What It’s Like to Navigate a Pandemic When You Have Obsessive Compulsive Disorder

I shouldn’t be writing this. When I tell people I have OCD, their reaction is a mix of projected shame, embarrassment, and at best, empathy. But that’s not why I’m writing this now; I’m talking publicly about having OCD because in 2020, I’ve realized just how misunderstood the illness is.

Obsessive compulsive disorder sounds scary. Obsessive: like some stalker serial killer. Compulsive: can’t stop, out of control. Disorder: something is wrong. The reality is that OCD affects more than 2 million Americans in roughly the same number of ways. The illness manifests itself in everything from counting how many times a drawer is closed to, most stereotypically, washing hands and cleaning. For people with OCD, there are “good” things and “bad” things, acceptable numbers and dedicated routines. These compulsions can either be repeated thoughts or actions, and the fears that fuel them, when said out loud, usually sound outlandish. Some may even say crazy.

I’m talking publicly about having OCD because in 2020, I’ve realized just how misunderstood the illness is.

OCD is listed as a disability. For some, this may conjure up a narrative that OCD is a problem, something to solve. In reality, like most disorders, OCD is likely genetic, and you learn to manage it rather than expunge it. Twenty-five percent of cases occur before the age of 14.

Always one to follow the rules, I was diagnosed at age 13 while in eighth grade. A doctor handed me a children’s picture book entitled What’s Wrong With My Brain?, and then asked if I watched the then-popular TV show Monk. No, I wasn’t an adolescent fan of a mystery procedural starring a middle-aged germaphobe. And wait, there’s something wrong with me?! The interaction was just as traumatic and laughably out of touch as it sounds. Plus, my childhood bedroom was always a mess, much to the dismay of my parents. There’s no way I had what Adrian Monk had.

Related: I Have a Panic Disorder. Here’s How I’m Coping With the Coronavirus Pandemic

For months, I felt guilty for creating something inside myself that was such an inconvenience for others, a trap for my brain that I seemed to be subconsciously building for years. It took a while before I came to terms with the fact that the diagnosis was not my fault. Ironically, that’s the cornerstone of the illness: you can’t control everything. And this year has proven that even further.

From finishing up college to coping with family crises, it’s been . . . a lot. Yet 2020 would seem to applaud those with OCD. The “washing hands” aspect of OCD has been glamorized by the likes of The Wall Street Journal, which just weeks into the pandemic, published a horribly offensive article titled, “Why We All Need OCD Now.” Why would we all need something that’s considered a disability? That’s right, because people can’t remember to wash their hands for 20 seconds! Memes of being “so OCD” about cleaning during COVID-19 further mocked those who actually have it.

Of course, there have also been recent strides in de-stigmatizing the illness. Singer Camila Cabello penned a personal essay describing her journey coming to terms with her diagnosis, and TikTok stars have reached wider audiences with videos identifying OCD intrusive thoughts. On screen, films and series like HBO’s Pure delivered more realistic portrayals of OCD, a far cry from characters like Monica from Friends, who used the label for laughs.

The truth is I don’t mind counting myself among the likes of Julianne Moore, Leonardo DiCaprio, Howie Mandel, Charlize Theron, and other beloved celebrities who have OCD. Studies have even linked anxiety disorders to higher intelligence. It doesn’t really sound like a disability anymore, does it? However, it’s true that my OCD has at times been debilitating, while later absent for months on end. The “flair ups” tend to correspond with stress and uncertainty. This year obviously has brought a lot of both.

Related: I Have an Anxiety Disorder – Here Are 5 Ways I’m Coping With This Tumultuous Year

Sheltering in my apartment in New York City – at one point the epicenter of the nation’s coronavirus cases – was definitely a dark experience. First of all, being inside with little to do is not ideal for someone with OCD. It can create problems where there once were none. If you don’t have to be anywhere, you can start fiddling with the placement of a stack of books, or refolding the same sweater after taking it off. You might even begin to think that a new spike in cases, or the foreboding fear of contracting the virus, or the worries about your loved ones across the country, stem from you not folding the sleeve correctly. Like I said, it sounds silly, but it’s true.

Being inside with little to do is not ideal for someone with OCD. It can create problems where there once were none.

If you think about the concept of a “butterfly effect,” and believe that one small move can change your path, it puts a lot of pressure on simple, everyday choices. Staying indoors during the pandemic heightened my awareness of those decisions, and limited the immediate world to televised news and my bedroom. The sameness of my surroundings, coupled with the state of the nation, emphasized the need to “fix” things. Welcome back, OCD.

Over the last few months, I’ve needed to reacquaint myself with the tools necessary to shrink OCD’s presence in my life. Sometimes I describe OCD as a separate entity that can sink its claws into me; other times I own that it’s part of myself. Ultimately, I cope by saying the fears attached to my choices out loud, visualizing different possible scenarios, and acknowledging that what’s happening outside is not due to whatever is going on inside my apartment. There is comfort in consistency.

Aside from the hardships of this year, I don’t like to talk about my OCD. I believe it is just a small part of who I am. No one should be defined by any singular detail, much less something that feels like such a foreign and obtuse label. I probably shouldn’t be writing this, but I have to, for me. It helps to talk about it, to demystify the illness, and ultimately, to learn from it. I hope 2020 can understand a little more now.

Coronavirus: The possible long-term mental health impacts

Researchers are also gathering empirical data which they hope will provide a better grasp of the long-term mental health side effects of this unique crisis, and therefore how to manage it. Major UK studies are looking specifically at the mental health of patients hospitalised with Covid-19 and nurses working on the front line. In Sweden, researchers at the Centre for Psychiatric Research in Stockholm are conducting a year-long project involving more than 3,000 people with pre-existing mental health conditions, including depression, anxiety and OCD. An Australian nationwide survey by the Matilda Centre for Research in Mental Health in Sydney is measuring the impact of the pandemic on the ongoing mental health and wellbeing of the general population. 

“There is concern that mental-health problems may rise or are rising, but this needs to be better understood,” says Nitya Jayaram-Lindström, operations manager for the Stockholm project. She says the Swedish research will focus on how much Covid-19 may have exacerbated existing mental health inequalities, how patients’ symptoms develop or change over the next year and which groups are worst affected. “We also want to understand factors that contribute to resilience, which is as important to understand as the risk factors.” 

At the Centre for the Study of Traumatic Stress in Maryland, Joshua C Morganstein argues that these sorts of projects will be an essential resource for both healthcare providers and governments. “Health surveillance of various populations to better understand these aspects of risk is essential for us to provide interventions and plan for subsequent pandemic waves as well as future public health emergencies,” he says. “Stress is like a toxin, such as lead or radon. In order to understand it and how it is affecting a society, we need to know who is exposed, when, how much and what effects were caused by the exposure.” Although there is little data so far, Morganstein predicts that long-term studies are likely to further expose the wellbeing disparities across race, gender and income which have already been highlighted during the pandemic, and need to be taken into deeper consideration when developing future responses. 

Resilience and hope 

Despite ongoing concerns about the long ‘tail’ of mental health challenges caused by the impact of Covid-19, psychiatrists say it’s important to recognise there are some positive takeaways, too. 

Taylor argues that while a significant minority may struggle long-term, the pandemic has highlighted high levels of resilience to stress in the wider population, alongside humans’ capacity to “bounce back” after catastrophic events. For instance, in Wuhan, where the pandemic first started and cases were brought under control after a strict 76-day lockdown and mass testing, the city staged a massive water-park music festival in August. Thousands of people crowded together shoulder to shoulder, with no masks and zero social distancing. Large gigs also returned in New Zealand after community transmission of the virus was curbed. These kind of events have taken place, Taylor reflects, despite a fatalistic mood at the start of 2020, when “many people doubted that life would return to normal, and some speculated about a grimly Dickensian post-pandemic world”. He believes that “similar events will likely occur elsewhere in the world when the pandemic is over”. 

Psychotherapist Nippoda points out that for some people, the adverse circumstances of the pandemic have actually had a “remarkably positive impact” on their mental health, which may also be long lasting. The experience of lockdown, she argues, helped reduce anxiety levels or stop panic attacks among some who had high levels of stress in the outside world before the pandemic. This is because they felt a greater sense of freedom and safety by spending more hours at home. Although there is a risk of social isolation and loneliness for those who retreat too much, she says that this enforced time indoors has encouraged some to strive for a better work-life balance in the future or to “take their own pace in life” when it comes to socialising – by finding “their own comfort zone within the boundaries between indoors and outdoors”. 

Others have used the era of social-distancing to declutter their homes, and “the new space within the home has been reflected positively within their mind, almost as if they were able to tidy up the complications in their head”, says Nippoda. Increased time for hobbies, especially making and doing things from scratch, is also thought to have provided a sense of satisfaction, fulfilment and stress-relief for many. 

But these sorts of experiences ring hollow for people like germaphobe Susan Kemp in Stockholm who are still struggling to visualise an end to their more acute mental health challenges connected to the pandemic. “Clearly there needs to be some balance between being careful and being an absolute hermit that I’m not able to achieve,” she laments. “But I irrationally can’t get over my fear. It’s very hard these days to decide when I’m being rational and when I am not.” 

“I find it really, really difficult to rebalance myself,” agrees American PTSD sufferer Lindsey Higgins, who says she’s unsure her symptoms will improve even if scientists develop a vaccine. “It is going to take time to distribute, and even longer to convince people they should even take the vaccine. Honestly, I’m not sure I’ll ever really feel secure again.” 

Obsessive Compulsive Disorder Market 2020-2027 with Coronavirus/COVID-19 Pandemic Analysis & Future Growth Analysis Report | Global Players – Zydus Cadila, Mylan NV, Mayne Pharma Group Limited, Teva Pharmaceutical Industries Ltd

This winning Obsessive Compulsive Disorder Market document encompasses the study about the market potential for each geographical region based on the growth rate, macroeconomic parameters, consumer buying patterns, possible future trends, and market demand and supply scenarios. The use of established statistical tools and coherent models for analysis and forecasting of market data makes this market report outshining. The study encompasses a market attractiveness analysis, wherein each segment is benchmarked based on its market size, growth rate, and general attractiveness. This Obsessive Compulsive Disorder Market research report gives explanation about the strategic profiling of key players in the market, comprehensively analyzing their core competencies, and drawing a competitive landscape for the industry.

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Market Analysis and Insights: Global Obsessive-Compulsive Disorder Market

Global obsessive-compulsive disorder market is expected to gain market growth in the forecast period of 2020 to 2027. Data Bridge Market Research analyses the market is growing at a healthy CAGR in the above-mentioned research forecast period. Emerging markets and huge investment in research and development are the factors responsible for the growth of this market.

The major players covered in the obsessive compulsive disorder market are Johnson Johnson Services Inc, Mallinckrodt plc, Sun Pharmaceutical Industries Ltd., Novartis AG, Endo Pharmaceuticals plc, Zydus Cadila, Mylan N.V., Mayne Pharma Group Limited, Teva Pharmaceutical Industries Ltd, Amneal Pharmaceutical Inc, Avet Pharmaceuticals Inc., Lannett, Aurobindo Pharma, Wockhardt, Currax Pharmaceuticals LLC and others.

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Factors such as high prevalence of mental illness and availability on large scale of specialty centres are prominent factors that influenced the growth of the global obsessive compulsive disorder market. In addition, launches of drugs annually and improvement in treatment are some of the major factors that drive the market growth. The growth of obsessive-compulsive disorder market is restrained by limited revenue opportunities coupled with product recalls.

Obsessive compulsive disorder is a type of mental illness characterized by repeated unreasonable thoughts and uncontrollable fears that results in repetitive action or activity by a person. The obsessive-compulsive usually compels the individual’s throws oneself into particular thought or fear.

Global obsessive-compulsive disorder market provides details of market share, new developments and product pipeline analysis, impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, product approvals, strategic decisions, product launches, geographic expansions and technological innovations in the market. To understand the analysis and the market scenario contact us for an Analyst Brief, our team will help you create a revenue impact solution to achieve your desired goal.

Global Obsessive-Compulsive Disorder Market Scope and Market Size

Obsessive compulsive disorder market is segmented on the basis of drug class, indication, route of administration, end-users and distribution channel.

  • On the basis of drug class, the global obsessive-compulsive disorder market is segmented into tricyclic obsessive compulsive disorder, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, serotonin antagonist and reuptake inhibitors, others
  • The Indication segment for obsessive compulsive disorder market is segmented into major depressive disorder, anxiety disorders, attention deficit hyperactivity disorder, others.
  • On the basis of route of administration, the obsessive compulsive disorder market is segmented into oral, injectable, others
  • On the basis of end-user, the obsessive compulsive disorder market has been bifurcated into hospitals, homecare, speciality centres, others
  • On the basis of distribution channel, the obsessive compulsive disorder market has been bifurcated into hospital pharmacy, online pharmacy, retail pharmacy

Global Obsessive-Compulsive Disorder Market Country Level Analysis

Obsessive compulsive disorder market is analyzed and market size information is provided by country, basis of drug class, indication, route of administration, end-users and distribution channel as referenced above.

The countries covered in the global obsessive compulsive disorder market report are U.S., Canada, Mexico in North America, Brazil, Argentina, Peru, Rest of South America, as part of South America, Germany, France, U.K., Netherlands, Switzerland, Belgium, Russia, Italy, Spain, Turkey, Hungary, Lithuania, Austria, Ireland, Norway, Poland, Rest of Europe in Europe, China, Japan, India, South Korea, Singapore, Malaysia, Australia, Thailand, Indonesia, Philippines, Vietnam, Rest of Asia-Pacific, in the Asia-Pacific, Saudi Arabia, U.A.E, Egypt, Israel, Kuwait, South Africa, Rest of Middle East and Africa, as a part of Middle East and Africa.

Among regions, North America especially the United States is highly attractive market for global obsessive-compulsive disorder market due to the high prevalence of obsessive-compulsive disorder, presence of refined healthcare expenditure and increased patient awareness level. Europe is considered as a second largest growing regional segment owing to the presence of global marketed players in this region and growing cases of mental illness.

The country section of the report also provides individual market impacting factors and changes in regulations in the market domestically that impacts the current and future trends of the market. Data points such as new sales, replacement sales, country demographics, disease epidemiology and import-export tariffs are some of the major pointers used to forecast the market scenario for individual countries. Also, presence and availability of global brands and their challenges faced due to large or scarce competition from local and domestic brands, impact of sales channels are considered while providing forecast analysis of the country data.

Patient Epidemiology Analysis

Global obsessive-compulsive disorder market also provides you with detailed market analysis for patient analysis, prognosis and cures. Prevalence, incidence, mortality, adherence rates are some of the data variables that are available in the report. Direct or indirect impact analysis of epidemiology to market growth are analysed to create a more robust and cohort multivariate statistical model for forecasting the market in the growth period.

Competitive Landscape and Global Obsessive-compulsive disorder Market Share Analysis

Obsessive-compulsive disorder market competitive landscape provides details by competitor. Details included are company overview, company financials, revenue generated, market potential, investment in research and development, new market initiatives, global presence, production sites and facilities, company strengths and weaknesses, product launch, clinical trials pipelines, product approvals, patents, product width and breadth, application dominance, technology lifeline curve. The above data points provided are only related to the companies’ focus related to global obsessive-compulsive disorder market.

Customization Available: Global Obsessive-Compulsive Disorder Market

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Modifying Treatment for OCD Patients During COVID-19

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Cannabis reduces OCD symptoms by half in the short-term

The researchers analyzed data inputted into the Strainprint app by people who self-identified as having OCD, a condition characterized by intrusive, persistent thoughts and repetitive behaviors such as compulsively checking if a door is locked. After smoking cannabis, users with OCD reported it reduced their compulsions by 60%, intrusions, or unwanted thoughts, by 49% and anxiety by 52%.

The study, recently published in the Journal of Affective Disorders, also found that higher doses and cannabis with higher concentrations of CBD, or cannabidiol, were associated with larger reductions in compulsions.

“The results overall indicate that cannabis may have some beneficial short-term but not really long-term effects on obsessive-compulsive disorder,” said Carrie Cuttler, the study’s corresponding author and WSU assistant professor of psychology. “To me, the CBD findings are really promising because it is not intoxicating. This is an area of research that would really benefit from clinical trials looking at changes in compulsions, intrusions and anxiety with pure CBD.”

The WSU study drew from data of more than 1,800 cannabis sessions that 87 individuals logged into the Strainprint app over 31 months. The long time period allowed the researchers to assess whether users developed tolerance to cannabis, but those effects were mixed. As people continued to use cannabis, the associated reductions in intrusions became slightly smaller suggesting they were building tolerance, but the relationship between cannabis and reductions in compulsions and anxiety remained fairly constant.

Traditional treatments for obsessive-compulsive disorder include exposure and response prevention therapy where people’s irrational thoughts around their behaviors are directly challenged, and prescribing antidepressants called serotonin reuptake inhibitors to reduce symptoms. While these treatments have positive effects for many patients, they do not cure the disorder nor do they work well for every person with OCD.

“We’re trying to build knowledge about the relationship of cannabis use and OCD because it’s an area that is really understudied,” said Dakota Mauzay, a doctoral student in Cuttler’s lab and first author on the paper.

Aside from their own research, the researchers found only one other human study on the topic: a small clinical trial with 12 participants that revealed that there were reductions in OCD symptoms after cannabis use, but these were not much larger than the reductions associated with the placebo.

The WSU researchers noted that one of the limitations of their study was the inability to use a placebo control and an “expectancy effect” may play a role in the results, meaning when people expect to feel better from something they generally do. The data was also from a self-selected sample of cannabis users, and there was variability in the results which means that not everyone experienced the same reductions in symptoms after using cannabis.

However, Cuttler said this analysis of user-provided information via the Strainprint app was especially valuable because it provides a large data set and the participants were using market cannabis in their home environment, as opposed to federally grown cannabis in a lab which may affect their responses. Strainprint’s app is intended to help users determine which types of cannabis work the best for them, but the company provided the WSU researchers free access to users’ anonymized data for research purposes.

Cuttler said this study points out that further research, particularly clinical trials on the cannabis constituent CBD, may reveal a therapeutic potential for people with OCD.

This is the fourth study Cuttler and her colleagues have conducted examining the effects of cannabis on various mental health conditions using the data provided by the app created by the Canadian company Strainprint. Others include studies on how cannabis impacts PTSD symptoms, reduces headache pain, and affects emotional well-being.

Understanding Obsessive Compulsive Disorder in Teenagers with High-Functioning Autism

Abstract

Research has shown that autism spectrum disorder (ASD) shares similar genetic roots with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). All three conditions share some common features, one of the most observed being that of impulsivity. This paper examines the neurobiology of OCD, and how the similarities in disruptions of the brain structures between OCD and ASD increases the risk of developing the comorbidity of OCD in teenagers with high-functioning ASD. Through looking at a case study of a teenager with ASD, this paper also explores the prognosis of interventions in individuals diagnosed with both conditions of OCD and ASD, and the applications of interpersonal neurobiology in the treatment of the conditions.

The DSM-5 (American Psychiatric Association, 2015) separates Obsessive Compulsive Disorder (OCD) from anxiety disorders, classifying it under the new category as Obsessive-Compulsive Spectrum Disorders (OCRDs), together with two newly defined disorders with obsessive-compulsive features. These are hoarding disorder and excoriation (skin-picking) disorder. Included in the new OCRD category are also body dysmorphic disorder (previously classified as a Somatoform Disorder) and trichotillomania (hair-pulling, previously classified as an Impulse Control Disorder Not Elsewhere Classified). By categorically separating OCD from other forms of anxiety disorder, the DSM-5 recognises that it is unique, and that its neurological and psychological underpinnings are different from that of anxiety disorders.Hence, the treatment of OCD is also different and the neuroanatomical target of therapy should also be different from that of anxiety disorders.

The Centers for Disease Control and Prevention (CDC), studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of about 1% (CDC, 2015), hence, Autism Spectrum Disorders (ASD) are among the most common neurodevelopmental disorders in the world. Although ASDs are typically diagnosed in early childhood (Di-Cicco-Bloom et al., 2006), there is no specific genetic test or clinical procedure for diagnosis. Diagnosis is based mainly on the following: impairments related to social interaction, communication, as well as restricted and repetitive behavior (American Psychiatric Association, 2015). In addition to impairments in these core symptom areas, many individuals with ASD also have impaired cognitive skills, atypical sensory behaviors, or other complex medical and psychiatric symptoms and conditions, such as seizure disorders, motor impairments, hyperactivity, anxiety, and self-injury/aggression.

Research has revealed that ASD shares similar genetic roots with obsessive-compulsive disorder, and attention deficit hyperactivity disorder (Jacob, Landeros-Weisenberger, Leckman, 2009). All three conditions share some common features and in terms of similarity in brain architecture, it has been found that there are disruptions in the structure of the corpus callosum in all three conditions. The corpus callosum is the bundle of nerve fibres that connect the brain’s left and right hemispheres.

The purpose of this paper is to examine the neurobiology of OCD, and how the similarities in disruptions of the brain structures between OCD and ASD increases the risk of developing the comorbidity of OCD in teenagers with high-functioning ASD. This paper also explores the prognosis of interventions in individuals diagnosed with both conditions of OCD and ASD, and the applications of interpersonal neurobiology in the treatment of the conditions.

The Neurobiology of Obssessive-Compulsive Disorder and Autism Spectrum Disorder

To have a clear understanding of OCD, and how the disorder affects behaviour, one must first recognize that obsessions and compulsions are two separate manifestations of an illness that have similar biological roots. The DSM-5 defines obsessions as “recurrent and persistent thoughts, urges, or images that are experienced as intrusive or unwanted,” and compulsions are “repetitive behaviours or mental acts that an individual feel driven to perform in response to an obsession or according to rules that must be applied rigidly” (American Psychiatric Association, 2015). Compulsions are the outward manifestations of the hidden obsessive thoughts. They could be likened to the tip of an iceberg, whereas obsessions are the part of the ice berg that is hidden beneath from the surface. Hence, when an individual is not acting out the compulsion, it does not necessarily mean the obsessions are also gone. Per research, obsessions are more resistant to treatment than compulsions and are the source of profound distress in patients.

Current perspectives on the neuroscience of OCD trace the root of the problem to disruptions in the communication between three core brain structures: the cortex, striatum and thalamus, also known as the cortico-striato-thalamic pathways (Jacob, Landeros-Weisenberger, Leckman, 2009). A breakdown in the proper transmission of information in the pathways, which may also be caused by a chemical imbalance in the pathways, explains why individuals with OCD are stuck in the repetitive loops of thoughts and behaviour. Further research carried out by has also found that white mattertracts in the brain might be affected in OCD. Unlike grey matter, which is largely made up of the cell bodies of neurons, white matter consists mostly of myelinated axons. By examining the brain matter of both OCD and non-OCD patients, they found that there are widespread abnormalities in the white matter of the former, as compared to the latter (Meier et al., 2015).

Aberrations were frequently found in the regions of the corpus callosum and cingulum. The corpus collosum connects the left and right hemispheres of the brain, and the cingulum is the fibre bundle that connects the primary structures of the limbic system, which includes theamygdala,hippocampus, thalamus,hypothalamus, basal ganglia, and cingulate gyrus. Besides reported abnormalities in the cortico-striato-thalamic pathways typically associated with OCD, there are also reports of abnormalities beyond them (Meier et al., 2015). These findings reinforced the perspective that OCD is a result of disintegration within the physical brain system, leading to faulty communications between different brain structures.

For the physical brain, integration is important as it is the basic process that links up the differentiated parts of a system to facilitate in promoting psychological and emotional well-being. These integrated linkages enable individuals to perform more intricate functions such as insight, empathy, intuition, and morality. Integration is essential for maintaining FACES in the neurological system—flexible, adaptive, coherent, energized and stable (Siegel, 2012). Dr. Siegel (2012) uses the river of integration metaphor to explain that if there is deviation from integration, that is represented by the smooth-flowing river in the centre, to the river-banks on either side, this would lead to chaos or rigidity or both, as represented by the river-banks. From this visual metaphor, the central implication is that like a river that naturally flows downstream, complex systems also have a natural compulsion towards integration. Therefore, when the brain and relationships are well integrated, it would lead to healthy minds. However, if there is impaired integration, it would lead to chaos and rigidity. As in the case of individuals with OCD, the breakdown in the communications between the physical brain structures impairs integration, hence, chaos in the mind and disintegration in relationships.

Similar patterns of disintegration are also observed in the brain patterns of individuals with ASD (Minshew Williams, 2007). ASD, like OCD, is also a neurobiological disorder of connectivity. For ASD, one similar behavioural feature it shares with OCD is that of restricted and repetitive behaviours. In depth studies into the topic has shown that restricted and repetitive behaviours often observed in individuals with ASD, are also caused by abnormalities in the cortico-striato-thalamic pathways. Restricted and repetitive behaviours are the result of disruptions to any one of the three macro circuits within the cortico-striato-thalamic loops. Problems with communication between the pathways connecting the three brain areas: thecortex,striatum, andthalamus(i.e. cortico-striato-thalamic pathways), will lead to an imbalance within these pathways, hence, may cause individuals with OCD or ASD to get stuck in repetitive loops of thought and behaviour (Minshew Williams, 2007).

Besides connectivity problems between different brain structures that explain how and why individuals are trapped in repetitive loops of thought and behaviour, research has also shown that several neurotransmitters are responsible for repetitive and rigid behaviour (Minshew Williams, 2007). One of the key neurotransmitter identified is Serotonin. Serotonin is responsible for proper regulation of memory, sensory perception, mood, learning and behaviour. Therefore, when there is an upset in the Serotonin level in the brain, it leads to abnormalities in behaviour and emotions—disintegration in proper function of the brain system results in chaos and rigidity. Similarly, dysregulation of dopamine, a neurotransmitter primarily responsible for attention and focus, relaying and processing of information, will result in abnormal behaviour and emotions—low dopamine levels impair attention and focus, whereas high dopamine levels increase sensory perception and sensitivity, causing the mind to race. Consequently, it leads to an overload on the brain’s ability to process. GABA (gamma-aminobutyric acid) is a neurotransmitter that occurs naturally in the brain, and is responsible for the regulation of brain activity. Unlike serotonin or dopamine, which are excitatory neurotransmitters, GABA is inhibitory and slows down neuronal firing. Hence, deficient levels of GABA or problematic GABA receptors contribute to the excitatory elements of ASD and OCD, leading to increase anxiety levels (Jacob, Landeros-Weisenberger, Leckman, 2009).

Interaction of OCD and ASD

The rate for comorbid diagnoses of OCD in patients with ASD differed from 1.5% to 81%. Studies focusing on children with Asperger’s Syndrome found that these children may experience level of impairment from OCD symptoms as children diagnosed with OCD alone. OCD symptoms and behaviour also contribute significantly to the distress faced by adults with ASD (Stone Chen, 2015). Individuals with ASD share common traits with OCD patients, like ritualistic and avoidance behaviours, the inflexibility of thoughts, and repetitive thoughts. On the other hand, research has shown that individuals with OCD also present with ASD traits. It is estimated about 3% to 7% of patients with OCD also meet the criteria for mild to moderate ASD (Stone Chen, 2015).

An intricate relationship exists between brain, mind and body, and is illustrated in the triangle of well-being (Siegel, 2012). The physical brain and nervous system allows for energy and information flow throughout our beings. The brain receives the electrical signals that travel through the nervous system, decodes the signals to give them meaning, and responds by releasing neurochemicals and dispatching electrical signals. In this consistent pattern of receiving, decoding and then dispatching new signals, the brain regulates the body, controls movement and influences emotions (Siegel, 2012).

However, for the individual diagnosed with OCD, the disintegration of the cortico-strito-thalamic loop disrupts the dispatching of electrical signals and release of neurochemicals in the body, contributing further to the breakdown of the brain system and the mind. The brain’s function as a social organ is disrupted, rendering it impossible to promote interaction with other brains. The mirror neurons in the brain gives it the capacity to develop empathy and insight (Llosa, 2011). However, for individuals with OCD and ASD, the inability to build interpersonal relationships that are attuned, would mean the inability to encourage the growth of integrative fibres in the brain. This neural integration is important and essential for it enables the embodied brain to function effectively, as well as the development of a coherent and well-balanced mind. Most importantly, when neurons are activated, the brain makes meaning of experiences. It follows that repeated activation creates, strengthens and maintains connections (Siegel, 2012)— “neurons which fire together wire together.” The repeated obsessive thoughts are reinforced if left uncontested, as the thoughts get embedded in the mind with the continuous activation of neurons. The rigidity of the ASD mind, due to connectivity problems and faulty system of neurotransmitters strengthens the resilience of obsessive thoughts, making them even harder to eradicate.

I have encountered a client with ASD, whom I would address as M, who struggles with obsessive thoughts that appear to be both irrational and delusional to the logical and rational individual. The thoughts started as a simple curiosity about little children and their physiological development. As M was brought up to respect privacy and to understand that asking questions about sexual development was inappropriate, it was a struggle within herself to have questions about the same topic that was taboo in her culture. The thoughts soon spiralled out of hand and generated irrational ideas that she could be a paedophile because she felt that she was not normal to be curious about sexuality and sexual development. As she struggles with her own curiosities, they conflicted with the rational side of M, that was also sending signals to her brain that such thoughts were inappropriate. The conflict between the two sets of thoughts increases anxiety in M. Compulsive acts of frequently washing her hands and prolong washing of her body started to surface. Prior to the obsession with the thoughts, there have been reports of compulsive acts of hand washing in M. But these acts were a result of her ASD, and they were more ritualistic and repetitive than compulsions driven by obsessions. During our conversations, M would share how she was compelled to stay in the baths for hours or wash herself repetitively because she had wanted to “wash out” her inappropriate thoughts. Parents also reported of M breaking down at home and calling herself a paedophile and should be institutionalised.

Her obsessions also led her to resist going to school or any places that had little children around. She was afraid she would be triggered and harm the children and she became excessively anxious as she sought to hide from small children. The physiological stress produced reduces further efficient cognitive functioning and mental flexibility. As her ASD condition would mean compromise to her executive function and flexibility in thoughts, the OCD only served to enhance the weaknesses and strengthen negative emotional tone. As the brain consistently sends signals of danger to her nervous system, there have been occasions where she enters “freeze” mode to cope with the intense stress and anxiety experienced. Although she is receiving cognitive behavioural therapy, improvements are small and her emotions continue to fluctuate daily. Further research also shows that individuals with OCD, particularly those with co-morbid ASD responded less well to cognitive behavioural therapy than those who did not have ASD (Murray, Jassi, Mataix-Cols, Barrow, Krebs, 2015).

In retrospect, CBT did contribute to improvement in her condition as occurrences of the compulsions might have reduced in that the compulsion to wash of hands continuously have been reduced, and she is showing more effort to overcome her obsessive thoughts. One of the methods employed was the externalisation of her thoughts processes, and helping her to understand what was happening in her brain as she struggles with the obsessions. In being able to name the emotions and the problem, the aim is to work towards taming it (Siegel, 2012). Nevertheless, in days when she is less successful in regulating her thoughts, she continues to be trapped in the struggle and becomes dysfunctional. As the mind is shaped via interactions with others because of the exchange of energy and information that occurs, her constant interactions within herself, and repetitive thought patterns reinforces certain ideas that seems to be leading to new obsessions. After 3 years of intensive treatment with CBT and exposure therapy, M learnt to manage her thoughts and eventually overcame the irrational thoughts. She started to accept that there were problems with her fundamental beliefs and not her curiosity, she was more opened to ask questions and when she started to change her belief system and re-evaluate her thoughts, her obsessions started to fade. She called me one day and happily told me when she saw this whole bunch of children at the playground, she was no longer triggered. From that point, it was onto the path of recovery. Today, M is a highly functional young lady who is working towards becoming a health professional herself, so she can help others.

Conclusion

Existing literature on the topic of ASD and OCD, explains the overlap of symptoms, and present the neurobiological evidence to explain why these overlapping takes place. However, there is still little writing on how the coexistence of both conditions may result in the impairment of cognitive abilities. Further research would be needed to explore the possible cognitive impairments because of ASD-OCD comorbidity.

A better understanding of the neurological causes of OCD, and the overlapping with ASD will provide me with the knowledge to consider how may I help my clients, majority whose main neurodevelopmental disorder is ASD. Many of them are high in anxiety, and this could explain the OCD traits in them (Ruzzana, Borsboom, Geurts, 2014). The disintegration of the brain system has rendered it impossible for them to self-regulate or develop relationships effectively, this could also be contributing to the restricted interests as the mind is inflexible and inclined towards repetitive actions that provide security and stability. There needs to be more enquiry into the negative interaction between ASD and OCD, so that with the increase knowledge and deeper understanding of the underlying environmental, neurobiological and genetic factors that govern the relationship, better diagnostic and treatment options could be made available (Ruzzana, Borsboom, Geurts, 2014).


References

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Ameis, S. H., Lerch, J. P., Taylor, M. J., Lee, W., Viviano, J. D., Pipitone, J.,…Anagnostou, E. (2016). A diffusion tensor imaging study in children with ADHD, Autism Spectrum Disorder, OCD, and matched controls: Distinct and non-distinct white matter disruption and dimensional brain-behavior relationships. The American Journal of Psychiatry, 173(12), 1213-1222. doi:10.1176/appi.ajp.2016.15111435

Anholt, G. E., Cath, D. C., Van Oppen, P., Eikelenboom, M., Smit, J. H., Van Megen, H., Van Balkom, A. J. (2010). Autism and ADHD symptoms in patients with OCD: Are they associated with specific OC symptom dimensions or OC symptom severity? Journal of Autism and Developmental Disorder, 40(5), 580-589. doi:10.1007/s10803-009-0922-1

Baron-Cohen, S. (2004). The cognitive neuroscience of autism. Journal of Neurology, Neurosurgery and Psychiatry, 75, 948-949. doi:10.1136/jnnp.2004.041293

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Di-Cicco-Bloom, E., Lord, C., Zwaigenbaum, L., Courchesne, E., Dager, S. R., Schmitz, C.,…Young, L. J. (2006). The developmental neurobiology of autism spectrum disorder. The Journal of Neuroscience, 26(26), 6897-6906.

Fogel, S. J., Rosin, M. (2014). Your mind is what your brain does for a living: Learn how to make it work for you. Austin, TX: Greenleaf Book Group Press.

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Kreslins, A., Robertson, A. E., Melville, C. (2015). The effectiveness of psychosocial interventions for anxiety in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Adolescent Psychiatry and Mental Health, 9(22), 1-12. doi:10.1186/s13034-015-0054-7

Llosa, P. D. (2011). The neurobiology of “we”. Parabola, , 68-75.

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Minshew, N. J., Williams, D. L. (2007). The new neurobiology of autism: cortex, connectivity, and neuronal organization. Archives of Neurology, 64(7), 945-950. doi:10.1001/archneur.64.7.945

Murray, K., Jassi, A., Mataix-Cols, D., Barrow, F., Krebs, G. (2015). Outcomes of cognitive behavior therapy for obsessive-compulsive disorder in young people with and without autism spectrum disorders: A case controlled study. Psychiatry Research, 228, 8-13.

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What is OCD (Obsessive compulsive disorder) | Detailed information on OCD (Obsessive compulsive disorder)

  • Overview

  • Cause Symptoms

  • Prevention Myths

  • Treatment

OCD, also known as Obsessive compulsive disorder is a type of mental illness which leads to repeated thoughts and the urge to do something over and over again. The ‘obsession’ is concerning the recurring unwanted thoughts, while the ‘compulsion’ is the urge to do something multiple times. The disorder can start from a really early age, while some people develop it at a later stage of life. The obsession or compulsion habits might fluctuate or change with time. You must be able to detect OCD correctly, as people often confuse it with their normal habits. A doctor is the best person to consult in such a scenario. He can not only correctly determine the status of your condition but also suggest the kind of treatment needed. Many people ignore this disorder and several are not even aware whether they have it or not. They unknowingly suffer in silence and don’t know that their condition is because of a neurological problem. It is neither a matter of shame nor something to be afraid of, as a large amount of the population have this disorder. According to the World Health Organization, OCD is one of the top 20 causes of illness-related disability, worldwide, for individuals between 15 and 44 years of age. Many other health conditions, such as anxiety issues, depressive episodes, attention deficiency, eating disorder, bipolar condition might also co-exist with OCD. You must equip yourself with the causes, symptoms, prevention, myths and treatment related to the disorder. It will not only help you diagnose your own self but will also help in detecting the disorder in a close friend or family member. People with OCD already deal with a lot, which is why they need the support of their near ones. Social stigma is a big issue, which is why many patients shy away from seeking medical help. People need to understand that OCD is not something to be afraid of. Only with proper knowledge and awareness can people detect and help the people already dealing with the disorder.

Study: Subjects Report Reduced Symptoms of Obsessive-Compulsive Disorder Following Cannabis Inhalation

Marijuana UseMarijuana Use

The inhalation of herbal cannabis is associated with temporary reductions in symptoms of obsessive-compulsive disorder (OCD), according to data published in the Journal of Affective Disorders.

A team of investigators affiliated with Washington State University analyzed data from 87 subjects who self-identified as suffering from OCD. Study participants used a smartphone application to track the severity of their symptoms immediately before and shortly following their use of cannabis over a 31-month period.

Authors reported: “Using a large dataset of medical cannabis users self-medicating for symptoms of OCD, we found that for the vast majority of cannabis use sessions individuals reported reductions in intrusions [unwanted thoughts or impulses], compulsions, and anxiety. … [R]esults indicated that after inhaling cannabis, ratings of intrusions were reduced by 49 percent, compulsions by 60 percent, and anxiety by 52 percent.” Decreases in compulsive behavior were most closely associated with the consumption of cannabis containing higher concentrations of CBD.

Subjects’ baseline severity ratings for anxiety declined over the course of the study. Baseline ratings for other symptoms, however, were unchanged – indicating that cannabis’ impact on OCD-related intrusions and compulsions was likely short-lived.

Authors concluded: “Results from the present study indicate that inhaled cannabis may acutely reduce symptoms of OCD. While the symptom severity ratings were reduced by approximately 50 to 60 percent from immediately before to after cannabis use, there was evidence that cannabis-associated reductions in intrusions may diminish over time. Collectively these results indicate that cannabis may have short-term, but not long-term beneficial effects on symptoms of OCD.”

Commenting on the study’s findings, NORML’s Deputy Director Paul Armentano said: “Few studies have assessed the potential efficacy of cannabis for the mitigation of symptoms of OCD. As such, these findings, though somewhat limited by the study’s design, indicate that cannabis – and, in particular, varieties high in CBD – holds promise as a therapeutic option for OCD patients and should be furthered examined in more rigorously designed controlled setting.”

The abstract of study, “Acute effects of cannabis on symptoms of obsessive-compulsive disorder” appears online here.

Study Suggests Cannabis May Alleviate Symptoms of Obsessive-Compulsive Disorder

Inhaling cannabis may yield a temporary relief from symptoms of obsessive-compulsive disorder, according to a new study out this month.

The study, conducted by researchers with Washington State University and published in the Journal of Affective Disorders, suggests that medical cannabis could serve as a viable treatment from those affected by OCD. The researchers worked with 87 individuals self-identifying with obsessive-compulsive disorder. The participating patients then “tracked the severity of their intrusions, compulsions, and/or anxiety immediately before and after 1,810 cannabis use sessions spanning a period of 31 months,” according to an abstract of the study.

“Patients reported a 60% reduction in compulsions, a 49% reduction in intrusions, and a 52% reduction in anxiety from before to after inhaling cannabis. Higher concentrations of CBD and higher doses predicted larger reductions in compulsions,” the researchers wrote. “The number of cannabis use sessions across time predicted changes in intrusions, such that later cannabis use sessions were associated with smaller reductions in intrusions. Baseline symptom severity and dose remained fairly constant over time.”

“Using a large dataset of medical cannabis users self-medicating for symptoms of OCD, we found that for the vast majority of cannabis use sessions individuals reported reductions in intrusions [unwanted thoughts or impulses], compulsions, and anxiety. … [R]esults indicated that after inhaling cannabis, ratings of intrusions were reduced by 49 percent, compulsions by 60 percent, and anxiety by 52 percent,” they  continued, as quoted by a blog published over at NORML. They concluded by offering that the study suggests “inhaled cannabis may acutely reduce symptoms of OCD,” while noting that, collectively, the “results indicate that cannabis may have short-term, but not long-term beneficial effects on symptoms of OCD.”

Issues With The Study

The authors, pointing to a dearth of research on the effects of cannabis on symptoms stemming from obsessive-compulsive disorder, said they sought out to discover three things in their research: “ 1) examine whether symptoms of OCD are significantly reduced after inhaling cannabis, 2) examine predictors (gender, dose, cannabis constituents, time) of these symptom changes and 3) explore potential long-term consequences of repeatedly using cannabis to self-medicate for OCD symptoms, including changes in dose and baseline symptom severity over time.” 

They also offered up a caveat to their findings, noting that the 87 participants were “self-selected, self-identified as having OCD, and there was no placebo control group.” 

Nevertheless, NORML’s Deputy Director Paul Armentano hailed the findings as yet another encouraging development in the growing body of cannabis research.

“Few studies have assessed the potential efficacy of cannabis for the mitigation of symptoms of OCD. As such, these findings, though somewhat limited by the study’s design, indicate that cannabis – and, in particular, varieties high in CBD – holds promise as a therapeutic option for OCD patients and should be further examined in a more rigorously designed controlled setting,” Armentano said

According to the Anxiety and Depression Association of America, obsessive-compulsive disorder affects “40 million adults in the United States age 18 and older, or 18.1% of the population every year.” A 2015 study found that CBD had demonstrated an efficacy in reducing the behaviors related to a host of disorders, including OCD.

Treatment for OCD | INTEGRIS

Every day, people of all ages and all walks of life suffer from an obsessive compulsive disorder (OCD), which is a mental health disorder that traps a person in a cycle of obsessions and compulsions.

Compulsions could include behaviors that a person feels they have to engage in to relieve stress or control obsessions while obsessions are intrusive images, urges or thoughts that can cause distress or intense feelings.

Even though it affects one out of every 100 adults and one out of every 200 children, most of what is commonly known about OCD is based on stereotypes and misconceptions.

According to the National Institute of Mental Health, the average age of onset in adults is 19 years old, and of those diagnosed each year, 50 percent are classified as having a “severe” form of the disorder. In children, OCD will generally first appear between the ages of 10 and 12 and can even set in as early as the age of four.

Most people experience obsessive thoughts or compulsive behaviors during their lives, but for a person suffering from OCD, those behaviors and the cycle of obsession and compulsions becomes so extreme that it disrupts normal life.

Luckily, treatments are found to be helpful in treating this disorder.

Exposure and Response Prevention therapy

Exposure and Response Prevention is a type of cognitive behavior therapy that is often used for OCD patients. Through this therapy, patients are exposed to the thoughts, situations, images or objects that trigger anxiety or obsessions.

As part of ERP, once exposed to your triggers, you make an active choice to NOT do a compulsive behavior after being exposed. This therapy is done under the watchful eye of a therapist at first because being exposed to your triggers can cause initial worry, fear or trepidation. However, through regular ERP therapy, you can learn to do the exercises on your own and manage your own symptoms.

ERP is oftentimes combined with medications called serotonin reuptake inhibitors, or SRIs. While the ERP is done by licensed mental health professionals in an outpatient setting, the combination of ERP and medications are found to be the most effective for 70 percent of OCD sufferers, according to the International OCD Foundation.

The medications often prescribed alongside ERP include:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil, Pexeva)
  • Fluvoxamine
  • Fluoxetine (Prozac)
  • Clomipramine (Anafranil)

Treatments via skype

Although ERP and medications may be the most successful way to control OCD, less than a quarter of cognitive-behavioral therapists have training in how to treat OCD. Those who do are most likely located in metropolitan cities, so a shortage of licensed therapists available to rural or remote patients can be a challenge.

However, technology like Skype therapy can be helpful. A recent study showed that those who did ERP therapy twice a week via Skype showed similar improvements to those who had in-person therapy.

In fact, in the study, 80 percent of teleconferencing patients said they rated their life as “much” improved after three months. This study suggests that online therapy can be just as effective as in-person therapy. 

The Anxiety and Depression Society of America also did a study which showed that internet-based therapy is also something patients like. In their study, 86 percent of respondents indicated that they “definitely would” or “possibly would” try Internet-based treatment for OCD.

The study also provided encouraging evidence that OCD can be treated online, requiring only a small amount of therapist time.

Other OCD resources

Just knowing you aren’t alone in the struggle against OCD can go a long way towards your recovery. In addition to different therapies and medications, a wealth of information is available on how to handle symptoms, where to find support groups, information on the OCD community and more.

The International OCD Foundation has a great resource page here, which includes blogs, helpful tips, facts and handouts, articles from experts and more.

Also, check out the NOCD website for more information and online treatment options.

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Living with severe obsessive-compulsive disorder – The Middlebury Campus

Sarah Fagan

Six years ago, I wouldn’t have been able to get out of bed. Six years ago, it would have taken me three hours to get ready for school. Six years ago, I would have been tapping and stomping and counting in order to get out of the car, eat a meal or walk to the bathroom. Six years ago, I never thought I would be where I am today: a student and an athlete at Middlebury College. 

October is National Obsessive-Compulsive Disorder (OCD) Awareness month, and I share my story now with the hope of raising consciousness about OCD in the Middlebury community. My experience is not unique, but I look to restore a sense of hope in others and help them untangle themselves from the chains of overwhelming fears and anxieties.

I have struggled with severe anxiety and obsessive-compulsive disorder for most of my life. But six years ago — when I was 12 — this condition reached its peak. Rooted in the fear of becoming sick, my OCD took hold of me until I was immobilized and could no longer function as a human being, let alone do the things I enjoyed the most, like swimming and spending time with my younger sister. 

My anxiety-ridden obsessions were so overbearing that I was unable to complete basic tasks such as eating, sleeping, engaging in personal hygiene or walking. Stuck in a place of depressive, dark anxiety coupled with an ever-spinning wheel of compulsory behavior, I was hopeless. As my behavioral compulsions became increasingly intense and overpowering, I was eventually forced to take a leave of absence from school. 

It became apparent to me and my family that an intervention was needed in order to help me get back on track. Living in a very rural community exacerbated the difficulties of finding adequate mental health services, particularly for the intensive treatment I needed. Beginning in the spring of 2014, I enrolled in an intensive outpatient program in the Bay Area, specifically designed for adolescents struggling with severe obsessive-compulsive disorder and other anxiety-related mental illnesses. I was lucky enough to have the support from my family that allowed me to temporarily move closer to the treatment center to complete a 10-week intensive program that focused on exposure response prevention therapy, commonly known as ERP. While the end result was utterly life changing, those moments in treatment were some of the most difficult days of my life.

My therapy consisted of progressively working through behavioral changes to disassociate fear and obsessive triggers from continual behavioral rituals, or compulsions. Every day posed a new challenge, and every day I found myself getting a little bit stronger. Over time, reversing and erasing rituals became easier and easier, and I was beginning to find myself again without the angry mask of the disorder which had haunted me for so long. 

At the end of treatment, I was able to walk, eat, sleep, study and go about my day without the overbearing stress of my compulsions. I was able to swim, return to school and spend time with friends once again. Most importantly though, I was able to smile and laugh and feel something besides fear. I was happy.

Six years later,  I am still that same girl. Even though the severity of my OCD has never returned to the levels it once peaked at, I still struggle. While getting sick may not be a large fear of mine anymore, circumstance lends itself to the power of the mind. In recent years I have struggled with an eating disorder, and while there are rougher and easier patches, my anxiety is still very much a part of who I am. The difference now, however, is that I have been to that incredibly dark place. I know what it’s like to wish everything would just stop so that there could finally be some peace. And I know what it is like to lose yourself.

I have come to accept that I will never completely overcome the obsessive-compulsive disorder, but I have learned what it means to be a fighter and overcome fear. I have the tools now to help me challenge intrusive thoughts and heightened anxiety. ERP was the most effective strategy, and I still rely on the cognitive tools that my therapists helped me develop when I was in the intensive program. I continue to use practices of mindfulness and visualization, which I incorporate into my life through activities such as yoga, journaling and meditation. Honest, open communication is paramount to success. I am forever thankful for the relationship I have with my family as well as the therapists and clinicians who have provided a space for my voice and responded with love and validation throughout the years.

I used to feel ashamed of my OCD, like it was some tremendous secret I needed to protect. I have come to realize that I am not defined by a diagnosis, nor am I guilty about who I am. My struggles have made me into the woman I am today. Confronting OCD at a young age forced me to mature quickly, giving me the opportunity to appreciate the nuances of life so much more. I have learned to harness the strength to overcome whatever life decides to throw, and I believe, with every part of me, that you can too.

Haley Hutchinson is a member of the class of 2023.