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Obsessive Compulsive Disorder (OCD) including Body Dysmorphic Disorder (BDD)

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, images, urges, or impulses that are interpreted as threating (obsessions). These lead to active and counterproductive attempts to reduce the thoughts and/or discharge the perceived responsibility associated with them (compulsions). Cognitive and behavioral approaches including exposure, response prevention, and behavioral experiments are effective treatments for OCD. This page also includes resources for body dysmorphic disorder (BDD). Read more

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43 of 43 resources

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy

Archived

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Worksheets

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Worksheets

Checking Certainty And Doubt

Psychologists have discovered interesting relationships between Checking, Certainty, And Doubt. This information handout contains an exercise helpful ... https://www.psychologytools.com/resource/checking-certainty-and-doubt

Information handouts

Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)

Individuals with body dysmorphic disorder (BDD) experience distress associated with their body image. The Cognitive Behavioral Model Of Body Dysmorphi ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-body-dysmorphic-disorder-bdd-veale-2004

Information handouts

Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)

Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-hebert-dugas-2019

Information handouts

Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Forrester, Richards, 1998)

The essential insight of the cognitive behavioral model of obsessive compulsive disorder (OCD) is that it is the client’s interpretation of the intr ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-obsessive-compulsive-disorder-ocd-salkovskis-forrester-richards-1998

Information handouts

Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Therapist Guide. Click on the fo ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-therapist-guide

Treatments That Work®

Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Workbook. Click on the following ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-workbook

Treatments That Work®

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty

Exercises

Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder: Therapist Guide

Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder comes in two volumes. This page is for the Therapist Guide. Click on the f ... https://www.psychologytools.com/resource/exposure-and-response-ritual-prevention-for-obsessive-compulsive-disorder-therapist-guide

Treatments That Work®

Exposure And Response Prevention

Exposure And Response Prevention (ERP, EX/RP) is an effective treatment for obsessive compulsive disorder (OCD). This CBT worksheet guides therapists ... https://www.psychologytools.com/resource/exposure-and-response-prevention

Exercises

Exposure Practice Form

Exposure is an effective treatment for many forms of anxiety. The Exposure Practice Form is a CBT worksheet which guides therapists and clients throug ... https://www.psychologytools.com/resource/exposure-practice-form

Exercises

Exposure Session Record

The Exposure Session Record is a tool for recording clients’ use of exposure. The worksheet guides clients to identify a specific fear they are will ... https://www.psychologytools.com/resource/exposure-session-record

Worksheets

Facing Your Fears And Phobias

The Facing Your Fears And Phobias guide is written for clients who struggle with fears or phobias. It provides comprehensive information about what fe ... https://www.psychologytools.com/resource/facing-your-fears-and-phobias

Guides

Fear Ladder

The Fear Ladder is a tool for exploring and ranking the contexts or situations in which a client experiences fear. It is designed to help the client a ... https://www.psychologytools.com/resource/fear-ladder

Worksheets

Habituation

The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ... https://www.psychologytools.com/resource/habituation

Information handouts

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty

Information handouts

Intrusion Record

What differentiates intrusive congitions in OCD is the meaning that clients with OCD attach to them. The Intrusion Record is a CBT worksheet for captu ... https://www.psychologytools.com/resource/intrusion-record

Worksheets

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record

Worksheets

Intrusive Thoughts Brain Metaphor

Intrusive thoughts are a common but sometimes distressing cognitive phenomenon. This information handout uses a simple metaphor to explain why we expe ... https://www.psychologytools.com/resource/intrusive-thoughts-brain-metaphor

Information handouts

Intrusive Thoughts Images And Impulses

Intrusive Thoughts, Images, And Impulses that are experienced as distressing are a feature of obsessive compulsive disorder (OCD). They are also a com ... https://www.psychologytools.com/resource/intrusive-thoughts-images-and-impulses

Exercises

Maximizing The Effectiveness Of Exposure Therapy

Despite its position as the leading treatment technique for anxiety disorders, not all clients respond to exposure therapy and some individuals relaps ... https://www.psychologytools.com/resource/maximizing-the-effectiveness-of-exposure-therapy

Information handouts

Obsessive Compulsive Disorder (OCD) Formulation

An important treatment implication of the cognitive behavioral model of OCD is that clinicians can work at the level of the meaning of the intrusion. ... https://www.psychologytools.com/resource/obsessive-compulsive-disorder-ocd-formulation

Worksheets

OCD Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). Clients will find ... https://www.psychologytools.com/resource/ocd-diary

Worksheets

OCD Hierarchy

Part of traditional CBT treatment for OCD is exposure to situations which trigger obsessions (classically accompanied by the prevention of the associa ... https://www.psychologytools.com/resource/ocd-hierarchy

Exercises

Recognizing Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) is characterized by obsessions (cognitive intrusions in the form of thoughts, urges, images, or impulses) and comp ... https://www.psychologytools.com/resource/recognizing-obsessive-compulsive-disorder-ocd

Information handouts

Self-Monitoring Record (Universal)

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/self-monitoring-record-universal

Worksheets

Theory A / Theory B

Human beings actively try to understand their world and what happens to them. However, these understanding can be inaccurate or unhelpful. Worse, unhe ... https://www.psychologytools.com/resource/theorya-theoryb

Worksheets

Theory A / Theory B (Archived)

NOTE: An improved version of this resource is available here: Theory A / Theory B . Older versions of a resource may be archived in the event that the ... https://www.psychologytools.com/resource/theorya-theoryb-edition-1

Archived

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Worksheets

Therapy Blueprint For OCD

A therapy blueprint represents the past (the problems, what maintained them), the present (the therapy itself, new knowledge learned and skills develo ... https://www.psychologytools.com/resource/therapy-blueprint-for-ocd

Worksheets

Thought Suppression And Intrusive Thoughts

Suppression is a common approach to unwanted thoughts, worriers, doubts, or urges. Unfortunately, there are good reasons why this strategy fails. This ... https://www.psychologytools.com/resource/thought-suppression-and-intrusive-thoughts

Information handouts

Treating Your OCD With Exposure And Response (Ritual) Prevention: Workbook

Exposure and Response (Ritual) Prevention for Obessssive-Compulsive Disorder comes in two volumes. This page is for the Client Workbook. Click on the ... https://www.psychologytools.com/resource/treating-your-ocd-with-exposure-and-response-ritual-prevention-workbook

Treatments That Work®

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record

Worksheets

Understanding Body Dysmorphic Disorder

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-body-dysmorphic-disorder

Guides

Understanding Obsessive Compulsive Disorder (OCD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are ... https://www.psychologytools.com/resource/understanding-obsessive-compulsive-disorder-ocd

Guides

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. In the 1960s, Aaron Beck identified several of these biases which were common in his d ... https://www.psychologytools.com/resource/unhelpful-thinking-styles

Information handouts

What Is Body Dysmorphic Disorder (BDD)?

Many people have concerns about how they look, but significant and persistent worry about one's appearance may be a sign of body dysmorphic disorder ( ... https://www.psychologytools.com/resource/what-is-body-dysmorphic-disorder-bdd

Information handouts

What Is Exposure Therapy?

Exposure is an effective evidence-based treatment for fear. This information handout describes the key principles of Exposure Therapy. Clients who are ... https://www.psychologytools.com/resource/what-is-exposure-therapy

Information handouts

What Keeps Body Dysmorphic Disorder (BDD) Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-body-dysmorphic-disorder-bdd-going

Information handouts

What Keeps Obsessive Compulsive Disorder (OCD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-obsessive-compulsive-disorder-ocd-going

Information handouts

Your Stone Age Brain

Your Stone Age Brain is an information handout which describes the freeze-flight-fight response: a set of evolutionary adaptations that increase the c ... https://www.psychologytools.com/resource/your-stone-age-brain

Information handouts

Assessment

OCD

Vancouver Obsessional Compulsive Inventory (VOCI) download archived copy
Yale Brown Obsessive Compulsive Scale – Second Edition (YBOCS-II) | Storch, E. A., Rasmussen, S.A., Price, L.H., Larson, M.J., Murphy, T.K., Goodman, W.K. | 2010
- Self Report Version link to the International OCD Foundation archived version of IOCDF.org
Obsessive Compulsive Inventory (OCI) download scoring grid
Relationship Obsessive Compulsive Inventory (ROCI) download archived copy
Partner Related Obsessive Compulsive Symptom Inventory download archived copy

BDD

Cosmetic Procedure Screening (COPS) ~~download~~ archived copy
Body Image Questionnaire (BIQ) ~~download~~ archived copy
Danesh, M, Beroukhim, K., Nguyen, C., Levin, E., & Koo, J. (2015). Body dysmorphic disorder screening tools for the dermatologist: A systematic review. Pract Dermatol, 2, 44-49. download archived copy

Intervention

Treatment guides

NICE guidelines for OCD and BDD (November 2005) download
Treatment of patients with OCD (APA guidelines, 2007) download
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) download archived copy
A psychological perspective on hoarding – DCP good practice guidelines download archived copy
Treatment manual for OCD download

Information handouts

OCD information booklet download archived copy
What you need to know about OCD download archived copy
OCD UK Support organisation for sufferers in the UK
Helpforhoarders.co.uk
Compulsive-hoarding.org has lots of information about hoarding
IntrusiveThoughts.org

Exercises, Worksheets & Workbooks

Self-help ERP exercises download archived copy
OCD identification and self-help download
Assessment and treatment of relationship-related OCD symptoms download archived copy

Self-Help Programmes

Caring less about your looks

The impact of appearance overconcern download archived copy
What keeps appearance concerns going download archived copy
Appearance focused attention download archived copy
Body checking and reassurance seeking download archived copy
Appearance altering behaviors download archived copy
Avoidance and safety behaviors download archived copy
Overvaluing appearance and self-management planning download archived copy

Overcoming body dysmorphia

Understanding body dysmorphic disorder (BDD) download
What keeps BDD going? download
Reducing appearance preoccupation download
Reducing checking and reassurance seeking download
Overcoming negative predictions, avoidance, and safety behaviours download
Adjusting appearance assumptions download
Self-managment planning download

Presentations

New directions in implementing exposure and response prevention: an inhibitory learning perspective – workshop presented by Jonathan Abramowitz in 2018 download archived copy
Cognitive Therapy for Contamination-Related OCD: ERP and Beyond – Workshop presented by Adam Radomsky in 2011 download archived copy
Interoceptive exposure: an underused weapon in the arsenal against obsessions and compulsions – workshop presented by Jonathan Abramowitz in 2018 download archived copy
Family affair: involving a partner or spouse in exposure and response prevention for OCD – workshop presented by Jonathan Abramowitz in 2018 download archived copy
A couple-based approach to CBT for BDD – workshop by Lillian Reuman and Jonathan Abramowitz in 2016 download archived copy
Body dysmorphic disorder | David Veale | 2017 download archived copy

What Is Obsessive Compulsive Disorder?

Signs and Symptoms of OCD

People with OCD experience obsessional thoughts, images, urges, and doubts. They often feel compelled to act or think in certain ways.

Obsessions are intrusive thoughts—thoughts that are unwanted and unacceptable, and which pop into our minds unbidden. Obsessions can be thoughts in the form of words, but also of images (pictures in our minds), urges or impulses, or feelings of doubt. Obsessive thoughts are experienced as unacceptable, disgusting, or senseless, and people with OCD find it hard not to pay attention to them. Examples of obsessions include:

thoughts such as ‘My hands have been contaminated with germs’ or ‘Perhaps I am a pedophile’
images of my family being murdered
doubts such as ‘Have I left the stove on?’
urges such as wanting to shout profanities

Compulsions follow from the way in which the individual interprets the intrusive thoughts. Compulsions are the reactions or mental actions that a person does in order to neutralize or ‘make safe’ following an obsession. People with OCD typically carry out compulsions in order to prevent a harm from happening for which they might be responsible, and/or to reduce any strong emotion which they feel. Exactly what someone with OCD may feel compelled to do will depend upon the meaning their intrusions have for them. Examples of compulsions might include:

carefully washing food after having an intrusive thought about germs;
calling family members to check they are OK after having an intrusive image about their deaths;
going back to the house to check after doubting whether the stove was turned off;
avoiding a public place after having an urge to shout profanities.

Prevalence of OCD

The lifetime prevalence rate of OCD in the United States is estimated to be 2.3% in adults (Kessler et al., 2005), and 1% to 2.3% in children and adolescents (Zohar, 1999).

Psychological Models and Theory of OCD

The cognitive behavioral theory of OCD proposes that when someone experiences an intrusive thought it is the appraisal—what they make of having the thought—that is most important (Salkovskis, Forrester, & Richards, 1998). Intrusive thoughts, even very unpleasant ones, are common and entirely normal. What seems to happen in OCD is that the fact of having intrusive thoughts is interpreted as being especially significant and, as a result, is especially anxiety-provoking. People with OCD are more likely to feel especially responsible for any potential harms and may feel especially strong emotion should they have intrusive thoughts about harm occurring. Compulsions are understood to be an active attempt to reduce harm. According to the cognitive model of OCD targets for intervention include:

understanding and addressing the meaning of the intrusions;
targeting compulsions and safety-seeking behaviors;
modifying attentional biases.

Evidence-Based Psychological Approaches for Working with OCD

Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment for OCD. Historically, CBT for OCD has involved the behavioral approach of exposure with response prevention (ERP). More cognitive approaches within CBT attempt to understand the patient’s appraisal of their intrusions and to find ways of exploring the validity and consequences of these appraisals.

Resources for Working with OCD

Psychology Tools resources available for working therapeutically with OCD may include:

psychological models of obsessive-compulsive disorder (OCD)
information handouts for obsessive-compulsive disorder (OCD)
exercises for obsessive-compulsive disorder (OCD)
CBT worksheets for obsessive-compulsive disorder (OCD)
self-help programs for obsessive-compulsive disorder (OCD)

References

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53–63.
Zohar, A. H. (1999). The epidemiology of obsessive-compulsive disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 8(3), 445–460.

Obsessive Compulsive Disorder (OCD) including Body Dysmorphic Disorder (BDD)

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OCD

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Treatment guides

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Exercises, Worksheets & Workbooks

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Caring less about your looks

Overcoming body dysmorphia

Presentations

Recommended Reading

OCD

BDD

What Is Obsessive Compulsive Disorder?

Signs and Symptoms of OCD

Prevalence of OCD

Psychological Models and Theory of OCD

Evidence-Based Psychological Approaches for Working with OCD

Resources for Working with OCD

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