When the Brain Gets Stuck in a Holding Pattern

OCD & Related Disorders

Obsessive-Compulsive Disorder

Commonly known as: OCD

OCD is one of the most misrepresented conditions in popular culture. It is frequently reduced to a quirk — someone who likes things tidy, or double-checks the stove before leaving. Real OCD is nothing like that. It is a relentless, exhausting cycle of intrusive thoughts and compulsive behaviors that can consume hours of a person's day and cause profound distress.

The obsessions in OCD are unwanted, intrusive thoughts, images, or urges that the person finds deeply disturbing — often involving harm, contamination, symmetry, religion, or sexuality. These thoughts are ego-dystonic, meaning they feel completely at odds with who the person is and what they value. A devoted parent tormented by intrusive thoughts about harming their child. A deeply religious person plagued by blasphemous images. A gentle person haunted by thoughts of violence.

Compulsions are the behaviors performed to neutralize the anxiety the obsessions create — checking, counting, washing, arranging, mental reviewing, seeking reassurance. They provide temporary relief, but they also reinforce the cycle. The more a person compels, the more the obsession returns. OCD is highly treatable with evidence-based behavioral therapy with an exceptional evidence base.

OCD & Related Disorders

Body Dysmorphic Disorder

Commonly known as: BDD

Body Dysmorphic Disorder involves a preoccupation with one or more perceived flaws in physical appearance — flaws that are either nonexistent or barely noticeable to others. The person is convinced something is wrong with how they look, and this conviction causes significant distress and consumes large amounts of time and mental energy.

Common areas of preoccupation include skin, nose, hair, weight, symmetry, and teeth — but any body part can become the focus. The person may spend hours examining themselves in mirrors, comparing themselves to others, seeking reassurance, or camouflaging the perceived flaw. No amount of reassurance provides lasting relief, because the problem is not in the mirror — it is in how the brain is processing what it sees.

BDD is associated with high levels of distress and functional impairment. Many people with BDD seek cosmetic procedures, which typically do not relieve the preoccupation and can sometimes worsen it. BDD responds well to evidence-based behavioral therapy as well as certain medications.

OCD & Related Disorders

Hoarding Disorder

More than clutter

Hoarding Disorder involves persistent difficulty discarding or parting with possessions, regardless of their actual value — leading to an accumulation of items that clutters living spaces and significantly impairs daily functioning. This is not laziness or disorganization. It is a genuine psychological condition with a specific profile of distress.

People with hoarding disorder experience strong urges to save items and significant distress when faced with discarding them. The reasons vary — fear of losing something important, a sense that items might be needed in the future, or a feeling of attachment or responsibility toward objects. The home often becomes unlivable — kitchens that can't be used, beds that can't be slept in, pathways that become impossible to navigate safely.

Hoarding disorder is distinct from collecting and is associated with significant shame, social isolation, and health and safety risks. It can be difficult to treat because many people with hoarding disorder do not recognize it as a problem, or feel ambivalent about changing. Specialized therapy approaches have shown promising results.

OCD & Related Disorders

Trichotillomania

Also known as: hair-pulling disorder

Trichotillomania involves recurrent, compulsive pulling of one's own hair — from the scalp, eyebrows, eyelashes, or other areas of the body — resulting in hair loss. It is not a bad habit. It is a body-focused repetitive behavior that shares features with OCD and can be deeply distressing and difficult to control.

Hair pulling often occurs in a semi-automatic state — while watching television, reading, or talking on the phone — without full conscious awareness. Other times it is more deliberate, preceded by tension or an urge that is relieved by the pulling. Shame is one of the most significant consequences — many people go to great lengths to conceal the hair loss, and the condition is widely underreported.

OCD & Related Disorders

Excoriation Disorder

Also known as: skin-picking disorder or dermatillomania

Excoriation Disorder involves recurrent, compulsive picking of one's own skin — resulting in lesions, scarring, and significant distress. Like trichotillomania, it is a body-focused repetitive behavior that can occur automatically or deliberately, and that many people feel profound shame about.

Picking may focus on areas of perceived imperfection — a pimple, a bump, a dry patch — or may occur on healthy skin. The urge can feel irresistible, and the temporary relief it provides reinforces the behavior despite the physical damage and distress it causes. Many people spend significant time each day picking, examining, or tending to the resulting wounds.

Excoriation disorder often co-occurs with OCD, anxiety disorders, and depression. It responds to behavioral approaches as well as certain medications. The first step for many people is simply learning that what they experience has a name — and that they are not alone.

Clinical Expertise

Why Dr. Fitzgerald González's expertise matters

51,000 hours of clinical and research experience across OCD spectrum presentations

Dr. Fitzgerald González has assessed and treated OCD and related conditions across the full range of clinical severity — including presentations complicated by co-occurring depression, anxiety disorders, trauma, and personality pathology. OCD in particular is one of the most frequently misdiagnosed conditions in clinical practice — mistaken for generalized anxiety, psychosis, or personality disorder depending on the content of the obsessions and the clinical experience of the evaluator.

Accurate diagnosis of OCD and related disorders requires distinguishing intrusive thoughts from delusions, compulsions from personality-driven rigidity, and body-focused repetitive behaviors from self-harm. These distinctions are not always straightforward — and getting them right determines whether the treatment that follows is evidence-based and targeted, or mismatched and ineffective.

The right diagnosis opens the door to treatment that actually works. OCD and related disorders have among the strongest evidence bases in all of psychiatry — but only when the correct condition has been identified.

Clinical Relevance

Why it matters for you

The right diagnosis changes everything that follows

If you have been in therapy that felt supportive but never quite broke the cycle — if your anxiety has been treated without anyone ever asking about intrusive thoughts or compulsive behaviors — there is a reasonable chance that OCD or a related condition has never been formally evaluated.

These conditions respond to specific, targeted treatment approaches. General anxiety treatment applied to OCD can sometimes make things worse. Accurate identification of what is actually driving the cycle is the foundation of treatment that produces real change.

An accurate diagnosis and evidence-based treatment changes everything.