What obsessive-compulsive disorder really is

Obsessive-compulsive disorder is not just the urge to be clean and tidy. It causes enormous distress to sufferers, but it is treatable.

Suggesting this is the case, without good reason, will probably frustrate people who either experience clinical OCD or care about someone who does.

There are also a variety of ways that OCD manifests. These include, but aren’t limited to: checking things repeatedly, ordering things, worrying about and avoiding contamination, hoarding and having intrusive thoughts – usually about checking, ordering, contamination or hoarding. Again, though, even extreme hoarding isn’t necessarily OCD – something I point out to my family when they suggest I need to clear out the garage.

Importantly – and this is one of the things that differentiates OCD from a preference for tidiness or fondness for back issues of the Listener – is the distress factor. If OCD involves repeatedly checking the lock on the door, it’s not because you really can’t remember if it’s locked, but because you feel compelled to do so and the thought of not doing it is distressing – impending-doom distressing.

In the most recent edition of the Diagnostic and Statistical Manual of Psychological Disorders, obsessive-compulsive disorders are a category in their own right and include more than “just” the OCD I’ve described, but also disorders such as trichotillomania (in which someone can’t resist the urge to pull out their hair) and body dysmorphia (pathological and extreme belief that there’s something wrong with how a part of the body looks). Importantly, these things have been separated from “straight” anxiety disorders (though they also involve anxiety) and trauma-related conditions such as post-traumatic stress disorder (PTSD).

Something that I’ve come across as a potentially important part of the equation, and that appears to be associated with severity of OCD, is “thought-action fusion”. Someone who exhibits this cognitive distortion experiences thinking about an action as equivalent to carrying it out. Have you ever had the feeling, in a lecture or public event, that you could just stand up and scream at the top of your lungs? Well, thought-action fusion means that just having that thought is as bad as actually doing it.

Not only is this distressing, but it means that many people with OCD have the strong feeling that thinking about something bad can make it more likely to happen. An overreaction to this, because it’s so distressing, might be to suppress the thought. This ultimately backfires because deliberately not thinking about something makes it more likely to come back and intrude on your thoughts.

Thankfully, this presents an opportunity for intervention. Talk therapies might invite a person with OCD to reality-test this idea: was there actually a volcanic eruption when you thought about there being a volcanic eruption? This makes it sound easier than it is, but the thing to remember is that OCD is treatable.

If this sounds like you, or someone you care about, good places to look for information and support include your GP (for a referral) and the Ministry of Health and Mental Health Foundation websites.

This article was first published in the August 3, 2019 issue of the New Zealand Listener.

National Alliance of Mental Illness holding Falls course – Lockport Union

National Alliance on Mental Illness Buffalo Erie County is now accepting registrations for its Family-to-Family classes for Niagara Falls. This 12-week course helps family members be effective advocates for a loved one who is challenged by mental illness.

Niagara Falls classes will begin at 6 p.m. Sept. 17 and will run for 12 consecutive Tuesdays. They will be held at Niagara Falls Memorial Medical Center. 

Participants need to make every effort to attend all 12 sessions. There is no tuition fee for the class. Space is limited and pre-registration is required. 

The Family-to-Family class covers a wide range of topics from diagnosis and medications to legal and health system concerns, and how to support your loved one for the best possible outcomes, as well as wellness and stress management for caregivers.

Materials are provided and there is no cost to participants.

Topics include: illnesses; including schizophrenia, major depression, bipolar disorder, panic/anxiety disorder, obsessive-compulsive disorder, borderline personality disorder, PTSD – coping skills such as handling crisis and relapse – basic info about medications and working with treatment professionals – listening and communication techniques – problem-solving techniques – recover and rehabilitation – caregivers’ self-care around worry and stress

Contact NAMI Buffalo Erie County at 226-6264 to register. Pre-registration is required.

Family-to-Family classes are offered several times a year in various WNY locations. For more information, or to receive notice of future class offerings, call 226-6264 or email namibuffalony@gmail.com.

Peripartum Anxiety Disorders More Prevalent Than Expected

As a result of a higher-than-expected prevalence of anxiety disorders during pregnancy and the postpartum period, investigators recommended more robust anxiety screening methods for clinicians in obstetrics and gynecology, according to results from a meta-analysis published in the Journal of Clinical Psychiatry.

The investigators conducted a search of PsycINFO and PubMed from inception to 2016 for articles on the prevalence of anxiety disorders in pregnant or postpartum women. Eligible articles reported the prevalence of 1 or more of the following eight common anxiety disorders: panic disorder, agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, and anxiety not otherwise specified. Anxiety disorder prevalence and potential predictive factors were extracted from each study. A Bayesian multivariate model was used to estimate the prevalence of each disorder, the prevalence of having one or more disorder, and the between-study heterogeneity of each disorder. Each study was scored for quality based on methodological criteria outlined in prior literature.

Of 2613 studies identified in the search, 26 were selected for meta-analysis. These 26 studies presented 28 prevalence estimates, among which 19 applied to pregnant women and 9 applied to the postpartum period. Individual disorder prevalence ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobias. The prevalence of having one or more anxiety disorder during pregnancy or postpartum was estimated at 20.7% across studies. A trend toward greater prevalence during pregnancy vs the postpartum period was observed, with a 3.1% increased risk for anxiety observed among pregnant women; however, this difference did not reach statistical significance. Significant between-study heterogeneity was observed, indicating that prevalence rates vary by cohort demographics. Specifically, higher anxiety prevalence was observed in North American samples (26.9%) compared with other samples (18.5%), driven largely by differences in the prevalence of obsessive-compulsive disorder (3.2%), social phobia (1.5%), and posttraumatic stress disorder (2.4%).

Approximately 1 in 5 (20.7%) women met diagnostic criteria for at least one anxiety disorder during pregnancy or postpartum, and 1 in 20 (5.5%) met criteria for at least 2 disorders.

“These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings,” the investigators concluded.

Reference

Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J Clin Psychiatry. 2019;80(4):18r12527.

Stop torturing yourself – remember you can’t fix everything

SUMMARY

A new theory says simply ­questioning why you’re fretting could be all it takes for you to snap out of it.

Obsessive compulsive disorder (OCD) is an anxiety disorder that causes obsessions

Are you someone who’s quick to be self-critical and blame yourself when things go wrong?

Do you torture ­yourself by going over and over ­problems until you’re trapped in a web of negative thinking?

Once in this downward spiral do you despair of even climbing out of it?

Well, a new theory says simply ­questioning why you’re fretting could be all it takes for you to snap out of it.

Research led by Dr ­Yoshinori Sugiura, from the department of behavioural sciences at Hiroshima University, Japan, reported: “People with OCD [are] tortured by repeatedly occurring negative thinking and they need some strategy to prevent it.”

Obsessive compulsive disorder (OCD) is an anxiety disorder that causes obsessions – thoughts that repeatedly pop into your head, such as thinking your hands are always dirty and need to be washed. It affects around one in 10 people in the UK.

General anxiety disorder (GAD) is also a very pervasive type of anxiety.

It is a long-term condition that causes a person to feel anxious about almost anything, not just one specific issue or event.

It’s thought to affect more than one in 10 people at some point in their life, according to charity Anxiety UK.

All of us have the odd OCD-like behaviour, such as repeatedly checking if a door is locked or the gas is switched off.

But it can go from a harmless habit to a disorder if the action is irresistible and frequent.

The researchers figured the anxiety of OCD and GAD stems from thinking you’re responsible for everything, which they call ‘inflated responsibility’.

They identified three instances where a person thinks they must take personal responsibility.

The first was a perceived responsibility to prevent or avoid harm; the second was blaming yourself for negative outcomes; and the third was thinking you’re ­responsible for solving a problem.

An online questionnaire sent to university students in the US revealed the students who reported often taking the blame or mulling over ­problems were more likely to have OCD or GAD.

Dr Sugiura suggests a simple, quick and easy way people can overcome inflated responsibility before it becomes a problem, to realise it’s your feelings of responsibility that are making you worry.

He says if you can ask yourself why you worry so much, and realise you can’t help it, you relieve yourself of feeling responsible.

Just realising this, Dr Sugiura believes, will open up some space between your burden of responsibility and your behaviour.

It’s worth a try.

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Dr Miriam Stoppard: Stop torturing yourself – remember you can’t fix everything

Are you someone who’s quick to be self-critical and blame yourself when things go wrong?

Do you torture ­yourself by going over and over ­problems until you’re trapped in a web of negative thinking?

Once in this downward spiral do you despair of even climbing out of it?

Well, a new theory says simply ­questioning why you’re fretting could be all it takes for you to snap out of it.

Research led by Dr ­Yoshinori Sugiura, from the department of behavioural sciences at Hiroshima University, Japan, reported: “People with OCD [are] tortured by repeatedly occurring negative thinking and they need some strategy to prevent it.”

Obsessive compulsive disorder (OCD) is an anxiety disorder that causes obsessions – thoughts that repeatedly pop into your head, such as thinking your hands are always dirty and need to be washed. It affects around one in 10 people in the UK.

General anxiety disorder (GAD) is also a very pervasive type of anxiety.

It is a long-term condition that causes a person to feel anxious about almost anything, not just one specific issue or event.

It’s thought to affect more than one in 10 people at some point in their life, according to charity Anxiety UK.

All of us have the odd OCD-like behaviour, such as repeatedly checking if a door is locked or the gas is switched off.

But it can go from a harmless habit to a disorder if the action is irresistible and frequent.

The researchers figured the anxiety of OCD and GAD stems from thinking you’re responsible for everything, which they call ‘inflated responsibility’.

They identified three instances where a person thinks they must take personal responsibility.

The first was a perceived responsibility to prevent or avoid harm; the second was blaming yourself for negative outcomes; and the third was thinking you’re ­responsible for solving a problem.

Read More

Dr Miriam

An online questionnaire sent to university students in the US revealed the students who reported often taking the blame or mulling over ­problems were more likely to have OCD or GAD.

Dr Sugiura suggests a simple, quick and easy way people can overcome inflated responsibility before it becomes a problem, to realise it’s your feelings of responsibility that are making you worry.

He says if you can ask yourself why you worry so much, and realise you can’t help it, you relieve yourself of feeling responsible.

Just realising this, Dr Sugiura believes, will open up some space between your burden of responsibility and your behaviour.

It’s worth a try.

Cannabinoids Could Help Treat OCD, Researchers Suggest

In a new review study, researchers examined evidence that suggests the endocannabinoid system (ECS) may play a role in helping relieve symptoms of obsessive-compulsive disorder (OCD) and other similar conditions.

OCD is a complex psychological condition in which patients have uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) and the urge to repeat actions over and over. In the United States, 2% to 3% of the adult population and according to a study published in May 2015 in the Archives of Disease in Childhood, up to an estimated 4% of children and adolescents have OCD.

The condition is difficult to treat. According to the International OCD Foundation, the most effective treatment is cognitive behavior therapy (CBT) combined with psychiatric medications such as antidepressants and anti-anxiety remedies. Only about 10% recover completely from OCD and just half improve with treatment, noted a Harvard Medical School publication in March 2009. 

Current Research

The study,The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?noted that there is a growing body of research showing the ECS plays a role in anxiety, fear, and repetitive behaviors.

The ECS is involved in regulating our neurotransmitters, the chemical messengers that carry signals between our nerve cells and other cells in the body, and affects just about all of our physical and psychological functions. 

“The research we reviewed in our article indicates that cannabinoids could one day play a role in the treatment of OCD and related disorders,” said lead author and psychiatrist Dr. Reilly Kayser of Columbia University/New York State Psychiatric Institute (NYSPI).

“We examined the complex workings of the ECS and found evidence from animal and human studies supporting a link between OCD symptoms and the ECS,” Kayser said. 

Promising Results 

NYSPI and Weill Cornell Medical College in New York performed the study, which noted: “[S]ome patients with OCD who smoke cannabis anecdotally report that it relieves their symptoms and mitigates anxiety, and several case reports describe patients whose OCD symptoms improved after they were treated with cannabinoids.”

In a pilot study analyzed by the team, 16 severe OCD patients who underwent therapy and received nabilone a synthetic form of THC that acts on the brain’s ECS — had nearly twice the reduction in symptoms after four weeks compared with their counterparts who received nabilone alone, or those who received cognitive therapy alone.

Kayser explained that nabilone works similarly to THC but does not have all of the chemical components of cannabis.

He noted that animal models and human imaging studies have suggested that cannabinoids can also enhance fear extinction learning, which involves creating a response that counters the fear response.

“People who have fears — like flying, PTSD [post-traumatic stress disorder], or OCD — have problems with fear extinction learning,” Kayser told Weedmaps News. “We know that CB1 receptor can boost that form of learning and help alleviate those fears.”

As the cannabinoid-1 receptor (CB1) is found throughout the body’s entire central nervous system, Kayser explained that there are high concentrations in regions of the brain that are implicated in OCD. 

“This is not direct evidence that the endocannabinoid system (ECS) is involved in the pathology that underlies OCD, but is one clue which suggests that such a link may exist,” he said.

Research so Far 

Kayser reiterated that there is an urgent need for new treatments as current medications are ineffective for many people.

“Fortunately, there have recently been a number of promising developments that researchers are actively pursuing,” Kayser said, “but at our site, we are continuing to study how cannabinoids impact OCD symptoms.”

Because research has shown that medical cannabis oil is effective in treating other neurological conditions, including reducing epileptic seizures and treating autism symptoms, scientists are broadening their look into the role of the ECS in a variety of conditions.

“OCD is a complex condition that shares features with other illnesses,” Kayser said. “Thus, we looked into studies that explored the role of the ECS in these related conditions as well.”

Expert Perspectives

Dr. Daniele Piomelli, Ph.D., director of the University of California, Irvine, Center for the Study of Cannabis, said the ECS may help regulate psychiatric conditions and provide therapeutic benefits — and his institute aims to prove it. 

“Our growing understanding of the ECS confirms the extraordinary interest of this signaling system in the control of many brain functions and in the regulation of human behavior in health and disease,” Piomelli said in an email.

“After a long absence, we are seeing a rebirth of pharmaceutical interest in the therapeutic potential of this system,” said Piomelli, who is the Editor in Chief of Cannabis and Cannabinoid Research in which the review article was published on June 14, 2019. 

“This review article offers a critical assessment of the evidence, focused on obsessive-compulsive disorder, and clues to future research,” Piomelli added. “I am optimistic that important advances will take place in the near future.”   

The Bottom Line 

Which cannabinoid agents to test and how to measure their effects will be among the important questions to consider in designing future studies.

“We need to do well-designed, placebo-controlled studies in humans to help us understand more about how cannabis and related substances impact symptoms of OCD and other psychiatric conditions,” Kayser said.

“At the moment, we have the results from two studies that are currently under review and will hopefully be published in the next few months, so stay tuned.”

 

TMS can offer relief from anxiety

Image of Lindsay Israel

by Lindsay Israel, MD

Transcranial magnetic stimulation, or TMS, is an FDA-approved, noninvasive treatment for major depression using magnetic pulses targeted at a specific location on the brain.

TMS is a completely outpatient procedure and is gaining momentum in the behavioral health community as an effective alternative treatment for medication-resistant depression.

However, even more statistically significant than depression, anxiety leads as the most commonly diagnosed mental illness in the United States, affecting more than 18% of the adult population every year, according to the Anxiety and Depression Association of America.

It has long been established that depression and anxiety are typically seen together in presentation. In fact, approximately half of the patients diagnosed with depression have some type of anxiety disorder as well.

Why TMS for anxiety should work

If TMS is an effective treatment for depression, and depression and anxiety are so interconnected and likely the result of a dysregulation of the same neurocircuit in the brain, then would TMS be an effective treatment for anxiety? The simple answer is yes. There is evidence.

Symptoms of mood and anxiety disorders are thought to result in part from disruption in the balance of activity in the emotional centers of the brain. The accepted TMS treatment protocol for depression utilizes rapid, stimulatory, high-frequency pulses on the left side of the head, targeted at the prefrontal area of the brain.

If depression and anxiety go hand in hand, then anxiety symptoms should follow suit and improve along with depression symptoms.

With TMS, often they do, and patients feel relief from the stimulatory pulses because the areas of the brain that are underactive in depression and anxiety are brought back to normal reactivity levels, as seen on functional imaging.

However, anxiety can have a life of its own.

Anxiety is thought to be the result of a misfiring of the electrochemical signaling, due to both hyperactive areas and hypoactive areas of the brain, triggering a feeling of excessive worry or fear, leading to physical symptoms including racing heart, shortness of breath, GI upset and muscle tension.

The theory for treating anxiety specifically with TMS was based on the understanding that the right side of the brain is known to send inhibitory signals to the left. Therefore, if the right side of the brain is subjected to repeated slow, inhibitory, low-frequency pulses, would that slow down the areas of the brain that are also overactive, having a calming effect on an anxiety-riddled brain?

Studies on treating anxiety with TMS

After hundreds of small studies conducted all over the world with very positive results, there is now more confidence that TMS can be an effective treatment for various anxiety disorders, including generalized anxiety disorder, panic disorder, and obsessive compulsive disorder.

There is still more to be known, and more consistency between the studies is needed to come to a consensus for an accepted protocol for anxiety, better defining treatment target location, number of pulses and number of treatments needed to achieve remission from anxiety symptoms.

Take-home Message

The uplifting message for those who are struggling with debilitating anxiety is that there is a cutting-edge technology available to them.

TMS can offer an approach to treating their symptoms where traditional methods, including psychotropic medications, have failed them.

TMS can bring them hope that they are not out of treatment options, and that they can get relief and resume their lives anxiety-free.

References:

Facts and statistics. Anxiety and Depression Association of America. Available at: https://adaa.org/about-adaa/press-room/facts-statistics.

Lindsay Israel, MD, is a board-certified psychiatrist. She specializes in TMS at Success TMS in Palm Beach Gardens, Florida.

Here’s When Hair-Pulling, Skin-Picking, or Nail-Biting Becomes a Disorder

You’re not alone if you find some “bad” habit weirdly satisfying: freeing an ingrown hair, plucking a stray gray, popping a pimple, gnawing off a pesky hangnail, or whatever else you might do in the privacy of your home (and maybe other places, too) Even if you know it’s probably not the best for you, you might derive some satisfaction from this habit all the same.

What you may not know is that when done often enough and in a way that causes harm, these habits can actually be what experts call body-focused repetitive behaviors (or BFRBs). If you don’t know that BFRBs are a thing, these behaviors might make you feel especially alone or ashamed, Nicholas C. Crimarco, Ph.D., clinical psychology instructor in the Division of Child and Adolescent Psychiatry at Columbia University, tells SELF. Most important, you might not know help is out there. Which, FYI, it is! But more on that in a bit. Let’s start by going over the basics of BFRBs.

What exactly are body-focused repetitive behaviors?

Body-focused repetitive behaviors are disorders that make people touch their hair and/or bodies repeatedly in ways that cause physical damage and psychological distress, according to the TLC Foundation for Body-Focused Repetitive Behaviors, a research and education organization.

BFRBs are categorized as “obsessive-compulsive and related disorders” in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-5), the classification and diagnostic tool of the American Psychiatric Association. But BFRBs and OCD have a few important differences that we’ll explore later.

The major BFRB conditions are:

Trichotillomania, also known as hair-pulling disorder

This is when people compulsively pull out hair from their scalps, eyelashes and eyebrows, pubic areas, or other parts of their bodies, according to the Mayo Clinic. While a habit of overplucking your eyebrows might lead to your brows looking more like cousins than sisters, someone with trichotillomania who pulls at their eyebrows is more likely to wind up with sparse, patchy brows. Trichotillomania doesn’t always lead to bald patches, though.

In fact, the diagnostic criteria for trichotillomania has loosened a little bit with the release of the DSM-5 in 2013. To be diagnosed, you used to need to cause visible hair loss, like bald patches. Since so many people go to great lengths to hide their hair loss or pull from parts of their bodies that they can cover easily, the DSM-5 changed that requirement. Now, trichotillomania is diagnosed in part by repetitive hair-pulling that results in hair loss along with multiple failed attempts to decrease or stop pulling. The hair-pulling can’t be related to any other mental or physical health condition.

Excoriation, also known as skin-picking disorder or dermatillomania

This is compulsive manipulation of the skin that leads to some sort of damage, like scarring, discoloration, or mutilation. One major diagnostic criterion is when a person has attempted repeatedly to stop the behavior, according to the TLC Foundation for BFRBs.

Even though it’s also called skin-picking disorder, excoriation can also take the form of touching, rubbing, scratching, scraping, or digging into the skin anywhere on the body. Some people pick at acne, blemishes, dry or chapped skin, but others will focus on a spot that might otherwise seem pretty arbitrary. As with trichotillomania, these behaviors can’t be better explained by some other condition or disorder.

Other specified obsessive-compulsive and related disorders

This diagnosis accounts for compulsive behaviors that aren’t hair-pulling or skin-picking. “It’s an umbrella term for nail-biting, nail-picking, lip-biting, cheek-biting, lip-picking, skin-chewing, [and] any other kind of picking or biting behavior,” clinical psychologist and member of the Scientific Advisory Board of the TLC Foundation for BFRBs Suzanne Mouton-Odum, Ph.D., tells SELF. Like trichotillomania and excoriation, physical damage and a person being unable to stop on their own are key markers of this condition.

In some cases, BFRBs can lead to further physical problems. For example, skin-pickers and nail-biters might leave themselves prone to infection, says Crimarco. And, in some cases, trichotillomania can have medical—not just aesthetic—side effects. According to the TLC Foundation for BFRBs, around 5 to 20 percent of people who have trichotillomania also swallow the hair, which in severe cases can result in serious intestinal blockage.

While the physical actions and repercussions involved can vary with different BFRBs, one overarching symptom is emotional distress or life impairment. Most people with BFRBs feel a strong sense of guilt and embarrassment around their behaviors, which can be almost as debilitating as the behaviors themselves, says Mouton-Odum.

On top of being isolating and awful to deal with, this shame can also interfere with a person’s life in a lot of ways, whether that’s personally, socially, academically, or professionally. Maybe you find yourself turning down invitations after going on a pulling spree that left you with half an eyebrow, you don’t date out of fear of judgment of your excoriation scars, or you shy away from work in the public eye that you might otherwise enjoy. If you sink a lot of time into the behavior itself or on dealing with the damage—like applying makeup to cover up scars or styling your hair to hide bald spots—that’s another good indicator of a BFRB, says Crimarco.

BFRBs can contribute to other mental health conditions like depression and anxiety, the Mayo Clinic says, and many people with at least one BFRB engage in multiple picking or pulling behaviors.

The overall cause of BFRBs is unknown.

We don’t know a ton about what causes BFRBs, but according to experts, there seems to be a genetic component. (Plus, watching someone you’re close to engage in these behaviors might make you more likely to mimic them in some way.) “We regularly see BFRBs in the family members of people with a BFRB that we’re treating,” says Mouton-Odum. That said, it’s not always the same behavior. Where you might be a hair-puller, your dad might be a nail-biter, or your mom might be a chronic pimple popper.

Beyond that, experts know more about what BFRBs are not. For example, they’re not an intentional form of self-harm, which is a complicated coping mechanism meant to purposefully to produce pain or discomfort. Unlike self-harm, BFRBs can actually feel pleasurable, says Mouton-Odum. That’s one of the things that distinguishes BFRBs from OCD, a condition marked by compulsive rituals and obsessions (which are persistent, unwanted, and intrusive thoughts often associating behaviors with preventing harm or danger). Many people with OCD loathe their compulsions, says Mouton-Odum, whereas people with BFRBs typically find some part of it soothing, enjoyable, entertaining, or otherwise pleasant.

Finally, BFRBs are not automatically a sign of trauma or abuse, says Mouton-Odum. While someone with a history of trauma or abuse might experience a BFRB disorder, there’s currently no known correlation between the two, according to the TLC Foundation for BFRBs.

BFRBs tend to happen in response to certain triggers.

In the absence of a known cause, mental health professionals tend to focus on what triggers a BFRB, which can inform treatment. Although specific triggers are not required for diagnosis, Mouton-Odum describes five main groups of triggers that BFRB patients typically report:

Sensory triggers: Any of the five senses—sight, smell, hearing, taste, and touch—might give you the urge to pull or pick. “You might see something that triggers it, like a gray hair or a blemish,” says Mouton-Odum. “You might feel something with your fingers, like a hair that feels different or out of place.” Smell, taste, and sound are also possible—like the sound you might hear when digging at your scalp—but those are less common, according to Mouton-Odum.

Cognitive triggers: These are thoughts or beliefs you have when engaging in your BFRB (or being about to), like, “I need to pull out my gray hairs so no one notices them,” or “If I pop this pimple, it will heal.” (These thoughts are a lot less intense than obsessions that come with OCD.)

Affective triggers: These are triggers of the emotional variety. According to Mouton-Odum, some people pick, pull, or perform another BFRB in response to feelings such as “anxiety, tension, fear, anger, or boredom, or to increase positive feelings such as gratification or relaxation.”

Motor triggers: This involves certain movements, postures, and unconscious behaviors that can kick off your BFRB. For example, maybe you typically rest your chin on your palm while working, which makes you more susceptible to noticing a rogue facial hair or zit.

Setting triggers: Finally, factors like where you are, what you’re doing, what time it is, and things in your environment could prompt you to engage in your BFRB. “For example, in the bathroom, late at night, by yourself, door locked, magnifying mirror, bright light, and tweezers,” says Mouton-Odum.

Professional treatment can help curb BFRBs.

According to Crimarco, the go-to treatment for BFRBs is cognitive behavioral therapy (CBT), specifically habit reversal training, which involves helping a person to be aware of their habit and its triggers, as well as helping them to develop what experts call “competing responses” to replace the BFRB.

Through habit reversal training, you and a therapist can discover the underlying function of your BFRB (for example, if it’s a distraction from emotional triggers or maybe a response to boredom) and work to address the root of the issue.

If you’re trying to find a therapist for help with a BFRB, it’s worth taking the time to seek out someone who is familiar with treating these disorders in particular, says Crimarco. The TLC Foundation for Body-Focused Repetitive Behaviors has a list of TLC Professional Members who have identified themselves as mental health providers familiar with treating BFRBs, many of whom have completed the TLC’s Professional Training Institute. It’s not an exhaustive list, but it may be a good place to start if you’re looking for someone who has, at the very least, a professional interest in BFRBs.

For resources in the meantime, Mouton-Odum is the co-owner and lead developer of the interactive websites StopPulling.com and StopPicking.com, which are both full of helpful information.

Unlike for OCD, medication isn’t a go-to treatment for BFRBs. But depending on what usually triggers your behaviors or what other mental health disorders you may have, your doctor might suggest medication, too. For example, if the trigger for your skin-picking is feeling anxious, your doctor might prescribe an anti-anxiety medication to see if that helps reduce the picking behavior. Similarly, while BFRBs and OCD are separate disorders, some people with OCD deal with BFRBs and vice versa, so if someone takes medication for their OCD, it might also help reduce their BFRBs. What might work for you really depends on your specific situation, so talk to your doctor or therapist.

The most important thing to keep in mind is that you can seek help whenever you want, even if you don’t hit the official diagnostic criteria for a BFRB or if you worry your behavior isn’t “bad enough.” If a habit is affecting you physically or getting in the way of how you live your life and you want help moving past it, professional help is out there.

“It’s always better to seek help for something you’re experiencing than it is to wait for it to get worse or to tell yourself you need to handle it on your own,” says Crimarco. “Too many people see BFRBs as a weakness or the result of lack of willpower, but we know [they’re conditions] in which people need to learn very specific strategies to manage them. That’s nothing to be ashamed about.”

Related:

Experimental Drug For OCD Could Give Patients Much-Needed New Treatment Option

PHILADELPHIA (CBS) — There is new hope for people with obsessive compulsive disorder. A new drug is being tested in the Philadelphia region to treat the mental illness that can be disruptive and impacts an estimated 2% of the population — or one in 50 people.

Drugs that are currently used to treat OCD don’t work well for many and often have side effects. That could be changing.

Every time Ted Nichols, who lives in Perkasie, passes the door, he has to check that it’s locked.

“It’s an irrational thought I know that I’ve locked the door,” he said, “but I just continue to check it anyway.”

He does the same thing with washing his hands.

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“For no reason, I feel dirty. I have to wash really thoroughly, not just like a one-and-done wash your hands. I have to do it three times,” Nichols said. “It seems ridiculous, but I can’t stop.”

Nichols has OCD and he gets fixated on something like locking the door and then compulsively checks it.

“My wife says, ‘You know what you’re doing, just stop.’ I would if I could, I really would but I can’t,” he said.

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve been only marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” Dr. Shivkumar Hatti said.

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Hatti, a psychiatrist in Media, is a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety. If the anxiety comes down, compulsion to perform an activity will also come down,” Hatti said.

Limited early results have been positive.

“It would dramatically change my life,” Nichols said.

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Nichols is thinking about enrolling in the trial to test the drug, hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country.

The drug is tested for a period of three months, but it can be extended if it’s determined to be helpful.

Anyone who would like more information about the trial can do so by visiting ocdtrial.org.

New Medicine Promises Better Relief For People With Obsessive-Compulsive Disorder

NEW YORK (CBSNewYork) – There could be new hope for people with obsessive-compulsive disorder.

An estimated 2% of the population, or 1 in 50, has OCD. Treatments currently available don’t work well for many and often have side effects.

As Stephanie Stahl reports a new experimental drug could change that.

Every time he passes a door Ted Nicholas has to check that it’s locked.

“It’s an irrational thought, I know that I’ve locked the door but I just continue to check it anyway,” he said.

Same thing with washing his hands.

“For no reason, I feel dirty,” said Nicholas. “I have to wash really thoroughly, not just like a one and done wash your hands. I have to do it three times… it seems ridiculous but I can’t stop.”

Nicholas has obsessive-compulsive disorder and gets fixated on things like locking the door, then compulsively checking it.

“My wife says, ‘You know what you’re doing, just stop,’” he said. “I would if I could, I really would but I can’t.”

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve only been marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” said psychiatrist Dr. Shivkumar Hatti, a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety,” said Shivkumar. “If the anxiety comes down, compulsion to perform an activity will also come down.”

Limited early results have been positive.

“It would dramatically change my life,” said Nicholas, who is thinking about enrolling in the trial to test the drug and hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country. To find out more information and sign up, visit the website at OCDTrial.org.

Experimental Drug For Obsessive Compulsive Disorder Showing Promising Results

PHILADELPHIA (CBS) — There is new hope for people with obsessive compulsive disorder. A new drug is being tested in the Philadelphia region to treat the mental illness that can be disruptive and impacts an estimated 2% of the population — or one in 50 people.

Treatments that are currently available do not work well for many and often have side effects. That could be changing.

Every time Ted Nicholas, who lives in Perkasie, passes the door, he has to check that it’s locked.

“It’s an irrational thought I know that I’ve locked the door,” he said, “but I just continue to check it anyway.”

He does the same thing with washing his hands.

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“For no reason I feel dirty. I have to wash really thoroughly, not just like a one-and-done wash your hands. I have to do it three times,” Nicholas said. “It seems ridiculous, but I can’t stop.”

Nicholas has OCD and he gets fixated on something like locking the door and then compulsively checks it.

“My wife says, ‘You know what you’re doing, just stop.’ I would if I could, I really would but I can’t,” he said.

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve been only marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” Dr. Shivkumar Hatti said.

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Hatti, a psychiatrist in Media, is a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety. If the anxiety comes down, compulsion to perform an activity will also come down,” Hatti said.

Limited early results have been positive.

“It would dramatically change my life,” Nicholas said.

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Nicholas is thinking about enrolling in the trial to test the drug, hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country.

The drug is tested for a period of three months, but it can be extended if it’s determined to be helpful.

Anyone who would like more information about the trial can do so by visiting ocdtrial.org.