnosis of anxiety is usually made by a GP, based on a patient’s symptoms and how long they’ve had them. In the case of GAD, diagnostic criteria include at least six months of excessive worry about everyday issues that is disproportionate to any inherent risk and causes distress or impairment to everyday life. Symptoms may include restlessness or nervousness, becoming easily fatigued, poor concentration, irritability, muscle tension or sleep disturbance – and tend to be present most of the time. However, anxiety is, in fact, a general umbrella term that that can describe a number of different anxiety disorders, including some less common conditions, such as phobias and panic disorders.

OCD

One group of anxiety disorders is characterised by repetitive thoughts or compulsions, of which obsessive-compulsive disorder (OCD) is probably the best known. About 1 in every 50 people suffer from OCD at some point in their lives, and unlike GAD, which is roughly twice as common in women as in men, OCD affects men and women equally. Those affected repeatedly experience unwelcome thoughts, images, urges, worries or doubts (obsessions) that can make them feel very anxious or uncomfortable. They also tend to engage in repetitive activities (compulsions) to reduce their anxiety, such as repeatedly checking medical symptoms on the internet, or whether a door is locked.

Health anxieties

Related to OCD are disorders where people experience obsessions and compulsions related to illness; or body dysmorphic disorder, with obsessions and compulsions related to their physical appearance.

Phobias

Phobias involving a person’s fear or anxiety being triggered by a particular situation or object, eg dogs, flying, clowns or injections. An estimated 10 million people in the UK have phobias. Simple phobias, such as a fear of heights or spiders, usually start during childhood, whereas complex phobias tend to start later in life. For instance, social phobia (also known as social anxiety disorder) often begins during puberty, and is associated with intense fear or worry in social situations – including before or after a social event has happened.

Agoraphobia, meanwhile, tends to first strike in a person’s late teens to early 20s, although complex phobias may continue for many years. Agoraphobia is more than just a fear of open spaces; those affected may feel anxious about being in places or situations that could be difficult to get out of, or where they may not be able to get help if they have a panic attack – a sudden episode of intense fear that triggers severe physical responses, and sometimes for no apparent reason.

Panic disorder

If someone regularly has panic attacks apparently out of the blue, without any obvious trigger, they may be diagnosed with panic disorder. It often coexists with agoraphobia, and in some cases, the fear of having a panic attack can itself trigger an attack. In the UK, the prevalence of panic disorder with or without agoraphobia is estimated to be 1.7%.

PTSD

There are many other types of anxiety disorders, but a final one of note is post-traumatic stress disorder (PTSD), which stands out because it strikes after experiencing or witnessing a traumatic event or serious injury. Roughly 50% of people will experience a trauma at some point in their lives, but only a fifth of them will go on to develop PTSD. Symptoms usually begin within three months of the traumatic event, but in some cases they begin years afterwards, and may include flashbacks or nightmares which can feel like you are reliving the fear and anxiety you experienced at the time. Like other anxiety disorders, PTSD can severely impair a person’s ability to function in social or family life, sometimes resulting in relationship problems or job instability.

The good news is that effective treatments exist for all of these anxiety disorders, so it is important to seek help.

Where to find help

If you think your anxiety, or that of a friend or family member, is becoming problematic, seek help by approaching a GP, who may be able to provide treatment and/or a referral to a therapist through the NHS. Private therapy is another option, although this can be expensive.

Various charities and community organisations run peer support groups, where individuals share their own experiences of anxiety and coping strategies in a supportive environment, including Mind, Anxiety UK and Rethink Mental Illness.

Mind 0300 123 3393

Anxiety UK 03444 775 774

No Panic 0300 772 9844

SANE UK 07984 967708

The UK Samaritans 116 123.

Severe OCD: Symptoms, Causes, and Treatment Options

Obsessive-compulsive disorder (OCD) is a mental health condition that causes a person to have persistent, recurring, intrusive, and often upsetting thoughts (obsessions), along with repetitive behaviors or mental acts (compulsions). These acts are performed in an attempt to reduce anxiety caused by the obsessions.

OCD has a lifetime prevalence of approximately 2.3% among adults in the United States. Up to half of adults with OCD experience serious impairment, known as severe OCD.

Read on to learn how OCD can cause intrusive symptoms that interfere with daily functioning and how these symptoms can be managed.

A person carefully aligns colored pencils on a table.

A person carefully aligns colored pencils on a table.

AntonioGuillem / Getty Images


Causes and Risk Factors of Severe OCD

OCD affects men and women equally. It can develop anytime from preschool to late in life, but begins most often during two peaks: between the ages of 9 to 11 and between the ages of 20 to 23. Up to 50% of cases have juvenile-onset, while less than 10% start after age 40.

Age of onset may play a role in severity. Early or middle childhood-onset has been associated with a better outcome and higher rate of spontaneous remission. Onset in adolescence or later in life may result in more persistent symptoms and course of the condition.

The exact cause of OCD isn’t known, but a number of factors that may play a role have been identified.

Genetics

While no specific genes for OCD have been identified, it appears to run in families, suggesting it has a genetic component.

Some research shows that if a parent has OCD, their child has a slightly increased risk of developing some forms of OCD (such as childhood-onset OCD).

Brain Activity

Brain studies have noted differences in the brains of people with and without OCD.

People with OCD show an overactive neural circuit between the prefrontal cortex (involved in cognitive behavior, executive decision making, and personality), and the nucleus accumbens (part of the reward system).

Imaging techniques, such as positron emission tomography (PET) and magnetic resonance imaging (MRI), are being used to study the brains of people with OCD to better understand how brain differences affect OCD.

Serotonin is neurotransmitter (chemical messenger in the brain) that has been associated with the development and maintenance of OCD. Medications that target serotonin levels can help reduce OCD symptoms.

Psychological Factors

OCD may be influenced by:

  • How a person interprets events and pays attention to information
  • Their beliefs about obsessions
  • Certain personality traits (such as perfectionism)

Life Experiences

Stress, such as marital problems, school exams, or a new baby, can increase symptoms for people with OCD.

Other conditions like depression or other emotional problems can also cause a worsening of symptoms.

Associated Conditions

Comorbidities (co-occurring conditions) are common in people with OCD. Studies show rates as high as 90% of people with OCD meeting the criteria for at least one other mental health condition in their lifetime.

Conditions seen alongside OCD include:

Many people with OCD also experience suicidal thoughts and actions.

Complications of OCD

OCD symptoms can be severe enough to greatly impact a person’s ability to function in daily life, such as attending school, being employed, sustaining relationships, and performing tasks such as running errands or self-care. In fact, worldwide, OCD is counted among the top 10 causes of disability.

About 20% of people with OCD have severely debilitating symptoms that can result in isolation (including staying in their homes), reduced quality of life, and economic hardship.

About 10% of people with OCD have severe symptoms that are resistant to all therapies, leading to great functional impairment.

Treatment for Severe OCD

Some research has found that prolonged treatment has lower relapse rates than short-term treatment, even after treatment is discontinued. This suggests that early intensive and long-term treatment may result in better outcomes for people with OCD.

There are several types of treatments available for OCD, which most commonly include medication and/or psychotherapy (talk therapy).

Medication

Medications that may be prescribed to treat OCD include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Prozac (fluoxetine)
  • Paxil (paroxetine)
  • Celexa (citalopram)
  • Luvox (fluvoxamine)
  • Zoloft (sertraline)
  • Lexapro (Escitalopram)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

  • Pristiq (desvenlafaxine)
  • Effexor (venlafaxine)
  • Cymbalta (duloxetine)

Tricyclic Antidepressants

  • Anafranil (Clomipramine)

These medications all target serotonin, and some also target the neurotransmitter norepinephrine. In some cases, such as if a person does not respond to serotonin-targeting medications, a combination of medications may be tried. For example, an SSRI antidepressant may be combined with a medication such as risperidone (also used to treat psychotic symptoms such as hallucinations and delusions).

Psychotherapy

Cognitive behavioral therapy (CBT) is the most common psychotherapy used to treat OCD. It helps with:

  • Controlling compulsive rituals/avoidance
  • Reducing the anxiety surrounding obsessions, ultimately reducing their intensity and frequency

CBT for OCD has two major components.

Behavior therapy and exposure and ritual prevention (ERP) involves:

  • Gradually increasing exposure to and confrontation of anxiety-inducing triggers, such as obsessions, while resisting the urge to use compulsive behaviors in response
  • Regularly repeating (up to two-hour-long sessions, at least four to five times a week) until the situation or experience no longer triggers distress

Cognitive therapy involves:

  • Helping a person with OCD learn to recognize their anxious beliefs about the meaning of their obsessions and substitute them with more realistic ones
  • Learning to recognize that their obsession doesn’t hurt anyone and does not have the power to, despite their anxious thoughts about it

Anxiety Management

A mindfulness-based program known as acceptance and commitment therapy (ACT) is emerging as a newer treatment for OCD. It’s less researched than CBT, but it is showing promise as a treatment used alongside CBT or for people who have not responded well to ERP.

Characteristics of ACT include:

  • Less focused on reducing intrusive thoughts (obsessions) and more focused on changing the way they are experienced
  • Distinguishes between thoughts, feelings, and actions
  • Believes thoughts, feelings, and bodily sensations are not under a person’s control, but how the person responds to them is
  • Aims to help a person with OCD experience anxious thoughts as neutral, letting them come and go without the need to respond, making them less intrusive

Residential Treatment

Increased intensity care may be needed for people with OCD who:

  • Have very severe symptoms
  • Have not responded effectively to less intensive treatments, such as medication and/or therapy
  • Are unable to have their needs met through typical treatment routes

Levels of therapy, from least to most intensive, include:

  • Traditional outpatient: Individual sessions with a therapist (generally 45 to 50-minute sessions, one or two times a week)
  • Intensive outpatient: May involve group sessions and one individual session per day, several days a week
  • Day program: Treatment sessions (typically group and individual therapy) are attended during the day (typically all day) at a mental health treatment center, up to five days a week
  • Partial hospitalization: Same as the day program, but treatment is received at a mental health hospital
  • Residential: Treatment is received while voluntarily living in an unlocked mental health treatment center or hospital
  • Inpatient: The highest level of care for a mental health condition, inpatient is used if a person poses harm to themselves or others or is unable to care for themselves. The person receives treatment in a locked unit in a mental health hospital (may be voluntary or involuntary).

Emerging Therapies

Research is being conducted on other ways to treat OCD, including some treatments that are beginning to be implemented. These treatments include:

  • Surgery: Involves a procedure known as deep brain stimulation (DBS), in which electrical leads are placed into specific areas of the brain and then connected to a neurostimulator (like a “pacemaker for the brain”). Surgery can also be used to create a lesion in the brain that interrupts the overactive circuit. Surgery is not a cure and is considered a last resort when other treatments have not been successful.
  • Electroconvulsive therapy (ECT): In ECT, controlled electrical currents are passed through the brain, inducing a controlled seizure. The person is under general anesthesia for the procedure (about five to 10 minutes). It may be suggested when first-line therapies have not been effective.

Summary

OCD is a mental health condition characterized by intrusive, recurrent thoughts (obsessions) and patterns of behaviors (compulsions) used to try to relieve anxiety caused by the obsessions. It is typically treated with medications, such as antidepressants, and psychotherapy, such as CBT.

Some people with OCD experience severe symptoms that cause debilitating disruptions to their level of functioning. More intensive treatments, such as programs within a mental health facility, may be needed for people with severe symptoms or who are unresponsive to conventional treatments. Emerging therapies that may be used as a “last resort” treatment for OCD include surgery and electroconvulsive therapy.

A Word From Verywell 

OCD can make it difficult to function in everyday life, particularly if symptoms are severe. If you are experiencing severe OCD symptoms, managing them may feel daunting. Fortunately, several effective treatment options exist for severe OCD symptoms, including ones that have shown promise in people who have not responded to typical treatment. Speak to a healthcare provider or mental health professional about what options may be right for you.

Frequently Asked Questions

  • Severe OCD is indicated based on the level of impairment the symptoms cause. Symptoms may be considered severe if they are causing significant disruption and distress.

  • There is no cure for OCD, but symptoms can wax and wane in severity over time, and many people go into remission from OCD. Evidence-based therapies can help manage symptoms and may promote OCD remission.

  • People with severe OCD that are not responding to other treatments may look for inpatient treatment, but untreated OCD does not mean hospitalization will be necessary. Inpatient care is considered a last resort.

Cluttered Consciousness: The Mental Effects of Growing Up With a Hoarder

Many of us are reluctant to throw things out.

We buy. We accumulate. We collect. Eventually our attics are packed with dusty heirlooms that we rarely, if ever, look at. Eventually we’re forced to pare down and head to the Goodwill.

But not all of us.



Andrew Guzick, PhD

Hoarding — or the prolonged difficulty of discarding unneeded possessions — is pervasive in our culture, affecting nearly 3% of the population. This compulsive collecting, and unwillingness to part with “stuff,” is even the subject of multiple popular television series.

We recently spoke with Andrew Guzick, PhD, an assistant professor of psychology at Baylor College of Medicine and an expert on anxiety disorders, about how growing up around hoarding behavior can affect future mental health and well-being.

How do you conceptualize hoarding behavior?

The core feature of hoarding is the inability to throw things away. This can be due to many different reasons, whether there’s a strong sentimental attachment or the belief that you will need these items one day. Compulsive buying is often involved, and inevitable clutter.

How was hoarding first conceptualized among psychiatrists and psychologists? And when did the term first enter the lexicon?

It was originally conceptualized as a difficult-to-treat subtype of obsessive-compulsive disorder (OCD). A lot of that work identifying this subgroup was going on in the late 1980s and early 1990s. There was a small but growing group of researchers demonstrating that this is fundamentally different from OCD in several ways.

In terms of the clinical presentation, the comorbidity patterns are different from those for OCD. And the course is a little bit different; we see a progressive development across the lifespan, as opposed to a clear-cut diagnosis earlier in life, as is typically seen with OCD. By the time a lot of people seek treatment, they’re often being brought in by, say, family members when they’re a little bit older. With hoarding, there is also this consistent pattern of poor treatment response across the board, whether to selective serotonin reuptake inhibitors (SSRIs) or behavioral therapy.

A lot of this work together led to advocacy for recognizing hoarding as an independent diagnosis in the DSM-5. I think official recognition by our “big book” prompted more attention to this population. Previously these patients probably would have been diagnosed with OCD, and it really isn’t appropriate to think of hoarding as purely an anxiety disorder.

Hoarding Exposure and Future Mental Health

You have a new study, published in the Annals of Clinical Psychiatry, looking at mental health among adult children of parents with hoarding problems. Can you tell us what inspired you to run this study, and what you found?

There were a couple of factors.

We’d seen a lot of folks with hoarding in OCD specialty clinics, so my clinical experiences with this population certainly drew me to this general area. But then, at the same time, I have this broad training in child mental health. And childhood trauma or adverse childhood experiences, which can include being around hoarding, can be a very difficult thing to live through and deal with. And here I have to give a lot of credit to Suzanne Chabaud, PhD, of the OCD Institute of Greater New Orleans, who’s one of the co-authors on the paper. She’s been beating the drum of thinking about the family and kids of people with hoarding disorders for years. My interests came from some of those experiences, but she had the good idea of really looking at this problem in a detailed way.

Prior to your paper, had there been research on the prevalence of mental illnesses such anxiety and depression in the children of people with hoarding behaviors?

That particular question was new to our paper. It was the first time anyone, to my knowledge, had looked at a validated assessment of anxiety and depression in this population.

How did you assess their symptoms and what did you find?

We asked study participants to think back on how they felt throughout their teenage years and gauged their responses with the patient health questionnaire (PHQ), a measure of mental health disorders. I should say upfront that we didn’t have a control group. But we found that among our 414 study participants, somewhere between 30% and 50% reported clinically significant anxiety or depressive symptoms, far higher than you’d expect in the normal population. So when looking back on how they were feeling as teenagers in that environment, they were struggling, and they often felt rejected by their parents.

We also found that almost 10% of participants were threatened with eviction at some point in their childhood; 15% had to live outside of their home at some point, due to the clutter; and 2% had involvement from child protective services and were removed from the home.

I know you recruited patients form online forums established by the children of hoarding parents. Presumably, these are the people most affected by this phenomenon. How does this play out in people who simply like to, say, collect something? Is this a continuum of behavior, with a breaking point at which it becomes a pathology?

I think it’s safe to conceptualize collecting and hoarding as a continuum, and you’ve got to draw a line somewhere in terms of clinical significance.

Did you assess whether the children of hoarders were more likely to hoard themselves as adults?

This is our follow-up paper; we haven’t looked at it yet.

But in looking at preliminary data, the prevalence seems pretty low, actually, at least in our sample. And as you mentioned, in our study there were folks who were seeking support specifically because they grew up in a really cluttered home.

Management

How do mental health providers typically address and treat hoarding?

To my knowledge, there are no current FDA-approved medications for hoarding, though psychiatrists will prescribe SSRIs and try to treat co-occurring problems such as depression and anxiety symptoms.

I can speak to cognitive-behavioral therapy (CBT) in a bit more detail. A number of randomized controlled trials support CBT for hoarding. I mentioned before that when we as a field treated hoarding akin to OCD and did exposure and response prevention therapy, we didn’t really target the specific features of hoarding. People didn’t do that well.

But now researchers are focusing on CBT interventions focused on discarding tasks that really address hoarding. You can create different categories for different items: Patients can either keep them, throw them out, or donate them. You can explore what thoughts or expectations are associated with these items and try to address them. Clinicians can help patients look at, say, different areas of their house and discuss what they might be willing to part with or at least think about parting with. You find their internal motivations for keeping things.

This sort of therapy generally takes longer than it does for, say, OCD. It can be a little bit slower, particularly if someone has a lot of stuff. And often it can involve doing home visits. In the age of Zoom this is a little bit easier because home visits aren’t always feasible.

What role does family play in managing hoarding? I imagine that including loved ones and friends in the process could be quite helpful.

Yes, absolutely. And social support, more broadly.

A colleague I worked with did a really interesting study where she looked at psychologist-delivered vs peer-delivered CBT for hoarding. They found that the biggest predictor of improved outcomes was having what they called a “clutter buddy,” which follows the Alcoholics Anonymous sponsor model. This would be somebody else struggling with the same problem who’s an accountability partner helping a patient follow through with their goals related to discarding. I think that finding underscores how important that social support is.

Any final thoughts for the Medscape audience of clinicians and researchers on how to approach hoarding?

I think there’s been a stigma — at least in psychology circles — that it’s not really treatable because of that earlier work with OCD. But on the CBT side, there’s now good reason to believe that people can live much happier lives and overcome this problem. CBT does seem to work for a lot of people with hoarding. That’s what I’d like to emphasize.

Multiple diagnoses are the norm with mental illness; new genetic study explains why

More than half of people diagnosed with one psychiatric disorder will be diagnosed with a second or third in their lifetime. About a third have four or more.

This can make treatment challenging and leave patients feeling unlucky and discouraged.

But a sweeping new analysis of 11 major psychiatric disorders offers new insight into why comorbidities are the norm, rather than the exception, when it comes to mental illness. The study, published this week in the journal Nature Genetics, found that while there is no gene or set of genes underlying risk for all of them, subsets of disorders—including bipolar disorder and schizophrenia; anorexia nervosa and obsessive-compulsive disorder; and major depression and anxiety—do share a common genetic architecture.

“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” said lead author Andrew Grotzinger, an assistant professor in the Department of Psychology and Neuroscience.

Andrew Grotzinger

Andrew Grotzinger

The finding could ultimately open the door to treatments that address multiple psychiatric disorders at once and help reshape the way diagnoses are given, he said.

“If you had a cold, you wouldn’t want to be diagnosed with coughing disorder, sneezing disorder and aching joints disorder,” Grotzinger said. “This study is a stepping stone toward creating a diagnostic manual that better maps on to what is actually happening biologically.”

How the study worked

For the study, Grotzinger and colleagues at University of Texas at Austin, Vrije Universiteit Amsterdam and other collaborating institutions analyzed publicly available genome-wide association (GWAS) data from hundreds of thousands of people who submitted genetic material to large-scale datasets, such as the UK Biobank, 23 and Me, IPsych, and the Psychiatric Genomics Consortium.

They looked at genes associated with 11 disorders, including: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder, Tourette syndrome, post-traumatic stress disorder, problematic alcohol use, ADHD and autism.

In addition, they looked at data gathered via wearable movement tracking devices, and survey data documenting physical and behavioral traits.

Then they applied novel statistical genetic methods to identify common patterns across disorders.

Linked diagnoses

They found 70% of the genetic signal associated with schizophrenia is also associated with bipolar disorder. That finding was surprising as, under current diagnostic guidelines, clinicians typically will not diagnose an individual with both.

They also found anorexia nervosa and obsessive-compulsive disorder have a strong, shared genetic architecture, and that people with a genetic predisposition to have a smaller body type or low BMI (body mass index), also tend to have a genetic predisposition to these disorders.

Not surprisingly, as the two diagnoses often go together, the study found a large genetic overlap between anxiety disorder and major depressive disorder.

When analyzing accelerometer data, the researchers found disorders that tend to cluster together also tend to share genes that influence how and when we move around during the day.

For instance, those with internalizing disorders, such as anxiety and depression, tend to have a genetic architecture associated with low movement throughout the day. Compulsive disorders (OCD, anorexia) tend to correlate with genes associated with higher movement throughout the day, and psychotic disorders (schizophrenia and bipolar disorder) tend to genetically correlate with excess movement in the early morning hours.

“When you think about it, it makes sense,” said Grotzinger, noting that depressed individuals often present as fatigued or low energy, while those with compulsive disorders can have difficulty sitting still.

In all, the study identifies 152 genetic variants shared across multiple disorders, including those already known to influence certain types of brain cells.

For instance, gene variants that influence excitatory and GABAergic brain neurons—which are involved in critical signaling pathways in the brain—appear to strongly underly the genetic signal that is shared across schizophrenia and bipolar disorder.

What’s next

While much more needs to be done to determine exactly what the identified genes do, Grotzinger sees the research as a first step toward developing therapies that can address multiple disorders with one treatment.

“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses and in some instances those medicines can have side effects,” he said. “By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions.”

Meantime, just understanding the genetics underlying their disorders may provide comfort to some.

“It’s important for people to know they didn’t just get a terrible roll of the dice in life—that they are not facing multiple different issues but rather one set of risk factors bleeding into them all.”

All about Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

Symptoms Obsession

Obsessions are usually extravagant versions of concerns and worries that most people have at some time. Common obsessions include:
• fear of contamination from germs, dirt, poisons, and other physical and environmental substances
• fear of harm from illness, accidents, or death that may occur to oneself or to others. This may include an excessive sense of responsibility for preventing this harm
• intrusive thoughts and images about sex, violence, accidents, and other issues
• excessive concern with symmetry, exactness, and orderliness
• excessive concerns about illness, religious issues, or morality

Symptoms of Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person’s distress related to an obsession. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Typical compulsions:

• Excessive or ritualized hand washing, showering, brushing teeth, or toileting
• Repeated cleaning of household objects
• Ordering or arranging things in a particular way
• Repeatedly checking locks, switches, or appliances
• Constantly seeking approval or reassurance
• Repeated counting to a certain number

Treatment

As for each person with OCD, every case is unique and has specific needs.
To determine if you have OCD, a mental health professional will consider several factors. First, your clinician will ask if you are experiencing any of the common obsessions and compulsions associated with OCD. The clinician will also want to know if your obsessions or compulsions are negatively affecting the way you function day-to-day.

Other factors your clinician will consider include other psychiatric conditions you might have, your family history, and any environmental, social, or physical problems you might be having that could contribute to your anxiety.
Working with an OCD specialist or someone well versed in the signs and symptoms of OCD is critical to obtaining a proper diagnosis. After receiving a diagnosis of OCD, you must have a care team that can help craft the proper treatment plan that works for you and your OCD, whether through talk/behavioural therapy, medication, or a combination of treatments.

Behavioral Therapy

Behavioral therapy involves a one-on-one relationship between a patient and a therapist. The most effective approach used to treat anxiety disorders and OCD is cognitive behavior therapy or CBT. The goal of CBT is to help the patient learn to think and behave differently when they experience fear or anxiety. CBT may also teach social skills. A clinician may recommend a specific type of CBT, depending on the diagnosis.

Exposure and Response Prevention

Many patients benefit from a specific type of CBT known as exposure and response prevention therapy, or ERP. This is often referred to as the gold-standard behavioural therapy approach for OCD.

This treatment, which is well supported by research, involves exposing the patient to triggers that cause their anxiety and teaching them to no longer respond to the exposure with rituals or compulsions. A specific treatment plan is created for each individual. ERP should be used with an OCD specialist.

Medication

Several different medications can be used to help relieve the symptoms of OCD. Medication is typically prescribed by a physician or psychiatrist. Examples of medications that may be used to treat OCD include beta-blockers, antidepressants, and anti-anxiety medications.

Stress Management

Research shows that self-care and relaxation techniques may help people with anxiety disorders like OCD to experience fewer symptoms. Examples of stress management techniques include regular exercise, yoga, meditation, and deep breathing. Getting plenty of sleep, focusing on nutrition, and limiting consumption of alcohol and caffeine are also recommended.

Self-help tips for people living with OCD

There are many ways that you can help yourself in addition to seeking therapy. Some suggestions are:
• Refocus your attention (like doing some exercise or playing a computer game). Being able to delay the urge to perform a compulsive behaviour is a positive step.
• Write down obsessive thoughts or worries. This can help identify how repetitive your obsessions are.
• Take care of yourself. Although stress doesn’t cause OCD, it can trigger the onset of obsessive and compulsive behaviour or make it worse. Try to practice relaxation (such as mindfulness meditation or deep breathing) techniques for at least 30 minutes a day.

OCD and Thoughts of Suicide: What Does It Mean?

Most people have random intrusive thoughts every now and again. But, if you have OCD, these tend to be persistent. It might be hard to let go of them, too.

With OCD, you might be so disturbed by an intrusive thought that you keep thinking about it. Thoughts, images, and urges can become increasingly persistent and disturbing. Persistent, disturbing thoughts are considered obsessions.

With OCD, those obsessions can take on different “themes.” This means you tend to have the same or very similar obsessions.

Common OCD themes include:

Suicidal OCD can be considered a kind of harm OCD.

Someone who has obsessions about ending their life doesn’t necessarily want to act on those thoughts. In fact, suicidal thoughts become an obsession because the person finds these thoughts so distressing they can’t stop thinking about them.

It’s not always easy to distinguish between suicidal ideation and suicidal obsessions. Discussing these images and thoughts with a mental health professional can help you understand them better and come up with ways to manage them.

What is pure-O OCD?

Pure-O OCD, or pure obsessional OCD, involves both formal symptoms of OCD: obsessions and compulsions.

Compulsions are rituals or repetitive actions that people with OCD do to relieve some of the distress obsessions cause. Compulsions might involve mental rituals, mentally repeating mantras, or self-reassurance.

In pure-O OCD, however, compulsions tend to be less obvious or less frequent, while obsessions are dominant.

Postpartum OCD: Symptoms, Causes, and Treatment

It’s normal for new parents to fret about the health and well-being of their baby. However, if these thoughts become intrusive (unwelcome and involuntary) and begin to affect your functioning, you may be suffering from postpartum obsessive-compulsive disorder (pOCD). 

In about 2.5% of women and some men, OCD symptoms can become worse during pregnancy or childbirth. When this happens, it’s called postpartum OCD or perinatal OCD. Luckily, treatments such as cognitive behavioral therapy can help. 

This article discusses postpartum OCD, including OCD symptoms, treatments, and how to help a loved one with this condition. 

Asian mother and baby.

Asian mother and baby.

rudi_suardi/Getty Images


What Is Postpartum OCD?

Postpartum OCD is an obsessive-compulsive disorder that emerges in the year after a person gives birth. OCD symptoms can also emerge during pregnancy. This is known as perinatal OCD. These conditions are treated similarly and are collectively known as pOCD.

Like OCD, pOCD is characterized by these two sets of symptoms:

  • Obsessions are intrusive thoughts, impulses, or beliefs that cause distress.
  • Compulsions are actions and rituals undertaken to try to control, prevent, or avoid obsessions.

Examples of Postpartum OCD

Understanding the symptoms of postpartum OCD can help you identify if you or a loved one is dealing with pOCD. Here’s what the symptoms might look like. 

Obsessive Thoughts

Obsessions can include:

  • Fear of accidentally harming your baby
  • Worry or obsession that someone else has harmed the baby
  • Intrusive thoughts about the baby dying
  • Intrusive thoughts about shaking, drowning, or harming the baby, even when this horrifies you 
  • Worry about the baby getting sick
  • Fear that you put the baby somewhere dangerous or forgot the baby 
  • Worry about SIDS (sudden infant death syndrome, the unexplained death of a seemingly health infant during sleep)

Although obsessive thoughts can be disturbing, research shows that they are normal, and mothers with pOCD are extremely unlikely to harm their infants.

Compulsions

In order to deal with obsessions, people with pOCD develop compulsions. These can include:

  • Checking on the baby excessively
  • Insisting on having another adult present when you’re with the baby
  • Not allowing others to watch or hold the baby
  • Avoiding activities like bathing, carrying the baby on stairs, or leaving the house
  • Handwashing and sanitizing in excess 
  • Not sleeping for fear of something happening to the baby

Other Symptoms of Postpartum OCD

While obsession and compulsions are the main symptom sets of OCD, they can lead to other symptoms. You may:

  • Feel depressed
  • Question your ability to parent
  • Hide your symptoms for fear that someone will take you away from the baby
  • Have trouble caring for or bonding with your infant
  • Experience distress in other relationships, like with your spouse

Postpartum OCD vs. Postpartum Anxiety

Postpartum and perinatal mood disorders can be difficult to tell apart because there is a lot of overlap with conditions like postpartum anxiety, depression, and OCD. Because of this, the medical community thinks that pOCD is likely underdiagnosed. 

Postpartum OCD differs from postpartum anxiety because it features both obsessions and compulsions. Still, OCD can cause anxiety, and anxiety can fuel OCD. It’s possible to have more than one postpartum mood disorder at once.

Whenever you’re experiencing symptoms of a mood disorder in the postpartum or perinatal period, it’s best to talk with an experienced health professional who can get you an accurate diagnosis. 

Causes and Risk Factors

Healthcare providers don’t know what causes postpartum and perinatal mood disorders, including postpartum OCD. It’s believed that hormonal changes and lack of sleep play a role. Postpartum OCD is most common in the birthing parent, but partners who did not give birth can also experience pOCD. 

People who have previously been diagnosed with a mood disorder are at higher risk for developing pOCD. Between 25% and 75% of people with OCD will have a recurrence after they give birth.

In addition, pOCD also occurs alongside other mood disorders. More than 70% of people with pOCD also experience depression and more than 27% also experience an anxiety disorder. If you’re getting treatment for postpartum depression or anxiety, but still experience symptoms of OCD, talk with your healthcare provider about whether you might also have postpartum OCD. 

Treatment for Postpartum OCD

Treatment for pOCD is similar to treatment for OCD. Cognitive behavioral therapy (CBT) is the first-line treatment for postpartum OCD. During CBT sessions, you’ll learn that intrusive thoughts are normal and not dangerous. This allows you to change how you interpret your thoughts, and eventually change or eliminate your compulsive behaviors. 

In addition, medications known as serotonin reuptake inhibitors (SSRIs) can help control symptoms of OCD. These are safe for most pregnant and breastfeeding people, although you should talk to your healthcare provider about your specific circumstances. 

It’s important to get help for postpartum OCD as soon as possible. Postpartum OCD often comes on suddenly and can be severe. Taking medication and attending therapy—even with your baby in tow— can help you feel healthy again.

Summary

Postpartum OCD is an obsessive-compulsive disorder that emerges or worsens in the first year after giving birth. It can also emerge during pregnancy, which is known as perinatal OCD. The condition is characterized by intrusive thoughts, such as worrying about the baby’s safety, and compulsions, like watching the baby sleep. Therapy and medication can both help control symptoms. 

A Word From Verywell

Many new parents anticipate that bringing home a baby is going to be a time of great joy. When you or your partner experiences postpartum mood disorders like postpartum OCD, it can be devastating. Remember that these conditions are normal complications of childbirth. Ask for help. Treatments are available that will have you feeling back to normal in no time. 

Frequently Asked Questions

  • It’s normal for new parents to experience some obsessive or intrusive thoughts. However, if these last longer than two weeks or interfere with your ability to care for your baby, they are considered postpartum OCD. It’s unclear how long postpartum OCD lasts, but it’s important to get treatment as soon as possible. 

  • Yes, postpartum OCD is related to postpartum depression. These two conditions can coexist and make each other worse. If you’re dealing with a postpartum mood disorder, talk to your healthcare provider about all your symptoms. 

  • Postpartum OCD is characterized by obsessions and compulsions. You might have intrusive thoughts of violence, like seeing yourself shaking the baby, but you know these are wrong. Postpartum psychosis is much rarer. It’s characterized by hallucinations and delusions, where you truly believe things that are false. For example, someone with postpartum psychosis might believe their baby is possessed and must be harmed.

  • The best way to help a loved one with postpartum OCD is to connect them with an experienced mental health professional. Assuring them that everything will be fine or downplaying their obsessions can actually make matters worse. Remember, postpartum OCD is a medical condition that requires medical treatment.

Real Event OCD: What It Is and How to Cope

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive thoughts (obsessions) and engages in specific actions (compulsions) to relieve anxiety caused by the obsessions. The compulsions are often unrelated to the nature of the obsession, and the adverse consequences are almost always imagined and irrational.

Unlike most manifestations of OCD, real event OCD centers around an actual event that occurred in the past, instead of imagined expectations of future events. While everyone experiences guilt or regret, people with real event OCD become fixated on an experience that makes them question their character or morals, engaging in thoughts and actions that seek to reassure themselves.

Read on to learn more about real event OCD and its treatments.

A woman sits with her head resting on her hand. She has a concerned expression on her face.

A woman sits with her head resting on her hand. She has a concerned expression on her face.

Jamie Grill / Getty Images


What Is Real Event OCD?

People with real event OCD (also called real-life OCD) become fixated on actual events or past experiences that caused them to question their morality, making them feel as though they aren’t a good person. They may replay the event over and over in their minds, analyzing all the details, and scrutinizing their role in it and any harm they may have caused through their actions.

They may worry about potential consequences of the event, such as losing a relationship with a loved one. They are also likely to take actions to reassure themselves, though this reassurance is short-lived.

The event can be something minor such as a rude remark to a customer service representative, something major like drinking and driving, or anything that makes them fear they are a bad person.

They may be focused on a recent event or something well in the past, such as an item they stole from a store as a child decades ago.

Trauma-Related OCD

OCD symptoms may also be triggered by real-life experiences, like trauma. Traumatic experiences can include abuse, neglect, or other disruptions to family life.

Examples and Signs of Real Event OCD

Real event OCD is made up of the following three components:

  • Event: What really happened
  • Obsession: Intrusive thoughts about what happened, often irrational or exaggerated
  • Compulsions: Actions taken to try to gain temporary reassurance

For example, a person with real event OCD might experience:

  • Event: You encouraged a school friend to try recreational drugs, which made them feel paranoid. Years later, they were diagnosed with schizophrenia.
  • Obsession: You become convinced the person’s schizophrenia was caused by the drugs and, therefore, it was your fault. You then believe that this makes you a bad person.
  • Compulsions: You research schizophrenia and its causes, ask others who were there when the person took the drug (and if they thought the person seemed reluctant to try it), replay the details of the event in your mind to see if you had pressured the person, and try to remember if you noticed any previous signs of mental health illness in the friend.

Common Obsessions

Real event OCD obsessions can arise from anything that causes the person concern about their moral character, such as whether they are a good person, or potential future fallout stemming from the event.

These obsessions may include:

  • Worrying they said or did something bigoted or offensive
  • Fearing they have acted inappropriately
  • Fearing consequences, such as punishment or being “cancelled,” or worrying about getting caught
  • Worrying their actions have caused others harm
  • Feeling they may have been critical, inauthentic, or unfair
  • Worrying their thoughts or actions make them a bad person
  • Having intense, overwhelming feelings of shame, guilt, or embarrassment

People with real event OCD tend to overestimate the importance of their actions. For example, they may ruminate regularly on a hurtful thing they said to a classmate in elementary school, worrying it caused them lasting harm, when their classmate doesn’t remember the incident.

If they can’t clearly remember every detail of the event, they are likely to assume something bad happened.

These obsessions cause anxiety that creates an urgent need to seek answers or reassurance.

Common Compulsions

A person with real event OCD will try to relieve the anxiety caused by their obsessions through compulsive actions. These might include:

  • Seeking punishment for their actions
  • Repeatedly going over past behaviors, looking for wrongdoings and evaluating their actions
  • Confessing or unnecessarily apologizing for their perceived wrongdoings (often after a long time has passed)
  • Seeking reassurance from friends and family either that they didn’t do anything bad or that they aren’t a bad person, sometimes using progressive hypothetical situations
  • Looking for ways to prove to themselves that they are a good person
  • Calling authority figures to inquire about potential consequences from past actions
  • Reimagining the event the way they would have liked it to go

The relief brought on by these compulsions is usually temporary. The intrusive thoughts seep back in, and the cycle begins again.

Treatment for Real Event OCD

First-line treatment for OCD is behavioral psychotherapy (talk therapy). Medication can be helpful for some people in combination with therapy.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) involves identifying problematic thought and behavior patterns and gradually changing them into healthy ones.

The main form of CBT used for OCD is exposure and response prevention (ERP).

Under the guidance of a mental health professional, people with OCD are exposed to their fears at gradually increasing intensities. For a person with real event OCD, this might mean:

  • Allowing intrusive thoughts to arise
  • Exposing themselves to things, such as music or images, that make them think of the event or experience
  • Writing stories or songs, or creating artwork about the event or the feared consequences of it
  • Visiting the location of the event
  • Engaging in actions that trigger the obsessive thoughts

During this exposure, the person is urged to resist doing any compulsions or actions to try to reduce the anxiety.

Over time and repeated exposures, the person builds an increased capacity to resist the compulsions and, ideally, the obsessions reduce.

Medication

Medication like antidepressants may be used to help manage symptoms, particularly along with therapy to strengthen the effectiveness of both treatments. Sometimes, other types of medications are used to increase the benefit of antidepressants.

Antidepressant medications that may be prescribed include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Prozac (fluoxetine)
  • Paxil (paroxetine)
  • Celexa (citalopram)
  • Luvox (fluvoxamine)
  • Zoloft (sertraline)
  • Lexapro (Escitalopram)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

  • Pristiq (desvenlafaxine)
  • Effexor (venlafaxine)
  • Cymbalta (duloxetine)

Tricyclic Antidepressant

  • Anafranil (clomipramine)

Mindfulness

Mindfulness involves allowing thoughts to come and go without assigning them judgment.

Acceptance and commitment therapy (ACT) is a type of psychotherapy that integrates aspects of mindfulness that can be used to teach people with OCD to accept their intrusive thoughts, rather than reacting or responding to them.

One of the goals of ACT is to separate the intrusive thoughts from the thinker, allowing them to be seen as separate entities and taking actions based on a person’s values, not their obsessions. This way, they can acknowledge the thought as an “OCD thought,” not as a fact.

Thoughts can also be reframed. For example, instead of thinking, “I am a horrible person,” they might think, “I feel bad that I did that.” Labeling the action—not the person—allows room for positive change.

From there, the person can take actionable steps to make the situation better now and/or avoid repeating the behavior in the future. This helps to move past the situation in a healthy, productive way, instead of being caught in an obsessive-compulsive cycle.

OCD Support Groups

Support groups are not a substitute for professional treatments like therapy, but they can be very valuable. Talking to others who understand your experiences firsthand is a great way to foster community, share resources, and offer and receive support.

The International OCD Foundation offers great information on how to find (or start) support groups.

Diet and Lifestyle Changes

OCD cannot be treated with lifestyle changes alone, but developing healthy habits is important for overall health and can be a great support for traditional treatments.

Healthy habits worth adopting include:

  • Eating nutritious foods
  • Moving your body regularly
  • Getting enough quality sleep
  • Practicing relaxation exercises, such as yoga, mindfulness, or meditation
  • Avoiding/limiting tobacco, caffeine, and alcohol
  • Following your treatment plan
  • Engaging in activities you enjoy
  • Fostering and maintaining positive relationships

Summary

Real event OCD is a form of OCD in which a person becomes consumed by thoughts and feelings of guilt about a real event that happened sometime in the past. These thoughts cause them to question their own morality. Compulsive actions follow in an effort to manage the anxiety triggered by the obsessions.

Real event OCD is typically treated with medication and/or behavioral therapy. Healthy lifestyle habits and mindfulness may also be beneficial.

A Word From Verywell 

Feeling a degree of guilt over an action that you believe caused harm is normal and can even be healthy. But if that guilt becomes consuming, is disproportionate to the actions, or you can’t seem to stop fixating on it, see a healthcare provider or mental health professional. They can help you find healthy ways to manage your feelings and move past the experience.

Obsessive-Compulsive Disorder Market: Rise in prevalence of people with OCD to drive the market

Albany NY, United States: Global Obsessive Compulsive Disorder Market: Overview

Obsessive-compulsive disorder (OCD) may be defined as an anxiety disorder that is characterized by unreasonable and uncontrollable thoughts and fears that lead an individual to perform repetitive behaviors. Obsessive-compulsive disorder compels a person to get stuck on a particular thought or fear. For example, a person afraid of contamination may wash his/her hands repetitively in an order to make sure his/her hands are clean. Likewise, a person may check a gas stove multiple times to be sure that it’s really turned off. Usually people affected with obsessive-compulsive disorder possess both obsessions as well as compulsions; however, in many cases individuals may have either obsessions or compulsions.

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Some common thoughts that usually pop up in mind of people with obsessive-compulsive disorder are fear of being contaminated by germs or dirt, excessive thinking about religious or moral ideas, superstitions, having things orderly or symmetrical, doubts that stove is turned off and thoughts of hurting oneself or others. These thoughts cause people with obsessive-compulsive disorder to perform actions like repeatedly checking of things such as locks and switches; repeatedly reciting certain words with intent to reduce anxiety, ordering or arranging things and accumulating wastes like newspaper, wine bottles or empty food containers. The exact causes of OCD are not known, however, some possible reasons may include differences in brain structure and genetic factors.

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The treatment involves psychotherapy as well as medication. Cognitive behavior therapy (CBT) is a specific type of psychotherapy that has been useful in treating people with OCD. Cognitive behavior therapy (CBT) teaches a person multiple ways of thinking, reacting and handling a particular situation. Most commonly used medications for treating OCD include antidepressants and anti-anxiety medications. A child suffering from PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is prescribed antibiotics for treating strep infections and SSRI medicines (citalopram, escitalopram, fluoxetine, sertraline and paroxetine).

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Global Obsessive Compulsive Disorder Market: Trends

The market for obsessive-compulsive disorder (OCD) is expected to grow globally under the influence of high prevalence of OCD and life style changes causing changes in thinking processes. According to International OCD Foundation, approximately 2-3 million adults are living with OCD in the United States. The International OCD Foundation also states that nearly 500,000 American children have OCD. A large number of cases of OCD go unreported as many people are not aware that there is any such specific disease. Also, many people hide their illness in order to avoid embarrassment.

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Global Obsessive Compulsive Disorder Market: Regional Outlook

Geographically, the market for obsessive-compulsive disorder (OCD) has been segmented into North America, Europe, Asia-Pacific and Rest of the World (RoW). North America was the largest regional market in 2013, followed by Europe, Asia-Pacific and Rest of the World (RoW). One of the major factors responsible for North America’s leading position in this particular market is well established health coverage in the region and high level of awareness regarding the illness. In Asia-Pacific and Rest of the World (RoW) regions, the market is expected to grow in coming future owing rise in prevalence of people with OCD and increasing wareness regarding the disease. Japan, China, India, Australia and New Zealand are the most potential markets in the Asia-Pacific region.

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Global Obsessive Compulsive Disorder Market: Key Players

Some major companies and research institutions that are extensively engaged in the development, manufacturing and marketing of OCD drugs include Abbott Laboratories, Pfizer Ltd., Merck Co., Sanofi, Novartis AG, University of South Florida, Ortho-McNeil Janssen Scientific Affairs, LLC and Indiana University.

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What is driving anxiety? Causes, symptoms, and treatment

For some people, driving anxiety may result from being in a road accident or witnessing one. However, according to the Anxiety and Depression Association of America (ADAA), most driving phobias are not related to an experience with an accident.

Below are some common fears and causes of anxiety about driving.

Past negative experiences

A person may remember past negative experiences they have had in a vehicle and worry that a similar scenario will play out again. Examples include:

  • driving through bad weather, such as a storm, snow, or fog
  • being a victim of road rage
  • having a panic attack while driving
  • getting lost

Existing anxiety disorders

People who have an anxiety disorder may experience symptoms while driving. For example, GAD may cause someone to have difficulty concentrating or making decisions while driving. This may lead to a person losing confidence in their driving ability.

Additionally, someone who is experiencing significant stress or life changes may be susceptible to driving anxiety.

Driving alone in an unfamiliar place

Some people may fear getting lost while driving, breaking down, or running out of gas. They may worry that their phone will have no signal, and they will not be able to get help if they need it.

Additionally, people may feel unsafe driving alone at night or worry that they cannot see potential hazards clearly when it is dark outside.

Fear of dying in an accident

Fear may cause a person to consider worst-case scenarios and not trust their own or other drivers’ abilities.

Even though someone may not have directly experienced a car accident, their imagination may make them feel anxious about the possibility of dying in an accident.

Being trapped and having a panic attack

People with existing anxiety about being trapped, such as claustrophobia, may become anxious while stationary in traffic. Additionally, people who have had a previous panic attack may fear that they will have one again while driving.

Losing control of the vehicle

Physical symptoms of anxiety, such as a racing heartbeat and sweating, may lead someone to believe they will lose control of their car and cause an accident. A person may feel highly stressed and uncomfortable, clutching at the wheel and worrying about what other drivers might be thinking.