Repetitive behaviors like hair pulling and skin picking can turn …

Lucy Harper, 17, a high school junior who lives in College Station, Tex., has been picking at her skin for as long as she can remember. When she was in seventh grade, she also started pulling out her hair.

“For a while my skin picking was under the radar, but it was because I was pulling my hair,” she says. “If I wanted my skin to clear up, I’d stop picking and start pulling. If I wanted my hair to grow back, I’d stop pulling and start picking.”

She lost so much hair that her middle school classmates asked whether she was going bald. “I tried everything to stop picking and pulling,” she says. “I bought tons of fidget toys. I tried constraining my arm with a wrist brace. I got permission to wear gloves and a hat to school, and I even once went to piano lessons with Band-Aids on every one of my fingertips.”

Harper suffers from trichotillomania (hair pulling) and excoriation (skin picking, also known as dermatillomania), two of several disorders collectively known as body-focused repetitive behaviors, or BFRBs. The umbrella term includes a number of repetitive “self-grooming” habits that can cause damage or injury through pulling, picking or scraping, or biting the hair, skin and nails.

Many people engage to some extent in nail biting or skin picking. But when these behaviors become extreme and out of control, they are regarded as serious disorders.

“There is significant psychosocial damage,” says Douglas Woods, a professor of psychology at Marquette University who studies these conditions. Among those who can’t contain the urge to pick, pull or bite, “depression is relatively common. People become very self-conscious, and self-esteem suffers. They start to avoid social situations in which people could notice the effects of their behavior, and often spend tremendous amounts of time trying to cover the effects.”

Historically, BFRBs had been considered impulse-control disorders, along with kleptomania and gambling addiction. However, in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, BFRBs are categorized as obsessive-compulsive disorders, or OCDs. “The truth is, they probably belong in an in-between category,” Woods says.

Although now regarded on the same spectrum, the two actually are quite different. Classic OCD occurs when someone experiences uncontrollable, recurring thoughts — such as a disproportionate fear of germs — and behavior she or he feels compelled to repeat over and over, such as excessive hand-washing.

Impulse-control disorders, on the other hand, typically involve an inability to resist a potentially harmful or self-destructive urge.

An estimated 2 percent to 5 percent of Americans suffer from trichotillomania, or hair pulling (which includes eyelash pulling) and 5 percent from skin picking, the two most-common BFRBs, according to the TLC Foundation for Body-Focused Repetitive Behaviors. Other BFRBs include hair or skin eating, lip and cheek biting, tongue chewing and compulsive hair-cutting, according to the foundation, a nonprofit based in Santa Cruz, Calif.

Before age 12, hair pulling occurs equally in boys and girls, but later it predominantly occurs in girls, according to psychologist Suzanne Mouton-Odum, a clinical assistant professor at the Baylor College of Medicine. “Why is this? We are not certain, but I suspect that many more females begin to pull around the age of puberty,” she says. “Likely there is a hormonal component that affects more females than males. Other hypotheses are that males are more able to cover hair loss, or maybe do not seek treatment as they can hide the results of their pulling.”

Researchers believe that these disorders probably have a genetic component, because they tend to run in families. Scientists are studying the genes of affected people, trying to identify markers that can provide clues to their origins. Several studies have shown a familial connection; one, for example, found higher rates of OCD in immediate family members of those with extreme cases of hair pulling than in the general population.

Also, evidence from a twins study suggested a higher occurrence of hair pulling in identical compared with fraternal twins. Research also has shown differences in the brains of people with these disorders compared with the brains of those who don’t have them.

“Each person seems to pull or pick for different reasons, or in different situations,” Mouton-Odum says. “Some do it in response to emotion — anger, anxiety, happiness — while others in response to needing to feel a certain sensory sensation, while others pull or pick in response to certain environmental triggers, such as activities, places, mirrors.”

Woods agrees. “The behaviors seem to be both a problem of a habit gone awry and a way of coping with emotional distress,” he says.

Medication such as clomipramine, an antidepressant used to treat OCD, can help, but experts say the most effective therapy is behavioral. There are two frequently used approaches.

The first is habit-reversal training, which teaches patients to be more aware of their pulling and picking, and its cues, and trains them to use a “competing response” when the urge hits, such as clenching the fist with the hair-pulling hand and pressing it to the side of the body.

The second is comprehensive behavioral treatment, or ComB, which “looks at each person as an individual and evaluates [his or her] individual pulling/picking profile,” Mouton-Odum says. ComB allows clinicians to design a treatment plan specifically for that person. “Strategies are offered based upon their unique pulling/picking triggers,” she adds. “It is not a one-size-fits-all approach. It is quite tailored.”

Because people often are unaware of when they pull or pick, some have found that using an app-equipped bracelet called Keen helps control the habit. The bracelets are programmed to detect when the behaviors begin, then send a gentle vibration to alert the individual to stop. The bracelet has not been studied in clinical trials, but anecdotal reports suggest it can be a valuable tool. Its price starts at $129.

Lesley Stevens, 37, an online content creator who lives near Phoenix, is a hair puller, skin picker, nail biter and thumb sucker. She wears one bracelet on each wrist — because she picks and pulls with both hands — and says they have been very useful in keeping her habits under control. “They buzz my wrist and make me aware when I’m doing anything I have trained it for,” she says.

For Harper, the Texas teenager, connecting with other BFRB people “who completely understand my struggles” has enabled her to cope, as has attending therapy workshops “that remind me that I am so much more than my BFRBs.” She says she still struggles “a little” with skin-picking, “but it doesn’t control my life anymore, and being open about it allows me to not be ashamed,” she says.

When anxiety takes over

Cognitive behavioral therapy is very helpful, and now magnetic stimulation shows promise Judy Siegel-Itzkovich reports Cleanliness is next to godliness, but when it occupies much of a person’s time and is pursued to the extreme, it becomes an obsession in one’s thoughts and a compulsion that drives one to abnormal behavior.

Excessive attention to cleanliness and warring against germs are the most common aspects of obsessive-compulsive disorder, which affects around 1% to 3% of the world’s population, whatever their culture, intelligence, gender, age, ethnic origin or socioeconomic status. It can hit the famous, the infamous and the ordinary. This anxiety disorder is a disrupting and debilitating condition that affects not only the victim but also their family and friends.

As with some other mental disorders such as schizophrenia, symptoms usually appear around the age of 20, but they can manifest at any age, even among toddlers. Studies done on twins have shown that OCD is three or four times more common in one identical twin if the other has it, but even then, it raises the risk no more than a few percentage points, and there is no direct inheritance.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, obsessions are repetitive, intrusive and distressing thoughts, ideas, images or urges that often are experienced as meaningless, inappropriate and irrelevant and persist despite efforts to suppress, resist or ignore them.

Compulsions are repetitive, stereotyped behaviors and/or mental acts that are used to diminish the anxiety and distress associated with the obsessions.

PRO F. JONATHAN Huppert, a clinical psychologist at the Hebrew University of Jerusalem’s Laboratory for the Study and Treatment of Anxiety has conducted much research on OCD and treated many patients.

Born in New Jersey, he did his bachelor’s degree at the University of Pennsylvania and doctoral degree at Boston University. Huppert was on the University of Pennsylvania’s faculty and researched OCD there before he and his wife Dr. Donna Zfat, a cardiologist at Hadassah University Medical Center, came on aliya a decade ago.

“The epidemiology for OCD is somewhat controversial. The standard psychiatric questionnaire is not very reliable. So it’s hard to know whether there is more OCD than there used to be,” he said in an interview with The Jerusalem Post.

He explained that cleanliness involves about 30% of OCD problems. “Our bodies are full of bacteria, some of which are harmful and some beneficial, but many people see them as bad,” Huppert said, as he recalled a man who drenched his skin with bleach all the time.

“It is not uncommon for people suffering from OCD organize their homes in a way to avoid things from being contaminated and to develop elaborate rituals. It’s easier for family members to go along than to fight the problem,” he continued.

Asked whether the devout of different religions have a different prevalence of OCD, Huppert – who is modern Orthodox – said Christians with OCD may be more fixated on intrusive thoughts, while observant Jewish and Muslims may exaggerate scrupulousness about religious ritual.

“From my clinical experience, I don’t think the modern Orthodox are at as great a risk of scrupulous compulsions as the ultra-Orthodox [Haredim].

“Haredim are less likely to feel ‘contaminated’ by AIDS, but they worry about niddah [physical contact between a husband and wife from the beginning of her menstrual period and until a week after it ends], about praying properly or about cleaning hametz [leaven] before Pesach [Passover], about having clean hands and bodies after going to the bathroom before praying, and the like.”

Huppert has had patients who spend long periods applying their phylacteries properly for prayers. One woman patient refused to eat anything made of flour the whole year round because of the fear that they had existed during Passover rather than being thrown out.

He treated her with cognitive behavioral therapy in which she was exposed to closed bags of flour that were gradually opened.

Another patient who was afraid of mixing dairy and meat utensils and plates used only disposables. He added that a yeshiva student who continues praying when all his peers are already in the dining room clearly has a problem.

“As cleanliness, especially before reciting prayers, is required by the Torah, having a clean body after relieving oneself is demanded.

But OCD patients may spend an hour in the bathroom making sure they are clean before thrice-daily prayers. This adds up to a lot of wasted time,” he said.

OCD among the observant is apparently not more prevalent among observant Jews, but when they do suffer from it, said the clinical psychologist, the obsessions and compulsions are more likely to involve religious matters.

“We did interviews with 15 Haredi rabbis on whether they knew about OCD and how they would deal with it. We were pleasantly surprised. All but one,” recalled Huppert, “knew about it and gave psycho-biological reasons for it. Only one thought it was a ‘spiritual problem.”

Huppert is accepted in the Haredi community as a therapist because of his reputation going back to the US and their preference of a religious psychologist. “They worry that a secular psychologist would use Sigmund Freud to blame their religious practices for the problem.”

Originally developed to treat depression, cognitive behavioral therapy is today considered the best treatment for OCD. A common type of structured talk therapy, it makes it possible for patients to develop personal coping strategies to change unhelpful patterns of thoughts, behaviors and emotions.

Combining the basic principles from cognitive and behavioral and psychology, it is a relatively short-term therapy, unlike psychoanalysis, which looks for the unconscious meaning behind behaviors and one’s childhood and relationship with one’s parents.

CBT focuses on treating specific problems, said Huppert, with the therapist helping the patient to find and practice ways to reduce symptoms and reach a goal. A person who fears being infected with HIV by touching an object, for example, could be taken to a medical library to touch and read books about the AIDS virus that were previously read by HIV carriers or go to the bathroom in a hospital where carriers are treated. Gradual exposure reduces the fears of contamination.

“Until the mid-1960s, before CBT, people saw no solution. Therapists claimed the disorder was resistant to treatment, but CBT is effective in 50% to 60% of cases. Not everybody goes into complete remission, but most find their symptoms are much relieved and they can have a fulfilling life.”

It may be possible to treat OCD patients via telemedicine, over a computer, and not only in face-to-face encounters, Huppert suggested.

DR. AV IGDOR (Victor) Bonchek, a longtime Jerusalem psychologist and ordained Orthodox rabbi, wrote a book in 2009 called Religious Compulsions and Fears: A Guide to Treatment. Born in Cleveland, a student at Bnei Brak’s Ponevezh Yeshiva, ordained by the Ner Israel Rabbinical College in Baltimore and a graduate in clinical psychology from New York University, Bonchek came on aliya with his family in 1971. He taught at the Hebrew University of Jerusalem’s School of Education and School of Social Work for many years and has long had a private practice, during which he has treated a large number of OCD patients, many of them religious.

He gives partial credit for his ideas and techniques to two mentors: Dr. Joseph Wolpe of Temple University who pioneered behavior therapy back in the 1950s and whose CBT course he attended in 1969, and Dr. Giorio Nardone of Italy, a strategic therapist with whom Bonchek studied for several summers.

Bonchek compares observing the commandments of the Torah to “holding a young dove in one’s hands. If he grasps it too tightly, he kills it. If he does not hold it firmly enough, it will fly away, and he will lose it. There needs to be a delicate balance to fulfill the Torah’s commandments in a healthy way.”

Religious women who observe family purity laws and suffer from OCD can get completely bogged down once a month when examining themselves for blood to determine when they are permitted to go to the ritual bath. Such compulsions can make it impossible for them to get pregnant. There are people who are compulsive about kissing mezuzot on doorposts, even though these are major spreaders of germs in public institutions, including hospitals.

Bonchek also knows of a Haredi man who had an uncontrollable urge to give charity; he never turned down a beggar or even a mailed request for a contribution and earned less than he handed out.

Kashrut is another halachic demand that lends itself to obsessions. OCD patients may constantly look for insects in the vegetables, beans or rice, or endlessly wash their hands after touching a ‘meat’ spoon before touching a dairy one. Despite such repeated tasks, worry about having a non-kosher kitchen can become a constant fear.

Bonchek said he was told that the Ukrainian-born sage Rabbi Yaakov Yisrael Kanievsky, who was known to followers as The Steipler and died in 1985, showed a great understanding of obsessive-compulsive behavior among the ultra-Orthodox when he was in contact with an American psychologist, even though the rabbi never studied psychology. He sent OCD sufferers for treatment.

When a compulsive ritual is performed, the person feels “immediate relief” afterward from his “inner tension.” If something positive occurs after the behavior, it is reinforced.

If a negative event occurs after the behavior, it is regarded as punishment. If there is no significant event after the behavior, there is “extinction,” and the act will eventually “fade out.”

Despite his Orthodox background and appearance, Bonchek has plenty of secular patients who seek help. When a patient is helped to properly confront his behavior, extinction can get a boost. Sometimes, Bonchek said, a “buddy” who is regularly in the patient’s environment can help when the therapist is not around. An important principle in CBT treatment, he wrote, is that it has to proceed gradually, step by step, and in a precise order. In addition, guided imagery is used.

“CBT is easier to use for patients suffering from the compulsion to do things than those with mental obsessions. Some people have one or the other, but most have both obsessions and compulsions,” Bonchek said.

OCD victims are rarely suicidal. “I remember reading in The New York Times years ago of a patient who shot himself in the mouth and didn’t die but cured himself of his OCD.

“As the frontal lobe of the brain is involved in the disorder, he knocked out the part that was causing trouble. But of course, this ‘method’ is not recommended,” he added with a smile. Anxiety itself can, in normal behavior, protect you from danger, but when exaggerated, it can be devastating.

Another common symptom OCD symptom involves safety. “Some patients always have to check things and feel in control.

They go again and again to check whether a door is locked, a window closed and the gas turned off before they go to sleep.”

While CBT has so far proven itself to be most effective in treating the disorder, Bonchek predicts that deep transcranial magnetic stimulation will be an effective, safe and non-invasive treatment for OCD.

A Jerusalem company named Brainsway has developed a medical device that uses “H-coil” technology for TMS. Founded 14 years ago in the capital’s Har Hotzvim neighborhood, with its US headquarters in New Jersey, the company maintains that by sending an electric current through a coil, an intense magnetic field is generated to treat the brain.

Still, in the research phase of clinical trials, the device has been patented; it is in various stages of regulatory approval for different indications, from OCD to depression. A multicenter study in OCD was recently conducted on the device at 11 medical centers, one in Israel, one in Canada and nine in the US.

Almost 100 patients who previously failed to respond well to drug or CBT underwent 30-minute sessions with the Brainsway system five times a week over six weeks. They showed statistically significant improvement in their condition compared to a placebo group.

What It’s Like To Survive Postpartum OCD

“To the OCD mind, they seem like brilliant ways to deal with your anxiety,” Notareschi said, laughing ruefully. “I decided in the first couple of days after my daughter was born that every time I had a scary thought I would have to repeat to myself a certain phrase, which was ‘Baby face, hairbrush, duckie.’ In my mind, it was going to neutralize the thought or magically make it OK.”

Dr. Deb’s Mental Health Vitamin: Obsessive-Compulsive Disorder

Dr. Deb Wade

By Dr. Deb Wade
GCU Vice President, Counseling and Psychological Services

Have you ever stepped outside, then began to wonder if you turned off the stove … so you ran back inside to check it? Perfectly natural!

Have ever been to a place and when you returned home, felt full of germs … so you disinfected your hands, maybe twice? Perfectly natural!

Have you jumped into bed, then began to wonder if you turned off the lights or locked the car … so you got out and checked? Perfectly natural!

Do you have a certain superstition, such as always putting the right leg into your pants first, then the left, thinking that this will help you start the day more in control? Perfectly natural!

The truth is that many of us have focused thoughts or repeated behaviors or feel a need to double-check something to ascertain that all is OK. Perfectly natural!

But what if certain obsessive thoughts and/or compulsive behaviors become so consuming that they interfere with your daily life? No matter what you do, you can’t seem to shake them … and the thoughts are so persistent and the unwanted routines or behaviors are so rigid, not doing them causes extreme distress.

The thoughts are not singular but pervasive, and it seems impossible to rid yourself from the loop that you get caught up in. The ritualistic behaviors are so demanding that you cannot step outside of the behaviors to move on about your day, and they seem to control you.

If you suffer from Obsessive-Compulsive Disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming that they will interfere with your daily life. No matter what you do, you can’t seem to shake free.

But the good news is that there is hope: You CAN break free of the unwanted, pervasive thoughts and irrational urges and take back control of your life.

While at its extreme this condition most likely will require professional help, the truth is that it is worth it because you get your life back and feel freedom from the condition. An OCD diagnosis requires the presence of obsessions and/or compulsions that are time-consuming (more than one hour per day), cause major distress and impair work, social life or other important functioning.

Approximately 1-2% of the American population suffers from this disorder, and it absolutely can be debilitating.

Let’s break it down:

Obsessions are recurrent and persistent thoughts, impulses or images that cause distressing emotions such as anxiety, disgust or overwhelm.

Often, one will recognize that these thoughts, impulses or images are a product of their mind and that they are excessive and unreasonable; however, the thoughts are so extreme that they cannot be settled or tackled by logic or reasoning.

A gentleman I once counseled was so controlled by his excessive hand-washing that his hands were raw and red from the action.

He claimed that he would go to a restaurant or to a theatre or to a friend’s/relative’s home, and once arriving back at his own home he would spend the entire evening trying to rid himself of the germs. In addition, he was not able to handle any items from the desk of a colleague for fear that he would get into the hand-washing cycle.

Using the restroom in a public place (or ANY place that was not his home) was entirely out of the question. His life was controlled by his obsessive fear of germs and filth.

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation.

In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Compounding the anguish of these ritualistic behaviors is the understanding that the compulsions are irrational; however, this realization does not change things.

I once counseled a young woman whose occupation was as a teller at a bank. At the end of the work day, she had to make sure her “drawer” (where she kept the day’s transactions and cash) balanced. Though she would balance it to the penny, she often stayed until the wee hours of the morning double-checking and triple-checking, and she could never quite satisfy herself that the task was finished.

Once home, she would perseverate over the fear that she had left something undone with her drawer and that she would get fired. Needless to say, her life became controlled by the fear and obsession that her job was always in jeopardy because she could not rest in the reality that her work was complete and well done.

While striving for excellence in a job well done is a wonderful attribute, the excessive and pervasive over-performing of tasks is way out of bounds. And while cleanliness is a virtue, excessive and obsessive worries about germs that invade every waking moment is absolutely life-impacting.

If you, or a loved one, suffers from the extreme nature of Obsessive-Compulsive Disorder, there ABSOLUTELY is help and relief. Don’t be ashamed – share your angst with a trusted therapist and find FREEDOM!

That gentleman and that young woman? They are living in freedom because they risked letting their angst be known and endeavored to conquer it!

Anxiety disorders taking toll on literate, urbanised states – Times of …

The burden of anxiety disorders is growing across India, especially in the literate and urbanized states, shows the country’s first state-level disease charts published in The Lancet last week.

While anxiety disorders were in the 40th place in 1990 as a contributor to disability adjusted life years (DALYS)—the World Health Organization’s special scale to measure loss of ‘healthy’ years—it climbed to the 26th place in 2016. In fact, the study listed it among the top 10 causes for morbidity across India in 2016 (in terms of YLDs or years lived with disability).

Anxiety disorders, which range from generalised fear to panic attacks and obsessive compulsive disorders, are generally not as crippling as depression but can cause disability and hit economic production.

Maharashtra, Delhi, Andhra, Karnataka and Kerala are among 10 states (see box) that have more problems due to anxiety disorders, said the study. These states also made the transition from communicable to non-communicable diseases, indicating they are more urbanised and literate.

“Urbanisation is a contributor to higher levels of anxiety disorders and depression,” said Dr Pallabh Maulik, an AIIMS-trained psychiatrist who is with the Delhi-based George Institute for Global Health.

The National Mental Health Survey of India 2015-16 said urban metros were witnessing a growing burden of mental health problems that result in disabilities and affect work, family and social life.

Mumbai-based psychiatrist Harish Shetty said anxiety is the mother of all mental illnesses. Making a distinction between anxious thoughts and anxiety disorders, Dr Shetty said, “In this quick and uncertain world, anxiety is ubiquitous. About two-thirds would be anxious while about 10% would have some anxiety disorders.”

Many with anxiety disorders could progress to depression, which is the leading cause for self-harm and suicides. “The key message is that anxiety disorders cannot be ignored. Some of these people could be at the start of a depressive disorder and should be helped at the earliest,” said Dr Maulik.

In recent years, research has linked anxiety disorders to mortality as well. A study by the University of Edinburgh published in the British Medical Journal in July 2012 said that mild mental health problems could be linked to increased risk of death from major causes. A Dutch study in the British Journal of Psychiatry in 2016 said the risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders as compared with the general population. It also quoted a meta-analysis about approximately five million deaths worldwide being attributable to mood and anxiety disorders each year.

However, doctors said people with most anxiety disorders could be helped easily. While severe forms of anxiety disorder will need medication, they said that many eastern practices could help the affected persons. “Be it meditation or yoga, eastern practices help people check general anxiety or anxiety disorders,” said Dr Shetty.

Breaking the Obsession: Children suffering from OCD |

HAMPTON ROADS, Va. – Obsessive Compulsive Disorder is a debilitating disorder that millions of people suffer from nationwide. It doesn’t just plague adults, it also affects children.

Doctors say children as young as three years old have been diagnosed with OCD, but there are signs parents can look out for to help their children cope with the disorder before it takes over their lives.

Doctors say OCD begins as an obsession developed from anxiety. They say patients become fixated on their obsession and in order to relieve the stress that comes with their obsession, they perform a certain behavior, which they call a compulsion.

Emily Woodhouse was only in second grade when she was diagnosed with OCD. She says her obsession when she was younger was with germs, specifically germs on her classmates.

“If they didn’t wash their hands I would track them throughout the day and would not touch anything that they touched,” said Woodhouse. “It was just a lot of work tracking everyone like if they touched the water fountain I guess I wasn’t drinking water anymore.”

The pressure of tracking germs eventually caught up to Woodhouse, leading her to breakdown in front of her mother one day.

“We were in the bathroom and she put her purse on the ground and when she went to pick it up I said, ‘Shouldn’t you wash your hands first?’ and then I burst into tears.”

Woodhouse was put into therapy and underwent Exposure and Response Prevention (ERP) therapy. Doctors describe the treatment as putting patients into situations that expose them to their obsessions and keep them from performing the compulsions that they typically did. Woodhouse says the therapy helped, but years later she developed another trigger – instead of germs, it was an obsession with death.

“I thought when I woke up everyone would be dead,” said Woodhouse. “I would sit in the car for a good amount of time going through all types of scenarios and then would stay awake at night and think, ‘Well if they are going to be dead, maybe I should just call the police now.'”

More therapy eventually helped Woodhouse cope with her thoughts about death. Doctors say that OCD is not a curable disorder, but if patients are able to figure out their triggers they are able to cope with the anxiety that may arise in their lives. When it comes to children, doctors say parent may be able to get help for their kids before OCD becomes debilitating.

“The earlier we diagnosis OCD, the less those compulsions are ingrained so they are easier to treat at that point so they haven’t affected life so they aren’t affecting your quality of life,” said Dr. Ryan Light of Tidewater Medical Center. “The earlier we can begin Cognitive Therapy as well as the ERP Therapy, the earlier it’s going to be treated and the better the results are.”

Dr. Light says parents should be on lookout for repeated behaviors or anxiety that comes when a child is unable to perform a certain task before starting another one.

More information about OCD in children can be found here.

Judge rules dog can stay in clash that pitted two Ohio State sorority sisters

Cory will stay with roommate Madeleine Entine at the Chi Omega house, a federal judge ruled Friday morning.

U.S. District Judge Algenon L. Marbley issued a preliminary injunction against Ohio State University that prohibits removing Entine’s “assistance animal” because a sorority sister blamed the dog for aggravating her allergies and Crohn’s disease.

“Under clearly established law, Entine and Cory prevail,” Marbley wrote in his 21-page opinion.

Entine suffers from severe anxiety that causes panic attacks that can leave her immobile and gasping for breath, which qualified her for the protection under the Americans with Disabilities Act, Marbley said. Entine said she has trained Cory, an 8-year-old Cavalier King Charles Spaniel, to be her “assistance animal” that helps her overcome the attacks by resting on her torso.  

It was unclear, Marbley said, whether Carly Goldman, who contended that Cory aggravated her Crohn’s disease, ever requested an accommodation under the ADA for her allergy. Crohn’s is a painful inflammatory bowel disease.

It was clear, the judge said, that the university’s ADA coordinator, Scott Lissner, who said Cory had to go, “did not even establish that it was Cory who aggravated the symptoms of Goldman’s disability.”

Entine’s lawsuit was filed against Lissner.

Marbley acknowledged that, for Lissner, “this case is about a thorny and largely unmapped legal issue: how the University should reconcile the needs of two disabled students whose reasonable accommodations are (allegedly) fundamentally at odds.”

The preliminary injunction stays in effect until the case goes to trial.


Mentally Ill Millennial: Anxiety at 26

Trigger warning: Article discusses mental illness, panic attacks, and self-harming behaviors.

Mental illness is not a new or unusual concept. Human beings’ brains are wired in such a way that allows for specific errors to occur. While these errors are problematic, they’re not a sign of personal failure or inferiority. They are simply an unfortunate side effect of being human. That being said, though, there’s a lot of misconceptions surrounding mental illness. This is particularly true of anxiety disorders.


Anxiety disorders are some of the most common mental illnesses, so it makes sense that they get a lot of attention. However, more attention also means more potential for misunderstandings. As a person who deals with severe anxiety on a daily basis, I think it’s important to clear up some of these issues.

Anxiety: The Facts

What is Anxiety?

First, let’s get some basic facts straight about anxiety disorders. Let’s get one thing clear right off the bat: anxiety disorders are more than just feeling “anxious.” I can see how people would make that mistake since in our cultural lexicon “anxiety” is frequently used as a general description.

But while feeling anxious is a normal part of being a human, anxiety disorders go beyond just general feelings of nervousness. A neurotypical person might get anxious before giving a speech, or a big test. That’s normal.

10 Reasons Why Jessica Cruz’s Anxiety Moves Us

What’s not normal is when these nervous feelings linger or begin to interfere with a person’s day to day life. Once normal functioning starts to be affected, that’s when you likely have an anxiety disorder. Why do I keep using the term anxiety disorder?

Well, that’s another misconception. Even when they acknowledge it as a mental illness, most people think of anxiety in one specific way. But there is not one defined way to have anxiety. In fact, there are many subcategorical disorders.

Types of Anxiety

What most people think of is likely Generalized Anxiety Disorder (GAD). This is the general excessive worrying that is taken to an unhealthy extreme. People with GAD may find it difficult to control their thoughts or to address their fears face-on. However, another thing many people think of when they think of anxiety is a panic attack. While people with GAD may have panic attacks, people who deal with them are more likely to have Panic Disorder.


One of the defining characteristics of Panic Disorder that sets it apart from GAD is the fear of panic attacks. People with Panic Disorder will legitimately live in fear of having another panic attack. This greatly impacts their standard of living. Panic Disorder often goes hand in hand with Agoraphobia. Agoraphobia is the fear of the outdoors, but in this context means that people with panic disorder are afraid to leave their house for fear of having a panic attack in public.

GAD and Panic Disorder are the most common subsets of anxiety disorders, but there are many more. One familiar subset is social anxiety, which happens when a person gets incredibly anxious about social settings. Think about going to a party where you won’t know anyone, or speaking to a roomful of strangers. These are situations that a neurotypical person might find nerve-wracking. But again, what sets this apart from normal nerves is the extent to which it impacts a person’s life.

Other mental illnesses may often have components of anxiety. Obsessive Compulsive Disorder (OCD), for example, is often related to feelings of anxiety. Obsessive thoughts are often related to something that makes the thinker anxious, and compulsions are used to offset these feelings. Post-Traumatic Stress Disorder frequently includes panic attacks when confronted with specific triggers.

Anxiety Symptoms

Obviously, many of the symptoms of anxiety disorders are mental or emotional. Think of extreme nervousness, fear, and panic. But what makes anxiety disorders so dangerous is that they are frequently accompanied by physical symptoms as well. This isn’t that radical a concept, of course. Anyone who has ever been nervous before a big speech can sympathize. Who hasn’t dealt with sweaty palms, an increased heart rate, or similar feelings?

Mental Health In the Media When Done Right

But again, what makes these symptoms problematic is when they fail to dissipate or negatively impact a person’s life. That person with sweaty palms who just gave a speech will likely calm down after their speech is over. But a person with GAD, for example, will likely continue to present these physical symptoms for a good while. This person may also be experiencing the physical symptoms of anxiety without a specific cause, which of course makes it difficult for the symptoms to dissipate because there is no trigger to move beyond.

The combination of symptoms is especially difficult for people with Panic Disorder. Panic attacks are a terrible combination of mental and physical symptoms. Oppressive fear joins in with racing heart rate, inability to breathe, headaches, even fainting. This explains why people with Panic Disorder are often agoraphobic; no one wants to have a panic attack in public if you know you might pass out.

Who Gets Anxiety?

Anxiety is one of the most common types of mental illness. According to the Anxiety and Depression Association of America, as many as 40 million adults in the United States experience an anxiety disorder in a given year. Anyone can deal with an anxiety disorder, though there are risk factors that make a person more likely to deal with one. Women are more likely than men to suffer from anxiety disorders. A person with a family history of anxiety or other mental illness is more likely to have an anxiety disorder.


Co-morbidity is also a risk factor. Co-morbidity refers to when a person deals with two or more illnesses at the same time. Mental illness has a high rate of co-morbidity, both with other mental illnesses and with physical illness. Co-morbidity is extremely prevalent in anxiety patients. One study found that almost half of all patients with a mental illness had at least one other presenting mental illness. In GAD and panic disorder, there is a high rate of co-morbid depression.

Young people are increasingly likely to develop an anxiety disorder. The ADAA estimates that one in eight children has an anxiety disorder. This is an extremely important point because younger generations often have a reputation — a distinctly negative reputation — for being oversensitive and weak. Terms like “special snowflake” and “participation trophy” seem designed to mock young people for their perceived weaknesses. But they aren’t weak. They are ill. These stereotypes are extremely harmful because they discourage young people from seeking treatment and undermine their health.

My Anxiety: A Journey

This might all seem pedantic and unnecessary to those who have never dealt with anxiety or never have a loved one suffering from an anxiety disorder. But for me, it’s incredibly personal. I deal with anxiety on a daily basis, and it affects my life. This has been a long, difficult journey, and my life is vastly different from what I thought it would be when I was younger.


I didn’t always have anxiety. In fact, when I was younger, I was distinctly un-anxious. I dealt with the layman’s anxiety, the nerves before a big speech type (I didn’t even use to get anxious over tests. I miss those days). What I did deal with were other mental illnesses. I was diagnosed with bipolar disorder at 18, but that wasn’t the start of my journey. For me, it began when I was 14 and had my first depressive episode.

PENNY DREADFUL: Depression or Demonic Possession?

I was away on a school trip; it was my first big trip away from home on my own. I was having a blast until suddenly I wasn’t. It was as simple as that like someone had flipped a switch. At 14, I had no idea what was happening to me. I went from having the time of my life, having light-hearted good times with friends, to hiding under a table in an abandoned room and crying. That might sound over-dramatic and exaggerated, but honestly, that’s what it was like for me.

I went through the rest of high school with no treatment. Similar episodes happened from time to time, but I never sought treatment. I attempted suicide and began to self-harm. I was as lost as I can imagine. On paper, my life seemed pretty good. I wasn’t well-off, but I had a decent home life, I was very successful academically, and I had great friends.

So why was I always sad? Unfortunately, that’s not an uncommon story for many young people dealing with mental illness. A person can have an outwardly perfect life and still deal with mental illness — because mental illness has nothing to do with a person’s circumstances and everything to do with brain chemistry.

Turning Point

When I was 18, I attempted suicide again. This time, I ended up in the hospital. I was put on academic probation at my college, and I would only be allowed to return if a psychologist deemed me stable enough. What could have completely derailed my life ended up being the best thing for me. Because I was forced to see a doctor, I was eventually able to be diagnosed with Bipolar II Disorder.

That doctor was terrific because he listened to me. I had often felt like no one could understand what I was going through. And while he may not have personally gone through everything, this doctor trusted me to be honest and open with him. I was initially being treated for depression, including taking anti-depressants (which, for the record, is incredibly dangerous if you have bipolar disorder). But when things weren’t adding up for me, I raised the topic of bipolar disorder.


Rather than dismissing my thoughts or decrying internet research, the doctor believed me and agreed to run some tests. Because he was willing to trust me, I was correctly diagnosed. But more than the diagnosis was the peace I felt at that trust.

When you deal with mental illness, you often feel incredibly alone and isolated, which of course only makes things worse. This doctor reinforced to me that I can trust in other people, and not assume that everyone has it out for me. Seven years later I still thank that doctor for saving my life.

That is not to say everything magically got better. In fact, it got much worse.


When I returned to school, I faced several hiccups in accessing mental health care. I stopped taking my anti-depressants because I didn’t like the way they made me feel. While I may have been right, it is never a good idea to change your own medicine without medical supervision. Worse, I did not begin taking anything else to help tackle the mood swings of my bipolar disorder. And on top of that, I stopped seeing the psychologist and did not restart therapy.

There were mitigating factors, of course. The Counseling and Substance Abuse Services at my school was not set up to treat long-term issues, but rather, minor issues like homesickness, stress, or alcohol infractions. So although they tried to accommodate me, they eventually ended up pushing me out to see a community doctor.

The problem with that is that it is incredibly difficult to access mental health care in our country. At the time, I was 19 years old, with crappy insurance and almost no income. I couldn’t afford to see a doctor consistently and frequently, and I couldn’t provide medication when my insurance would regularly refuse to cover it.

Millennials, Meme Culture, and Mental Illness

The lack of treatment, combined with increased stress at school, eventually led to a relapse. After another bout of suicidal ideation, I was back to being treated. Except for this time, I ended up getting the right treatment. I was finally put on mood stabilizers, three years after my initial bipolar diagnosis. I saw a therapist weekly, which was very important when I developed PTSD after a very distressing incident.

This PTSD was my first brush with anxiety. It was incredibly difficult for me because, despite my long-running issues with depression, suicidal ideation, and mood swings, I still had not truly experienced anxiety. While PTSD isn’t quite the same thing, it was still a challenging experience. I started to have panic attacks and trouble sleeping. Soon, though, it would get worse.


What led to this? I made a rookie mistake — I graduated college and thought I was ready to be an adult (spoiler alert: I wasn’t). I moved away to go to law school, which ultimately derailed my life. For the first time, I was incredibly anxious about school. The overwhelming stress I felt impacted my ability to be successful, and I eventually dropped out.

On top of the academic success was a growing agoraphobia. I moved to a bad neighborhood because it was all I could afford in the city where I moved. I was afraid to leave the house by myself because I did not feel safe. At one point, while a friend was visiting, we were attacked on the metro. Although no one was seriously injured, it only added to my fears of the outdoors.


After dropping out of law school, I moved back to the city where I went to college. I was able to get into a low-cost community clinic, where I began seeing an excellent therapist and an excellent psychiatrist. The psychiatrist diagnosed me with panic disorder, and it was an appropriate diagnosis. I had panic attacks, then panicking about having panic attacks. I was afraid to leave the house, which was impacting my daily life.

My therapist was a true angel as I dealt with this. I had to take the bus to get to my appointments, which was nerve-wracking. She encouraged and praised me for my efforts. Eventually, we would meet in public for my therapy, and I was enjoying being out of the house. The time I spent with her did miracles for helping me accept, if not truly overcome, my anxiety diagnosis.

Living with Anxiety… and Hope

Things are not perfect in my life by any means. Since my anxiety diagnosis, a lot of other things have gone wrong. But, thanks in no small part to the support I found, I am still here.

I live with my anxiety every day. I take several different medications, both for the bipolar disorder and the panic disorder. A large chunk of my money goes to prescription costs, not to mention the cost of doctor’s visits. But I do my best to keep up with my medicine because I have seen what happens if you don’t.

HYPERBOLE AND A HALF: How NOT To Talk To Someone With Depression

My anxiety still negatively affects my life. I am not able to do all the things I want to. I can’t watch certain TV shows or movies because they might trigger an episode. Minor things that most people might not even think about are huge undertakings. I struggle inordinately with talking on the phone or asking people for favors. But I am also taking steps to deal with these issues. I started watching GAME OF THRONES… just with an anxiety pill handy, just in case. I had begun learning to drive, something I put off for many years after an unfortunate car accident when I was younger.

Most importantly, I try to take things as they come. A lot of terrible things happen every day, to people all over the world. While my anxiety puts me a step behind others at dealing with these issues, I can still overcome them. I take my medicine; I talk to people, I let my loved ones know what to expect so that we are all prepared. My anxiety won’t get the best of me, not if I have anything to say about it.

There is Hope for You Too

If nothing else, let my experience be a lesson to everyone reading. Anxiety is a terrible experience, to be sure, but it’s not life-ending. When so many people are dealing with it, it’s important to be understanding, empathetic, and kind.


And most importantly, be kind to yourself. Anxiety disorders don’t make you lesser than anyone else. It’s important to be cognizant of your symptoms and to take careful care of yourself. But you do not have to let anxiety keep you down.

Support groups are available online. Many communities may have support groups, and look for low-cost clinics if reaching treatment is difficult. If you or a loved one is experiencing severe distress or thoughts of self-harm, you can find help online at and by phone at (775) 784-8090.

div.wpmrec2x div.u > div:nth-child(3n){margin-right:0px;}


No Association Between Comorbid Anxiety Disorders, Suicide Attempts

Patients with comorbid anxiety disorders had similar survival curves compared with patients without comorbid anxiety disorders.

According to the results of a study published in European Psychiatry, comorbid anxiety disorders among patients with depression or bipolar disorder were not associated with suicide attempts.

In a 2-year prospective study, researchers evaluated 667 participants with major depression or bipolar disorder for suicide attempts, depression, and anxiety at 3, 12, and 24 months. The results were compared among patients with lifetime comorbid anxiety disorders (n=229) and those without (n=438). Anxiety disorders included panic disorder, post-traumatic stress disorder, social phobia, obsessive-compulsive disorder, generalized anxiety disorder, and agoraphobia.

A total of 480 patients completed all 3 follow-up sessions. Overall, 85 suicide attempts were made by 63 patients (13.1%) during the 2-year follow-up.

Patients with comorbid anxiety disorders had similar survival curves compared with patients without comorbid anxiety disorders (P =.6). Similarly, no difference was noted when participants were stratified by the number of comorbid anxiety disorders (0, 1, or 2; P =.8).

Suicide attempts during the study period were associated with female sex (hazard ratio [HR] = 3.66; P =.001), previous suicide attempts (HR =3.27; P =.001), and higher scores on the Buss-Durkee Hostility Inventory (HR = 1.05; P .001).

The investigators concluded that “the presence of comorbid anxiety disorders does not seem to be a risk factor for suicide attempts in patients with mood disorders, although patients with anxiety disorders had [significantly] higher scores for depression, hopelessness, suicidal ideation, impulsivity, aggression, and hostility, all risk factors for suicide attempts.”


Abreu LN, Oquendo MA, Galfavy H, et al. Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective studyEur Psychiatry. 2017; 47:19-24.

24 Jokes You’ll Relate To If You’re Always Picking At Your Skin

By the way: Humor is a great way for a lot of people to cope with their skin-picking compulsions, but if you found a lot of things in this post a little too relatable, you might want to look into ways to take care of yourself. So, here are some quick resources, just in case:

You might want to read more about dermatillomania (a disorder that causes people to repetitively touch, rub, scratch, pick at, or dig into their skin in ways that result in physical damage). While you’re there, you can check out their resources and information on how to get treatment.

You can read about anxiety disorders and obsessive-compulsive disorder, since skin-picking can be a symptom or coping mechanism of both.

You might also want to check out these strategies our readers use to keep from picking their skin.

Understanding a Hoarding Disorder

A lot of us hold on to our most treasured items in our homes. From pictures and antiques, to heirlooms and valuables, keeping those things near to us is what makes them special. Though for some, letting go of certain items might be harder to handle.

Compulsive hoarding can be difficult to overcome. People can have a hard time letting go of even the simplest of materials such as magazines and old papers. Making this harder for those around them if they must live in the clutter that’s been created.

It can also make others stay away from coming over and  even cause signs of loneliness. They think to themselves, “I can’t let go of this. What if I need it one day?” People can also see hoarding as not a serious problem and make getting treated challenging. The good news is help is possible. Here are signs and symptoms you can spot for hoarding.

First, it’s important to understand what is hoarding. According to the Anxiety and Depression Association of America, hoarding is the constant difficulty of parting with possessions, regardless of their values. Common hoarded items can be anything from newspapers, magazines, paper, food, cardboard boxes and even plastic bags.

It should also be noted that hoarding isn’t the same as collecting. When it comes collecting a certain thing, people can have a sense of pride about their possessions and will have no problem showing off. Collectors will also keep their items in a nice condition and feel happy about adding more to their collection. Those who hoard usually feel ashamed about their mess and clutter and often don’t want others to see. They can also feel sad and depressed.

Signs that someone can be suffering from a hoarding disorder is the inability to throw away possessions and severe anxiety when attempting to discard items. They can also have great difficulty categorizing or organizing possessions and even have obsessive thoughts and actions of running out of an item.

Knowing what to spot first can also be a key difference. According to the Mayo Clinic, symptoms start as early as teenage and adult years. By the time the person hits their middle ages, symptoms are much more severe. People with a hoarding disorder can also experience other mental health disorders such as anxiety, obsessive-compulsive disorder and attention-deficit/hyperactivity disorder.

Causes for a hoarding disorder aren’t very clear, but it’s being studied that genetics, brain functions and stressful events might be possible causes.

Ultimately, treatment can be also challenging because many who suffer from a hoarding disorder might not recognize it. If you feel you or someone might be suffering from hoarding, seek professional help as soon as possible.

© 2017 KXTV-TV

Mental illness can happen to your child | SunStar

CHILDREN can also develop a mental disorder like an adult. But most of the time, the symptoms are different. Sometimes people would think that the children are misbehaving but it could be a sign of a mental health condition. There is also stigma attached to mental disorders. Some others find it impossible to think that children may develop a mental health illness.

According to, children can experience a range of mental health conditions, including:

Anxiety disorders. Children who have anxiety disorders — like obsessive compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder — experience anxiety as a persistent problem that interferes with their daily activities.

Some worry is a normal part of every child’s experience, often changing from one developmental stage to the next. However, when worry or stress makes it hard for a child to function normally, an anxiety disorder should be considered. 

Attention-deficit/hyperactivity disorder (ADHD). This condition typically includes symptoms in three categories: difficulty paying attention, hyperactivity and impulsive behavior. Some children with ADHD have symptoms in all of these categories, while others may have symptoms in only one.

Autism spectrum disorder (ASD). Autism spectrum disorder is a serious developmental disorder that appears in early childhood — usually before age 3. Though symptoms and severity vary, ASD always affects a child’s ability to communicate and interact with others.

Eating disorders. Eating disorders — like anorexia nervosa, bulimia nervosa and binge-eating disorder — are serious, even life-threatening, conditions. Children can become so preoccupied with food and weight that they focus on little else.

Mood disorders. Mood disorders — like depression and bipolar disorder — can cause a child to feel persistent feelings of sadness or extreme mood swings much more severe than the normal mood swings common in many people.

Schizophrenia. This chronic mental illness causes a child to lose touch with reality (psychosis). Schizophrenia most often appears in the late teens through the 20s.

Mayo Clinic also shared warning signs that a child may have a mental health condition:

Mood changes. Look for feelings of sadness or withdrawal that last at least two weeks or severe mood swings that cause problems in relationships at home or school.

Intense feelings. Be aware of feelings of overwhelming fear for no reason — sometimes with a racing heart or fast breathing — or worries or fears intense enough to interfere with daily activities.

Behavior changes. These includes drastic changes in behavior or personality, as well as dangerous or out-of-control behavior. Fighting frequently, using weapons and expressing a desire to badly hurt others also are warning signs.

Difficulty concentrating. Look for signs of trouble focusing or sitting still, both of which might lead to poor performance in school.

Unexplained weight loss. A sudden loss of appetite, frequent vomiting or use of laxatives might indicate an eating disorder.

Physical symptoms. Compared with adults, children with a mental health condition may develop headaches and stomach aches rather than sadness or anxiety.

Physical harm. Sometimes a mental health condition leads to self-injury, also called self-harm. This is the act of deliberately harming your own body, like cutting or burning yourself. Children with a mental health condition also may develop suicidal thoughts or actually attempt suicide.

Substance abuse. Some kids use drugs or alcohol to try to cope with their feelings.

If you think that your child may be experiencing these signs, it is important that you bring them to a mental health professional like a psychologist or a psychiatrist. They will recommend treatment for them.

Remember that mental health is as important as physical health. Having a mental health disorder means, the child or an adult has a medical condition that can be treated, cured or managed. It’s ok to ask for help. Visit your doctor now!