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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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Problem

Therapy tool

Avoidance Hierarchy

Avoidance and safety-seeking behavior serves to maintain anxiety, and exposure to the fear stimuli/situation is an effective treatment for anxiety. Th ... https://www.psychologytools.com/resource/avoidance-hierarchy/

Exercise

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/

Worksheet

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/

Worksheet

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 Handout

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 Handout

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 Handout

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 Handout

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/

Exercise

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/

Exercise

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/

Exercise

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 Handout

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 Handout

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/

Worksheet

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/

Worksheet

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 Handout

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/

Exercise

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 Handout

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/

Worksheet

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/

Worksheet

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/

Exercise

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 Handout

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/

Worksheet

Theory A / Theory B (Edition 1)

“The most effective way of changing a misinterpretation … is to help the person come up with an alternative, less threatening interpretation o ... https://www.psychologytools.com/resource/theorya-theoryb-edition-1/

Worksheet

Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

Worksheet

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/

Worksheet

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 Handout

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/

Guide

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

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 Handout

What Keeps Obsessive Compulsive Disorder (OCD) Going?

Our “What Keeps Disorder Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Frien ... https://www.psychologytools.com/resource/what-keeps-obsessive-compulsive-disorder-ocd-going/

Information Handout

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 Handout

Assessment

OCD

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 Dermatol2, 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

Exercises, Worksheets & Workbooks

Self-Help Programmes

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

Recommended Reading

OCD

  • Clark, D. A., & Rhyno, S. (2005). Unwanted intrusive thoughts in nonclinical individuals. Intrusive thoughts in clinical disorders: Theory, research, and treatment, 1-29 download archived copy
  • Doron, G., & Derby, D. (2015). Assessment and treatment of relationship-related OCD symptoms (ROCD): a modular approach. Handbook of Obsessive-Compulsive Disorder across the Lifespan. Hoboken, NJ: Wiley (Forthcoming). download archived copy
  • Gillihan, S., Williams, M. T., Malcoun, E., Yadin, E., Foa, E. B. (2012) Common pitfalls in exposure and response prevention (EX/RP) for OCD. Journal of Obsessive-Compulsive and Related Disorders, 1, 251-257 download
  • Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793-802 download archived copy
  • Mataix-Cols, D., et al (2010). Hoarding disorder: A new diagnosis for DSM-V? Depression and Anxiety, 27, 556-572. download archived copy
  • Salkovskis, P. (1999). Psychological treatment of obsessive–compulsive disorder. Behaviour Research and Therapy, 37, S37-S52 download archived copy
  • Salkovskis, P. M. (2007). Psychological treatment of obsessive–compulsive disorder. Psychiatry6(6), 229-233 download  archived copy
  • Veale, D. (2007). Cognitive behavioural therapy for obsessive compulsive disorder. Advances in Psychiatric Treatment. 13, 438-446 download archived copy
  • Veale, D., Freeston, M., Krebs, G., Heyman, I., & Salkovskis, P. (2009). Risk assessment and management in obsessive–compulsive disorder. Advances in psychiatric treatment, 15(5), 332-343. download archived copy

BDD

  • Danesh, M., Beroukhim, K., Nguyen, C., Levin, E., & Koo, J. (2015). Body dysmorphic disorder screening tools for the dermatologist: A systematic review. Pract Dermatol2, 44-49.  download  archived copy
  • Krebs, G., de la Cruz, L. F., & Mataix-Cols, D. (2017). Recent advances in understanding and managing body dysmorphic disorder. Evidence-Based Mental Health, 20(3), 71-75.  download  archived copy
  • Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image ,1, 113-125 download archived copy
  • Veale, D. (2001). Cognitive-behavioural therapy for body dysmorphic disorder. Advances in Psychiatric Treatment, 7, 125-132 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.