Cognitive Therapy Plus Exposure and Response Prevention Effective in OCD

The treatment led to significantly greater symptom relief and belief reduction compared with exposure and response prevention.

The addition of cognitive therapy to exposure and response prevention (ERP) resulted in improved outcomes in patients with obsessive-compulsive disorder (OCD), according to the results of a study published in the British Journal of Clinical Psychology.

The use of ERP in patients with OCD is considered an effective first-line therapy and is recommended by major guidelines. ERP therapy results in effective and lasting change in OCD, regardless of symptom presentation and severity and the presence of comorbidities. Both intensive and outpatient therapies are effective. Cognitive therapy is less well established in the treatment of OCD, although it is effective as well. Most studies have compared ERP with cognitive therapy (CT) and both have shown significant and equivalent efficacy. However, the integration of ERP and CT has been proposed in treatment guidelines such as those from the National Institute for Health and Care Excellence (NICE). This is the first randomized controlled study to directly test whether integrated manualized CT offers a therapeutic benefit greater than ERP alone.

Neil A. Rector, PhD, C.Psych, of the Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, and the Department of Psychiatry, University of Toronto, Canada, and colleagues conducted a longitudinal randomized controlled trial to compare treatment that integrated CT with ERP (ERP + CT) with ERP alone. The investigators measured obsessive-compulsive symptoms before treatment, post-treatment, and at 6-month follow-up.

The investigators randomized 127 patients with OCD to receive individual outpatient ERP or ERP + CT. ERP + CT led to significantly greater symptom relief and belief reduction compared with ERP. The added benefit was equivalent to a medium to large treatment effect. More participants in the ERP + CT group were judged to be recovered than patients in the ERP group. Benefits were found in the main OCD dimensions, including contamination/washing, doubting-harming/checking, order-symmetry/repeating and pure obsession (harming, sexual, somatic, and religious).

Limitations of the study included the failure to examine the differential effects of ERP or ERP + C vs another form of psychotherapy, and given the high rates of depression in individuals with OCD, that a diagnosable mood disorder was the basis for exclusion from the trial. Nonetheless, the investigators argued that these findings support NICE treatment guidelines that recommend the integration of ERP and cognitive therapy for OCD.


Rector NA, Richter MA, Katz D, Leybman M. Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting [published online July 8, 2018]. Br J Clin Psychol. doi:10.1111/bjc.12188

Retroactive jealousy: Obsessed with my partner’s past

Illustration of a couple talking in a restaurant

Zachary Stockill’s obsessive thoughts about his partner’s previous sexual experiences led to the collapse of his first serious relationship. It took time for him to discover that his problem had a name – and that thousands of other people also suffer from it.

I was in my early 20s and, for the first time, I was in love.

One evening my girlfriend and I did what a lot of new couples do at the beginning of a relationship – we started talking about our pasts. The conversation moved on to previous relationships we’d both had.

A switch flicked in my brain.

There was absolutely nothing she said that was out of the ordinary, no details that were particularly unusual, shocking or even titillating. But something changed.

Her romantic history was suddenly all I could think about.

I grew up in a small town in northern Ontario, Canada. My parents had an excellent marriage and for the most part I had a great relationship with them. I didn’t grow up with mental health challenges – no depression, no anxiety, no obsessive compulsive disorder (OCD).

I loved women.

By grade three (aged eight) I had two girlfriends! But that was probably one of the few times I dated more than one person at a time. I enjoyed typical high school relationships.

Then I went to university and as an undergraduate I met and fell in love with a woman unlike any I’d met before. She was beautiful, extremely intelligent, artistic, and curious.

But when she spoke about her earlier life an emotion I’d never experienced began to take over.

Most of us have an impression of what “normal” jealousy looks like. Maybe feeling a pang when you see your partner attract the attention of someone in a bar or perking up when a colleague’s name starts cropping up more often in conversation.

Illustration of a final frame of a movie

Most people don’t like the idea of imagining their partner with someone else, such as an ex, but what I was feeling was entirely different.

My romantic history was, shall we say, more “colourful” than hers, but the thought she had been intimate with anyone other than me started plaguing me.

I didn’t know the name of it then but what I had is sometimes called “retroactive jealousy”. I’d learn much more about it in the years that followed.

I started playing mental movies in my head of her in situations with her ex and imagine them as if was happening in real time, right in front of me. It was as if she was cheating on me.

Her past suddenly became my present.

I’d latch on to some trivial detail and paint a hugely vivid picture around it. I would add details and turn insignificant events into full-blown scenarios in my mind.

If we went out to eat I’d wonder if she and her previous partner had been to the same restaurant. We’d walk by a hotel and suddenly I’d wonder if they had made love there.

Her previous relationships were the first thing I thought about in the morning and the last thing at night.

Social media is a huge magnifier for this issue. You have a backlog of posts and comments and images from your partner’s past. And I dived into it.

I became an online detective.

Illustration of a desk and laptop showing social media sites

I’d scroll through old photos from before I knew her, reading comments, trying to figure out who certain people were, how they fitted into her life, whether there was an untold adventure from her past.

These were the things I did in private, then there was the real-life toll on our relationship.

I’m ashamed of how I acted then.

Compulsive Sexual Behavior Is Now Recognized as a Disorder, But It isn’t the Same as Sex Addiction

Though the concept of sex addiction has been a subject of debate for some time, there actually hasn’t been an official diagnosis that addresses problematic sexual behavior—until now.

Last month, the World Health Organization (WHO) released the proposal for the 11th edition of the International Classification of Diseases (ICD-11), the first revision of the global standard diagnostic catalogue since 1990. And among the proposed changes is the addition of a mental health condition called compulsive sexual behavior disorder (CSBD), which is a pretty big milestone in the mental health community.

“This is the first time internationally that there is a category for dysregulated or problematic sexual behavior,” Shane W. Kraus, Ph.D., director of the Behavioral Addictions Clinic at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Mass., and assistant professor of psychiatry at the University of Massachusetts Medical School, who was part of the WHO work group that developed the diagnostic criteria for CSBD, tells SELF.

CSBD is classified as an impulse control disorder, meaning it appears in the ICD-11 alongside conditions like gambling disorder and kleptomania.

CSBD is characterized by “a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour,” according to its diagnostic description in the ICD-11; this can include both the act of sex and sexual fantasies.

The umbrella term “impulse control disorder” includes a variety of psychiatric disorders “whose essential features are the failure to resist an impulse to perform an act that is harmful to the individual or to others,” according to the ICD. Individuals typically experience an increased sense of tension before the act, but then pleasure or gratification when they do the act, it goes on to explain.

According to the ICD, the hallmark symptoms of CSBD are “repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.”

For example, someone with CSBD might be over and over again engaging in sexual behavior that they full well know is damaging their relationship with the person they love, like putting their impulse to have sex over their partner’s desires and other aspects of their relationship, or having sex with someone who is not their partner (assuming they’re in a monogamous relationship) in order to satisfy those strong and frequent urges, or engaging in this behavior to the detriment of their job or other responsibilities.

While the official diagnosis may be new, for many mental health professionals, the condition is something they see and discuss often. “A lot of the therapeutic community has been talking about this issue and working with patients seeking help for these kind of sexual problems long before it was canonized in the ICD-11,” Rory Reid, Ph.D., LCSW, assistant professor and research psychologist in the Department of Psychiatry and Biobehavioral Sciences at UCLA, tells SELF.

Reid compares the lag between clinical evidence of a problem and an official diagnosis to the trajectory of PTSD: The disorder was recognized by the APA in the DSM in 1980 after a wave of veterans sought professional help for their similar experiences. “We had all these military personnel coming back from the Vietnam War having these symptoms—flashbacks, anxiety—and they were going in to therapists and psychiatrists to talk about them,” he says. “So therapists started working with it long before it was canonized as a disease or a disorder, and then the scientific community caught up and said, ‘Yeah we’re seeing this, too.’”

It’s worth noting that a CSBD diagnosis is not same thing as having a high sex drive or large number of sexual partners.

Having a lot of sex or sexual desire doesn’t mean you have a condition, similarly to, for instance, how not everyone who drinks what some might consider a lot has alcoholism. “[Their behavior] might cause distress or it might be an issue for them, but it doesn’t mean they have a mental health problem,” Kraus explains.

The ICD criteria also cautions against conflating violating social or cultural norms with having a clinical condition. It explicitly states that “distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours” does not factor into a CSBD diagnosis. For instance, being into kink, having multiple sexual partners, or frequenting sex parties may not be everyone’s cup of tea but it doesn’t qualify you as having CSBD. “Compulsive sexual behavior, when properly diagnosed, is not in any way related to who or what it is that turns a person on,” certified sex addiction therapist (CSAT) Robert Weiss, author of Sex Addiction 101, host of the podcast Sex, Love, and Addiction 101, and CEO of Seeking Integrity, tells SELF.

“People have sexual behaviors that vary across people and cultures and groups, and we want to make sure we’re not overpathologizing people based on specific values,” Kraus explains. The CSBD diagnostic criteria are based on science rather than conjecture, and “very specifically take morality and personal judgement out of the equation,” Weiss says.

In fact, the fear of overpathologizing sexual behavior based on what we view as normal, proper, moral, or socially acceptable is actually one of the controversies that led the American Psychiatric Association (APA) to reject the proposed addition of “hypersexual disorder” to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) back in 2013, Reid points out.

The APA objected that the diagnostic criteria for hypersexual disorder did not clearly differentiate between “normal range high levels of sexual desire and activity” and “pathological levels of sexual desire and activity,” according to a paper that Reid co-authored in 2014. This lack of clarity created a potential for “false positives,” the APA argued, “erroneously diagnosing an individual with a mental disorder that is a normal variant of human behavior.”

WHO’s addition of CSBD has stirred up this existing controversy on the subject of how to define and diagnose disorders related to sexual behavior. “There was never any dispute that healthcare professionals are seeing [the issue of CSBD] all over,” psychologist Eli Coleman, Ph.D., director of the Program in Human Sexuality at the University of Minnesota Medical School and founding editor of the International Journal of Sexual Health, tells SELF. “It’s just been a matter of debate about what we call it.”

The specific language that the medical community (and society in general) uses for a particular condition matters; it shapes our conception of the condition, and in turn, determines how people dealing with those issues are perceived and the treatment they receive. In the case of psychiatric and behavioral disorders, the name experts settle on and the category they file it under (addiction, impulse control disorder, obsessive compulsive disorder) refers to the underlying brain mechanism, or how that particular disorder is thought to be working in the brain. That then tells us how to approach treatment and what treatments are most likely to be effective, Reid explains.

So does this mean that sex addiction is now a formally recognized mental health condition? Well, not exactly.

In regards to CSBD, the largest point of contention is whether or not the disorder should be categorized as an addiction. “There is ongoing scientific debate on whether or not the compulsive sexual behavior disorder constitutes the manifestation of a behavioral addiction,” WHO spokesperson Christian Lindmeier tells SELF. “WHO does not use the term sex addiction because we are not taking a position about whether it is physiologically an addiction or not.”

But unlike the phrase compulsive sexual behavior disorder, most people are familiar with the term sex addiction. It’s also long been used by the mental health professionals that counsel people with these issues.

“I and many others have used multiple terms interchangeably for many years: sex addiction, sexual compulsivity, hypersexuality, compulsive sexual behavior,” says Weiss. “The term I’ve tended to use most often is sex addiction, primarily because that’s the term that the people who are suffering with this disorder will most easily identify with.”

Some experts, including Weiss, feel there is no question whether the sexual behavior patterns associated with CSBD resemble an addiction.

“Anyone who has been to a 12-step sexual recovery meeting can see for themselves the honest pain of the individuals attending,” Weiss says. “They talk about their preoccupation to the point of obsession, their loss of control, and their negative consequences, the same as recovering addicts do in Alcoholics Anonymous and Narcotics Anonymous.”

In some ways, the comparison makes perfect sense. In both cases of substance use disorders and CSBD, the person has difficulty controlling urges to keep engaging in behavior (having sex, using heroin, taking a drink) that is harmful to their own well-being or that of someone they love, negatively impacting their lives, taking priority over all (or almost all) else, and, despite maybe resulting in an instant sense of pleasure, gratification, or relief, definitely not making them feel happy, content, or satisfied in any deep or lasting sense.

And in Weiss’s experience, he sees people struggling with this issue using sex as a coping mechanism, similarly to how a person dealing with alcoholism turns to a drink. “As with other addictions, the ‘substance’ (in this case sexual fantasy and activity) is used to ‘numb out’ and to avoid stress, loneliness, boredom, sadness, and other uncomfortable feelings,” he explains. Oftentimes, “Sex addicts, like [many] other addicts, are not using to feel good, they’re using to feel less.”

There is also some evidence to suggest that the mechanism behind this kind of sexual behavior is addictive.

A 2016 literature review co-authored by Kraus cited neuroimaging studies showing the same systems in the brain may be involved in both compulsive sexual behavior and substance abuse.

But the evidence isn’t definitive, at least not yet. That paper also concluded that the growing body of research is still rife with holes. “Clearly there is not sufficient evidence to say that [compulsive sexual behavior] is an addiction or even a behavioral addiction,” Coleman says.

And Reid points out that despite some overlap, CSBD also lacks key features associated with addiction. “People might argue sexual addiction is similar in nature [to other addictions], and there probably are a lot of similarities with various addictive behaviors,” he notes. “But there are differences too, such as a lack of evidence for symptoms of withdrawal and tolerance in compulsive sexual behavior, whereas these are common symptoms of substance-related addictions.”

There just isn’t enough proof demonstrating CSBD closely mirrors addiction,
whereas with gambling addiction, for example, two of the diagnostic criteria laid out by the APA are a “need to gamble with increasing amount of money to achieve the desired excitement” (e.g. tolerance-building) and being “restless or irritable when trying to cut down or stop gambling” (e.g. withdrawal).

And many experts argue that unless scientific evidence can prove that this issue is actually an addiction, we should refrain from calling it one, as WHO opted to do.

Outside the strictly scientific argument about whether this qualifies as an addiction, there are other rationales for taking this more conservative stance and avoiding the term sex addiction.

What we call something in public discourse shapes our understanding of what the issue is. Coleman fears that the term sex addiction is so overused and imprecise that it has lost significance. “One of the problems is the term sex addiction is used so casually that the scientific meaning is lost in really understanding the underlying mechanisms,” he says. “It has a lot of connotations that don’t really reflect what the condition is about.”

Even more importantly, the label we give the condition also has ramifications for how we treat it. “The term [sex addiction] implies that it is like alcohol or heroin addiction, and that’s a completely different mechanism, so you could apply inappropriate treatment to this condition,” Coleman explains. For example, addiction treatment typically involves abstaining from the thing the person is addicted to. “And sex is a basic appetitive drive, so abstinence doesn’t work…Counting the days of going without sex? It doesn’t make any sense.”

From Coleman’s perspective, the optimal approach is more akin to the treatment of an eating disorder, which involves refraining from dysregulated behavioral patterns and relearning to engage in the behavior in healthy ways.

Experts agree that we need more research on compulsive sexual behavior, and that this research will reveal more about what exactly the disorder is and how to treat it.

“The jury’s still out on trying to really tease out these nuances both clinically and scientifically so that we can have clarity about what this phenomenon is exactly,” Reid says.

It’s also entirely possible that there are multiple disorders underpinning these displays of behavior. “The problem is that for people with out-of-control sexual behavior, it could be driven by a number of different mechanisms,” Coleman explains. “I think that [WHO] recognizes that it’s still uncertain if this is where it should be, as an impulse control disorder, but there is quite a bit of literature that supports that for many of these people that it is like an impulse control disorder.” Either way, “I think what we call it and how we describe it is very much going to evolve with good research over time,” Kraus says.

Kraus and Reid both note as an example how the understanding of pathological gambling as a behavioral issue has changed over time. It was initially categorized as an impulse control disorder, because that’s what the limited evidence pointed to. But a cadre of subsequent research produced enough scientific evidence to re-categorize it as an addictive disorder in the DSM-5, Reid explains. “We could see a similar trajectory for compulsive sexual behavior disorder. It’s too early to tell at this point.”

WHO’s inclusion of CSBD in the ICD-11 isn’t putting an end to this debate; it establishes that it’s one worth having, and a debate worth putting research dollars towards.

“Settling on this term will help us open up the conversation and do the research that may enable us to come up with more accurate frameworks and better terminology to talk about it,” Reid explains. “Now let’s continue to press forward scientifically and clinically learn more about it in terms of what’s causing this, what brain mechanisms or other biological factors might be linked to this, and how we best treat it.” Kraus thinks it’s likely that WHO’s designation will influence both future research in the U.S. and discussions about adding CSBD, or something similar, to future versions of the DSM.

And in the meantime, the immediate benefit of the classification is that it will hopefully help people suffering feel destigmatized and seek treatment.

“I think the broader goal of this classification is that it will open access to healthcare, hopefully reduce stigma, and increase people seeking help,” Kraus says. (Providers will be able to use the ICD diagnostic code to bill insurance, for instance.)

Weiss adds, “People who are struggling with [this] finally have an official diagnosis they can point to…This seemingly simple thing may help a great deal with the shame they typically feel.”

And as Kraus puts it, “This is definitely not the final solution, but it’s a good starting place for more research and treatment for people.”

You could argue that for now, it’s less important what we call CBSD, and more important that we have a way to talk about and diagnose the issue, even if it’s not a perfect process.

While Weiss, for example, has long been comfortable with the term sex addiction, he doesn’t especially care what term we agree to officially use. He thinks giving therapists accurate guidelines to identify the issue is more important. “Compulsive sexual behavior disorder is fine by me. As long as we have accurate, research-based criteria we can use to identify and diagnose the issue, I’m happy,” he says. “And the WHO has just provided us with exactly that.”

Reid points out that many patients, too, are probably less interested in the technical diagnostic term their health care providers use than in actually having their problems recognized and treated. “There are some of these scientific nuances, but I think for the person out there who’s struggling. they’re not going to really differentiate between what we label it,” he says. “They’re going to say ‘You can call it impulsive sexual behavior, you can call it hypersexual disorder, you can call it sex addiction—this is what describes me.’”


I’ve Lived With Trichotillomania For A Decade & Here’s What I Want You To Know

I am exceptionally good at applying false eyelashes. It’s a talent I share with my friends who danced competitively, or competed in pageants, or simply subscribe to the Geordie lass approach to makeup. But they practised in dressing rooms or at pre-drinks, magnifying mirrors in one hand and a vodka cranberry in the other. My talent is a lonelier one. I rehearsed alone, applying and reapplying and adjusting and repositioning until the lashes concealed the bare pink strip where I’d pulled out my eyelashes. I’ve pulled for over a decade now. I want you to know what living with trichotillomania is like.

Trichotillomania is an impulse control disorder, defined by the urge to pull out your own hair. According to OCD-UK, its classification has been contested — “it may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive–compulsive disorder,” the charity explains. A spokesperson for AnxietyUK told me, “People with trichotillomania are likely to also have anxiety, stress, depression, and other OCD-like behaviours such as compulsive skin picking.” Conveniently, I’ve accrued all of those diagnoses, as well as OCD. My makeup bag boasts an assortment of colour-correctors and concealers, used to disguise the evidence after I’ve turned a tiny blocked pore into a bleeding crater; in my bathroom, there’s a small arsenal of acid peels, retinoids, and essential oils, each purchased in the hope that they’ll erase my picking scars.

I’ve been pulling out my hair — typically my eyelashes and eyebrows — since I was 14; at 25, I can barely remember what life was like before.

“Trichotillomania seems to be more prevalent in children and young adults, and may be down to a change in hormone levels during puberty,” the AnxietyUK spokesperson said, continuing, “Women are more likely to be treated for trichotillomania, but this may be due to the reluctance of men at seeking treatment.” I’ve been pulling out my hair — typically my eyelashes and eyebrows — since I was 14; at 25, I can barely remember what life was like before.

I hesitate to discuss my trichotillomania. It’s easier to talk about the OCD I was diagnosed with at the same time, though the latter has proved a far more definitive aspect of my life. It’s difficult to explain, or to understand myself, why I’m compelled to repeat such a nakedly destructive action. My friends and family flinch when they see the lash spring out of the follicle, or frown as they attempt to determine, after a particularly brutal spate of pulling, what looks weird about my face. I believe, resolutely, in the deconstruction of the stigma attached to mental illness. But it’s difficult, when faced so bluntly with other people’s discomfort, to apply that to myself.

I began picking as an unhappy teenager, miserably convinced of my own worthlessness. I picked absentmindedly in class, but deliberately at home, ripping my lashes and brows out with a fury that made my eyes water. I didn’t know how better to cope with the self-loathing that threatened to overcome me other than to wear it, plainly, across my face. It looked wrong, ugly, when I looked back in the mirror — and it matched, I thought. It fitted all the wrongness and ugliness inside.

Chelsea Victoria/Stocksy

It’s hard to admit — to others, or to myself — that I still experience feelings of self-loathing as an adult sometimes, so completely and so viciously that I’m afraid to go outside. I am vain, and shallow, I tell myself in the mirror. I am a bad feminist. And then I pull out an eyelash, and roll it in my fingers, and I don’t go out the house.

Of course it’s untrue, I’ve been told by friends and family and psychologists alike. My rational brain believes it too. I’m not self-obsessed, not shallow, not a disappointment to the feminist movement. But anxiety disorders don’t deal much in rationality. Anxiety disorders convince you of anything but the truth.

Mental health professionals haven’t always taken my condition seriously. As a teenager, first receiving counselling for OCD, I pointed out my naked eyelids to my clinical psychologist and asked if I could have trichotillomania. She devoted less than five minutes to the topic, told me not to diagnose myself, and left me wincing in teenage shame. Seven years later — after a period of suicidal crisis — I watched my counsellor write, on a faded yellow pad, that I looked healthy, in part because I was wearing make-up. She didn’t notice that my eyeliner was tailored to the gaps in my lashline; that my foundation was concealing dark red scabs where I’d clawed relentlessly at my face.

Last week, I proudly directed my mam’s attention to my full set of lashes; today, I’m nursing several sparse patches, plus an eye infection brought on by the pulling.

But treatment is available, and I’ve benefited from it, at times — though too often, I’ve languished on NHS waiting lists, bumped down to the bottom when I moved to and from university. The AnxietyUK spokesperson explained the treatment options thus: “Cognitive Behavioural Therapy is recommended for those with trichotillomania, especially a form of CBT called Habit Reversal Training, and has been used in treating stammering, nail biting and skin picking.”

They added, “Items such as stress-balls, tangle toys and fidget cubes can be effective tools for reducing the frequency of hair pulling by redirecting the compulsive behaviour into something less destructive. Some find keeping a record or diary of their hair pulling helps them identify when the impulses are at their strongest.” There’s no universal trichotillomania sufferer, of course. Your GP should be committed to figuring out what’s best for you.

I keep a hair tie around my wrist at all times, a habit picked up from a forum when my first psychologist dismissed my concern. On bad days, I snap it against my wrist, hoping the pain will overpower the desire to pull. On better days, it’s just a hair tie around my wrist. It’s a relief, sometimes, just to blend in.

My trichotillomania is manageable now, though I’m cautious about becoming complacent. Last week, I proudly directed my mam’s attention to my full set of lashes; today, I’m nursing several sparse patches, plus an eye infection brought on by the pulling. The damage only took a single stressful day.

But I remember, still, the secondary school History class, when I filled a gap in my lashes with eyeliner in the back of the classroom and prayed no teacher would notice it. The time I plucked out every last lash with tweezers, and refused to leave my flat in daylight until they began to grow back. And the first date I wore a cat-eye to, and hesitated before we kissed, for fear my make-up would smear away. I’ve recovered before, I reassure myself. And this time, I’ll recover again.

8 Symptoms Of Silent Panic Attacks You Should Know How To Recognize

Considering the dictionary definitions of “panic” and “attack,” it’s no surprise that when many people think of a panic or anxiety attack, they automatic picture the super noticeable symptoms associated with panic, like shaking, sweating, crying, or hyperventilating. However, the term “panic attack” is somewhat of a misnomer: While some people who experience panic attacks do have symptoms that are very apparent, others can experience silent panic attacks. This is when someone who is diagnosed with a panic or anxiety disorder has a panic attack without displaying any outward symptoms whatsoever. Someone who has silent panic attacks could have them in public, at home, in the office, or virtually anywhere without anyone noticing, or realizing that something was wrong.

The National Alliance of Mental Illness (NAMI) estimates around three million people in the U.S. have some type of panic disorder, and another 37 million Americans have some other type of anxiety disorder. And while they may be less likely to draw attention than panic attacks that have visible symptoms, silent panic attacks are just real, valid, and frightening for the person experiencing it. Here’s a rundown of eight symptoms of silent panic attacks you should be aware of, especially if you have an anxiety disorder.

1Feeling Dizzy Or Tingling In Your Limbs

Andrew Zaeh for Bustle

According to Prevention, “When you start having a panic attack, there is less blood in your extremities. In turn, some people feel weaker in their arms, legs, hands, and feet.” This decrease in blood flow can also make your feet and hands tingle, or feel a bit numb, as if you stayed put in one position too long.

2Derealization Or Depersonalization

Andrew Zaeh for Bustle

3Your Heart Rate Increases Or Feels Like Its Skipping A Beat

Andrew Zaeh for Bustle

If your heart rate is faster than normal, or you begin to have heart palpitations, it could be a sign of a silent panic attack. It also may be one of the first physiological symptoms you experience with any sort of anxiety.

4Intrusive Thoughts

Andrew Zaeh for Bustle

One of the hallmark symptoms of both anxiety and panic disorders, as well as obsessive-compulsive disorder (OCD), is intrusive thoughts — which, according to the Calm Clinic, are thoughts that “so deeply occupy your mind that you may not be able to focus on your life, or experience joy from your activities.”

Intrusive thoughts are uncontrollable, and often times, conjure up disturbing images that can make the person experiencing them feel afraid to the point of immobility. Though people can experience intrusive thoughts without having a full-blown silent panic attack, they are often a symptom of one.



Andrew Zaeh for Bustle

7Your Throat Closes Up

Hannah Burton/Bustle

8Changes In Your Vision

Hannah Burton/Bustle

Blurred vision, eye floaters, and light sensitivity are just a few ways that Silverstein Eye Centers reported silent panic attacks and anxiety can impact your vision. Of course, you should rule out that you don’t actually have an optical disorder. However, chances are, if you are experiencing vision issues only when these other symptoms crop up, it’s caused by panic.

Being aware of the invisible, physiological symptoms that can occur during a panic attack is super important for people who have anxiety disorders. It may even help you stop a panic attack it its tracks.

7 Warning Signs You May Have an Anxiety Disorder

Everyone feels anxious once in a while, because let’s be real: between family obligations, workplace drama, and all the other things you’re juggling, life is stressful. And in some ways, that stress can be a positive thing. “If we didn’t have anxiety, we probably wouldn’t prepare for a meeting or a test, or we wouldn’t care what people think,” says E. Blake Zakarin, PhD, assistant professor of medical psychology in psychiatry at the Columbia University Medical Center.

All that said, day-to-day anxiety can cross a line and become the type that’s so frequent and intense that it consumes your life. “When it stops being helpful, and starts being impairing,” that’s when it’s time to seek help and be evaluated for an anxiety disorder, Zakarin says.

Anxiety disorder symptoms aren’t always easy to spot, and they vary widely from person to person. Some people have panic attacks and others experience phobias, for instance. What’s more, there are multiple types of anxiety disorders, including obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and social anxiety disorder, and there’s no set anxiety disorder test to take. Still, there are warning signs to watch out for. Here, we down what to look for to determine whether you should talk to your doctor about the possibility of having an anxiety disorder.

Signs you may have an anxiety disorder

1. You have a major case of avoidance.

If you start making excuses for not participating in activities like parties or after-work happy hours or even networking events that’ll advance your career, it’s time to take a step back and determine why. “Avoidance is something we brush off and rationalize, like saying you don’t want to go meet new people because you’re tired,” Zakarin says. It often starts small—like hanging with close friends but skipping out when they invite others—and then you realize you’re saying no more and more often.

Procrastination, though typically pretty common, can also reveal anxiety. If you’re not turning in work because you fear your boss or co-workers will hate it or criticize you, that’s when putting off a project becomes a little more serious than missing a deadline by a day. “If it becomes a chronic problem, because it’s too distressing to face actually doing the project, that’s a good signal of anxiety,” says Zakarin.

Anxiety disorders affect 40 million adults in the United States.

2. You consistently ask for a second opinion.

This might seem easier to spot in a loved one with anxiety, but pay attention to it for yourself, too. “Probably the most common observation from people close to individuals trying to manage intense anxiety is that they appear aroused, ‘hyped up, continually doubt themselves, and seek reassurance,” says Christine Maguth Nezu, PhD, professor of psychology at Drexel University. “In making a decision, someone might ask friends or co-workers if they are making the right decision, or they’ll continually search the internet, never satisfied that they have enough information, and worrying they may make the ‘wrong’ decision.”

3. You’re having trouble sleeping.

Restless nights come and go as quickly as bad days, but if you find yourself lying in bed with eyes wide open more often than not, it could mean you need some anxiety assistance. “We all have a night or two when we can’t sleep, but if it’s more chronic or really impacting your daytime wakefulness,” then it could be anxiety, Zakarin says. “If it’s taking you more than 30 minutes to fall asleep at night, on an ongoing basis, or you’re waking up and having trouble going back to bed, those are signals that anxiety is affecting your sleep.”

4. You’re experiencing GI issues.

Lots of bodily reactions occur when that fight-or-flight response kicks into gear in your sympathetic nervous system. First, the part of the brain that looks out for danger (the amygdala) sends a signal to your hypothalamus that you’re in danger, which then communicates to the rest of the brain (and body) that you have to act in survival mode. So, as you get the burst of energy to fight or flee, your “rest and digest” system—involved in actual digestion—turns off, and adrenaline and cortisol pumps throughout the body. This is likely why you’ll feel some distress in your digestive system if you’re constantly anxious, Zakarin says.

5. You have consistent muscle aches or headaches.

Similar to GI issues, you could feel physical aches in your muscles or your head if you’re constantly stressed and tense about what’s to come, Zakarin warns. “These aren’t always due to anxiety, but like poor sleep, they’re symptoms we tend to overlook like they’re not a big deal,” she says. Poor sleep could also be a contributing factor to the aches, along with general tightness throughout the body from chronically carrying around stress.

6. Your heart is racing or you’re breathing heavy.

Another consequence of the fight-or-flight physical reaction: Blood flows to areas that need it more—specifically, your heart, which then works in over time, pumping harder and faster, Zakarin explains. You’ll also try to take in more oxygen, which leaves you breathing heavy. It’s like you’re exercising, even if you’re hardly moving.

“The bodily changes that occur are built in for our survival. Therefore, most of the symptoms are normal…and predictable, like a rapid heartbeat, breathlessness, smothering sensations, increased blood pressure, feeling sick, hot, dizzy, faint or sweating,” Nezu says. “The irony here is that people rarely brush off intense symptoms of anxiety as ‘normal.’ They tend to worry even more, making an interpretation that their rapid breathing is due to a heart attack, or feeling faint may mean they have a brain tumor. You can imagine how this triggers more fear of harm, creating a vicious cycle.”

7. You’re really tired for no reason

Yes, you might be skimping on sleep if you’re up all night worrying about what’s to come. But even if you do catch quality shut-eye, the fact that your body is consistently working—physically fighting to survive, even if it’s not really threatened—can make you feel pretty fatigued, Zakarin says. So, if you’re tired for no reason, take a look at how you feel during the day and whether tension is really what’s weighing you down.

What to do if you think you have an anxiety disorder

If you can easily check off the seven signs of anxiety above, then it might be time to take a tough look at your lifestyle. Zakarin says sleep, exercise, and healthy eating could all help ease tension, as well as social support too and sharing your frustrations and worries. If making simple changes in your day-to-day doesn’t offer any improvements in how you feel, mentally and physically, then it could be time to see a professional. The most common treatment for anxiety is cognitive behavioral therapy, which points out that our thoughts and behaviors impact how we feel and what we do, and vice versa, she explains. You’ll work to notice and manage unhelpful thoughts and reduce avoidance.

“The good news is that using specific psychological and emotional management tools on a regular basis can actually weaken these strong connections over time and can train the brain toward more resiliency,” says Nezu. Besides cognitive behavior therapy, calming techniques could also include relaxation training, mindful meditation, emotion-focused problem-solving therapy, acceptance and commitment therapy and metacognitive therapy.

How Strep Throat May Lead to a Severe Psychiatric Disorder in Children

July 20, 2018

Strep throat is a bacterial infection, most commonly associated with sore throat in children. In most cases, it can be effectively treated with antibiotics. But strep can also lead to serious psychological and neurological complications known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.

A special report on ABC’s news magazine 20/20 airing tonight profiles three families coping with the devastating effects of PANDAS.

‘Out of the Blue’

According to the National Institute of Mental Health (NIMH), symptoms of PANDAS can happen “overnight and out of the blue.” They include vocal and physical tics, anxiety, and obsessive-compulsive disorder (OCD). Children may also show signs of anger and even violence.

“Many times the symptoms can be relatively mild, so the child just has some behavioral regression. They start acting a little young for their age, maybe they are a little more clingy or whiny, but that resolves in a few weeks,” says Susan Swedo, MD, the chief of the pediatrics and developmental neuroscience branch at the National Institute for Mental Health in Bethesda, Maryland.

“The symptoms, however, can be quite extreme,” Dr. Swedo says. “A child can go from being an A student to suddenly crawling around on the floor, talking baby talk, playing with an infant sibling’s toys, sleeping in a parent’s bed, spending hours and hours doing compulsive rituals, and having extreme anxiety.”

The Strep-PANDAS Connection

Caused by the bacteria Streptococcus pyogenes (group A strep), strep throat is spread by contact with secretions from an infected person’s respiratory tract when that person coughs or sneezes. It mostly affects children ages 5 to 15, but anyone can get it.

When a child has strep throat, his or her immune system produces antibodies to fight the strep bacteria. But in the case of PANDAS, these antibodies can also attack molecules in the brain.

Diagnosing PANDAS is not without controversy, and some medical experts question whether it’s a real disease related to strep.

According to Stanford T. Shulman, MD, a professor of pediatrics at Northwestern University in Chicago, “the best scientific studies that have been done have not been able to confirm that strep is related to these behavioral abnormalities.”

RELATED: What You Should Know About PANDAS

Uncommon and Severe

Few children who get strep throat develop PANDAS symptoms.

Swedo, who was on the research team that first identified PANDAS, in a 1994 paper published in the journal Pediatrics, estimates that two-thirds to three-quarters of grade-school-age children have a strep throat infection every year; but only as few as 1 in 500 will have the post-strep reaction that manifests as PANDAS.

Still, Steven Schlozman, MD, the codirector of the Clay Center for Young Healthy Minds at Massachusetts General Hospital (MGH) in Boston, says parents should look out for any signs of PANDAS. He points out that one of the defining characteristics of the syndrome is how quickly it appears.

“It’s not the severity of the disease but the rapid onset of the psychiatric symptoms that should bring to mind the possibility that there’s an autoimmune response to an infection with strep,” says Dr. Schlozman. “You may see this sudden onset of tics that are vocal or movement-related, like flicking a middle finger.”

According to Swedo, other warning signs include sleep disturbances, increased urinary frequency, and dilated pupils.

Profiles of Children With PANDAS

The 20/20 report profiles three children whose brush with strep led to dramatic changes in their behavior and many unanswered questions about the underlying cause and possible treatment:

  • Fourth grader Parker Barnes, from Prior Lake, Minnesota, suddenly became anxious, depressed, and occasionally violent. One day, Parker was found in a trance, holding a knife in his hand.
  • Nine-year-old Kathryn Ulicki from Cheshire, Connecticut, developed extreme paranoia, believing that she was allergic to anything that she swallowed.
  • Four-year-old Alexia Baier from Montgomery, Illinois,  after treatment for strep, became angry overnight and violently attacked her mother.

“When interviewing families impacted by PANDAS, we saw kids in various levels of distress,” says ABC News’s Juju Chang. “Their symptoms ranged from rages to depression, crippling anxiety to disturbing convulsions.”

Can PANDAS Be Treated?

Swedo says that diagnosing and treating strep infections with antibiotics early on can reduce the risk of developing PANDAS.

“My advice for any parent who has any suspicion that their child may have strep is to get a throat culture — not just a rapid strep test, because that misses about 15 to 20 percent of the cases,” says Swedo. “This can help prevent PANDAS, rheumatic fever, and other post-strep complications like arthritis and kidney disease.”

Besides treatment with antibiotics, Chang says, “the families I spoke with believe these kids also need to have treatments of dual tracks and that cognitive behavioral therapy is key to overcoming some of their symptoms. Even if their condition was triggered by a virus, they believe the fix is not in a pill alone.”

In some cases, PANDAS patients may need psychiatric treatments, behavior therapy, and medications.

Schlozman says that extreme cases may require plasmapheresis, a process that removes harmful antibodies from the blood. Research suggests that patients with PANDAS can also benefit from intravenous immunoglobulin (IVIG) treatment.

The ABC News report airs tonight on 20/20 at 10 p.m. EDT.

Study Finds That Crocheting Leads To A Variety Of Mental Health Benefits

If you’ve dismissed crocheting as something only older ladies do, you might want to rethink the stereotype. New research is giving all of us — old, young, male or female — plenty of incentive to pick up the activity as a means of engaging in self-care.

That’s right: Crocheting can do wonders for your health.

According to a study done by researchers at the University of Wollongong Australia, crocheting can yield major mental health benefits, including improved focus and memory, and relief from depression and anxiety. Out of the 8,000 participants interviewed in the survey conducted by the University, 99 percent were female, half of which were between 41 and 60 years old.

Ninety percent of those surveyed declared that crocheting made them feel calmer, while 82 percent believed themselves to be happier while crocheting. Over 70 percent felt that the hobby improved their memory and concentration.

“The results from the survey show that crocheting provides many positive benefits for people in terms of wellbeing,” Dr. Pippa Burns told Martha Stewart. “Being aware that crocheting can provide positive benefits may encourage people to take up the hobby as a self-care strategy.”


According to CNN, crafting — including crocheting and knitting — can “ease stress [and] increase happiness by releasing a neurotransmitter called dopamine.” Experts say that fully engaging in an activity like crafting allows you to temporarily forget about your problems.

Another study proving the positive effects of crafting, published in The British Journal of Occupational Therapy, found that in a survey of over 3,500 knitters, 81 percent of those with depression reported feeling happy after knitting.

Other poignant research has been done in relation to crocheting, knitting and the elderly. The American Counseling Association found that crocheting can help those aging who may struggle with things like dementia and obsessive-compulsive disorder. In addition, the hobby has been proven to aid with insomnia and anxiety by keeping the hands busy and the mind focused.

Have you ever crocheted? How did you feel?

When your child has an obsessive compulsive disorder

Since Jayden Roja was a two-and-a-half years old, he would immediately stop eating if he accidentally spilled food on his hands or clothes. He would then insist that his mother washes it off and change his clothes before he would continue eating.

He is now six years old, but he hasn’t changed. “It is odd. He is just too obsessed with being clean,” says his mother, Jane Wangui.

But that is not the only thing that Jayden is obsessed with. He is particular about how his clothes are arranged in his closet, which usually is according to colour and size. He gets upset when objects are touched or moved in his room. If something is moved or placed in a different position, Jayden will put it back to its original position. He also has sleeping ritual. He has to sleep at 8pm everyday without fail.  Even more appalling, is his anxiety about his family’s safety. Jayden gets worried excessively about bad things happening to his family members, and constantly asks his parents if something bad might happen to them.

Jane says she often got frustrated with her son’s obsessive habits until about a year ago when a close friend told her about Obsessive Compulsive Disorder (OCD). “Being a first-time mum, naturally I assumed that was a regular phase of childhood and he would outgrow it. But things seemed to get worse by the day. I took him to a therapist for assessment and indeed he was found to have one of the most common mental illnesses among children; OCD. To say I was confused would be an understatement,” she narrates. Jayden has since started therapy, which his mother says has shown great improvement.


Zipporah Kanyeki, a child psychologist, describes obsessions as thoughts or urges that a person does not want, but cannot get out of their head, ending in them feeling anxious or fearful. They include imagining that loved ones might get hurt or die, getting scared of getting sick from touching dirty things, feeling unsettled if their books or toys are not arranged in the right order and so on.

Compulsions are things a person feels they must do over and over, and cannot stop doing even if they don’t want to.  They include washing hands repeatedly, praying, repetitive counting or tapping, or strange obsession with certain clothes. “If your child has unwanted thoughts or behaviour that gets in the way of their daily life, they might have OCD and therefore, it is necessary to have them checked,” says Kanyeki.

Managing OCD

Cause of OCD is not known. However, children may develop OCD if family members have a history of anxiety or if children have been through a stressful or traumatic event. “It’s not a child’s, parents’ or teachers’ fault if a child develops the condition. Children with OCD will do their rituals even if they are punished for doing them,” she explains.

Many times, a child with OCD may not know why they need to do something, only that they need to do it. For example, she might say that she wants the books placed in a certain way on the table, but can’t say what will happen if they aren’t lined up. Kanyeki notes that OCD is not self-correcting, and if not addressed early, might lead to emotional health problems later in life. So, seeking professional treatment is important. And since it affects a child’s ability to relax and enjoy life, they might have challenges such as trouble paying attention or doing homework, have disrupted routines, get fatigued, develop social and self-esteem problems, among others.

Treatment for OCD include Cognitive Behaviour Therapy (CBT)and in severe cases, medication might be used in combination with therapy. CBT is a form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviours, and thoughts.

At home a parent can help manage a child’s anxiety by helping him to relax, for example, deep breathing, muscle relaxation and meditation, positive self-talk, distraction, introduce a worry box or set aside a calm place where the child can do activities that distract him from worries.

What is health anxiety – and how can you combat it?

Health anxiety is a condition we don’t generally hear much about – but it’s something many people in the UK suffer with.

You may often hear health anxiety referred to as hypochondria, and it’s when you spend so much time worrying about your health and wellbeing, that it begins to take over your life. Health anxiety comes under the Obsessive Compulsive Disorder (OCD) spectrum of anxiety disorders – so it’s a behaviour that can easily feel uncontrollable.

If you find yourself worrying about every little ache or pain in your body, or growing anxious about every change you see in yourself on an obsessive level – you may be suffering from health anxiety.

In fact, it’s something that even celebrities find themselves dealing with.

Recently, Loose Women panellist Stacey Solomon confessed that she often finds herself overly concerned about her health.

On the show, she confessed, “I have more checks than usual… I have health induced anxiety… I have tests done so I know what to look out for and what to be aware of.

“It’s not something I think is normal, it’s just me and my own anxieties… People MOT their car every year, why not your body? I’d rather have no car and be healthy. That’s all that matters.”

So what are the symptoms of health anxiety?

According to the NHS, constantly worrying about your health is the first symptom.

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Checking your body too often for potential signs of illness, such as a lump or rash.

Always seeking reassurance, from family or medical professionals, that you are healthy

Obsessively checking your symptoms on the internet or in the media

health anxiety

Worrying that your doctor or tests may have missed something.

Avoiding anything that discusses serious illness – such as a TV documentary.

Health anxiety can also manifest itself in some real, physical symptoms too, which could in turn make your anxiety worse.

Physical symptoms of health anxiety

Stomach pain


Racing heartbeat

Feelings of nausea

Health anxiety is real and debilitating – and it’s important not to disregard it because you think you’re being ‘paranoid’ or ‘crazy’.

So how can you attempt to combat it?

Treatment for health anxiety

The NHS recommends keeping a diary of every time these kind of intrusive thoughts cross your mind – such as when you feel the need to Google a symptom, or book a doctors appointment for something you’ve already addressed with a medical professional.

By taking note, you can deduce how much a problem your anxiety is becoming – and therefore whether or not you need to seek professional help.

Another interesting tactic is distracting yourself every time you feel like you’re beginning to overthink about your health.

health anxiety

For example, whenever you get the urge to check your body for an ailment, distract yourself by meeting up with a friend, or heading to the gym instead.

Some people may however need to seek professional help to deal with their anxiety.

If you feel that your health anxiety has become overwhelming, and is affecting your day-to-day life, book an appointment with your GP, who can offer help and advice.

Many medical professionals advise a course of cognitive behavioural therapy (CBD), which can help to change your thought process over time.

MORE: Coleen Nolan uncovers huge health concern

The Anxiety Association of America has explained the concept.

They said, “The main concept behind CBT is that our thoughts about a situation (such as the fear of AIDS) affect how we feel (afraid and anxious).

We tend to assign meaning to specific situations (lightheadedness means we have brain cancer). It’s not the actual situation causing your anxiety, but the meaning, whether accurate or not. And when you have anxiety, you give your thoughts a lot of meaning, and thus a lot of power.

“CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviours.”

Doctors may also prescribe medicine for anxiety, which can help to ease your nervous thoughts.

Anxiety UK also has a range of self-help groups around the country, where you can go to seek support for your issue. Find the full list here.

But most importantly, it’s key to remember that there is always help out there if you’re suffering from anxiety – and that asking for it is the first step towards feeling better.

Living with obsessive compulsive disorder

Growing up, Tina’s son Matt always seemed like a normal kid.

He was happy, outgoing, and was a little ball of energy that couldn’t sit still.

But certain things bothered him – he never wore jeans because he didn’t like the feeling of them on his skin, and didn’t like going to the beach because he hated the dusty feeling of sand on his hands.

As Matt, a Vancouver Island resident whose name was changed to protect his identity, got older, he was diagnosed with anxiety and attention deficit hyperactivity disorder. But it wasn’t until he turned 12 when things changed – and quickly.

Matt started over-worrying about things and then his focus turned to contamination. Matt would wash his hands several times in a row, and if he washed his hands and went to do another task, would wash them again. He worried about touching his game controller, in fear he would contaminate that and would be forced to wash his controller. He only used a towel once and as soon as it hit the floor Matt thought it would be dirty and would contaminate the floor.

Shortly after, Matt was diagnosed with obsessive compulsive disorder (OCD). According to the International OCD Foundation, OCD is a mental health disorder that occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings.

RELATED: Addictions to online games can destroy real lives

The Canadian Psychological Association reports between one and two per cent of Canadians will have an episode of OCD. It describes the condition like this:

“Obsessions are recurrent and persistent intrusive thoughts, images or impulses that are unwanted, personally unacceptable and cause significant distress. Even though a person tries very hard to suppress the obsession or cancel out its negative effects, it continues to reoccur in an uncontrollable fashion.

“Obsessions usually involve upsetting themes that are not simply excessive worries about real-life problems but instead are irrational concerns that the person often recognizes as highly unlikely, even nonsensical.”

According to the CPA, OCD can be chronic — waxing and waning with life’s stresses. It seldom disappears without treatment, and can have a profound negative impact on functioning — interfering with jobs, schooling, social interactions and relationships.

“It exploded on us, it came out of nowhere. It was very confusing for him as well,” said Tina, who is calling for more mental health services on the Island.

“It [contamination] was transferable almost. Say I touched the car door that he thought was contaminated, then I touched something else, then that would be contaminated. It’s just that snowball effect.”

After the diagnosis things became more severe. His fears of contamination escalated to the point where Matt would use his sleeves to open car doors. If he thought a part of the car was contaminated he would move to another seat, and then another, until he would finally ask his mother to wash the whole car.

The disorder began to affect his relationships as well. If he was hanging out with friends and his clothes got dirty he would have to go and change his clothes a bunch of times or they would want to go for a bike ride and he felt he couldn’t do it. As a result, he lost some friends in the process.

Tina said watching the disorder take over his life was difficult.

“Watching him and how debilitating it was for him and how much it was hurting him emotionally, that’s the worst part,” she said.

Shortly after, Matt received treatment at the Ledger House at Queen Alexandra Centre for Children’s Health, where he received therapy for seven weeks.He went on to participate in the OCD program through the B.C. Children’s Hospital in Vancouver for another six weeks.

RELATED: A day to tackle the stigma surrounding mental health

According to the BC Children’s Hospital website, treatment for OCD typically consists of psychological and psychiatric assessments, after which the assessing team meets with the family to discuss its findings and implement a treatment plan.

The evaluation includes a look at the patient’s medical, developmental, family and school history and his or her mental state, with attention to the potential presence of other psychiatric disorders.

First-line treatment for mild and moderate cases typically consists of cognitive behavioural therapy — basically, getting a better understanding of, and control of, the issues through talking.

“The aim of CBT is not about learning not to have these thoughts in the first place, because in essence…intrusive thoughts cannot be avoided. Instead it is about helping a person with OCD to identify and modify their patterns of thought that cause the anxiety, distress and compulsive behaviours,” reads a statement by the OCD-UK, a British charity dedicated to those affected by OCD.

“What therapy will teach the person with OCD is that it’s not the thoughts themselves that are the problem; it’s what the person makes of those thoughts, and how they respond to them, that is the key to recovery from OCD.”

For more serious cases, where the patient distress is severe, or ability to function significantly impaired, or where there is resistance to CBT, drug treatment is also recommended.

“Poor insight into the irrational nature of the obsession and/or compulsion can lead to resistance to CBT,” the Children’s Hospital practice parameter document states. “The need for close family involvement will make successful implementation of CBT more difficult in chaotic or non- intact families.”

RELATED: Centre for youth seeking mental health and addictions support opens in Victoria

Tina said Matt, now 17, has good and bad days. While school had been put on the back-burner, Matt is busy with a job and hangs out with his co-workers.

Despite the fact that her son was able to get treatment, Tina said there aren’t enough mental health services on the Island.

“We don’t have any of those programs here,” Tina said. “There’s a big lack of services.”

— with files from Black Press

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