Body Dysmorphic Disorder and Hoarding

Plus Frotteurism and Other Unusual Mental Health Disorders

Oct 27, 2009

Mental health conditions like depression or anxiety are familiar to most. But conditions like frotteurism, BDD and hoarding are among psychiatry`s more unusual diagnosis.

The DSM-IV is a diagnostic wonder tool for many psychiatrists. Not surprisingly, the book goes far beyond familiar mental health conditions like depression and anxiety disorders including pica and forms of self-harm.

Having an ever-growing in-pile, an eclectic collection of decades old shoes or drawers full of pens that don’t work is one thing. But if you’ve got whole rooms literally stuffed full of possessions, you may have a problem with cluttering or hoarding.

DSM-IV associates hoarding with Obsessive Compulsive Personality Disorder and defines it as an inability to discard worthless or worn-out things, though they have no sentimental value. But in the textbook Obsessive Compulsive Disorders, Practical Management (Third Edition 1998 – Harvard University Press), Dr. Randy Frost suggests that hoarders do develop a strong attachment to their possessions and also actively acquire them.

“For example,” writes Dr. Frost, “one of our study participants bought and kept more than 30 bottles of shampoo; if her hoard fell below that number, she felt compelled to buy more. Another participant had rooms full of 'gifts' that she had purchased over several decades. She did not know to whom she would give them, but they were 'good buys' that she couldn't pass up.”

Dr. Frost’s research suggests hoarding is more closely related to OCD – and it’s difficult to treat.

Case studies suggest hoarders respond to cognitive behavioural therapy when the notion of discarding items is gradually introduced and issues like perfectionism, need for control and fear of decision making are examined.

Body dysmorphic disorder (BDD) is a condition where sufferers, usually adolescents, spend hours a day worrying that perhaps their skin is scarred, their nose too big, their body too large or their hair is thinning. It’s often dismissed as simple youth and vanity. But researchers at Brown University’s Body Dysmorphic Disorder Centre in Providence Rhode Island, say BDD is anything but trivial.

People with BDD will shun social contact, miss school, avoid dating and even visit plastic surgeons as a result of their condition.

Marshall Robinson, a research assistant at the BDD Centre says the condition is often misdiagnosed – mistaken for other disorders like social phobia or agoraphobia.

“A lot of people do tend to treat it like subset of OCD,” says Robinson. “In fact, it has more in common with depression.”

The treatments that appear most effective are cognitive-behavioral therapy and promising medications include serotonin re-uptake inhibitors (SRIs) like Prozac and Zoloft.

Frotteurism is a sexual disorder (or paraphilia) where a person touches or rubs his genitalia against another, non-consenting person – or fantasizes about doing so. Typically, these acts happen in crowded places and are usually committed by 15 to 25 year old men.

“In a sense, it’s often a substitution for normal sexual activities,” says Dr. Paul Fedoroff, staff psychiatrist and head of the outpatient psycho-legal clinic at Toronto’s Clarke Institute. Federoff says sexually motivated frotteurism it’s what’s known as a courtship disorder, together with things like exhibitionism and voyeurism.

“Normally people meet, get to know each other, touch, kiss. Frotteurs skip steps or get fixated on the steps. Frotteurs are people who touch before they know the person.”

But Federoff adds that people with the disorder don’t always touch for sexual purposes – many are developmentally delayed and touch to understand their world.

Frotteurism is one of the easier paraphilias to treat (with behavioural therapy or medication), according to Federoff. And it tends to decline at later ages, partly because frotteurs develop real relationships and no longer need to act out for satisfaction.

The copyright of the article Body Dysmorphic Disorder and Hoarding in Personality/Anxiety/Mood Disorders is owned by Cindy McGlynn. Permission to republish Body Dysmorphic Disorder and Hoarding in print or online must be granted by the author in writing.