People with obsessive-compulsive (OC) related disorders experience repetitive and unwanted thoughts and/or actions that seem to take over their lives. Portland Psychotherapy has an expert team of therapists who specialize in treating OC related disorders such as obsessive compulsive disorder (OCD), trichotillomania (hair-pulling disorder), excoriation (skin-picking disorder), and hoarding disorder. We also provide low-fee services for OC related disorders for people with limited financial means or inadequate health insurance.
OC related disorders don’t tend to respond to traditional talk therapy and require a structured and individualized behavioral approach. Please contact using the form below if you’d like to discuss your options.
If you would like to learn more about OC related disorders or wonder whether you might need treatment, please see the information below about specific OC related disorders.
Obsessive Compulsive Disorder (OCD) is an often misunderstood problem, even among professional therapists. Many people associate OCD with being overly clean or orderly, but OCD can involve any number of themes, and some people with OCD are actually more disorganized as a result of struggling with OCD.
- Obsessions– persistent thoughts that the person experiences as intrusive and unwanted. They are very distressing, and often very disturbing to the individual.
- Compulsions or rituals – repetitive behaviors or mental acts performed in an attempt to get rid of or neutralize obsessive thoughts. Compulsions may include mental rituals (e.g., saying a particular phrase; counting; prayer), seeking reassurance from others, or exhaustive research (e.g., Internet) among other compulsions.
- Some forms of OCD don’t have clear obsessions – for example, people with “just right” OCD may be extremely bothered if objects appear out of place, but they cannot articulate a specific fear or consequence.
- People with OCD may or may not actually believe their obsessions – however, their obsessions are usually so distressing that they want to get rid of them and/or they may fear they cannot tolerate the distress associated with the obsessions.
Body Focused Repetitive Behaviors (BFRB) is a term for a number of problems that involve pulling, biting, picking, or scraping at one’s own hair, skin, or nails. People with BFRB’s are often extremely frustrated in their attempts to stop, and many do not realize that what they’re struggling with is a recognized condition.
- Hair pulling or trichotillomania – repeatedly pulling hairs at one or more sites on the body. Common sites include the scalp, eyelashes, or eyebrows. People with trichotillomania often pull so frequently they experience bald patches and hair thinning, and it is often a source of shame and embarrassment.
- Skin picking or excoriation – repeatedly picking at one or more sites on the body. The face is common and one of the greatest sources of embarrassment, but people pick at multiple places on the body. Often in the moment, the person believes he or she is engaged in grooming, but the end results is often bleeding or scarring. Some people require medical treatment from creating large, open sores or developing infections.
- Other BFRB’s – biting of the cheek, nails, skin around nails, lips.
- BFRB’s can destructive – often leading to cosmetic damage such as bleeding or scarring—sometimes infection.
Hoarding Disorder is characterized by the presence of (1) clutter that significantly affects use of one’s home, (2) difficulty discarding and/or excessive acquisition of objects, and (3) significant distress or problems in one’s life as a result of their hoarding behavior and/or clutter. Hoarding is often a chronic condition that does not improve without treatment.
- Treatment works, but many people are reluctant to seek it – there are a number of scientifically-validated approaches that can help a person who is hoarding – if they are willing to participate in treatment. Unfortunately, those who have hoarding disorder may often be reluctant to seek help for several reasons including:
- Shame, guilt, and embarrassment
- That they see acquiring items as rewarding, not problematic
- Discomfort caused by letting go of items
- Lack of insight into the problem
- Family members can lead the way – as the person who is hoarding often doesn’t fully appreciate their problems, it’s common for loved ones to seek help first. In this case, the therapist starts by working with the loved one, followed by engaging the person who is hoarding. This team approach (therapist, individual with hoarding disorder, loved ones) can often be successful in decreasing clutter and problematic hoarding behaviors.
- If your loved one suffers from hoarding disorder, feel free to contact us to find out more about our treatment and consultation services.
Treatment of OC Related Disorders
What we know about treating OC related disorders from years of research and experience is that effective treatment requires a structured, active approach. Simply talking about obsessions, compulsions, and and/or urges is unlikely to lead to improvements. Neither is talking about one’s past. In fact, one of the most common statements we hear from folks who call our clinic is: “I’ve tried talk therapy and it just wasn’t enough.” Instead, our therapists will act as coaches helping you develop new skills. Together, you will collaborate with your therapist to identify all the tricks of your OC related disorder, as well as develop skills that will loosen the tight grip it has on you.
Exposure and Response (or Ritual) Prevention
The treatment for OC related disorders with the greatest research support is called Exposure and Response (or Ritual) Prevention—or ERP for short. With ERP, the therapist and client collaboratively come up with exercises in which the client learns to confront feared and/or avoided situations (e.g., contaminated surfaces, urges to pick or pull, discarding possessions) without performing mental or physical actions that would normally subdue their distress. This process is done step-by-step: less scary situations or obsessions are approached first and gradually we work up to the hardest obsessions and compulsions. Our therapists guide you through these activities with compassion and may even confront situations alongside you in solidarity. Ultimately, by doing these exposures you will show your OC related disorder that you can do the things it tells you you cannot do. Nearly all of our clients share that this work is empowering, and often that it is easier than they anticipated once they get started.
Acceptance and Commitment Therapy
There’s also a newer treatment for OC related disorders based on a cognitive behavioral approach called Acceptance and Commitment Therapy (ACT, said as one word “act”). In ACT, treatment focuses more broadly on learning to how make space for uncomfortable inner experiences such as thoughts, feelings, and bodily sensations, and to take action towards what’s most important to us.
ACT-Enhanced ERP for OCD
Many of our clinicians have found it helpful to begin with 4-5 sessions of ACT before transitioning into ERP. ACT skills training provides people a means to practice mindfully observing obsessive thoughts, images, and/or urges and learning to experience discomfort rather than attempting to escape or avoid it. Developing this skill can be highly beneficial prior to engaging in more intense ERP work. There are a number of research studies that have found that even brief ACT interventions help people be more open to doing something uncomfortable (and helpful) such as ERP. Many clients who are very scared of ERP in the beginning of treatment are more open to it after a few sessions of ACT.
An additional benefit of beginning with ACT is that clients will develop skills for managing non-OC-related thoughts and feelings, and for living their lives as a whole. ACT is about learning to let go of the struggle inside ourselves and to take action towards meaningful directions. The goal is to take back your life from OC related disorders, live better, and do the things that are most important to you!
Individualized Assessment & Treatment Planning
While it is likely that treatment for your OC related disorder will involve ERP and/or ACT, your therapist’s approach will be tailored to your unique needs. At the beginning of treatment your therapist will ask you many questions (i.e., via interview and/or questionnaires) in order to identify an appropriate diagnosis and treatment goals. Therefore, based on your specific OC related issues, treatment may involve other research-based interventions (e.g., habit reversal training for BFRBs, organizational skills training for hoarding disorder). Equally importantly, your therapist will learn about your socio-cultural identities and contexts, help you understand your issue from an anti-oppressive lens, and collaborate with you to make sure that your treatment plan aligns with your cultural worldview.
It’s never too late to get help.
We’ve worked with people who were able to lead new lives after struggling with obsessive-compulsive and related disorders for decades. If you would like to see if one our therapists might be a good match, please call us at 503-281-4852 or contact us using the form below: