Obsessive-Compulsive & Related Disorders Clinic

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is characterized by two major elements that are related to each other: obsessions and compulsions.

Obsessions are intrusive and unwanted thoughts, images, or impulses that cause distress. Individuals with OCD view obsessions as inconsistent with their sense of self and the type of content they wish to have on their mind. For example, a common type of obsession involves taboo thoughts, such as unwanted and upsetting thoughts of stabbing a loved one. Another common example includes thoughts about getting dirty and contaminated and spreading dirtiness to others.

Common themes of obsessions include the following:

• Fear of physical or mental/emotional contamination
• Desire for symmetry and exactness
• Needing a “just right” feeling
• Fear of harming one’s self or others
• Concerns of sexual orientation or about having sexual thoughts
• Hoarding/saving obsessions
• Scrupulosity and being a good/moral person
• Preoccupation with physical health
• Having a strong preference or strong dislike of certain words, numbers, or colors.

OCD is also defined by compulsions (also called safety behaviors or rituals), which are repetitive behaviors that are aimed to “undo” or neutralize the obsessive thoughts and reduce distress from the obsessions. For example, if an individual with OCD has distress from an obsession about being dirty from touching a doorknob, they might wash their hands as a compulsion. Compulsions can be performed physical or mentally and can include the addition of behaviors (rituals) or subtraction of behaviors (avoidance and escape).

Common themes of compulsions include the following:

• Repeating behaviors (flipping light switches, touching and tapping)
• Lining up, straightening, fixing
• Excessive or ritualized washing, cleaning, and sanitizing one’s body or objects
• Attempting to “undo” a thought
• Excessive reassurance-seeking (asking others if something is okay or safe)
• Checking behaviors (making sure the stove is turned off, checking if the door is locked, making sure someone isn’t hurt)
• Excessive or ritualized praying, counting, mantras, and other verbalizations (this can be aloud or not aloud)
• Avoidance of triggering situations, places, people, or things.

Both obsessions and compulsions cause significant distress and functional impairment. They often require expert treatment.

What are obsessive-compulsive and related disorders (OCRDs)?

OCRDs are a family of conditions with common biological, psychological, and behavioral features and mechanisms, as well as shared genetics and treatment response. Although there is not a definitive list of OCRDs, common ones include obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, body-focused repetitive behaviors (e.g., skin picking and hair pulling), tics and Tourette’s disorder, obsessive-compulsive personality disorder, perfectionism, and illness anxiety disorder (formerly hypochondriasis). OCRDs also share many similarities with other families of conditions, such as anxiety disorders, autism spectrum disorder, impulse control disorders (e.g., gambling, addiction), and eating disorders.

What are body-focused repetitive behaviors (BFRBs)?

Trichotillomania (hair pulling disorder) and excoriation disorder (skin picking disorder or dermatillomania) are two types of BFRBs. Trichotillomania refers to the repetitive, uncontrollable pulling of hair from one’s body, and excoriation disorder is the recurrent, uncontrollable picking of one’s skin. Both disorders result in significant physical damage and emotional distress, as the behaviors are often difficult to curtail.

What is hoarding disorder?

Hoarding is characterized by a difficulty discarding one’s belongings—irrespective of their value—because of the distress from doing so and the perceived need to save them. For example, individuals with hoarding might save newspapers from decades ago, empty bottles, or other items others might consider of little worth. Much of the time, hoarding presents with too much acquiring behavior, such as buying new items or saving mail. The difficulty discarding (and, when present, acquiring behaviors) causes considerable clutter to the extent that areas of the home cannot be used for their intended function (e.g., using the kitchen to cook). Clutter and hoarding cause considerable distress and impairment to the individual with hoarding, loved ones, neighbors, and/or community members (e.g., emergency responders).

How are OCRDs treated at UChicago Medicine?

In the Obsessive-Compulsive and Related Disorders (OCRDs) Clinic, we provide evidence-based treatment for adolescents and adults with the full range of OCRDs. We offer medication consultation and management, as well as gold standard, empirically supported cognitive-behavioral interventions. This includes strategies such as exposure and response prevention for OCD, habit reversal training and other behavioral approaches for BFRBs and tics/Tourette’s disorder, and specific cognitive-behavioral therapy (CBT) protocols for hoarding disorder, body dysmorphic disorder, perfectionism, and other related conditions. We also complement gold-standard CBT protocols with other techniques as needed to address co-occurring conditions. Examples include stimulus control and situation selection strategies, contingency management, motivational interviewing, emotion regulation and distress tolerance skill development, social skills and assertion training, metacognitive and cognitive restructuring, acceptance-based strategies, and behavior activation.

During an initial evaluation, we aim to assess symptom presentation, treatment goals, and the level of treatment appropriate for each person. We offer treatment ranging from sessions once per week to daily, intensive treatment.

How do I learn more information about being treated through the OCRDs Clinic at UChicago Medicine?

We accept many insurances, including traditional Medicare and some Medicaid plans. If you’re interested in learning more about the services offered through the OCRDs Clinic at UChicago Medicine, or if you would like insurance verification, please contact the department’s intake office 773-702-3858.