Encouraging Women to Report Perinatal-Specific Symptoms of OCD and Using DSM-5 Leads to Higher Prevalence Estimates

Point prevalence of perinatal obsessive-compulsive disorder (OCD) gradually increases and peaks at close to 9% at about 8 weeks postpartum before declining, researchers found in a study published in the Journal of Clinical Psychiatry.

The researchers collected data from February 2014 through February 2017 from 580 women living in British Columbia, Canada. Women completed online questionnaires and a telephone interview in late pregnancy (mean=36.89 weeks, standard deviation (SD)=1.96) and twice postpartum: at a mean of 9.9 weeks (SD=1.94) and at a mean of 21.27 weeks (SD=3.83). They were followed from late pregnancy (at 32 weeks gestation or later) through up to 38 weeks postpartum.

Of the 580 participants, 270 provided data for 3 interviews, 182 for 2 interviews and 122 for only 1 interview. Diagnostic data were collected retrospectively for 101 patients who missed the prenatal interview and 49 who missed the early postpartum interview.

They were assessed for OCD using the Structured Clinical Interview for DSM-5 (SCID-5).

Researchers asked participants about OC symptoms they had experienced in the past 2 weeks at each interview. Participants also were asked to identify the 2-week period during pregnancy or afterward when their OC symptoms were the most intense. They were asked about infant-related harm thoughts and associated behaviors postpartum.

Estimated point prevalence of OCD diagnosis from the model was 2.6% (95% CI .4-4.8) at 6 weeks prior to delivery, 8.3% (95% CI 5.4-11.2) at 10 weeks postpartum and 6.1% (95% CI 3.3-8.8) at 20 weeks postpartum. Estimated average point prevalence during the prenatal period was 2.9% (95% CI 2.7-3.2) and 7.0% (95% CI 6.9-7.2) during the postpartum period. Weighted period prevalence during pregnancy (n=375) was estimated at 7.8% (95% CI 5.1-12.0).

At the beginning of the postpartum period, 93 of 535 participants had a diagnosis of OCD. The period prevalence through the final postpartum interview at 38 weeks was estimated with logistic regression as 16.9% (95% CI 14.0-20.2). Period prevalence through 8.8 weeks was 6.9%. Up to 13 weeks, it was 7.8%.

Incidence of new OCD diagnoses was estimated at 4.7 (95% CI 3.2-6.1) new cases per 1,000 women per week postpartum, with a total of 49 new cases reached by 22 weeks postpartum. The average person time of follow-up was 18 weeks. Cumulative incidence of new cases of OCD was 5% for 4 weeks, 6% for 8 weeks, 7% for 12 weeks, and 8% for 16 weeks postpartum, respectively. By 6 months postpartum, cumulative incidence rose to 9%.

Of the 100 women who reported symptoms during the perinatal period that were consistent with a diagnosis of OCD, 60 reported that clinical levels of OCD began during the pregnancy or postpartum.

These prevalence estimates are higher than those found in previous studies, which the researchers attributed to more comprehensive evaluation of perinatal-specific OC symptoms and differences between DSM-IV and DSM-5 diagnostic criteria. This study was the first to use DSM-5 diagnostic criteria.

Limitations included the fact that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts and that the history of OCD prior to participation was collected only for participants who experienced OCD symptoms.

The study authors said, “Our study suggests that when women are encouraged to report their perinatal specific symptoms, and current diagnostic criteria are applied, estimates for perinatal OCD may be higher than previously believed.”

Reference

Fairbrother N, Collardeau F, Albert AYK, et al. High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psychiatry. Published online March 23, 2021. doi: 10.4088/JCP.20m13398

The impact of anxiety disorders and how to manage them

Alice Bertoldo, psychologist (GGZ, NIP) and psychosomatic psychotherapist, trained in Cognitive Behaviour Therapy and Psychodrama, tells us how to deal with an anxiety disorder.

Anxiety disorders are among the most common mental health conditions. Often, they are paired with other mental health issues, such as major depressive disorder or personality disorders. Most people who are experiencing anxiety disorders try to cope with life using alcohol or drugs.

Cognitive schema

A cognitive schema is a mental framework that helps individuals to process and organise information. Cognitive schemas come from Core Beliefs; the way we see the world, ourselves and our future. When Cognitive schemas are biased they process ambiguous stimuli from the environment as a “catastrophe” or as a “threat”. Thus, the mind perceives as ‘dangerous’ stimuli that otherwise might be neutral.

How an anxiety disorder can impact your life

Anxiety disorders can impact life in a variety of ways, such as:

  • You avoid feared places and situations
  • You can’t sleep, suffer from insomnia
  • You postpone tasks
  • You isolate yourself socially
  • You suffer from indecisiveness
  • You overthink everything
  • You have difficulty trying new things

Key factors

There are several factors that play a part in developing anxiety such as:

  • Genes
  • Chemical imbalance in the brain
  • Trauma
  • Social media and isolation
  • A lifestyle that does not suit your needs and wants

Four types of fear

Anxiety can be grouped into four different conceptualisations of fear:

1. Catastrophic

The fear that something very negative and catastrophic like the “worst-case scenario” is going to happen. It includes separation anxiety, arachnophobia (the fear of spiders), ophidiophobia (the fear of snakes).

2. Evaluation

The fear of being watched and judged, such as in social anxiety, selective mutism and glossophobia (fear of public speaking).

3. Losing control

The fear of losing control (panic attacks and agoraphobia).

4. Uncertainty

Feeling uncertain (generalised anxiety disorder and obsessive-compulsive disorder).

How to overcome and manage anxiety

Let’s have a look at the different ways you can help overcome and manage anxiety:

Cognitive Behaviour Therapy (CBT)

This is particularly useful to treat anxiety disorders. In particular, exposure techniques (in-vivo or imaginal) have proven to be highly effective.

Psycho-education

This is the very first step to help the person realising that avoidance of feared situations and places maintains anxiety.

Mindfulness

This can help as it will teach you to pay attention to the present moment, to accept thoughts and feelings without judging them and focusing on breathing.

Bodyscan

When you lay or sit comfortably, close your eyes and start to scan your body from your toes to your head and whenever you feel tension, relax that spot. Focus on your breathing and on the present moment.

Walking meditation

While you walk, slowly focus on the sensations you are experiencing while walking. Focus on your toes, and feet and your legs’ movement. Do this for 15 minutes.

Deep breathing

This is a fantastic tool to thin out the “white fog” (anxiety) in your mind and to feel grounded. Sit comfortably and breathe for six seconds, making sure that your stomach fills in with air. Leave your shoulders and chest still and relaxed. Let the air in via your stomach only. Breathe out the air from your stomach and then breathe in again. 

Sports

Exercising can reduce anxiety.

Walks in nature

Exercising while being in nature can help reduce anxiety even more.

Alcohol smoking

Limit your intake of alcohol (especially in the evening) and smoking.

Do something fun and creative!

Use your passions to momentarily distract yourself from the problem. Do activities in which you can use your hands such as painting for instance.

Don’t be afraid to seek professional help

In conclusion, to overcome anxiety disorders, it’s advisable to ask for professional help. Therapy allows you to get to know yourself and your vulnerabilities and acquire a different and more healthy perspective of yourself. Moreover, there are several ways through which it’s possible to manage anxiety, for instance with mindfulness, sports, art, and by surrounding yourself with nice people.

Alice Bertoldo, psychologist and psychosomatic psychotherapist, offers in-person and online therapy sessions to treat anxiety disorders, depression and trauma. 

Seeking Help: My Orthorexia Journey

I thought I was done with the dating game when I met my husband Matt in 2010. I was wrong! Make no mistake, we’re happily married. What I’m talking about is finding a therapist. When my primary care physician diagnosed my anxiety, obsessive-compulsive disorder and an unspecified eating disorder, I figured he would provide me with several resources. At this point, I thought I had already taken the biggest step forward by admitting I needed help. I didn’t know what that help would look like and apparently neither did my doctor. He advised me to just “look online” for resources.

Having never looked for a therapist before I told myself it couldn’t be that hard. I’ll just do what I always do, turn to Google. However, when you type in “male therapist for eating disorders, OCD and anxiety,” you don’t really find what you need. There were several local eating disorder clinics for in-patient care, their websites were painted with images of women, who spoke about their battles with anorexia and bulimia but none of this was relatable to me.

I was a 34-year-old male with an eating disorder that didn’t even have a label. I often questioned whether or not I actually had an eating disorder since I was still eating food and not purging. I didn’t see the need for in-patient care but what other options were there? Nothing matched my needs, plus I had no idea exactly what I even needed at that point.

Talk about feeling lost! I was frustrated, angry and alone. I felt invisible to our country’s mental health care system, especially as a guy who has some weird relationship with food. Already at my lowest point mentally, physically and emotionally, I gave up my search for a couple of days. I couldn’t handle it. Finding a therapist felt like the straw that broke the camel’s back. Maybe I would just have to face the fact that I’m just not fixable. Perhaps, I’m sentenced to this hell I’ve been living in for so long. And who knows, this unspecified eating disorder thing sounds made up so maybe I’m not really that sick.

I didn’t want to waste mental health resources on my situation when there are other people out there a lot worse off than me. Man, talk about being unable to see the gravity of my own situation. This disillusionment was the result of two major factors: being a male with one of the “other” eating disorders and the simple lack of available mental health resources.

I resumed my search after a couple of days. My results revealed I was only going to be able to address some of my issues with a therapist. So I focused on my anxiety and OCD first. I’ve later learned this was the right decision for my specific situation but I stumbled across that revelation on my own, not with any medical guidance. I sent out over twenty messages to prospective therapists, but the majority resulted in the following responses:

“We’re currently not accepting new patients.”

“We can schedule you for a consultation in 3 months.”

“We’re unable to help you with regards to your specific conditions.”

At least they responded because some of these therapists never even returned my message. Then one day, a counselor named Sean replied. We connected over video chat for a 15-minute consultation. His approach felt like the perfect fit for my anxiety and OCD issues, which ultimately stemmed from unresolved pain during my adolescence. Sean admitted he hadn’t dealt with many eating disorder cases but was still willing to work with me. I am forever grateful for his willingness to grow with me.

We reconnected the following week for my first appointment. Match.com could not have made a better connection. A few sessions into therapy with Sean, my anxious and obsessive thoughts were starting to subside. My mind cleared just enough for me to tackle the next obstacle in my way, that unspecified eating disorder.

I started looking for nutritionists in my area. The eating disorder recovery clinics just were not a fit for me. Again, I felt like I wasn’t sick enough to go plus I felt I didn’t meet their demographic. I was a guy with an “other” eating disorder, whatever that is. I knew I was sick. I was at my lowest weight ever, always cold with a low pulse and constant body pain. Yet, I couldn’t wrap my mind around what was wrong with me, which escalated when it seemed professionals couldn’t either.

The first nutritionist I spoke with seemed well-versed in sports nutrition. She could develop a nutrition plan to build muscle but she was clueless when it came to my eating disorder. Her focus was macronutrients and lots of protein, not the disordered mind. Yes, I needed someone who was going to help repair my body but I also needed someone who held the basic human compassion to understand my mental turmoil around food.

I thanked her for the consultation and resumed my search. I repeatedly told Matt how tired I was of this. Maybe I’ll just work with my therapist on the other issues and hope the eating disorder fixed itself. Then one day I stumbled across my RDN’s website. I liked her approach to intuitive eating and set up a consultation. She seemed like the perfect match for me. She knew her nutrition but she was always willing to work through me and my orthorexic thoughts. Kassandra is not a therapist, but she is a human. I knew her and Sean were my dynamic duo.

One catch, though, the nutrition program costs thousands out of pocket. Insurance wouldn’t cover it. Don’t even get me started on that!

I instantly flung myself on the bed in a fit of tears. I didn’t want to put that financial strain on us for some stupid non-descript eating disorder. Matt, like he always does, reassured me that I was worth it. He said, “The most important thing is helping you get better.” The next day I enrolled in my nutrition program with Kassandra who has been by my side each step of the way. She has helped to restore me physically while Sean has helped repair my mind and soul.

Admitting I needed help was hell. I initially felt like a failure to myself and those around me. Finding help was even harder. This time I felt invisible or unimportant to the system. I’ve seen several friends struggle with finding help but I constantly reassure them that they can’t give up hope. They’re worth it, just like I am.

Our mental health professionals are overwhelmed and I worry the situation will worsen. We must change the narrative and make sure everyone’s voice is heard and understood so nobody has to feel invisible or like their problems don’t matter. Mental illness does not discriminate. We are always told to embrace our uniqueness. My hope is that we can fully live up to that expectation so that one day we can live in a world where everyone feels worthy of help and most importantly, can find it!

 

Previously Published on orthorexiabites.com

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Living with OCD in a post-Covid world

Govind Sekhar is a Bengaluru-based digital marketing specialist. He also has Obsessive-Compulsive Disorder (OCD), an anxiety disorder due to which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Such repetitive behaviour can significantly interfere with a person’s daily activities and social interactions.

For him, and many others living with the disorder, the pandemic was a huge trigger. “The news alone was triggering. My partner’s brother was in China and when he picked him and came from the airport, it was extremely difficult,” he says.

Increasing numbers

Dr Naveen Jayaram, consultant psychiatrist, says that many people who had obsessive-compulsive personality have, over the course of the past year, developed OCD. The signs can be hard to miss as they simply indulge in behaviour that could be misconstrued as simply following the guidelines.

So how does one define ‘excessive’? “How much time is the person spending on worrying about this? Have they become fixated on the virus and following precautionary methods. Yes, wash your hands, but if they are washing it 10 ten times, it is a problem,” he says. 

The compulsiveness does not simply have to be in terms of indulging in behaviour to help prevention but can also be seen in terms of an obsessive fear of contracting the virus.

“While most people have become more careful than before, people with OCD will clearly overdo it. And, they are always aware that the behaviour is hampering their day-to-day life,” he says.   

Nithya J Rao, co-founder, Heart It Out says that about 20 – 30 per cent of their clients came with a diagnosis of OCD and most of them fall within the 25-39 age group.

“For some people, it’s a temporary trigger, which probably will worsen and then revert back to a healthy amount of anxiety when the environment becomes safer, but for some, the situation has deepened the symptoms,” she says. 

The biggest struggle, she observes, is the knowledge that it’s irrational. “People with OCD know that their fears aren’t true. But, because they are being exaggerated by the news, and there is constant fear-mongering on social media, they can’t now just brush it off as a stray thought,” she says. The self-doubt coupled with the compulsions takes away from their time being used productively and efficiently as well as causes emotional distress. 

Share the struggle

For many, sharing their struggles have become difficult because of people have co-opted the term ‘OCD’, taking away from the people that actually
struggle.

“I met a couple recently. The wife was obsessed with following the precautionary measures and would force everyone in the family to do so. Initially, everyone obliged because they thought she was being careful. After a point, however, they couldn’t comply,” says Dr Jayaram. In most cases, people started seeking help after the lockdown as others in their life started to show irritation over their obsessive behaviour.

“Awareness is important. You need to take note of the small things so people can get the needed help earlier,” he says. 

Govind made it a point to stay away from news and unfollow social media pages or people who constantly kept posting about the pandemic.

“I went to a couple of close friends for legitimate information and didn’t get lost in the clutter that gets shared on platforms,” he says.

While the guidelines that asked people to follow basic hygiene routine and sanitise proved to be a source of relief for him, for others the way they have been communicated didn’t help.

“They mostly only deal with what to do and what not to do. There is no reassurance, or information about where to seek help, or how to deal with it after one tests positive. It gives no information on emotionally coping with the situation, which makes it all the more confusing and worse,” adds Nithya.

Ask for help 

Guidelines and safety precautions are important, especially with the increasing numbers.

“Safety is difficult to define. If you feel distressed that the precautionary methods are taking over their life, reach out for help. Mindfulness and meditation help,” says Dr Jayaram.

Keeping himself occupied helped Govind during this time. “I started a company, which was something I have always wanted to do. I devoted all my time to it, which helped. I also kept my therapist close and got help to any employee that required it through a friend,” he says.

 

Signs to watch out for

Very often signs that point out the condition can go unnoticed as many are unaware. Nithya J Rao, co-founder, Heart It Out, lists out some things to watch out for:

Compulsively checking the news

Agitation

Compulsive hoarding of pamphlets and information

Hypervigilance

Impulsivity

Meaningless repetition of one’s own words

Repetitive movements

Ritualistic behaviour such as repeated sanitising

Social isolation

Increased anxiety

Apprehension

Guilt

Panic attacks

Lack of motivation

Anger outbursts

Meltdowns

Food aversion

Nightmares

Repeatedly going over thoughts. 

Here are some tips she suggests for someone with OCD, who may be struggling to cope during this time:

Create a reasonable safety plan.

Be in touch with a therapist that can help manage flareups.

Limit news consumption

Limit listening to other people’s opinions on what’s right to do.

Practice self-compassion

Develop healthy distractions such as hobbies that consume time (example: carpentry, puzzles, gaming)

Ask for support

Share with peers

Tingling tongue and anxiety: Causes, treatment, and more

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When a person is anxious, their body prepares them for a fight-or-flight response, triggering a wide range of physical changes. One of these changes is that the blood vessels constrict. This constriction reduces blood flow, which can cause numbness and tingling, especially in the feet and hands. It is also possible to experience tingling in the tongue.

A tingling tongue is a relatively common oral symptom. Although it can sometimes be due to physical issues, such as nerve damage, anxiety can also lead to tingling.

A 2015 case study reports on a 32-year-old man who had experienced tingling on the tip and right side of his tongue for 5 months. An examination revealed no physical cause.

Based on the man’s other symptoms, doctors diagnosed him with psychogenic lingual paresthesia, which is tingling in the tongue for psychological reasons, along with mixed anxiety and depressive disorder. The tongue sensation resolved after he began taking an antidepressant.

Sometimes, anxiety causes tics, which are sudden, uncontrolled, repetitive movements. Some tics, such as chewing or sucking motions, can injure the tongue.

Some injuries may lead to numbness, pain, or tingling. Although anxiety is ultimately the cause, it is important to seek medical treatment for the injury.

How to Incorporate Videoconferencing Into OCD Treatment

Evidence-based treatments for obsessive-compulsive disorder (OCD) such as exposure therapy and psychopharmacology are often unavailable to people with OCD. Faculty at the Center for OCD and Related Disorders, located in the Columbia University Medical Center in New York, have studied digital health approaches such as videoconferencing to improve access to OCD treatment. They found 5 useful ways to incorporate the technology.

1. Hybrid EX/RP: Exposure with response/ritual prevention delivered in a hybrid format that includes both in-person and videoconferencing, can be effective. Therapists can use video to conduct home visits, which eases travel burden. Therapists could also start therapy in person and plan transition to video if the sessions go well. This also reduces travel burden and can make scheduling easier.

2. Fully remote EX/RP: Fully remote therapy is cost-effective and accommodates patients who are home-bound, live in rural areas, or lack access to OCD treatment facilities. Patients with “substantial shame” about their symptoms may be more amenable to remote treatment, the researchers state. Because patients are at home, exposures could promote “independent skill development and generalization of learning to real-life contexts.”

3. Videoconferencing-assisted psychopharmacology: This option expands consult and treatment beyond metro centers where most programs are located. Patients may also appreciate having the option to pursue medication, EX/RP, or both. Therapists would not be able to perform in-person neurological exams, which is a limitation of this option.


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4. Virtual support groups: This solution compliments EX/RP and psychopharmacology. Participant surveys suggest support groups can reduce loneliness, isolation, and stigma while reinforcing CBT techniques. The ability to see one another makes this option more engaging than phone support groups.

5. Videoconferencing-assisted clinical supervision: A shortage of experienced clinicians limits access to evidence-based OCD treatments. Videoconferencing helps increase access. In addition, supervisors can view trainees’ recorded treatment sessions and provide feedback. They can also listen in on trainees’ sessions and offer solutions when trainees get “stuck.”

Limitations include the fact thatthere is limited research on outcomes for fully remote EX/RP and none for video-assisted psychopharmacology. In addition, virtual support groups and video-assisted supervision need refinement and testing before broad implementation.

“Although digital health technologies such as videoconferencing are unlikely to replace

in-person OCD treatment, they are quickly becoming important tools to increase access and improve care for this debilitating, undertreated condition,” the researchers conclude.

Disclosure:Dr HB Simpson has received research support from Biohaven Pharmaceuticals, royalties from Cambridge University Press and UpToDate, and a stipend from the American Medical Association for her role as associate editor at JAMA Psychiatry.

Reference

Kayser RR, Gershkovich M, Patel S, Simpson HB. Integrating videoconferencing into treatment for obsessive-compulsive disorder: Practical strategies with case examples. Psychiatr Serv. Published March 26, 2021. doi:10.1176/appi.ps.202000558

Spit samples uncover genetic risk factors for paediatric obsessive-compulsive disorder

When Sam was 14 years old, his mind was so full of fear, he couldn’t think about anything else.

“I had really bad tendencies,” says Sam, now 17. “I would dehydrate myself to prevent going to the bathroom. I was very picky about things being sanitary. It was getting in the way of everything.”

After school he would shower for up to two hours, using two bars of soap. He would then worry that the books he had brought home weren’t clean enough to bring in the house. Sam says that when things were at their worst, he was diagnosed with obsessive-compulsive disorder (OCD).

Researchers at the University of Calgary and The Hospital for Sick Children (SickKids), in Toronto, have discovered genetic risk factors for OCD that could help pave the way for earlier diagnosis and improved treatment for children and youth.

“Our group made the first finding of a genome-wide significant risk gene relevant to childhood OCD,” says Dr. Paul Arnold, MD, PhD, co-principal investigator, a professor and director of The Mathison Centre for Mental Health Research and Education at the Cumming School of Medicine. “We’ve known that OCD runs in families, but we hadn’t identified and validated specific genetic risks of OCD symptoms in children and youth until now.”

Paul Arnold

The research drew on the Spit for Science study, a research project led by SickKids looking at how genes interact with the environment to impact physical and mental health. Participants from the community were recruited via an innovative research design run out of the Ontario Science Centre, which has generated a diverse sample of 23,000 participants thus far. Participants provide a DNA sample through their saliva, do a cognitive task, and complete questionnaires on their health, lifestyle and behaviours.

Genetic variant in the gene PTPRD linked to greater risk

In this study, saliva samples from over 5,000 children and youth were scanned and compared to participant responses using the Toronto Obsessive-Compulsive Scale (TOCS). The TOCS is a questionnaire used to evaluate obsessive-compulsive traits developed by Dr. Arnold and the team at SickKids. After looking across millions of genetic variants from the saliva samples, the team identified that children and youth with a genetic variant in the gene PTPRD had a greater risk for more obsessive-compulsive traits. The findings were published in Translational Psychiatry on Feb. 3, 2021.

“Discovering the genes involved in OCD is critical to help improve patients’ lives. It is still early days, but our hope is these findings will lead us to understand the causes of OCD, which in turn could help identify people with OCD sooner and develop better treatments,” says Dr. Christie Burton, PhD, lead author and research associate in the Neurosciences and Mental Health program at SickKids.  

Christie Burton, Jennifer Crosbie and Russell Schacha

The research team, which also includes co-principal investigators, Drs. Jennifer Crosbie, PhD, clinical psychologist at SickKids, and Russell Schachar, MD, psychiatrist at SickKids, highlight that a greater understanding of the underlying genetics may eventually be an important complement to clinical assessment and could help guide treatment options in the future.

OCD can present very differently and at various ages in each individual, adding to the challenge of treatment and diagnosis,” says Crosbie, who is also an associate scientist in the Neurosciences and Mental Health program at SickKids. “Studies like this one are an important step towards developing precision medicine approaches for mental health.”

OCD diagnosis surprised Sam and his family

With therapy and medication, Sam has been able to face his obsessions and compulsions, ride out the anxiety and control his actions. Looking back at his childhood, Sam says he had some OCD tendencies as early as elementary school, but neither he nor his family realized he had a mental illness. The researchers hope that by understanding the genetics of OCD, they can develop better treatments, improve outcomes and diagnose youth like Sam earlier.

“At first I wasn’t sure what to do with the diagnosis, it was very foreign, I didn’t want to perceive myself as having a mental health issue,” says Sam. “But, knowing I have OCD helped me overcome the challenges. With therapy and medication, I’ve stopped OCD from overtaking my life and taken back control of my thoughts.”

Sam is a real teenager, but Sam isn’t his real name. He says due to the stigma around OCD he would prefer to remain anonymous.

This study is supported by the Canadian Institutes of Health Research and SickKids Foundation.

What Are the Different Types of Anxiety?

There are several different types of anxiety or anxiety disorders. Here are some of the more common types according to the National Institute of Mental Health.

Generalized anxiety disorder (GAD)

If you have generalized anxiety disorder (GAD), you’ll likely experience excessive worry that’s difficult to control. This worry often takes the form of rumination, or spending time excessively thinking or mulling over different events in the future — how they may play out and how you may deal with them.

It’s not uncommon to have symptoms and not be able to explain why. For people with GAD, symptoms like those listed above are present most days and for at least the past 6 months.

Social anxiety disorder/social phobia

Social anxiety disorder, also referred to as social phobia, is a fear of being embarrassed, humiliated, or criticized in a public setting like school or work.

You may have trouble talking to people or being in a large group. It’s not uncommon to avoid the places and situations that trigger this phobia.

Panic disorder

Panic disorder is characterized by recurring, unexpected panic attacks.

They often happen without warning and result in physical symptoms like chest pain, shortness of breath, sweating, shaking, and dizziness. They also may involve feeling dissociated from reality or having a sense of impending doom.

In general, an attack lasts less than 20 minutes.

Phobias

Phobias and specific phobias involve an irrational, overwhelming, and excessive fear of a place, situation, or object. Some of the more common phobias include:

  • acrophobia (fear of heights)
  • claustrophobia (fear of tight spaces)
  • aerophobia (fear of flying)
  • hemophobia (fear of blood)
  • trypanophobia (fear of needles)
  • hydrophobia (fear of water)

Separation anxiety disorder

Separation anxiety disorder is most commonly diagnosed in kids, especially young children. However, adults can also experience this type of anxiety if they have extreme fear about something bad happening to a person in their life.

In children, the symptoms of fear, panic, worry, and anxiety surface when they’re separated from a parent or loved one. Adults may have extreme fear and worry about something tragic happening to a family member or loved one, even when they’re together.

Agoraphobia

Agoraphobia often occurs in response to panic attacks. If you have agoraphobia, you feel extreme fear or anxiety about having a panic attack or fear that something bad may happen in a specific place — usually outside the home.

You may avoid that place, usually confining yourself to the home, in order to stave off the possibility of something bad happening where you can’t access support or help.

You’ll often avoid feared places and situations at all costs.

Other types of anxiety

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) also lists other, less common types of anxiety, including:

  • selective mutism
  • substance- or medication-induced anxiety disorder
  • anxiety disorder due to another medical condition

Some mental health conditions are commonly referred to as anxiety disorders and may have once been classified as one, but now have a separate diagnostic category in the DSM-5.

These include:

  • Obsessive-compulsion and related disorders (OCRDs), which includes obsessive-compulsive disorder (OCD)
  • Adjustment disorders, such as post-traumatic stress disorder (PTSD)

People with trauma exposure at increased risk for obsessive-compulsive symptoms

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Trauma exposure appeared significantly associated with obsessive-compulsive symptoms among a community sample, according to a presentation from the Anxiety and Depression Association of America annual conference.

These findings aligned with those of prior research efforts into obsessive-compulsive symptoms following trauma exposure.

“Research back into the 1990s suggests endorsement of trauma is significantly, independently associated with OCD symptoms,” Rose Luehrs, MA, MS, a clinical psychology doctoral candidate at Suffolk University in Boston, said during the presentation. “Some individuals may be at an increased risk for developing comorbid PTSD plus OCD following trauma exposure compared with others. OCD and PTSD symptoms following trauma can be difficult to distinguish from traditional PTSD given the conceptual overlap.”

Leuhrs and colleagues aimed to assess the potential relationship between diagnosis of PTSD and obsessive-compulsive symptoms among the general population. They analyzed data included in the restricted access National Comorbidity Survey Replication (NCS-R) dataset, since this version allowed the researchers to observe various types of traumatic events that individuals had endorsed. The first part of the NCS-R included 9,282 participants who comprised a nationally representative sample aged 18 to 74 years. The second part included 5,692 participants. A total of 1,808 were assessed for OCD. Luehrs and colleagues selected for analyses PTSD and obsessive-compulsive symptom data that had been assessed via the WHO World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI).

Results showed participants’ worst traumatic event, on average, occurred at age 24.1 years. Participants endorsed an average of 11.5 PTSD symptoms, and 6.8% of the sample met criteria for lifetime PTSD and 1.6% for obsessive-compulsive symptoms at the clinical threshold. Further, bivariate correlation showed lifetime PTSD was significantly and positively associated with several obsessive-compulsive symptoms, including recurrent concern about germs and washing; recurrent impulse to check things; recurrent impulse to arrange and order things; urge to save unneeded things; recurrent disturbing thoughts about sexuality or religion; recurrent unpleasant thoughts about morality or sin; recurrent concern about doing something terrible; and recurrent concern about being seriously ill.

The researchers also noted significant, positive associations between type of trauma exposure and obsessive-compulsive symptoms, including experiencing a natural disaster and concern with dirt/germs and excessive washing; being mugged, held up or robbed and recurrent impulse to order or arrange things; and having a child with a life-threatening illness and excessive concern with dirt/germs. Participants who learned about a traumatic event happening to a loved one were more likely to exhibit recurrent impulse to order and arrange things, compulsion to collect unneeded things and excessive concern with dirt/germs.

“The literature both from a clinical and research standpoint would really benefit from having some more rigorous investigations on the relationship between trauma and OCD and PTSD for specifically treatment-seeking samples,” Luehrs said. “We really need research in these areas to clearly distinguish the theoretical differences between potentially overlapping symptoms in PTSD and OCD. We have difficulty differentiating symptoms of OCD from PTSD following trauma, and this may contribute to a lack of clarity around terminology and intervention planning.”

Reference:

Luehrs R, et al. The relationship between trauma, OCD and PTSD: Translating research into practice. Presented at: The Anxiety and Depression Association of America Annual Conference; Mar. 18-19, 2021 (virtual meeting).

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Social Anxiety and Obsessive-Compulsive Disorder Are Common Among Persons With Multiple Sclerosis at King Abdulaziz Medical City, Riyadh

This article was originally published here

Cureus. 2021 Feb 28;13(2):e13619. doi: 10.7759/cureus.13619.

ABSTRACT

Background Multiple sclerosis (MS) is associated with a physical disability and disturbed psychosocial functioning in young people. Many psychological and psychiatric comorbidities have been reported in MS. Objective To determine the frequency of social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) among MS patients and their relation to MS severity. Methods A cross-sectional survey was conducted in an adult MS cohort. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Social Phobia Inventory (SPIN) were used to determine the presence and severity of OCD and SAD. The Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY) was used for statistical analysis. The Mann-Whitney U test and logistic regression were used to assess the association of the two diseases with the severity of MS. Results A total of 145 persons with MS (pwMS) were studied. The mean age was 33.5 (±8.5) years; the mean duration of MS was 7.2 (± 5.1) years. The majority (74.1%) were women; 57.3% were married; 63% had a college education; 50% belonged to the higher middle-class socioeconomic strata. Relapsing-remitting multiple sclerosis was the most common type of MS (92.2%). The mean Expanded Disability Status Scale (EDSS) score was 2.24 (±2.19). SAD was reported by 26.9%, and OCD was reported by 31% of the cohort. PwMS with walking difficulty but not wheelchair-bound had a statistically significant increased risk of SAD (p = 0.036). There was no direct association between MS-related disability and OCD. However, pwMS with SAD were more likely to have concomitant OCD (t=4.68, p-value 0.001, 95% CI: 0.47-1.16). Increasing disability was associated with higher chances of developing social anxiety and, in turn, OCD (t=3.39, p-value 0.001, 95% CI: 0.66-2.52). Conclusions Social anxiety and obsessive-compulsive disorders were present in nearly one-third of pwMS. Impaired walking but not wheelchair dependence was associated with social anxiety. PwMS with SAD were more likely to have obsessive-compulsive disorder.

PMID:33816018 | PMC:PMC8010157 | DOI:10.7759/cureus.13619

Psychologist shares skills to help families cope when a loved one has OCD

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Credit: The Guilford Press

New York, NY–When a loved one has Obsessive-Compulsive Disorder (OCD), it’s a constant struggle. It hurts to see your spouse so anxious or your teen spending so much time alone. This is especially true right now, as the COVID-19 panic has exacerbated OCD symptoms for many people who struggle with the disorder.

Psychologist Jonathan Abramowitz is an internationally recognized expert on OCD and anxiety disorders. Over the course of his 25-year career, he has come to believe that OCD isn’t an individual issue; it is a family issue.

The key to successfully helping your loved one? First you must focus on your own behavior and learn to reduce patterns of “family accommodation,” such as helping with rituals, tolerating avoidance of triggers, or looking the other way as the person with OCD performs obsessive-compulsive rituals.

“I’ve worked with countless families affected by OCD. And I’m here to tell you that it doesn’t have to be this way. You can turn things around. You don’t have to walk on eggshells. You don’t have to argue…The solution is to provide the kind of consistent support that helps your relative develop the confidence and skills to manage OCD in a healthier way and without needing to lean so much on you or others,” Dr. Abramowitz writes in his new book, The Family Guide to Getting Over OCD.

Use the ‘SMART method’ to reduce family accommodation and help your loved one with OCD

Dr. Abramowitz recommends using the acronym SMART to help you optimize your goals and maximize your likelihood of success. Here’s how it works:

S is for SPECIFIC — Make your goals as detailed and specific as possible. Simply saying “My goal is to stop accommodating” is too hazy. Instead, use “I will no longer help Ariel check the doors and appliances before bed.” Try to choose goals that rest solely on your own actions (for example, “I will leave the house regardless of whether Brandon is ready to go” vs. “Brandon will stop preforming rituals that make us late.”) You’ve got a better chance of meeting goals when they’re fully under your control. Keep the focus on changing your own behavior.

M is for MEASURABLE — Your goals for reducing accommodation also need to be measurable so that you know when you have succeeded. Choose concrete goals that you can keep track of. “Stop throwing away items Antonio has deemed ‘contaminated'” provides a specific target to be measured: whether or not you’ve thrown anything away. On the other hand, “Do a better job of not accommodating Antonio’s OCD” is not measurable: How will you decide if you’ve done a better job? Setting goals to change observable behaviors (that someone else would be able to see) is your best bet for making sure your goals are measurable.

A is for ACHIEVABLE — Your goals should challenge you to stay focused and committed
to your program, but at the same time they need to be realistic. If you set goals that stretch you (and your loved one with OCD), you will continue to put in the effort to achieve them. On the other hand, you probably won’t stay committed to goals that are too far out of reach. For example, “I will never reassure my sister again” is probably unattainable, especially if you’ve become accustomed to providing reassurance and your sister is clever about getting it from you. Instead, “I will stop answering my sister’s texts when she asks for reassurance” is probably a more reasonable (and also a more specific) goal.

R = RELEVANT — Without an emotional tie to your goals, you’ll lose the motivation to stick with them. In this case, they should obviously relate to (1) helping your loved one develop self-confidence and the ability to manage anxiety on her own, (2) reducing your involvement in her OCD symptoms, and (3) improving your and your family’s quality of life. Tying goals to one or more of these things will build your commitment to success.

T is for TIME BOUND — Finally, your goals should have a time frame. This means stipulating when you’ll begin changing your behavior–for example, “beginning tomorrow.” By specifying a time frame, you make your goal a priority, which increases motivation. Goals without specific time frames are less likely to be met because you feel you can put them off.

Overcoming family accommodation of OCD is not easy. “But remember,” says Dr. Abramowitz, “by gently but firmly encouraging the person you care about to face their fears, you can stop being controlled by their OCD. Ultimately your relationship will grow stronger, and your whole family will grow more confident and hopeful.”

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OCD among new mothers more prevalent than previously thought

Obsessive compulsive disorder (OCD) among those who have recently given birth is more common than previously thought, and much of this can be attributed to thoughts of harm related to the baby, new UBC research has found.

The researchers also learned that OCD can go undetected when new parents aren’t asked specifically about infant-related harm.

OCD is an anxiety-related condition characterized by the recurrence of unwanted, intrusive and distressing thoughts. If left untreated, it can interfere with parenting, relationships and daily living.

The study estimates that eight per cent of postpartum women report symptoms that meet criteria for a diagnosis of OCD at some point during pregnancy, and 17 per cent do so in the 38 weeks after delivery. Prior research had estimated the prevalence of OCD at about 2.2 per cent over the pregnancy and postpartum period.

“What really matters now is that we screen for and assess OCD among perinatal women with perinatal-specific questions and assessment methods. It is especially important that we include questions about intrusive thoughts of infant-related harm. This ensures that perinatal women suffering from OCD are not missed and can be directed toward appropriate treatment,” said Dr. Nichole Fairbrother, a clinical associate professor in the UBC department of psychiatry who was lead author of the study. “Perinatal OCD is common and we have a responsibility to identify those who experience it and ensure they receive timely, evidence-based treatment.”

The study is one of the first to use newly updated criteria for diagnosing OCD which somewhat lowers the threshold for a diagnosis

However, the researchers also believe they uncovered more OCD by asking the right questions. New mothers appear not to recognize their infant-related thoughts in the standard questions asked during OCD assessments. By including specific questions about harm to the baby, the researchers were better able to uncover symptoms.

“The traditional questions are framed in a way that doesn’t really help women connect to the intrusive thoughts they’ve had about their baby.” said Fairbrother. “If they don’t recognize their experience in the questions that are asked, they may be underreporting.”

Fairbrother and her team from UBC, the University of Victoria, the Women’s Health Research Institute and King’s College London surveyed 580 women in British Columbia during their third trimester of pregnancy and for six months afterward. Participants completed online questionnaires and interviews designed to assess the presence and severity of OCD symptoms.

The prevalence of OCD among new mothers peaked approximately eight weeks after delivery at nearly nine per cent. The study data suggests that it resolves naturally among some women as they become used to parenting, but for others it persists and may require treatment.

It’s important for care providers to know when women are most at risk, because they may be reluctant to report their symptoms.

“When mothers have these kinds of thoughts they might think, ‘There’s something wrong with me and I can’t tell anyone because there could be terrible consequences for me and my baby,’ Fairbrother said.

Education for both women and their care providers is needed, she said. If care providers are able to distinguish between thoughts that are perfectly normal, those that might indicate a need for treatment, and those that might signal a threat to the baby, they are less likely to err on the side of caution in a way that would have consequences for women and their babies.

The study was published today in the Journal of Clinical Psychiatry.