Complexities in Obsessive Compulsive and Related Disorders

Obsessive-compulsive and related disorders (OCRDs) have received considerable attention over the past two decades, culminating with the inclusion of a new classification category of “Obsessive-Compulsive and Related Disorders” in the DSM-5. This group of conditions includes obsessive-compulsive disorder along with two newly minted conditions (hoarding disorder and excoriation disorder) and others previously classified as somatoform disorders (body dysmorphic disorder) and impulse control disorders (hair-pulling disorder). In addition, other conditions that are not discussed in the DSM-5 have received attention, such as misophonia and orthorexia nervosa. The implications for research on these conditions, as well as their relations with one another, are significant since their aggregation is based on putative central mechanisms with limited empirical support to date. Indeed, the past decades have seen a dramatic surge in research on OCRDs across several domains, including clinical phenomenology, assessment, and psychological therapies. With these issues in mind, this comprehensive text addresses recent advances in the field of OCRDs, highlighting psychosocial theoretical and intervention approaches. As researchers and clinicians will be increasingly focused on this topic in light of the changes to DSM-5, this book is a timely addition to the literature in guiding clinicians in advances in OCRDs that will impact their practice.

Advances in Treating Obsessive-Compulsive Related Disorders Other than OCD?

The most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders includes a new chapter on obsessive-compulsive and related disorders (OCRDs) that lists five main diagnoses: obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, excoriation disorder (skin-picking disorder; SPD), and trichotillomania (hair-pulling disorder; HPD). While the latter two conditions share some characteristics with OCD, there are also important differences. This chapter reviews the clinical characteristics of SPD and HPD, presents cognitive-behavioral models of these disorders, provides an overview of core cognitive-behavioral therapy interventions and treatment packages, and reviews recent advances in the use of technology in the treatment of these conditions. The understanding and treatment of SPD and HPD represents a promising area of research with the hope of improving the lives of those who struggle with these debilitating disorders.

Hair-Pulling Disorder

Trichotillomania (TTM) is characterized by the recurrent pulling of one’s hair, resulting in hair loss and significant distress or impairment. Traditional treatment has several limitations that may lead to non-response or relapse. Recent advances that aim to improve treatment include addressing the individual’s pulling patterns, negative or uncomfortable inner experiences that instigate and maintain pulling, or contextual variables that impact pulling. This chapter discusses theoretical models of TTM and developments in behavioral and pharmacological treatments. Habit reversal training (alone and enhanced with dialectical behavior therapy or acceptance and commitment therapy), the comprehensive behavioral model, and web-based treatment are evaluated. Pharmaceutical treatment options, including selective serotonin reuptake inhibitors, antipsychotics, naltrexone, and N-acetylcysteine, are discussed as methods of augmenting behavioral treatment. While considerable advancement has been made in recent years acknowledging the broad range of clinical features associated with TTM, future research must employ rigorous methods to investigate the outcomes of behavioral and pharmacological interventions across the complex patterns among hair pullers.

Tourette and Trichotillomania

This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.

Co-Occurrence of Trichotillomania and Polycystic Ovarian Syndrome: A Case Report

Trichotillomania (TTM) or hair pulling disorder is characterized by repetitive pulling of hair on the body whereas Polycystic Ovarian Syndrome (PCOS) is a metabolic-endocrine disorder, manifested by irregular menstrual cycle and clinical hyperandrogenism. Both disorders commonly occur in young females. TTM and PCOS may be related and share the same pathophysiology. We reported a case of a teenager with TTM and PCOS, which were triggered by stress. Neurobiological mechanism may explain the co-occurrences between TTM and PCOS. Further research in the neurobiology of TTM and PCOS may better explain the cooccurrences between the two disorders.