Due to the rates of comorbidity between OCD and EDs, it is common for clinicians to encounter patients with subclinical features of each disorder. This can present in various ways, such as patients having a primary diagnosis of one disorder but with subclinical features of the other, or patients having a subclinical secondary feature of the other disorder. One of the most common co-occurring traits in EDs and OCD is perfectionism, which may present as high achievement, rigidity, overpreparedness, thoroughness, extreme promptness, and checking behaviors related to many domains, but it can also present as avoidant and somewhat scattered. Perfectionism in EDs would typically include content related to diet, eating behaviors, and exercise, whereas in OCD it may be related to morality-based obsessions. Impression management is another trait that is often seen in both disorders, which can cause anxiety and self-doubt. This can make it difficult for patients to be honest with their provider, thus hindering the treatment process. Orthorexia is a subclinical disorder that has traits of both EDs and OCD, highlighting the complication of subclinical features presenting at the same time.

This chapter reviews the theoretical and research literature on self-, public, and structural stigma and stigma’s impact on mental health for the largest ethnic minority groups in the United States: African Americans, Latinx, Asian Americans, and Native Americans. None of these ethnic minority groups receives mental health treatment commensurate with treatment need. Research documents that stigma deters minority mental health help seeking, especially for Asian and African Americans. Limited research suggests that pubic and structural stigma may interfere more with access to high-quality care and success in community functioning, although suitably formulated hypotheses remain to be tested. As researchers move beyond ethnic categorization for studying stigma disparity’s role, they must better specify cultural differences explaining minority-White disparities in stigma. They must also further explain stigma disparities in comprehensive models that explain how stigma disparities explain disparities in minority help seeking. Findings can inform culturally attuned anti-stigma interventions and public health messages to reach ethnic minority communities and guide outreach by trusted actors and institutions seeking to break down stigma’s barriers, recruit more minority persons into care, and provide a welcoming environment for successful community living.

Patients with hoarding disorder (HD) experience difficulties discarding that result in excess clutter in the home. HD causes distress and impairment for patients and family members and represents a significant public health burden, highlighting a need for treatment research. In this chapter, we provide an overview of cognitive behavioral therapy (CBT) for hoarding, a promising avenue to treat core HD features in a collaborative and time-limited manner. We begin by discussing etiological factors for HD, including familial features, information-processing deficits, and core beliefs about the self and possessions. Next, we describe HD assessment, including standardized measures and case conceptualization considerations. After discussing the research evidence for individual and group CBT for HD, we provide an overview of treatment components, including psychoeducation, motivational enhancement, skills training, behavioral exposures, cognitive techniques, and relapse prevention. Barriers to treatment are also considered. We end with a case vignette illustrating the successful application of CBT for HD in an individual outpatient setting.