Conditions related to OCD

Doctors group a few conditions together with obsessive-compulsive disorder (OCD). They are called "obsessive-compulsive and related disorders." Each one involves a thought, urge or worry that keeps pulling a person back into the same repeated action.^1,7

This page covers three of them: body dysmorphic disorder, hair pulling disorder and skin picking disorder. They are more common than most people think. They often stay hidden because of shame. The good news is that each one has treatments that help.

How these conditions are like OCD

In OCD, a person has unwanted thoughts (obsessions) and does rituals (compulsions) to ease the fear. You can read more on our signs of OCD page. The related conditions share that same loop. A worry or an urge builds up. A repeated action brings short relief. Then the urge returns, often stronger.

Hoarding disorder is also in this family. It has its own page because it raises special safety issues.

The conditions differ in what drives them:

Many people have more than one of these, or have them along with OCD, anxiety or depression.^9,10

Body dysmorphic disorder (BDD)

BDD is more than not liking how you look. A person with BDD spends a lot of time each day worried about one or more "flaws." Other people see nothing wrong, or only a small difference.^1,2 The worry causes deep distress and gets in the way of work, friendships and daily life.²

Common areas of concern include the face (nose, skin, teeth, eyes, jaw), hair, body build and weight, and the breasts.² Some people worry that their body is too small or not muscular enough. Doctors call this muscle dysmorphia.¹

Signs of BDD

People with BDD often:²

• Check mirrors again and again, or avoid mirrors completely
• Hide the "flaw" with makeup, hats, clothing or posture
• Compare their looks with other people's
• Ask family over and over whether they look all right
• Spend a long time grooming, or pick at their skin to "fix" it
• Avoid bright light, photos, social events or going out
• Visit many doctors seeking cosmetic procedures

Insight varies a lot. Some people know their worry is overblown. Others are fully convinced the flaw is real and serious.¹ Poor insight is common.² Many people with BDD look for cosmetic treatment rather than mental health care.⁴

How common is BDD?

Studies find BDD in about 2 to 3 people out of every 100. That is roughly 1 in 50 people, or 5 to 10 million people in the U.S.³ In the general public, about 6 in 10 people with BDD are women.³ It is much more common among people seeking cosmetic care. About 1 in 7 people at cosmetic surgery clinics have it, and about 1 in 5 people seeking nose surgery.³

Why cosmetic treatment usually does not help

It makes sense that someone who hates a feature would want it changed. But studies of people with BDD who had surgery or other cosmetic procedures found that most did not feel better overall. Only about 2 in 100 had lasting relief from their BDD.⁴ Often the worry moved to a new body part, or got worse.⁴ For this reason, experts advise against cosmetic treatment as a fix for BDD.^1,4

BDD and suicide

BDD can be a very heavy burden. Nearly half of people with BDD have thoughts of suicide, and about 1 in 4 have made an attempt.¹ If someone you love has BDD, it is okay to ask them directly and kindly whether they are thinking about suicide. Our safety plan tool can help you plan together.

Hair pulling disorder (trichotillomania)

Trichotillomania (trick-oh-till-oh-MAY-nee-uh) is a strong, repeated urge to pull out your own hair. People pull from the scalp, eyebrows, eyelashes or other body hair. It can leave bald patches or thin areas.⁷ Many people feel tension before pulling and relief afterward.⁷ Some pull without noticing, for example while reading or watching TV. Others pull on purpose to ease a feeling.¹⁰

About 1 to 2 people in every 50 have this problem at some point in life.⁸ It often starts around ages 11 to 13.⁷ In children it affects boys and girls about equally. By adulthood, 8 or 9 out of 10 people who report it are women.⁸

Some people chew or swallow the hair. This can form a hair ball that blocks the gut, which needs medical care.⁷ People with hair pulling often also feel sad, anxious or bad about themselves.⁷

Skin picking disorder (excoriation)

Skin picking disorder means picking at your skin over and over until it causes sores or damage, and being unable to stop.⁸ People often pick at pimples, scabs, bumps or rough patches on the face, arms or hands.¹⁰ Like hair pulling, picking may happen automatically or in response to stress, boredom or tension.¹⁰

A large U.S. survey of more than 10,000 adults found that about 2 in 100 had skin picking disorder at the time. About 3 in 100 had it at some point in their lives.⁹ Many of them also had anxiety or depression.⁹ Picking can cause scars, skin color changes and open sores.⁸

Hair pulling, skin picking, nail biting and cheek biting are sometimes grouped as body-focused repetitive behaviors (BFRBs).⁸ Most people bite a nail or pick a scab now and then. It becomes a disorder when it causes harm, distress or problems in daily life.¹⁰

What treatment looks like

All three conditions can improve with the right help. A therapist trained in these specific problems makes a big difference.

If you already take medicine, talk with your doctor or pharmacist before changing anything.

To find a therapist, see How to find a therapist. Ask whether they treat BDD or BFRBs and use CBT, ERP or habit reversal. Peer support can also ease shame. See Support groups and peer support.

Things you can try today

These steps do not replace therapy, but they can help you start:

• Track it. Write down when the urge to check, pull or pick shows up, where you are and how you feel. Keeping track is part of habit reversal, and patterns point to triggers.¹¹
• Make it harder. For pulling or picking, try gloves, finger bandages, clothing that covers picking spots, or a fidget toy to keep your hands busy.¹¹
• Cut back on checking. Cover a mirror or set a time limit for grooming. Delay a ritual a few minutes longer each day. Our self-help for OCD page explains how.
• Ride out the urge. Urges rise and fall like a wave. Slow breathing, such as the cyclic sigh, or grounding can help you wait it out.

In later life

These conditions usually start in the teen years, but they do not always fade with age.^6,7 Some people live with BDD for decades, with flare-ups now and then.⁶ Normal aging, such as thinning hair, wrinkles or weight change, can feed old worries about appearance.⁶ Big life changes like retirement, illness or the loss of a spouse can also bring symptoms back.⁶

Older adults may feel embarrassed to talk about looks or habits, and may worry about seeming vain. Shame can keep them from getting help.⁶ Treatment can still help at any age.

If picking or scratching starts for the first time in later life, see a doctor first. Aging skin makes less oil, so dry, itchy skin is common.¹² Skin conditions, medicine side effects or memory changes can also play a part. If you care for someone with dementia who picks or pulls, a behavior diary can help you spot causes like discomfort or boredom. See our dementia section for more.

Helping someone you love

It is natural to want to reassure someone ("You look fine!") or to tell them to "just stop." But reassurance tends to feed BDD, and willpower alone rarely stops pulling or picking. A calmer approach is to show that you care, notice the distress, and encourage expert help. Our page on helping a family member with OCD explains how to step back from reassurance kindly.

When to get help

See a doctor or mental health professional if:

• Worry about your looks takes up an hour or more a day, or keeps you from going out, working or seeing people
• Pulling or picking leaves bald patches, sores or scars, or you cannot stop
• A sore looks red, swollen, warm or is getting worse
• You are thinking about cosmetic surgery to fix a feature others say looks fine

Is BDD the same as vanity?

No. Vanity is enjoying your looks. BDD is the opposite. It is a painful, often hidden belief that you look wrong, and it can take over a person's life.^1,2

Is BDD an eating disorder?

No, but they can overlap. Some people with BDD worry about weight or body shape. Doctors check whether an eating disorder better explains the worry. A person can have both.¹

Is hair pulling or skin picking a form of self-harm?

Usually not in the way people mean. Most people pull or pick to ease tension or out of habit, not to hurt themselves.^7,10 Still, it causes real harm and deserves care, not blame.

Can children have these conditions?

Yes. Hair pulling, skin picking and BDD often begin in childhood or the teen years.^6,7,8 When hair pulling starts before age 6, it may go away on its own.⁷ Talk with your child's doctor if it lasts or causes distress.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.