OCD and Related Concerns
People with obsessive-compulsive disorder (OCD) experience both obsessions - unwanted, intrusive thoughts, images, or urges that cause distress or anxiety - and compulsions - behaviors or mental rituals that a person engages in in order to reduce their distress or anxiety. Common obsessions include fears of germs or getting a disease, fears of hurting someone or oneself, fears of doing something embarrassing or immoral, fears of forgetting to do something, and the need for symmetry or for things to be "just right." Common compulsions include excessive checking, washing or cleaning, arranging, repeating actions, saving things, and mental rituals such as counting, praying, reviewing. People with OCD often spend a great deal of time focusing on their obsessions and completing rituals/compulsions. OCD can interfere with an person’s ability to function at school, work, or home, and can interfere with family relationships and friendships. Some people with OCD can recognize that their obsessions or compulsions are not rational and are excessive, whereas others cannot. Some people refer to having "Pure O" OCD, which is where the person has obsessive thoughts and engages in mental compulsions or rituals that are not observable to others.
Trichotillomania, or hair-pulling disorder, is characterized by recurrent hair pulling that results in hair loss and emotional distress. Both trichotillomania and excoriation disorder as considered body-focused repetitive behaviors (BFRBs). A person with trichotillomania may pull their hair due to anxiety, stress, boredom, an urge, or out of habit. The location and severity of hair pulling is quite variable. Common locations for hair pulling include one's head, eyebrows, and eye lashes. The hair pulling can result in thinning hair or bald spots; people may be missing their entire eyelashes or eyebrows. There is a great deal of shame and embarrassment associated with the hair loss, and people with trichotillomania may try to cover up their thinning or missing hair (using hats, sunglasses, makeup, etc) or avoid social situations altogether.
Excoriation, or skin-picking, disorder (also called dermatillomania) is characterized by recurrent skin picking that results in skin lesions or tissue damage. People may pull, pick at, scratch, rub, scrape, dig into, or bit their skin. The target of one's skin picking may be cuticles, acne, scabs, calluses, bug bites, or otherwise healthy skin. Like hair pulling, those who engage in skin picking may do it because of anxiety, stress, boredom, an urge, out of habit, or because of sensations like a bump or coarseness, or noticing blemishes. It is often associated with a great deal of emotional distress, including shame or embarrassment, and people may try to mask their skin lesions or scars (using concealer or clothing to cover) or they may avoid public situations all together to avoid embarrassment.
While many people do not like some aspects of their appearance, those with BDD spend hours each day preoccupied by their perceived flaws. Any body part or body region may be a source of distress for someone dealing with BDD, but some commonly-focused on sources of distress include face, nose, skin, hair, muscle mass, chest, or stomach. Negative thoughts about one's looks can be overwhelming and cause very low self-esteem and severe emotional distress. Though others may tell someone that they look fine, someone with BDD will find this difficult to believe. BDD can be so severe that people avoid school, work, or any other social situations, leading to withdrawal and isolation. Individual with BDD also may engage in other behaviors to improve their flaws, such as seeking plastic surgery, using photo-editing apps to change their appearance, camouflaging one's flaws, checking in or avoiding mirrors, excessive grooming, and excessive exercising.
People with hoarding disorder have significant difficulty discarding or getting rid of things, regardless of their actual value. While many people may save objects, especially those with a sentimental value, people with hoarding disorder collect an excessive number of items to the point where it can interfere with their living space. While one may feel overwhelmed or embarrassed by their possessions, it may cause severe anxiety or distress to attempt to get rid of items or to decide where to keep things. Their inability or difficulty parting with possessions can cause people who hoard significant emotional distress, as well as problems within their relationships, as well as financial or health repercussions.
Though not a technical DSM-5 diagnosis, people with perfectionism can experience debilitating distress or anxiety. More and more children and teens struggle with perfectionism than in the past, and it is largely considered to be a maladaptive way of coping. People with perfectionism set unrealistically high standards for themselves - even when there is not pressure from others to do so. They may fear making the smallest of mistakes and may be excessively preoccupied with failure. In fact, anything less than perfect may be perceived as a failure. They often catastrophize, or think of the worst possible outcomes, even though those outcomes are very unlikely. People who display perfectionism believe that it will lead to success and high achievement, though it can actually hurt performance.