OCD and body focused repetitive behaviors like trichotillomania are treatable


Obsessive compulsive disorder is defined by the National Institutes for Mental Health as “a common, chronic and long lasting disorder in which a person has uncontrollable, recurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over and that interferes with all aspects of life.”  The causes are unknown but there is research being conducted into the factors of genetics and brain chemicals that may be involved.

In all likelihood, if you are reading this you are concerned either about yourself or someone you care about.  The obsessive thoughts may be about germs, contamination, forbidden or frightening thoughts, aggressive thoughts or rigid, ordered thinking.  Perhaps you wash your hands before and after entering the shower or touching surfaces; maybe you triple and quadruple check to confirm the stove burners are turned off before leaving home; maybe you spend 30 minutes every morning and evening ordering the clothes hanging in closet so they are exactly one inch apart and not touching.  Such thoughts and behaviors definitely affect and possibly interfere with daily life.

Body focused repetitive behaviors (BFRBs) are very similar to OCD behaviors.  Pulling hair from the scalp, eyebrows or eyelashes is called trichotillomania and is a common habit disorder as is skin picking, cheek biting and chewing the fingernails and cuticles. One difference between OCD and a BFRB is when the compulsive act is performed. Obsessive thoughts create anxiety and compulsive acts are performed to relieve the anxiety.  You think your hands are dirty so you wash them to relieve that thought.  Most BFRBs, on the other hand, are performed during sedentary activities, absent mindedly, without a sense of relief, often to the point of body harm or disfigurement.  


Treatment for OCD and BFRBs is similar and consists of either or both SSRI medication and a special cognitive behavioral strategy called Exposure and Response Prevention (ERP).   ERP involves intentionally exposing yourself to the triggering situation and preventing yourself from doing the compulsive behavior that relieves the anxiety or fear.  For example, in the case of the clothes in the closet, intentionally placing clothes touching and standing there looking at them until the urge to touch has passed. This must be repeated over and over again without allowing the compulsive action to put distance between the hangers.  It is difficult to force yourself to do but is the most effective treatment.

It is important to be patient with the person who demonstrates OCD and BFRBs but is even more important not to enable their  behaviors.   You can support the person without supporting their behavior. 

Habit disorders are treatable and it requires commitment, diligence and courage on your part.  Are you ready?