On Sunday, October 25, Fugen Neziroglu, Ph. D. was the keynote speaker at the NJOCF tenth annual conference. Dr. Neziroglu is a New York licensed psychologist, and co-founder and Clinical Director of Bio-Behavioral Institute in Great Neck, Long Island, one of the premiere facilities for training, research, and treatment of OCD and OCD Spectrum Disorders in the country. She is presently Clinical Professor in Psychiatry at NYU and an Adjunct Full Professor at Hofstra. She has authored or co-authored over 140 journal articles, 32 books or book chapters, and has made over 200 clinical presentations.

Dr. Neziroglu began by explaining that obsessive compulsive spectrum disorders (OCSD) are related to obsessive compulsive disorder (OCD) with similar symptoms of obsessions and/ or compulsions, treatment response, and family history. OCSD include OCD, hoarding, BDD, hypochondriasis, eating disorders, trichotillomania, tourette’s syndrome, and self-mutilation.

Body Dysmorphic Disorder (BDD) is diagnosed when a person has a preoccupation with an imagined defect, or if slight physical anomaly is present, concern is excessive. Longevity and severity distinguish BDD from normal adolescent or adult worries, and risk factors include a history of abuse, teasing, dermatological problems, anxiety, depression, and/ or perfectionism.

Individuals with BDD have faulty beliefs about their appearance that are connected to their identity, such as “if I feel unattractive, it means I look unattractive,” “if I looked better, my life would be better, and “my appearance is defective, so I’m worthless.” Avoidance and safety behaviors maintain and reinforce BDD and these include, for example, mirror gazing or avoiding, excessive grooming (e.g., makeup application), reassurance seeking, and repeated checking of body parts.

Hypochondriasis, or health anxiety, is diagnosed when a person has a preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms. The preoccupation persists despite appropriate medical evaluations and reassurances. The individuals are concerned with the meaning of the pain, not the pain itself; for instance, a headache is a sign of a tumor, versus the focus being on taking medicine for the headache.

Effective treatments for BDD and hypochondriasis include cognitive therapy (CT) and exposure and response prevention (ERP), with CT occurring before ERP for maximum therapy benefit. CT challenges the individuals’ overvalued ideations, meaning it helps them not to believe the faulty beliefs so strongly and replace them with realistic appraisals of their perceived defect or fears. In BDD, CT targets the individuals’ values on appearance, and in hypochondriasis, CT targets lowering the probability of a symptom indicating a serious illness and increasing coping.

Dr. Neziroglu concluded her presentation with an overview of hoarding, which is a disorder of acquisition and failure to discard. This results in clutter that prevents usage of functional space, and causes individuals to experience significant distress and functional impairment (while family members tend to have high distress as well). Rituals and avoidance behaviors include doubting, checking, and reassurance seeking before discard. Treatment focuses on teaching the individuals with hoarding to organize and make decisions, and engage in exposure to tolerate the discomfort of discard.

The tenth annual conference was completed with an emotional highlight: the Living with OCD panel moderated by Dr. Allen Weg. The panel consisted of a 62 year old woman with contamination obsessions and hand washing rituals, a 23 year old female with intrusive thought OCD, a 17 year old male who proudly reported being “98% OCD free,” an 11 year old girl with repeating compulsions, and a 15 year old female with contamination obsessions and ritual avoidance, as well as this last girl's mother, who discussed issues around having an OCD-afflicted adolescent in the home and the effects on parents and families in general. Each panel member shared his or her courageous experiences living with OCD, and then audience members then asked a wide range of questions. As in previous years, the panel members encouraged, educated, and offered optimism to the individuals with OCD, their loved ones, and the professionals that treat them. DVD’s of the entire conference are available through the website, http://www.njocf.org.