Reference — Mental Health
OCD & Related Disorders Reference
OCD anchors a spectrum of disorders that share an urge-driven, repetitive structure. This reference lines them up with the treatment they share — ERP plus high-dose SSRIs.
Educational use only. Diagnosis, behavioral therapy, and medication choices are provider-directed. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Obsessive-Compulsive Spectrum
| Disorder | Key feature | Nursing points |
|---|---|---|
| OCD | Obsessions (intrusive thoughts) and/or compulsions (repetitive acts), >1 hr/day | Allow rituals at first; gradually limit; ERP; high-dose SSRI |
| Body dysmorphic disorder | Preoccupation with a perceived physical flaw others don't see; mirror-checking | High suicide risk; avoid reassurance about appearance; CBT + SSRI; screen for unnecessary cosmetic procedures |
| Hoarding disorder | Persistent difficulty discarding possessions; clutter that impairs use of living space | Safety/fire/fall hazards; respect autonomy; gradual, collaborative decluttering with CBT |
| Trichotillomania | Recurrent hair-pulling causing hair loss; tension before, relief after | Habit-reversal training; assess bald patches; rule out trichophagia/bezoar if eating hair |
| Excoriation (skin-picking) | Recurrent skin-picking causing lesions | Habit-reversal training; wound/infection care; SSRIs may help |
Exposure & Response Prevention (ERP)
ERP is the first-line behavioral treatment for OCD. The patient is exposed to the trigger (e.g., touching a “contaminated” surface) and then resists performing the ritual (no washing). Anxiety rises, then falls on its own (habituation), proving the feared outcome doesn’t occur and the ritual isn’t needed. For body-focused behaviors (hair-pulling, skin-picking), the analogue is habit-reversal training. Nurses support ERP by encouraging the patient to tolerate the discomfort and by not providing reassurance or doing the ritual for them.
Pharmacology
SSRIs are first-line (e.g., fluoxetine, fluvoxamine, sertraline) and typically require higher doses and longer trials (8–12 weeks) than in depression. Clomipramine, a tricyclic with strong serotonergic action, is an effective alternative — monitor anticholinergic effects, orthostasis, sedation, and cardiac (QT) status. Reinforce adherence, set realistic timelines, and don’t stop abruptly. Antipsychotic augmentation is sometimes added for treatment resistance.
NCLEX Pearls
- ✦OCD spectrum: OCD, body dysmorphic disorder, hoarding, trichotillomania (hair-pulling), excoriation (skin-picking).
- ✦ERP = exposure to the trigger + preventing the ritual → anxiety habituates; nurses don't give reassurance or do the ritual.
- ✦SSRIs are first-line for OCD — higher doses and longer trials (8–12 weeks) than for depression; clomipramine is the TCA option.
- ✦Body dysmorphic disorder carries high suicide risk — avoid reassuring about appearance and watch for repeated cosmetic procedures.
- ✦Hoarding creates real safety hazards (fire, falls) — respect autonomy and declutter gradually with CBT.
- ✦Habit-reversal training is the behavioral treatment for hair-pulling and skin-picking.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →