Center for OCD and Related Disorders (CORD)

The Center for OCD and Related Disorders (CORD) at Massachusetts General Hospital specializes in the treatment and research of OCD and related disorders (OCRDs):

• OCD
• Body dysmorphic disorder (BDD)
• BDD by proxy
• Olfactory reference syndrome (ORS)
• Tourette syndrome (TS)
• Chronic tic disorder (CTD)
• Hoarding
• Hair pulling disorder
• Skin picking disorder

These disorders are commonly grouped together because they have some overlap in symptoms (repetitive thoughts or behaviors) and may share a common neurobiological and genetic basis. In addition, patients often have more than one of these disorders.

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The Center for OCD and Related Disorders was founded in 1980 by Michael Jenike, MD, and is now under the leadership of Sabine Wilhelm, PhD. Our team includes psychiatrists, psychologists and clinical research associates who are among the field’s most experienced and renowned clinicians and researchers. We provide state-of-the-art outpatient care for people with OCD and related disorders, including cognitive-behavioral therapy (i.e., exposure and response prevention and cognitive therapy) and medication treatment. We also provide one-time consultations, evaluations and follow-up care.

Disorders We Treat

Our center specializes in providing evidence-based treatment for people with OCRDs. We offer a variety of treatment options:

• Cognitive behavioral therapy (CBT)
• Medication management
• Clinical research studies

Obsessive-Compulsive Disorder (OCD)

OCD is a psychiatric illness characterized by persistent and intrusive obsessions and/or repetitive, time-consuming compulsions. These compulsions are performed repeatedly in an attempt to reduce the anxiety associated with an obsession or prevent a feared outcome.

Some common obsessions include:

• Fear of accidentally causing harm
• Concern with order, symmetry or exactness
• Violent or horrific images
• Sexually disturbing thoughts
• Frequent thoughts about particular sounds, images, words or numbers

Some common compulsions include:

• Excessive cleaning or washing (e.g., washing hands repeatedly, brushing teeth repeatedly or in a certain way)
• Checking (e.g., repeatedly checking if the stove is turned off or the door is locked)
• Arranging items in a particular fashion

OCD can develop at any age, though in most people symptoms begin before age 25.

Learn more about OCD services

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is characterized by a severe preoccupation with a perceived defect in one’s appearance. Any body part can be the focus of concern, but the most common are the face, hair and skin. Sufferers often describe themselves as hideous, deformed or ugly when they appear quite normal or even attractive to others. BDD usually begins in late childhood or early adolescence. It affects both men and women, regardless of age, ethnicity and cultural background.

Individuals with BDD often spend hours each day thinking about their appearance. In addition, most people with BDD engage in compulsive or ritualistic behaviors to reduce their distress or improve their appearance, such as:

• Frequently checking the mirror
• Going out of the way to avoid reflective surfaces
• Covering up the perceived defect with makeup or clothing
• Picking at slight imperfections in the skin
• Following a rigid grooming routine
• Seeking cosmetic surgery (often multiple times)

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Body Dysmorphic Disorder (BDD) by Proxy

Body Dysmorphic Disorder (BDD) by proxy is a form of BDD in which individuals are preoccupied with a slight or perceived defect in another person’s appearance and engage in compulsive behaviors to reduce their own distress or to improve the appearance of the person of concern. The person of concern may be a family member (e.g., spouse, child, parent or sibling), partner, friend or acquaintance. Individuals may be concerned with more than one person’s appearance. Concerns may include, but are not limited to, a daughter’s “crooked” nose, a father’s “short stature” or a significant other’s “thinning hair.”

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Olfactory Reference Syndrome

Olfactory reference syndrome (ORS) is characterized by excessive worry that one is emitting a foul or offensive body odor, although the odor is not perceived by others. Those who suffer from ORS may be preoccupied with “bad breath” or a fear that they smell like sweat, garbage, or rotting fish. Patients often experience significant distress and anxiety related to ORS and may feel a sense of responsibility for the perceived odor. Individuals with ORS often engage in time-consuming behaviors to mask the odor, including:

• Repetitive showering
• Frequent changing of clothes
• Excessive use of sprays or perfumes
• Avoiding public and social situations

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Tourette Syndrome & Chronic Tic Disorder

Tourette Syndrome (Gilles de la Tourette Syndrome or TS) is a neurological disorder characterized by multiple motor tics and at least one vocal tic, though both types of tics do not necessarily need to be present at the same time.

A tic is a sudden, rapid, repetitive, involuntary muscle movement (motor tic) or vocalization (vocal tic).

Tics may be “simple”:

• Eye blinking
• Neck or shoulder jerking
• Sniffing, grunting, barking or chirping
• Or tics may be complex:
• Arm flapping
• Facial grimacing
• Coprolalia (the involuntary uttering of obscene words or phrases)
• Palilalia (involuntary repetition of one’s own words)
• Echolalia (involuntary repetition of another person’s words or phrases).

Tic disorders are categorized according to age of onset, severity, duration of symptoms, and presence of vocal and motor tics, though distinguishing between different tic disorders can be difficult.

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Hoarding

Hoarding is a psychiatric illness characterized by an excessive collection of objects/clutter, an inability to discard objects and impairment and/or distress. Difficulty organizing items is also a common symptom of hoarding. Research suggests that the disorganization is in part caused by neurological impairment associated with information processing, memory, categorization and decision-making. Further research is needed to better understand hoarding etiology.

Many people with hoarding also suffer from Obsessive-compulsive Disorder (OCD) which is why it falls under the umbrella of OC-spectrum disorders. In fact, approximately 25% of individuals with OCD also exhibit hoarding compulsions. The relationship between the two disorders is not entirely clear and typical OCD treatments do not always improve hoarding symptoms.

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Trichotillomania (Hair-pulling Disorder)

Trichotillomania, also known as “hair pulling disorder”, is characterized by repeated pulling of one’s hair for non-cosmetic reasons, most often involving hair on the scalp, eyelashes, eyebrows, beard or pubic area. Trichotillomania can start at any age, but typically symptoms begin in early adolescence.

The Trichotillomania Clinic and Research Unit was founded more than 20 years ago and is directed by Nancy Keuthen, PhD. It is one of a few clinics in the world that offers specialized treatment for trichotillomania and other body-focused repetitive behavioral disorders. Our faculty offer both cognitive behavioral treatment and medication management approaches reflecting the latest advances in treatment outcome studies. Research conducted by staff has contributed significantly to our understanding of these disorders.

Learn more about trichotillomania services

Excoriation (Skin-picking Disorder)

Excoriation, also known as skin-picking disorder (SPD), is distinguished by the recurrent picking of one’s skin that causes noticeable skin damage. Individuals often pick from a variety of body areas, but the most common are the face, arms and hands. Most skin picking is done by hand, but it is not uncommon to use tools like as tweezers or pins. People with SPD often spend at least an hour per day (and sometimes several hours) picking their skin, thinking about their skin picking and resisting the urge to pick. Another important feature of SPD is the distress and impairment that these skin-picking behaviors cause.

Learn more about SPD services

Pediatric Services

The Pediatric Psychiatry Obsessive-Compulsive Disorder (OCD) and Tic Disorders Program is a specialized program within the OCD and Related Disorders Program that provides evaluation and, when deemed appropriate, pharmacological treatment options for children and adolescents with obsessive-compulsive disorder, tic disorders and associated co-occurring conditions, including hair-pulling and skin picking disorders, anxiety disorders and ADHD. We often see patients that have meet criteria for and/or have symptoms in multiple domains within the spectrum of obsessive-compulsive orders.

This program, originally founded in 1992 by Daniel Geller, MD, and Barbara Coffey, MD, MS, has been formally rejuvenated under the leadership of Erica Greenberg, MD. Dr. Geller continues as the program’s director of research.

What We Do

The Pediatric OCD and Tic Disorders Program provides consultation, evaluation and ongoing clinical medication management for young patients. Our practice focuses on children and adolescents up through age 18 years old with OCD and related disorders, including:

• OCD
• Body dysmorphic disorder
• Trichotillomania
• Skin picking disorder
• Tic disorders/Tourette syndrome
• And commonly associated co-occurring conditions, including ADHD, anxiety and intermittent explosive disorder/rage

Your child’s initial evaluation will provide psychoeducation around your child’s presenting condition(s). We will formulate an assessment based on your child’s complex of symptoms and provide recommendations, both behavioral and pharmacological, for future treatment approaches.

We collaborate and coordinate closely with other programs and services, including the Child Cognitive Behavioral Therapy (CBT) Program, the Pediatric Tourette Syndrome/Tic Disorders Clinic, neuropsychology and social work to help provide appropriate support and referrals to other resources and related care needs (including therapists, school advocates, educational resources).

We maintain a close relationship between our clinical services and our voluntary research-related endeavors and offer opportunities for patients to participate in ongoing research. These research efforts serve to help us to learn more about these impairing conditions so that we can better serve future patients and their families.

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