Anxiety symptoms: Do you have unhealthy patterns of behaviour? It could be OCD

Cleanliness/order

Examples include obsessive household cleaning or hand-washing to “reduce an exaggerated fear of contamination”.

There may be an “obsession with order and symmetry, with an overwhelming need to place objects, such as cutlery, in a particular place”.

Counting/hoarding

This can include “repeatedly counting items or objects, such as pavement blocks when walking”.

“Hoarding items such as junk mail and old newspapers” could be an example of obsessive compulsive behaviour.

READ MORE: Social anxiety: The clues you may be suffering from this condition

The impact of the COVID-19 pandemic on those with OCDs – News

Researchers from the University Medical Centre Hamburg-Eppendorf and University Hospital, Munich in Germany, have reported their findings on the course of obsessive-compulsive disorders (OCDs) during the coronavirus disease 2019 (COVID-19) pandemic. Their study, titled “Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?,” was published in the latest issue of the Journal of Anxiety Disorders.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, has infected a large proportion of the global population, with over 56.42 million cases confirmed worldwide. SARS-CoV-2 is a highly infectious virus that spreads via aerosols and airborne droplets from the mouth and nose. These microbe-laden droplets may also contaminate surfaces. Recent research suggests that the viral microbes landing on surfaces can survive on them for up to 72 hours, increasing the risk of surface (or fomite) transmission. Hand hygiene and mask-wearing are therefore among the primary preventative measures used to curb the spread of SARS-CoV-2.

The study’s authors state that these measures are particularly affecting those with obsessive-compulsive disorder (OCD) around sanitation and cleanliness. Those with washing compulsions have been particularly affected, they write. At present, however, there is little empirical evidence regarding how those with washing compulsions are fairing during the ongoing pandemic.

Mental health problems associated with the pandemic

The researchers point out that several mental health problems have been exacerbated by the pandemic and its associated public health measures. Social isolation measures and the economic downturn has also led to the flaring up of pre-existing mental health problems among many.

To study how COVID-19 has affected those with OCDs, the team used the diathesis-stress model to explain the “development and maintenance” of mental health problems among those susceptible to it. The team explains that those at risk suffer from additional contributing factors such as “low resilience, fewer social contacts, and reduced psychiatric care.” Problems aggravated by the pandemic include depression and anxiety disorders as well as associated behavioral problems such as substance abuse disorders, eating disorders and OCD, the team wrote.

Obsessive-compulsive disorder

A common form of OCD, called “contamination-related OCD (C-OCD),” and those with washing compulsions are often among the worst affected during a pandemic. The researchers explain that compulsions of washing and “ritualized washing behaviors,” have been considered to be part of the “new normal.” These behaviors have been advocated by health bodies such as the World Health Organization (WHO).

Fear of not having enough cleaning products has also led to a stockpiling of soaps, sanitizers, disinfectants, toilet papers and other hygiene products. This has been seen not only among those with OCD but also among others as well.

Guidelines and recommendations

According to the consensus statement from the International College of Obsessive Compulsive Spectrum Disorders and the Obsessive-Compulsive Research Network of the European College of Neuropsychopharmacology, patients with OCD need help adapting to the pandemic even with a pause in treatment to allow, “exposure and response prevention (ERP).” The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has also recommended ERP as an effective and recommended treatment for OCD.

The researchers write that what was perceived earlier as exaggerated could be the “new normal” and this may help reduce the stigma. They write, “people with OCD (particularly those with washing compulsions) may also experience relief due to reduced stigmatization or other factors. Some patients may (paradoxically) even experience a sense of competence as a result of their functional beliefs and use of adaptive coping strategies.”

Study design

For this study, a total of 394 persons diagnosed with OCD were included. Of these, 223 had washing compulsions. Persons aged 18 to 80 years were included. Participant recruitment was between March 23rd and May 18th, 2020. During this period, Germany was under a nationwide lockdown.

An assessment of OCD severity was made using the German version of the Obsessive-Compulsive Inventory-Revised (OCI-R). The severity of depression was assessed using the German version of the Patient Health Questionnaire (PHQ-9).

The participant took an online survey with a new set of questions developed by the researchers. Some of the questions were regarding changes in the participants’ OCD symptoms and reasons the participants attributed to this change.

Some participant responses included “reduced mobility, reduced availability of cleaning products, economic factors, lack of availability of doctors/therapist, interpersonal conflicts.” The team of researchers also assessed the beliefs and experiences of the participants of the COVID-19 pandemic.

Findings

The study results showed that most people with OCD were negatively affected by the COVID-19 pandemic. These were most pronounced among “washers,” and the most common cause of worsening symptoms included reduced mobility and interpersonal conflicts.

Overall results were:

  • At the start of the study, the OCD severity was moderate to severe among participants, with a mean score of 27 on the OCI-R. The average depression severity score was 12.41 on the PHQ-9, indicating that depression levels among the participants were largely moderate.
  • An increase in OCD symptoms was reported by 71.8 percent
  • This worsening was more significant among “washers” compared to “non-washers.”
  • Some patients, however, experienced a decrease in symptoms (6.5 percent), and some saw no change in symptoms (21.7 percent).
  • Dysfunctional beliefs regarding the pandemic were mainly hygiene-related, and these were more prevalent in “washers” than in “non-washers”. These also led to a rise in OCI-R scores and an increase in OCD symptoms overall.
  • “Washers” were also were more confident in their rituals and adaptability and provided other people with advice to prevent the spread of SARS-CoV-2 infection. A total of 22.4 percent offered advice to others.
  • Washers were, unfortunately, more likely to receive poor feedback from the people they provided with advice regarding infection prevention through hygiene. Overall, feedback in response to hygiene advice was 39.7 percent positive and 24.7 percent negative as per the participant survey.

Conclusions and implications

The researchers found that most participants with OCD were negatively affected by the COVID-19 pandemic, and this was more prominent among “washers” than in “non-washers”.

They called for rapid and specific interventions against OCD to prevent long-term and long-lasting implications of this pandemic-induced aggravation of symptoms among those with OCD.

COVID-19 may trigger and worsen obsessive compulsive disorder in children and adolescents, new study finds

The COVID-19 pandemic has taken a heavy toll on the mental health of all, irrespective of whether you had diagnosed mental health conditions before this or not. Studies published since the beginning of the pandemic show that stress and anxiety levels have increased among people, leading not only to psychological disorders but also to increased risks of substance abuse. Scientists, mental healthcare professionals and organisations across the globe are therefore warning against postponing therapy and treatment even as the pandemic continues to rage because not having your needs met is only likely to increase susceptibilities further.

But while there is currently more research regarding the psychological impact of COVID-19 among adults, studies about the effects of the pandemic on younger populations are scarce. The findings of a new study published in BMC Psychiatry are likely to bridge this gap in knowledge by providing much-needed insight into the impact of the pandemic on the psychological health of children and adolescents.

OCD and COVID-19 trauma among children

The study, conducted by researchers at the Aarhus University and the Centre for Child and Adolescent Psychiatry, Denmark, looked particularly at obsessive-compulsive disorder (OCD) and its onset or worsening among children. The researchers start out by observing that OCD – which is a psychiatric disorder characterized by unwanted thoughts, images or urges, and repetitive behaviours that occur in response to anxiety or unpleasant feelings – is known to have a major impact on the everyday life of children suffering from it.

Childhood trauma can have a lifelong impact on the physical and psychological health of children. Studies also show that there is a strong relationship between childhood traumas and the severity of OCD symptoms, the occurrence of comorbid anxiety, increased impulsiveness, higher incidence of attention deficit hyperactivity disorder (ADHD) and low education levels. While the fear, stress, anxiety and trauma associated with COVID-19 infection may not be comparable to the trauma due to childhood sexual abuse, studies have shown that depression, anxiety disorders, post-traumatic stress disorders (PTSD), etc may be the psychological consequences of COVID-anxiety. What’s more, children who have already suffered previous traumas might be more susceptible to OCD and other mental health issues triggered by COVID-19 .

Worsening OCD symptoms

To understand if this has truly been the case, the researchers behind this study sent questionnaires in spring 2020 to two groups of children and adolescents between the ages of seven and 21 years. One group of participants consisted of clinical patients newly diagnosed at a specialized OCD clinic, while the other contained participants identified by the Danish OCD Association. All participants were in regular contact with a therapist or doctor and most had received primary psychological treatment.

The researchers found that participants from both groups experienced a worsening of their OCD and the worsened symptoms were more significant in the second group. As their OCD symptoms were aggravated, the anxiety, depression and the extent of avoidance behaviour of the participants also increased. This indicated a vicious circle of aggressive OCD symptoms and worsening of other psychological parameters. This trend was more pronounced in children with early OCD onset and a family history of ADHD.

The study thus concluded that fear, stress and anxiety due to COVID-19 has a huge impact on the OCD incidence and worsening of symptoms. The researchers particularly observed excessive handwashing and disinfection among the children, which clearly correlates to the previous knowledge that OCD patients tend to have higher health anxieties and aversions to bacteria and dirt. The researchers recommend that since the pandemic is far from over, it’s very important for parents and guardians to observe higher frequencies of OCD behaviours in their children and to contact mental healthcare professionals for help before the symptoms get worse or lead to further trauma.

For more information, read our article on Obsessive-compulsive disorder

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

Hoarding, stockpiling, panic buying: What’s normal behavior in an abnormal time?

Symptoms of depression, anxiety and obsessive compulsive disorders have emerged or worsened for many during the pandemic. This is no surprise to clinicians and scientists, who have been increasing worldwide access to mental health information and resources.

But what effect has the pandemic had on another common but often misunderstood problem – hoarding? The issue first received attention when people piled up paper towels, toilet tissue and hand sanitizer in their shopping carts at the start of the pandemic, leading some people to wonder whether they or a loved one were showing signs of hoarding disorder.

The short answer is: Probably not. Hoarding disorder goes beyond stockpiling in an emergency. I am a psychiatrist at the University of Florida and the director of the Center for OCD, Anxiety and Related Disorders. I also recently authored a book on hoarding disorder. My work focuses on identifying the causes of hoarding and its impact on individuals and on society.

Millions of Americans have hoarding disorder.
Millions of Americans have hoarding disorder, a serious psychiatric illness.
shaunl via Getty Images

Millions have hoarding disorder

Although often sensationalized in the popular press as a behavioral oddity, hoarding disorder is a serious psychiatric illness affecting more than 13 million American adults. The cause is a complex interaction of biological and environmental factors. Doctors have known about hoarding for centuries, although the disorder was only formally recognized by the psychiatric community as a distinct psychiatric illness in 2013. Perhaps the most famous person who had a hoarding disorder was Howard Hughes.

The disorder is chronic and often lifelong. Although symptoms typically begin in adolescence, they usually do not become problematic until mid- to late adulthood. No one knows exactly why the disorder takes so long to manifest; perhaps as those with hoarding symptoms get older, their ability to decide what to discard becomes increasingly impaired. Or they might have fewer people around, like parents or spouses, to encourage them to get rid of unneeded items.

What is clear is that the increase in hoarding behaviors across the lifespan is not just a result of a lifetime’s accumulation of clutter. About 7% of adults over age 60 have problematic hoarding; that’s one in every 14 people.

And contrary to popular belief, the defining feature of hoarding disorder is not clutter. Instead, it is the difficulty in discarding what’s no longer needed. The most commonly hoarded items are everyday belongings: clothes, shoes, containers, tools and mechanical objects like nails and screws, household supplies, newspapers, mail and magazines. Those with the disorder report feeling indecision about what to discard, or fear the item will be needed in the future.

This trouble in disposing of items, even common items like junk mail, plastic bags and plastic containers, leads to the accumulation of clutter. Over time, living and work spaces become unusable. In addition to affecting living spaces, hoarding also causes problems between spouses, between parents and their children, and between friends. At its worst, hoarding can also impact one’s ability to work.

Hoarding disorder has a substantial impact on public health, including not only lost work days but also increased rates of medical illness, depression, anxiety, risk of suicide and cognitive impairment. As many as half of those suffering from hoarding disorder will also suffer from depression, and 30% or more will have an anxiety disorder.

Hoarding-related clutter in homes increases the risk of falls, pest or vermin infestation, unstable or unsafe living conditions and difficulty with self-care. It may stun you to know that up to 25% of deaths by house fire are due to hoarding.

During the pandemic, stores across the U.S. ran out of common household items, like toilet paper.
Because of excessive stockpiling and panic buying, stores across the U.S. ran out of common household items during the pandemic.
Icon Sportswire via Getty Images

Stockpiling and panic buying

What is the difference between stockpiling, panic buying and hoarding? Will someone who stockpiled toilet paper and hand sanitizer in the early days of the pandemic develop hoarding disorder? Or are they instead rational and thoughtful planners?

While these terms are often used interchangeably, stockpiling and panic buying are not symptoms of hoarding disorder. Nor are they necessarily the result of a psychiatric or psychological condition. Instead, stockpiling is a normal behavior that many people practice in preparation for a known or anticipated shortage. The goal of stockpiling is to create a reserve in case there’s a future need.

For example, people who live in cold climates may stock up on wood for fireplaces and salt for driveways before the winter. Similarly, those who live in the southeast U.S. may stock up on gasoline and water before hurricane season.

That said, stockpiling can be excessive. During a crisis, it can lead to national shortages of essential items. This occurred early in the pandemic, when people bought toilet paper in large quantities and emptied store shelves for everyone else.

Ironically, the more media attention on stockpiling, the more it triggers additional stockpiling. People reading about a potential shortage of hand sanitizer will be driven to buy as much as possible until it’s no longer available for weeks or months.

While stockpiling is planned, panic buying is an impulsive and temporary reaction to anxiety caused by an impending crisis. Items, even if unneeded, may be purchased simply because they are available on store shelves. Panic buying may also include purchasing enormous quantities of a particular item, in volumes that will never be needed, or emptying a store shelf of that item. Panic acquiring, which involves getting free things through giveaways, food pantries or scavenging, also occurs during a crisis.

Unlike those with hoarding disorder, panic buyers and stockpilers are able to discard something no longer needed. Usually, after the crisis has passed, they can easily throw or give these items away.

How to get help

For some with hoarding disorder, the pandemic has made it even harder to dispose of unneeded items. Others find their material belongings provide comfort and safety in the face of increased uncertainty. Yet others have used the lockdowns as a reset – time to finally declutter their home.

If you or someone you know has problems with hoarding, help is available. Resources are on the American Psychiatric Association website and at the International Obsessive Compulsive Foundation.

Anxiety: Signs, Symptoms, and Complications

Anxiety is a mental health condition that is typically associated with worry, fear, difficulty concentrating, as well as physical symptoms like nausea, shaking, and muscle tenseness. There are multiple types of anxiety disorder, and your symptoms will differ based on what type of anxiety you have.

It might feel like your anxiety symptoms control your life, whether that means fear of a panic attack, avoiding people due to social anxiety, or just a constant feeling of worry and agitation. Understanding the symptoms of your specific type of anxiety can help you seek the most appropriate treatment, and improve your quality of life.

What Is Anxiety?

Anxiety is described by the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) as anticipation of a future threat.  Everyone feels anxious at one point or another, but not everyone experiences an anxiety disorder.

There are multiple types of anxiety disorder, including generalized anxiety, social anxiety, and more. These conditions should not be confused with day-to-day worrying.

It’s normal to be anxious about important events, like a job interview, a performance, a first date, a big exam, childbirth, or any number of life moments. Sometimes, however, this normal, healthy worrying gets out of control and becomes an anxiety disorder.

Anxiety disorders are diagnosable mental health conditions characterized by excessive fear, anxiety, and related behavioral changes that may worsen over time. This fear manifests as both physical and mental symptoms, and impacts daily activities such as school, work, leisure, and relationships.

A woman with furrowed brows holds her head and looks at her phone

 JGI / Jamie Grill / Getty Images

Symptoms

Everyone experiences anxiety differently, but there is usually a combination of physical, psychological, and social symptoms. The exact symptom profile will differ based on individual circumstances, specific type of anxiety disorder, and personal triggers.

Some overarching symptoms of anxiety disorders include:

  • Excessive fear and anxiety
  • Dry mouth
  • Muscle tension
  • Nausea
  • Irregular heartbeat
  • Difficulty sleeping
  • Cautious, avoidant behavior
  • Panic attacks

Keep in mind that this is not an exhaustive list of symptoms, because each type of anxiety disorder has its own symptom profile according to the DSM-5.

symptoms of generalized anxiety disorder

Verywell / Cindy Chung

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) experience excessive and persistent worry, fear, and anxiety that is hard to control, and is disproportionate to the situation. GAD can be diagnosed when these symptoms occur for the majority of days over at least six months.

Symptoms of generalized anxiety disorder include:

  • Anxiety or worry
  • Restlessness
  • Irritability
  • Increased fatigue
  • Muscle tension, soreness, and ache
  • Difficulty sleeping

Adults must experience a minimum of three of the above symptoms, in addition to anxiety or worry, to be diagnosed with GAD. Children only need one of the above symptoms, in addition to anxiety or worry, for a diagnosis.

Social Anxiety Disorder Symptoms

Illustration by Brianna Gilmartin, Verywell​

Social Anxiety Disorder

Social anxiety disorder, which was previously called social phobia, is characterized by excessive fear of social and performance situations. It is more than just shyness. People with social anxiety disorder feel intense anxiety that may lead to avoidant behaviors around meeting new people, maintaining relationships, speaking in front of others, eating in public, and more.

Symptoms of social anxiety disorder include:

  • Disproportionate fear and anxiety in one or more social situations
  • Blushing
  • Sweating
  • Trembling
  • Rapid heart rate
  • The feeling of “mind going blank”
  • Self-judgment and self-consciousness
  • Nausea
  • Avoiding social situations, or experiencing intense fear during them
  • Impairment in social, occupational, and other areas of functioning

People can either experience general social anxiety disorder, or performance-specific social anxiety disorder (such as when speaking or performing in front of an audience).

Social anxiety disorder can look different in children. Notably, for children the anxiety must occur in peer situations, and not just with adults. Symptoms can manifest as tantrums, freezing, crying, clinging, and refusal to speak.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) involves recurring, unwanted thoughts that lead to specific and repeatable actions, which interfere with daily life. OCD is no longer classed as an anxiety disorder as of the DSM-5, but its symptoms cause anxiety. For that reason, professionals associate OCD with anxiety disorders.

Symptoms of obsessive-compulsive disorder include:

  • Obsessions: Thoughts and worries that are recognized as excessive but won’t stop. Obsessions commonly include a fear of germs, fear of losing something, aggressive or taboo thoughts, desire for symmetry or order, and more.
  • Compulsions: Repeatable behaviors performed to relieve anxiety and typically related to the obsessions. Compulsions commonly include counting, excessive cleaning or hand washing, overly precise ordering and arranging, repeated checking, and more.
  • Minimum one hour per day spent on obsessions and compulsions

OCD typically emerges either in childhood or young adulthood, and will occur earlier in boys than girls.

Panic Disorder

Panic disorder is a mental health condition that involves recurrent and unexpected panic attacks. A panic attack is an episode of extreme fear and anxiety, which some people describe as feeling like a heart attack.

Symptoms of a panic attack include:

Panic attacks by themselves are not a mental health condition. They occur in many anxiety disorders, including panic disorder.

Someone who has panic disorder will experience repeated panic attacks, intense anxiety around future panic attacks, and avoidant behaviors around situations that could induce a panic attack.

To be diagnosed with panic disorder, at least one panic attack must be followed by a month-long period of avoidant behaviors. For example, this could mean not going to the grocery store for months because you experienced a panic attack there.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder the emerges after a person either directly experiences or witnesses a traumatic event such as serious injury, combat, sexual violence, natural disaster, or actual or threatened death. Military personnel, first responders, and police officers are at increased risk of PTSD, but anyone can have PTSD.

Symptoms of PTSD include:

  • Detachment from others
  • Irritability
  • Hyper vigilance
  • Difficulty concentrating
  • Difficulty sleeping
  • Exaggerated startle response
  • Difficulty remembering the traumatic event
  • Negative beliefs about oneself or the world
  • Persistent negative emotions such as fear, horror, and guilt
  • Persistent inability to feel positive emotions such as happiness and satisfaction
  • Self-destructive behaviors
  • Avoidance of triggers associated with the traumatic event
  • Intrusive symptoms, such as recurrent and involuntary memories, distressing dreams, dissociative reactions or flashbacks, psychological distress when exposed to triggers.

Children can experience PTSD differently from adults, due to developmental differences. The DSM-5 categorizes children age 6 and younger as having PTSD in preschool children. Instead of acting distressed by the traumatic event or intrusive symptoms, some children may appear excitable or “over-bright.”

Other Anxiety Disorders

There are additional anxiety disorders besides those listed above. Each of these anxiety disorders has a unique symptom and diagnostic profile that is detailed in the DSM-5.

  • Separation anxiety disorder
  • Specific phobia
  • Selective mutism in children
  • Agoraphobia
  • Substance/medication-induced anxiety disorder
  • Anxiety disorder due to another medical condition

Complications

Anxiety symptoms can change and worsen over time if left untreated. Due to fear of symptoms or anxiety attacks, you may start avoiding situations that were previously meaningful or brought you joy. This can lead to social isolation.

People who have an anxiety disorder also may develop depression, substance-use disorder, and even digestive issues such as irritable bowel syndrome (IBS).

What Is an Anxiety Attack?

“Anxiety attack” is not an official medical term, but it is often used to describe a panic attack. A panic attack is a period of intense, uncontrollable anxiety that may result in shortness of breath, shaking, chest pain, and feelings of doom.

Anxiety attacks are all-consuming and frightening, and sometimes mistaken for heart attacks. They are a primary symptom of panic disorder, but may occur in any anxiety disorder.

When to See a Doctor

Worry is a normal part of life, but when your worry becomes ongoing and disproportionate to the situation, it may be time to see a doctor.

People with anxiety disorders experience fear and anxiety that impairs daily functioning. This might appear as avoiding going out in public, not returning phone calls or meeting up with friends, canceling performances or presentations, persistent nausea, changes in sleep, and more.

If you feel that your anxiety is preventing you from living a full life, speak to your doctor.

If you or a loved one are struggling with anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word from Verywell

Anxiety can be a disabling condition that affects all areas of your life, from how you think about yourself, to your relationships, to physical changes. Know that there is help available for anxiety.

Anxiety is treatable, and many people are able to work through their anxiety symptoms through personalized treatment plans that might involve medication, therapy, lifestyle changes, and healthy coping mechanisms.

When Unwanted Thoughts Intrude: Understanding Obsessive-Compulsive Disorder

OCD is a mental health condition that causes repeated unwanted thoughts, called obsessions. This can trigger compulsions—the urge to do things over and over to deal with the troubling thoughts. You don’t need to have both to have OCD.

Many people with OCD have a fear of germs or contamination. This can lead to obsessive thoughts about things being “dirty.” Some people may feel a need for things to be symmetrical or in a perfect order. Worries about harm to yourself or others are also common. In some cases, these unwanted thoughts can be violent or disturbing.

“An obsession is an intrusive, distressing thought that usually kids or adults with OCD are able to recognize as a fear that doesn’t make a ton of sense,” explains Dr. Kate Fitzgerald, an OCD expert at the University of Michigan. “But these intrusive thoughts tend to cause them much anxiety.

People with OCD may develop rituals meant to relieve their anxiety from their thoughts. This could involve behaviors like excessive hand washing or cleaning, arranging things in a certain order, or compulsive counting.

Many of us are a little “obsessive.” So when is there cause for concern? The biggest sign is if these thoughts or habits are making it hard to function in your day-to-day life, explains Fitzgerald.

This can mean problems with family, work, or school. Spending more than one hour a day on thoughts or behaviors can indicate a problem. See the Wise Choices box for more signs and symptoms.

You may have heard someone say that they’re “OCD” about cleaning or organizing. But OCD is a debilitating disorder.

“Those terms are just kind of out there in the popular culture without recognizing that true OCD can paralyze people,” notes Fitzgerald. “There are people who can’t work, can’t go to school, can’t function because of the illness.”

People usually develop symptoms of OCD as a child or young adult. Most people are diagnosed by about age 19. But childhood-onset of OCD often occurs as early as eight or nine years old.

Scientists aren’t sure what causes OCD. But genetics are likely to play a role. People with a parent or sibling with OCD are at a higher risk for developing the disorder themselves.

OCD is usually treated with antidepressant medication and psychotherapy. One of the most common forms of psychotherapy for OCD involves exposing people to their triggers. Therapists then help people overcome their compulsive thoughts or actions. This form of therapy is called exposure and response prevention.

Although psychotherapy helps many people with OCD, it isn’t effective for everyone. Fitzgerald and her team are trying to learn more about who responds to psychotherapy. Her studies suggest that people with certain patterns of brain activity are more likely to benefit. One day, brain scans or other testing might help match people with OCD to the best treatment.

Is it OCD?

Everyone double checks things sometimes. But a person with OCD generally:

  • can’t control his or her thoughts or behaviors, even after recognizing that they’re excessive. 
  • spends at least one hour a day on these thoughts or behaviors.
  • doesn’t get pleasure when performing the behaviors or rituals, although they may bring brief relief from anxiety.
  • experiences significant problems in his or her daily life due to these thoughts or behaviors.

Pill for OCD and anxiety may prevent worsening Covid-19, early study says

A pill ordinarily prescribed to treat obsessive compulsive or anxiety disorder prevented symptoms of nonhospitalized Covid-19 patients from worsening compared to placebo, a small randomized controlled trial concludes, suggesting the drug’s immune-modulating effects could be further explored as a treatment for the disease.

The authors say their results, published Thursday in JAMA, fall short of demonstrating efficacy because the study was so small and looked at relatively few measures of illness. But experts say the idea merits further study in a larger group of patients.

Researchers from Washington University in St. Louis divided 152 patients diagnosed with Covid-19 in the previous seven days into two groups. Eighty were given fluvoxamine — a kind of antidepressant known as an SSRI that also has a strong effect on inflammation — and 72 patients got a placebo. After 15 days, none of the patients who got the drug saw symptoms deteriorate — defined as shortness of breath and lower oxygen saturation — but six of the patients on placebo did get worse. Four of them were hospitalized and one required a ventilator to breathe. That 8.3% deterioration rate in the placebo group is considered statistically significant.

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Nahid Bhadelia, an infectious disease physician at Boston University, would also like to see the preliminary data lead to larger trials and a better understanding of the possible biological mechanisms at work.

It seems like a lot of antiviral candidates have shown limited or early benefit only, which has really highlighted for me how much of severe disease is immune driven,” she told STAT. “An outpatient medication that is oral and reduces progression to disease would be a great addition to our arsenal.” 

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Antiviral monoclonal antibodies, such as Eli Lilly’s bamlanivimab, which received emergency use authorization this week, are IV medications. They may help, Bhadelia said, “but the infusion aspect makes it more cumbersome to make available to a large group of people. An oral candidate could help bridge access and equity issues if larger trials show efficacy.”

Previous studies have shown that fluvoxamine dampens the inflammatory response during sepsis, an overwhelming infection. The drug stimulates an immune receptor that controls how much cytokine is produced. “Cytokine storms” have been blamed for triggering severe cases of Covid-19, as part of an overreactive immune response worse than the coronavirus it seeks to destroy, although recent research has cast a shadow on that interpretation. The new study’s authors cite a recent report, for example, that found lower levels of cytokines in patients with severe Covid-19 versus patients with bacterial sepsis.

Their fluvoxamine study was conducted remotely, with the drug or placebo and other supplies delivered to patients’ homes, including thermometers and devices to check their blood pressure and oxygen saturation. Patients reported their oxygen saturation, vital signs, whether they took their medications, and how their Covid-19 symptoms felt by phone or internet.

In each group, about 70% were white, about one-quarter were Black, and the other people were Asian or their race was unknown.

Eric Topol, director of the Scripps Research Translational Institute, called the study an interesting one looking at a drug that hasn’t received much attention, a putative immune response modulator.

“The good part is that it was tested for early illness, for which we have nothing except potentially monoclonal antibodies,” he told STAT. “The encouraging results are countered by multiple limitations (as the authors appropriately acknowledged) so I’d say it is now a candidate drug intervention seeking a real, larger, rigorous randomized trial.”

Steven Nissen, a cardiologist at the Cleveland Clinic, said he is “moderately skeptical” of the small study with self-reported outcomes, underscoring the limitations listed in the study itself. “It is statistically fragile. Extremely fragile,” he told STAT.

 

Q&A: Obsessive-compulsive disorder, what it is — and is not

A: OCD is an anxiety disorder consisting of a cycle of intrusive, unwanted obsessions, recurring thoughts, ideas, or impulses, and subsequent compulsions, strategies or rituals used to lower distress brought on by the obsessions. Rituals to reduce distress include overt behavior such as repetitive washing, covert behaviors such as seeking reassurance, or mental acts such as replaying events or repeating words to one’s self.

Q&A: Obsessive compulsive disorder, what it is — and is not

A: OCD is an anxiety disorder consisting of a cycle of intrusive, unwanted obsessions, recurring thoughts, ideas, or impulses; and subsequent compulsions, strategies or rituals used to lower distress brought on by the obsessions. Rituals to reduce distress include overt behavior such as repetitive washing, covert behaviors such as seeking reassurance, or mental acts such as replaying events or repeating words to one’s self.

Q&A: Obsessive compulsive disorder, what it is – and is not

A: OCD is an anxiety disorder consisting of a cycle of intrusive, unwanted obsessions, recurring thoughts, ideas, or impulses; and subsequent compulsions, strategies or rituals used to lower distress brought on by the obsessions. Rituals to reduce distress include overt behavior such as repetitive washing, covert behaviors such as seeking reassurance, or mental acts such as replaying events or repeating words to one’s self.

Patients with Depression, Anxiety, and Bulimia at Heightened Risk of Unhealthy Drinking and Associated Health Issues

Newswise — People experiencing depression, anxiety disorder, or bulimia are at heightened risk of unhealthy drinking, according to a new study involving more than two million patients. Unhealthy drinking is known to frequently co-occur with behavioral health conditions, potentially impeding disease management and leading to more serious problems such as alcohol use disorder (AUD) and chronic medical issues. Although one in four US adults drink beyond recommended limits, little is known about the relationship between particular psychiatric diagnoses and varying levels of alcohol consumption. The study in Alcoholism: Clinical Experimental Research aimed to change that.

The National Institute of Alcoholism and Alcohol Abuse (NIAAA) recommends that men aged 18–64 not exceed four drinks a day or 14 drinks per week; men 65+ and women should not exceed three drinks a day or seven per week. Investigators used data representing more than 2,720,000 primary care patients who were screened in Kaiser Permanente Northern California for alcohol use beyond those limits between 2014 and 2017. The researchers identified patients who had any of eight psychiatric diagnoses in the past year — depression, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa — and compared their self-reported alcohol use over the previous three months to that of patients without those diagnoses. They categorized alcohol consumption levels as no reported use, low-risk use (within NIAAA limits), and unhealthy use (beyond those limits). Unhealthy use was further differentiated into exceeding only daily limits, only weekly limits, or both limits — drinking patterns that are associated with varying health risks. The researchers used statistical analysis to explore associations at a single point in time between demographic and health characteristics and reported alcohol consumption.

Patients with psychiatric diagnoses were less likely than those without such conditions to say they used alcohol. Among those who reported drinking, however, mental health conditions and unhealthy alcohol consumption commonly co-occurred. Most strikingly, patients with anxiety disorder, bulimia nervosa, or depression were more likely than others to report exceeding daily and weekly alcohol limits. Patients diagnosed with both anxiety and depression were also more likely to report drinking beyond weekly limits. People with schizophrenia and schizoaffective disorder were particularly likely to report not drinking, suggesting that they may avoid alcohol as a means of self-care. These two conditions, along with anorexia nervosa and bipolar disorder, were not linked to unhealthy alcohol use in this study (the research on these associations is mixed). Overall, men, younger people (18–34), and smokers were more likely to report exceeding daily drinking guidelines, and both daily and weekly limits. Women, people aged 65+, and those with chronic medical conditions were more likely to report exceeding weekly limits.

The researchers recommend that health care systems and clinicians tailor and target alcohol use screening, assessment, and intervention for patients with depression, anxiety, and bulimia. This could potentially help them limit their drinking, manage their behavioral health conditions, and prevent additional health problems.

Associations between psychiatric disorders and alcohol consumption levels in an adult primary care population. V. Palzes, S. Parthasarathy, F. Chi, A. Kline-Simon, Y. Lu, C. Weisner, T. Ross, J. Elson, S. Sterling (pp xxx).

ACER-20-4419.R1

Can Cannabis Treat OCD?


Obsessive Compulsive Disorder (OCD) impacts millions of people in the United States. The mental health disorder occurs when people find themselves in an endless cycle of obsessive thoughts and compulsive actions.

Cannabis may emerge as a treatment to help break that cycle. A new study from the University of Washington, published in the Journal of Affective Disorders, found that those who smoked weed saw a reduction in the symptoms common for those who suffer from OCD.

“Inhaled cannabis appears to have short-term beneficial effects on symptoms of OCD,” the researchers wrote. However, researchers noted that they need to also study long-term use as it might lead to a buildup of tolerance to the beneficial effects of cannabis.

Other studies have found similar results when it comes to marijuana and anxiety. And the public certainly made its opinion known by increasing the use of cannabis to deal with anxiety during the coronavirus pandemic.

Related: Dabbing in the USA: Was Miley Cyrus Hallucinating, Or Did She See A UFO?

Details of the study

To understand the impact of cannabis, researchers worked with 87 medical marijuana patients who self-identified as having OCD. The study involved a whopping 1,810 cannabis sessions over 31 months. 

Researchers reported the following results.

  • Patients reported a 60 percent reduction in compulsions.
  • They claimed a 49 percent reduction in intrusions (unwanted thoughts).
  • They also saw a 52 percent reduction in anxiety from the time before and after smoking cannabis.

They also found that higher concentrations of cannabis led to a larger reduction. The number of cannabis use sessions across time also led to a smaller reduction in intrusions – in other words, as the study went on, cannabis became a little less effective.

Related: THCA And THC: What’s The Difference?

While not a great deal of research has been done in this area, some earlier studies support the findings from the University of Washington researchers.

For example, researchers from Columbia University published a review of Cannabis and Cannabinoid Research studies that focused on studies that show the endocannabinoid system plays a role in regulating anxiety, fear, and repetitive behavior. They also noted that OCD patients have reported that cannabis helps with their OCD.

“Taken together, these findings suggest that the endocannabinoid system could be a potential target for novel medications for OCD,” the researchers wrote. They added, “Although preliminary, the available clinical data indicates that cannabinoids influence OCD-relevant processes, impacting anxiety symptoms, enhancing fear extinction, and reducing certain repetitive behaviors.”

A study recently published in Frontiers in Psychology also found evidence that the cannabinoid system is involved in the pathophysiology of OCD. They also noted that cannabis provides so many benefits that it’s hard to know if it directly impacts OCD or other factors contributing to the issue.

They wrote, “It also cannot be ruled out that treatment with medicinal cannabis only indirectly influenced OCD symptoms by reducing stress or improving other symptoms such as anxiety, depression, or sleeping problems.”

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