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    Raising awareness about postpartum depression

    Deborah Rimmler was so looking forward to the birth of her first baby. “My whole life, I wanted to have a family,” she says. She married late and had her baby boy when she was 43, in 2009. Within a week of giving birth, she was wrestling with postpartum depression (PPD), which affects about 15 percent of new mothers.

    Rimmler’s case was a variation on the illness, called postpartum obsessive-compulsive disorder. On June 21, Rimmler, who lives in Lenox with her husband and two sons, ages 4 and 2, will participate in a fund-raiser called Climb Out of the Darkness. She will hike Mount Greylock with others to help raise money and awareness for postpartum depression.

    Q. Tell me about the hike. How did you come up with the idea?

    A. I helped set up a nonprofit called Postpartum Progress Inc.
    We want to help people understand the massive size of the problem. With part of the funds we raise, we’ll put together materials for OB-GYNs and pediatricians to give out to new moms that talk honestly about this stuff. On June 21, women all over the world will participate in the first annual Climb Out of the Darkness. It’s the longest day of the year in the Northern Hemisphere, and PPD survivors will climb or hike a local mountain or park to symbolize our collective rise out of the darkness. There are more than 85 different climbs. Mine is Mount Greylock.

    Q. Can you describe what happened when your first baby was born?

    A. For a couple of days I felt okay. But then I started having horrible, intrusive thoughts. I had just seen the last episode of “M*A*S*H,’’ and Hawkeye is having a flashback about being on a bus that breaks down with a bunch of South Koreans on it. There’s North Korean patrols in the area, and a woman had to strangle a chicken so it would quit making noises. But it turned out it wasn’t a chicken, it was a baby. The most gruesome thoughts kept getting replayed in my brain.

    Q. What sort of thoughts?

    A. You start to have an image that you could hurt your child. I was scared to be alone with my child. Needless to say, it’s horrifying. I’m an attorney, and I’m lucky I could afford a doula during childbirth. She started noticing stuff and asked me if I was OK Finally, I broke down in tears. I’d heard of postpartum depression, but no one gives you a handout that tells you what it is, what the symptoms are.

    Q. What is it exactly?

    A. It’s sort of the perfect storm in your brain. Your hormones drop precipitously after birth. You’re not just a little depressed. You feel hopeless, awful, and extremely anxious. Some people can’t get out of bed. Some have crazy thoughts like I was having. In simple terms, your brain is just misfiring.

    Q. What helped you?

    A. I had a wonderful doctor, and a doula who told me I would get better. I took an anti-anxiety drug and that helped calm it down but it really took four or five months for the symptoms to go away. One night in despair, I stumbled upon a blog written by an amazing community of postpartum mood and anxiety disorder survivors [www.postpartumprogress.com]. It was founded by Katherine Stone in 2004, after her first child was born. It’s grounded in the latest science and research, and she has doctors and social workers who blog. When I first met her, I thanked her for saving my life. When I got pregnant again, I went on an anti-depressant and the symptoms cleared. I had another perfectly beautiful, healthy son.

    Q. Does everyone get better?

    A. From my lay perspective, I think you will get better with professional help. We try to be really careful and not say we are totally in favor of medication because a lot of people are opposed to that. But I think that especially with medication, you will get better. What I had is very treatable.

    Q. Is there a stigma attached to PPD?

    A. Most people are very reluctant to talk about it. I’m general counsel of a multinational corporation and I’m putting it out there that I’ve got a mental health issue. I’ve actually had supportive family and friends, but the thing is, most people don’t get it.

    Q. Were there any indications in your life that something like this might happen?

    A. When I look back at it, I had similar things. I was anxious. I stopped watching TV news because I had too many nightmares.

    Q. Why are you going public?

    A. I want to be honest so other moms know these intrusive thoughts are a symptom of a disease and not coming from some awful dark place in their soul. Instead of women keeping this nightmare to themselves they should reach out for professional help so they can move on to bonding with their babies.

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    ‘If I sit down too quickly, will I break my spine?’ How Ian Puleston-Davies …

    By
    Sue Crawford

    16:00 EST, 15 June 2013


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    16:00 EST, 15 June 2013

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    It is testimony  to Ian Puleston-Davies’s acting skills that he plays a tough, carefree builder in Coronation Street.

    For it is a character completely at odds with his own. Ian suffers such extreme anxiety he worries that if he picks up his children, he might hurt them, or that if he sits down too quickly he will crack his coccyx.

    While his soap character Owen merrily blusters about in the Rovers Return pub, for Ian just drinking a pint is an ordeal.

    Taking control: Actor Ian Puleston-Davies who plays Owen Armstrong in Coronation Street,opens up about his long struggle with crippling OCD

    Taking control: Actor Ian Puleston-Davies who plays Owen Armstrong in Coronation Street,opens up about his long struggle with crippling OCD

    ‘I’m terrified that the glass is cracked and I’ll swallow glass, or that it’s stained and dirty,’ he explains.

    ‘Before rehearsing every scene, I have to go through a series of checks, like feeling the lip of the glass with my finger to make sure it’s not chipped and examining it for stains.

    ‘I sip very slowly as I think I’ll cut myself if I drink too quickly, and I make sure my teeth are far away as I’m convinced I’d scratch them otherwise.

    ‘If I jump into a van I practise sitting down in it first, or if I sit down quickly I check the seat has padding, as I worry I’ll break my coccyx. I am always checking that things won’t hurt me.’

    Ian, 54, suffers from Obsessive Compulsive Disorder (OCD) and is constantly plagued by intrusive worries about contamination, germs and harm.

    The condition is one of Britain’s most common mental health problems and is characterised by unsettling thoughts or compulsions.

    Compulsions: Ian, pictured with Anna Windass, played by Debbie Rush on Coronation Street, has suffered from severe OCD since he started working as an actor and feared it would wreck his career

    Compulsions: Ian, pictured with Anna Windass, played by Debbie Rush on Coronation Street, has suffered from severe OCD since he started working as an actor and feared it would wreck his career

    ‘I liken it to an overactive antenna,’ says Ian, who lives in Chester with his girlfriend Sue MacPherson and their two children, Maggie, five, and Charlie, two. ‘When most people process information, they discard 99 per cent. But my antenna gets clogged up, so my brain ends up full of unnecessary thoughts.’

    OCD usually starts in early adult life but can begin at any time, including childhood, as Ian found out. He was just seven when he was teased by schoolfriends for compulsively checking his trouser zip was fastened during football kickabouts.

    He recalls: ‘I also began checking my shoes every few yards I walked, in case I’d trodden in dog dirt. As a teenager I was always last to leave the changing rooms after swimming as changing in a small cubicle was a nightmare. I took ages because the fear of dropping my clothes on the wet floor was too horrific for words and my body had to be bone dry.’

    By the time Ian reached adulthood, he had realised his behaviour was unusual but thought he was the only person who felt that way. By then his anxieties were extreme.

    ‘My first fear of the day was lifting my head off the pillow – I thought if I did it too quickly, my neck would break. Then I’d be scared that if I sat up too quickly I’d damage my spine and if I stood up too quickly I’d break my ankles.’

    Outside the house, things were even worse. ‘I’d worry there were germs on door handles. On the pavement I saw every mark and would analyse how far away it was and whether it was toxic.’

    At 21, Ian began working as an actor. He has appeared in countless shows and films, including the Guy Ritchie movie Revolver, Ghostboat with David Jason and acclaimed drama My Beautiful Son. But he feared his obsessions would wreck his career.

    OCD MAKES NORMAL LIFE IMPOSSIBLE FOR THOUSANDS

    More than 750,000 adults and children in the UK suffer from OCD – more than one per cent of the population.

    Symptoms are usually intrusive thoughts or repetitive compulsions. Some people suffer only compulsions – such as repeated checking or tidying – while others experience only obsessions or extreme worrying.

    ‘There are three main components,’ says Consultant Psychiatrist Dr Jim Bolton.

    ‘The obsessional thoughts, the anxiety they cause, and the compulsion – the thing someone does to relieve the anxiety, such as washing their hands.

    Half of sufferers undertake compulsive rituals so often that normal life is impossible.’

    The exact cause is unknown. It can run in families or be triggered by stressful events. It often goes hand-in-hand with illnesses such as anxiety and depression

    Another explanation – believed by Ian – is that OCD is triggered by low levels in the brain of serotonin, a neurotransmitter that regulates mood and anxiety.

    ‘I’d almost been late on stage several
    times. I’d be in my dressing room obsessing about marks on the mirror.
    And once I missed my cue as I was still standing on a chair examining my
    fingernails under the light, worrying they were too long.’

    While
    many people have only mild or moderate OCD, about half of all sufferers
    have it severely, like Ian, and the condition completely takes over
    their life.

    He says: ‘At its worst it was 24/7, because I was dreaming it as well. I couldn’t go to the cinema for 20 years because I’d obsess about people sitting around me – are they friends? why are they here? – and it would ruin the film.’

    Ian was 35 when he finally got help. During a bout of depression following a relationship break-up, he began seeing a counsellor and confided in her about his behaviour.

    ‘By then I’d narrowed it down to three things: early dementia, a blood clot or madness. Now people know a lot about OCD, but back then I didn’t know what it was and nobody around me did either.’

    The counsellor referred him to a private psychotherapist in Harley Street, who diagnosed OCD. ‘I wept with relief that I wasn’t going crazy and also with anger and frustration that no one had told me what I’d had since I was seven.’

    Ian was prescribed Prozac and referred to the Maudsley Hospital in South London, which specialises in mental health problems. There he received Cognitive Behavioural Therapy, which trains the brain to think in a different way. He also began attending a self-help group.

    The treatment helped him feel more in control at work and his career flourished. In 2010 he joined Coronation Street, where the cast have been very supportive.

    ‘Antony Cotton [barman Sean Tully] knows about my condition and when he serves me a pint he’ll say, “It’s clean, it’s not chipped – I’ve examined it.” The people I work with closely are my safety blanket because when I’m overwhelmed I turn to them for help.

    ‘I’ll say to Mikey North, who plays Gary Windass, “I just scratched my head. My nails aren’t so long that I would cut my scalp, are they?” ’

    After more CBT, Ian came off medication last year and believes he is 85 per cent cured.

    ‘The final straw came when we were on holiday last summer. Sue and I were arguing a lot about my OCD, which was particularly bad. I worried when I picked up Maggie or Charlie – had I scratched them or wrenched their neck? I was completely obsessive.

    ‘I was 54 and my OCD was still no better. I didn’t want my family to suffer another minute so vowed to finally get rid of it. There’s no easy escape; you just have to be determined to beat it. But I honestly believe you can, and since then I have been much more in control.

    ‘I want on my gravestone, “Ian did not go to his grave clutching his wet wipes.” OCD is like the twin I wish I never had, and I despise it for tampering with my life. I don’t want to live with it any longer.’

    lan is a patron of OCD-UK, which supports children and adults affected by Obsessive Compulsive Disorder. For more information, go to ocduk.org.

    The comments below have not been moderated.

    Poor King Thistle, surely Nanny Plum can help.

    – Shirefolk , Yorkshire, United Kingdom, 16/6/2013 08:05

    I didn’t mean to offend, I am very much a fan of his voice acting and am quite thankful for Ben and Holly as a parent. I wish him the very best.

    Shirefolk
    ,

    Yorkshire, United Kingdom,
    16/6/2013 22:37

    Yes get a grip get a life pull your self together great job great salary stop moaning make the most of it

    Mr Pink
    ,

    Ashford Kent,
    16/6/2013 20:57

    Ian, if you’re reading this, perhaps we can eliminate one of your smaller issues. Tooth enamel is harder than glass so the glass won’t cut your teeth in the same way as glass won’t cut diamonds, it’s physically impossible. And glass is actually a liquid, so perhaps if you remember that when you start to worry, things may get a little better where glass is concerned.

    Hope that helps a tiny bit and good luck!

    djonh
    ,

    doncatser, United Kingdom,
    16/6/2013 19:44

    I think I have a bit of OCD not sure how extreme it is whether it goes so far it is clinical physiological illness or not, but you don’t know what it is like to feel fear of not being able to do things or that things like spiders which I am afraid of could appear and run at me at any time. But I have had so much stress in life more than my fair share, its that constant unrelenting stress that is behind OCD, that’s what I believe anyway.

    Just Me
    ,

    The North, United Kingdom,
    16/6/2013 17:30

    Oh get a grip you wimp, too many people pandering to wet nellies these days!!

    An Englishwoman
    ,

    Newcastle UK-Tampa FL,
    16/6/2013 16:59

    I thought he was the head of modern languages at William Dunwoody School and got the lab technician pregnant? One for the Partrdige fans.

    horseloverphat
    ,

    dublin,
    16/6/2013 16:10

    Without realising I suffered OCD for years. From an early age I had a terror of eating away from home. I could not have school meals, did not attend the birthday parties of childhood friends, and couldn’t even eat at the homes of relatives. I have gradually overcome most of this, but even now I have no idea why I was frightened. I can cope if I plan things in advance and have actually enjoyed many meals in restaurants. However, if I am caught unawares I still panic – if I am out somewhere and I am offered food or drink I have a desperate urge to run away. One thing that I still cannot manage is drinking from a cup or glass someone else has used. I remember once going ballistic when a friend took a sip from my glass – I picked up the glass and threw the drink in his face. Friends sometimes tease me about my desperate need to have everything in the right place, another aspect of my OCD. I always know when things have been moved and have to put them right. It is miserable at times.

    Philip
    ,

    Birmingham,
    16/6/2013 15:09

    Without realising I suffered OCD for years. From an early age I had a terror of eating away from home. I could not have school meals, did not attend the birthday parties of childhood friends, and couldn’t even eat at the homes of relatives. I have gradually overcome most of this, but even now I have no idea why I was frightened. I can cope if I plan things in advance and have actually enjoyed many meals in restaurants. However, if I am caught unawares I still panic – if I am out somewhere and I am offered food or drink I have a desperate urge to run away. One thing that I still cannot manage is drinking from a cup or glass someone else has used. I remember once going ballistic when a friend took a sip from my glass – I picked up the glass and threw the drink in his face. Friends sometimes tease me about my desperate need to have everything in the right place, another aspect of my OCD. I always know when things have been moved and have to put them right. It is miserable at times.

    Philip
    ,

    Birmingham,
    16/6/2013 15:09

    It is a very debilitating illness , which can effect all aspects of your life , anyone who has had experience of this will know that it takes over your life and every aspect of it , in very severe cases . i really feel for people who are suffering , some in silence with this .

    blowyournose
    ,

    LEEDS, United Kingdom,
    16/6/2013 13:17

    Very courageous of Ian to speak about this very debilitating condition. My son has Aspergers and also OCD with high anxiety disorder. My son is constantly checking, re-checking things. A light switch has to be pushed on and off several times before he is okay with the light being on or off, everything is done over and over again and painful to watch. For those trolls who think it is something and nothing, let’s hope you never suffer from anything like it, it is real and a living nightmare for the sufferers.

    oldgirl
    ,

    Braintree,
    16/6/2013 13:04

    The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline.

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    Obesity Linked To Obsessive-Compulsive Behavior Via Brain Circuit

    Featured Article
    Academic Journal
    Main Category: Obesity / Weight Loss / Fitness
    Also Included In: Neurology / Neuroscience;  Psychology / Psychiatry
    Article Date: 11 Jun 2013 – 3:00 PDT

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    An investigation of the brain circuits behind compulsive behavior has surprisingly revealed they may be intimately linked
    to circuits that control obesity. The US researchers say the discovery offers new insights into the development and treatment of
    both compulsive behavior and eating disorders.

    Study leaders and neuro-psychiatrists Michael Lutter and Andrew Pieper of the University of Iowa (UI), and colleagues, write
    about their work in this week’s online early edition of the Proceedings of the National Academy of Sciences (PNAS)
    .

    They describe how they bred mice missing a gene known to cause obesity, and suspected of being involved in compulsive behavior, and mated them with mice bred to have compulsive
    grooming and were surprised to see offspring that were neither obese nor compulsive groomers.

    They say this shows the brain circuits that control obsessive-compulsive behavior are meshed with circuits that control food intake
    and body weight: a finding that will have implications for treating the compulsive behavior in many psychiatric
    diseases like obsessive-compulsive disorder (OCD), Tourette syndrome, and eating disorders.

    Obese Mice and Compulsive Groomers

    The researchers worked with two types of mice engineered for studying human disorders: one bred to study compulsive behavior
    (Pieper’s field of interest), and the other bred to study an inherited form of obesity (Lutter’s specialism).

    The compulsive behavior mice are missing a brain protein called SAPAP3, the lack of which causes them to groom themselves
    excessively. The behavior can be effectively controlled with fluoxetine, a drug commonly used to treat OCD in people.

    The inherited obesity mice lack a brain protein called MC4R. Mutations in the MC4R gene are the biggest single-gene cause of
    over-eating and morbid obesity in people.

    Lutter, an assistant professor of psychiatry at the UI Carver College of Medicine, is interested in MC4R signaling pathways and
    how they affect the development of obesity.

    “I’m also interested in how these same molecules affect mood and anxiety and reward, because it’s known that there is a
    connection between depression and anxiety and development of obesity,” he explains in a statement.

    What Happened When the Two Strains Interbred

    Lutter and Pieper, who is an associate professor of psychiatry and neurology at Carver, were aware of an old study that suggested
    MC4R might play a role not only in food intake and obesity, but also in compulsive behavior, so they decided to test the idea, as
    Lutter explains:

    “We knew in one mouse you could stimulate excessive grooming through this MC4R pathway and in another mouse a different
    pathway (SAPAP3) caused compulsive grooming.”

    “So, we decided to breed the two mice together to see if it would have an effect on compulsive grooming,” he adds.

    The breeding experiment bore out their hypothesis: knocking out the MC4R protein in OCD mice lacking SAPAP3 normalized their
    grooming behavior. And they also found chemically blocking the protein had the same effect, which was mirrored by normal
    patterns in brain cell communication linked to compulsive behavior.

    Unexpected Finding: Deleting Both SAPAP3 and MC4R Led to Normal Weight Mice

    But they were surprised by another totally unexpected finding. Deleting SAPAP3, lack of which causes compulsive grooming,
    restored normal weight in mice without MC4R, lack of which would normally make them obese.

    “We had this other, completely shocking finding — we completely rescued body weight and food intake in the double null mouse,”
    Lutter exclaims.

    Thus it appeared that they were influencing two, until now unknown to be related, brain regions simultaneously: one involved in
    grooming and behavior, the other with food intake and body mass.

    Explanation May Lie In Evolution

    Lutter suggests that while a connection between obesity and obsessive-compulsive behavior might not be obvious at first, there
    could be an evolutionary explanation. Survival depends on eating clean, safe food, so when this is abundant, the drive increases,
    and when it is scarce, it decreases.

    “Obsessive behavior, or fear of contamination, may be an evolutionary protection against eating rotten food,” he
    explains.

    Oils and fats are calorie- and nutrient-rich but also spoil more quickly than foods that are less dense in nutrients and calories like
    onions, apples and potatoes.

    (Refrigeration, which reduces risk of contamination, has not been around long enough to have made an impact on the evolution of
    these brain circuits.)

    Lutter wonders if the circuits they have found help determine whether or not to eat calorie-dense foods.

    Perhaps a disturbance in the circuits may on the one hand result in obesity because people are less anxious and obsessive and
    consume energy-dense foods, and on the other hand they are excessively anxious and obsessive and limit their food selection or
    intake, leading to disorders like anorexia nervosa, Tourette syndrome, or OCD.

    Pieper says they now want to find out if the two pathways talk to each other. Whatever the answer, it is likely to increase
    understanding toward new drugs for treating some of these disorders.

    Funds from The Hartwell Foundation, the Brain and Behavior Foundation, the National Institutes of Health and a NARSAD
    Young Investigator Award helped finance the study.

    In another study published in January 2013, researchers at MIT describe how they used optogenetic brain stimulation to block compulsive behavior
    in mice lacking SAPAP3.

    Written by Catharine Paddock PhD

    Copyright: Medical News Today

    Not to be reproduced without permission of Medical News Today

    • Additional
    • References
    • Citations

    “Double deletion of melanocortin 4 receptors and SAPAP3 corrects compulsive behavior and obesity in mice”;

    Pin Xu, Brad A. Grueter, Jeremiah K. Britt, Latisha McDaniel, Paula J. Huntington, Rachel Hodge, Stephanie Tran, Brittany L.

    Mason, Charlotte Lee, Linh Vong, Bradford B. Lowell, Robert C. Malenka, Michael Lutter, and Andrew A. Pieper; PNAS,

    published online ahead of print 10 June 2013; DOI: 10.1073/pnas.1308195110; Link to Abstract.

    Additional source: Iowa Now from The University of Iowa.

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

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    obesity – good blog

    posted by Alina Mark on 11 Jun 2013 at 12:23 pm

    This blog provide good information to those who are obese. Obese patients know very little about their problems but this blog contribute alot for the patients.

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    ‘Obesity Linked To Obsessive-Compulsive Behavior Via Brain Circuit’

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    Obsessive-Compulsive And Obesity Genes Could Be Related

    Follow us

    The study, led by neuropsychiatrists Michael Lutter and Andrew Pieper from the University of Iowa, examined the effects of breeding two genetically altered mice. One of the mice lacked a gene called SAPAP3, which caused it to groom itself to the point that it had lesions in its skin, while the other mouse lacked a gene called MC4R, causing it to be obese. Deficiencies in MC4R are the most common single-gene cause of morbid obesity and over-eating in people. The gene is also suspected to play a part in compulsive behavior.

    Based on previous studies, the team knew that obesity gene MC4R was related to compulsiveness in some sort of way. Their original intent was to see the effects breeding would have on compulsiveness.

    “We knew in one mouse you could stimulate excessive grooming through this MC4R pathway, and in another mouse a different pathway (SAPAP3) caused compulsive grooming,” Lutter said. “So, we decided to breed the two mice together to see if it would have an effect on compulsive grooming.”

    Their hypothesis was correct. The mice born to the two genetically altered mice had neither MC4R nor SAPAP3, and their grooming behavior was normal. This meant that the compulsiveness associated with a lack of SAPAP3 was balanced out by the lack of MC4R, which can cause compulsiveness when present — their brain cell communication patterns linked to compulsive behavior were normalized.

    But going further than normalized grooming, the researchers also found that the mice didn’t grow to become obese. Although the mice had no MC4R, which could have caused them to become obese, the lack of SAPAP3 took away their compulsive behavior.

    “We had this other, completely shocking finding — we completely rescued body weight and food intake in the double null mouse,” Lutter said. “So, not only were we affecting the brain regions involved in grooming and behavior, but we also affected the brain regions involved in food intake and body weight.”

    Compulsive behavior has been associated with many forms of psychiatric disease, most notably obsessive-compulsive disorder (OCD), but also Tourette syndrome, and eating disorders.

    When speaking about his specialty, MC4R, Lutter said, “I’m also interested in how these same molecules affect mood and anxiety and reward, because it’s known that there is a connection between anxiety and development of obesity.”

    According to a 2006 National Institute of Mental Health-funded study, one out of four cases of obesity is associated with a mood or anxiety disorder. However, the causal relationship between the two remains undetermined. The study found that the increasing rates of obesity in the U.S. are in-line with the increasing rates of depression, bipolar disorder, panic disorder, and many other disorders. It also found that social and cultural factors seem to influence the presence of obesity, with the strongest connection among college-educated non-Hispanic whites ages 29 and younger.

    However, Lutter believes that the connection between compulsive behavior and obesity lies in the evolutionary need to eat safe, clean food.

    “Food safety has been an issue through the entire course of human evolution — refrigeration is a relatively recent invention,” he said. “Obsessive behavior, or fear of contamination, may be an evolutionary protection against eating rotten food.”

    Sources: Lutter M, Pieper A, Xu P, et al. Double deletion of melanocortin 4 receptors and SAPAP3 corrects compulsive behavior and obesity in mice. PNAS. 2013.

    Simon GE, Korff M, Saunders K, et al. Association Between Obesity and Psychiatric Disorders in the U.S. Adult Population. Archives of General Psychiatry. 2006

    10 signs you may have obsessive-compulsive disorder

    Hooked on hand sanitizer? Closet organized to a T? Quirks like this can usually be chalked up to personality or preference, but in some cases they may point to a more serious issue: obsessive-compulsive disorder (OCD), a condition marked by obsessive thoughts and compulsions that affects about 1 percent of U.S. adults.

    How can you tell if OCD tendencies are symptoms that require professional help? There’s no easy test, as it’s usually a matter of degree, said Jeff Szymanski, executive director of the International OCD Foundation, a Boston-based advocacy organization. Still, there are certain patterns that may indicate the full-blown disorder. Here are 10 of the most common.

    Hand-washing

    Compulsive hand-washing or hand sanitizer use is so prevalent in OCD that “washers” has become a widely accepted category of OCD patient. The urge commonly stems from a fear of germs (the most common obsession seen in OCD), but it also can be rooted in fears of making others sick or of being impure or immoral.

    When to seek help: If you think about germs even after washing your hands, worry that you’re not scrubbing well enough, or have irrational fears about disease (such as getting HIV from a shopping cart), it could be a sign that your hand-washing is compulsive, Szymanski said. Elaborate hand-washing routines—needing to wash five times and get soap under each nail, for example—are another warning sign.

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    Overzealous cleaning

    People with OCD who fall into the “washers” category also tend to clean compulsively. As with hand-washing, housecleaning is often a way of easing germaphobia or feelings of impurity. Although cleaning can help chase these obsessive thoughts away, the relief does not last, and the urge to clean is often even stronger the next time.

    When to seek help: If you spend hours a day cleaning, it’s almost certainly related to OCD, but it’s harder to know if cleaning for an hour a day could be a sign of OCD. “It’s really the consequence of stopping,” said Dr. Michael Jenike, a psychiatrist at Massachusetts General Hospital, in Boston. “If you don’t [clean], you get terribly anxious and fearful.”

    Checking behavior

    So-called checking behaviors—returning three, four, or even 20 times to make sure the oven is off or the front door is locked—are the most common compulsions associated with OCD, affecting nearly 30 percent of people with the disorder. Like other compulsive behaviors, checking can be driven by a variety of obsessions, ranging from a fear of getting hurt to deep-seated feelings of irresponsibility.

    When to seek help: It’s normal to double-check something once in a while. But if checking interferes with your daily life (by making you late for work, say), or becomes a ritual that you can’t do without, it could be a sign of OCD. Jenike has patients who are compelled to check the oven exactly three times, for instance.

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    Counting

    Some people with OCD perform tasks according to a certain numeric pattern or count to themselves as they do everyday things (such as climbing stairs or cleaning). These behaviors may be driven by superstitions. For instance, a belief that the number seven is good may lead someone to feel that they’ll hurt themselves or someone else if they don’t take seven steps at a time.

    When to seek help: “It’s all about context—does the behavior make sense in your life?” Szymanski says. Counting can be a good distraction as you walk to your car or climb the stairs to your office. “If it doesn’t bother you or anybody else, you are fine,” Jenike said. “People come to me if they can’t get numbers out of their head.”

    Organization

    People with OCD can take organizing to the level of perfectionism. “It has to feel just right, look just right, be symmetrical, be the right number [of items],” Szymanski says. This fussiness is often driven by obsessions about order and symmetry.

    When to seek help: “I’m neat and organized and like things a certain way, but it is out of preference,” said Szymanski, author of The Perfectionist’s Handbook. OCD enters in when want to becomes have to: People like Szymanski enjoy a tidy desk and find it helpful, whereas people with OCD may not necessarily want to organize their desk but feel they must, in order to relieve their anxiety.

    Health.com: Natural Remedies for Anxiety

    Fears of violence

    Everybody has fleeting thoughts about the possibility of being affected by violence or other misfortunes. The more we try to avoid thoughts like this, the more they pop into our heads, research shows—and this appears to be especially true for people with OCD. They “could be trying harder to suppress these thoughts,” Szymanski said, “or they may react more intensely to them because they deem them as unacceptable.”

    When to seek help: It’s important to recognize that we all have occasional dark thoughts, Szymanski said. But it could be a sign of OCD if thoughts of getting mugged make you avoid the park, for example, or if concern for your mother’s safety spurs you to call her several times a day.

    Unwanted sexual thoughts

    Just like violent thoughts, recurring unwanted thoughts about inappropriate or taboo sexual behavior frequently occur in OCD. Patients may imagine for an instant that they are going to grope their coworker or molest a child, or wonder if they are gay instead of straight (or vice versa).

    When to seek help: “Most people can say, ‘Oh, I don’t really want to do that or it doesn’t represent who I am as a person,'” Szymanski said. “But someone with OCD thinks, ‘These thoughts are terrible, no one else has them, what do they mean about me.'” Changing your behavior as a result of these thoughts—avoiding gay friends or a coworker you’ve thought about sexually, for instance—is another red flag.

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    Dwelling on relationships

    People with OCD are known to obsessively dissect their relationships with friends, coworkers, romantic partners, and family members. For example, they may dwell at length on whether an offhand comment at work alienated a coworker, or whether a small misunderstanding ruined a romantic relationship. This mind-set may reflect an exaggerated sense of responsibility and difficulty accepting uncertainty.

    When to seek help: “Breaking up with a girlfriend or boyfriend can make anyone ‘obsess,’ whether or not they have OCD,” Jenike said. But it may be a sign of OCD if thoughts like this get stuck in your head and snowball into excessive self-doubt or fears of being a bad person.

    Seeking reassurance

    One way people with OCD try to soothe their anxiety is by asking for the opinion of their friends and family. If they’re concerned they embarrassed themselves at a party, for instance, they may repeatedly ask a friend to replay the incident. Asking friends to weigh in (“Does my house seem dirty to you?”) can also be a strategy for avoiding compulsive behaviors.

    When to seek help: Everyone uses their friends as a sounding board, but if you catch yourself repeating the same question over and over—or if your friend points this out—it could signal OCD. What’s more, the reassurance you get from loved ones could be enabling your obsessiveness.

    Health.com: 12 Signs of Depression in Men

    Hating your looks

    Body dysmorphic disorder (BDD) is a condition related to OCD in which people fixate on a part of their body they consider abnormal or unattractive—often their nose, skin, or hair. (Unlike eating disorders, BDD doesn’t involve a focus on weight or diet changes.) The obsessive thoughts associated with BDD are very similar to those seen in OCD. Many people with BDD also have OCD and worry about the cleanliness of their body in addition to how it looks.

    When to seek help: It’s normal to dislike some aspects of your features. But people with BDD may spend hours a day checking the mirror. “You overvalue how important it is to you and others and may avoid being around people,” Szymanski said.

    This article originally appeared on Health.com

    All About Dermatillomania (Skin Picking)

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    Brain Circuits Link Obsessive-Compulsive Behavior and Obesity

    The University of Iowa-led researchers bred mice missing a gene known to cause obesity, and suspected to also be involved in compulsive behavior, with a genetic mouse model of compulsive grooming. The unexpected result was offspring that were neither compulsive groomers nor obese.

    The study, published the week of June 10 in the online early edition of the Proceedings of the National Academy of Sciences (PNAS), suggests that the brain circuits that control obsessive-compulsive behavior are intertwined with circuits that control food intake and body weight. The findings have implications for treating compulsive behavior, which is associated with many forms of psychiatric disease, including obsessive-compulsive disorder (OCD), Tourette syndrome, and eating disorders.

    UI neuro-psychiatrists Michael Lutter, M.D., Ph.D. and Andrew Pieper, M.D., Ph.D., led the study. The team also included researchers from Stanford University School of Medicine, University of Texas Southwestern Medical Center, Beth Israel Deaconess Medical Center, and Harvard Medical School.

    Lutter, an assistant professor of psychiatry, and Pieper, an associate professor of psychiatry and neurology at the UI Carver College of Medicine, both recently arrived at the UI and use mouse models in their laboratories to study human disorders and conditions.

    Pieper is interested in compulsive behavior. His mouse model of compulsivity lacks a brain protein called SAPAP3. These mice groom themselves excessively to the point of lesioning their skin, and their compulsive behavior can be effectively treated by fluoxetine, a drug that is commonly used to treat OCD in people.

    Lutter works with a mouse that genetically mimics an inherited form of human obesity. This mouse lacks a brain protein known a MC4R. Mutations in the MC4R gene are the most common single-gene cause of morbid obesity and over-eating in people.

    “I study MC4R signaling pathways and their involvement in the development of obesity,” Lutter explains. “I’m also interested in how these same molecules affect mood and anxiety and reward, because it’s known that there is a connection between depression and anxiety and development of obesity.”

    An old study hinted that in addition to its role in food intake and obesity, MC4R might also play a role in compulsive behavior, which got Lutter and Pieper thinking of ways to test the possible interaction.

    “We knew in one mouse you could stimulate excessive grooming through this MC4R pathway and in another mouse a different pathway (SAPAP3) caused compulsive grooming,” Lutter says. “So, we decided to breed the two mice together to see if it would have an effect on compulsive grooming.”

    The experiment proved their original hypothesis — knocking out the MC4R protein in the OCD mouse normalized grooming behavior in the animals. In addition, chemically blocking MC4R in the OCD mice also eliminated compulsive grooming. The rescued behavior is mirrored by normalization of a particular pattern of brain cell communication linked to compulsive behavior.

    However, the breeding experiment revealed another totally unexpected result. Loss of the SAPAP3 protein from the mice that were obese due to lack of MC4R produced mice of normal weight.

    “We had this other, completely shocking finding — we completely rescued body weight and food intake in the double null mouse,” Lutter says. “So, not only were we affecting the brain regions involved in grooming and behavior, but we also affected the brain regions involved in food intake and body weight.”

    Although obesity and obsessive-compulsive behavior may seem unrelated, Lutter suggests that the connection may be rooted in the evolutionary need to eat safe, clean food in times of a food abundance, and to lessen this drive when food is scarce.

    “Food safety has been an issue through the entire course of human evolution – refrigeration is a relatively recent invention,” he says. “Obsessive behavior, or fear of contamination, may be an evolutionary protection against eating rotten food.”

    Oils and fats have lots of calories and nutrients but they also spoil much more easily than less nutrient- and calorie-dense foods like potatoes, onions, or apples.

    “I think this circuit that we have uncovered is probably involved in determining whether or not people should eat calorically dense foods,” he says.

    Lutter suggests that slight perturbations in this system might lead, on one hand, to disorders that link anxiety and obsessive behavior to limited food selection or intake, such as anorexia nervosa, Tourette syndrome, or OCD, and on the other hand, to obesity, where people over-consume high-fat foods and may have decreased obsessive behavior and anxiety.

    “The next step will be to determine how these two pathways communicate with one another, in hopes of identifying new ways to develop drugs to treat either of these disorders,” says Pieper.

    The research was funded by grants from The Hartwell Foundation, the Brain and Behavior Foundation, and the National Institutes of Health (DK081185-01, DK081182-01, MH084058-01A1, RO1DK075632, P30DK046200, P30DK057521, F3DK078478). Lutter also was funded by a NARSAD Young Investigator Award.

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