The Self in Obsessive-Compulsive-Related Disorders: Hoarding Disorder, Body Dysmorphic Disorder, and Trichotillomania

The document from 2016 examines the significance of self-concept in hoarding disorder, body dysmorphic disorder (BDD), and trichotillomania (TTM), suggesting that these conditions involve a strong identification with aspects of the self, such as possessions, appearance, or hair, which can lead to emotional distress and maladaptive behaviors. In hoarding disorder, individuals may form emotional attachments to items as part of their identity, influenced by self-concept issues, memory deficits, and a need for safety, often exacerbated by ADHD and negative urgency. Cognitive-behavioral therapy (CBT) is the primary treatment, aiming to restructure beliefs about possessions. BDD is characterized by a negative self-image based on physical appearance, leading to excessive self-focused attention and behaviors aimed at alleviating distress, with acceptance and commitment therapy (ACT) potentially beneficial. TTM involves hair-pulling that significantly affects body image and self-worth, with shame and negative self-evaluations playing a role in the disorder's severity. The document concludes that self-concept, shame, and emotion regulation are crucial across these disorders and should be a focus in future research and treatment.