Understanding Autism

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New Moms May Experience OCD Symptoms

Image: JUSTIN PAGET Corbis

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We all experience the occasional life-changing event—a new baby, a cross-country move, a serious injury. In rare cases, such events can precipitate a mental disorder. The problem is compounded because people often assume their suffering is par for the course after such upheaval. In reality, relief is probably a short treatment away, via therapy or medication.

For a new mother, dealing with a newborn is fraught with anxieties. Did I fasten the car seat properly? Is the baby still breathing? In more than one in 10 new mothers, these normal worries can escalate into more serious obsessions that can interfere with her ability to care for herself and her baby.

Most of the research on postpartum psychiatric problems has focused on depression and psychosis. Obstetricians such as Emily Miller of Northwestern University, however, were also noticing a range of anxiety-related disorders, including intrusive thoughts and repetitive behaviors. “It’s good to check that your baby is strapped into the car seat,” Miller notes. “But these women aren’t just doing it once. They’re doing it over and over, and it’s interfering with their lives.”

With her colleagues, Miller followed 461 women after they gave birth. Eleven percent said they had obsessions and compulsions two weeks after delivery that the researchers found to be the equivalent of mild to moderate obsessive-compulsive disorder (OCD)—a sharp increase over the 2 to 3 percent rate of OCD in the general population. Half of these women’s symptoms continued six months’ postpartum, and an additional 5.4 percent developed new OCD symptoms in that time. The afflicted women indicated that their symptoms were distressing, taking up a significant amount of time and otherwise interfering with their daily life.

Nearly three quarters of the women with OCD also showed signs of postpartum depression. As with depression, therapy would probably help new moms cope with OCD, according to Miller. “If OCD symptoms are mild and resolve by six weeks’ postpartum, they may be normal,” Miller says. “But if they interfere with a patient’s daily functioning and persist, she should talk to her doctor.”

More Unusual Causes of Mental Symptoms

Common life events occasionally lead to mental distress. If you think any of these scenarios might describe you or a loved one, tell a doctor: treatments today are more effective than ever.

Reading or hearing about a traumatic event may lead to a specific phobia, the persistent fear of a certain situation or object. Targeted exposure therapy has been shown to diminish, and perhaps erase, such phobias in a few sessions.

Bacterial infections, such as strep throat, may cause symptoms of obsessive-compulsive disorder in kids. Only a small subset of all OCD cases, which affect 3 percent of children, are thought to be caused by infections. Treatment with antibiotics cures most infected kids.

Eating more processed foods may be linked to experiencing greater levels of anxiety and depression. Avoiding grocery items with trans fats (hydrogenated oils) may help lift your mood.

Moving to a new house or school may trigger anorexia or bulimia in teens. Treatments such as talk therapy usually reverse the eating disorder.

More about how motherhood affects the brain:

This article was originally published with the title OCD in New Moms.

My Life with OCD


The impact of OCD and related anxiety based disorders on the family is often overlooked.  In this multi-part series, we present first-hand accounts of the ongoing impact of OCD, BDD, and Bipolar Disorder on one man and his family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

Those suffering with OCD require understanding and treatment

My name is Robert and I have Obsessive-Compulsive Disorder (OCD).  I am a thirty-four year old, single man and work as a personal fitness trainer. My story is not typical, but it is the only one I have . . .

I was four years old when I looked at a picture Bible and saw an image of Satan. My thought was, “Satan is cool!” He wore a red cape and was “ripped!”  My obsession was that, since I thought he was cool, I was evil and I would go to hell. I knew that evil people hurt others, and I was terrified of hurting someone. It never occurred to me to tell my parents. I figured all kids thought this way too, but the other kids just seemed to be “managing” it better than I was. They didn’t appear bothered by the eternal consequences of their actions like I was. They were talking back, swearing, being disrespectful and acting cocky, but weren’t worried about going to hell. I figured that thinking Satan was cool and that I was evil was “normal”, and that I just had to be more laid back and figure out how to worry less.

One day when I was fourteen, I had an intrusive thought that I wasn’t funny. I couldn’t shake it and kept a journal of funny quips so I could be “funny” in social situations. I tried to keep up the compulsion of memorizing stuff from the “funny book” so I wouldn’t be “slow”. I wanted to be quick witted, playful and charming.  The irony is people said I was funny – I just didn’t “feel” like I was.  I fought to I remember “my lines” to get rid of the anxiety. At about the same age, I had the obsession that my penis wasn’t the right size. I was pre-pubescent and a “late bloomer.” When in the locker room at school, I compared the boys’ penises to my dad’s penis and thought, ”Wow! They’re tiny!” I even asked my mom one day, “Does size matter?”

During this time, I also became obsessed with my dad singing loudly in church. I’ll never forget the day that I noticed the faces of people laughing at my dad’s passionate singing. I wanted to kill them. I would tease him about it around the house sometimes, but I felt guilty when I would see my mom quietly motion to him to “tone it down” because she knew how much it bothered me. She told me I should be proud of him and I knew she was right. I just couldn’t stop thinking about it.

At sixteen, in my junior year of high school, I couldn’t get rid of the thought that I was repulsive. My stomach used to hurt and make loud noises. I would sit in class and hold my breath in hopes that would take the noise level down, thus causing me not to be seen as “repulsive.” I was exhausted trying to hold my breath to control the noise and went to lots of doctors including gastrointestinal specialists. The tests showed I didn’t have an ulcer or anything else of concern. I would say, “My stomach won’t stop hurting and I feel like I’m going to throw up every day.” I realized that it didn’t hurt when I didn’t think about it and they told me to just not think about it.  If only it were that easy!  I couldn’t stop. I felt stupid because I couldn’t stop the thoughts and felt that the doctors were insensitive to say the least.

During my senior year I was no longer worried about my stomach and its noises. I was in love and happy, and life was good.  But this was short lived. One day I raised my hand to ask a question in class and I saw a sweat mark under my armpit. My family lived in Georgia back then, so it was pretty hot a lot of the time.  But this was the first time I ever noticed my sweat.  I remember saying to myself, “What in the world is that? I have a huge patch of sweat in my armpit!” I was disgusted. My obsession became “I am repulsive due to my excess sweating.” The more I worried about it, the more I would sweat and the more anxious I would get. It was a vicious cycle. One of my coaches commented on the amount of sweat I produced, so I knew it wasn’t “in my head.” I strategized by wearing three shirts at a time and kept going to the restroom to take one off when it got soaked. I thought, “I’ll get this under control and come back to class.” I couldn’t concentrate in class and spent many periods in the counselor’s office due to the thought that my sweating caused me to seen as repulsive. This obsession drove me at twenty-three years old to get the surgery called a sympathectomy, in which a part of the sympathetic nervous system is severed so the face and hands won’t sweat. The surgery was successful, but unfortunately, it didn’t stop the intrusive thought.  I had never heard the words Body Dysmorphic Disorder at that time, but in retrospect, I can see that BDD is a part of my OCD, and I still have this obsession to this day.

As long as I can remember I would make “wagers” with the cracks in the sidewalk and the streetlights. My mind would say something like, “If I get through the intersection before the light turns yellow, my mom won’t die tragically.” The lights were usually right. I didn’t realize it then, but this was my way of trying to dodge doubt and gain some sense of certainty. I would play this “game” with anything I was obsessed or anxious about.  When my dad was very ill and about to go into surgery, the lights “said” he would get through it. The lights were correct – he did get through surgery.  But then he died the next day. There were numerous ways to “win” and “lose” at this game. Some days the wager was, “If I get through the intersection before the light turns yellow, then I’m not repulsive.” But if I got through the light in time, and then saw in the rear view mirror that it had turned yellow, I would think “I am repulsive”.

My mom was worried about some of my behavior when I was seventeen. She noticed I couldn’t make the decision of whether or not to switch schools; I was obsessed with my stomach pain while holding my breath to cut down the noise, I wasn’t sleeping and I was looking at a lot of pornography. She felt I was depressed but I assumed it was normal teenage angst. Once again, I figured everybody went through this stuff. My mom took me to a psychiatrist and after a thorough assessment; I was given the diagnoses of both OCD and Bipolar II Disorder. When my mom heard for the first time in his office about me making wagers with the “lights” to prevent her from dying tragically, she lost it. She recalls not being able to breathe and feeling overwhelmed with sadness hearing how much anxiety and pain I had been in for so long.

Having Bipolar Disorder has greatly compromised treatment for my OCD. My experience has been that my Bipolar meds drive my obsessions. When I try to be “mindful” of my thoughts, as is recommended in OCD treatment, it tends to increase my mania.  It’s like being stuck in my skin! Fortunately, after many years of trial and error, I have found a medication that helps me – I am currently on Luvox, which helps stave off my morbid obsessions.  But if forget to take it or just skip it for a few days, I want to shoot myself in the head! The obsessions are exhausting and I just want “out” when I’m not taking this medication.

I tried to quiet the obsessions with pornography, gambling and dreaming about death – the ultimate way to stop the thoughts. I did have two suicide attempts, but it’s not easy to pinpoint whether it was the OCD, the Bipolar, or both that contributed to the desperate “cry for help.” I remember cutting my wrists and bleeding to relax.  I remember thinking that if I “emptied everything out”, everything would lose its importance. I also overdosed once on the anti-anxiety medication, Klonopin, and my heart rate was down to 30 beats per minute.  I’m not trying to glamorize this by any means.  I’m just illustrating the attempts I’ve gone to in order to try to escape from the obsessions and anxiety – to get rid of my feelings of hopelessness and utter exhaustion. My mom made me promise I would not kill myself while she was alive. I have kept that promise.

When I was twenty-four years old, my mom convinced me to try Electro-Convulsive Therapy (ECT). I don’t recall being any more depressed than usual during the winter of 2003, but according to her, my depression was the worst it had ever been. Unfortunately, the ECT did not have the dramatic effect we had hoped for. I don’t regret trying that extreme therapy (I did it for my mom), but my memory is not as sharp as it used to be. Again it’s difficult to pinpoint if it was the OCD or the Bipolar that caused the extreme depression, or a combination of the two, but I can tell you that, to my core, the intrusive thoughts left me feeling lonely, fearful, angry and desperate.

I would have to say the most frightening and disturbing obsession I still have is that I’m evil and will hurt someone. I now know this is what is known as Harm OCD.  The one obsession that affects me the most on a daily basis is that I’m repulsive because of my excess sweating. As a personal fitness trainer, I do cardiovascular exercises with my clients and I inevitably sweat. Not a day goes by that it doesn’t come into my mind numerous times. As for living with OCD, I think the worst part is that my true self will never be known. The flip side is that I’ve never met a dumb person with OCD and I’ve been forced to get a different perspective on things due to the disorder.

My advice to others with OCD is to not try to explain your obsessions/compulsions to those without OCD. They will never understand it and will only make you feel more alienated.  Also, I recommend taking your prescribed meds to a tee without deviation. And though it’s not easy, try to remember that a thought is just a thought. Maybe try telling yourself “this thought can’t beat me!” Even though the thoughts are processed as true in my head, I know they aren’t true. I say get on with the business of living despite what’s going on in your head! Don’t fight the thoughts, fight with action for who you want to be, and that will save your life.

I also think it’s important to get at least one mentor to get an outside look at your actions and ideas – someone who will “shoot you straight”. I believe wisdom is never gained alone. It can’t be attained without other people and is crucial. Without wisdom, you’ll never have the perspective to change. And lastly, exposure, exposure, exposure! Exposure and Response Prevention has been the most effective part of my treatment for my OCD.  So don’t waste your time and money with “alternative” treatments that don’t work.

My advice to family members and loved ones of people with OCD is to do your homework and learn as much as you can about the illness. I often feel like other people just don’t understand how overwhelming OCD can be.  It’s as if there is a bridge that fundamentally can’t be gapped. My mom bridged that gap by putting herself in my shoes. She was relentless in her quest for information and treatment options. It’s important not to coddle the loved one with OCD or reinforce their obsessions by giving reassurance. It might seem harsh but it will save their life. I no longer ask my mom if I’m repulsive because I know what her answer will be . . . “Rob, I can’t answer that question.” I don’t like living with OCD, but I accept it. I am committed to living a full and adventurous life despite it and encourage others to as well.

Stay tuned for part two, in which Rob’s mom discusses her struggles to cope with her son’s illness, and to get him appropriate treatment.

Elizabeth Kassel, MSW, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.

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Twitter ‘Surrenders’ to Tourette Syndrome

(CNN) —
“Build a biscuit, put a sheepdog on top,” @sammsy posted to Twitter Thursday

It could be dismissed as just another nonsensical tweet, one of
many that fill the social media space. But a closer look reveals the post is
followed by a hashtag — #surrenderyoursay — and a link to www.surrenderyoursay.com.

The site is home to a new project from the Tourette Syndrome
Foundation of Canada. “Build a biscuit, put a sheepdog on top” is
actually a verbal tic, and it’s been posted to @sammsy’s feed as part of
project designed to raise awareness about Tourette Syndrome.

Users surrendered their Twitter feeds to the project for 24 hours
— sign-up for the project closed late Thursday. During that time, a program
posted tweets containing real-life verbal tics, sent to the foundation from
people who have Tourette Syndrome. These could be anything from random sounds
like “ins ins ins” to swear words to illogical sentences.

“We were trying to think of a way to get people to experience
Tourette Syndrome,” art director Rachel Kennedy said. “Twitter is
sort of like your online voice… you’re judged on the things you are

People with Tourette Syndrome suffer from involuntary tics, which
can be either verbal or physical. Physical tics may include jumping or
twitching. People with the syndrome describe a tic like a sneeze — impossible
to hold in without extreme discomfort.

Watch: ‘American Idol’ finalist James Durbin talks about life with
Asperger and Tourette Syndrome

Many know it only as the “swearing disease,” but only
about 10% of people with Tourette Syndrome swear, says Cathy Wylie, president
of the Tourette Syndrome Foundation of Canada.

“The people who have Tourette are really the same as the rest
of us, with just these tics added in,” Wylie said. “It doesn’t affect
anything else in their life.”

Wylie’s son was diagnosed with Tourette Syndrome 20 years ago.
Back then there wasn’t a lot of information available for families. Over time,
awareness has increased, but it’s still not a well-understood condition, Wylie

“People looked at him like, ‘You should behave — why are you
doing that?'” she remembers. “That’s difficult when that’s something
you have no control over.”

It’s unknown exactly how many children living in the United
States or Canada
have Tourette Syndrome. The Centers for Disease Control and Prevention
estimates that three of every 1,000 American children have been diagnosed;
other estimates are slightly higher.

What is known is that males are three times more likely to suffer
than females, and that white children are diagnosed more often than Hispanic or
non-Hispanic black children, according to the CDC.

People with Tourette Syndrome usually have an associated disorder
as well, Wylie said, such as attention deficit disorder or obsessive-compulsive
disorder. Anxiety, sleep problems and learning disabilities are also common.

Users did not have to give the project their password or account
information, and they were still able to log in and tweet during the 24-hour
period. The additional tweets — or tics — happened at random intervals.

More than 8,900 people agreed
to give up their Twitter feeds to Surrender Your Say. Many signed up before the
project launched at 9
a.m. ET on Wednesday.

People were very apprehensive about losing control of their online
presence, co-executive creative director Helen Pak said. “They say, ‘I’m
fearful to surrender for 24 hours and there are people who live with this all
the time?'”

For more information about Tourette Syndrome visit SurrenderYourSay.com.

 photo courtesy CNN.com

What Is Psychological Health?

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Psychologist takes aim at anxiety disorders – Binghamton University Research News

When it comes to dealing with anxiety disorders, Meredith Coles has no interest in modest goals.

“How grandiose do we want to be?” she said when asked about her dream for the field. “I don’t want anyone to have obsessive-compulsive disorder, ever again. That’s pretty grandiose.”

But Coles, director of the Binghamton Anxiety Clinic and an associate professor of psychology at Binghamton University, has mapped out an ambitious plan that just might do it. She envisions a combination of research projects to promote better outcomes and large-scale policy analysis to help set goals. Her work may lead to treatments for obsessive-compulsive disorder (OCD) and social anxiety disorder that are cheaper, more effective and more widely available.

OCD and social anxiety disorder have similar pathologies. The patient feels increasingly acute anxiety that’s alleviated either by avoiding social contact or through a ritual. A classic example of OCD is perpetual hand-washing. Patients with social anxiety disorder often avoid situations such as giving speeches or interacting with strangers.

A certain level of anxiety is normal and perhaps even healthy. Fearing flat tires may encourage a driver to check tire pressure regularly. The problem is when the anxiety is associated with dysfunctional behavior. And the difficult part of both ailments is that, left untreated, they rarely go away on their own. In fact, strategies people employ to cope with the disorders may offer short-term relief but ultimately reinforce the anxiety: You get out of giving a speech, let’s say, but the next time you have to prepare one, you’ll be even more anxious.

Coles and her staff have already looked at some of the roots of the disorders, including research that points out the difficulty patients have in perceiving the reality around them. One paper by a graduate assistant showed that people with social anxiety disorder often focus on less emotive parts of the face, so they have problems perceiving reaction to social interaction. Other research suggests a difficulty assessing the legitimacy of threats.

“We have treatment, and it works,” said Coles, whose treatment focuses on cognitive and behavioral methods.

But the current treatment can’t cure everyone. In fact, most patients continue to experience symptoms of the disorders.

Early diagnosis and treatment are critical, Coles said, because that prevents years of suffering and impairment. The longer a patient has OCD or social anxiety disorder, the more likely he is to develop additional problems such as depression or substance abuse.

This is where her latest project — a large-scale quantitative study — takes the next step. Coles received a two-year, $400,000 grant from the National Institute for Mental Health to survey 500 people about barriers to seeking treatment for anxiety disorders.

Her preliminary data suggest most people delay treatment because they think they can cope without help. They can’t. Others may fear real or imagined stigma for seeking psychological help. Many people may not understand the disorder or may lack access to appropriate care. In fact, some of Coles’ patients travel three hours across to get to her campus clinic.

“There are so many people suffering and not seeking help,” Coles said. “I want to bring that up a step. Therapy helps. I want people to get it.”

But psychologists lack details of how different factors play into the delay, and how influential each factor is. “The majority of people never access treatment for anxiety disorders,” Coles said. “Can they recognize something is wrong? What do they know about anxiety disorders? Do they even know what they are?”

Her survey hopes to answer some of those questions.

Understanding what people know and think about OCD and anxiety disorders can help treatment at the personal and community levels, said Gail S. Steketee, dean of the Boston University School of Social Work. “The beginning part of any good therapy is education about these psychological issues,” she said. “We can also do this on a more mass-media level, and it has been pretty successful when you consider that the stigma of seeking help is much less today than a generation or two ago, thanks to magazines, newspapers, the Internet and so forth.”

In particular, Coles is interested in pediatric diagnosis and education. It’s an exercise in math: Almost all cases of OCD or social anxiety can be diagnosed by the time the patient is 21 years old. Many cases begin in childhood or adolescence. Yet previous research suggests that patients will delay treatment an average of nine years after they recognize they’re having trouble. And they don’t recognize they’re having trouble for five years following the point where they would receive a diagnosis.

“The younger we educate kids, the better off they’ll be,” said Coles, who serves on the Scientific Advisory Board of the Anxiety Disorders Association of America. “We need to prevent mental disease in kids.”

Australia already has programs in place to educate and screen children as young as 4 for anxiety disorders. Coles has looked into its health-care system to see what lessons America can learn.

Steketee hesitates to suggest that 4-year-olds need to be targeted for education, but certainly younger people in general must be. “It is reasonable to try to get education into the hands of parents and teachers of grade-school- age children, as early intervention is most likely to be helpful and to prevent worse problems,” she said. “But many people do not develop a serious OCD or social anxiety problem until their teenage years or their early 20s.”

The good news? They are older and can be more “rational” about the need for help. However, they are also in the throes of concern about what their peers would think if they knew about the problem.

“This and other factors delay the treatment-seeking process,” Steketee said. “Education that targets this young adult group would be especially helpful and is most likely to occur through the media.”

That brings Coles full circle: back to the focused research on outcomes and progression of OCD and social anxiety that constitutes about 90 percent of her work to date. If programs can be put in place to screen and educate children as young as 4, can that same mechanism be used to identify the predictors that lead to the diagnosis? And if the cause can be pinned down, can ways be developed to prevent OCD and social anxiety disorder?

These are big questions, and Coles completed a study in 2009 to begin answering them.

The data supported the hypothesis that cognitions are important in the development of OCD, Coles said. “Specifically, particular types of beliefs such as a heightened sense of personal responsibility to prevent harm, the likelihood of threat and the importance of and need to control one’s thoughts were related to increased levels of OCD symptoms over time.”

Further, she said, her study showed that combining those tendencies with a heightened self-consciousness proved to be useful in predicting OCD symptoms later on. She and her staff are continuing this research with a larger study examining multiple risk factors.

But awareness is only one aspect behind recognizing and treating OCD and social anxiety disorder, Steketee said. Stigma takes more time to address, especially because it’s a cultural factor. “Slowly but surely, we are breaking this barrier down,” she said, “and every famous person or person of power who stands up and admits a problem and how they are seeking help moves this effort forward.”

Steketee said informing mental-health professionals about effective treatment methods is also a challenge. “Most clinicians want to do the right thing to help their patients/clients, but adopting new methods seems harder than it should be,” she said. “Moving mental-health research into practice is a major goal of nearly every national mental-health professional organization and of the federal government.”

Overcoming those stumbling blocks will have major implications for people with anxiety disorders and public-policy makers. Early intervention, Coles said, can mean:

  • Less dysfunction with the incumbent loss of productivity
  • Less expertise needed to treat the disorder
  • Less money spent to provide that treatment

At least that’s the assumption, Coles said. Proving it is another question.

“There’s always another question,” she said. “I’m always asking another question.”

And Coles isn’t afraid to ask the grandiose one, too.


Visit go.binghamton.edu/coles to see a video featuring Meredith Coles talking about her research.

Hallelujah PTSD Lyrics Packed Its Bags And Left Me

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Examining the benefits of estrogen therapy for girls with anorexia


Estrogen replacement therapy may significantly reduce anxiety symptoms among girls diagnosed with anorexia, according to findings presented this week at the Endocrine Society annual meeting.

The clinical trial involved a group of girls ages 13 to 18 who met DSM-IV criteria for anorexia nervosa and had been part of a previously published cohort examining the effects of estrogen replacement on bone density over 18 months. During the study, researchers randomly assigned participants to estradiol patch with cyclic progesterone or a placebo and evaluated their anxiety levels, eating behaviors and body image perception. As a recent MedPage Today story reports, researchers found that the girls’ anxiety decreased as estrogen levels increased.

Interested to know more about the potential use of estrogen therapy for treating anxiety among anorexia patients, I contacted James Lock, MD, PhD, a Stanford professor and psychiatric director of the Comprehensive Eating Disorders Program at Lucile Children’s Packard Hospital, about the significance of the findings. He told me:

Patients with anorexia commonly have anxiety disorders, including obsessive compulsive disorder. Anxiety can interfere with treatment. There are many ways to treat anxiety in patients with anorexia such as reassurance, cognitive behavior therapy and low dose atypical antipsychotics. This article implies that treating bone loss secondary to anorexia using estrogen is an effective treatment for bone loss, which studies have not shown. It seems to me using estrogen to treat anxiety in anorexia would be a treatment that would be deferred until other options of treatments that have been shown to be useful for anxiety had failed. These data on estrogen are quite preliminary.

Seeking additional information on study authors’ assertion estrogen therapy can improve bone accrual in girls with anorexia, I reached out to Neville Golden, MD, a professor of pediatrics and expert in bone health in anorexia. He said:

Estrogen treatment is not standard treatment to treat bone loss in anorexia nervosa.  Estrogen is usually administered to adolescent girls orally in a combination estrogen-progestin preparation such as that found in oral contraceptive pills.  Multiple studies, including one of our own studies, have shown that oral estrogen-progestin preparations do not increase bone mass in adolescent girls. [Madhusmita Misra, MD, the study’s lead author] and her colleagues studied the use of an estrogen patch and found a positive effect on bone mass in 31 girls with anorexia nervosa compared with 30 control subjects. Transdermal administration of estrogen bypasses the liver and has the theoretical advantage that it does not suppress  important growth factors that promote bone formation.  In contrast, the oral contraceptive pills suppress production of these factors.  However this is a single study with a small number of patients and use of an estrogen patch is very much in the experimental stage.  The study has to be replicated in larger number of patients and is by no means standard treatment for low bone mass in patients with anorexia nervosa.

Previously: Eating-disorder hospitalizations decline, How anorexia is striking what many consider to be an unlikely group: boys and young men, What a teenager wishes her parents knew about eating disorders and Stanford’s eating disorder program owes its success to holistic treatment
Photo by Charlotte Astrid

Top 10 List Of Things That Caused Me Panic Attacks

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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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