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Body Dysmorphic Disorder, Hypochondriasis, Hoarding, and other OCD Spectrum Disorders; Comparing and Contrasting Treatments with OCD Fugen Neziroglu Ph.D., ABBP, ABPP    Bio-Behavioral Institute   Great Neck, NY www.biobehavioralinstitute.com
Obsessive Compulsive Spectrum Disorders ,[object Object],[object Object],[object Object]
Obsessive Compulsive Spectrum Disorders
Obsessive-compulsive Spectrum Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Body Dysmorphic Disorder ,[object Object],[object Object],[object Object]
Prevalence ,[object Object],[object Object],[object Object],[object Object]
General Demographics For BDD ,[object Object],[object Object],[object Object],[object Object]
Comorbidity ,[object Object],[object Object],[object Object],[object Object],1 Hollander 1993;  2 Bienvenu et al. 2000;  3 Phillips, 1998
Adolescent Feelings Of  Ugliness vs. BDD ,[object Object],[object Object],[object Object]
Percentage of People with  Body Image Dissatisfaction Phillips (1996)
Normal Concerns vs. BDD ,[object Object],[object Object],[object Object]
Risk Factors for BDD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Is BDD a Problem of: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
How Do All These Aspects Interrelate? Based on genetically and/or ethologically transmitted need for symmetry or aestheticism, maladaptive beliefs and values are learned which influences information processing and perception.
Beliefs About Appearance   ,[object Object]
[object Object],[object Object],Beliefs About Appearance (Cont.)
Faulty Beliefs - Cognitive Distortion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Faulty Beliefs - Cognitive Distortion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Safety or Avoidance Behaviors in BDD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Safety or Avoidance  Behaviors in BDD (Cont.)
Avoidance Behaviors in BDD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Skin Picking and Hair Cutting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Compulsive Skin Picking   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Safety Behaviors in BDD ,[object Object],[object Object]
BDD vs. OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Example of Differentiating BDD From OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OVI in OCD ,[object Object],[object Object],[object Object]
OVI in BDD ,[object Object],[object Object]
OVI in BDD vs. OCD ,[object Object],[object Object],[object Object],[object Object]
Quality of Life ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quality of Life in OCD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Quality of Life in BDD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quality of Life BDD vs. OCD (cont) ,[object Object],[object Object],[object Object],[object Object]
Symptom Severity in  OCD & BDD Y-BOCS   obsessions  Y-BOCS  compulsions  OCD (n=61) M = 12.9 Severe BDD (n=53) M = 12.8 Severe OCD (n=61) M = 11.2 Severe BDD (n=53) M = 12.0 Severe
Overvalued Ideation Levels in BDD & OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],OVIS * * = p < .001
Quality of Life in BDD & OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],QOLI * * = p < .05
BDD: Severity of Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],Phillips KA et al. (2006), Compr Psychiatry 47(2):77-87
Frequency and Percentage of  Abuse in BDD and OCD Abuse Type BDD (N=50) OCD (N=50) Any Abuse 19 (38%) 7 (14%) Sexual 11 (22%) 3 (6%) Physical 7 (14%) 4 (8%) Emotional 14 (28%) 1 (2%) Neziroglu F, Khemlani-Patel, S & Yaryura-Tobias. (2006). Body Image 3: 189-193
Appropriate Treatments for BDD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Inappropriate Treatment for BDD ,[object Object],[object Object],[object Object]
CBT Working Model Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + CS UCS CR UCR Information Processing Bias Classical/Evaluative Conditioning Body Dysmorphic Disorder Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],[object Object],[object Object],[object Object],Biological Predisposition CBT Working Model (Cont.) Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],[object Object],[object Object],[object Object],[object Object],Biological Predisposition Operant Conditioning CBT Working Model (Cont.) Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],+ Biological Predisposition Operant Conditioning CBT Working Model (Cont.) Social Learning Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],CS Body part Words: (blemish, red)  + Biological Predisposition Operant Conditioning CBT Working Model (Cont.) Social Learning UCS Abuse Teasing Acne Puberty UCR Disgust Anxiety Shame  Depression CR Mood Biased Information Processing/ Relational Framing Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],[object Object],[object Object],[object Object],Operant Conditioning: Maintenance Of BDD Mood/CR Avoidance Behaviors Negative Reinforcement CBT Working Model (Cont.) Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
[object Object],[object Object],[object Object],[object Object],Operant Conditioning: Maintenance Of BDD Mood/CR Avoidance Behaviors Negative Reinforcement CBT Working Model (Cont.) Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920
CBT Working Model (Cont.) Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + Body Dysmorphic Disorder Neziroglu  et al. (2004), Psychiatr Ann 34(12):915-920 CS UCS CR UCR Information Processing Bias Classical Conditioning
Cognitive Therapy: Initial Strategies ,[object Object],[object Object],[object Object],[object Object]
Engagement   ,[object Object],[object Object],[object Object],OVI = overvalued ideation
Engagement (Cont.) ,[object Object],[object Object],[object Object]
Early Goals ,[object Object],[object Object],[object Object]
Cognitive Therapy:  Targeting BDD Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cognitive Therapy: Targeting  Values on Appearance ,[object Object],[object Object],[object Object],[object Object]
Pie Chart of Values Artistic  Achievement  30% Attractiveness  20% Family  15% Friendship 15% Money  10% Education  10% Neziroglu F, Khemlani-Patel S
CBT for BDD in Social Situations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
4 Ways To Challenge Beliefs for BDD ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
HYPOCHONDRIASIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Historical Conceptualization Of Hypochondria ,[object Object],[object Object],[object Object]
Hypochondria ,[object Object]
Cost of HC Per Year ,[object Object]
Phenomenology of HC ,[object Object]
HC Demographics ,[object Object],[object Object],[object Object],[object Object]
Common HC Symptoms Parts of the Body Affected ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common HC Symptoms Parts of the Body Affected (con’t) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differential Diagnosis of HC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reported Dissimilarities Between OCD & HC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OCD and HC Anxiety and Depression Scales
OCD and HC Obsessions and Compulsions DS-Disorder Specific
OCD and HC Body Sensations and Mobility p<.05;**p<.01
HC Obsessions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HC Compulsions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Modalities For HC ,[object Object],[object Object],[object Object],[object Object]
Kellner’s Reassurance Intervention ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Outcome Data ,[object Object],[object Object],[object Object],[object Object]
Cognitive Behavioral Model of Hypochondriasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Cognitive Therapy for Hypochondriasis ,[object Object]
COGNITIVE THERAPY FOCUS ,[object Object],[object Object],[object Object],[object Object],[object Object]
COGNITIVE RESTRUCTURING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ellis’ ABC Paradigm in the Treatment of OCD Applied to HC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cognitive Theories ,[object Object],[object Object],[object Object]
Cognitive Theories ,[object Object],[object Object],[object Object]
Common HC Belief Distortions ,[object Object],[object Object],[object Object]
Common HC Belief Distortions (Cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common HC Belief Distortions (Cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Common HC Belief Distortions (Cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Four Ways To Challenge Beliefs (Hypochondriasis) ,[object Object],[object Object],[object Object],[object Object]
Conclusions  (CT for HC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Conclusions about ERP vs. CT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hoarding ,[object Object],[object Object]
Hoarding: Additional Criteria ,[object Object],[object Object],[object Object]
Disorders with Hoarding Behavior ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence ,[object Object],[object Object],[object Object]
Possible Etiology of Hoarding ,[object Object],[object Object],[object Object],[object Object]
Co-morbidity in Compulsive Hoarding   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Model of Hoarding
Hoarding Cognitions: Normal Behavior vs. Disorder ,[object Object],[object Object],[object Object],[object Object]
Obsessional Thoughts in Hoarding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obsessional Thoughts in Hoarding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obsessional Thoughts in Hoarding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differences between Hoarding and OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hoarding vs. OCD: Obsessions ,[object Object],[object Object],[object Object],[object Object]
Hoarding vs. OCD:  Rituals and avoidance behaviors ,[object Object],[object Object],[object Object]
Hoarding vs. OCD:  Insight, distress & interference ,[object Object],[object Object],[object Object]
Hoarding vs. OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hoarding vs. OCD: Neuroanatmony ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Demographics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Y-BOCS ,[object Object],[object Object],[object Object]
Y-BOCS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Beck Anxiety Inventory ,[object Object],[object Object],[object Object]
Beck Depression Inventory ,[object Object],[object Object],[object Object]
Overvalued Ideas Scale ,[object Object],[object Object],[object Object]
Quality of Life Issues For Everyone ,[object Object],[object Object],[object Object],[object Object]
Lack of Functional Living Space ,[object Object],[object Object],[object Object],[object Object]
Unhealthy Living Conditions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Unsafe Living Conditions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Unsafe Conditions (Cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Additional Storage Is Not the Answer ,[object Object],[object Object],[object Object],[object Object]
Effects of Hoarding on Families ,[object Object],[object Object],[object Object],[object Object]
Getting Help ,[object Object],[object Object],[object Object],[object Object]
Treatment Steps for Family Members ,[object Object],[object Object],[object Object],[object Object],[object Object]
Applying the Intervention Technique ,[object Object],[object Object],[object Object],[object Object]
Before Intervention: The Kitchen
Before Intervention: The Kitchen
Before Intervention: The Kitchen
After Intervention: The Kitchen
Before Intervention: The Living Room
Before Intervention: The Living Room
After Intervention: The Living Room
Before Intervention: The Guest Room
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OCD Spectrum Disorders

  • 1. Body Dysmorphic Disorder, Hypochondriasis, Hoarding, and other OCD Spectrum Disorders; Comparing and Contrasting Treatments with OCD Fugen Neziroglu Ph.D., ABBP, ABPP Bio-Behavioral Institute Great Neck, NY www.biobehavioralinstitute.com
  • 2.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. Percentage of People with Body Image Dissatisfaction Phillips (1996)
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16. How Do All These Aspects Interrelate? Based on genetically and/or ethologically transmitted need for symmetry or aestheticism, maladaptive beliefs and values are learned which influences information processing and perception.
  • 17.
  • 18.
  • 19.
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  • 32.
  • 33.
  • 34.
  • 35.
  • 36. Symptom Severity in OCD & BDD Y-BOCS obsessions Y-BOCS compulsions OCD (n=61) M = 12.9 Severe BDD (n=53) M = 12.8 Severe OCD (n=61) M = 11.2 Severe BDD (n=53) M = 12.0 Severe
  • 37.
  • 38.
  • 39.
  • 40. Frequency and Percentage of Abuse in BDD and OCD Abuse Type BDD (N=50) OCD (N=50) Any Abuse 19 (38%) 7 (14%) Sexual 11 (22%) 3 (6%) Physical 7 (14%) 4 (8%) Emotional 14 (28%) 1 (2%) Neziroglu F, Khemlani-Patel, S & Yaryura-Tobias. (2006). Body Image 3: 189-193
  • 41.
  • 42.
  • 43. CBT Working Model Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + CS UCS CR UCR Information Processing Bias Classical/Evaluative Conditioning Body Dysmorphic Disorder Neziroglu et al. (2004), Psychiatr Ann 34(12):915-920
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50. CBT Working Model (Cont.) Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + Body Dysmorphic Disorder Neziroglu et al. (2004), Psychiatr Ann 34(12):915-920 CS UCS CR UCR Information Processing Bias Classical Conditioning
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57. Pie Chart of Values Artistic Achievement 30% Attractiveness 20% Family 15% Friendship 15% Money 10% Education 10% Neziroglu F, Khemlani-Patel S
  • 58.
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  • 60.  
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  • 62.
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  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71. OCD and HC Anxiety and Depression Scales
  • 72. OCD and HC Obsessions and Compulsions DS-Disorder Specific
  • 73. OCD and HC Body Sensations and Mobility p<.05;**p<.01
  • 74.
  • 75.
  • 76.
  • 77.
  • 78.
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  • 122.
  • 123.
  • 124.
  • 125.
  • 130. Before Intervention: The Living Room
  • 131. Before Intervention: The Living Room
  • 132. After Intervention: The Living Room
  • 135. Before Intervention: The Living Room
  • 136. After Intervention: The Guest Room

Editor's Notes

  1. Hollander D (1993): Introduction. In: Hollander E, editor. Obsessive-Compulsive Related Disorders . Washington, DC: American Psychiatric Press, 1-16 Hollander E, Neville D, Frenkel M, et al: Body dysmorphic disorder: diagnostic issues and related disorders. Psychosomatics 33: 156-165, 1992 Bienvenu OJ, Samuels JF, Riddle MA , et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000 Aug 15;48(4):287-93 Implications: many of same strategies, both for primary treatments and augmentation
  2. Classical Conditioning:Acquisition of BDD CS UCS UCR Body part abuse disgust teasing anxiety acne shame puberty depression
  3. Be aware of the agenda / goals of patient have they been sent by cosmetic surgeon or relative shut them up. Make the diagnosis - don’t say imagined defect- we try to give an alternative explanation for their symptoms with the CBT model. We emphasise the the role of selective attention and impossible ideals If depressed start on SSRI??