How to overcome obsessive thoughts


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A few weeks ago, someone sent an email to our Ask Dr. Mayim column, and it seems to have struck a nerve with a lot of people. The question was about constantly going over past conversations to the point of spending years worrying about things said or done. You can read my full answer here, but the gist of it was I recommend a therapist to help with these kinds of perseverative thoughts. I also suggested that 12 step programs such as Al-Anon can help with thoughts like this if the person has been touched by the disease of alcoholism; sometimes these kinds of thoughts are driven by fear or excessive responsibility.

After we posted the Ask Dr. Mayim article, follow-up questions came pouring in about obsessing. So I recruited one of my oldest friends who is a licensed psychologist specializing in Cognitive Behavioral Therapy, Dr. Jacob Gisis, to help answer the most pressing ones. Here are Dr. G’s answers to some of your questions along with some of my input!

Mayim Bialik: I had recommended seeing a therapist, but in what specific ways can a therapist actually help with obsessive thoughts?
Dr. Jacob Gisis: I agree with your recommendation to see a therapist, and I’d specify even further that it ought to be a cognitive behavioral therapist. Someone who specializes in CBT is important because it’s the fastest and most efficient way to treat virtually all anxiety based disorders, which this is likely an example of.

Part of treating these kinds of difficulties is that we want to define a desired end state. And—this obviously reflects my background in neuroscience—we want to recondition the nervous system so that it actually produces that desired end state and an integral part of that is to generally relax it. So what most cognitive behavioral therapists would do, in appreciation of it being an anxiety based disorder, is to start by teaching a relaxation technique to decrease anxiety levels overall.

Once that relaxation is put in place, then the goal is to not feel like the individual has to review past experiences or memories. We want to help them be less interested in those thoughts when they come up. It’s not easy to do. It’s generally a gradual process. There’s training in terms of what to do with the mind when these things come up and there are various options.

My orientation is toward assisting my clients with deciding what they want to do with their minds instead. In other words, what experiences do they desire to have and what mental processes are going to facilitate them having those experiences? Oftentimes mindfulness, which tends to be defined as a non negatively judgmental present-focused awareness, is the goal and one path toward it involves focusing on sensory experience and then not judging it negatively. However, like I said, it is really up to the client to determine what they want to experience and then we usually work together to see to that.

The abbreviated way to describe that process is that there are ways to train your mind to direct yourself away from obsessing and it takes a certain amount of effort at first but then it becomes second nature.
It does require effort and with repetition you are establishing a new circuit; a new neural network. The nervous system is trained to engage in a new pattern that’s been repeated. We truly are creatures of habit!

Someone asked a related question about worrying and losing sleep over future conversations.
These kinds of thoughts are generally associated with anxiety as they involve considerations of hypothetical negative future events. Anxiety can be thought of as future fear. Treatment is similar to what I briefly outlined earlier. As it’s anxiety-inducing to review potentially negative future conversations and as anxiety and sleep are not friends, unfortunately, it’s quite common for sleep to be adversely affected.

Someone asked if this type of obsessing can be related to aging. This woman says her husband has started obsessing with the past and he’s in the beginning stages of Parkinson’s Dementia. And she also has a neighbor in her 70s who won’t speak to her because of something she said three years ago. Can this be related to aging or is it more that we see these things in dementia?
It can be. One way to think of that connection is as related to the neural pruning that occurs with aging. We have fewer nerve cells and fewer cognitive and behavioral patterns accessible to us as we age and as our brains degenerate. And if this kind of obsessing is something you are doing quite regularly because your anxiety is pushing you to do it and you don’t have much awareness of how to manage it because you’re not working with a cognitive behavioral therapist, then it’s quite likely to become a very dominant pattern.

Someone asked, “Why is worse at night when I am trying to fall asleep?”
It could be the case of idle mind. That you’re not actively focused on something else. Then, there is more room for your anxious parts to hijack control of your thinking parts.  Some people have elevated anxiousness related to darkness. At nighttime, our visual system, which is our primary sensory system, doesn’t work as well and we could feel more vulnerable and, therefore, more anxious.

Can this be indicative of a larger issue?
It is usually a symptom of an anxiety disorder, or commonly, Obsessive Compulsive Disorder.

Is there a “normal” amount of overthinking? When do you know it is a problem?
I would suggest that just about everyone overthinks at some time or another. I would suggest an even stronger statement that all of the dimensions of any mental health diagnosis—maybe with the exception of psychotic diagnoses—are relevant and exist in everybody to some extent. It’s not like people who carry these diagnoses have different brain parts than what others have.  It is just usually a matter of degree. Some criteria we look at to determine how problematic this is are: Is it getting in the way of other goals, occupational functioning, sleep, social functioning, your familial life? Usually those are the criteria that determine whether we consider this pathological or not.

Visit NIMH for more information on generalized anxiety disorder and Obsessive-Compulsive Disorder.

Guest column: One man’s battle against obsessive compulsive disorder

By Danny Gautama

As a 5-11, 240-pound man, if you saw me on the street you would not think anything is wrong with me. The truth though is far different — I have endured Obsessive Compulsive Disorder, depression and anxiety for most of my life.

My first incident occurred when I was just four years old. I watched Thriller and saw Michael Jackson turn into a werewolf. It traumatized me. When I started kindergarten, I would hide underneath tables because I was afraid my teacher would turn into a werewolf. I started seeing a psychiatrist shortly thereafter (around five years old).

However, my behaviour didn’t get better. If anything, it got worse.

A couple of years later, I had just come up from my basement when I had the irresistible compulsion to go back down, this time with the lights off. I felt the need to repeatedly go up and down the stairs with the lights off, walking further and further into the basement each time. In my teenage years, I displayed other “weird” behaviours — when one ended, another new compulsion began.

Some activities started consuming my life — like when I needed to repeatedly wash my hands, check my car to see if I accidentally hit someone, walk backwards down stairs, take frequent showers or brush my teeth for nine minutes (and exactly nine minutes). I cleaned my body with Lysol wipes. I tapped the floor with my foot and a table with my hand nine times to protect people I loved. If something added up to a bad number then I would use nine to make up for it.

As I grew older, my compulsions controlled my life. When I went to nightclubs with friends I would stand in four directions irrespective of where I was.

I often had to ask if I could work from home (sometimes for weeks at a time) because my compulsions worsened.

I remember my first panic attack. I was walking in a mall with friends, laughing and joking when all of sudden I felt my chest tighten up. I had difficulty breathing. I started to sweat and told my friends I needed to go to the hospital. Very concerned, they told me to take deep breaths, since I was too focused on the fear! My next panic attack occurred while eating, when I felt food going slowly down my throat. I went to the ER, only to find out again I was fine.

I experienced many more panic attacks. Each time I felt drained and tired afterward. I eventually stopped going to public places, fearing another panic attack and worrying that my OCD would go out of control. Needless to say, my relationships started to suffer.

My friends would pick me up and I would have to duck to go to their house. I covered my face with my hands in the car so no one could see me. My girlfriend had to take me out when no one was around.

Depression followed. I isolated myself from everyone and stopped speaking to friends. I cried frequently. Yet, despite my struggles, part of me said, “I can’t give up.” I kept fighting each and every day.

Sylvester Stallone is my hero so I had to be a fighter.

The breakthrough came one morning when I finally addressed a scary fact: to change my life, I needed to change myself. I did not want to struggle anymore so I decided enough is enough. I had faith in God and most importantly, I had faith in myself. I walked outside feeling like a free man.

It was extremely difficult — my mind started playing games. I felt the further I walked from home, the more likely I would suffer a panic attack. But this time it was different — this time I confronted those thoughts. I continued walking. Every day I would walk — going further and further, slowly but steadily, taking deep, steady breaths every time.

After suffering agoraphobia for about four years, I eventually started going out more, socializing and meeting friends. I felt unstoppable. I was breaking free and making steady progress with depression, anxiety and OCD. Actively challenging my negative thoughts paid off.

Today I write inspirational articles and am happier and full of passion.

You deserve to be happy, too. Whatever you are going through, you will beat it. Nothing will bring you down and nothing can stop you. You are strong. You are loved, valued, worthy, and important.

You are not alone. I am not only a person with OCD, depression and anxiety, I am a fighter. And you could be, too.

Danny Gautama lives in Windsor where he writes inspirational articles for mental-health organizations and is working on an inspirational book.

The Representation & Misrepresentation of OCD in Television

With characters like Sheldon Cooper and Monk, we’ve seen OCD in television for a while. But just how well do they represent and respect the condition?

First, just what is OCD? As defined by Psychiatry.org, Obsessive-Compulsive Disorder is:

An anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.

The average person may experience obsessive thoughts and repeated behaviors, but they are usually infrequent and do not disrupt daily life, and are therefore not considered OCD. For those with OCD, they are basically incapable of not thinking about their compulsions, and being prevented from following through with the resulting routine can cause them extreme distress.

What people fail to realize, or likely just don’t care about, is that while OCD affects a small portion of the population, it is one of the top ten most common mental illnesses, and is regularly classified as one of the leading disabling conditions, along with bipolar disorder and schizophrenia. OCD can ruin lives, plain and simple. Not just the lives of the people with the condition, but those around them bear the brunt of it. And misrepresenting that struggle for the sake of a laugh isn’t doing the people suffering from it, or the general public’s understanding of it, any good.

A regular misconception about OCD is that its about tidiness, and people who really want something in a particular order are exhibiting OCD symptoms. While ordering and arranging is definitely an example of a compulsion, OCD is not as simple as wanting your desk in a certain order. Usually, if someone says, “I’m so OCD about my _____”, odds are they’re not actually suffering from OCD, but possibly a personality disorder, OCPD, less severe than true OCD.

For people with OCD, they’re plagued with persistent and unwelcome thoughts that result in heightened anxiety, followed by the drive to perform a behavior or act to relieve the anxiety. The National Institute of Mental Health lists common obsessions as including:

  • Fear of germs or contamination

  • Unwanted forbidden or taboo thoughts involving sex, religion, or harm

  • Aggressive thoughts towards other or self

  • Having things symmetrical or in a perfect order

Entertainment websites have published lists of the best characters with OCD in movies and TV, but usually include characters who do not have OCD but are exhibiting traits commonly mistaken for it, resulting in the continued misunderstanding and misrepresentation of OCD. For example, the character of Monica from ‘Friends’ is often argued to have OCD, specifically for her cleaning compulsion. While Monica had been shown to feel a need to clean everything to an extreme level and is likely experiencing Obsessive Compulsive Personality Disorder, there have been only a few depictions of her possibly having true OCD. Monica reacted to Rachel cleaning the apartment by staying awake at night obsessing over the placement of shoes, as well as showing up at the apartment of a woman Ross went out with, offering to clean her apartment and admitting that she couldn’t relax knowing the apartment was in horrible shape. However, it’s unlikely someone with OCD would obsess over the cleanliness of a place he/she doesn’t go to and has no direct connection to.

With shows like ‘Friends’ and ‘Big Bang Theory’, the problem is the compulsions are primarily played for laughs without seriously showing the effect not completing such a compulsion can have on someone. In ‘Big Bang Theory’, Sheldon is regularly shown being afraid of germs, the compulsion to knock multiple times, and other traits related OCD. But a handful of times we’ve seen Sheldon interrupted during his ritual of knocking, with his resulting actions played for comedic effect until the interrupter, usually a giggling Penny, allows him to finish the action. However, in reality, the failure of someone with OCD to complete their ritual, as well as that person attempting to fight that which they are well aware is illogical, can have very serious issues that are far from comedic. In the case of ‘Big Bang Theory’, we have a character experiencing a tremendous inner battle while one of his best friends stands by watching and being amused by it. However, Sheldon doesn’t fully fit into OCD since he’s exhibited little, if any, acknowledgement that his obsessions and rituals are illogical. In Sheldon’s mind, everything he does is perfectly acceptable and reasonable, making him more OCPD than OCD. Another way the show doesn’t treat the condition with respect is that Sheldon’s issues are treated as something that others find to be completely annoying, instead of providing Sheldon with the understanding and support he really needs, and even instigating an episode for their own amusement.

The series ‘Monk’ is known for being one of the better portrayals of OCD, but wasn’t without its own shortcomings. Many times, the character of Monk was depicted as phobic, rather than compulsive, showing a fear of touching things but not the repeated behaviors. Also, much like other comedies addressing the subject, Monk’s behaviors are mostly shown as charming quirks, rather than the debilitating and time-consuming rituals they most often are.

The show ‘Scrubs’ was also praised for its depiction of OCD, in a season 3 episode with guest star Michael J. Fox playing Dr. Kevin Casey. Though Dr. Casey’s compulsions of touching everything while saying “bink” is meant for laughs, the show take a serious turn to show the dark effect of the disorder when Dr. Casey is struggling with still washing his hands over two hours after finishing surgery.

Outside of the fictional reality of these shows, Howie Mandel has become a real world example of OCD. Originally known for his stage act where he’d put a rubber glove on his head and blow it up through his nose, no one knew that the bit was only possible due to the numerous rubber gloves Mandel kept on him so he wouldn’t have to touch certain things. While it was known that Mandel preferred fist bumping over handshaking, It wasn’t until he let it slip during an appearance on the Howard Stern show that people found out the extent of his OCD. But even after that, his condition was still the butt of jokes by others while he served as Kelly Ripa’s co-host, purposely making Howie uncomfortable just to see how he’d react.

“So what’s the problem if a TV show doesn’t give an accurate depiction of OCD? It’s just entertainment.” True, it’s entertainment, but it’s also perpetuating myths and misconceptions about OCD, and doing so in a way that is consumed by more people than the actual facts of the disorder. Regardless of the fact that the show is a work of fiction, it is still influencing the way people perceive the condition, and if the show is making light of it or playing it off as just being a “neat freak”, that viewer is less likely to understand it or take it seriously in life.

Recently, pictures of a business vehicle using OCD as a tagline for their garage organization services were shared online to vastly differing responses. While many didn’t see a problem with it and found it funny, commenters who have OCD, or have loved ones with the condition, were slammed for either pointing out the incorrect correlation to OCD, or saying its in bad taste. A few years ago, a young girl went viral after posting a picture of a Christmas sweater at Target that used OCD as its theme. The young girl was berated and insulted by a multitude of internet trolls, saying she was just a millennial snowflake, a p*ssy, and just needed to get over it.

No one is saying that we can’t have a laugh at the condition. Just that the humor should not be at the expense of misrepresenting the condition, or not truly showing the depths of the condition. Yes, they’re just comedies, but its leading to a major misunderstanding of the condition, and mental health in general, which our society today does not take as seriously as it should.

Untangling the Ties between Autism and Obsessive-Compulsive Disorder

Steve Slavin was 48 years old when a visit to a psychologist’s office sent him down an unexpected path. At the time, he was a father of two with a career in the music industry, composing scores for advertisements and chart toppers. But he was having a difficult year. He had fewer clients than usual, his mother had been diagnosed with cancer, and he was battling anxiety and depression, leading him to shutter his recording studio.

Slavin’s anxiety—which often manifested as negative thoughts and routines characteristic of obsessive-compulsive disorder (OCD)—was nothing new. As a child, he had often felt compelled to swallow an even number of times before entering a room, or to swallow and count—one foot in the air—to four, six or eight before stepping on a paving stone. As an adult, he frequently became distressed in crowds, and he washed his hands over and over to avoid being contaminated by other people’s germs or personalities. His depression, too, was familiar—and had caused him to withdraw from friends and colleagues.

This time, as Slavin’s depression and anxiety worsened, his doctor referred him to a psychologist. “I had had an appointment booked for weeks and weeks and months,” he recalls. But about 10 minutes into his first session, the psychologist suddenly changed course: Instead of continuing to ask him about his childhood or existing mental-health issues, she wanted to know whether anyone had ever talked to him about autism.

By coincidence, a relative had mentioned autism to Slavin two days prior, wondering if it might explain why he dislikes social situations. Slavin knew little about the condition but had conceded it was possible. By the time his therapy session ended, his psychologist was almost certain: “She said to me that I’ve either got high-functioning autism or some kind of brain damage,” Slavin recalls with a chuckle. Only a few years earlier, a doctor had finally diagnosed him with OCD. His new psychologist diagnosed him with autism as well.

At first glance, autism and OCD appear to have little in common. Yet clinicians and researchers have found an overlap between the two. Studies indicate that up to 84 percent of autistic people have some form of anxiety; as much as 17 percent may specifically have OCD. And an even larger proportion of people with OCD may also have undiagnosed autism, according to one 2017 study.

Part of that overlap may reflect misdiagnoses: OCD rituals can resemble the repetitive behaviors common in autism, and vice versa. But it’s increasingly evident that many people, like Slavin, have both conditions. People with autism are twice as likely as those without to be diagnosed with OCD later in life, according to a 2015 study that tracked the health records of nearly 3.4 million people in Denmark over 18 years. Similarly, people with OCD are four times as likely as typical individuals to later be diagnosed with autism, according to the same study.

In the past decade, researchers have begun to study these two conditions together to work out how they interact—and how they differ. Those distinctions could be important not only for making correct diagnoses but also for choosing effective treatments. People who have both OCD and autism appear to have unique experiences, distinct from those of either condition on its own. And for these people, standard interventions for OCD, such as cognitive behavioral therapy (CBT), may provide little relief.

Missed diagnoses:

Obsessions and compulsions can strike anyone: It’s common to worry about having left the oven on or to rifle anxiously through a purse in search of keys. “They’re really part of the normal experience,” says Ailsa Russell, clinical psychologist at the University of Bath in the United Kingdom. Most people find ways to dismiss those unpleasant thoughts and move on. Among people with OCD, though, those worries build up over time and disrupt daily functioning.

Some people, like Slavin, count steps or breaths to quell their terror that something bad will happen. Others describe themselves as ‘checkers,’ who investigate—again and again—that they’ve done a task properly. Still others are ‘cleaners,’ who wash constantly in response to a fear of filth and contamination. “Mostly, people with OCD realize it’s not that rational,” Russell says, but feel trapped by their worries and rituals.

The overlap between OCD and autism is still unclear. People with either condition may have unusual responses to sensory experiences, according to a 2015 analysis. Some autistic people find that sensory overload can readily lead to distress and anxiety. Slavin, for example, dreads police sirens and the peal of doorbells, which he likens to a bomb exploding in his nervous system. Some researchers say the social problems people with autism experience may contribute to their anxiety, which is also a component of OCD. Not being able to read social cues might lead people to become isolated or be bullied, fueling anxiety, the reasoning goes. “It’s complicated to tease out anxiety from autism,” says Roma Vasa, director of psychiatric services at the Kennedy Krieger Institute in Baltimore, Maryland.

These shared traits make autism and OCD difficult to distinguish. Even to a trained clinician’s eye, OCD’s compulsions can resemble the ‘insistence on sameness’ or repetitive behaviors many autistic people show, including tapping, ordering objects and always traveling by the same route. Untangling the two requires careful work.

One crucial distinction, the 2015 analysis found, is that obsessions spark compulsions but not autism traits. Another is that people with OCD cannot swap the specific rituals they need, Vasa says: “They have a need to do things a certain way, otherwise they feel very anxious and uncomfortable.” By contrast, autistic people often have a repertoire of repetitive behaviors to choose from. “They’re just looking for anything that’s soothing; they’re not looking for a particular behavior,” says Jeremy Veenstra-VanderWeele, professor of psychiatry at Columbia University.

Credit: Rebecca Horne for Spectrum

Clinicians, then, have to probe why a person engages in a particular action. That task is doubly difficult if the person cannot articulate her experience. Autistic people may lack self-insight or have verbal, communicative or intellectual challenges, which leads to misdiagnoses and missed diagnoses, like Slavin’s.

Clinicians long overlooked Slavin’s OCD and autism, although he was no stranger to a psychologist’s office growing up in the suburbs of northwest London. He did not speak for his first six years and says his memories are peppered with frequent visits to speech therapists and psychiatrists. Even after he began talking, he was socially withdrawn and disliked eye contact. He was plagued with anxieties and stomachaches.

At around 11, he was diagnosed with ‘infantile schizophrenia’ and prescribed valium and lithium. Doctors warned his parents that he might need to be institutionalized for life. Instead, he attended a progressive boarding school and graduated, as he puts it, a “slightly more functional” person. He pursued his passion for music, met his wife Bonnie and started a family.

His autism diagnosis so many years later was empowering, he says, but it also raised new complications. When he spoke with clinicians, for example, his autism always seemed to eclipse his other challenges, including an auditory-processing disorder. “Once you’ve had a diagnosis of autism, doctors say ‘Oh, it’s because of the autism,’ and they don’t look at the nuances,” he says. He found that no one could tell him whether a particular behavior was a result of his OCD or his autism—or what to do about it.

Common biology:

Answers to Slavin’s questions may emerge as more researchers study autism and OCD together. Just 10 years ago, virtually no one did that, says Suma Jacob, associate professor of psychiatry at the University of Minnesota in Minneapolis. When she told people she was interested in researching both conditions, “top advisers in the field said you have to pick one,” she says. That’s changing, in part because researchers have come to appreciate how many people have both conditions.

Jacob and her colleagues are tracking the appearance of repetitive behaviors—which could be linked to autism or OCD—by age 3 in thousands of children. “From the brain perspective, these [conditions] are all related,” she says.

In fact, scientists have found some of the same pathways and brain regions to be important in both autism and OCD. Brain imaging points to the striatum in particular, a region associated with motor function and rewards. Some studies suggest that people with autism and people with OCD both have an unusually large caudate nucleus, a structure within the striatum.

Animal models, too, implicate the striatum. Veenstra-VanderWeele is studying autism and OCD using rodents that show repetitive behaviors. In both conditions, he and other neuroscientists have found anomalies within the brain’s cortical-striatal-thalamic-cortical loop; this system of neural circuits runs through the striatum and plays a part in how we start and stop a behavior, as well as in habit formation. Another line of inquiry highlights interneurons, which often inhibit electrical impulses between cells: Disrupting interneurons in the striatum can create twitching, anxiety and repetitive behaviors in mice that appear similar to traits of OCD or Tourette syndrome.

Credit: Rebecca Horne for Spectrum

Among male mice specifically, interfering with interneurons in the striatum also leads to sharp drops in social interaction, forging a tenuous connection to autism. “Lo and behold, the mice also had social deficits identical to what we’ve seen in [animal models] associated with autism,” says Christopher Pittenger, director of the OCD Research Clinic at Yale University, who led this work. For that reason, he says, interneurons might be a common treatment target for both autism and OCD.

Some of the shared wiring researchers are uncovering could reflect a genetic overlap. The 2015 Danish study found that people with autism are more likely than controls to have relatives with OCD. But genetic comparisons of the two conditions thus far have yielded contradictory results or been hampered by how little is known about the genetics of OCD. “We know much more about the genetics of autism than we do about OCD, almost embarrassingly so,” Pittenger says. That gap could explain why a 2018 meta-analysis of genome-wide association studies—encompassing more than 200,000 people with 25 conditions, including autism and OCD—found no shared common variantsbetween OCD and autism.

Unpublished work from another group suggests that rare ‘de novo mutations,’ which occur spontaneously, can significantly increase the risk of having autism or OCD. Some of the genes the researchers linked to both diagnoses relate to immune functioning, suggesting that an interaction between environmental factors and the immune system might play a role. Another gene on that shared list, CHD8, regulates gene expression.

Adapting treatment:

Until scientists can connect these preliminary findings to pathways, new drug treatments are a long way off. But people who have both conditions do have other routes for finding help.

On a chill evening in December, people across the U.K. dial in to a monthly ‘OCD Autism Support Group’ meeting organized by OCD Action, a U.K.-based charity for people with OCD. The group size varies from one session to the next, but on this particular night, just days before Christmas, there are only four callers.

During the session, a woman named Michelle (everyone on the call uses first names only) explains that she cannot leave the house unless she is convinced all the switches and appliances are turned off. Thomas loses hours of the day to showering. Both talk about social difficulties—and how that can make them anxious. They often worry about what people think of them and whether their repetitive behaviors, caused by OCD or autism, make them appear strange to others.

As with most support-group meetings, the call reassures its participants that they are not alone. The callers also share updates and tips, such as using a timer to cut down on the time spent on hand-washing. Three of the callers mention CBT, which can help people understand and manage their obsessions and compulsions. As with other talk therapies, though, CBT isn’t always effective for people with autism. The therapy did not help Slavin, for example.

He suspects that he was unable to follow his therapist’s approach due to his auditory-processing difficulties and cognitive inflexibility, which he attributes to his autism. “Many people on the spectrum have a problem picturing a situation and picturing how it could have a different outcome, so traditional CBT doesn’t always work,” he says. Slavin instead manages his OCD—with mixed success—using antidepressants.

Credit: Rebecca Horne for Spectrum

Some researchers are trying to adapt CBT for people with autism by, among other things, “making sure that somebody can notice and rate their emotional state,” Russell says. Working with her colleagues at King’s College London, Russell found in a pilot study that the modified methods help some adults with both autism and OCD manage their anxiety. Drawing on the success of a subsequent larger trial, she and her colleagues published a guide for clinicians in January.

A more personalized variation of CBT might also work for people who have both autism and OCD. Various schemes include involving parents in sessions, adjusting the language to meet an autistic person’s ability, using visuals and offering children rewards. One trial is comparing these adaptations with standard CBT in more than 160 children who have both autism and OCD. The unpublished results suggest that standard CBT is beneficial, but an individualized approach is best of all.

Slavin sees the merits of more personalized treatment options, although he hasn’t tried it himself. Working with OCD Action and nonprofit advocacy groups for autism, he has come to appreciate the diversity that exists in both conditions. “It’s almost like you need a different diagnosis for every single person, a different category for every single person, because everyone is so different,” he says.

A decade after his autism diagnosis, Slavin is eager to share his experiences, in part to counteract the lack of resources he initially faced. In 2010, he launched a website and, later, a YouTube series to describe what he has learned about life with autism.

“I just see [autism] as a set of circumstances that you can use to your benefit to say ‘Okay, I’m going to forgive myself if I don’t quite understand things in the way other people do,’” Slavin says. “You can almost enjoy being a bit quirky, a bit different in some ways… [but] OCD, there’s just nothing good about that.”

In October, he published a book that chronicles the progress he has made. For now, at least, the book’s title begins: “Looking for Normal.”

FURTHER READING

This story was originally published on Spectrum.

Types of Eating Disorders: Symptoms, Causes and Effects

Eating disorders are about more than just fad diets and vanity; they are a serious mental illness that could ultimately cause the end of someone’s life. It’s estimated that as many as 30 million people in the U.S. suffer from an eating disorder. Approximately 4-10% of male and 10-20% of female college students are dealing with an eating disorder.

In spite of heightened awareness of some of the more common types of eating disorders, there are still many misconceptions. Let’s take a look at some facts to help dispel the myths of eating disorders.

What is an Eating Disorder?

Eating disorders revolve around abnormal eating habits and often include physical changes.

For some, eating disorders involve limiting the amount of food that is consumed; for others, it involves uncontrollable eating. Some people with eating disorders become obsessed with diet and exercise. Others will eat large quantities of food and then vomit.

There is no single demographic at risk for eating disorders; they’re diseases that can occur in people of any gender, race, religion, or socio-economic background.

Types of Eating Disorders

Let’s take a look at the most common types of eating disorders and discuss some of the symptoms and effects of each.

Anorexia Nervosa

Anorexia is the most well-known eating disorder. When people think or talk about eating disorders, this is usually what they are referring to.

Anorexia is characterized by restricting food intake. This could be limiting oneself to only a particular food, for example carrot sticks, or limiting the amount of food and/or calories that are consumed.

People with anorexia are typically underweight, but this not always the case. Some people can have all the behaviors without the significant weight loss or without the appearance of losing weight. There are also those who have the binge-purge subtype. This means the person will restrict food intake most of the time but have times of eating too much food and following that with purging usually by vomiting.

Symptoms of Anorexia

The most common symptoms of anorexia include:

  • Fear of gaining weight
  • Distorted body image; seeing oneself as fat even when underweight
  • Frequent monitoring of weight
  • Restricting calories
  • Being underweight comparted to people of a similar age and height
  • Weight being linked to self-esteem and self-worth

While it is mostly women who suffer from anorexia, people of other genders can also become anorexic. According to one study, 0.9% of American women will suffer from anorexia in their lifetime.

Bulimia Nervosa

Like anorexia, bulimia tends to develop in adolescents and young adults and is more common in women. An estimated 1.5% of American women suffer from bulimia during their lifetimes.

Bulimia involves purging food from the body to reduce the number of calories consumed. This purging can take place through compensatory behaviors like vomiting, excessive exercise, laxatives, diuretics, or enemas.

Some bulimics eat large quantities of food in a short period of time and can become painfully full. Eating large quantities of food in a short period of time is called binging. The purging is often to reduce that painful feeling from overeating.

It is important to understand that bulimia is different from the binge purge sub-type of anorexia. Most bulimics maintain a normal body weight while most anorexics are underweight. Bulimics also do not typically restrict their food intake on a regular basis.

Symptoms of Bulimia

The most common symptoms of bulimia include:

  • Eating in a short period of time an amount of food that is definitively larger than what most individuals would eat in a similar time period under similar circumstances
  • Feeling of a lack of control over food and eating during an episode
  • Recurring inappropriate compensatory behaviors(purging) to avoid weight gain

Those suffering from bulimia often have physical repercussions for their behaviors. Those side effects may include:

  • Tooth decay and eroded tooth enamel
  • Severe dehydration
  • Acid reflux
  • Frequent sore throats
  • Ulcers
  • Intestinal distress
  • Electrolyte imbalances – levels of potassium, sodium, calcium, and other minerals can be too high or too low – this can result in a heart attack or a stroke

People suffering from bulimia often also have comorbid substance abuse issues, particularly alcohol abuse, or mental health issues like depression, anxiety, or bipolar.

Diabulimia

Diabulimia is the deliberate underuse of insulin in people with type 1 diabetes for the purpose of weight control.

Diabulimia may also be referred to as Eating Disorder-Diabetes Mellitus Type 1, which is any eating disorder that co-exists with diabetes.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not have a specific listing for diabulimia, but insulin manipulation is often viewed as a compensatory behavior or a purging behavior when discussing bulimia. The key difference and the reason there’s a need to discuss this individually is because of the serious health risks posed by this behavior. With approximately 38% of females and 16% of males with type 1 diabetes having disordered eating behaviors, and the serious health risks it poses, it is important to be aware of this type of eating disorder.

Symptoms and Warning Signs of Diabulimia

The most common symptoms and warning signs of diabulimia include:

  • Secrecy about diabetes management
  • Neglect of diabetes management
  • Fear of low blood sugars
  • Fear and/or talk of “insulin makes me fat”
  • Anxiety about body image
  • Strict food rules
  • Avoiding eating with others
  • Preoccupation with food, weight, calories, or blood sugar levels
  • A1c continuously at 9.0 or higher
  • Fatigue and/or increased sleep
  • Increase in diabetes symptoms

As with untreated diabetes, there are a lot of significant physical issues that can occur. Those with diabulimia are at risk for retinopathy, peripheral neuropathy, kidney disease, liver disease, heart disease, coma, stroke, or even death. A 2008 study showed that diabulimia increased the risk of death threefold.

Binge Eating Disorder

When the DSM-5 was released in 2015, a new eating disorder was added, binge eating disorder.

People with binge eating disorder (BED) have lost control over his/her eating. Like the binge eating in bulimia, they tend to eat large quantities of food in a single sitting, more than an ordinary person would eat in that same situation. Unlike bulimia, however, there is no compensatory behaviors. Because of this, people with BED are often overweight.

BED is believed to be the most common eating disorder in the United States with an estimated 2.8% of adults in America suffering from BED within their lifetimes.

Symptoms of Binge Eating Disorder

  • The most common symptoms of binge eating disorder include:
  • Eating even when full or not hungry
  • Eating alone or in secret to avoid embarrassment
  • Eating unusually large quantities of food in a specific period of time
  • Eating much for rapidly than normal
  • Eating until uncomfortably full
  • Feeling disgusted or ashamed of oneself or feeling guilty after eating
  • A feeling of a lack of control when it comes to food and eating

Typically, those with BED are overweight or obese. This can increase the person’s risk of medical complications like type 2 diabetes, stroke, and heart disease.

More than half of those with BED also have an anxiety and/or mood disorder.

Orthorexia

Orthorexia, sometimes called orthorexia nervosa, falls under the category of eating disorders not otherwise specified (EDNOS). While it is not recognized in the DSM-5 as its own type of eating disorder, it is becoming more and more common.

Unlike most other eating disorders, the focus of orthorexia is not on weight. Orthorexia is an obsession with healthy eating. People suffering from orthorexia develop fixations on eating only foods they deem to be pure or healthy.

While it may start out as a person just trying to become healthier, the obsession can lead to some serious negative consequences including malnutrition.

Symptoms of Orthorexia

The most common symptoms of orthorexia include:

  • An increased concern about the health of the ingredients of food
  • Compulsively checking the list of ingredients and nutrition labels
  • Cutting out multiple food groups (all sugar, all carbs, all meat, all animal products, all dairy, etc.)
  • A refusal and inability to eat anything except a narrow group of foods deemed healthy or pure
  • Spending hours a day thinking and worrying about what foods may be served at an upcoming function or meal

While it may start with good intentions of eating healthier, once the line is crossed into obsession orthorexia occurs.

People with orthorexia typically have another eating disorder, obsessive-compulsive tendencies, high anxiety, or a need for control.

Because there are no formal diagnostic criteria, it is difficult to get an accurate estimate of the number of people who suffer from orthorexia.

Rumination Disorder

Another eating disorder that was first discussed in the DSM-5 is rumination disorder.

In this eating disorder, a person voluntarily regurgitates food that he/she has already eaten. The person may re-chew the food, re-swallow the food, or spit the food out. This takes place within the first 30 minutes of eating.

This disorder can develop in infants between three and twelve months old. In those cases, it often disappears on its own. When this occurs in children and adults, it is more serious and typically requires treatment. When occurring in children, it can rob the child of the nutrients needed to grow and develop correctly.

Symptoms of Rumination Disorder

The most common symptoms of rumination disorder include:

  • Repeated regurgitation of food; the food may be re-chewed, re-swallowed, or spit out
  • The regurgitation is voluntary and is not due to any medical conditions
  • Weight loss
  • Tooth decay and bad breath
  • Frequent stomach aches

While this disorder is typically seen in children, it can also be seen in some adults. It is most commonly found in those with developmental disorders, intellectual disabilities, stress, or anxiety.

While thought to be uncommon, there is no real information about the number of people who suffer from rumination disorder. This may be because it happens more in children or because adults feel so much shame about this behavior.

Causes of Eating Disorders

While eating disorders typically appear in the teen years or young adulthood, eating disorders can develop in those younger or older than that. Eating disorders can occur in people of all genders. Eating disorders are not caused by vanity and fad diets alone. Biological, psychological, and societal influences can all contribute to an eating disorder.

Biological

  • Genetics: Eating disorders do tend to run in families. While it is still debated if this is a situation where nature or nurture is the cause of this trend, there has been research done looking into the genetics of eating disorders. So far, the research has been promising in finding some substantial genetic influence. Currently, it is estimated that 50-80% of the risk for anorexia or bulimia is genetic.
  • Type 1 diabetes: With approximately 38% of females and 16% of males with type 1 diabetes having disordered eating behaviors, including diabulimia, this becomes an important risk factor for developing an eating disorder.
  • History of dieting: Sometimes a history of dieting can lead to the development of binge eating or bulimia.

Psychological

  • Perfectionism: As we discussed, sometimes things like perfectionism can lead to the development of an eating disorder. A need to eat only the “perfect” foods or to look “perfect” can lead to disorders like anorexia, bulimia, diabulimia, orthorexia, or even rumination disorder.
  • Obsessive tendencies or a feeling of a loss of control: Obsessive tendencies and a need to feel in control can also lead to eating disorders. If a person is feeling as if he/she has no control over the things in his/her life, the person may turn to one thing that can be controlled – food.
  • Poor body image: Body image is how one feels about and in his/her body. This could be from feeling as if one were born to the wrong gender, from feeling overweight or disproportionate, or just having a different idea of what someone should look like. This can lead to controlling food intake in order to reach that ideal body image one has.
  • Depression and/or Anxiety: Many people with eating disorders also have depression and/or anxiety. It is also possible for the person to have other mental health issues like bipolar, obsessive-compulsive disorder, or schizophrenia. It is estimated that 33-50% of those with anorexia have a comorbid mood disorder and about 50% have an anxiety disorder.

Societal

  • Teasing and bullying: Being teased or bullied about weight is becoming a common reason for people to develop an eating disorder. With an increase in cyberbullying and a need to have a picture-perfect life on social media, this is becoming a more common reason for eating disorders to develop particularly in teenagers.
  • Trauma/abuse: A history of trauma or abuse can lead to the development of an eating disorder. For some, the trauma can lead to the feeling of being unworthy of food. For others, the feeling of “if I looked perfect, this wouldn’t have happened to me” takes over and leads to the development of an eating disorder.
  • Lack of friendships/social support: Some people have reported turning to eating disorders, particularly binging and purging, after feeling bored. For others, they hope to be able to make friendships if they lose weight or are more attractive.

Seeking Treatment for an Eating Disorder

Eating disorders have the highest mortality rate of any mental illness. At least one person dies as a direct result of an eating disorder every 62 minutes.

It is important to know, however, that eating disorders are treatable. There is help available to those suffering from an eating disorder. You can visit the National Eating Disorders Association (NEDA) website for some useful tools. You can use this screening tool to determine if you or a loved one may be suffering from an eating disorder. You an also contact the NEDA helpline for support and resources.

National Eating Disorders Awareness Week (#NE Awareness) is February 25 – March 3, 2019. We’re changing the conversation around food, body image, and eating disorders! Join the movement and #ComeAsYouAre, not as you think you should be. www.nedawareness.org.

Rebecca Encao, MSMHC is both an instructor and a team lead for Southern New Hampshire University and has taught psychology and social science courses for SNHU since 2015. Prior to that she worked with eating disorder patients at Eating Recovery Center in Denver.

Letter to the editor: People with anxiety disorders deserve acceptance, treatment

Imagine being unable to breathe or even move, feeling trapped and as if the world as you know it is over. Now imagine feeling like that completely out of nowhere, regularly.

According to the Anxiety and Depression Association of America, “anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States, or 18.1 percent of the population every year.” And among this 18 percent of the population, about 36 percent receive treatment.

There are many different types and examples of anxiety disorder: post-traumatic stress disorder, general anxiety disorder, obsessive-compulsive disorder and forms of depression. Women are more likely to suffer from these forms of anxiety as well. Anxiety disorders affect 25.1 percent of children ages 13 to 18.

Many people do not view mental disorders as serious. They are often quick to note that stress is just a part of the real world. However, with the technological advances of today, we are able to see the strong effect that such a disorder can hold. That people with anxiety may be hit harder by social interactions or criticism than those without.

More people need to become aware of the experiences that people are facing every day. When these disorders become more socially acceptable, the chances of the victims of these disorders feeling more comfortable and stepping forward and receiving treatment will increase. Then they could have more opportunity to live a regular life without such awful side effects, because when it comes down to it, who really wants to be hearing, “something’s wrong, something’s wrong, something’s wrong” constantly?

Katia Bazilchuk

Gorham


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Exploring the ins and outs of anxiety – Enumclaw Courier

Health experts say anxiety is a normal part of every day life.

But while most people experience it occasionally as stressful situations ebb and flow, an estimated fifth of the U.S. population’s daily activities are affected by persistent anxiety, which can lead to numerous physical and mental health problems if left untreated, according to the Anxiety and Depression Association of America.

This is why, as the second part of its three-part workshop series about suicide prevention and mental health education, the Rainier Foothills Wellness Foundation, the Enumclaw School District, and the Enumclaw Schools Foundation is hosting a showing of “Angst,” on Wednesday, March 6, from 6 to 8 p.m. in the Enumclaw High commons.

After the movie is finished, there will be an follow-up panel discussion with four Enumclaw School District counselors — Tina Hickcox from Kibler Elementary, Rebecca Bowen from Southwood Elementary, Sandy Wright from Thunder Mountain Middle School, and Kami Johnson from EHS.

In a group interview with them and several other district counselors, they all agreed that one of their biggest concerns when it comes to their students are their stress and anxiety levels, which appear to be on the rise, even for elementary school students.

“There’s more of an awareness with what’s happening in the world. The information that’s out there, there’s more access, so kids are bringing up things that are well beyond their years more frequently than before,” said Bowen, who’s been a counselor for more than 25 years. She added that she’s had students ask her about terrorists and suicide, topics that rarely came up in conversation pre-9/11. “There’s this connection they don’t have, the prefrontal cortex development, to understand how that relates to them personally. It has created, in my experience, a lot more general anxiety, with a lower ‘a’, not a capitalized diagnosable [disorder], amongst more children.”

This is normal brain development — according to the University of Rochester Medical Center, the brain typically doesn’t finish developing until the mid-20s. Until then, children and teenagers think with their amygdala, where the brain process emotions, whereas adults use their prefrontal cortex, where rational thinking is done.

This could explain why, as Enumclaw Middle School Counselor Kristina Grundmanis put it, middle and high schoolers have a hard time separating presentation from reality, especially on social media.

“I project my ideal life in my Instagram. That doesn’t mean that’s my day-to-day life. And I’m an adult and I understand that difference,” she said. “When you’re younger, everything you see is reality. Everything that is presented to you is reality.”

But the problem isn’t that we experience stress or anxiety, they all said. Those emotions, in a healthy, safe situation, ought to encourage people to be prepared and excel — you would never study for a test if you weren’t anxious about the outcome, Johnson said.

Instead, the issue is that some students don’t have the opportunity or time to healthily deal with that normal anxiety, which can build on itself.

“In addition to busy schedules and being more engaged in technology is less access to things that research has shown to reduce anxiety,” Bowen said. “Being out in nature, having calm time, mindfulness of just being, conversations with caring adults that are not distracted… a lot of that is hard to find these days in kids.”

And in a society so focused on instant gratification — especially instantaneous emotional gratification through social media — some students just don’t understand de-stressing takes time and effort, Johnson said.

“You can’t take five deep breaths and instantly feel better,” she continued. “It’s all about those neural pathways.”

For example, students that are constantly pulled from class because they tell their counselors that they’re anxious are training their brains to avoid stress rather than coping with it, Johnson said. This is not always a healthy coping mechanism, especially since avoiding class makes graduating high school an uphill battle.

“It’s difficult, once we get to high school, to have those times to teach them and say, it’s alright” to be stressed, Johnson continued.

This is why it’s important to start teaching students at a young age techniques to cope with stress, they all agreed. Wright said it helps when students take time to name their feelings and have a calm discussion about where their stress is originating from.

When students are exhibiting extreme stress, Grundmanis said one successful technique she uses is called “grounding.”

“One of my favorite questions to ask students when I see them starting to elevate and escalate is, ‘What do you smell right now?’ because it brings that attention to… what is that sensory input right then. And then we go through the other senses,” she said.

Bringing attention away from the emotional center of the brain to another part is a technique Scilla (pronounced Sheila) Andreen, the director of “Angst,” said she learned early on in her professional life.

“I get so much anxiety before my public speaking, when I’m doing a big presentation, so I carry a little smooth rock that I’m constantly touching, or I snap, because people don’t seem to notice when I snap, and I snap quietly,” Andreen said. “It helps to move the energy from the amygdala to the frontal cortex — anxiety can’t exist there.”

Although Andreen said she has some general and social anxiety in her life, that wasn’t why she decided to make a documentary about mental health.

“A friend of mine asked if I could make a movie about mental health, and I said no, I don’t even know how to touch that topic,” she said. “And she died by suicide, so I was very motivated to make a movie about mental health, and thought, if our audience is schools and communities and corporations around the world, how do we make a movie that audience is going to want to watch, from ages 10 and up?”

The answer she came to was anxiety, because she believes many more serious mental health issues stem from too much uncontrolled anxiety.

“We can fall into these bigger, deeper, medical health issues, whether it’s depression or OCD,” Andreen said, clarifying that there are genetic components to anxiety disorders, as well as environmental factors. “Anxiety is the tip of it, and if you can maintain a healthy dose of anxiety, that’s awesome. The minute it becomes a disorder, you have to address it.”

Addressing and treating actual anxiety disorders isn’t a part of the Enumclaw School District counselors’ jobs, the counselors said, although they are aware several of their students have diagnosis, and suspect several others could be diagnosed. They can help in a pinch — like Grundmanis using her grounding techniques to help a student out of a panic attack — but they all said when it comes to real disorders, they help parents refer out to specialists. After a child is diagnosed, they continued, then they can work with the mental health professional to aid the child in school.

Luckily, they added, with more available information about anxiety disorders out there — like the movie “Angst, — more parents are willing to have a conversation about anxiety disorders and help seek treatment for their children.

The phrase “anxiety disorder” is an umbrella term for several disorders, according to the National Institute of Mental Health, which include generalized anxiety disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder (OCD), separation anxiety disorder, agoraphobia, and other specific phobias.

And while depression isn’t classified as an anxiety disorder, there is a strong connection between the two.

“It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa,” the Anxiety and Depression Association of America’s website reads. “Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.”

The ADAA says anxiety disorders as the most common mental illnesses in the U.S., affecting 18 percent of the country’s population.

Of the myriad disorders, social anxiety disorder is one of the most common, affecting nearly 7 percent of Americans. According to a 2007 survey, 36 percent of people who identified as having social anxiety disorder waited 10 years or more before seeking treatment.

Other disorders, like generalized anxiety disorder and panic disorder, each affect about 3 percent of Americans, with women being twice as likely to be affected than men.

According to the ADAA and the National Institute of Mental Health, roughly a quarter to a third of children between the ages of 13 and 18 have an anxiety disorder, although only roughly 8 percent suffer from “severe impairment.”

“Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse,” the ADAA’s website reads.

But research also shows that anxiety disorders are highly treatable — though only 37 percent of people with a disorder seek treatment — the ADAA continued, and the Enumclaw School District counselors agreed that families tend to be more open now about discussing mental health and mental health treatment, and there are more services for people wishing to seek treatment, even in town, including Nexus Youth and Families and Valley Cities.

However, while many families appear to be willing to discuss mental health and even seek treatment for their child during a crisis, the counselors notice when there’s no followthrough, and they agreed that even when a crisis is over, seeking continued treatment is important.

“It will take time,” Johnson said. “There is no instant fix out there.”


Anxiety versus Panic – Know the Differences and How To Deal with Both

Anxiety versus Panic – Know the Differences and How To Deal with Both

Mridu Walia – Mechanical
Posted on: February 20, 2019

Today I will be mainly be talking about the differences between an anxiety attack and a panic attack because more often than not, people talk about it as if they are the same thing and use the terms interchangeably in a conversation. However, that is not the case as even though the symptoms for both anxiety and panic are kind of overlapping, they have key characteristics that distinguish one from the other. Therefore, we will be beginning with an overview of the symptoms experienced during an anxiety and panic attack respectively, and then go on to outline the main differences between them. We will also discuss some ways to deal with both anxiety and panic attacks, including home remedies and simple lifestyle changes you can implement, as dealing with these issues can be both difficult and disruptive.

Anxiety attacks are more gradual and less intense as compared to panic attacks. Some of the emotional symptoms for an anxiety attack include – stress, restlessness, nervousness, fear, irritation; whereas some of the physical symptoms would include: shortness of breath, muscle tension, disturbed sleep, headache, sweating etc. However, these symptoms do overlap with the emotional and physical symptoms experienced during a panic attack along with some key ones that include: chest pain, heart palpitations, shaking/trembling, abdominal pain, intense pangs of fear, nausea etc. In the moment, it can often feel like you might be dying from a heart attack. Panic attacks are generally unexpected and sudden and bring on a sense of overwhelming and intense fear. Sometimes, an anxiety attack can lead to a panic attack too. Allow me to draw on my personal experiences and share this with you.

It was my first year at the university and I was supposed to participate in a presentation on our team project. The entire week I spent preparing for it, I remember being constantly anxious, eating lots of ice-cream (oh common? It was summer, and I was really stressed) and just pacing back and forth as I was trying to remember the lines for this presentation. I could not stand still in one place, I was so nervous. But I practiced a lot and finally began feeling confident that I might be able to pull this off. So, fast forward to the day of the presentation, my team and I have been watching our classmates present their projects. When it’s our turn to present, I get so majorly anxious as I walk towards the podium. My anxiety attack had turned into an intense panic attack because I have stage fright. I remember feeling nauseous, dizzy and light-headed as I waited for my turn to speak, and then when it was finally my turn to present, I remember my legs going numb and feeling this blinding abdominal pain. I wanted to sit down to catch my breath because I literally could not breathe. Needless to say, I didn’t do a great job presenting that term. So, just wanted to share this little anecdote before I continue talking about the differences between anxiety and panic attacks. But don’t worry, I will be sharing another incident that happened with me later on, so keep reading!

So, we now know how the symptoms can align as well as differ between anxiety and panic attacks. But what would also help, is to look at the clinical differences between these two terms. The Diagnostic and Statistical Manual of Mental Disorder, 5th edition or DSM-5, acts as a standard and is used by mental health professionals to diagnose mental illnesses. According to VeryWell Mind, the DSM-5 uses the term “panic attack” to describe the hallmark features associated with the condition known as panic disorder, which is categorized as an “anxiety disorder”. The term “anxiety attack” is not defined in the DSM-5. Rather, “anxiety” is used to describe a core feature of several illnesses identified under the headings of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) etc.

Alright, Ms. Walia, why don’t you Hakuna Matata? Well, if you have made it so far, thank you for being so patient. So that was a lot of information, right? Let’s give you a breather and discuss easy home remedies and lifestyle changes along with treatment options. I have GAD and here are a few things that have worked out for me and some people I know. Again, I am not a mental health professional, however, I would definitely like to share things that helped me deal with anxiety and panic attacks, in the hopes that it would help someone else out there.

I found out that drinking cold water or taking a walk in the cold really helps me to calm down and reconnect with my body. Deep breathing, I know it sounds cliché, but trust me when I say, it works! Panic attacks are commonly characterized by hyperventilation, which can amplify emotions such as fear, making it worse. By practising deep breathing, you are teaching your body how to control your breathing which can significantly reduce the hyperventilation. According to Healthline, focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four. I know we have very busy lives, however, try and exercise on a regular basis. I am sure you all know the benefits to exercise, however, a quick recap: Having an active lifestyle not only keeps you fit (Confidence++) but also, releases endorphins in our systems. According to mindbodygreen, even moderate walking helps boost cognitive functions like reasoning, memory, attention span, and the expansion of information and knowledge.

I find that taking a hot shower or drawing myself a luxurious bath with salts really helps me deal with stress. If you are prone to panic attacks, have a travel size bottle of lavender oil on you. When you feel like you’re overwhelmed with anxiety or it feels like the onset of a panic attack, rub a few drops on your arms and just breathe in the scent. Lavender scent has stress-relieving and soothing qualities which, according to research, lowers the heart rate and blood pressure.

Enforce positive thinking by recognizing behaviours that affect you negatively. For example, consider this: you stepped on black ice, slipped and sprained your foot. Instead of saying, “Why does this happen to me?”, consider saying, “Okay, remember to walk like a penguin next time!”. Lastly, and this one is important, be forgiving of yourself. I strongly believe that things happen for a reason. Yes, when your life starts falling apart like dominos tiles, it’s difficult to believe that. I was very self-critical of myself and would internalize everything that happened in my life. But with time, I would realize, well this wasn’t really my fault now, was it? So, I am pretty new to this myself, but I try and forgive myself if something is not going the way I anticipated it to go. I tell myself: okay, take a minute and analyze what did you that was wrong and how could you do it better the next time? I know it is not as simple as that sounds, but if you get in the habit of thinking positively, it will become a behaviour eventually. I know I am going to try and implement this in my life, and I strongly encourage you all to try the same, because if you don’t love yourself, then who will? Forgiveness is a big part of loving someone, so answer me this: Do you love yourself enough to forgive yourself?

Alright! So, remember that other incident I mentioned about 750 words ago? Here it goes: I gave a presentation last term as part of my work term experience. I am proud to say it went very well! Naturally, I was anxious, but because I had been implementing positive behaviours and my coping mechanisms, I prevented that anxiety from turning into a panic attack. End result? I delivered a great presentation in front of the entire staff and 26 other coops and got a great evaluation from my supervisor too. It was an amazing experience altogether! Which brings me back to the conclusion: anxiety and panic attacks are different based on the intensity and longevity of the symptoms, but with the correct combination of treatment i.e. coping mechanisms and therapy etc, it can be a lot easier to deal with. To my readers, I hope you enjoyed reading this article and had a good reading break. Also, if you have midterms coming up, I wish you good luck!

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Obsessive compulsive disorder (OCD): causes, symptoms and treatment

Obsessive compulsive disorder, or OCD as it’s more commonly known, is a mental health condition in which a person has frequent obsessive thoughts and compulsive behaviours.

A common misconception is that OCD is a habit, usually in relation to cleanliness, but OCD is in fact a mental health condition affecting millions of people worldwide that can be extremely distressing and interfere with your life.

But how can you tell if you’re suffering from it and how is it treated? Dr Roger Henderson explains:



What is obsessive compulsive disorder?

Obsessive compulsive disorder (OCD) is a common but serious anxiety-related condition where the sufferer experiences frequent and recurring obsessive thoughts, usually followed by repetitive compulsions or impulses in response to the obsession.

A sufferer with OCD will typically fall into one of four main categories:

🔹 Checking rituals
🔹 Contamination thoughts
🔹 Hoarding tendencies
🔹 Intrusive thoughts and constant rumination on a particular subject



What are obsessions?

Obsessions are persistent, unwanted and intrusive unpleasant thoughts that keep coming into your mind. These are different to the normal everyday worries we all have about simple problems.

Obsessions are persistent, unwanted and unpleasant thoughts that keep coming into your mind.

Typical obsessions include fears about contamination with dirt and germs, or catching viruses such as HIV.

Others include leaving doors unlocked, causing people harm, worrying about swearing, needing things to be arranged in certain exact ways or a fear of behaving badly in public. However, an obsession can be about anything.



What are compulsions?

Compulsions are repetitive physical actions or mental rituals that are performed repeatedly to try to neutralise the anxiety caused by obsessions.

These often interfere with normal daily living – for example, washing your hands dozens of times a day – and any relief from anxiety they may cause reinforces the original obsession, and so effectively worsens the OCD.

Other examples of compulsions include checking doors repeatedly to make sure they are locked, compulsive cleaning, counting, organising, and saying words or numbers silently.

💡 It is important to point out that people with OCD do realise that their actions are irrational but feel powerless to prevent doing them because of their anxiety.

Who is at risk of OCD?

The exact cause of OCD is unclear but the chances of developing it is higher than average if your mother, father, brother or sister suffers from it.

Anyone of any age can develop OCD – regardless of gender or social background.

It is thought that between 1-3 in 100 adults in the UK have OCD. The World Health Organisation has ranked OCD in the top 10 of the most disabling illnesses of all kinds, in terms of how it affects someone’s quality of life and their associated loss of earnings.

Anyone of any age can develop OCD – regardless of gender or social background – but it usually first develops between the ages of 18 and 30.

Estimates put the number of UK sufferers at almost three quarters of a million people, but at least half of these are classified as being in the severe category of OCD and sufferers often go many years without being diagnosed, often because of feelings of shame or guilt they have about their OCD.



How is OCD diagnosed?

If you are concerned that you may have OCD, see your doctor. They will ask a number of questions, including the following:

  • Do you wash or clean a lot?
  • Do you repeatedly check things?
  • Are there persistent thoughts that upset you?
  • Do your daily activities take a long time to finish?
  • Are you concerned about putting things in a special order?
  • Do you have to start all over again if this order is disturbed?
  • Are you upset by mess?

    If it is felt from these initial questions that OCD may be a possibility, then a more detailed assessment is needed. It is diagnosed when any obsessions and compulsions take up at least an hour or more of time, cause significant distress in someone’s life, or interfere with normal daily functioning at home, work or school, or interfere with family life and relationships.

        Children suffering from OCD may be referred to a specialist mental health team who deal with assessing and treating children with OCD.



        What is the treatment for OCD?

        There are a few effective treatment plans for obsessive compulsive disorder:

        ✅ Cognitive behaviour therapy (CBT)

        CBT is a type of ‘talking’ therapy that focuses on the immediate problems someone has and helps them explore alternative ways of thinking to help challenge their beliefs and anxieties. It is probably the single most effective treatment for OCD. So, if you have OCD it is very helpful to understand that thoughts or obsessions in themselves do no harm, and that compulsive acts are not needed to counteract them.

        ✅ Medication, usually with an SSRI antidepressant medicine

        Although they usually used to treat depression, SSRI antidepressant medicines can also reduce the symptoms of OCD, even if depression is not present. It is believed they work by altering levels of the brain chemical serotonin, which many specialists believe is directly involved in causing OCD symptoms.



        Mental health support

        If you think you might have OCD, make an appointment with your GP. Meanwhile, try one of the following resources:

        ✔️ OCD UK: a charity which specifies in helping those suffering from OCD.

        ✔️ OCD Action: a charitable group offering support to and raising awareness of OCD sufferers.

        ✔️ Anxiety UK: a charity which supports those with any type of anxiety, OCD included.

        ✔️ The Samaritans: a charity providing support to anyone in emotional distress.

        ✔️ Mind: a charity that makes sure no one has to face a mental health problem alone.



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Phobias
Traumatic stress disease

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New medication being tested in Atlanta could help people with OCD

  • By:
    Linda Stouffer

    Updated: Feb 14, 2019 – 6:56 PM

ATLANTA – Crucial research underway in metro Atlanta could lead to relief for millions of people with a debilitating mental illness.

An estimated 2 percent of the population, or one in 50, has obsessive compulsive disorder.

UGA grad student Rachel Johnson realized something was wrong when she was 18.

“It was absolutely miserable, and I thought I was just losing my mind,” said Johnson.

OCD involves obsessive thoughts, then compulsive behavior to reduce the anxiety caused by those thoughts.

It can manifest itself in different ways. For some people, it’s excessive hand-washing, even to the point of their hands bleeding. Others repetitively flip light switches or check locks.

Johnson’s obsessive thoughts involved feeling the need to pray a certain number of times and in a certain way or her family and friends would die.

“Sometimes I would just spend hours and hours just praying. But it had to be, like, a certain way or I’d have to start all the way over,” said Johnson.

After a year of agony, Johnson searched her symptoms online, saw a therapist and was diagnosed with OCD.

She’s now managing her OCD through a combination of medications and therapy.

Now, there could be new help for Johnson and others with OCD.

iResearch Atlanta in Decatur is part of a clinical trial testing a new medication by Biohaven Pharmaceuticals.


MORE 2 INVESTIGATES STORIES:


Unlike current drugs on the market that are used broadly for depression, anxiety and OCD, the new medication being tested specifically targets OCD.

“It actually helps reduce the amount of glutamate that’s in the brain that may be causing a lot of the anxiety and the rituals and compulsions and obsessions that one is experiencing,” said iResearch Atlanta’s Dr. David Purselle.

Purselle told Channel 2 Action News 20 to 30 percent of the OCD patients who use the current medications on the market get very little benefit from them.

The hope is the new medication will reduce obsessive thoughts, compulsions and anxiety.

That could be life-changing for people with OCD in terms of overall happiness and productivity.

“It makes it very difficult to hold down jobs, to form good relationships, to have a good, active social life,” Purselle said.

The clinical trial will last two to three years.

For information on how to participate, click here: www.OCDtrial.org.