Conquering More Than the Usual Worries at Summer Camp

“We all have occasional fears that go away without treatment, like being afraid of the dark, or the fear that someone is going to break into your house and kill you,” Dr. Mathews said. “O.C.D. is not the existence of these illogical thoughts, it is the inability to suppress them. The brain doesn’t shut down these thoughts, so if the thoughts keep coming back, your brain starts signaling that I might really need to worry about this.”

Well-intentioned parents often try to help calm their children’s fears by helping them avoid the triggers — such as allowing a child who is afraid of the dark to sleep with a lamp on — but experts say that exposure and response prevention, a form of cognitive behavioral therapy (CBT), is a better way of learning to deal with the fear.

The camp days are divided into taking part in group activities and one-on-one therapy and counseling. Each camper is assigned a therapist and a counselor for the week. The counselors stay with their campers the entire day.

The families pay a registration fee of $200, which helps to cover the costs of the space and supplies. The campers’ insurance is billed for therapy; the camp counselors, who are mostly undergraduate students, volunteer their time.

On the first day of camp, the children come up with “fear hierarchies” with their therapists, which is a standard treatment for O.C.D., Dr. Mathews said.

“You write down all the fears you have and then you rate them from 1 to 10, with 10 being the highest, meaning there is no way you are going to make me do that,” Dr. Mathews said.

The children who attend the camp often have several fears they are trying to overcome.

Ella said she is terrified of tornadoes and getting sick. She and her mother, Katie, traveled from their home in Nashville to attend therapy sessions in the clinic, and to attend the June session of the camp, which had been recommended to them by one of Ella’s therapists.

Anxiety Attack vs Panic Attack – How to Tell the Difference

Figuratively raise your hand if either of these sounds like something you’ve gone through:

You’re a bit of a worrier, but some days — when there are too many details up in the air, you’ve got a heap of work, your babysitter calls in sick, and your carefully constructed house of cards starts to wobble — you become completely overwhelmed. Everything feels equally urgent and yet you’re paralyzed. What’s gonna happen if you can’t figure it all out? At that moment, your breathing is really shallow and you can’t think. When your partner tells you not to worry, that it’ll all work out somehow, it’s all you can do not to punch him in the throat.


You’re feeling fine, and then suddenly, for no apparent reason, your heart starts to race, it’s hard to take a deep breath, and weirdly, you feel both chilled and sweaty at the same time. Whoa, you need to sit down — you’re dizzy and want to puke. It’s a such a strong physical takeover of your body that you’re scared you’re actually dying! You’re about to call 911, but then you feel a little better and over the next 20 minutes or so, the feeling dissipates. You’re left exhausted, with a giant question mark — and the hope that it never, ever happens again.

      So did you have a panic attack, an anxiety attack, or some hideous combo platter of both?

      Short answer: If you have experienced something like the second scenario, that was likely a panic attack, which is a clinical term for a tsunami of intense, mostly physical symptoms, sometimes with no obvious cause. You are suddenly drowning in a deep ocean of fear, and then fairly quickly, the waters recede and you find you can stand again.

      The first is what many people refer to in conversation as an “anxiety attack,” which isn’t something healthcare providers diagnose and has no official definition. So many people use the term, however, that it is generally understood to mean that you are feeling way more anxiety than you can handle — you feel “attacked” by it, because it’s all just too much.

      How to Tell the Difference Between Panic Attacks and Anxiety Attacks

      Panic attacks and anxiety attacks are really two distinct experiences, says Amanda Spray, Ph.D., Clinic Director of the Steven A. Cohen Military Family Center and a Clinical Assistant Professor in the Department of Psychiatry at NYU Langone Health in New York City. “The difference between the two is about the suddenness of the feelings — usually (but not always) people who get panic attacks will feel okay before it happens,” she says. The symptoms will then typically go away within 30 to 60 minutes.

      In contrast, those who have anxiety attacks tend to carry around a low level of anxiety most of the time. The feeling of anxiousness ramps up during an attack and then eventually (anywhere from a few minutes to a few weeks) it settles back down to a normal-for-them level. Generally, panic attacks have more severe physical symptoms, whereas anxiety attacks are more of a “slow burn,” says Craig Sawchuk, Ph.D., a professor of psychology at the Mayo Clinic in Rochester, Minnesota,

      So why the confusion? Because panic attacks and anxiety attacks overlap in a few ways, and some unlucky people experience both. Plus, people use the terms interchangeably.

      “When people say ‘I’m having a panic attack,’ ‘I’m having an anxiety attack,’ or just ‘I’m freaking out,’ we know what they mean,” says Sawchuk. “The question is, at what point do either one meet clinical criteria?”

      What Panic Attacks and Anxiety Attacks Have in Common

      Both panic and anxiety attacks are “upregulating” states, meaning they move you to action. “They both activate the fight, flight, or freeze reaction in the body,” says Spray. That’s when your sympathetic nervous system triggers your brain to release of a bunch of hormones, including adrenaline and noradrenaline, that rev your body up. This alarm bell reaction is a good thing when we’re facing danger, as it spurs us to get to safety or otherwise protect ourselves.

      The problem is both panic and anxiety attacks happen when you’re not truly at risk, says Sawchuk. They’re misfires of this alarm system when one or all of three things is going wrong:

      • The alarm goes off too loudly. With panic attacks, for instance, “your heart is pounding out of your chest, you’re sucking air, and you’re dripping with sweat,” says Sawchuk. With an anxiety attack, your brain might have thoughts pinballing around that feel dire, even though no one is going to die if you are, say, five minutes late to work.
      • It’s hard to turn the alarm off. With anxiety attacks, you can’t just snap out of feeling the way you do, and while panic attacks end on their own pretty quickly, they leave you spent.
      • It’s a false alarm. There is no actual danger in either scenario — it only feels like there is.

        Some symptoms, such as shallow breathing and trouble thinking clearly, can happen in both panic and anxiety attacks; both can be amplified by worrying about them even more; and both of them can lead to behavioral changes, says Sawchuk. “If they start to happen with any frequency, the person might start to avoid certain activities that they associate with the attacks.”

        The Symptoms of a Panic Attack

        As similar as they may seem, there are some distinct differences between anxiety and panic attacks. A panic attack is an abrupt surge in intense fear or intense discomfort that reaches its peak within minutes, during which a person can experience:

        • palpitations
        • sweating
        • trembling or shaking
        • sensations of shortness of breath
        • feelings of choking
        • chest pain
        • nausea or GI upset
        • dizziness or lightheadedness
        • chills or heat
        • numbness or tingling
        • feeling of unreality or that the person is detached from themselves
        • fear of losing control or fear of dying.

          The Symptoms of an Anxiety Attack

          An anxiety attack means different things to different people, but symptoms of Generalized Anxiety Disorder include:

          • excessive and hard-to-control worry, often about many different everyday things (like finances, relationships, or work)
          • restlessness
          • difficulty concentrating
          • irritability
          • muscle tension
          • trouble sleeping

            Do I have an anxiety disorder?

            Either panic attacks or anxiety attacks can rise to the level of disorders, depending on their frequency and severity. Say you have a panic attack when you ask a store clerk for another size. If you find yourself no longer shopping for clothes because you’re afraid of another attack or avoiding the mall altogether, that may signal a panic disorder.

            A doctor may diagnose someone with a panic disorder if the attacks lead to a month or more of worrying about another attack or maladaptive changes in behavior, says Spray.

            There are a several different anxiety disorders (including Generalized Anxiety Disorders, Obsessive Compulsive Disorder, and Social Anxiety Disorder) but what they all have in common is that the anxiety gets in the way of your life to a significant degree, says Sawchuk.

            How do I treat or manage these attacks?

            All the health and wellness practices we should probably all be doing can go a long way in managing panic and anxiety, says Sawchuk. These include getting the right amount of sleep for you, following a healthy diet, eating regularly to avoid blood sugar dips, and exercising. Meditation, mindfulness, and a solid social support system can also keep you on an even keel.

            Cognitive behavioral therapy (CBT) has also been shown to help people manage both panic and anxiety. In CBT, you learn how to recognize the thoughts and triggers bring on these attacks, and how to think about them differently so they no longer amp you up, or if they do, you learn how to tolerate it. In the case of panic attacks, the CBT may involve exposure therapy in which the therapist carefully and gradually brings on the symptoms of a panic attack, says Sawchuk. Suppose you had a panic attack while running and felt like you were going to die; a therapist might have you do something to get your heart pounding again, to show you that a pounding heart does not equal certain death.

            “It’s about retraining the brain and rewiring the alarm system to it’s not going off whenever those symptoms get stimulated,” he says. “You start to gain confidence, knowing that you can handle the symptoms and that they’re not dangerous. You can actually retrain your brain to become bored with these symptoms.”

            And if therapy alone isn’t enough, “medication is always an option,” he adds. These usually start with SSRIs such as Prozac or SSNIs like Effexor, which you take daily. “These don’t work in the moment, but rather over time,” he says. Some doctors will prescribe benzodiazepines like Ativan, but only on a short-term basis, he adds.

            What should I do if I’m having an attack?

            Controlled breathing can help deescalate an attack or even nip it in the bud, says Spray. “It’s very helpful to have your exhale be longer than your inhale restore the balance of Co2 and oxygen in your body,” she says. Shallow breathing can throw these proportions off, so addressing this imbalance early on may help prevent the cascade of other symptoms, such as sweaty palms and racing heart.

            Her favorite technique is called paced breathing. Here’s what to do:

            • Breathe in through your nose for a count of four.
            • Hold for a count of one.
            • Breathe out of your mouth for a count of six. “Purse your lips and pretend you’re blowing out a straw,” she says.
            • Hold for a count of one.
            • Repeat until you feel calmer.

              The bottom line: If you are having trouble managing your anxiety or panic, let your primary care provider know. He or she can refer you to a therapist who can teach you the skills to dial them down.

What Is ERP for Obsessive-Compulsive Disorder?

What do you value in life?

When Noah’s next therapist asked him, “What and who matters most in your life?” Noah indicated that all he cared about was to eliminate the intrusive thoughts and anxiety. It made sense to him as he believed that once he could control his thoughts and feelings, he could move on with life. Noah had put his life on halt believing that he could master his internal experiences (i.e., thoughts, memories, feelings, sensations, and urges) before he could strengthen his friendships, go back to school, date again, get married, and have a family.

During treatment Noah learned that behaving towards internal events as if they were external ones was not effective. For example, he could easily discard appliances when they weren’t working, but he could not remove thoughts or feelings when they were unpleasant. Viewing and treating internal events as if they were external experiences led him to get trapped in the OCD cycle.

Why is ERP effective?

Your mind’s inherent job is to protect you, and when you struggle with OCD, your mind works overtime. Thoughts that appear useful may lead you to avoidance and compulsions. When you avoid situations and become stuck, you are not able to disrupt the beliefs and expectations related to your anxiety and despair.

On the other hand, when you become proactive in facing your fears, you can truly learn and discover what happens. Instead of falling for your mind’s advice, you can be willing to interact with the experiences that bring fear but may also disconfirm your mind’s assumptions. You will discover that you have the inner wisdom to handle any situation even when it’s terrifying. However, if you don’t give yourself a chance, you’ll never know.  

What may ERP look like for you?

Your treatment plan is personally designed. But learning occurs before, during and after exposures. You can focus on the things that are important and meaningful rather than trying to eliminate what’s occurring naturally.

Your treatment provider will guide you through ERP. The exposures are done randomly and not in a hierarchy because life does not take place according to your fear hierarchy. Life happens and you can learn to be willing to face whatever shows up, so you can cultivate the life you wish to live.

During Exposures:

As you increase awareness of your internal events, you will be able to acknowledge them as such — thoughts, memories, feelings, sensations, and urges. You can learn to welcome them, and you don’t have to like them. You’ll learn to make room for them because you know it is futile to resist them.

Your focus will be on your values — what you want your life to be about (i.e., relationships, employment, education, spirituality, etc.). What you’ve been missing out on because of OCD. The question you’ll ask yourself is, “If I act on my mind’s advice, will that lead me to living the life I want?”

You will also learn to accept the uncertainty that OCD brings. Though this is difficult, the more exposures you do, the more willingness you will develop in accepting uncertainty, which after all is part of life for every human being.

After Exposures:

You will recognize that life does not need to be about getting through the anxiety and fear. With repeated exposures, you will learn that allowing the emotions and sensations, instead of fighting them will give you more freedom to live purposefully. You will feel empowered as you practice the skills to develop more flexibility in your thinking.

After each exposure answer these questions:

  • What did I learn from this experience?
  • What can I do next time to be more flexible when I encounter a trigger?
  • Where can I find more opportunities to practice the skills that will help me face my fears and focus on improving the quality of my life?

Noah learned skills to view his internal events with a different mindset. He acknowledged and allowed them to naturally come and go without having to wrestle with them. He was able to live the life he had yearned for. He recognized that he had a choice of whether to act or be acted upon by his OCD mind.

ERP is not about facing your fears and white-knuckling the situation. You already do that every day. Your therapist will provide skills to prepare you to do ERP. This practice can give you long-lasting results and enable you to live a richer and fuller life, even when the OCD mind spits out unhelpful thoughts.

Give it a try!


Craske, M. G., Liao, B, Brown, L. Vervliet B. (2012). Role of Inhibition in Exposure Therapy. Journal of Experimental Psychopathology, 3 (3), 322-345). Retrieved from

Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-compulsive and Related Disorders, 6, 167–173. Retrieved from

Anxiety disorders increase hospital visits, costs in type 2 diabetes

Adults with type 2 diabetes who are diagnosed with an anxiety disorder visit the hospital emergency department more frequently and spend more on hospitalization than those without such diagnoses, according to findings published in Diabetes Care.

“Anxiety disorders are serious. They cause extreme distress and harm people’s abilities to live fulfilling lives,” Esti Iturralde, PhD, a mental health researcher in the division of research at Kaiser Permanente Northern California in Oakland, told Endocrine Today. “Doctors who treat diabetes might miss the importance of anxiety disorders because these patients often do not appear ‘sicker’ in a medical sense—but we found that anxiety disorders contribute to problematic health care use that exposes patients to unnecessary medical risks and impacts the whole health care system.”

Iturralde and colleagues searched for diagnoses of anxiety disorders such as obsessive compulsive disorder, PTSD and agoraphobia along with diagnoses of depression in electronic health records of 143,573 adults (mean age, 64 years; 48.1% women) with type 2 diabetes who were members of Kaiser Permanente Northern California from 2008 to 2012. A database provided information on ED visit frequency and hospitalization costs in 2012. The researchers defined chronic visitation as three ED visits in each of the previous 3 years.

An anxiety disorder was diagnosed in 12.9% of the study population and 52.9% of those with an anxiety disorder were diagnosed with depression, according to the researchers. Of those with an anxiety disorder, 35.2% visited the ED at least once vs. 23.6% of those without an anxiety disorder (P .001). The rate at which a participant with anxiety would visit the ED was 27% higher compared with those without anxiety (incidence rate ratio [IRR] = 1.27; 95% CI, 1.21-1.34), according to the researchers, who added that the rate at which a participant with depression would visit the ED was 13% higher vs. the rate for a participant without depression (IRR = 1.13; 95% CI, 1.09-1.18).


Chronic visitation was reported in 1.5% of those with anxiety disorders compared with 0.2% of those without such conditions (P .001), with the researchers noting that the risk for chronic visitation was more than double for those with anxiety (OR = 2.55; 95% CI, 1.9-3.44) and 1.66 times higher for those with depression (OR = 1.66; 95% CI, 1.29-2.14). Iturralde added that “anxiety disorder was associated with 255% higher odds of visiting the emergency department multiple times a year for multiple years in a row.”

Individuals with anxiety disorders spent an average of $5,790.45 on hospitalization in 2012 while those without such conditions spent an average of $4,105.89 (P .001). According to the researchers, being among the top 20% of spenders in the Kaiser Permanente Northern California system was 29% more likely for those with anxiety (OR = 1.29; 95% CI, 1.23-1.36) or depression (OR = 1.29; 95% CI, 1.24-1.34).

“Anxiety causes physiological symptoms that resemble physical symptoms in diabetes — so it may cause people to overtreat or undertreat their diabetes condition. Anxiety also causes people to engage in unhelpful behaviors, such as avoiding daily diabetes management tasks, or becoming ‘burned out’ through excessive worrying or even checking their blood sugars too often,” Iturralde said. “Therefore, because the two problems are so intertwined, it makes sense for anxiety treatment to be integrated more closely with diabetes treatment.” – by Phil Neuffer

For more information:

Esti Iturralde, PhD, can be reached at

Disclosures: The authors report no relevant financial disclosures.

Niall Horan health: One Direction singer’s hidden condition – the symptoms

He said: “I have mild obsessive compulsive disorder, that’s what doctors call it. That is, I feel like I have to do things in a certain way.

Niall explained he’s had the condition since childhood and left him feeling isolated from his schoolmates.

Today, OCD still affects the musician’s live performances.

He divulged: “I have one fixed sequence. I always have to sing in the same order, move and so on.

“I’ll basically do everything immediately, otherwise I’ll get nervous quickly.”

According to the ‘Slow Hands’ singer, his OCD causes “tics”.

Former Sun Journal journalist publishes book about his mental health journey

North Carolina writer Matthew Tessnear struggled through anxiety, depression and Obsessive-Compulsive Disorder (OCD) for more than 30 years of his life before committing to fully understand his challenges and address them. Now, he has published a book, titled “Eating Me Alive: How Food, Faith and Family Helped me Fight Fear and Find Hope,” which explores his life with mental illnesses in hopes of helping others be more aware of and sensitive to their impacts. The book is available in paperback via

“I am sure some people who’ve known me will be surprised to see my name associated with a book about mental illness, but I’ve journeyed through some very dark days in my life,” shares Tessnear, who served as a reporter and then city editor of the Sun Journal from 2007 to 2011. “I was teased often when I was a child and continued to be prodded and embarrassed when I was an adult, to the point that I was afraid to be vulnerable. I buried my fears so deep I didn’t even fully understand them myself. Finally, I reached a point when I was so battered by worry and dread that I couldn’t ignore it anymore if I wanted to keep living, and as I started to explore the mental illness community, I realized I was not alone. So, I started to take care of myself, and I developed a deep desire to share my story to let everyone else, especially men who think they have to be tough and soldier through all pain, know that it’s OK to need and seek help.”

Tessnear, a native of Gaston County in western North Carolina, spent almost two years studying his own life and working to improve his mental and physical health while also writing his story. During that time, he shed nearly 80 pounds, completely changed his approach to eating, committed himself to a simple yet persistent exercise regimen, started taking medicine for his anxiety, and taught himself how to bake pies from scratch, a process he found to be deeply therapeutic. Most of all, he learned how to enjoy life, something he admits he never fully grasped as a child as he navigated a constant haze of worry.

In “Eating Me Alive,” Tessnear shares how his Christian faith, his closest family members and his love for cooking have provided him with the strength to work through his challenges. The book even includes a baker’s dozen of his most favorite and meaningful recipes, many of them passed down through members of his family in Gaston, Cleveland and Rutherford counties of western North Carolina.

“Like me and my life, my book is the combination of many different things,” Tessnear explains. “It’s part mental health memoir. It’s part family and local history book. It’s also part cookbook. The book is full of unfiltered honesty about who I am. I believe that all of our stories as people are connected through our common interests and experiences, and I truly think everyone will find something to identify within this book.”

Matthew Tessnear is a writer, foodie and former newspaper journalist. This is his first full-length book. He is also the author and illustrator of the children’s book “The Monkey The Bear.” He lives in North Carolina with his wife Molly, with whom he publishes a collection of favorite American South recipes and restaurants at FoodieScore.Blog. Find him on Twitter and Instagram @MatthewTessnear.

How Maria Bamford KO’d OCD | Humor Rx

Stephen Colbert said Maria Bamford is his “favorite comedian on earth” during an interview on his show in 2016. Anyone who’s seen her act knows why.

Rolling Stone named Maria one of their 50 Funniest People and in 2014 she won the American Comedy Award for Best Club Comic. Her exceptional comedic talents are on display in this short Comedy Central clip on dating.

Comedian Maria Bamford
Maria Bamford – Comedy Central Presents

Maria’s act often incorporates references to her struggles with mental illness, and she’s an outspoken mental health advocate who uses her difficult personal experiences to help others.

She not only encourages others to find humor in the midst of their pain, but to also find the help that they may not yet have realized is available.

Maria actively sought professional help for her intrusive violent and sexual thoughts from numerous mental health practitioners for 15 years to no avail before finding one with specialized training in her disorder.

She found a Cognitive Behavioral Therapist who quickly recognized that Maria was suffering from Unwanted Thoughts Syndrome – a form of Obsessive Compulsive Disorder (OCD) in which unwanted thoughts grow into obsessions and result in intense psychological distress and anxiety.

Individuals suffering from Unwanted Thoughts Syndrome are not actually violent or aggressive, only their thoughts are. They turn the pain of those thoughts inward to hurt themselves rather than outward to hurt others.

Those who live with UTS live in deep fear that others won’t understand, that they will be considered “bad” for having such thoughts, and often don’t seek treatment for these reasons.

Maria’s story is for them, and for anyone else who fears pursuing mental health treatment for similar reasons.

The intrusive, disturbing thoughts she fought for 15 years were gone within two months of receiving the proper diagnosis and appropriate treatment.

Maria’s Cognitive Behavioral Therapist used a CBT treatment technique called “flooding” that’s highly effective in treating phobias and anxiety disorders, including PTSD.

Flooding involves exposing a patient to their worst fears in a therapeutic environment to desensitize them to those fears.

In the following interview with Dr. Carolyn Phelps on PBS’s “Speak Your Mind,” Maria details her 15 year journey with Unwanted Thoughts Syndrome, her difficulties gaining access to appropriate treatment, the stigma she faced along the way, and the wisdom she gained from her experiences, both good and bad.

Access to appropriate and effective mental health treatment isn’t always easy to find, but it does exist.

A common refrain heard among those with mental illness is, “You don’t ever overcome it, or beat it, you just learn to live with it.”

Maria Bamford, and others like her, are living proof that you don’t have to just “learn to live with it.” Many mental illnesses can, in fact, be beaten.

In the beginning of this article, you imagined what it would be like to suffer from unwanted thoughts of an extremely violent and sexual nature for 15 years.

Now imagine if you gave up seeking effective treatment after 14 years of searching for it. Imagine you accepted that you just had to live with your misery for the rest of your life, never knowing freedom from your pain was only a year away.

It’s important to look to those, like Maria, who have walked that path and who can show you how to successfully navigate it rather than allow yourself to fall into the all-to-common and self-defeating belief that you are merely a victim of mental illness who can never hope to become a victor.

For additional information about Cognitive Behavioral Therapy and the conditions for which it is most effective, read Dr. Ben Martin’s recent Psych Central article, “In-Depth: Cognitive Behavioral Therapy.”

16 Things That Can Make Anxiety Worse That Are Subtler Than You’d Think

Anxiety is a tough and sometimes unpredictable condition. While treatments like cognitive behavioral therapy and medication can help, small things can make anxiety worse without your expecting it. If you struggle with anxiety, you may not know that certain aspects of your daily routine may also be setting off anxious thoughts. Small habits can contribute to your anxiety levels, even if you barely notice them — and they can have a significant negative effect over time.

There are many different types of anxiety, from generalized anxiety disorder to specialized anxiety issues like PTSD, obsessive-compulsive disorder or social anxiety. Your specific anxiety likely has its own individual triggers and characteristics; anxiety is highly personal, and everything from symptoms to contributing factors can differ from person to person.

These certain small acts may not cause anxiety in and of themselves, but can contribute to greater overall anxiety levels and more intense symptoms. Habits like smoking and sitting still a lot might seem like they help you calm down, but in the long run, research indicates the opposite. Fortunately, small habits can be easy to change — as long as you notice what’s happening and start gradually. Here are a range of small things that may be worsening your anxiety.

1. Having Irregular Sleep Times

Denis Val/Shutterstock

Maintaining the same sleep routine every night can help reduce anxiety, but sometimes it’s the anxiety itself that keeps people awake. “Far too many people suffering from anxiety avoid sleep, allowing their stresses to keep them awake,” explains The Calm Clinic. “Sleep is one of the most important tools for coping with stress, so when you allow yourself to be kept awake, you make it much more likely for stress to affect you later.” Maintaining a routine and regular bedtime can help to reduce the impact of sleep deprivation on anxiety in general.

2. Procrastination

Always putting off till tomorrow what you could do today? People with anxiety disorders told The Mighty that procrastination in general heightened their symptoms and made them feel less in control of their lives. “I know the things I need to do, yet cannot bring myself to do them because I feel overwhelmed. This causes more anxiety and sends me into a feedback loop I have a hard time getting myself out of,” said one contributor.

3. Too Many Stimulants

Staying away from coffee before bedtime is a good idea for all of us, but consuming other stimulants throughout the day, including chocolate and sugary foods, could be heightening your body’s arousal levels and anxiety response, too. “Remember, there is caffeine in chocolate and tea as well, and a great deal of caffeine in many sodas. If you’re taking in these stimulants often, your anxiety is bound to get worse,” says the Calm Clinic.

4. Irregular Exercise Routines


You might not love the gym, but if you have anxiety, skipping it could create issues. “Regular intense exercise such as running can help alleviate anxiety, while being sedentary may worsen your social anxiety,” notes VeryWell Health. “During exercise, you release endorphins that give you a feeling of well-being and may reduce anxiety.” The added benefit of a regular, reliable routine can make weekly exercise a great anxiety-buster.

5. Over-Monitoring Email

Does your job mean you’re attached to your email all the time, even after hours? Do you find you check it constantly even when off the clock? Over-monitoring email can be both a symptom of anxiety and can fuel it, says Prevention: “Are you waiting for an important document or are you trying to never miss a beat? If it’s the latter, try setting aside some phone-free time slots.”

6. Too Much Time On Social Media


Scroll through Instagram or Twitter whenever you have a spare second? That habit could be increasing anxiety, psychiatrist Dr. Thea Gallagher of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania told Prevention. “Social media becomes habitual,” she explained. Even if you don’t think you check it that much, it’s probably a good idea to monitor your usage or keep it off your phone if you have anxiety.

7. Smoking

This is one of those interesting paradoxes: smoking may be thought to relieve anxiety momentarily, but in reality it tends to make it worse, according to VeryWell Mind. “Research has shown that smoking cigarettes may be linked to an increased risk of anxiety disorders,” they note. “The effect of cigarette smoking on your anxiety may be related to the indirect effects of the habit on breathing, as well as the direct effects of nicotine on your body.” Nicotine tends to create withdrawals that increase anxiety rather than reducing it.

8. Getting Dehydrated

Getting dehydrated during the day or during a workout can fuel anxiety, according to the Mayo Clinic. “Even mild dehydration can affect your mood,” they explain. Make sure to bring a bottle of water with you.

9. Eating Food You’re Sensitive To

De Repente/Shutterstock

The Mayo Clinic also notes that if you happen to have food sensitivities, even if they’re pretty mild, not paying attention to those can heighten anxiety symptoms. “In some people, certain foods or food additives can cause unpleasant physical reactions. In certain people, these physical reactions may lead to shifts in mood, including irritability or anxiety,” they note. Don’t eat that banoffee pie if it makes your stomach upset, even if it does look delicious.

10. Isolating Yourself Till You Feel Better

Research shows that isolating oneself from others in times of stress can actually contribute to overall anxiety levels, explains the Calm Clinic, even if you feel like you just need some alone time. “Being alone is often the exact opposite of what you need to do to overcome anxiety,” they explain. “That’s because when you have anxiety, your thought processes tend to become skewed, and you become far more internalized (focused inside of your head). Anxiety is associated with negative and fearful thoughts, and anxiety puts you inside of your head, concentrating the experience of those negative thoughts.”

11. Keeping All Your Social Connections Online

If you tend to maintain all your social connections on Whatsapp, that might not be helping your anxiety. “Phone calls and social networks have their place, but nothing can beat the stress-busting, mood-boosting power of quality face-to-face time with other people,” notes the Help Guide. “No matter how much time you devote to improving your mental and emotional health, you will still need the company of others to feel and function at your best. Humans are social creatures with emotional needs for relationships and positive connections to others.” Make the effort to have face-to-face time with friends, even if you’re not doing very much at all.

12. Sitting Down Whenever You Have Free Time

Sitting calmly might seem like a good idea when you have anxiety, but it can be too much of a good thing. “After lengthy analysis, researchers found that the risk of anxiety risk increases as sedentary behavior increases — and, specifically, sitting time spikes one’s likelihood of experiencing anxiety,” explained the Huffington Post in 2017. While you may want to wallow, it’s better to get up and move around a little.

13. Watching Reading Too Much “Serious” Material

RK Studio/Shutterstock

Yes, the world is in a lot of trouble, but one of the quickest ways to ease anxiety symptoms is to laugh, notes Healthline — and it can be tough to do that if you’re constantly feeling doom and gloom. “Try watching a funny TV show or hanging out with friends who make you laugh,” they suggest. And no, John Oliver doesn’t count.

14. Avoiding Looking At Your Bills

Even a small amount of worry around money can elevate anxiety levels in general — and the habit of avoiding looking at your bills, or your bank account, can contribute. “As you find proactive ways to stay on top of your finances, you just may find that the anxious feeling that comes when checking your bank balance dissipates in favor of control and confidence,” explains Money Crashers.

15. Saying Yes Too Much

Saying yes to too many things and feeling incapable of backing out can cause high levels of anxiety and stress, says mental health organization Mind. Good boundaries around your own capabilities can be helpful to lower your anxiety.

16. Thinking Too Much About The Future

You may habitually think four steps ahead — what’s going to happen after this strategy goes into effect at work? — but that habit can fuel anxiety, says Psychology Today. “Focusing on future potential events rather than staying focused on the present or very-next-action invites anxiety problems,” they note. Instead, try to retrain your brain to look at what you’re dealing with right now, rather than speculating about what might or might not happen.

Small shifts in habits can help to reduce anxiety. The good news is that noticing your habits, and how they contribute to your anxiety levels, can lead to lower anxiety overall, with a few simple changes.

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.

The Prevalence of Body Dysmorphia Disorder |

By Madeleine Latimer

Have you ever heard of Body Dysmorphia Disorder? Body Dysmorphia Disorder, also called BDD, is an extremely common disorder, even more so than Obsessive Compulsive Disorder (OCD), anorexia, and schizophrenia, developing often in adolescence. BDD is most easily described as a body-image disorder. Sure, everyone has parts of themselves that they don’t like; but people with BDD spend the majority of their time obsessing over their imperfections. BDD is not curable. It can last for someone’s entire lifetime. It can also lead to suicide.

For people with BDD, they spend almost all of their time obsessing over their body. Most of the time, these thoughts that people have about their body and the things they are obsessing over are delusions or complete exaggerations of their imperfections or flaws. Most people would barely recognize these things a person with BDD might obsess over and think are highly noticeable. Common behaviors of BDD may be obsessively checking oneself in the mirror, excessive self-grooming (such as compulsive hair styling, hair cutting, shaving, plucking eyebrows, plucking body hair), extreme makeup application, constantly asking other people if they look okay, skin picking, frequent changing of clothes, tanning to cover freckles or pale skin, and shopping for beauty products and clothing items constantly. Most people with BDD attempt to hide the things they hate about themselves by doing things like wearing a hat all the time, wearing sunglasses, wearing bulky clothes that cover their body, wearing very heavy makeup, or by holding their body in certain positions, like turning the perceived “bad side” of their face away from other people. These thoughts they have can cause extreme emotional stress and interfere with their day-to-day functions. BDD is not simply hating your smile or the way your thighs look. It is a disorder that is much more pervasive and self-destructive, needing to be diagnosed by a doctor and addressed with treatment. BDD in its extreme can even result in suicide.

About 1 in 50 people is affected by Body Dysmorphia Disorder. It affects about 2.4% of the population and is almost equally distributed amongst women and men. According to Katherine A. Phillips’ article “Suicidality in Body Dysmorphic Disorder,” 80% of people who suffer with BDD have had suicidal thoughts and 28% of them have attempted suicide. The suicide rate for those diagnosed with BDD is very high. The suicide attempt rates are estimated to be 6–23 times higher than what is reported for the US population. It is within the range reported for depressed outpatients, and it is higher than that reported for generalized anxiety disorder, panic disorder or agoraphobia. People with BDD tend to isolate themselves in social situations because they feel they are unacceptable in the eyes of others because of perceived flaws or inadequacies. BDD can be a lead in to additional disorders such as bulimia, anorexia and binge-eating. It can also bring other disorders, such as Major Depressive Disorder, Social Anxiety Disorder, and Obsessive-Compulsive Disorder. A significantly higher amount of people with BDD, compared to people with OCD, have reported suicidal thoughts. One study found that lifetime suicide attempts, with the leading cause being their disorder of either BDD or OCD, had a higher rate among people with BDD than those subjects with OCD. People with BDD are at 22% compared to people with OCD at 8%. Another study found a higher lifetime rate of suicide attempts, being at 40% among people with combined diagnosis of both BDD and OCD, compared to those with only a single diagnosis of either BDD or OCD. BDD is not curable and there are no medications that can treat it, since the disorder is purely psychological. Therapy is the primary treatment which can help change the way that a person processes information and copes with their BDD, but just like depression and anxiety, it can never fully be cured so the goal is management.

BDD is not widely known. More awareness for the disorder needs to be spread through community education at all age levels, throughout the medical specialties and within the educational institutional ranks. Often times, it goes unrecognized due to people not knowing or fully understanding what this disorder is and the signs which give rise to a possible affliction with BDD. Often people may be too ashamed to tell their doctor during check-ups they are having these feelings, even further, the questions are not being asked by physicians. There are depression and anxiety surveys that most doctors ask teens to complete during these annual check-ups, but not for Body Dysmorphia Disorder. Those practicing in this area of specialty agree that mental health check-ups should be at least a bi-annual expectation for all patients.

When it comes to types of treatments, those most commonly used are serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT) both of which appear to be effective for a majority of patients. Cosmetic treatments, such as surgery and dermatologic treatment, are typically ineffective for BDD as this fails to address the underlying psychological issue resulting in the disorder.

Social media and media in general, has a strong effect on today’s youth. It is causing an increase in the prevalence of Body Dysmorphia Disorder. Television, social media, and peer competition have their own influences on how one looks at themselves and their body. Many believe that a simple fix to this problem is to simply put down your phone. This is not in itself an effective solution. The media is everywhere and almost impossible to avoid. Tom Quinn, an eating disorder specialist says that “teaching emotional intelligence and embedding coping mechanisms into the school curriculum can ensure that young people grow up not only aware of their emotional needs but also able them to support themselves.” The school curriculum could benefit from an overhaul to health education and the issues facing teens and young adults today. Outside of social media, even advertisements are at fault for encouraging people to feel bad about their bodies. A 2014 Victoria Secret ad campaign had ten women, all of which were tall and slender, and only featuring three women of color. It was called “The Perfect Body” and received much backlash due to its lack of variety in body types, shapes and sizes.

Body Dysmorphia Disorder is not exclusive to young adults. BDD is something that will affect a person their entire life. Michael Jackson and Andy Warhol both suffered from BDD. Michael Jackson’s tell was his extreme plastic surgery, which even though he denied, was quite obvious to everyone else. Andy Warhol obsessed over the redness of his nose. He was very obsessed with his image and the way he looked. A few other famous people known to struggle with BDD include Franz Kafka, Sylvia Plath and Shirley Manson. There are most likely more famous people with BDD, but since the topic is not widely talked about, people are less likely to bring it up. It is not similar to the discussion surrounding depression. Depression is talked about on a global scale. Many famous people and influencers will bring it up to influence others to go get help with their depression or call the suicide hotline. BDD does not have that.

Body Dysmorphia Disorder is not well known, and although it only effects 2.8% of the population, it is a rapidly growing disorder due to the effects of social media. It is also going on without treatment because it is less known than the other psychological disorders. There should be more knowledge of BDD. The BDD suicide rates are so much greater than they should be. Education and recognition of this disorder is critical to improving the outcome of this segment of the population. The proper diagnosis and treatment for those suffering from BDD is the only way to slow the growth of this public health problem and improve the mental health and body images of our next generation. If people become educated about BDD and a global conversation, it could lower the rates of suicide caused by BDD and open up resources for people get the help they need to become more comfortable dealing with their BDD on a day to day basis.

Header photo from

Adkins, Alyce. “How Social Media Contributes to Body Dysmorphic Behavior.” The Lexington Line, The Lexington Line, 9 May 2018,

“Famous People with BDD.” BDD, Body Dysmorphic Disorder Foundation,

Phillips, Katharine A. “Suicidality in Body Dysmorphic Disorder.” Primary Psychiatry, U.S. National Library of Medicine, Dec. 2007,

“Body Dysmorphic Disorder (BDD).” Anxiety and Depression Association of America, ADAA, Anxiety and Depression Association of America,

With diagnosis and treatment lacking, nonprofit strives to raise awareness of OCD in Japan

A peer-inspired dieting competition triggered the unhealthy lifestyle, but it wasn’t only an eating disorder that haunted Sayaka Hashiba’s late sister.

Hashiba, a 34-year-old Tokyo office worker, said her younger sister’s behavior became visibly erratic when she was around 12 years old.

An athletic, upbeat girl with good grades, she nevertheless began adopting peculiar eating habits, including broccoli-only meals that quickly shredded her weight from 40 kilograms or so to around half of that in a matter of months. She started repeating routine activities, such as climbing up and down staircases and recounting each thing she had done since waking up in the morning.

Meanwhile, the excessive fasting deteriorated her health, and she was hospitalized and diagnosed with anorexia nervosa. Her condition kept her away from school, and her weight remained unstable, bouncing up and down. Her family didn’t know what to make of her odd habits, Hashiba recalled.

Still, her sister was able to maintain a semblance of normality as a young adult, working at izakaya pubs, although her colleagues occasionally complained of her overuse of alcohol disinfectant sprays and oshibori (wet hand towels).

Several years ago, she reached out to Hashiba, telling her via instant messenger that she may have obsessive-compulsive disorder. But Hashiba said she didn’t take her sister’s claim seriously at the time, something she regrets to this day. In September, she died at home from heart failure — nearly two decades of a dangerously unbalanced diet and low caloric intake had taken a toll on her fragile body. She was 31.

Sayaka Hashiba's sister, who suffered from OCD, passed away last year. Hashiba, 34, now volunteers for OCD Japan to raise awareness of the anxiety disorder. | ALEX MARTIN
Sayaka Hashiba’s sister, who suffered from OCD, passed away last year. Hashiba, 34, now volunteers for OCD Japan to raise awareness of the anxiety disorder. | ALEX MARTIN

“The World Health Organization says OCD is nonfatal, but it’s a mental disorder that tortures people for the longest time,” Hashiba said. “And despite the hell my sister must have been going through, none of us in the family figured out what was wrong with her. We left her struggling alone.”

Compared to countries such as the United States, where a growing understanding and acceptance of OCD has led some celebrities to open up about their battle with the anxiety disorder, there is a general lack of awareness regarding the illness in Japan, preventing patients and their families from seeking necessary help and leaving them suffering in silence.

In fact, according to studies, it takes an average of 90 months before those with OCD visit a medical institution in Japan — enough time to complicate symptoms and delay treatment. In Hashiba’s sister’s case, she was diagnosed with OCD only nine days before her death.

“My sister used to say she wanted to do something, anything, that could help others,” said Hashiba, who now volunteers for OCD Japan, a nonprofit led by experts offering advice on how to tackle the disorder. “I know it’s too late now and that nothing I can do will bring her back. Still, I want to believe she would be happy if I worked to raise awareness of the illness that took her life.”

OCD was once ranked by the WHO among the top 10 most disabling illnesses in terms of lost income and decreased quality of life. The organization also lists anxiety disorders, including OCD, as the sixth largest contributor to nonfatal health loss globally.

Despite the extreme distress the disorder can provoke, the condition is often misunderstood and is even used as an adjective for being meticulous or organized.

In Japan, the word keppekishō is used as a blanket term to describe people who are over-particular about cleanliness, obscuring and downplaying what may be far more serious than mere fastidiousness.

The U.S.-based National Institute of Mental Health, the largest research organization in the world specializing in mental illness, defines OCD as a common, chronic and long-lasting disorder in which a person has uncontrollable, recurring thoughts and behaviors that he or she feels the urge to repeat over and over. These include obsessions, such as fear of germs or contamination and having things symmetrical or in perfect order, as well as compulsions including excessive cleaning, hand washing, compulsive counting and repeatedly checking on things — all symptoms Hashiba’s sister checked off at one point or another.

And while no comprehensive figures are available, around 1 in 50 to 1 in 100 people, or roughly over 1 million nationwide, are thought to have OCD, said Ayako Kanie, a psychiatrist at the National Center for Cognitive Behavior Therapy and Research and a member of OCD Japan.

Symptoms typically begin during adolescence, and there appears to be a genetic component involved as well as psychological factors. “People with OCD may also be diagnosed with other disorders including depression and anorexia,” Kanie said. “Some OCD patients also exhibit a strong aversion toward eating certain foodstuffs, such as products using chemicals, which can lead to excessive weight loss.”

According to the International OCD Foundation, the most effective treatments for the condition are cognitive behavioral therapy, with or without medication. More specifically, the organization says a type of CBT called exposure and response prevention has the strongest evidence supporting its use in the treatment of the disorder, while a class of medications called serotonin re-uptake inhibitors are effective.

“The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions,” the International OCD Foundation says on its website. “While the Response Prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been ‘triggered.’”

Kanie said that such heightened anxiety typically recedes in 30 minutes or so, a period that, once successfully overcome, gives patients confidence over time.

“For example, the treatment will involve patients with an aversion to germs being asked to touch something dirty and then restraining themselves from washing their hands.”

However, the process requires the supervision of trained professionals and the cooperation of family members and others close to patients, Kanie said, options that may not be available for all depending on personal circumstances.

While the method is thought to alleviate symptoms in around 70 percent of cases, there are not enough trained therapists, said Noriko Nakayama, a clinical psychologist and a member of OCD Japan.

“While patients can be diagnosed with OCD at psychiatry clinics and be prescribed with antidepressants, whether they provide CBT depends,” she said. That is one reason her organization is educating medical professionals on how to conduct the therapy.

On June 2, Hashiba and members of OCD Japan organized their first OCD Walk, an International OCD Foundation-backed awareness and advocacy event that originated in 2013 and now takes place in many cities across the U.S. The event gathered around 70 participants, who marched through the bustling shopping district of Shibuya toward Yoyogi Park as they played music from speakers and held up banners and flags.

Participants of the OCD Walk march down the streets of Tokyo on June 2. | ALEX MARTIN
Participants of the OCD Walk march down the streets of Tokyo on June 2. | ALEX MARTIN

A 52-year-old reporter at a major newspaper covering the event, who asked to remain anonymous, said he suffered from OCD.

“It started in middle school when I began excessively double-checking if doors were closed,” he said. The symptoms receded for some time but resurfaced a couple of years after he began working. He would worry about being contaminated by germs in toilets, and his condition worsened after he was transferred to Tokyo, where the overcrowded city caused him to become a social recluse, or hikikomori.

“When it was really bad, I would spend an hour washing my hands and two hours in the bathtub,” he said.

His wife recommended he receive professional counseling and accompanied him to therapy sessions. Coupled with medication, his condition gradually improved to the point he could go back to work.

“I still stay away from public bathrooms in train stations and fret over whether I stepped on someone’s spit,” he said. “But I’ve learned to live and deal with these situations.”

For Hashiba, the walk was just the start in what she considers to be her mission to spread the word about OCD.

She’s often flooded with countless memories of her little sister, about how she was an expert skier as a child or how she would be the first to comfort Hashiba when she was feeling down.

“She was a strong, cheerful woman who never let her struggles take the best of her,” she said, while showing photographs of her sister stored on her smartphone.

“Discussing mental health is often taboo in Japan, but that needs to change for the sake of those who are suffering.”

A woman prays at the site of a mass stabbing on June 4, a week after the incident in which a knife-wielding man killed two and injured more than 15 people near a bus stop in Kawasaki.Image Not AvailableDoing things by the book: Outlets offering elementary legal advice are available in Japan but, at ¥5,000 per half hour, they're not cheap.

Postpartum OCD Is Real. This Is What You Need to Know About It

After her second child was born, Britney Asbell, 29, became obsessed with the thought that someone might break into their home or their house might catch on fire. At the time, she also fixated on the safe where the family’s gun was kept. “I would just sit and spend probably the first hour or two of my day repeating the code [to the safe],” she said. “That was my compulsive behavior then. I had to know. What if something happened and I needed to protect my children?”

Among the mental health disorders that affect new mothers, postpartum obsessive-compulsive disorder just might be the most misunderstood, if it’s even recognized at all. Postpartum OCD is believed to affect between 2 and 3 percent of people who have recently given birth, while affecting only 1.08 percent of the general population, according to research published in the Journal of Clinical Psychology. The jury’s still out as to why.

Postpartum OCD is much different from postpartum depression. It’s important to differentiate between the two so that mothers can receive the treatment they need, allowing them to be healthy and happy in their new role. PPD is characterized by intense sadness, loss of interest in things once enjoyed, guilt, worthlessness, and lack of motivation, said Margaret Howard, professor of psychiatry, human behavior and medicine at Brown University.

Obsessive-Compulsive Disorder, however, is characterized by unwanted and relentless thoughts that cause significant distress,” Howard explained. Postpartum OCD also varies from postpartum psychosis, which is characterized by delusions, hallucinations, or extreme feelings of elation. The minimal but developing research on postpartum OCD shows that people managing it do not want to harm their child. Instead they can become consumed with the fear of causing intentional harm to their child, or of something bad accidentally happening to them.

For Asbell, a mom of three in Macon, Georgia, these thoughts play on repeat in her head. One thought, ‘What if I drop baby down my stairs?’ could easily result in hours spent working through that what if question, mentally playing out each potential scenario that could have followed.

The symptoms of postpartum OCD are very specific. Intrusive thoughts are a normal part of the new mom experience, with the vast majority (between 70 and 100 percent) of people who recently gave birth reporting at least some thoughts related to harming their baby unintentionally. As pointed out by BMC Psychiatry, maternal OCD is different than the typical experience, though, because the onset often takes place immediately after birth, because of how frequent and distressing those intrusive thoughts become, and the manner in which people cope with them. The sheer volume of terrifying thoughts is what transforms run-of-the-mill new parent nerves into unmanageable anxiety for people with postpartum OCD.

Stephanie Saunders, a 28-year-old mother of one living in British Columbia, said that her intrusive thoughts became more pronounced and debilitating around five months after she delivered her child. “I was petrified that if I stood on the balcony with her that she would somehow fall off the railing and die, and that I wouldn’t be able to protect her,” she said. Fear of missing a red light and getting into a gruesome car accident made it difficult for her to leave the house. She began avoiding social outings, worried that when her daughter began to cry, the other mothers would assume she was an incapable mother.

More from VICE:

“The response to these distressing thoughts is to engage in behaviors or even mental rituals such as counting or saying certain words over and over, that are believed to ‘neutralize’ the obsessive thoughts,” Howard said. Sometimes, the behaviors individuals turn to for comfort from these obsessive thoughts are obvious—excessive washing and sanitizing in the house to deal with fear of germs, for example. Other times, behaviors may be disguised as “normal” new mom things, like checking their baby’s breathing. Avoiding situations that cause anxiety, like bathtime or leaving the house, is also a common compulsive behavior.

Compulsions may even arise in subtle ways such as thought monitoring, according to Jenny Yip, clinical psychologist and a member of the International-Obsessive Compulsive Disorder Foundation, or IOCDF. Thought monitoring is what’s known as a covert compulsion, which can involve repeated reviewing of thoughts to determine if they’re “right” or “good.” As a mother of twins with a childhood history of OCD, Yip began to experience obsessive thinking after their birth surrounding the fear that she might love one more than the other. She fell into a habit of compulsively checking her thoughts about her babies to manage her anxiety.

According to Howard, screening for postpartum OCD is the first step if I doctor feels their patient could be at risk—that should be followed by a clinical interview that confirms the diagnosis. If diagnosed, a proven method of treatment for it is exposure and response prevention therapy, Yip said. This specialized therapy is recommended to the majority of people with OCD by the IOCDF and works on identifying triggers for obsessive thinking. Then, in a therapeutic setting, individuals are taught to trigger these thought processes and intentionally chose not to engage in compulsive behaviors, which reduces behaviors and anxiety over time.

Unfortunately, people with postpartum OCD often fall through the cracks, Yip said. This is often the result of inadequate screening—regular screening for anxiety disorders like OCD is performed by as little as 20 percent of care providers. And, with so little accurate information about postpartum OCD readily available to new moms, their fear of judgment, or worse, holds them back from seeking help.

“The whole point of the initial postpartum period is bonding,” Yip said. “It’s supposed to be bliss. Instead, you’re going through this really rough period of having the intrusive, horrific images and that interferes with the bonding period.”

This was the case for Asbell, who struggled after the births of all three of her children but didn’t report her intrusive thoughts until her third postpartum period. After her second child, she reached out to her physician at eight weeks postpartum after experiencing what she calls a bought of rage, throwing a toy across the foyer in her home to release pent up, overwhelming emotions. It was hard for her to speak up. She was afraid they might see her act of anger, although it wasn’t directed at her children, as a reason to take her children. Because she felt being honest about her feelings and actions was already “pushing the envelope,” she kept quiet about her obsessive thoughts.

She doesn’t recall being screened formally at all, but was treated for postpartum depression with a prescription. She found her symptoms getting worse. After a panic attack at four months postpartum, she was accepted into an outpatient partial program for PPD. This was the first time it crossed her mind that she might have obsessive-compulsive tendencies. She remained in therapy throughout her third pregnancy and continued on after the birth of her child. It was at this point that she finally felt comfortable voicing her intrusive thoughts and eventually received a postpartum OCD diagnosis.

Many people in her position may fear that they’ll be hospitalized which, unfortunately, isn’t a baseless fear, according to Yip, who explained that there are still physicians who haven’t been educated on postpartum OCD and very well may suggest hospitalization or a 72-hour-hold for psychiatric evaluation. For new moms who want nothing more than to care for their new child, this can be a terrifying thought.

She doesn’t want people to be afraid to speak up. Instead, she suggests that parents who believe they’re experiencing these symptoms should begin by doing their own research to prepare themselves for their follow-up appointment. “If you’re going to your doctor for the purpose of getting help, I would highly suggest you [seek out] information about postpartum OCD,” she says. “Take it to your doctor and tell them, ‘Hey, these are my symptoms and this is what I believe I’m experiencing.’”

Self-advocacy is difficult during a vulnerable time in your life, but it’s often necessary. Lindsey Aerts, a 36-year-old from Salt Lake City, who experienced postpartum OCD after the birth of her first child, doesn’t recall being screened at her six-week check-up and found herself googling “Does having scary thoughts mean I’ll act on them?” before reaching out to her care provider again at three months postpartum. Now, along with Asbell and Saunders, she’s taken to social media to spread awareness about the disorder using the hashtag #PPOCD.

“Luckily, I feel like I got the treatment I needed but I know so many moms who are not in the same situation,” Aerts says of her experience after being referred to a psychiatrist and diagnosed with postpartum OCD.

Ultimately, it seems that OCD is pretty misunderstood in general. Yip points to the media, which focuses largely on quirky behaviors like counting or handwashing, without giving the public a view of the disturbing, obsessive thoughts that may be driving these comforting, compulsive behaviors. The hope is that, with experts like Yip and Howard spreading awareness among professionals caring for new parents, and more people sharing their own stories online, fewer will suffer in silence.

“Once I started sharing, I had friends and even strangers saying, ‘Because you shared your experience, I felt less alone in mine,’” Asbell said. “It made me think that if more women opened up, more women might get the help they need.”