Hoarding Disorder

Hoarding Disorder involves persistent difficulty discarding or parting with possessions, regardless of their actual value. Individuals may feel a strong emotional attachment to items or fear that something bad will happen if they throw things away.

Common Signs:

• Rooms becoming cluttered or unusable
• Difficulty organizing or cleaning
• Distress when asked to discard items

Body-Focused Repetitive Behaviors (BFRBs)

Body-Focused Repetitive Behaviors (BFRBs) are repetitive, hard-to-control behaviors directed at the body, often used to relieve tension, manage uncomfortable sensations, or cope with stress. These behaviors are not simply “bad habits”—they can cause significant distress and physical impact, and often require specialized treatment.

Trichotillomania (Hair Pulling)

Trichotillomania involves recurrent pulling out of one’s hair, which can lead to noticeable hair loss on the scalp, eyebrows, or eyelashes.

Common Signs:

• Bald spots or thinning hair
• Pulling that occurs during periods of stress, boredom, or even while relaxing (e.g., watching TV)
• Attempts to hide hair loss

Many individuals experience a build-up of tension or urge before pulling, followed by a sense of relief, satisfaction, or temporary calm afterward. Some pulling is automatic (done without full awareness), while other times it is more intentional.

Excoriation (Skin Picking Disorder)

Excoriation Disorder involves repeated picking at the skin, often leading to sores, scabbing, or skin damage.

Common signs include:

• Picking at the face, arms, or other areas of the body
• Difficulty stopping despite attempts to do so
• Visible marks, scars, or infections

Similar to hair pulling, individuals may feel tension, anxiety, or a sensory urge before picking, followed by temporary relief or satisfaction afterward. Over time, the behavior can become difficult to control and may impact self-esteem and daily functioning.

Olfactory Reference Syndrome (ORS)

Olfactory Reference Syndrome (ORS) is a condition in which an individual has a persistent belief that they smell bad or are emitting an unpleasant odor, even though others do not notice any smell.

This mismatch between internal perception and external reality can lead to significant distress and anxiety.

Individuals with ORS may:

• Engage in excessive washing, grooming, or changing clothes
• Frequently seek reassurance from others
• Avoid social situations due to fear of embarrassment
• Misinterpret others’ behaviors (e.g., someone touching their nose) as confirmation of the odor

Although ORS shares similarities with OCD and Body Dysmorphic Disorder, it is a distinct condition that requires a tailored treatment approach.

Individualized Treatment for OCRDs

Effective treatment for obsessive-compulsive related disorders requires more than a one-size-fits-all approach. At Mid Island Psychology Associates, we tailor treatment to the specific diagnosis, symptom presentation, and functional impact on daily life.

We offer flexible, customized treatment options, including:

• In-person therapy sessions
• Virtual/telehealth treatment
• Home-based services when clinically appropriate
• Community-based exposure therapy (e.g., malls, schools, restaurants, public settings)
• Virtual reality–assisted exposure therapy for enhanced skill generalization
• Family-based treatment and parent training to support progress outside of sessions

Treatment intensity is also individualized. Some patients benefit from traditional once-weekly sessions, while others may require more structured support, including multiple sessions per week or intensive, multi-hour treatment blocks.

Family involvement is often a critical component of successful treatment, particularly for children and adolescents. Parent training and family-based interventions focus on reducing accommodation, improving responses to symptoms, and creating a consistent, supportive environment that reinforces therapeutic gains.

Our approach emphasizes evidence-based care, including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), with a strong focus on helping patients build skills that translate into real-world functioning.