Are Treatments for Psychiatric Disorders among Children Safe and Efficient?

Psychiatric Disorders Among Children

Researchers review the antidepressants currently used for psychiatric disorders among children and their possible adverse effects.

Depressive disorders, anxiety disorders, obsessive-compulsive disorders (OCD), and posttraumatic stress disorders (PTSD) are psychiatric disorders that are often seen among children and adolescents. A recent systematic review and meta-analysis carried out in the US and published in JAMA Psychiatry have set out to examine the use of certain antidepressants for psychiatric disorders among children and adolescents.

Currently, first-line treatments for this young subgroup of patients are antidepressants called selective serotonin reuptake inhibitors, also known as SSRIs. Another group of antidepressants is called serotonin-norepinephrine reuptake inhibitors, also known as SNRIs. Due to a lack of compelling evidence, SNRIs considered second and third-line treatment options. The review investigated the efficacy and safety of these antidepressants, compared to a placebo, for psychiatric disorders in children and adolescents.

The results obtained from the review of 36 trials, including 6,778 participants, demonstrated that SSRIs and SNRIs provide better treatment than placebo for children and adolescents diagnosed with these psychiatric disorders. However, the authors of the review state that the overall difference between drug and placebo is small and differs between disorders, with a larger response seen in anxiety than depression, particularly with the SSRIs.  This variability in drug-placebo response is attributed to the fact that the response to placebo was higher in the pediatric depression groups.

The authors explain that this difference between SSRIs, SNRIs, and placebo in children and adolescents with depression could be due to the lack of clearly defined criteria for the diagnosis of depression, which is further complicated by the fact that there is a high rate of comorbidity of depression with other mental disorders such as anxiety.  In addition to this, the patients with OCD demonstrated a low response to both drug and placebo treatments when compared to both anxiety and depression.

This review found that patients receiving an antidepressant reported more adverse events and discontinuation of treatment than those receiving placebo. These results correspond to the results from other meta-analysis studies conducted in the past, in which increased suicide and suicide attempts were observed in children and adolescents receiving SSRIs and SNRIs. These results highlight the reservations surrounding the safety of antidepressants in children and adolescents.

To conclude, the authors state the main findings of this systematic review and meta-analysis are:

  • The similar response rate for depression and anxiety deserves subsequent investigation, which could lead to a change in current prescribing guidelines.
  • The difference in responses to drug treatments and placebo between OCD and anxiety/depression strongly suggests that there are major differences in the causes and development (or etiology) of the disorders. Hence, additional measures might be necessary for pediatric patients with OCD.
  • Additional research is needed in order to establish factors that may affect the efficacy of the SSRI’s and SNRI’s in children and adolescents.
  • The variability in assessing and reporting adverse events needs to be reviewed in order to establish a standardized method for reporting these adverse events.

This last finding is of paramount importance as the risk of life-threatening events in this young group of patients needs to be addressed in order to determine treatment and treatment combinations that are the most appropriate for patients. Psychiatric disorders among children and adolescents need to be thoroughly studied to improve outcomes and minimise risks.   Therefore, further research is required to minimise the risk of adverse events and to improve the clinical outcomes for these disorders.

Written by Jade Marie Evans, MPharm, Medical Writer

Reference: Cosima L et al . (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents A Systematic Revie. Available: Last accessed 01/09/2017.

Cherie Jewell: Neurofeedback: A successful treatment of depression and anxiety

By Cherie Jewell

Anxiety? Depression? Or both?

Anxiety and depression disorders are not the same, although in many ways they are similar in our brains. Depression generates emotions such as hopelessness, despair and anger. Energy levels are usually very low, and depressed people often feel overwhelmed by day-to-day tasks, as well as personal relationships.

A person with an anxiety disorder, however, experiences fear, panic or anxiety in situations where most people would not feel anxious or threatened. The sufferer may experience sudden panic or anxiety attacks without any recognized trigger, and often lives with a constant nagging worry or anxiousness. Without treatment, anxiety and depression disorders can restrict a person’s ability to work, maintain relationships, or even leave the house.

Despite their differences, both anxiety and depression treatment are similar, which may explain why the two disorders are so often confused.

In a study, 85 percent of those with major depression were also diagnosed with generalized anxiety disorder, and 35 percent had symptoms of panic disorder as well as other anxiety disorders including obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Where is the connection? There has been a ton of research that documents how depression and anxiety are both associated with an imbalance of the right and left pre-frontal cortex. A large number of brainwave (EEG) studies have demonstrated that the left frontal area is associated with more positive emotions and memories, and the right hemisphere is more involved in negative emotions.

When there is a biological predisposition to depression, the left frontal area is less activated. This means that such individuals are less aware of positive emotions while at the same time being more in touch with the negative emotions that are associated with the right hemisphere. Neurofeedback provides physiological assistance to balance these areas of the brain. Using neurofeedback to train the brain will help develop the skills needed to reduce or eliminate anxiety.

Can anxiety and/or depression be treated without medication? The latest research has shown that medication is only mildly more effective then placebo in treatment of depression and anxiety. In treating these conditions, neurofeedback offers an effective alternative, permanent treatment with zero side effects.

How does neurofeedback work? Neurofeedback sessions begin with first getting what is called a “brain map” using a QEEG (Quantitative Electroencephalograph). This non-invasive study is easy and is often completed within 45 minutes. Based on your brain map results, you are given two protocols to follow. These protocols are designed to train your brain by moderating your response to stress so that anxiety and depression is minimized and occurs less frequently. With sufficient training, your brain permanently learns to maintain healthier patterns on its own more consistently. Neurofeedback is like exercise or physical therapy for the brain.

What is a neurofeedback session like? Typically, a protocol recommends between 20 to 40 sessions. During a session, a sensor will be placed on both sides of your head and ears. You sit in a comfortable chair and watch your favorite TV show or movie. Neurofeedback uses audio and visual cues to change timing and activation patterns in the brain. As the session starts, you will hear and see occasional “skips” that only last a second in the video you are watching. This is the signal that prompts your brain to “reset” and optimize itself. Neurofeedback training is non-invasive. We are not shocking the brain; we are reinforcing when the brain wave’s function in an optimal fashion for the task at hand.

Neurofeedback is one of the quickest and most efficient ways to teach people how to help themselves, and it’s completely non-pharmaceutical. It has been used for many years with solid, proven results. Completing neurofeedback can decrease the need for dependence upon medications and improve quality of life by teaching the brain to make healthier patterns on a more consistent basis. The brain will learn how to decrease anxiety and depression while allowing your mood to improve.

Cherie Jewell is a neurofeedback technician at the T. Murray Wellness Center. For more information about neurofeedback or to schedule and appointment, visit the website, or call (603) 447-3112.

How seeing problems in the brain makes stigma disappear

David Rosenberg, Wayne State University

(THE CONVERSATION) As a psychiatrist, I find that one of the hardest parts of my job is telling parents and their children that they are not to blame for their illness.

Children with emotional and behavioral problems continue to suffer considerable stigma. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, for many, access to high-quality mental health care remains elusive.

An accurate diagnosis is the best way to tell whether or not someone will respond well to treatment, though that can be far more complicated than it sounds.

I have written three textbooks about using medication in children and adolescents with emotional and behavioral problems. I know that this is never a decision to take lightly.

But there’s reason for hope. While not medically able to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.

All of us experience occasional sadness and anxiety, but persistent problems may be a sign of a deeper issue. Ongoing issues with sleeping, eating, weight, school and pathologic self-doubt may be signs of depression, anxiety or obsessive-compulsive disorder.

Separating out normal behavior from problematic behavior can be challenging. Emotional and behavior problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, depression rates increase much more dramatically in girls than in boys.

It can be very hard for people to accept that they – or their family member – are not to blame for their mental illness. That’s partly because there are no current objective markers of psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Inconceivable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they don’t have control over the situation.

Fortunately, there are now excellent online tools that can help parents and their children screen for common mental health issues such as depression, anxiety, panic disorder and more.

Most important of all is making sure your child is assessed by a licensed mental health professional experienced in diagnosing and treating children. This is particularly important when medications that affect the child’s brain are being considered.

Thanks to recent developments in genetics, neuroimaging and the science of mental health, it’s becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medication.

Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – while sometimes used among laypeople to describe someone who is uptight – is actually a serious and often devastating behavioral illness that can paralyze children and their families.

Through sophisticated, high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have become available recently, we can actually measure the child brain to see malfunctioning areas.

We have found, for example, that children 8 to 19 years old with OCD never get the “all clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feeling safe and secure. That’s why, for example, people with OCD may continue checking that the door is locked or repeatedly wash their hands. They have striking brain abnormalities that appear to normalize with effective treatment.

We have also begun a pilot study with a pair of identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further study is clearly warranted, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment as compared to children without OCD.

Exciting brain MRI and genetic findings are also being reported in childhood depression, non-OCD anxiety, bipolar disorder, ADHD and schizophrenia, among others.

Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.

New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what is going on in a child’s brain and genes. For example, by using MRI, our laboratory discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a critical role in childhood OCD.

When I show families their child’s MRI brain scans, they often tell me they are relieved and reassured to “be able to see it.”

Children with mental illness continue to face enormous stigma. Often when they are hospitalized, families are frightened that others may find out. They may hesitate to let schools, employers or coaches know about a child’s mental illness. They often fear that other parents will not want to let their children spend too much time with a child who has been labeled mentally ill. Terms like “psycho” or “going mental” remain part of our everyday language.

The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness today has. In the Middle Ages, one was considered to be possessed by the devil. Then, more advanced thinking said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate on themselves but a crazy person? Many patients with epilepsy were locked in lunatic asylums.

Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but the appropriate treatment.

That is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology and structure. This can help better diagnose and precisely treat childhood onset mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.

This article was originally published on The Conversation. Read the original article here:

Search Of DNA In Dogs, Mice And People Finds 4 Genes Linked To OCD

Dogs may not wash their paws compulsively, but some humans and canines have similar genetic mutations that may influence obsessive behavior.

Ute Grabowsky/Photothek via Getty Images

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Ute Grabowsky/Photothek via Getty Images

Dogs may not wash their paws compulsively, but some humans and canines have similar genetic mutations that may influence obsessive behavior.

Ute Grabowsky/Photothek via Getty Images

People who have obsessive-compulsive disorder can get trapped inside a thought. It repeats itself, like a stuck song. Did I lock the door? Is that doorknob clean enough to touch? I better wash my hands again — and again.

The biology underpinning this loop remains murky to scientists, but scientists are beginning to sniff out potential genetic factors behind OCD and shed light on how the disorder affects the brain.

Research published Tuesday in Nature Communications identifies four genes with the strongest links to OCD to date. “There had been a few studies that looked for genes associated with OCD, and they found some interesting ones, but they were never able to achieve statistical significance,” says Elinor Karlsson, a senior author on the study and a geneticist at the Broad Institute of MIT and Harvard University.

To identify the genes, Karlsson and her collaborators searched three sets of DNA. Two came from dogs and mice that had compulsive tendencies. “Dogs, it turns out, are surprisingly similar to people,” Karlsson says. “They’re chasing their own tail or chewing themselves or chasing shadows like normal, but they’re doing it for hours. They literally can’t stop.” The last set came from humans.

The researchers were looking for any genes in dogs and mice that had been tied to compulsive behavior. In humans, they examined genes previously suggested as having a role in OCD or that were linked to autism, which shares some characteristics with OCD. “We looked at anything that looked interesting,” Karlsson says. “It was about 1 out of every 30 genes of all 20,000 total in the genome, and the regulatory regions around them involved when the gene’s turned on and off.”

In the first cut, the researchers identified 608 genes of interest from all three species. The team then took those genes and compared them in roughly 600 people with OCD and 600 people without. Out of that analysis, just four genes began showing up consistently in people with OCD as having some kind of mutation, says Hyun Ji Noh, a geneticist at the Broad Institute and the lead author on the study.

People with mutations in these genes don’t necessarily have OCD, though, Karlsson points out. “OCD is a really complicated disease. All we can say is if you have variations in these genes, you are more likely to have OCD,” she says.

But by identifying these genes, the study helps to paint an early picture of how OCD works in the brain, says Dr. Marco Grados, an OCD researcher at the Johns Hopkins University School of Medicine who did not work on the study. “[The study] does confirm some prior findings,” he says.

The genes are active in a specific circuit of the brain, the cortical-striatal loop, which is thought to help control actions. “Brain imaging has shown hyperactivity in this circuit [in OCD],” Grados says, and two of the four genes code for proteins that help hold connection points between brain cells or synapses in this circuit together. Mutations in these genes might stop neurons from communicating with one another effectively in this region. Specifically, Grados says they might be breaking down a stop mechanism in the loop.

In a brain without OCD, a thought may come up and say, “Wash your hands.” Once you’ve actually washed your hands, that stop mechanism would kick in and the thought would end. But in a brain with OCD, Grados says the genes Karlsson and her team identified suggest those brakes have been cut. The thought can’t end, and people feel compelled to continue the action. “That’s the speculation,” Grados says.

One gene that the authors found, called REEP3, was a little unexpected, Grados says. This gene seems to be important in learning and forming new connections in the brain, he says. “OCD and anxiety are kind of like learning disorders,” he says. “Often with OCD, people have a fear of germs. You can’t touch tables or door knobs and every time it’s the same sensation. You didn’t learn that the last time you touched a doorknob, nothing happened. It’s like touching it for the first time ever.”

If there’s a mutation in genes like REEP3, Grados says that might start to explain this aspect of OCD. “We’ve done a recent study – the results are not completely worked out – but we’re finding [learning] genes like this to be the main ones in OCD,” he says. “This is kind of novel, but these results make sense. It’s confirming some stuff we’re suspecting.”

Angus Chen is a journalist based in New York City. He is on Twitter: @angRChen.

Obsessive-Compulsive Disorder & Chronic Pain

Until a few years ago, obsessive-compulsive disorder (OCD) was grouped into anxiety disorders by the American Psychiatric Association (APA). In 2013, the organization added a chapter specifically on OCD and related disorders to its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Today,  practitioners continue to work through this new and distinct classification. Despite a scarcity of research linking OCD and related disorders to pain, it is important to be aw

The obsessions may take the form of persistent, intrusive thoughts or images of pain. Although catastrophizing is not the same as intrusive thoughts, engagement in this behavior in patients with chronic pain may provide some insight and support for this assertion.15

A number of case reports have detailed patients who overvalue their pain experience to the point of it being an obsession.16 Patients with complex regional pain syndrome, for example, may reveal bizarre perceptions, similar to a body dysmorphia, about a part of their body that they wish to amputate despite the prospect of further pain and functional loss.17 Patients with chronic pain receiving adequate relief with opioids also may hoard their medication, for example, to ensure a continuous supply by stockpiling reserves for a future need.18

Patients with OCD may also require treatment for pain conditions.

The compulsions consist of repetitive behaviors, such as rubbing, limping, guarding, or groaning, performed in response to the obsessive thoughts and images.1 Trichotillomania and excoriation, or skin-picking, are not perceived by the patient as self-harm but rather self-soothing behaviors. Both conditions fall under the body-focused repetitive behavior category, which is an umbrella term for impulse control behaviors that involve compulsively damaging one’s physical appearance or causing physical injury and, at times, added pain. Despite similarities, these cognitions and repetitive behaviors do not have the senseless or unrealistic quality of classic OCD symptoms. However, the psychological functions that these pain behaviors serve may be the same as those served by OCD.

Patients who struggle to control obsessions may take comfort in the ability to contain some component of aversive stimuli, such as exposure to physical pain.19 In other words, individuals with OCD might be willing to endure physical pain as a distraction from emotional distress, an expression of negative self-worth, or as a means to gain control over some aspect of suffering.19

This action, in turn, may lead to fear-avoidance behaviors. For example, a person with a cleaning obsession may suffer from lower back pain and avoid bending to place dishes into the dishwasher and instead wash them meticulously by hand. In addition, the kitchen sink may be low depending on the height of the individual, which would require the patient to hunch over, causing other pain and difficulties. Pain-anticipation and fear-avoidance beliefs can significantly influence the behavior of patients with chronic pain in that they motivate avoidance behavior.20

Providers must be aware of the powerful effects of these cognitive processes. There are different reasons why individuals may be averse to internal sensations. Unfortunately, a comprehensive model explaining the importance of hiding or expressing emotions is still lacking.

The lack of a common nomenclature for internal states and experiences is a barrier to better understanding this phenomenon, and there is much still to be learned about how people make sense of their internal worlds.19

Defining Related Disorders

APA’s new chapter distinguishes OCD from related disorders by identifying important differences. Some disorders are characterized by cognitive symptoms, such as perceived defects or flaws in appearance (eg, body dysmorphic disorder) or the perceived need to save possessions (ie, hoarding disorder). Others are characterized by recurrent body-focused repetitive behaviors, such as hair-pulling (eg, trichotillomania) and skin-picking (eg, excoriation).

Substance/medication-induced disorder is defined as having symptoms that are due to substance intoxication or medication withdrawal. OCD-related disorder due to another medical condition is described as involving symptoms characteristic of OCD that are the direct pathophysiological consequence of a medical disorder. Other specified/unspecified OCD consist of symptoms that do not meet criteria for a recognized disorder because of atypical presentation or uncertain etiology.1

Adding Hoarding Excoriation to the Mix

The new chapter on OCD and related disorders reflects the increasing evidence of these disorders’ relatedness to one another and, importantly, their distinction from other anxiety disorders. Two new disorders have been added to the DSM-5 and to this chapter: hoarding disorder and excoriation.1 APA’s addition of these unique diagnoses in DSM-5 was intended to increase public awareness, improve identification of cases, and stimulate research and development of specific treatments for these conditions.1

Hoarding disorder reflects the persistent difficulty with discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. Beyond the mental impact of the disorder, the accumulation of clutter can create a public health and safety issue (eg, tripping and fire hazards). Hoarding disorder may have unique neurobiological correlates, is associated with significant impairment, and may respond to clinical intervention.1

Excoriation disorder is characterized by recurrent skin-picking resulting in medical issues, such as infections, skin lesions, scarring, and physical disfigurement. This disorder has strong evidence for its diagnostic validity and clinical utility.1 Symptoms can lead to clinically significant distress or impairment in social, occupational, or other key areas of functioning.

John Green’s Turtles All the Way Down, reviewed.

If Green’s fiction has a fault, it’s the way his characters’ thoughts and dialogue lean so hard toward the aphoristic, neat if melancholy formulations that seem purpose-built for excerption on a Goodreads favorite-quotes-from page. “Every loss is unprecedented,” Aza thinks, with a sense of perspective that’s distinctly unadolescent. “You can’t ever know someone else’s hurt, not really.” But in Turtles All the Way Down, he turns even this propensity toward less expository ends. The characters in the novel keep repeating a certain saying along the lines of “Sometimes you think you’re spending money, but all along the money is spending you,” a motto also applied to power. Eventually, the reader comes to see that even though she never quite states it, this is also Aza’s fear, and by extension Green’s: That she thinks she is telling a story, but all along the story is telling her. Green has said that after the publication and tremendous success of The Fault in Our Stars, he suffered a relapse of his mental illness. Writing had previously helped him, getting him out of his own head and, presumably, providing him with a sense of control, at least over his own fictional creations. But as he became convinced he would never produce a follow-up to his monster hit, the thing that had once eased his fears had become itself a source of anxiety.

A drug-free, all-natural approach to eliminate anxiety

What is anxiety?

Anxiety is a general term used to describe worry, fear or apprehension. It is a normal response to a traumatic, dangerous or fear-inducing circumstance.

However, if you are experiencing anxiety without those normal causes, that can be an indication of a more serious imbalance in brain function.

Anxiety disorders can disrupt every part of your life — relationships, work, sleep — and can dramatically affect your ability to enjoy life itself.

There are many types of diagnoses that involve anxiety. Panic disorder, Obsessive Compulsive Disorder (OCD), social phobias, post-traumatic stress disorder (PTSD), and generalized anxiety disorder, just to name a few.

Sometimes anxiety will be triggered by a reminder of a traumatic event — such as a loud noise for a soldier dealing with PTSD.

How anxiety manifests in the brain

We’re all familiar with the physical changes associated with anxiety. You feel anxious or afraid, your body responds with hormones that speed up your heart and respiration, make your mouth dry, and slow down digestion. These are some of the sympathetic nervous system’s response to ready the body for “fight or flight.”

Once the feeling of anxiety passes, the parasympathetic nervous system takes over, calming the body down for rest and recovery.

But what happens if your brain is in a constant state of worry? The fight or flight mode can become your natural state if your brainwaves are imbalanced. Anxiety sufferers tend to have repetitive, negative thoughts that create a chronic state of fear or dread. This type of brainwave activity is usually related to excessive beta brainwave activity in the right side of the brain. This activity can now be measured, using a QEEG (quantitative electro-encephalogram). This is also known as a “brain map.”

What does this mean for people with chronic anxiety ?

Up to now, the standard approach to these issues is either medications, therapy, or both. Medications can be effective in easing the symptoms caused by an anxious brain.

However, the effects are temporary, and side effects can be severe. Therapy sessions can take years, and require sometimes painful revisiting of past traumas in order to produce change.

There is another way: Neurofeedback training

Neurofeedback training is an all-natural approach that can create long-term changes in brain function. These changes go to the source of the anxiety — imbalanced brainwaves in the brain itself.

The process is simple. Neurofeedback uses your brain’s natural ability to learn new things to help it heal. From a branch of psychology known as behaviorism, neurofeedback uses a system of audio and visual feedback to re-train your brain, and bring it back to balance.

All you have to do is sit back, relax, and watch a movie or video. While doing this, the computer measures your brainwave output, using small sensors placed on your scalp. The sensors tell the computer when your brainwaves are outside of the desired range, based on your personal brain map.

When the beta brainwaves are too high (indicative of anxious-type thoughts) the audio and visual inputs grow dim, causing your brain to return its focus to the video. This happens hundreds of times per minute over a typical 30 -minute training session.

As you can imagine, over time your brain learns to “stay within the lines” even when you’re not actually training. Just like riding a bike, with training you get better and better at it.

Once the brain learns to stay balanced (it usually takes three to four weeks for initial changes to happen) you begin to feel calmer and more in control. The effects are long-lasting, since neurofeedback creates actual change in the way your brain works, just like physical exercise can build muscle mass with a proper regimen.

Compared to traditional therapies, neurofeedback is safe, long lasting, and has no side effects. The technology was first used in 1972 to eliminate epilepsy.

If you’re looking for a provider to give you a drug-free approach to ending your anxiety, go to and look under the practitioner tab.

Dr. Ed Carlton is founder of the Carlton Neurofeedback Center and author of the book “The Answer.” “My first degree is engineering. Neurofeedback is a cross between medicine and engineering, using the best of both to provide relief for my patients. The Answer explains how neurofeedback stopped my bipolar symptoms, and how it can help others do the same.”

[The content provided through this article and should be used for informational purposes only and is not intended to be a substitute for professional advice. Always seek the advice of a relevant professional with any questions about any health decision you are seeking to make.]

For more DAILY VIEWS, The News’ contributor network, click here.

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Please stop using OCD to describe your obsessive personality traits

Please stop using OCD to describe your obsessive personality traits
(Picture: Liberty Antonia Sadler)

If you spend time on social media, you’ll be no stranger to spotting people tweeting about having ‘OCD’, using the term to describe habits that are in no way related to an actual OCD diagnosis. 

I’m not saying everyone who uses the term doesn’t know what it means – or that they haven’t been diagnosed with it.

But a large proportion of the people using the term are using it incorrectly – and are getting it mixed up with obsessive-compulsive personality disorder.

I’ll see people calling themselves ‘OCD’ when they talk about liking the items in their cupboard lined up in a certain way. Perhaps they like their wardrobes colour-coordinated or their makeup in dedicated drawers.

But this isn’t OCD. This is a form of OCPD.

OCPD is totally different to obsessive compulsive disorder, and it’s important people know this. Not only so that they stop talking about a serious mental illness incorrectly, but to prevent misconceptions around OCD, and ultimately to help actual sufferers of the illness highlight how debilitating it can be.

OCPD is a personality disorder characterised by a general pattern of concern with orderliness, perfectionism, excessive attention to detail and interpersonal control.

(Illustration: Monika Muffin for

OCD, however, is an anxiety disorder that’s characterised by recurrent obsessions and compulsions.

Sure, at first they may sound pretty similar – but they’re not.

Characteristics of OPCD consist of people who have an excessive need for perfectionism and order. This involves attention to detail, ordering their lives with rules and lists, and hoarding items despite them no longer having value.

This is the disorder – if diagnosed – that you should be using to describe your need for order. Not OCD.

Why? Because OCD isn’t about order.

To break it down, let’s look at OCD as it is: Obsessive. Compulsive. Disorder. This means it’s a disorder that is made up of both obsessions and compulsions. Obsessions of OCD cause extreme distress.

They’re intrusive thoughts, horrible images or unwanted ideas that won’t go away. They’re thoughts that feel impossible to control, taking over your mind with the feeling of no escape.

They’re not simple worries about everyday problems. They’re obsessions so intense you’ll try every route to get rid of them – which is where the compulsions come in.

(Picture: Ella Byworth for

Compulsions within OCD are generally used to get rid of the intrusive thoughts and images. They’re ritual behaviours that you’ll carry out over and over.

For example, someone may walk around the house fifteen times over the space of two hours to check all the doors are locked, because they have horrible thoughts of someone breaking in and hurting them.

Or washing your hands over and over until they’re raw, because you’re terrified you’re going to risk contamination and infection – even if you’ve not touched something dirty beforehand.

OCD compulsions are rituals that a sufferer can end up carrying out so often that it becomes debilitating and their everyday life is affected. Compulsions aren’t just an act of suppressing an obsession – they’re an urge that can leave you feeling uncomfortable and incredibly on edge if they’re not carried out multiple times.

I have been diagnosed with OCD, and over the years I’ve experienced many intrusive thoughts and images, and have carried out compulsions in an attempt to control them.

I once went through a phase of spending three hours a night walking around my flat with my partner to convince myself all of the lights were off, the plugs were unplugged and the doors were locked because I was terrified bad things were going to happen while I slept. It didn’t matter how many times I checked these things, I had this horrible urge in my body that meant if I didn’t carry out the checks until I felt somewhat satisfied I’d toss and turn with worry.

(Picture: Liberty Antonia Sadler for

I would, and still do, wash my hands over and over until the skin peels because I convince myself that if I don’t I’m going to develop infection.

I’ve had awful thoughts. Some I feel too embarrassed to even write about because they feel so messed up. Death, mutilation, assault, and deeply disturbing images that have left me shaken and upset, unable to get them out of my head.

Which is why I find it so deeply insulting when people so easily use the term ‘OCD’ without even realising the serious extent of the disorder.

OCD is distressing. OCPD is not the same. While both disorders may involve attention to detail, with OCD this is done to reduce overwhelming anxiety caused by the intrusive thoughts. With OCPD, it’s done to improve efficiency.

If you’re living with the latter, please take the time to research your struggles before so easily labelling them as a debilitating mental illness.

While it’s annoying, I don’t blame the people saying they have OCD when they don’t. It’s not their fault. It’s the fault of everyone who over the time has created the illusion that OCD is simply an obsessive personality disorder.

We see it in films, in TV, in the media and in books where people label themselves with OCD at the slightest obsession.

(Picture: Liberty Antonia Sadler)

This is worsened by the people who pick up on this label, and go on to use it in every day use – especially on social media.

Some people may say I’m overreacting, that it’s just a term.

But OCD is a mental illness. It’s an illness. While it may be an invisible one, it doesn’t make it any less serious.

You wouldn’t say you had pneumonia if you had a cold, and you wouldn’t say you’ve broken your leg if you’ve got a bruise. So why is it okay to use a mental illness to describe your personality traits?

Using a mental illness to describe your traits without an actual diagnosis is wrong. It’s damaging to the people who live with it and the people who still don’t understand it.

As a sufferer, I know firsthand what it’s like to say I live with OCD only for someone to say: ‘Yeah, it sucks. I can’t stop organising my drawers.’

It’s infuriating and it takes the seriousness away from the illness, and goes on to further the misunderstanding around the illness.

It’s so easy to simply stop using the term and to start describing your traits correctly – so why aren’t we doing it? Because it’s easier to use a mental illness? Because people might take you more seriously?

(Picture: Ella Byworth for

It’s having the opposite effect. The more people who are using the mental illness as a descriptive term, the less seriously the illness is being taken.

And the less seriously it’s being taken, the less likely sufferers are to want to seek help for it.

Please, people, stop using mental health terms to describe your habits. Or at least do a little research into the term before publishing it to the world.

MORE: No, mental illness is not ‘quirky’, it’s debilitating and needs to be taken seriously

MORE: What it’s like to live with compulsive skin picking disorder

John Green Tells a Story of Emotional Pain and Crippling Anxiety. His Own.

“Turtles All the Way Down,” published on Tuesday, Oct. 10, is Mr. Green’s most personal book yet. Its narrator, Aza Holmes, is a 16-year-old girl in Indianapolis who wrestles with anxiety and obsessive thought spirals. Aza has normal teenage preoccupations, and struggles to navigate the rites of adolescence: dating, fretting about college, calming her overbearing mother, appeasing her demanding best friend.

But she is also frequently overcome by extreme dread. She’s certain that she’s contracted an intestinal bacteria that can be fatal. She worries that a cut on her finger, which she presses on uncontrollably, will become infected and kill her. She starts drinking hand sanitizer. She often wonders if she is fictional: If she can’t direct her own thoughts, who is really in control?

“Turtles All the Way Down” is an emotionally fraught project for Mr. Green, whose young adult novels are beloved for their quirky humor and sharp, sensitive teenage protagonists. His books have more than 50 million copies in print worldwide; two have been adapted into films. Mr. Green, 40, who lives in Indianapolis with his wife, Sarah Urist Green, and their two children, Henry, 7, and Alice, 4, is one of the publishing industry’s biggest stars, and over the past decade, he and his brother Hank have built an online video business with 16 educational shows that have collectively drawn more than 2 billion views on YouTube.

Mr. Green’s onscreen persona for YouTube shows like “Crash Course,” is ceaselessly energetic and positive. But he has wrestled with weighty subjects in his books — his young characters battle illness and mortality, depression and bullying — and has occasionally addressed his own mental health issues. In a video posted this summer, he discussed how difficult it is to talk about his experience of obsessive compulsive disorder, in part because language so often fails to capture abstract feelings.


With “Turtles All the Way Down,” Mr. Green tried to bridge the language barrier by bringing readers inside Aza’s consciousness, subjecting them to her anguished obsessions. Now, with the book’s release, he’s speaking to fans and interviewers about something deeply painful and personal.

“I want to talk about it, and not feel any embarrassment or shame,” he said, “because I think it’s important for people to hear from adults who have good fulfilling lives and manage chronic mental illness as part of those good fulfilling lives.”

On Monday, Mr. Green started his book tour with an event in Manhattan, where more than 100 fans gathered to see him and his brother put on a variety show of sorts. Mr. Green apologized for the slapdash quality of the performance — it was a rehearsal — then read passages from his novel that describe Aza’s debilitating fear about the wound on her finger. He told the audience that her crushing anxiety paralleled his own experience.


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“I spent a lot of my childhood consumed with obsessive worry and dread,” he said, adding that he hoped the novel would “help people who struggle with that terror to feel less alone.”

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Mr. Green was about 6 years old when he first became aware of his obsessive thought patterns. He was often afraid that his food was contaminated, and would only eat certain foods at particular times of day.

As he got older, he was able to keep his anxiety in check, with the right mix of medication and cognitive behavioral therapy. But every once in a while, uncontrollable thoughts can overwhelm him.

It happened once when he was 24, living in Chicago and working as a book reviewer for Booklist. He was so depressed he couldn’t eat, so he drank a couple of two-liter bottles of Sprite a day. Sometimes he couldn’t get up from his kitchen floor, where he lay staring at the bubbles in the soda bottle. He couldn’t read the books he was supposed to review because he couldn’t parse the words on the page.

He went to stay with his parents, saw a psychiatrist and found the right medication. He returned to Chicago, where he began writing what would become his debut novel, “Looking for Alaska,” a semiautobiographical novel about a boarding-school student who is bullied. He sold it to Dutton for a tiny advance, and went on to publish several more acclaimed young adult novels, including “Paper Towns” and “The Fault in Our Stars,” the story of two teenagers with cancer who fall in love, which became a global best seller. Sudden fame was unsettling. Mr. Green, anxious about touching strangers, found himself at events, confronting crowds of fans, some of whom wanted to hug him and take photographs.

Writing provided some relief, though he is careful to separate his creativity from his illness. At his sickest, he’s unable to think coherently enough to write.

“For me, it’s a way out of myself, to not feel stuck inside myself,” he said, adding, “I want to be super careful not to claim there’s some huge benefit to this brain problem that I have.”

In 2015, Mr. Green again suffered a severe onset of anxiety. It had been three years since he published “The Fault in Our Stars,” which became a megaseller, with more than 23 million copies in print worldwide, and was adapted into a feature film. Following up a success on that scale felt impossible. Mr. Green started and abandoned several novels. He worried he might never write another book.

Then, hoping to jump-start his creativity, he went off his medication. He plummeted. “I can’t think straight — I can only think in swirls and scribbles,” he wrote about the experience.


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When he recovered in late 2015, he started writing the new novel, and finished a draft. He spent another year revising it with the help of his longtime editor, Julie Strauss-Gabel, who called the novel an “unbelievable act of translation” that gives readers a glimpse of what it’s like to suffer from mental illness. “He has worked really hard as a human being to figure that out,” said Ms. Strauss-Gabel.

Hank Green said that when he first read the novel, he felt like he understood for the first time what it must feel like to live with obsessive compulsive disorder: “Even having a brother who deals with OCD, I never really got it until I read the book.”

In the book’s acknowledgments, Mr. Green thanks his doctors and notes how fortunate he is to have a supportive family and mental health care that many don’t have access to.

“It’s not a mountain that you climb or a hurdle that you jump, it’s something that you live with in an ongoing way,” he said. “People want that narrative of illness being in the past tense. But a lot of the time, it isn’t.”

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What Does It Mean to Have OCD? These Are 5 Common Symptoms

obsessive compulsive disorder (OCD) isn’t easy. The condition, marked by uncontrollable thoughts and behaviors, strikes about 2% of the general population—a figure that in the U.S. alone means nearly 6.5 million people. If you’ve made it past young adulthood without developing any symptoms, you’re likely in the clear.

You wouldn’t know that to hear people talk, however. In recent years, OCD has become the psychological equivalent of hypoglycemia or gluten sensitivity: a condition untold numbers of people casually—almost flippantly—claim they’ve got, but in most cases don’t. Folks who hate a messy desk but could live with one for a day do not necessarily have OCD. Nor do those who wash their hands before eating but would still have lunch if there was no soap and water nearby. Yet the almost sing-songy declaration “I’m so OCD!” seems to be everywhere.

Some of the confusion is understandable. The Diagnostic and Statistical Manual (DSM)—the field guide to psychological conditions—lists OCD among the anxiety disorders, and nearly everyone has experienced anxiety. The thing is, though, you’ve experienced headaches, too, but that doesn’t mean you know what a migraine feels like unless you’ve had one. Same with the pain of OCD, which can interfere with work, relationships and more.


“The brain is conditioned to alert us to anything that threatens our survival, but this system is malfunctioning in OCD,” says psychologist Steven Phillipson, clinical director of the Center for Cognitive-Behavioral Psychotherapy in New York City. “That can result in a tsunami of emotional distress that keeps your attention absolutely focused.”

No single fear defines the condition. There are familiar obsessions like washing your hands or checking the stove. But there’s also hoarding, hypochondria or a terrible fear you’re going to harm somebody. People with a common type of OCD can even have paralyzing anxiety over their own sexual orientation.

As with any mental illness, only a trained clinician can offer a reliable diagnosis. But here are a few behaviors that experts say can be genuine symptoms of OCD.


It’s common for people with OCD to believe that if they check the stove just once more, or Google just one more symptom of a disease they’re convinced they’ve got, then their mind will be clear. But OCD typically reneges on the deal. “The brain becomes biochemically associated with the thing you fear,” says Phillipson. “Performing the ritual just convinces it that the danger is real and that only perpetuates the cycle.”

Feeling compelled to perform certain rituals

Could someone pay you $10—or $100, or whatever is a relevant sum of money to you—not to do a ritual like checking the front door twenty times before leaving for work? If your anxiety can be bought on the relative cheap like that, you may have an idiosyncrasy—you worry about burglary a little too much, perhaps—but you probably don’t have a disorder, Phillipson says. For the person with OCD, he explains, the brain is signaling what feels like a life and death risk, and it’s hard to put a price on survival.

Being tough to reassure

For people with OCD, the phrase “yes, but” may be a familiar one. (Yes, your last three blood tests for this or that disease were negative, but how do you know they didn’t mix up the samples?) Since absolute certainty is rarely possible, almost no reassurance clears the yes, but hurdle, and that keeps the anxiety wheels spinning.

Remembering when it started

Not all people with OCD can point to the exact instant the disorder first struck, but many can, says Phillipson. OCD is a sort of free-floating anxiety before the initial symptoms strike, but then it alights on a particular idea—the fear you’re going to lash out at somebody with a knife when you’re making dinner, for example. These experiences tend to roll off of most people. But for someone with OCD, the bottom falls out, Phillipson says. “It’s the moment when a panic marries a concept,” he says. Like most bad marriages, it’s hard to end.

Feeling consumed with anxiety

OCD is a matter of degree, especially since there are real-world risks associated with nearly all obsessive-compulsive triggers. Houses do burn down, and hands do carry germs. If you can live with the uncertainty those dangers can cause—even if they make you uncomfortable—you likely don’t have OCD, or at least not a very serious case of it. If the anxiety is so great it consumes your thoughts and disrupts your day, you may have a problem. “The D stands for disorder, remember,” Phillipson says. “OCD causes your life to become disordered.”

There are proven treatments available for OCD. Medications, including certain antidepressants, are often a big part of the solution, but psychotherapy—especially cognitive behavioral therapy (CBT)—can be just as effective. One potent type of CBT is a protocol known as exposure and response prevention (ERP). As the name suggests, ERP involves gradual exposure to increasingly provocative situations—under the guidance of a therapist—while avoiding any rituals to undo the anxiety. Begin by touching a doorknob without washing your hands, for example, progress up the ladder of perceived danger—a handrail on a bus, a faucet in a public bathroom—and slowly the brain unlearns the fear.