What’s the Difference Between Occasional Obsessive Thoughts and OCD?

OCD is a term that’s incorrectly thrown around a lot to describe when people are being particular or obsessive about something. But obsessive compulsive disorder (OCD) is a clinical mental health diagnosis, and this flippant use of the term isn’t just inaccurate and stigmatizing—it can also prevent people from truly understanding what the condition is and the various ways it can actually present in people.

OCD is a chronic mental health condition characterized by uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions), according to the National Institute of Mental Health. The condition affects approximately 2.2 million people in the U.S., which is about one percent of the population, according to the Anxiety and Depression Association of America (ADAA). Obsessions are defined as intrusive and unwanted thoughts, images, or urges that cause a person to be stressed or anxious, while compulsions are behaviors that someone feels compelled to do in order to ease their stress or anxiety, or to help suppress their thoughts.

Common obsessions include thoughts about harming someone, a fear of germs or contamination, or unwanted thoughts about topics like sex, aggression, or religion. Compulsions are repetitive acts that the person feels they must perform in order to relieve the anxiety of the obsessions or, sometimes, to prevent something from happening, according to the National Alliance on Mental Illness (NAMI). Common compulsions can include checking behaviors (like repeatedly checking to make sure the stove is off or the door is locked), excessive cleaning or hand washing, or compulsive counting.

There’s a difference between occasionally feeling the urge to double check or deep clean something and having OCD.

Everyone repeats or double-checks things sometimes, and you may also like to do things a certain way, Mark Reinecke, Ph.D., chief of psychology at Northwestern Memorial Hospital, tells SELF. The key things to keep in mind are the frequency of these behaviors, the level of distress someone feels over them, and the amount that it interferes with a person’s life.

“Simply liking things a certain way is a matter of preference and you get a sense of reward for it,” Dr. Reinecke says. So, for example, you probably feel good (or at least glad it’s over) when you clean your kitchen or fold your laundry. But OCD is an anxiety disorder, and people take action based on things that they see as a threat, he explains. That could be germs, worry about a fire, or a personal safety concern (though compulsions aren’t always logically linked to an obsession). When people with OCD engage in their compulsions, they may feel temporary relief from their anxiety, but it doesn’t last, Dr. Reinecke adds.

People with OCD are also often distressed by their thoughts and behaviors, even when they recognize that they’re excessive, licensed clinical psychologist John Mayer, Ph.D., author of Family Fit: Find Your Balance in Life, tells SELF. “OCD causes conflict within the individual, whereas order or organization is a pleasant and peaceful thought,” he says. OCD is also repetitive and exists over a long period of time. This is very different from occasionally having the urge to stay home and clean your place or occasionally running home to make sure you locked your door.

People with OCD also spend at least an hour a day on their obsessions or compulsions, and have significant problems in their life due to their obsessions or compulsions, Jason S. Moser, Ph.D., an associate professor of psychology at Michigan State University, tells SELF. OCD can interfere with a person’s ability to get to work on time, or their ability to begin or maintain relationships, he says.

There’s also a difference between having occasional intrusive, obsessive thoughts and having OCD.

Again, the difference boils down to three major things, Dr. Moser says: how often you’re having these thoughts, how intense they are, and how much they interfere with your life.

“It’s pretty common for people to have ‘obsessions,’ that is, stressful thoughts that pop into our heads and feel uncontrollable,” Dr. Moser says. A lot of the things that people with OCD and those who don’t have the disorder obsess over can be similar, he says, like concerns about dirt and germs, personal safety, and fears that a spouse is unfaithful.

If you’re obsessing over a problem at work but stop once it’s resolved, it’s unlikely that you have OCD. But if you spend at least an hour every day having obsessive thoughts about an issue and have associated rituals that make you feel better, you may actually have OCD.

There is treatment for OCD. And with the right regimen, OCD can be very manageable.

The disorder is usually treated with medication, psychotherapy, or a combination of both, Dr. Reinecke says, adding that the combination seems to be the most effective.

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) can be used to help reduce OCD symptoms, the NIMH says. Certain types of psychotherapy, including cognitive behavioral therapy (CBT) and a specific form of CBT called exposure and response prevention (ERP) can be incredibly helpful for some people, according to NAMI.

ERP involves purposefully facing the things that make the person with OCD uncomfortable or fearful (like dirty handles) while not performing compulsions (washing their hands). “The therapist and client work together to build a list of situations or things that make the patient uncomfortable and gradually work up the ladder of distress,” Dr. Moser says. “When the person gets the experiences of exposing him/herself to something distressing but sits with that distress until it goes away, they get the learning experience that it is not as bad as they think and they can manage the distress without using their compulsion.”

However, therapy isn’t a one and done thing, Lawrence Needleman, Ph.D., a psychiatrist at The Ohio State University Wexner Medical Center, tells SELF. Many patients will start out going to therapy more regularly, like once a week, and then gradually reduce the amount they go to every three, and then six weeks, until they’re able to face their fears without compulsions, he explains.

If you suspect that you have OCD, reach out to a mental health professional for help. It can make a huge difference in your quality of life.

For many people, some combination of medication and therapy can greatly improve their symptoms so that they can live a fulfilling, productive life. “A person can recover and thrive,” Dr. Mayer says. “The cycle of OCD can be broken.”

Related:

Surgical option a potential life-changer for patients with OCD

Erin, an otherwise bright and engaging young woman, has been paralyzed by obsessive compulsive disorder. That’s determined the trajectory of her life since childhood. She was just 4 years old when a doctor prescribed medication. That began what – until recently – was a fruitless search to control the mental illness that controlled her life.

“I’d have anxiety attacks multiple times a day. I’d just be overthinking everything,” recalled Erin.

Something as routine as going out to eat would trigger an emotional meltdown.

“I’d feel like it would be the end of the world if I was going to pick the wrong thing,” she explained.

Then, there were the compulsive actions.

“If I came home from babysitting and I was the last one in the house, I would have to lock the door 33 times, even though I knew it was locked,” she explained. “I felt like something bad was going to happen if I didn’t do it.”

WEB EXTRA: Erin O’Donnell

School was a challenge. A messy blackboard would co-opt her attention, forcing her from the classroom. There were hospitalizations and suicide attempts.

When her longtime psychiatrist, Dr. Zvi Klopott, was asked if Erin was the worst case of OCD he had ever treated, “Probably,” he answered.

Frustrated by ineffective treatments, Klopott learned about a surgical option — deep brain stimulation. Used successfully for years to help relieve symptoms of Parkinson’s disease was holding out hope for people like Erin. Approved about 10 years ago by the FDA, it’s slowly catching on.

“Well, this may be a way to save her, because nothing else is working and she’s getting worse. She was hospitalized several times,” pointed out Klopott.

“I wasn’t that freaked out about the surgery, because it had so much potential to change my life,” noted Erin.

“The general theory is that the brain is abnormally firing and DBS [deep brain stimulation] creates a white noise that allows the brain to fire normally,” explained Dr. Julie Pilitsis, a neurosurgeon at Albany Medical Center.

Experienced with DBS for Parkinson’s patients, Pilitsis performed Erin’s surgery at Albany Medical Center on March 15. It was a first for her and the hospital – the only facility offering this treatment between New York and Boston.

This is what happened – two leads were inserted in Erin’s brain. While asleep for most of the procedure, she was woken up to ensure MRIs and GPS mapping of her brain had directed Pilitsis to the right spot for stimulation.

“She cracked a joke and smiled and looked content, which was new for Erin and for my interactions with her,” pointed out Pilitsis.

A pacemaker-like device was implanted near her collarbone. Then, leads from the brain were threaded down through the fatty area of the neck and attached, ready to deliver the right dose of stimulation to keep the intrusive thoughts at bay – which Erin will be able to control through an app on her phone.

Since the surgery, Erin is literally back at the plate, getting her groove back again to play softball at Elms College in Massachusetts, where she expects to return to in the fall – finally able to swing for the fences again.

“I used to be so ashamed of my mental illnesses and I used to try so hard to hide it,” she explained.
While her treatment is still ramping up, she’s already enjoying little victories – open kitchen cabinets that once triggered rage and an anxiety attack are now just open cabinets.

“I would have to run over and slam them closed,” remembered Erin. “Then, the other day, I noticed that they were open and I kind of just let it be for a little bit,” she pointed out.

That smile Dr. Pilitsis saw back in the operating room also means more.

“Now, it’s not like a fake it ‘till you make it smile. Now, it’s like a real, genuine happy smile,” beamed Erin. “Now, I can be who I really am and tell people my story and hopefully inspire people and help people along the way.”

WEB EXTRA: Dr. Julie Pilitsis

DBS is not a cure and it doesn’t provide 100 percent relief from symptoms. So far, it’s the only treatment that’s helped Erin and many others with resistant OCD.

There are strict guidelines about who is eligible for the surgery.


More information:

National Institute of Mental Health: Obsessive Compulsive Disorder

Deep Brain Stimulation info from International OCD Foundation

What is health anxiety and how can you overcome it?

It’s normal to worry about your health from time to time, but when the worry persists with no justifiable cause for concern, and the fear of illness becomes so great it hinders your whole life, it’s possible you might have health anxiety.

The condition, also known as nosemaphobia or hypochondriasis, is one of the most common reasons people seek therapy through Anxiety UK. The charity believes cases of health anxiety have been exacerbated in the modern era by Dr Google, with the worried searching their symptoms online and often wrongly concluding that a minor symptom is really a sign of serious illness.

People with health anxiety often worry about minor aches and pains (Thinkstock/PA)

Nicky Lidbetter, chief executive of Anxiety UK (anxiety.org.uk), says: “Health anxiety can be a vicious circle and if you constantly check your body for signs of illness, such as a rash or bump, you’ll eventually find something, often following this up with a Dr Google appointment.

“Often it won’t be anything serious – it could be a natural body change, or you could be misinterpreting signs of anxiety such as increased heart rate and sweating, as signs of a more serious condition.

“This form of self-diagnosis is a key factor behind the rise of health anxiety.”

  What is health anxiety?  

A person with health anxiety has persistent concerns about a specific illness or disease, such as cancer, HIV or heart disease, fearing they are already unwell or worrying they’re eventually going to get a diagnosis they don’t want to hear.

“It can also be a constant fear or worry about a series of health conditions that causes health anxiety,” explains Lidbetter. “It’s very natural for us all to worry about any form of illness and that could rise or fall depending on other stress or anxiety. But if the anxiety or worry is wholly focused on a preoccupation with a serious illness, despite reassurance from your GP or other medical professionals, then it would be classed as health anxiety.”

 What are the signs of health anxiety? 

People with health anxiety are likely to be extremely aware of minor symptoms such as headaches, joint pain or sweating, and think they’re symptoms of a serious medical complaint.

This can lead to stress and spark a vicious cycle, as stress can cause symptoms including headaches, nausea and pain, leading to worries that further symptoms of the feared disease are developing.

Sufferers may become nervous and obsessed with frequently checking possible symptoms. Some may need constant reassurance, complaining of their symptoms to friends and family, and visiting the doctor regularly, despite tests showing everything is normal.

People with health anxiety often become obsessed with checking for health symptoms (Thinkstock/PA)

Other sufferers may avoid visiting the doctor altogether, because they’re frightened of hearing bad news. They may also be reluctant to share their fears with loved ones, either because they’re afraid of having their fears confirmed, or because they believe they won’t be taken seriously.

“As with many forms of anxiety or phobias, the impact of health anxiety can range from it being a constant frustration that impacts on day-to-day quality of life,  to being extremely debilitating,” says Lidbetter.

“For some, the anxiety becomes chronic, and they may spend many hours checking for symptoms, seeking reassurance from others, surfing the internet for information about different diseases, or repeatedly visiting the doctor.”

What causes health anxiety?

“Your mind is your prison when you focus on your fears…” 🌑

A post shared by Anxiety UK (@anxietyukofficial) on

Sep 12, 2017 at 5:30am PDT

 

Knowing someone with a serious illness may be a trigger for health anxiety, but there are many other possible causes for the condition to develop, including a family history of a particular long-term or chronic illness such as cancer or heart disease.

Other triggers may include negative experiences in childhood, publicity campaigns around specific illnesses, or general anxiety leading to concerns about health.

Links to OCD

Health anxiety and obsessive compulsive disorder (OCD) can sometimes be  linked, because health anxiety sufferers can rapidly go from fearing illness to becoming obsessed about illness, convincing themselves that every ache and pain is a sign of something sinister.

Anxiety UK says that when health anxiety has its roots in OCD, sufferers often change the illness they’re worried about. For example, many young people with health anxiety initially worry about HIV, but as they get older they begin to worry about cancer and heart disease instead.  For this reason, it’s important that treatment doesn’t just focus on alleviating concerns about a specific disease, as the sufferer could then begin to worry about a completely different disease instead.

What’s the treatment?

Health anxiety is treatable, but recovery can take some time. Initially it might help to have a thorough check-up with a GP to help calm fears about specific illnesses. Talking therapy such as cognitive behavioural therapy (CBT), prescribed anti-depressant medication, or a combination of both is the most common form of treatment.

Local self-care and self-help support groups can help with finding ways to manage the condition, and Lidbetter notes that self-help books can be useful.

If you need extra advice, Anxiety UK can also provide help and information, as well as access to CBT support on 03444 775774.

Women’s experiences with postpartum anxiety disorders: a narrative literature review

Back to Journals » International Journal of Women’s Health » Volume 10

Authors Ali E

Received 1 December 2017

Accepted for publication 3 March 2018

Published 29 May 2018
Volume 2018:10
Pages 237—249

DOI https://doi.org/10.2147/IJWH.S158621

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Leyla Bahar

Peer reviewer comments 4

Editor who approved publication:
Dr Everett Magann

Elena Ali

Faculty of Nursing, University of Calgary, Calgary, AB, Canada

Purpose: Postpartum anxiety disorders are common and may have significant consequences for mothers and their children. This review examines the literature on women’s experiences with postpartum generalized anxiety disorder (GAD), postpartum panic disorder (PD), obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).
Methods: MEDLINE (Ovid), CINAHL, PsycINFO, and reference lists were searched. Qualitative and quantitative studies assessing women’s experiences with GAD, postpartum PD, OCD, and PTSD were included. Narrative approach to literature synthesis was used.
Results: Fourteen studies (among 44 articles) met the criteria for review to identify descriptions of women’s cognitive, affective, and somatic experiences related to postpartum anxiety disorders. Loss, frustration, and guilt, accompanied by physical symptoms of tension, were some of the experiences identified across studies. Most women suffered from more than one anxiety disorder, in addition to postpartum depression. To date, research has focused on prevalence rates of postpartum anxiety disorders, and evidence about clinical and subclinical symptoms of postpartum anxiety disorders and outcomes on mother and child is lacking. Postpartum anxiety disorders may have negative effects on parenting and child development; however, the nature of the underlying mechanisms is unclear.
Conclusion: More robust longitudinal studies are needed to examine the impact of postpartum GAD, PD, OCD, and PTSD symptoms on the mother and the mother–child relationship to develop targets for therapeutic preventative interventions.

Keywords:
postnatal anxiety, postnatal distress, childbirth, women’s beliefs and attitudes

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License.

By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Boston Medical Center to test web therapy for kids | Boston Herald

Boston Medical Center will receive a whopping $13.5 million to study treatment for childhood anxiety — an issue growing in prevalence that can have lifelong consequences.

“If it goes untreated, it can result in school difficulty, school failure, substance use and even suicide attempts,” said Dr. Lisa Fortuna, medical director for child and adolescent psychiatry services at BMC and the study’s principal investigator. “If children can’t receive treatment, it’s definitely going to get worse.”

Boston will be one of four research sites studying a group of more than 1,800 children ages 3-17 with mild to moderate anxiety.

Each child will be randomly assigned to receive 12 weeks of either online or in-person therapy and two subsequent years of monitoring.

The study will test whether receiving online counseling is as effective as face-to-face treatment.

If online therapy proves as effective, it could be a boon for mental health care access, Fortuna said.

“Help would be more accessible,” Fortuna said. “If patients come in and are screened as having anxiety disorders, then families could be provided with options.”

Researchers will use cognitive behavioral therapy — or CBT — to treat children. The approach involves patients confronting sources of anxiety to overcome their fears.

Anxiety disorders include: panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder and separation anxiety disorder.

Most children with anxiety do not receive treatment for several reasons, including stigma, a shortage of therapists and issues getting to appointments.

It is estimated that as much as 32 percent of adolescents suffer from anxiety, according to the National Institute of Mental Health.

Camila Cabello Opening Up About OCD Is a Big Deal — Here’s Why

taking care of their minds and bodies in 2018.

*

Earlier this month, singer Camila Cabello opened up to the world about living with obsessive-compulsive disorder (OCD). “If I get really stressed thinking about something, I’ll start to have the same thought over and over again, and no matter how many times I get to the resolution, I feel like something bad is about to happen if I don’t keep thinking about it,” the “Havana” singer told Cosmopolitan UKA few days later, Stranger Things and Riverdale actress Shannon Purser went public with her own struggle with OCD and suicidal ideation.

While many people across North America still seem to have an idea or preconceived notion of what obsessive-compulsive disorder is, there still seem to be a lot of misconceptions about what the disorder actually entails. This is why is it so important when stars like Cabello and Purser open up to the media about living with the disorder. 

Currently, it is estimated that about one to two percent of the population has OCD or will have it at some point in their lives. When hugely popular and public figures talk about their experience with a mental health disorder, we work towards breaking down the stigma and shame that surrounds such disorders. We also work toward advancing true and accurate representations of what conditions like OCD truly look like.

anyone in the mood for some….. #sangriawine? @pharrell

A post shared by camila (@camila_cabello) on May 16, 2018 at 2:43pm PDT

The invisible, cognitive aspects of OCD go far beyond what many have stereotyped as the “hand washing” mental illness. An obsessive-compulsive disorder is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).

While it can present differently in each person, obsessive-compulsive disorder isn’t just about the compulsive behaviors that may first come to mind (like hand washing); life-consuming obsessive thoughts can be a debilitating experience for sufferers. According to the Canadian Psychological Association, over 90 percent of people with clinical OCD have both obsessions and compulsions, with 25 to 50 percent reporting multiple obsessions. In fact, OCD is one of the top 20 causes of illness-related disability, worldwide, for individuals between 15 and 44 years of age.

If we want to undo misunderstanding and continue to support people who have been diagnosed, we need to know the best way to support them. The first thing we can do is learn how to change our language surrounding the OCD.

First and foremost, we need to stop making quirky statements about how we feel “so OCD” whenever we’re doing things like being organized or clean. These types of statements make those who are living with the disorder feel like their experiences are not valid. You should stop using “OCD” as a catch-all term to describe “obsessive” behaviors. Also, if someone shares with you that they do have OCD, maybe, just maybe, don’t ask if they wash their hands a lot. It’s likely, not the time and not the best way to support your friend.

📸: @hannahshlapak

A post shared by Shannon Purser (@shannonpurser) on Mar 31, 2018 at 9:43pm PDT

Let’s hope that, with more and more celebrities stepping forward, we can help change the narrative and better help change experiences for those around the country — and the world — who are living and dealing with OCD.

(Photo by Frazer Harrison/Getty)

Lily Bailey’s Because We Are Bad Made Me Rethink OCD

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Cognitive Behavioral Therapy Tailored To Anxiety

Cognitive behavioral therapy programs are easily quantifiable and testable, and have been the subject of numerous empirical researches which have proven the effectivity of the programs in resolving various psychological disorders which includes trauma related disorders, obsessive compulsive disorders, depression, and anxiety. There are over 40 studies in the instance of youth anxiety showing the effectiveness of cognitive behavioral therapy.

 

Anxiety disorders are a grouping of mental disorders associated with excessive worry or fear. The Diagnostic and Statistical Manual of MEntal Disorder lists 11 types: selective mutism; specific phobia; substance induced anxiety; generalized anxiety; unspecified anxiety disorder; social anxiety; agoraphobia; panic disorder; specified anxiety disorder; separation anxiety; and anxiety due to another medical condition.

 

Common characteristics of all anxiety disorders include negative thought process and poor means of social adaptations, restlessness, severe worry or fear, inability to control worry or fear, muscle tension, difficulty concentrating, and irritability; these symptoms result in problems in occupational and social functioning.

 

Cognitive behavioral therapy programs involve a well defined knowledge of patient condition which includes full medical and psychological history, comorbidities, psychological evaluation, and behavioral observations. CBT principle is that negative thoughts and behaviors affect emotions, and are products of irrational thinking and/or beliefs. Cognitive behavioral therapy programs focus on helping patients define and understand the condition of anxiety, followed by therapeutic sessions designed to focus on helping patients to dispute irrational thoughts and/or beliefs using various techniques such as mediation, mindfulness based therapy, and cognitive restructuring. Patients are taught appropriate means in which they can better handle their condition, reducing negativity, reducing resolution of irrational thoughts and/or beliefs using these techniques, many studies have shown these techniques to directly affect patient emotions and behavior. New thought process are strengthened through adaptive measures which are inculcated in patients during cognitive behavioral therapy programs. 

 

Cognitive behavioral therapy has been proven by many researchers to be an effective tool in the treatment of anxiety. Effectiveness of the psychotherapy using various inclusion criteria support prior empirical evidences of its efficacy in the treatment of anxiety. Specific anxiety disorders, and generalized anxiety have been found to be highly treatable using cognitive behavioral therapy programs, with there being ample evidence using multiple randomized control trials to support successfulness. Good therapeutic relationship, cognitive restructuring, comprehensive assessment, and skills training are helpful in achievement of greater success during CBT.

 

My intrusive sexual thoughts were actually pure OCD

Rose Cartwright was 15 when a series of disturbing thoughts suddenly began flashing through her head.

“I started getting intrusive thoughts that maybe I had abused a child, or that I could.”

They were accompanied by flashing mental images of it happening. “I was still a child myself, a virgin and extremely naive, and seeing things that were anathema. It was a nightmare.”

She had no idea these repetitive thoughts, doubts and mental images were a type of obsessive-compulsive disorder (OCD) referred to as ‘pure-O’ or ‘pure-OCD’.

The more she desperately tried to banish the thoughts from her mind, the more uncontrollable they became.

What is Pure OCD?

OCD is an anxiety disorder which has two main components: obsessions and compulsions, says Rachel Boyd, Information Manager at the mental health charity Mind.

“Pure O stands for ‘purely obsessional’. Unlike OCD, people can experience distressing intrusive thoughts but there are no external signs of compulsions, such as checking or hand-washing. If you have Pure O you will still experience mental compulsions, but you might not be aware of them. Because they are not as obvious as physical compulsions it can sometimes be difficult to define exactly what these compulsions are.”

‘I would delve around looking for clues as to whether or not what my thoughts were accusing me of were true’

Research suggests 1.3 per cent of the population have OCD, according to Mind. But a lack of awareness deterred Cartwright from telling anyone about what she was experiencing. “I thought I would go to prison if I told anybody.”

Cartwright, a writer and creative director based in London, became obsessed with trying to understand where the thoughts were coming from. “I’m not religious but I would repeatedly ask for forgiveness for my ‘sins’,” she recalls. “I would ruminate and delve around looking for clues as to whether or not what my thoughts were accusing me of were true.”

Am I gay?

Doctorsprescribed talking therapies and antidepressants (Photo: Joe Raedle/Getty Images)

The theme of her intrusive thoughts shifted as she grew older, taking the form of more general sexual thoughts. Now she began seeing mental images of people naked: friends sat across from her in the pub, uni lecturers in class, prospective bosses interviewing her for jobs.

She began to obsessively doubt herself and question her identity. “Maybe I’m gay? Maybe I’m bisexual? Maybe I don’t really want to be with the men I’m with?” The more she compulsively soul-searched for reasons behind these thoughts, the more overbearing they became, until her whole life was consumed by them.

“I became very severely depressed and highly anxious,” she says. “I started self-harming. I was bulimic. I desperately wanted to be loved by men, but I thought I can’t without knowing who I am.”

Cartwright struggled to articulate all of this to doctors, who prescribed talking therapies and antidepressants, treatments which were unsuccessful.

‘Repetitive intrusive thoughts were a hallmark of OCD, and actually, sexual scenes and violent scenes within that were extremely common’

But by 27, Cartwright had managed to tentatively tell a boyfriend what was happening to her. After conducting her own extensive research and a decade blighted by intrusive thoughts, she had what she calls her “eureka moment”.

“I discovered repetitive intrusive thoughts were a hallmark of OCD, and actually, sexual scenes and violent scenes within that were extremely common. This was exactly describing my life. From that point I was able to start telling doctors exactly what I thought was going on.”

Exposure prevention therapy

‘Exposure therapy tried to get me to embrace the doubt’ (Pixabay)

She eventually chose to undergo exposure and response prevention therapy [ERP], deciding to pay privately for treatment with an OCD specialist based in New York. “I was never offered that on the NHS. It is available, and I believe things are getting better all the time. But it’s a postcode lottery.”

ERP involves gradually exposing the person to their obsessive theme to get them to tolerate their presence instead of compulsively trying to escape them. According to Ms Boyd, ERP works by helping you confront your obsessions and resist the urge to carry out compulsions.“It is a recommended treatment for OCD, but it will work well for some people and not as well for others.”

‘I was taught to look at materials and just accept whatever emotions and anxiety that comes up when I do’

Exposure therapy tried to get her to embrace her self-doubts, says Cartwright. “When I had an intrusive thought about a woman, maybe when I was walking down a street and thinking about her breasts or thinking about having sex with her, instead of giving into the temptation to compulsively ruminate about what that meant, I would just have to go – ‘Maybe I’m attracted to her? Maybe I don’t want to be with my boyfriend?”

These ideas did not sit well with her – “I really did want to be with my boyfriend and would rather not be thinking about naked women. But resisting the temptation to run away from it took away some of its power.”

The therapy also saw her engaging with structured exposures to sexually explicit and pornographic content. “I was taught to look at materials and just accept whatever emotions and anxiety that comes up when I do.”

Bowled over by support

The publication of her story in a piece for The Guardian in 2013 under the pen name Rose Bretécher marked the first time her family had any idea of what she had been experiencing. Her piece was shocking, but she was bowled over by their support. The article, read more than 180,000 online in two days, caused “a bit of a stir”. People found her online almost immediately, telling her how they too were secretly experiencing what she had described. “I’ve been getting messages from people ever since, and that was five years ago.”

‘I don’t have these big identity questions that I once had. I just let them be there’

“Experiencing OCD can be very lonely and frightening,” says Ms Boyd. “Asking for help is one of the most important things to do. Speak to someone you know and trust – such as a friend or family member – or go to your GP, who can talk you through the support that’s available.”

Cartwright wrote a crowd-funded book on her experiences, Pure, which is now the subject of a six-part Channel 4 drama, due to air in autumn. She hopes this will create more awareness of this kind of OCD. “I still have intrusive thoughts, intrusive doubts, intrusive mental images, but they don’t ruffle my feathers like they used to because I don’t engage compulsively with them,” she says. “I don’t have these big identity questions that I once had. I just let them be there.”

Pure by Rose Bretécher is available for £8.99 here

Speaking to your GP about mental health for the first time can seem daunting, so Mind has produced a guide called ‘Find the Words’ to help you prepare for your appointment. It is available here. Visit Mind’s website for more information or call 0300 123 3393.

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Social Anxiety Doesn’t Get The Attention It Deserves

As a result of such stigmas, the socially anxious are prone to self-medicating in an attempt to face their fears, says Johnson. But seeking professional help from a qualified therapist who is familiar with the current research-based treatments can go a long way in alleviating the symptoms. Such therapies include cognitive behavior therapy, commitment therapy and exposure therapy. In-person support groups and online forums, like the Anxiety Tribe Group, can be beneficial.

LISTEN | Mshoza opens up about her obsessive-compulsive disorder

Mshoza said she was lucky in that she decided to write out her goals whenever she felt the urge to write in her books.

“I wrote my dreams, my future. I can’t say that I predicted because I wrote things that I was going to do, not things that I wished. It started when I was young, so as I grew up, I grew up doing the same thing and my mom used to say, ‘you need to see a doctor, there’s something wrong with you.”

Mshoza said when she was young she would write about how big of a superstar she would be. She said before she knew that she was constantly affirming her dreams through her writing, a result of her OCD, she was already a child star.

Since then Mshoza has released chart topping songs and has equally been at the centre of controversy, with everything from skin bleaching to abusive relationships. Soon after her mother died last year, she revealed that she was struggling with depression.

9 Things You Didn’t Know Anxiety Can Look Like – Bustle

As someone who has severe gastrointestinal issues, when I experience severe anxiety, it first pops up in my digestive tract: I’ll encounter acid reflux, heartburn, and unexpected vomiting. It will feel like my body is fighting against me, but in many ways, it’s my stomach’s way of telling me to slow down and address my mental health. And although I loathe the feeling that follows, I am grateful for this warning sign.

It’s not the way anxiety is portrayed on television and in film — uncontrollable shaking, shortness of breath, fainting, etc. — and I know now that many people who struggle with their mental health can exhibit their internal mindset in varying, subtly external ways. Anxiety is a subjective experience: there is no one-size-fits-all depiction.

According to a 2013 study by the Anxiety and Depression Association of America, approximately 40 million American adults struggle with some form of an anxiety disorder. Now, more than ever, it is crucial to look out for indications of anxiety, past just a racing heart or heightened anticipation, so that we can help both ourselves and those we care for call attention to mental health.

Here are some of the different ways that that anxiety can manifest itself — so the next you or a loved one is grappling with your mental health, you can address it head on.

1Eating Disorders

Andrew Zaeh for Bustle

When anxiety feels like an uncontrollable, heavy burden that weighs them down, some may turn to what they can control instead: their bodies. According to a 2016 study by the Anxiety And Depression Association of America, eating disorders commonly co-concur with anxiety disorders, and can make symptoms much worse.

This can manifest in many different ways, from an eating disorder like anorexia or bulimia, to an obsession with healthy food and exercise. They’re all are harmful ways of coping with and managing crippling anxiety. It is crucial that those struggling with both anxiety and an ED get treated for not just one, but both.

2Sleep Problems

Andrew Zaeh for Bustle

Severe anxiety can trigger a plethora of sleep problems, from insomnia or narcolepsy, to sleep walking or lucid dreaming. “One of the most common signs and symptoms of anxiety are what we call parasomnias — problems sleeping,” Dr. Gary Brown, licensed psychotherapist, tells Bustle. “When we feel anxious, it can be difficult to fall asleep, stay asleep, and we can also have disturbed sleep in the form of nightmares and even night terrors. As upsetting as this can be, these are upsetting but perfectly normal responses to anxiety.”

3Excessive Substance Consumption

Andrew Zaeh for Bustle

Binge drinking, or even popping prescription medication, can be telltale signs that someone is struggling with the larger issue of anxiety or depression.

“Feelings of anxiety can be so painful that we can be tempted to “numb the pain” by self-medicating with alcohol, prescription and non-prescription medications, and street drugs,” Dr. Brown says. “Whenever we self-medicate, we run the risk of creating an even bigger second problem of substance abuse on top of the anxiety that we feel.”

4Posting A Lot On Social Media

Andrew Zaeh for Bustle

If someone starts to become hyperactive on social media platforms, it could be a sign that they are struggling with anxiety. According to a 2017 study published in Society for Consumer Psychology, many people with anxiety disorders have a paradoxical need to reach out to others, and a fear of ‘bothering’ another person. Social media gives them the outlet they desire without the threat of face-to-face confrontation.

5The Need To Control Things

Andrew Zaeh for Bustle

Sometimes when people try to control their anxiety, it can manifest as a form of OCD. “One of the underlying feelings associated with anxiety is fear that there are things in our life that we can’t control,” Dr. Brown says. “The need to reassert control is why many people develop obsessive compulsive disorder as a way to reestablish and maintain control in our lives. OCD is often expressed in doing the same things, compulsively, and repetitively to the point of trying to make everything orderly and perfect.”

6Nervous Ticks Like Itching, Picking, Or Biting

Andrew Zaeh for Bustle

Itching compulsively, picking at scabs, or biting nails are extremely common, physical ways of channeling one’s anxiety into a physical outlet. “Anxiety can be experienced in any number of ways, as it relates to severity,” Dr. Brown says. “It’s typically a result of the cumulative stressors that all of us can experience during certain phases of our lives. It can be the result of stressors at work, school, home, or other situations we encounter in our life.”

7Developing An Unexplained Phobia

Ashley Batz for Bustle

Developing a phobia late in life that seems somewhat random or unexplained can be linked to an unspoken fear or underlying anxiety. “Some of the more common phobias include fear of flying, fear of heights, fear of being trapped in a confined space, fear of crowds, and numerous other phobias,” Dr. Brown says.

8Avoiding Social Situations

Ashley Batz for Bustle

If you find yourself more isolated than usual, avoiding all forms of social interaction, and only engaging when with the people in your life when forced, this could be a sign of a larger anxiety disorder. “Many people who suffer from anxiety, are chronically afraid of social situations because they fear being judged, ridiculed, and rejected by others,” Dr. Brown says. “Social Anxiety Disorder is one of the more painful ways that anxiety can manifest.”

9Problems Digesting Food

Ashley Batz for Bustle

According to a recent study by Harvard Health, the gastrointestinal tract is heavily tied to emotion, and anxiety, depression, anger, and more, can all trigger gut problems. This can range from temporary diarrhea or acid reflux, to chronic pain and illness, like IBS or Gastroparesis.

If you are struggling with anxiety, depression, or any other form of mental illness, know that you are not alone. Just because your experience of anxiety doesn’t look like somebody else’s, it doesn’t make it by any means illegitimate. Don’t be afraid to reach out for help, because your mental health is important and your feelings are valid.