OCD in Kids is Difficult to Diagnose

Childhood OCD is a Difficult Diagnosis Obsessive-compulsive disorder (OCD) is an anxiety disorder often characterized by unwanted thoughts or repetitive behaviors. In children, OCD is difficult to diagnose and a definitive diagnosis is often delayed.

A new German study discusses diagnostic and treatment challenges of OCD, in the journal Deutsches Ärzteblatt International. In the article, Susanne Walitza, M.D., and colleagues point out that appropriate early recognition and treatment can positively affect the course of the disease.

Walitza discovered that compulsive washing, the most common obsessive-compulsive manifestation among children and adolescents, is present in up to 87 percent of all patients.

Children may also demonstrate compulsive repetitive behavior and checking, and obsessive thoughts of an aggressive type.

Attention deficit hyperactivity disorder is present in more than 70 percent of patients. Obsessive-compulsive disorder presenting in childhood or adolescence often becomes chronic and impairs mental health onward into adulthood.

Researchers believe the specific manifestations of obsessive-compulsive disorder can be diagnosed early with psychodiagnostic testing.

Behavioral therapy, although time-consuming, has been found effective and is considered a first-line treatment. In behavioral therapy, the patient is confronted with the situation that precipitates the obsessive-compulsive manifestations, while suppressing the manifestations.

Second-line treatment consists of behavioral therapeutic intervention combined with drug therapy.

Despite intensive treatment, the pervasive nature of the disorder often means that patients will need ongoing psychotherapy or combination therapy to prevent a later recurrence.

Experts believe much is still to be learned about the disorder. Currently, researchers believe the disorder stems from a complex, multifactorial combination of psychological, neurobiological, and genetic factors.

Source: Deutsches Aerzteblatt International



<!– Related News Articles
–>
<!– Related Clinical Articles
–>


jQuery(‘.nrelate_default’).removeClass(‘nrelate_default’);

 

 

<!–

ADHD, Advocacy and Policy, Anxiety, Children and Teens, General, Health-related, LifeHelper, Medications, Memory and Perception, Mental Health and Wellness, OCD, Parenting, Professional, Psychology, Psychotherapy, Research, Stress, Students

–>

‘My house is my safe zone’

ST. CATHARINES – 

She thinks I look awkward, like I don’t know what to do at her door. She gets that a lot. People wondering, “Should I shake her hand? Should I not?”

She’s used to it. She extends her hand towards me first. A firm, warm shake with a smile to match.

I step into her house, remove my shoes and walk into her living room. I have socks on. She notices all this. Acutely, uncontrollably, compulsively aware. She makes me a cup of coffee. Hands me a mug. We start talking.

Ashley Berry, 27, has lived with Obsessive Compulsive Disorder since she was about nine years old. She’s been hospitalized twice.

She wants people to understand it. To understand her.

“It’s not just a germ thing,” she offers straight up, smiling.

We talk more. She is candid, eager to explain. She started therapy four years ago and is doing better.

Yet, she is still at its mercy.

“My house is my safe zone,” she tells me.

If I would have walked on her floor with shoes on, or bare feet, she would have panicked. Footprints are like wet paint, she explains. They get smeared by other people walking over them, and contaminate the entire house. Bare feet, mean warts, mean disinfecting her floors with vinegar.

The coffee mug I use is not hers. She has her own that no one else touches.

I leave it on the living room floor and she has a hard time picking it up after I’m gone. There is coffee inside. And it’s lukewarm — prime breeding ground for bacteria.

She manages to pick it up. “I already felt contaminated,” she says. She had prepared herself to have a “dirty day” anyway. She doesn’t know me, or the state of my own house, and I am in her space.

She throws out the coffee and puts the cup in the dishwasher. She hasn’t touched it since.

“I won’t use it again until it feels right,” she says. Maybe in a couple of months.

She washes her hands. Since shaking my hand, she’s been careful not to touch her hands to her face. Then, awhile later, she showers with hot water.

She’s allowed one shower a day. She planned for my visit by having a shower the night before. She knew she couldn’t have one in the morning, because she’d need one after I left.

People often say things to her like: “Oh, I have OCD too. I love it when my house is clean.”

There is no comparison. None.

“You may like a clean house,” she says.

“I can’t get it out of my mind that my house isn’t clean.”

cheryl.clock@sunmedia.ca

Ashley’s List of Fears:

• Only shower once a day (20 anxiety)

• Only wash body parts once while in the shower (20 anxiety)

• Only clean washroom once a week (20 anxiety)

• Not showering for a full day (30 anxiety)

• No showering for 30 minutes after going to the gym (40 anxiety)

• Walk with socks down the hallway at the hospital (50 anxiety)

• Walk down the same hallway without socks (60 anxiety)

• Be around someone who has been in contact with a wart (70 anxiety)

• Be around someone with a wart (80 anxiety)

• Touch a wart and wash hands (90 anxiety)

• Touch a wart without washing hands (100 anxiety)

• Swim in a public pool without swim shoes (100)

Ashley’s recovery began in 2008 when she started seeing a psychiatrist at the Anxiety Treatment and Research Centre, at St. Joseph’s Hospital in Hamilton.

Part of her healing involved facing her worst fears. In her words, “a calculated form of torture.” Planned exposures to events that make her live in fear until her anxiety drops by half.

She is writing a book about her experiences. It’s full of raw, honest anecdotes. Warts are her biggest fear. She’d rather have cancer than warts.

She writes about her first appointment with her psychiatrist, a woman she calls Dr. X.

She took me into her office and told me to take a seat. There were two chairs in her tiny office; it took me a minute to decide on which chair I would sit in, and which chair would occupy my ‘clean’ purse. I hated putting my purse on the ground, as the bottom would get contaminated and eventually end up in my room. The contamination would spread from my purse to my floor to my socks to my bed sheets to my raw skin. Purse on floor now meant panic attack later. So I often kept it above my waist. When I try and explain contamination fears to people I often tell them to think of it like never-ending wet paint. Watch it’ tracks and you’ll see what I see.

Therapy began by developing a list of her worst fears, rating them out of 100. Showering was the first to be tackled.

At this point in my life I was showering 2-4 times per day. I had shower rituals that would take up to 45 minutes each time. I cleaned the washroom every other day with a bucket of pure bleach, with a new clean pair of latex gloves every day. I would use a different towel every time I showered, and was careful not to touch my feet to the tiled floor when exiting. We had two rugs in the washroom that I allowed myself to step on with bare feet. I changed my socks 5 times a day, depending on if I was out in public it would be more. I kept an extra pair in my purse just in case of emergency. Most people keep money for an emergency, I choose socks.

She kept her showers to 10 minutes, once a day, with lukewarm water. She whittled them down to seven minutes.

She felt confident. Empowered. Enthused to tackle more fears.

Then came her third session. When Dr. X announced she had to be “completely honest,” Ashley’s thoughts exploded.

“Oh no, do you have a wart?” My heart was racing. If she had a wart that means that her whole office would be contaminated. I would have to burn my clothes, and all of the other clothes that I’ve worn here, I need to make a list and burn them all. I can buy new clothes, but I can’t come back here. I can’t believe she has a wart. How did I get stuck with a psychiatrist who happens to have a wart. Only 10% of people have a wart at this moment in time, how am I with someone who is in that percentile? She interrupted me with her confession.

Dr. X confessed that her daughter had a wart on her foot.

Ashely had a wart, once. It took her a year to get rid of it. A year that consumed 2-4 hours of her life every night. Exhaustive, self-imposed rituals involving multiple latex gloves and handwashing in red-hot water. If she didn’t execute it precisely, she’d start again.

“It’s not about the pain,” she says. “It’s about the ritual, the exhaustion.”

Immediately after her doctor’s confession, Ashley was engulfed in a full-blown panic attack. She felt like she was going to die. Racing heart. Watery eyes. Red hot. Burning up inside. Short, gulps of breath. Drenched in sweat. The room was spinning.

No one can touch her. During an attack, a hug is abrasive and painful. She is not ashamed; she just needs time.

Dr. X helped her breathe and relax. Ashley felt like she’d run a marathon and was driven home, exhausted.

I was contaminated. I took an hour shower when I arrived home. Scalding hot, including all my rituals. Hair washed first, then face, scrubbed from shoulders to toes, repeat twice. When I got out of the shower, my body was red, burned, and hot to the touch. I was finally clean. A stage that would last for only seconds, but I cherished these tiny moments, as they were few and far between.

Over many weeks, Ashley completed exposure therapy. She walked in her socks, then in her bare feet, down the hospital hallway. She walked barefoot on the deck of an indoor pool. Swam without water shoes, bare feet touching the shiny, wet ladder on the way down.

The air was warm and humid, and it smelled blissfully like ‘clean’ chlorine. There were other swimmers, just two in the far right corner of the pool. I stood on one tile, feet together and belly breathing. I wasn’t sure if I was ready. The girl in the corner got out of the pool and was trying to dive back in. I noticed that she was handicapped, and her father was teaching her how to swim. Her illness was so clear to the world. Mine was hiding. I sometime wish that I could wear a bracelet or some sort of insignia that people knew I had a mental disorder. It would free me from all of the worrying about what people actually thought of me when I was freaking out in the middle of a panic attack. The girl dove in as her father caught her just in time. We were a lot alike, me and this girl. She also needed her father to help her as much as I needed my mother there to encourage me. I smiled as she came out of the pool to attempt another dive. If she could do that, I could certainly do this. I took another step onto another tile and waited for my anxiety to drop. There were metal steps leading into the pool that I was instructed from Dr. X to go down. Silver, shiny and wet, the three words that I could certainly do without.

 

People in Business for Sunday, Nov. 25

Union Bank promotes Nelson and Moritz


Union Bank Trust has promoted Chad Nelson to vice president-manager in greater Nebraska and Amanda Moritz to officer-branch manager in Grand Island.

Nelson has been with the bank for 10 years and began his career as branch manager of the Fairbury branch. He transferred to Grand Island as branch manager in 2009.

With his promotion, Nelson will oversee and lead the retail and lending aspects of Union Bank’s 12 locations across greater Nebraska. Nelson earned a bachelor of science in business administration from Doane College in Crete.

Moritz has been with the bank for 11 years and was a branch supervisor and consumer loan specialist in Lincoln before transferring to Grand Island as branch supervisor in 2009. With her promotion, Moritz will be responsible for staff management and fostering a culture of customer service, as well as business development, mortgage, consumer and commercial lending.

Moritz attended Nebraska Wesleyan University in Lincoln. She serves on the board for the Boys and Girls Club of Central Nebraska and is a member of the Grand Island Area Chamber of Commerce Young Professionals Group.

Grand Island law firm hires Malm, Hruza

Tim Malm has joined the Leininger, Smith, Johnson, Baack, Placzek Allen law firm in Grand Island.

He received a bachelor of arts from the University of Nebraska at Omaha in 2009, double majoring in history and political science. He graduated cum laude from the University of Illinois with his juris doctorate in 2012.

Malm is admitted to practice in Nebraska and U.S. District Court, District of Nebraska. He is a member of the Nebraska Bar Association. He sits on the board of the Central Plains Chapter of the American Red Cross. A Plattsmouth native, Malm and his wife, Kasey, moved to Grand Island in June.

Tim Hruza has joined the Leininger, Smith, Johnson, Baack, Placzek Allen law firm as an associate attorney.

He graduated from the University of Nebraska at Kearney in 2009, receiving a dual degree in political science and economics cum laude. Hruza was involved in both the honors program and student government at UNK, serving as the student body president and student regent during his senior year.

Hruza received his law degree from the University of Nebraska-Lincoln in May, graduating with distinction. He also received a certificate of concentrated study in the area of agricultural law, focusing heavily on water law issues and farm program compliance. While in law school, Hruza was a member of the Nebraska Moot Court Board and won awards for his performance in oral advocacy competition.

He grew up in Ord and is married to his wife, Rachel.

Bachman announced as managing broker

Woods Bros. Realty has named Max Bachman as the managing broker for the Grand Island office at 819 Diers Ave.

Bachman has a bachelor of arts in business administration from the University of Nebraska-Lincoln. He received his real estate sales license in 1992 and his broker’s license in 2005. Bachman has been associated with Woods Bros. Realty since 2000.

Bachman, a lifelong Grand Island resident, has been married to his wife, Melanie, for 30 years. They have two children.

Bachman can be reached at 380-1983 or Max.Bachman@WoodsBros.com.

Grand Island downtown announces new director

The Grand Island Downtown Business Association has named Tami Brunk as its new director, effective Nov. 1.

Brunk has more than 22 years of property management experience working for Costello Property Management in government housing as its Nebraska regional manager. She received Manager of the Year from U.S. Department of Agriculture Rural Development in 1999.

She is also a general notary public.

Brunk and her husband, Dr. Douglas Brunk, own Equine Veterinary Associates in Grand Island.

She can be reached at 404 W. Third St. from 8 a.m. to 2 p.m. Mondays through Fridays, 398-7022 or director@downtowngi.com.

New case manager joins Hope Harbor

Beth Rhodes has been hired at Hope Harbor as self-sufficiency case manager.

The new self-sufficiency program will fill gaps for those who successfully leave Hope Harbor by continuing to offer support in their quest for self-sufficiency.

Rhodes will assist with building and maintaining community support, help locate safe and affordable housing and provide in-home case management and financial education. She recently moved to Grand Island from California.

AseraCare Hospice adds Gunderson to staff

AseraCare Hospice in Grand Island has hired Phyllis Gunderson as an advanced practice registered nurse.

She will be responsible for face-to-face assessments to certify hospice eligibility.

Gunderson attended the University of Nebraska Medical Center through the University of Nebraska at Kearney to become a registered nurse, earn her bachelor of skilled nursing and become an advanced practice registered nurse.

She has also worked with Department of Veterans Affairs and is a member of the Nebraska Nurses Association.

New stylist seeing clients at Fringe salon

Molly Clark has joined the stylist team at Fringe in Grand Island.

She has been a stylist at Great Expectations in Omaha, J.C. Penney Salon in Kearney, DeAnna’s in Kansas City and E.J. Bain in Kansas City. She graduated from Bahner College of Hairstyling in 2000.

Clark is an advocate for Freedom Stylist, a branch for the nonprofit organization Rapha House, which educates and trains at-risk young women in communities where they are in danger of being sold into slavery or exploited. A portion of each salon service is donated to Rapha House through the Freedom Stylist program.

Originally from Doniphan, she and her husband have three sons and one daughter.

Fringe is at 3406 W. Capital Ave. Suite 2. For appointments, call (308) 258-3758.

McElroy wins Health Care Social Work Leader of Year

St. Francis Medical Center Social Work Director Cris McElroy was recognized as the Health Care Social Work Leader of the Year on Oct. 18 in Lincoln at the Nebraska Hospital Association convention.

Established in 2000, the award recognizes an exceptional chapter member of the Nebraska Society for Social Work Leadership in Health Care.

The award recognizes a social work leader from any of the health care settings in which social work is influential and honors a social work leader in health care who develops and implements creative and innovative ways to improve the delivery of social work services.

Schwan attends training on EEG neurofeedback

Joan Schwan, a licensed mental health practitioner and owner of Joan Schwan Counseling Services in Grand Island, attended a two-day intensive mentoring program with neuroscientist Dr. Mike Cohen on Nov. 10 and 11 in Jupiter, Fla.

The training focused on new brain research affecting mental health protocols for treatment, as well as skills to enhance reading electroencephalography (EEG) brain waves, brain mapping and EEG neurofeedback.

EEG neurofeedback can be used to treat attention deficit hyperactivity disorder, anxiety, depression, obsessive compulsive disorder, autistic spectrum, sleep disorders and other issues. It can also be used to enhance peak performance training.

Research conducted by the psychiatry department at the University of Western Ontario has shown neurofeedback as a “safe, inexpensive and accessible tool for modulating brain function in health and disease.”

Schwan can be reached for questions or appointments at 381-7010.

Hutchinson receives national NAIFA Quality Award

Michael C. Hutchinson, an agent for New York Life Insurance Co. and financial adviser with Eagle Strategies, a registered investment adviser in Grand Island, has received the NAIFA Quality Award from the National Association of Insurance and Financial Advisers for 2012.

The award recognizes professionalism through education and earned designations, production, adherence to the NAIFA code of ethics and service to the association.

Hutchinson serves individuals, families and businesses in Grand Island, Kearney and the surrounding communities. His office is at 1213 Allen Drive in Grand Island, and he can be reached at 382-0619.

Seven nominated for March of Dimes award

Seven nurses from St. Francis Medical Center were nominated for the March of Dimes Excellence in Nursing Award.

They included Amy Djernes, Pam Glaser, Mary Micek (retired from St. Francis), Alice Quick, Linda Ulmer, Maxine Vieth and Sue Whitman. Quick and Vieth were among 25 recipients of an award given for clinical excellence.

St. Francis Vice President of Patient Care Servicers/CNO Francine Sparby congratulated the seven nurses on their accomplishment.

Bullied, Institutionalized for Tourettes

From the age of 7, Frank Bonifas has endured the most severe form of Tourette syndrome, and it started long before the medical community even had a name for the neurological disorder.

Doctors convinced his parents that he could control his tics and outbursts, which had him grunting, jerking and swearing with impunity. They blamed his mother for coddling him and, in 1968, as a young teen, they sent him to a psychiatric hospital for 18 months.

Bonifas, now 58 and living in Coldwater, Ohio, experienced assaults by school bullies and was forced to take high-dose medications that made him so listless one year, he lost two months of school.

Even in hospital wards, he was tortured by staff members who thought his outbursts were deliberate. He even had to fight with Social Security to get disability payments because Tourette syndrome was not listed in the medical journals.

“I resented all psychiatrists, psychologists and social workers,” he said. “They had no idea what was wrong with me and blamed me, my mom, dad and sister for my problems.”

Now, in a self-published memoir, “Fu-Fu-Fu Frank,” he writes about his wrenching childhood and the determination he had to overcome the odds of living with a misunderstood disorder.

Bonifas prefaced his Thanksgiving day telephone interview with ABCNews.com in anticipation of his uncontrollable use of the “F word,” punctuated with grunts and screams.

“I am not a violent person,” he said. “I am a loving person who just has Tourette’s.”

Despite severe physical handicaps, Bonifas was able to write the book because of Marilyn Kanney, a former nurse and friend of his late mother who has loved and supported him since he was in high school. He calls her “a second mother.”

“She took my thoughts and put them into sentences and wrote them into paragraphs and chapters,” he said. “They were all my words, but she allowed me to make it a reality … It took us 15 years to finish it.”

Bonifas decided to go public with his story after friends encouraged him to write. His first goal was to educate others about Tourette syndrome. But the second was to be financially independent and get off disability assistance and Medicaid.

The turning point in his life was in 1973, when a husband-wife psychiatric team, Drs. Arthur and Elaine Shapiro of New York Hospital, gave his condition a name.

At 18, Bonifas was one of the first people in the United States to be diagnosed with Tourette syndrome.

“I taught my doctor everything he knows about Tourette,” said Bonifas. “Dr. Shapiro said to me at the time, ‘Frank, to your credit, you haven’t blown your brains out by now.

“I put my trust in doctors and nurses for the first time in my life,” he said.

According to the Tourette Syndrome Foundation, the disorder is defined by multiple motor and vocal tics lasting for more than one year. The verbal tics can include grunting, throat clearing, shouting and barking.

It was named for a French neuropsychiatrist, Gilles de la Tourette, who assessed the disorder in the late 1800s. But it wasn’t until the 1970s that it was widely recognized in the U.S., where it was thought to be exceptionally rare.

In 1980, the condition was broadened to include milder cases of tics. Fewer than 10 percent of all patients swear or use socially inappropriate words, which makes Bonifas’s condition so socially isolating.

The first symptoms, usually before the age of 18, are involuntary movements of the face, arms, limbs or trunk, such as kicking or stomping. They are frequent, repetitive and rapid. The patient cannot control these movements and they can involve the whole body.

ADD and OCD Can Accompany Tourette Syndrome

According to Dr. Jonathan Mink, chief of pediatric neurology at Rochester University, who sits on the board of the Tourette association, the disorder is still poorly understood and likely has a genetic link.

Many patients, like Bonifas, also have symptoms associated with attention deficit hyperactivity disorder and obsessive compulsive disorder.

“The majority of kids, even those bad enough to seek treatment, are likely to have their tics diminish or go away,” said Mink.

Habit reversal therapy — teaching a person with Tourette to hold his or her breath, for example, instead of saying the repeated word, can sometimes help. Antidepressants are used to treat associated anxiety.

Today, several medications have helped Bonifas manage his symptoms, but his early years were spent in torment, in and out of mental institutions, hospitals and experimental programs.

In the introduction to his memoir, doctors attest to the “exorcisms” that Bonifas underwent to rid him of his “demons.” He claims he was exploited and abused, even sexually, by many who were entrusted to care for him.

A devote Catholic and former altar boy, Bonifas once considered entering the seminary. Strangely, his first outburst of profanity occurred in the seventh grade when looking at a church spire.

The thought — “The Blessed Virgin Is a F***er” — just burst into his mind. He was convinced he would burn in hell.

But Bonifas had no control over that or other obsessive-compulsive habits, such as dressing, washing and brushing his teeth in a particular sequence.

His behavior in school was problematic, too. Teachers saw his outbursts as an attention-seeking device. He was “barking, snorting, sniffing, hissing and more.”

By high school, he was badly bullied. Seniors pulled down his pants, taunting: “Now we’ll see if he is a dog or a human being.”

Another time, he was pushed into a large garbage can and rolled down the steps to the first floor.

After being sent to a local hospital ward for treatment, he got “special care” more than a half dozen times. Orderlies confined Bonifas to a locked steel cell with a pillow and a pad. After that, he developed lifelong claustrophobia.

In exercise classes in a swimming pool, he claimed the leader seemed to enjoy dunking his head underwater until his lungs “nearly burst.”

But eventually, Bonifas found New York Hospital, where modern treatments and an educated and understanding medical team, gave him hope. He was the 35th patient Dr. Shapiro had ever treated.

His roommate was Dr. Orrin Palmer, a Maryland doctor who overcame Tourette and now practices psychiatry.

“Frank and I went through hell on these protocols,” Palmer wrote in one of the forwards in the book.

Doctors experimented with an array of high-dose medicines that caused side effects, such as insomnia, motor restlessness, mood swings and even Parkinson’s symptoms.

“I had to sign papers that I was a guinea pig,” said Bonifas. “If the medicine made me incompetent or I lost my mind or was comatose or died, they were not responsible.”

His response to his doctor’s orders was, “Just tell my small town that I am not the devil, not doing this on purpose and that I have a mind.”

After five months, his mother brought him home and things started to get better. Were it not for her, “they would have institutionalized me for life,” he said.

Today, Bonifas works as a part-time mail clerk at a local bank. He said life is still “incredibly difficult.”

But since the publishing his book, he said, “Many people have a better understanding of what I go through on a daily basis, and I have been treated much better.”

He takes a low dose of haldol, ativan, cogentin and many natural vitamins. Bonifas also has taken up yoga with a trainer.

Bonifas cares for his 88-year-old father who lives upstairs. His beloved mother died of Alzheimer’s disease in 2004.

“I just wish she were alive to read it, but my faith tells me that she is in Heaven and is proud of everything I’m trying to accomplish,” he said.

More recently, cultural attitudes toward those with Tourette syndrome have begun to change, according to Bonifas.

“Most people who have become familiar with it are more understanding,” he said. “However, many are not aware of how serious the disease is, still feel that anyone afflicted with it should be able to control all of its symptoms.”

Much still needs to be done, according to Bonifas.

“Parents and teachers can be more supportive and understanding of people who are different,” he said. “Children learn at a very early age how to treat others, and there are too many bullies today as a result of the prejudices of all who teach them.”

Bonifas volunteers in schools and organizations to help change attitudes.

With all the hurdles he has overcome, the dark shadow of growing up in a world ignorant of his needs still haunts Bonifas.

“I have tried to put my past behind me, but every day is challenging and difficult,” he said. “I’m working on it.”

“I think that all people should accept those who are different or handicapped,” he said. “They should have to spend one day in their shoes, and see how it feels.

His faith and the encouragement he has received from readers of his memoir keep him going.

“It just comes down to this: There is you and God,” he said. “I have a lot of faith and a lot of determination.”

Also Read

OCD Brain Has Higher Activity When Dealing With A Moral Dilemma

Editor’s Choice
Academic Journal
Main Category: Psychology / Psychiatry
Also Included In: Anxiety / Stress
Article Date: 11 Nov 2012 – 0:00 PST

email to a friend   printer friendly   opinions  

<!– rate article

Patient / Public:

3.75 (4 votes)

Healthcare Prof:

5 (1 votes)

Morality problems cause much more worry for people with OCD (obsessive-compulsive disorder), compared to the general population, researchers from the Hospital de Mar, Barcelona, Spain, and the University of Melbourne reported in Archives of General Psychiatry.

The authors added that their findings prove that patients with OCD are much more morally sensitive than people without the disorder.

Obsessive-compulsive disorder is a chronic (long-term) condition in which the patient has persistent and repetitive thoughts and compulsive behaviors.

Co-lead authors, Carles Soriano, said:

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more.”

The scientists studied how the participants’ neurofunctional activity rose when faced with moral dilemmas with the use of fMRI (functional magnetic resonance imaging). They recruited 146 volunteers, 73 with OCD and 73 “healthy” individuals. They measured each person’s brain activity when faced with different moral questions – choices had to be made between two alternatives, neither of which led to positive consequences.

For example, they were presented with a classic in philosophy classes – The Crying Baby. The participants had to imagine they were in a war and enemy soldiers were lying in wait to attack. The whole village is hiding in a cellar. A baby starts crying. Unless the crying is stopped immediately, the solders will find the villagers. Smothering the baby’s crying would save the villagers, but would also risk suffocating the baby – would it be right to stop the crying in this way?

Soriano pointed out:

“The brain activations displayed by participants in the face of such a moral question were compared to those displayed for trivial choices, like choosing between going to the countryside or the beach for the weekend.

The authors found that during moments of moral dilemma, those with OCD had significantly more activity in the orbitofrontal cortex, especially in the medial part, which is associated with decision making processes and the development of moral sentiment.

The researchers wrote “The data allows us for the first time to objectify the existence of cerebral dysfunctions related to alterations in complex cognitions, such as experiencing morality. This allows us to expand further on the characterization of altered cerebral mechanisms in OCD.”

OCD and Anxiety compulsion

Obsessive-compulsive disorder is characterized by persistent thoughts (obsessions) that trigger worry and fear, as well as repetitive behaviors (compulsion) which are performed in an attempt to reduce associated anxiety. Approximately 2% of people are affected by OCD.

OCD patients are generally categorized into different types. “The majority are characterized by being obsessed with dirt and compulsive cleaning or by doubting that they have carried out important actions properly, like turning off the gas. Such behavior makes then repeatedly check whether they have performed such actions.”

Other obsessions and compulsions may include the need to be surrounded by perfectly symmetrical objects – patients may hoard them.

In some cases, patients may suffer from unwanted sexual or religious thoughts in which they are not sure whether they have committed an unacceptable sexual act, and wonder (worry) whether they have blasphemed. “This last group of patients is identified for precisely having a higher level of moral hypersensitivity.”

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

  • Additional
  • References
  • Citations

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘OCD Brain Has Higher Activity When Dealing With A Moral Dilemma’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

back to top | home |
privacy policy

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Disability insurance urged for dental hygienists

Identify Depression Among ‘Perfect’ Colleagues

BY CYNTHIA BIRON LEISECA, RDH, EMT, MA

The dental hygiene job market is saturated in some areas and soon to be saturated in more areas. There are fewer full-time positions, and the part-time positions usually have no health insurance benefits. For many, this means paying for their own health insurance, and what is affordable has a high deductible and probably little or no prescription coverage.

Dental hygienists who are not practicing are working odd jobs in unrelated fields or are simply unemployed. Some have given up on the profession entirely, and are becoming educated in other professions. The financial strain and frustration can lead to anxiety and situational depression, even in those people who have never before experienced depression.

This article is dedicated to a dental hygienist who practiced for over 25 years, and due to the recent scarcity of jobs, could find only a part-time position. She had no benefits and only catastrophic medical insurance because that’s all she could afford. She suffered from depression, and the only treatment that seemed to help was a “specialty drug” (medical insurance term for brand name top tier) she could not afford, and her insurance would not pay for it. She described her severe anxiety and emotional pain as “unbearable.” Sadly, she took her own life.

In order to protect her identity, details about her are not included in this article. The personality trait that was a contributing factor to her severe anxiety and depression was called elevated perfectionism. Another factor that contributed to her depression was stress.

The objectives of this article are to promote an awareness of these factors and their association with general anxiety disorder (GAD) and major depressive disorder (MDD); discuss how the combination of anxiety and depression increases the chances of suicidal ideation; and to promote awareness and suicide prevention.

ELEVATED PERFECTIONISM

Striving for excellence is a healthy goal, but when people have unrealistic expectations of themselves and others, they create unhappiness in themselves and their relationships. Continuously functioning in this self-deprecating manner often leads to severe anxiety and depression. With perfectionism of this magnitude, there is often procrastination due to fear of failure, or even difficulty with decision making, as the choice may result in failure.1

Adjustment to life changes that do not align with lofty pursuits can result in extreme anxiety and profound sadness. For the elevated perfectionist, coping with day-to-day life is a challenge, but when a traumatic event occurs, coping can become nonexistent.1

Research has shown that elevated perfectionism not only makes certain individuals vulnerable to depression; it also makes them vulnerable to a variety of anxiety disorders, eating disorders, and obsessive-compulsive disorders. Many psychotherapists now use assessment scales to diagnose and treat perfectionism to reduce anxiety, depression, and associated disorders.3

Here is a link to the free electronic Multidimensional Perfectionism Scale: http://www.bbc.co.uk/science/humanbody/mind/surveys/perfectionism/

HEALTH-CARE PROVIDERS MUST STRIVE FOR PERFECTION

The accuracy and attention to detail required of dental hygienists make perfectionists ideal candidates for the profession.4 Ask any dental hygiene instructor about their daily dealings with students, and they’ll tell you that many insist on getting an “A” in every class or on every clinical exam. Perhaps we’ve recruited many perfectionists into the profession. You may remember being in dental hygiene school and hearing your instructors say, “Dental hygiene is not an exact science. Therefore, we call it ‘practice’ because we never get it perfect!”

Unfortunately, that expression falls on deaf ears of people with elevated perfectionism. She or he is the one who becomes anxious at patient checkout for fear the dentist will discover some minor omission in the dental hygiene patient exam. Then one day that hygienist may find something the dentist missed in his or her patient exam, and hopefully the hygienist will learn that “Perfection is unattainable.”

FROM STRESS TO ANXIETY AND DEPRESSION

Fear of failure, or just plain trying to survive, when there is insufficient income for living expenses is a daunting situation. The uncertainty of survival and lack of adequate medical care can keep someone in fight or flight mode. This is anxiety on a continuous level, the type that causes insomnia and physical symptoms common to general anxiety disorder (GAD).

Anxiety disorders include:

  • Panic attacks — occur due to a sense of doom and lack of control.
  • Obsessive compulsive disorders — obsessive thoughts or repeated behaviors of checking, counting, or hoarding, often paired with eating disorders, over-exercising, and a variety of routines that relieve anxiety.
  • Posttraumatic stress disorder — anxiety and depression that occur within three months of a traumatic incident. Flashbacks replay the trauma as if it were occurring again.5

The following link includes a free anxiety assessment scale: Taylor Manifest Anxiety Scale (http://personality-testing.info/tests/TMA.php).

Major Depressive Disorder (MDD)

Major depressive disorder includes a variety of depressions that may or may not include all of the symptoms in the syndrome of generalized depression:

  • Inability to function
  • Inability to concentrate
  • Fatigue
  • Lack of energy
  • Feeling immobilized
  • Sleeping too much
  • Insomnia or sleep disturbance
  • Loss of interest in daily activities
  • Loss of interest in sex
  • Overeating or lack of appetite
  • Nervousness and agitation
  • Persistent sadness, crying
  • Anxiety and hopelessness
  • Guilt and worthlessness
  • Thoughts of death or suicide

Physical symptoms such as headaches, pain, and gastrointestinal disturbances that become chronic and resist treatment are often associated with major depression.6

Comorbid Anxiety and Depression

Current reviews of the literature show evidence of high risk of suicide in people with a combination of anxiety and depression.7 The largest percentage of people presenting with this combination are middle-aged women.8 There is an overlap in the symptoms of the two disorders, making it difficult to discern whether the anxiety is a symptom of the depression, or a separate disease entity that will not be relieved by antidepressants.

Comorbid anxiety and depression often require a combination of antidepressants such as selective serotonin reuptake inhibitors (SSRIs), or selective serotonin-norepinephrine inhibitors (SNRIs) and antianxiety drugs such as benzodiazepines. Examples of common antidepressants are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and desvenlafaxine (Pristiq). Common antianxiety drugs are alprazolam (Xanax), diazepam (Valium), and clonazepam (Klonopin). If the patient’s condition still resists treatment, antidepressant augmentation with aripiprazole (Abilify) has shown complete remission in some patients with comorbid anxiety and depression, and pramipexole (Mirapex, Mirapexin, Sifrol) has shown complete remission in some patients with depression not combined with anxiety.9,10,11,12

Patients may not be diagnosed with comorbid anxiety and depression, but may be treated on symptoms. Most antidepressants do not relieve every symptom on the MDD list.13 The physician may treat various symptoms with additional drugs, e.g., benzodiazepines for anxiety, sedative-hypnotics for insomnia, and proton pump inhibitors for acid reflux. A patient may be on an array of medications for various symptoms and still not be in complete remission from depression. Could the profile of comorbid anxiety and depression be masked by the regimen? Does failure to diagnose comorbid anxiety and depression present a greater risk for suicide ideation? More research is needed to answer these questions.

Comorbid anxiety and depression require a multimodal therapy carefully planned by the physician who has conducted a comprehensive evaluation of the patient using all assessment scales and diagnostic methods to arrive at the accurate diagnosis. Psychotherapy as well as pharmacotherapy must be included in the treatment plan.13

Suicide Awareness

Not everyone exhibits classic signs of depression or suicidal ideation. If they did, more lives would be spared. But if someone you know is depressed, it’s a good idea to ask that person if he or she is having thoughts of suicide. Suicide websites and training kits contain information stating that asking does not provoke someone who is not suicidal into becoming suicidal, and asking may be the key to getting someone to accept help.

NOW, you the reader — Do you have thoughts of suicide? If you answered yes, call the National Suicide Prevention Lifeline 800-273-TALK (8255).

For a complete guide to suicide awareness, go to www.suicide.org/index.html.

Local hotlines are also helpful for those with suicide ideation. Here is the National Suicide Prevention hotline link for finding a center categorized by country or state — http://www.suicide.org/suicide-hotlines.html.

Our fallen colleague was an elevated perfectionist, but out of the darkness of her quest for perfection, there was a crack of bright light filled with her love for friends and animals. She was an excellent caregiver to others. One could say she truly served the greater good, except she lacked self-love. She was perfect in many of her accomplishments, but not in her pursuit of happiness.

She is greatly missed and loved by many.

From the lyrics of the song “Anthem” by Leonard Cohen:

Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in
.14RDH


Top 10 Signs Your a Perfectionist

  1. You cannot stop thinking about a mistake you made.
  2. You are intensely competitive and can’t stand doing worse than others.
  3. You either want to do something “just right” or not at all.
  4. You demand perfection from others.
  5. You will not ask for help if asking can be perceived as a flaw or weakness.
  6. You will persist at a task long after other people have quit.
  7. You are a fault-finder who must correct other people when they are wrong.
  8. You are highly aware of other people’s demands and expectations.
  9. You are very self-conscious about making mistakes in front of other people.
  10. You noticed the error in the title of this list3

Source: Gordon Flett, PhD

References

1. Flett GL, Stainton M, Hewitt PL, Sherry SB, Lay C. (in press) Procrastination automatic thoughts as a personality construct: An analysis of the Procrastinatory Cognitions Inventory. Journal of Rational-Emotive and Cognitive-Behavior Therapy.
2. Flett G. “York researcher finds that perfectionism can lead to imperfect health” York’s Daily Bulletin, York University, Toronto, Canada, June 2004.
3. Egan SJ, Wade TD, Shafran R. “Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. 2011 Mar; 31(2):203-12. Epub 2010 May 5. Source: School of Psychology and Speech Pathology Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia. s.egan@curtin.edu.au.
4. Henning K, Ey S, Shaw D. “Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students” Medical Education article first published online 4 Jan 2002 DOI: 10.1046/j.1365-2923.1998.00234.x.
5. Stein MB. Attending to anxiety disorders in primary care. J Clin Psychiatry 2003;64 (suppl 15):35-39.
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR) Washington DC, American Psychiatric Publishing, Inc. 2000.
7. Cyranowski JM, Schott LL, Kravitz HM, et al. Depress Anxiety. 2012 Aug 28. doi: 10.1002/da.21990. Psychosocial features associated with lifetime comorbidity of major depression and anxiety disorders among a community sample of midlife women: The Swan Mental Health Study. Source: Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
8. Joffe H, Chang Y, Dhaliwal S, et al. Arch Gen Psychiatry. 2012 May;69(5):484-92. Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes. Source: Department of Psychiatry, Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Simches Research Bldg, 185 Cambridge St, Ste 2000, Boston, MA 02114, USA.
9. Hori H, Kunugi H. The efficacy of pramipexole, a dopamine receptor agonist, as an adjunctive treatment in treatment-resistant depression: an open-label trial. ScientificWorldJournal. 2012;2012:372474. Epub 2012 Aug 1.
10. Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol. 2012 Aug 29:1-18.
11. Yoshimura R, Kishi T, Hori H, Ikenouchi-Sugita A, Katsuki A, Umene-Nakano W, Iwata N, Nakamura J. Comparison of the efficacy between paroxetine and sertraline augmented with aripiprazole in patients with refractory major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jul 17.
12. Maher AR, Theodore G. Summary of the comparative effectiveness review on off-label use of atypical antipsychotics. J Manag Care Pharm. 2012 Jun;18(5 Suppl B):1-20.
13. Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry. 2008;10(3):222-8.
14. Pychyl TA. Words of Healing for Perfectionists: Forget Your Perfect Offering. Psychology Today 2010 Nov 19.

CYNTHIA BIRON LEISECA is president of DH Methods of Education, Inc., Home of Boot Camp for Dental Hygiene Educators. She is also the producer of two DVDs, “Precision in Periodontal Instrumentation,” and “A Focus on Fulcrums.” Cynthia is the distributor of “The Sharpening Horse Kit,” www.DHmethEd.com.

More RDH Articles
Past RDH Issues

Rockets to meet with White about his anxiety disorder

The Houston Rockets will meet with rookie forward Royce White on Monday to work out issues regarding his anxiety disorder

Jamie Grace Is Holding On

Share

Jamie Grace Harper may be the world’s only musician with Tourette syndrome, ADHD, obsessive-compulsive disorder, echolalia, anxiety disorder—and a Grammy nod. Nominated for Best Contemporary Christian Music Song (for her breakout hit “Hold Me”), Harper, 20, attended February’s Grammy ceremony with her family; the rest of the year, she lives in Atlanta with her parents, James and Mona Harper, cofounders and pastors of Kingdom City Church.

Harper is open about her struggles with Tourette syndrome, which started when she was about 8 years old in the form of tics—involuntary movements and sounds—and an obsession to repeat certain behaviors and phrases. “It took our lives for a spin,” she says of the diagnosis. “I learned early on that Tourette’s is not life-threatening, but it is life-altering.”

Harper has been crazy busy since releasing her debut album, One Song at a Time, in September 2011. In addition to more than 100 shows, she’s been working on a new album, writing a novel, recording a Christmas song (with older sister Morgan) for a holiday project, speaking on the Revolve Tour (for teen girls), acting in a movie (Grace Unplugged, due in 2013), and, incredibly, graduating from college, with a degree in children’s ministry from Point University (formerly Atlanta Christian College). All before her 21st birthday.

Question Answer

Your Facebook page includes your phone number. Why?

It’s a public number anybody can call if they just want to say hey or leave a voice mail. A couple times a month I’ll reply to a few of them, and sometimes I’ll just answer it myself, and we’ll chat about life and stuff. It’s fun to connect with people.

Why is that important to you?

As a kid, I was always on message boards for my favorite singers. I once sent ZOEgirl a message about something I was struggling with, and when [they] replied, it was like the kindest thing ever. I just want to do the same thing.

How does Tourette syndrome affect you today?

Mostly I repeat things I hear, sometimes obscure and random things, over and over. Lately, I’ve been saying one line from a movie, The Master of Disguise. I’ll start saying, “I’m going to be the master of disguise,” and I don’t even realize it. My friends will say, “Jamie, you’re quoting The Master of Disguise again.” Sometimes you just have to laugh at yourself! But I’ve been able to train myself out of it a little bit. I’ll cover it up by singing it instead of saying it, or saying it under my breath. Or I’ll do something to distract myself, like play my drums or go for a run.

You became an overnight sensation when “Hold Me” exploded. How has sudden fame affected you?

It was a little overwhelming. “Hold Me” was just a very personal song between me and Jesus. I was thinking it was like the worst song ever; I didn’t even want it on the album! I’ve always prayed that God [could] use my story to touch other people, but I never thought he’d use that song. But my mom encouraged it—which just goes to show you that, one, moms know everything, and, two, God can take your dreams and do more than you can ever imagine.

More: JamieGrace.com

Hometown: Atlanta

Church: Kingdom City Church

Reading now: Books by Lisa Harper; The Hunger Games, by Suzanne Collins

On your iPod: Johnnyswim, Natalie Grant, Reba McEntire

Favorite movie: Princess Diaries 2

Favorite Bible verse: Psalm 30:5

Favorite website: YouTube

Your hero My parents

What makes you laugh? When 2-year-olds sing my songs

Best meal you cook? Ham, cheese, and spinach omelet

Richard Russo’s ‘Elsewhere’: unraveling the mystery of a troubled mother

‘Elsewhere: A Memoir’

by Richard Russo

Knopf, 243 pp., $25.95

Richard Russo has mined his childhood with enormous energy, humor and craftsmanship. He’s populated most of his stories and novels (one, “Empire Falls,” a Pulitzer Prize winner) with wonderfully believable characters found in fading mill towns nestled in upper New York State.

These towns, once vibrant, clattering, stinking centers where animal hides were turned into famously excellent gloves and other leather goods, were dying by the 1950s when Russo was growing up just north of the Adirondacks foothills. His hometown was Gloversville, in what was later labeled the Central Leatherstocking District — two names so simultaneously sad and absurd that Russo might have made them up . (A place proudly named after an extinct industry not once, but twice, is the sort of stuff Russo appreciates.)

It isn’t unusual for a novelist to tell her or his own story over and over, of course. Russo has been more transparently autobiographical and skilled than many of his peers. In fact, Russo has done such a good job of capturing his characters that “Elsewhere: A Memoir,” seems almost redundant. Or to put it another way, this book may have been written more for the author than for his longtime readers.

For Russo, the distinction between novel and memoir makes for an important journey. “My fictional hometowns are no better or worse than the real one. They’re just mine, mostly because I’m free to see them with my own eyes, whereas the real Gloversville I still see with my mother’s,” he writes.

Jean Russo was a fiercely independent woman who struggled with the many financial and social strikes against a single mother of her era, as well as what her son later discovers was obsessive-compulsive disorder. Her anxiety, odd rituals and rules, and periodic unhinged fury in which she would scream things like “Don’t I deserve a life?” in rhetorical hysteria, came to make posthumous sense as one of Russo’s daughters was successfully treated for OCD.

“From the time I was a boy I understood that my mother’s health, her well-being, was in my hands … My rock, as she was so fond of saying. My own experience, however, had yielded a different truth — that I could easily make things worse, but never better.”

He is likewise never free of his sense of duty. With the sort of painfully funny irony for which Russo is famous, even as his mother trumpets her independence, she is packing up to accompany him to college on the other side of the country. She never fully leaves. If half of what he writes about his mother’s later years is true, Russo’s wife, Barbara, should be canonized.

There is nothing wrong with memoir serving as a mature writer’s reflections on the effect of a demanding, complicated parent. One might even say that someone with Russo’s impressive bibliography of eight novels (and a successful career as a college English professor) has earned the right to work out childhood stuff, finally, without the protective tissue of fiction.

Yet at the same time, it seems to me that gifted writers who publish a memoir somewhat earlier in their career often give readers a braver, more revelatory gift — think Anne Lamott and Mary McCarthy, as well as “Poser” author Claire Dederer and Cheryl Strayed (“Wild”). I’m sure there are men lurking in this category, somewhere, but it does seem as if women are more willing to reveal themselves to their readers in this way, earlier.

Blaming a gifted writer for this may not be quite fair. Clearly Russo used his books and a lot of years to figure out his mother and their connection. He began to work the issue more pointedly in his last novel, “That Old Cape Magic,” which creates a mother every bit as exasperating, pitiful and wonderful as Russo’s own. When he was good and ready to write this memoir, he wrote it.

But those writers who fling themselves bravely into memoir earlier seem, to me, to do it better. There is an arresting rawness (think Mary Karr) and a willingness to examine oneself from every angle that is best done by the young (or at least, younger) and very flexible.

Following that logic, the upside here may be that readers discovering Russo through this memoir and then returning to his first few titles are embarking on a delightful voyage with a gifted writer about whom they now know a great deal.

Kimberly Marlowe Hartnett is a writer living in Portland, Ore.

Royce White Absent as He and Houston Rockets Remain at Odds

Royce White, Houston Rockets at Odds as White Remains Absent from Team

Thomas Campbell-US Presswire

Houston Rockets rookie power forward Royce White suffers from anxiety disorder, fear of flying and obsessive compulsive disorder which is why the team agreed to workout a plane for White to deal with his disorders and fears while also keeping him ready to go for games and practices.

The arrangement between the Rockets and White which was made was to have White fly only to certain games and then take a bus to the others that were close in distance to where the team would be. For instance to begin the season White flew with his team from Houston to Michigan to take on the Detroit Pistons because of the lengthy distance and then traveled by bus to the next few road games versus the Atlanta Hawks and Memphis Grizzlies.

Now the 16th overall selection in the 2012 NBA Draft has essentially gone AWOL after not appearing for the Rockets’ Monday night loss to the Miami Heat, the team’s Tuesday practice or their shoot around prior to Wednesday night’s game versus the New Orleans Hornets. There has been word as to when or if White will rejoin the team from either the Rockets or White himself but recently White tweeted on his verified Twitter account that the Rockets have been “inconsistent” with helping him.

White has yet to see any type of playing time this season and that could also be a partial factor in to him being absent from the team along with the 6’8″, 260 pound forward feeling that the team isn’t doing all they can to assist him with this situation. The Rockets organization will fine White for everyday that he remains away from the team or fails to meet with his therapist according to the Houston Chronicle.

Why Some of Us Fret More Over Moral Dilemmas




brain areas

CREDIT: Dreamstime


Imagine yourself in a time of war. You’re huddled in a cellar with your entire village, hiding from armed enemy soldiers outside. A baby starts to cry, threatening to expose the hideout. Do you cover the infant’s mouth tightly and risk suffocating it to save the others?

When we’re faced with tough choices like this, certain parts of our brain light up, helping us navigate morally sticky situations. New research finds that these brain regions are more active in individuals with obsessive-compulsive disorder (OCD), which suggests they tend to be more distressed by moral quandaries than people without the condition.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” study researcher Carles Soriano, of the Hospital de Bellvitge in Barcelona, told Spanish news agency SINC.

Soriano and his team studied 73 patients with OCD and 73 control subjects, measuring their brain activity with an fMRI machine as they were faced with decisions, such as the classic crying baby dilemma.

Compared with the control subjects, the patients with OCD had a higher degree of activation in the orbitofrontal cortex, a region with ties to the decision making processes and the development of moral sentiment, the researchers found. The OCD patients did not have the same responses when making more trivial choices, such as choosing between going to the countryside or the beach for the weekend, the researchers note.

“The data allows us for the first time to objectify the existence of cerebral dysfunctions related to alterations in complex cognitions, such as experiencing morality,” Soriano said. “This allows us to expand further on the characterisation of altered cerebral mechanisms in OCD.”

OCD is thought to affect at least 1 percent of the population and is characterized by repetitive behaviors that aim to reduce anxiety.

While the majority of cases involve compulsions to clean and perform other rituals or routines, other forms of the disorder are marked by pathological sexual or religious guilt, suggesting OCD patients might be prone to moral hypersensitivity.

The new study appears in the journal Archives of General Psychiatry.

Follow LiveScience on Twitter @livescience. We’re also on Facebook  Google+.

OCD May Heighten Moral Sensitivity

OCD May Heighten Moral Sensitivity Individuals with obsessive-compulsive disorder (OCD) appear far more sensitive when it comes to moral dilemmas.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” said Carles Soriano, Ph.D., researcher at Hospital de Bellvitge in Barcelona.

For the new study, scientists looked at the neurofunctional basis of this increased moral sensitivity. Using functional magnetic resonance imaging, they measured the brain activity of a group of 73 patients with OCD and 73 healthy patients.

All participants had to face a variety of moral problems in which they had to choose between two alternatives both leading to very negative consequences.

For example, they were asked to imagine themselves in a hypothetical war. Enemy soldiers lie in wait to attack and the entire village is hiding in a cellar. A baby starts to cry. If nobody makes the baby stop, the enemy soldiers will find them. Would it be justifiable to smother the baby’s cry, possibly suffocating it to save the others?

The results demonstrated that during situations of moral dilemma, the brains of those with OCD showed a higher degree of activation in the orbitofrontal cortex, especially in the medial part, which is associated with decision making and the development of moral sentiment.

“The majority [of people with OCD] are characterized by being obsessed with dirt and compulsive cleaning or by doubting that they have carried out important actions properly, like turning off the gas. Such behavior makes then repeatedly check whether they have performed such actions,” said Soriano.

There are other types of obsessions and compulsions as well, such as needing objects in the environment to be perfectly symmetrical and in order.   

There are also those that suffer from involuntary and unwanted thoughts of a sexual or religious kind.  They may feel unsure whether they have committed a sexual act that is unacceptable in their opinion or they worry that they have blasphemed God.

“The last group of patients is identified for precisely having a higher level of moral hypersensitivity,” said Soriano.

The research included help from experts at Barcelona’s Hospital del Mar and the University of Melbourne in Australia.

Source:  Archives of General Psychiatry
 

 
Very anxious woman photo by shutterstock.



<!– Related News Articles
–>
<!– Related Clinical Articles
–>


jQuery(‘.nrelate_default’).removeClass(‘nrelate_default’);

 

 

<!–

Brain and Behavior, General, Mental Health and Wellness, OCD, Psychology, Research

–>