Anxiety Looks Different in Men

When a man explodes in anger over something seemingly insignificant, he may appear like just a jerk. But he could be anxious.

Anxiety problems can look different in men. When people think of anxiety, they may picture the excessive worry and avoidance of frightening situations that often plague those who suffer. These afflict men, too. But…

Presence of hoarding symptoms does not negatively impact CBT response in youth with OCD

Hoarding has historically been closely associated with OCD but is now considered in its own category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is a phenomenon that is increasingly being discussed in the media.

“While evidence in adults suggests that hoarding can be debilitating and interfere with a patient’s ability to benefit from CBT, we found that the presence of hoarding symptoms does not interfere with treatment response to CBT for pediatric OCD,” said lead author Michelle Rozenman, PhD, Assistant Professor at the University of Denver, Denver, CO, and Adjunct Assistant Professor at the UCLA Semel Institute for Neuroscience Human Behavior, Los Angeles, CA, USA.

“Pediatric hoarding symptoms are prevalent, as nearly half of all youth affected by OCD also experience hoarding symptoms. Given the contrast between our data and studies of hoarding in adulthood that suggest poorer CBT treatment response, clinicians should assess for hoarding in their pediatric OCD patients in order to address these symptoms prior to adulthood when symptoms may worsen and interfere with an individual’s functioning,” Dr. Rozenman added.

The findings are based on data from children and adolescents presenting for services at the UCLA Child OCD, Anxiety, and Tic Disorders Program, a university-based specialty research and clinical program directed by John Piacentini, PhD.

A cohort of 215 children and adolescents between the ages of 7 to 17 who received a primary diagnosis of OCD were enrolled. The authors found that a substantial proportion of OCD-affected youth (43 percent) reported hoarding symptoms.

Evidence-based clinical interviews were conducted to determine OCD and other psychiatric diagnoses, OCD symptom severity and impairment, and presence of hoarding symptoms. A subsample of 134 youth were enrolled in research clinical trials where they received 12 sessions of CBT, with OCD symptom severity and impairment also assessed at the end of treatment.

OCD-affected youth with hoarding symptoms had a higher number of concurrent psychiatric diagnoses on average than those without hoarding symptoms (1.5 vs. 0.78). However, OCD-affected youth with hoarding symptoms did not differ from those without hoarding symptoms in regard to OCD symptom severity and impairment.

The investigators also found that the proportion of OCD-affected youth with hoarding symptoms did not differ from those without hoarding in their treatment response to CBT (50 percent vs. 60 percent), or in improvements in OCD symptom severity.

Importantly, age did not influence any of these relationships, suggesting that the findings apply across childhood and adolescence.

Free at last: Opening up about his OCD diagnosis helps KARE 11 anchor Bryan Piatt help others

From the outside, it looked like Bryan Piatt had everything going for him. An anchor at KARE 11 news, he fit the job description with his carefully coiffed hair, smooth voice and Midwestern good looks. But on the inside, Piatt, 33, felt he was the opposite of his pulled-together image.

“I’d hit a pretty big low point,” he said. “I remember crying on the floor in my condo with a friend. I was still working on air at KARE then, but I was a mess on the inside. I just couldn’t do it anymore.”

For most of his life, Piatt has struggled with mental illness. Diagnosed with anxiety disorder while in middle school, he tried for years to understand the troubling, repetitive thoughts that tumbled through his head. When he was diagnosed with obsessive–compulsive disorder (OCD) during college, Piatt felt a measure of relief, but he didn’t fit the classic OCD stereotype of a hand-washing germaphobe. Instead, he often felt crippled by repetitive, anxiety-producing thoughts that felt impossible to set aside.

While Piatt did his best to put up a good public front, on the inside it had gotten to the point where he felt he was falling apart.



“Having to get up and be in front of the camera every day and struggling with panic attacks around that got to be way too much for me,” he said. “I finally realized I had to make a shift.”

For Piatt, making a shift involved making major changes in his life. First, he realized that he had to let his colleagues know about his mental illness, and then he had to ask for time away from the camera. While Piatt’s family and closest friends knew about his mental health struggles, he had otherwise kept them to himself.

“I always felt like stepping in front of the camera was me having to be a character, to be ‘News Bryan,’” Piatt said. In order to succeed in the image-focused world of TV news, he needed to project an aura of cool control. But that image was slipping. “I feel like somewhere along the line, I’d lost the ability to do that. I had outgrown that version of me,” he said. “Maybe that’s where the anxiety came from.”

Wherever it originated, Piatt’s anxiety was crippling and serious.

In the studio, “It got to the point where my heart would be beating out of my chest and I would be really short of breath,” he said. “When it would be my turn to talk into the camera. I would usually play it off, as if I had something in my throat. But there were a couple of times where I would literally have to cough and have somebody else finish reading for me.”

Piatt eventually gathered his courage and talked his boss about what was going on.

“I’ve been lucky to have a good relationship with her,” he said. “I told her, ‘I’m struggling a lot with anxiety and I’m wondering if there is any way I can step into a position that is not in front of the camera, at least for the time being.’”

Piatt’s supervisor helped him shift into a new, off-camera role, as a producer for KARE’s morning show. The change has reduced his anxiety and given him space to focus on his recovery. It’s a good move for now, but Piatt said he’s not planning on staying out of the spotlight for good.

“I think we need more people out there who are being really real about whatever it is that they’re going through,” he said. “I feel like I want to be part of creating things that are authentic and genuine and not super sugar-coated. I feel like that’s going to be my next step.”


High anxiety

Piatt can hardly remember a time when he wasn’t worried about something. He was in sixth grade when he had his first serious anxiety attack, in the noisy lunchroom of his Fargo middle school.

“Out of nowhere I felt this huge wave of what I now know to be the experience of depersonalization, this feeling of being detached from your body, almost like you are in a dream,” Piatt recalled. “I remember it shook me to my core. From that day forward, my mental health has not been the same.”

Though the experience was scarring, the young Piatt somehow managed to keep his emotions under wraps. “Honestly nobody watching me would have any idea that any of that happened,” he said.

Later, he told his parents about the experience. “They were wonderfully supportive,” he said, “but I didn’t start going to therapy just then.”

By the time Piatt was in college, at St. Cloud State University, studying broadcast journalism, his feelings of anxiety were building. He’d suspected for some time that he might be gay, but he tried to suppress those feelings.

“I was one of these people who was in an incredible amount of denial,” he said. “I knew I was attracted to other guys but I didn’t really say it to myself until a number of months before I actually told someone for the first time. There was anxiety that definitely built around that. It was building, building, building and then I just kind of felt like I couldn’t keep it inside anymore. I finally came out when I was 22.”

By that time Piatt had worked with therapists and tried traditional “talk therapy.” While he appreciated his therapists’ efforts, he often felt he wasn’t making much progress with his OCD.

“Things weren’t really changing for me,” he said. “I just kept up the same cycle of thoughts over and over again.”



While Piatt wasn’t seeing the progress he wanted with his mental health, he was making progress in his career. His first jobs were at smaller-market stations, in Mankato and Austin, but just three years out of college he’d landed his dream job in the Twin Cities at KARE. While he knew that he should have felt he’d hit the big time, Piatt often felt too overwhelmed by his mental health to really appreciate just how far he’d come.

Alison Dotson

He was reporting a story about local OCD activists who had had taken issue with a Target Christmas sweater that made light of the disorder when he met Alison Dotson, president of OCD Twin Cities, a local affiliate of the International OCD Foundation.

Piatt told Dotson about his diagnosis, and she encouraged him to come to some of her organization’s events. Piatt joined an OCD book club, where he learned that he has purely obsessional, or pure OCD, a type of OCD in which a person engages in hidden compulsions and mental rituals. The realization felt miraculous, he said.

Dotson, who also lives with pure OCD, said that it is common for people with this form of the disorder to go decades before finally getting a diagnosis that fits them.

“It took almost 20 years for me to figure out what I had because what I knew about OCD is the hand-washing, scared-of-germs or symmetry stuff,” Dotson explained. “I didn’t have any of that stuff. It was more intrusive thoughts.”

In Pure OCD, Piatt explained, random, sometimes disturbing thoughts somehow become a bigger obsession. “A lot of OCD is these outward compulsions like washing your hands,” Piatt said. “In pure OCD, a lot of the rituals and compulsions are mental, or inner, so I do a lot of mental checking, like ruminating and things like that. It’s not visible on the outside.”

Everyone has disturbing thoughts pop into their heads, but most people can dismiss them and go on with their lives. “For the person with OCD,” Piatt said, “that thought can get really stuck in our thinking and ruminating and examining it from every angle, ‘What does that mean about me?’”

One of Piatt’s first vivid, intrusive thought happened when he was in middle school.

“I was in the kitchen with my mom,” he said. “I remember seeing a knife on the table. I had the thought, ‘What if I grabbed that knife and stabbed my mom?’ It’s just a weird thing that our minds can do to us. I remember thinking, ‘I must be a really bad person because I had that thought. What does that say about me if I’m having those thoughts?’”

Dr. Kaz Nelson

This rumination cycle is how pure OCD manifests itself. “This type doesn’t get talked about as much,” Piatt said. “It is painful. It can really go down this huge direction of questioning your own worthiness.”

Kaz Nelson M.D., vice chair for education in the University of Minnesota’s Department of Psychiatry, compares OCD’s intrusive thoughts to “earworms.”

“It’s like when someone hears a song that plays in their head over and over. Sometimes people have a similar experience with thoughts. People can be so disturbed by their thoughts that they assume they are a serial killer, for instance. They mistake intrusive thoughts as an urge. But that urge actually is the body scanning for danger. In an anxious person, the brain says, ‘Don’t do that.’ It intrudes on the brain to warn you to stay safe.”

Through Dotson and OCD Twin Cities, Piatt eventually found a therapist in New York who specializes in the treatment of OCD. During weekly Skype sessions with this therapist, Piatt learned that traditional talk therapy isn’t always helpful for people with the disorder.

“There’s a gold-standard treatment for OCD which is called ‘exposure and response prevention,’” Piatt said. In this approach, clients expose themselves to their anxiety-causing issues and then work to learn to live with the anxiety.

This approach has helped him, he said: “Once I started working with an OCD-trained therapist, it was a big shift for me.”

But recovery from mental illness doesn’t always follow a straight line, and Piatt is no exception. Though he felt that he was making great progress with his therapist, he eventually decided to step away and find his own form of treatment.

Piatt had been on Lexapro, a psychiatric medication commonly used to treat mood disorders like depression and anxiety, since college. A serious devotee of yoga, he decided to stop taking his medication and try to treat his symptoms naturally. “I always felt like the medication would change who I was, or that I would be cheating on life if I stayed on a medication,” he said. He’d had a positive experience with yoga, and he thought it might be all he needed to stay mentally healthy: “A holistic approach really speaks to me, so I felt I was robbing myself of that because I was on medication.”

When Piatt reached his low point, the one where he found himself crying on his condo floor, he had been off Lexapro and away from his therapist for several months. “I think that low point for me was a big eye-opening experience of how I need to figure out how to put my mental health at the forefront, how I need to see a therapist regularly and home in on things like my diet and my medication,” Piatt said. He went back to a therapist and back on medication.

Nelson supports Piatt’s approach to treatment.

“The best recovery rates come from certain types of therapy in conjunction with a medication,” she said. “It’s like if someone had a back injury and you just gave them Advil. That might help with the pain, but they need physical therapy along with the Advil to get completely better.”

Piatt said that this combination approach has been working for him. He’s been able to strike a balance — still practicing yoga and focusing on a natural approach to healing while at the same time taking the psychiatric medication he needs to keep his ruminations in check.

“For me I’ve discovered that the balance is finding a middle ground between holistic, yoga and Western approaches, going to therapy and taking meds. I’ve been back on medication for three months now. It’s been super-helpful. I feel so much better, so much more grounded. It turns out that it’s what I needed to do to get back on track.”

Open book

Piatt spent decades keeping his OCD under wraps, but these days he’s taking the opposite approach.

Since opening up in the workplace about his mental health, he’s decided to open up to the rest of world. He’s learning that telling others about his struggles has actually helped to take some of the heavy burden off of his shoulders.

“I think that has been a huge help, not feeling like I have to go it alone,” Piatt said. “Being human and vulnerable is powerful.” He’s now committed to telling his story, making it part of the way he sees himself in the world. It’s been tough, but with each day it’s getting easier.

One of the main reasons Piatt wants to tell his story is so that he can help other people get help sooner and not have to spend years struggling with OCD symptoms. “I want to help so the kid in middle school who feels like I did can say, ‘I think this might be that anxiety thing that I’ve heard about. I need to go talk to a therapist.’ That would’ve been such a game-changer for me. If I could’ve talked that out with somebody instead of letting it build up and internalize it, I wouldn’t have lost so much time to my OCD.”

Dotson understands where Piatt is coming from. Her decision to step into a leadership role at OCD Twin Cities came from the same place.

“Once I was diagnosed I wanted to help other people,” she said. “I had gone so long without a diagnosis: It was really scary. Now that I know what’s going on I feel a responsibility to spread the world so other people will get help.”

Dotson treats her OCD with a generic form of Paxil and occasional meetings with a specialist. “Medication worked really well for me,” she said, “maybe because I was so far gone when I went on it. It provided me with a little bit of relief. It slowed the obsessions for me. They were coming at such a rapid pace. It helped me calm down and reduce the anxiety.”

She strongly believes that education and open communication is key to getting the right treatment for OCD. Too many people suffer for too long. She wants that to change.

“The average number of years from onset of symptoms to diagnosis of OCD is 14 to 17 years,” Dotson said. “Awareness is growing, but there’s still not enough actual information out there about what it is.”

Piatt is hoping that he can use his position as a local TV personality as a way to get his story of struggle and recovery out to more people. “I’ve been blessed to have this platform at KARE 11,” he said. “I want to try to use that to help as many people as I can.”

While recovery from OCD takes time and patience, it is possible, Piatt said. He’s living proof.

“So much of this stuff is manageable at face-value,” he said. But keeping it bottled up inside only makes things worse. “When there is so much shame and secrecy around your diagnosis, you start feeling that there is something deeply wrong with you as a human being. That’s when this stuff can take you down. That’s why we need more people talking about their experience. This is what I hope to do.”

Road to recovery

Recovery from OCD is achievable, said Alik Widge M.D., assistant professor of psychiatry at the University of Minnesota and director of the Translational Neuroengineering Lab. A nationally respected expert on OCD, he agrees that exposure therapy is often the most beneficial approach to treatment of the disorder.

By learning how to identify and respond to OCD’s persistent impulses, patients learn how they can claim power over the disorder. After exposure therapy, Widge said, “You will still have the thoughts, but you are going to be able to say, ‘Hello, OCD. That’s an interesting thought. You are not in charge of me today. That’s not what I am going to do,’ and move on.”

Exposure and response prevention therapy, Widge said, helps individuals with OCD “find ways to not respond to disruptive feelings and break the cycle of having the thoughts and having the urge and doing the ritual. We have to break the chain.”

Medications can help to reduce a person’s anxiety and free the mind to respond to therapy, Widge said: “For some individuals, medication brings them down to the level that they are doing self-exposure patterns.”

Dr. Alik Widge

Other treatment approaches for OCD that involve physical contact with the brain have shown some success, Widge said, including transcranial magnetic stimulation, a noninvasive procedure that can be done in a doctor’s office, or deep-brain stimulation, a surgical procedure that involves implanting a device in the brain similar to the one used to treat Parkinson’s disease.

Piatt is happy to hear that so many options exist for treating OCD.

These days, he’s feeling healthier than ever before. He’s supporting his continued recovery with his work, relishing the opportunity to be a producer at KARE. “It turns out I like being behind the scenes,” he said. “I get to really focus on other people’s stories.”

He’s also excited about a side project called Refresh Network, a YouTube channel where he and his videographer, Bruce Meyers, produce stories and interviews about living with mental illness. Piatt launched Refresh Network back in 2016 as a way to expand on stories of interesting people he’d met; recently he relaunched the network with a focus on mental health.

“Now our intention is to go around and have conversations with people about their mental health,” he said. “I want it to be a safe space for people to have open, real and vulnerable conversations about mental illness.”

There is certainly no shortage of interview subjects. “I have a lot of people in my mind that I would like to talk to,” Piatt said. “I am letting this project unfold as organically as I can. We’re on pace to put a new one out every three weeks.”

He’d like to see Refresh Network grow, maybe even into a broadcast show. “My ultimate dream behind this project is to one day have a morning show that helps people get their day started with mental health top of mind,” he said. “It makes so much sense, it feels right. It’s almost like my whole life has been leading up to this moment.”

On Aug. 15 at 6:30 p.m., Bryan Piatt will be a guest at “The Courage to Be Real,” a special event hosted by grief therapist and author Kelly Grosklags at Adath Jeshurun Congregation, 10500 Hillside Ave. W., Minnetonka. More information and tickets are available online.

How To Help Your Anxious Partner — And Yourself

Anxiety comes in many forms and is experienced at different levels, and its impacts can vary. However, there are ways to help your partner navigate challenges while you take care of yourself.

Living with anxiety can be tough — your thoughts might race, you might dread tasks others find simple (like driving to work) and your worries might feel inescapable. But loving someone with anxiety can be hard too. You might feel powerless to help or overwhelmed by how your partner’s feelings affect your daily life.

If so, you’re not alone: Multiple studies have shown that anxiety disorders may contribute to marital dissatisfaction.

“We often find that our patients’ … partners are somehow intertwined in their anxiety,” says Sandy Capaldi, associate director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.

Anxiety is experienced at many different levels and in different forms — from moderate to debilitating, from generalized anxiety to phobias — and its impacts can vary. But psychiatrists and therapists say there are ways to help your partner navigate challenges while you also take care of yourself.

Start by addressing symptoms.

Because an anxiety disorder can be consuming, it can be best to start by talking with your partner about the ways anxiety affects daily life, like sleeplessness, says Jeffrey Borenstein, president and CEO of the Brain Behavior Research Foundation in New York. Something as simple as using the word “stress” instead of clinical labels can help too. “Often people may feel a little more comfortable talking about stress as opposed to … anxiety [disorders],” Borenstein says.

Don’t minimize feelings.

“Even if the perspective of the other person absolutely makes no sense to you logically, you should validate it,” says Carolyn Daitch, a licensed psychologist and director of the Center for the Treatment of Anxiety Disorders in Farmington Hills, Mich. Try to understand your partner’s fears and worries, or at least acknowledge that those fears and worries are real to your partner, before addressing why such things might be irrational.

Anxiety doesn’t have an easy solution, but helping someone starts with compassion. “Too many partners, particularly male partners, want to fix it right away,” Daitch says. “You have to start with empathy and understanding. You can move to logic, but not before the person feels like they’re not being judged and … misunderstood.”

Help your partner seek treatment — and participate when you can.

If your partner is overwhelmed by anxiety, encourage your partner to seek therapy. You can even suggest names of therapists or offices, but don’t call the therapist and set up the appointment yourself, Borenstein says. You want the person to have a certain level of agency over treatment.

Capaldi says she often brings in a patient’s partner to participate in therapy and to bolster the patient’s support system at home. “The three of us — patient, partner, therapist — are a team, and that team is opposed to the anxiety disorder,” she says.

But don’t talk to your partner at home the way a therapist might. For example, don’t suggest your partner try medication or ways of modifying behavior. “Let the recommendations about treatment come from the professional” even if you yourself are in the mental health care field, Borenstein says. “I personally am a professional, and I wouldn’t [prescribe anything] to a loved one.”

It can also be helpful to do some research on whatever form of anxiety your partner might be living with, Capaldi says (The National Alliance on Mental Illness’ guide to anxiety disorders is a great starting point). “Many times, people with anxiety feel as if they’re misunderstood,” she says. “If the partner takes the time to research it a little bit, that can go a long way.”

For tips on how to help your partner pick the right type of therapy, check out this guide from the Anxiety and Depression Association of America.

Encourage — don’t push.

When your partner suffers from debilitating anxiety and you don’t, your partner’s behavior can be frustrating, says Cory Newman, a professor at the University of Pennsylvania’s Perelman School of Medicine. But you should never patronize or diminish your partner’s fears. Comments such as “Why can’t you do this? What’s your problem?” will probably be ineffective.

Instead, try to encourage your partner to overcome the anxiety. “Channel your encouragement in a positive direction,” Newman says. “Say something like ‘Here’s how it will benefit you if you can face [this] discomfort.’ ”

Daitch cites the example of someone with an immense fear of flying: “Start off saying, ‘I really understand how scared you are of flying. It makes sense you’d be scared. You can’t get off the plane if you have a panic attack, [you’re] afraid you might embarrass yourself … or it feels like you’re out of control when there’s turbulence.’ See things from their perspective.”

Then you can try to gently push your partner to overcome those fears.

Cultivate a life outside your partner’s anxiety.

To maintain your own mental health, it’s important to cultivate habits and relationships that are for you alone, such as a regular exercise regimen or weekly hangouts with friends. Have your own support network, like a best friend or a therapist (or both), for when your partner’s anxiety overwhelms you.

Partners definitely need support of their own, Capaldi says, “whether that means their own therapeutic relationship or just friends, family [and] other interests or activities that set them apart from the world of anxiety they might be living in.”

And don’t let your partner’s anxiety run your family’s life. For example, someone with obsessive-compulsive disorder, which is closely linked to anxiety disorders, might want family members to keep everything very clean or organized in arbitrary ways. Newman says it’s important to restrict how much you will organize your household around your partner’s anxiety — and not to indulge every request or mandate.

“Try to be respectful, but also set limits,” he says.

Help your partner remember that the goal is to manage anxiety — not to get rid of it.

“A lot of people with anxiety disorders understandably view anxiety as the enemy,” Newman says. “Actually, it’s not. The real enemy is avoidance. Anxiety causes [people] to avoid things — like applying to schools, flying to a cousin’s wedding — [that can lead to] an enriched life. … And that causes depression.”

It can also reduce the number of life experiences you and your partner share.

“You can have an anxious life, but if you do things — you’re doing that job interview, you’re saying yes to social invitations, you’re getting in that car and driving to the ocean even though … you don’t want to drive 10 miles — you’re doing those things still,” Newman says. “OK, you might need [medication] or therapy, but you’re still living life.”

Susie Neilson is an intern on NPR’s Science Desk. Follow her on Twitter: @susieneilson.

12 YA Books About Obsessive-Compulsive Disorder

I remember the first time I read a book about someone with obsessive-compulsive disorder. Although I’d first begun treatment for the disorder in middle school, I didn’t read a book featuring a character with OCD until a decade later—during my senior year of college. It had a profound effect on me. I’d undergone years of therapy and understood that I was more than my mental illness, but I felt so much less alone and ashamed of my condition after encountering a narrator who understood what I was going through.

Obsessive-compulsive disorder affects 2.2 million people in the United States, and about 25% receive a diagnosis by age 14—though one-third report experiencing symptoms in childhood. For that reason, it’s essential for YA books to portray characters with OCD and other mental health issues.

Read on to discover 12 books featuring protagonists with obsessive-compulsive disorder. From 2019 debuts to well-loved classics, these books can help those with OCD feel less alone and those without it understand what it’s like to have this condition.

Every Last Word by Tamara Ireland Stone

From the outside looking in, Samantha McAllister looks like anyone else at her high school. But none of her friends, she believes, would ever understand her battle with obsessive-compulsive disorder. Sam has a subset of the condition called purely-obsessional OCD, which causes a stream of intrusive thoughts and worries to invade her mind all of the time. But then Sam meets Caroline, a classmate who seems to understand what it’s like to struggle with mental illness. And when Caroline introduces her to a spoken word poetry club at their school, she’s able to find a way to creatively express her doubts and worries.

The Weight of Our Sky cover imageThe Weight of Our Sky by Hanna Alkaf

Like many girls growing up in Malaysia during the 1960s, Melati Ahmad loves music—especially anything to do with the Beatles. But Mel harbors a dark secret: unless she performs tapping and counting rituals every day, she believes that she will cause her mother’s death. When racial tensions turn her city into a war zone on the evening of May 16th, she and her mother become separated. Worrying that her greatest fears have come true, she enlists the help of a Chinese boy named Vincent to find her mom. But to do so, she must not only overcome her obsessive-compulsive thoughts but also her own racial prejudices.

history is all you left me book coverHistory Is All You Left Me by Adam Silvera

Griffin’s best friend and ex-boyfriend Theo was the only person who understood his obsessive and sometimes consuming rituals with numbers. Even when they broke up and Theo started dating someone else, Griffin always thought that they were soulmates. But then Theo dies in a drowning accident, which sends Griffin’s depression and OCD into a spiral that threatens to derail his entire life. So, after Theo’s funeral, he turns to the only person who could understand his grief and help him pick up the unfinished pieces: Theo’s boyfriend, Jackson.

Kissing Doorknobs coverKissing Doorknobs by Terry Spencer Hesser

This book is considered a classic in the mental health community, and for good reason: it was one of the first mainstream YA books to portray the diagnosis and treatment of obsessive-compulsive disorder. From a young age, Tara Sullivan has lived in fear that unless she performs time-consuming rituals every day, the people she cares about will die. But when she reaches her teen years, her compulsive behavior reaches new heights that agonize her friends and loved ones to watch. Through serendipity, she meets a boy named Sam who puts a name to her worries (OCD) and helps her find treatment. With the help and support of her psychologist, her family, and Sam, can she find peace against the intrusive thoughts that have plagued her since childhood?

turtles all the way down book coverTurtles All the Way Down by John Green

Aza Holmes sometimes feels like a prisoner in her own mind. It’s so easy for her to get trapped in the never-ending spiral of her obsessive thoughts. But then the billionaire Russel Pickett goes missing with a $100,000 reward on his head. Ada and her friends are determined to find him and claim the prize. Their search, however, takes them to unexpected places. Such as, for example, the home of a childhood friend. Not only does this search cause Aza to confront her own past, but it escalates her OCD to a crisis point that she can’t overcome on her own.

Four Weeks, Five People by Jennifer Yu

This YA contemporary follows five teens as they support and rely on each other while overcoming their mental health issues. Clarissa is determined to confront her OCD—and her overbearing mother—once and for all. Andrew wants to deal with his eating disorder so he can pursue his dreams of becoming a musician. Mason has narcissistic personality disorder, but he’s starting to realize that it’s not just everyone else in his life who has a problem. Film lover Ben struggles with depersonalization, but he wants to experience more of life than just what he sees in movies. And Stella’s depression causes anger issues that are hard for her and others to understand. A wilderness therapy program brings these five together and, during the most difficult month in their lives, they’re able to address their issues together and begin to heal.

Waiting for Fitz coverWaiting for Fitz by Spencer Hyde

Addie doesn’t want to leave her mom or her dog Duck, but her obsessive-compulsive disorder has taken over her life. Between the counting rituals and fixation with rhythms, she knows that she can’t go on like this. So she begins treatment as at the inpatient ward of the Seattle Regional Hospital. Here she meets Fitz, a boy with schizophrenia who shares her love of puns, existentialism, and absurdist theater. But Fitz is haunted by his past, as well as delusions that don’t give him much peace. Addie and Fitz cling to each other in a world full of uncertainties and try to find the courage to face their inner demons.

OCD the Dude and Me CoverOCD, The Dude, and Me by Lauren Roedy Vaughn

Danielle Levine knows that, even at her alternative high school, she’s what others would consider an “outcast.” Between her sarcastic attitude, her plus-sized body, and her obsessive-compulsive tendencies, she’s decided to embrace the misanthropic stereotype that others have assigned her. But when her scathing and mildly scandalous English essay sends her to the school psychologist, she’s forced to enroll in a “social skills” class. Here she meets Daniel, a quirky classmate who’s obsessed with The Big Lebowski, who convinces her that she doesn’t have to go through high school alone.

The Unlikely Hero of Room 13B by Teresa Toten

Fifteen-year-old Adam’s OCD support group is what some would call “unconventional.” His counselor encourages them to see themselves as superheroes in charge of their own fates and mental health issues. So when a new girl named Robyn joins the group, Adam longs to be her Batman. But Adam has a lot more going on in his life than a crush: between his parents’ divorce, his mom’s hoarding tendencies, and his own intrusive thoughts, he often feels anything but “normal.” With Robyn and the rest of his support group’s help, however, he’s able to find something better than normalcy: closure.

Lexapros and Cons coverLexapros and Cons by Aaron Karo

Chuck Taylor’s shared name with a shoe brand isn’t even the worst thing going on for him. His OCD has always been an issue but by high school, it has consumed his life. His elaborate hand-washing routines and intrusive thoughts frighten his friends and isolate him from his peers. Unless he gets a closer reign on it, he worries that he’ll never have control over his mental illness again. But with graduation approaching, Chuck is determined to face his issues head-on—even if it means getting his hands a little dirty.

Tiffany Sly Lives Here Now coverTiffany Sly Lives Here Now by Dana L. Davis

When 16-year-old Tiffany Sly loses her mother to cancer, she leaves her friends in Chicago to live with a dad that had never really been present in her life. Her OCD and generalized anxiety clashes with her dad’s strict house rules. And her four stepsisters are used to a lifestyle of wealth and luxury that she’d never known. Nobody seems to understand her grief or her mental health struggles until she meets Marcus, the boy next door. Through their blossoming friendship, Tiffany is finally able to make peace with her mother’s death and take risks to overcome her OCD.

under rose-tainted skies by louise gornall book coverUnder Rose Tainted Skies by Louise Gornall

Between her obsessive-compulsive disorder and agoraphobia, Norah is trapped in her home and her mind. From the moment she wakes up to her last thoughts before falling asleep, she’s paralyzed by fears that no amount of compulsions alleviate. She tries to convince herself that she’s content with the glimpse of the outside world she gets from social media until a boy named Luke knocks on her door. Luke knows that Norah is more than her mental illness, and he wants her to see that, too. Through their friendship and eventual romance, Norah finds the courage to face her fears and stop viewing herself as broken.

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‘I spent years living with OCD before I realised I was ill’

Welcome to You Don’t Look Sick – a weekly series about people living with invisible illnesses and hidden disabilities.

Each week, we discuss a different illness with someone who lives with it, talking about symptoms, treatments and their experiences of how people react to them because they don’t look ill.

Andrew Stevens, from Scotland, has obsessive compulsive disorder (OCD) – a mental health condition in which a person has obsessive thoughts and compulsive behaviours.

He spent 10 years living with the condition, after he started to display symptoms when he left the army, but says he had no idea that there was a name for what he was experiencing.

Andrew had a career in the armed forces as a painter and finisher but was made redundant in 2007.

After coming out of the RAF, he got a job driving a bus but he found it difficult to adjust to civilian life.

Shortly after starting the job, he got a cold but went into work. After seeing how unwell he was, he was sent home.

But when he returned to work after a few days later, he was told about the procedures around taking days off, something he wasn’t used to in the army.

He explains: ‘I became obsessive about making sure I was healthy all the time after that. I was obsessed with everything being clean.


Andrew, who has OCD, with his family
Andrew with his family (Picture: RAF Benevolent Fund)

‘I became anxious and depressed and quite quickly things spiralled out of control. I began to worry about everything, my finances, my family, about my new job, my home.’

Andrew started to have compulsions to wash his hands, which gradually became worse.

He explains: ‘Everyday was very long as pretty much every action had a routine to it. The worst was washing my hands or leaving the house.

‘I wouldn’t eat food if I thought anything was wrong with it. I was only eating food from one branch of Tesco.

‘I was checking the wrappers and binning it if there was any problems with the packaging. The reasons were bizarre but very real and justified to me at the time.

‘People think you’re weird but it doesn’t make a difference as your anxiety wouldn’t allow to try anything different.’

His compulsions were having a real impact of every aspect of his life – including being a dad to his three children.

He says: ‘When I got home I wouldn’t go near my children. I know it sounds crazy but I couldn’t risk touching them.

‘I was washing my hands four or five times and was still not happy.


Andrew with his son Craig, when he was in the RAF
Andrew with his son Craig, when he was in the RAF (Picture: Andrew Stevens)

‘I would make the bed and if it didn’t look exactly how I wanted it, I would start it all over again.

‘I began to avoid certain parts of the house and then eventually stopped going out too. I would spend hours of time in the shower, trying to get clean.

‘I wouldn’t touch my food and I would pace around the house checking I had locked everything.’

These symptoms continued for 10 years before Andrew finally got help, after his wife suggested going to the GP.

He explains: ‘My wife Claire booked me an appointment and insisted I must go. The doctor quickly decided I had severe OCD.’

Andrew was signed off work and referred for counselling on the NHS, but he was told the waiting list was at least three to six months long.


Andrew in his RAF uniform
Andrew in the RAF (Picture: Andrew Stevens)

He called the RAF Benevolent Fund, a charity set up to help ex-service personnel. They enrolled him in a listening and counselling service within weeks, allowing him to return to work within three months.

This helped Andrew to start to learn how to deal with his compulsions

He explains: ‘I wasn’t the sort of person to share my problems in a group. This meant talking on the phone to specialist doing CBT therapy was my best option.

‘The reason I talk about it now is to let others know you can get through this. I don’t want others to suffer as long as I did.

‘What really sticks with me is the speed in which the Fund stepped in and offered support. I wouldn’t be here without them. I was close to ending things.

‘I started realising I could get better and there was a future.’

After starting to deal with his mental health, Andrew was more open with friends and family about what he had been experiencing, after years of hiding his symptoms, and most said they had no idea that anything was wrong.



What are the symptoms of OCD?

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

This pattern has 4 main steps:

  1. Obsession – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind.
  2. Anxiety – the obsession provokes a feeling of intense anxiety or distress.
  3. Compulsion – repetitive behaviours or mental acts that you feel driven to perform as a result of the anxiety and distress caused by the obsession.
  4. Temporary relief – the compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon returns, causing the cycle to begin again.

NHS

He adds: ‘Once I was diagnosed everyone said “I never knew. You worked hard and had a laugh in the group”

‘When you feel like I did, you make excuses not to go to family event or out with your friends and that’s very easy when you work a lot of shifts.

‘My life became eat, sleep, work, repeat as I thought a had control then.

‘After months of therapy, I started seeing people again and they would ask where I had been. When I told them, they would say “You wouldn’t have guessed there was anything wrong as you always seemed fine.”’

‘I could hide it pretty well so that no one knew. People wouldn’t understand as I looked fine.

‘Only the people very close to you can see you’re not ok but you don’t want them to worry so you just get on with life.’


Andrew Stevens who has OCD in a military uniform when he was in the RAF
Andrew returned to civilian life after a long career in the military and struggled to adjust (Picture: Andrew Stevens)

Andrew also feels there is a lack of understanding because people have started to misuse the term OCD to mean they are very particular or like to be clean.

He says: ‘“I’m OCD” is something people say all the time just because they like to keep things tidy.

‘I want people to understand how severe OCD can be. It is a type of anxiety and if you truly have to do that routine then you may need a little help.’

Andrew’s mental health has improved and he says he is now able to enjoy life again.

‘I am now a year and a half after it all, my kids have got their father back, I’ve got a lovely wife, I live in a great part of Scotland. We’re doing things that we’ve never done for years.’

He’s recently set up his own business Courage2Explore, combining corporate team building with military style training. He’s also working with young adults in schools.

‘I really try not to let it hold me back or stop me achieving what I want in life. It’s important for me to strive to live as much of a normal life as possible; I am living independently, holding down a full time job and now have my own family.’



How to get involved with You Don’t Look Sick

You Don’t Look Sick is Metro.co.uk’s weekly series that discusses invisible illness and disabilities.

If you have an invisible illness or disability and fancy taking part, please email youdontlooksick@metro.co.uk.

You’ll need to be happy to share pictures that show how your condition affects you, and have some time to have some pictures taken.

MORE: You Don’t Look Sick: ‘I was born with half a heart but it won’t hold me back’

MORE: You Don’t Look Sick: ‘People forget that I am visually impaired’

MORE: You Don’t Look Sick: ‘Don’t tell me my mental health condition is just attention seeking’

MORE: You Don’t Look Sick: ‘I vomit almost every time I eat but people just assume I’ve been drinking’

Metabolic factors likely contribute to anorexia

Scientists have defined anorexia nervosa as a metabolic as well as a psychiatric illness. They suggest that treatments should address the hybrid nature of the potentially lethal eating disorder.

A new study explores the genetic underpinnings of anorexia nervosa.

The international team of more than 100 researchers studied the DNA of tens of thousands of people with and without anorexia nervosa.

A Nature Genetics paper describes how they identified eight genes with a strong link to anorexia nervosa.

Some of the genes have significant links with other psychiatric illnesses, such as schizophrenia, depression, anxiety, and obsessive-compulsive disorder.

However, the findings also reveal genetic links to physical activity, the metabolism of glucose, how the body uses fat, and body measurements. In addition, these links appear to be independent of common genetic ties to body mass index (BMI).

“Until now,” says co-senior study author Cynthia M. Bulik, a distinguished professor of eating disorders in the School of Medicine at the University of North Carolina at Chapel Hill, “our focus has been on the psychological aspects of anorexia nervosa, such as the patients’ drive for thinness.”

However, the new findings about the role of metabolism could help explain why people with anorexia “frequently drop back to dangerously low weights, even after therapeutic renourishment,” she adds.

‘A complex and serious illness’

“Anorexia nervosa is a complex and serious illness, affecting 0.9–4.0% of women and 0.3% of men,” note the study authors.

Even when their body weight has reached dangerously low levels, people with anorexia can be terrified of increasing it.

The self-perception of individuals with anorexia nervosa who reach a very low body weight is that they are still overweight. They also appear to be unaware of the dangers of being severely underweight.

Anorexia nervosa is the most fatal psychiatric illness.

Many people with anorexia die of metabolic collapse and starvation, while others die by suicide. As a cause of death, suicide is more common in women with anorexia than in women with other types of psychiatric illness.

For the recent study, Prof. Bulik and colleagues brought together data from several sources. The total dataset came from 16,992 people with anorexia nervosa and 55,525 people of European ancestry who did not have the condition.

They carried out a genome-wide association study (GWAS) of the data. A GWAS is a technique that rapidly looks for genetic differences in people’s DNA.

Scientists find GWAS a useful tool for identifying genes behind complex conditions such as cancer, diabetes, asthma, and heart disease, as well as psychiatric illnesses.

New approach to anorexia

The team identified eight “significant” differences between the DNA of individuals with anorexia and those without the condition.

“The genetic architecture of anorexia nervosa,” write the authors, “mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid, and anthropometric traits, independent of the effects of common variants associated with [BMI].”

The researchers suggest that the link to physical activity could explain why people with anorexia nervosa tend to be very active.

“Metabolic abnormalities seen in patients with anorexia nervosa are most often attributed to starvation, but this study shows they may also contribute to the development of the disorder,” says co-senior author Gerome Breen, Ph.D., a reader of neuropsychiatric and translational genetics at King’s College London, in the United Kingdom.

“These results suggest that genetic studies of eating disorders may yield powerful new clues about their causes and may change how we approach and treat anorexia,” he adds.

A failure to consider the role of metabolism may have contributed to the poor track record among health professionals in treating this illness.”

Prof. Cynthia M. Bulik

Scientists Find Eating Disorders Are Triggered By Your Genes, Not Your Choices

NEW YORK (CBSNewYork) – There are an estimated 30 million people in the U.S. with an eating disorder.

Now, CBS2’s Dr. Max Gomez reports that new research has found that there are certain genes that make a person more likely to develop a serious eating disorder.

For 10 long and difficult years, Cayetana Martinez lived with eating disorders. First anorexia from age 15, then bulimia from 18.

“It’s hell… On top of having the worst critic inside your head all the time, you do feel like it’s your fault,” Martinez said.

Scientists at Berghofer Research Institute in Australia say they can identify people at risk of anorexia – by looking at their DNA. Examining samples from almost 17,000 people worldwide with the illness, and 55,000 people without, eight genes were identified.

“There’s still some myth, a misconception that people choose to have anorexia, that’s not true. People are deprived of control once they catch it,” Dr. Warren Ward explained.

The study also found strong genetic links between the illness and other psychiatric conditions like obsessive compulsive disorder, depression, anxiety, and schizophrenia. Researchers found it’s metabolism that plays a role.

“There’s some hint that people prone to anorexia are processing those carbohydrates and fats differently to the rest of the population,” Prof. Nicholas Martin said.

Now there are hopes a drug will be developed in the future to help treat the illness.

“It would have given a big part of my life back, and made me feel like I could have been cured rather than feeling like I had to figure it out by myself,” Martinez added.

It’s important to realize that genetics are not necessarily destiny. Many factors go into turning these genes into actual anorexia cases, so not all carriers will develop an eating disorder.

Knowing that it’s not their fault goes a long way to removing the stigma of eating disorders.

Anxiety disorder: Manage your anxiety naturally

Anxiety sets in when a normal emotion of worry, fear or nervousness goes overboard and becomes a hurdle in your daily life. It is a normal reaction to stress and might be helpful in some situations. But, when it starts to hinder your day to day life then it’s a sign that you have anxiety disorder. There are mainly five type of anxiety disorders. These are generalised disorder, social anxiety disorder, obsessive compulsive disorder, panic disorder and post-traumatic disorder. Anxiety varies from person to person. You might get butterflies in your stomach or a racing heartbeat. Some might experience nightmares while others may not be able to sleep well. It becomes difficult for people to concentrate and control their thoughts. You might start avoiding situations and places to prevent these feelings. You must consult a doctor if you experience any of these symptoms. Here, we give a few tips to help you deal with this disorder.

Anorexia stems from body as well as mind – study

Laura Shah

Image caption

Laura Shah was diagnosed with the disease when she was 15 years old

The origins of the eating disorder anorexia nervosa are in both the mind and the body, according to an international study.

Anorexia is seen as a serious psychiatric disease.

But doctors at King’s College London showed changes hardwired into some people’s DNA altered the way they processed fats and sugars and may make it easier to starve their bodies.

The eating disorder charity Beat said the findings were groundbreaking.

What is anorexia?

It is an eating disorder that leads people to lose as much weight as possible by eating little and sometimes exercising excessively.

People with anorexia often have a distorted image of themselves and can feel fat even if they are dangerously underweight.

It is more likely to affect young women but can affect anyone of any age or gender.

In the long term, anorexia can damage muscles, bones, the heart, fertility and can be fatal.

It can be treated and people can make a full recovery.

What is it like to have anorexia?

Laura Shah, 23, from Suffolk, was diagnosed when she was 15 and signed off school for treatment.

She was a bright high-achiever using exercise as a coping mechanism but it “spiralled out of control”.

She said the disease had had a “massive and quite horrible” impact on her family.

Her mother had had to quit her job to be her carer (her father had been working abroad at the time) and it had created “a lot of trust issues”.

She is doing much better now – but anorexia continues to be a challenge, particularly:

  • going out for a meal on a date, when “it’s embarrassing not being able to eat”
  • listening to people at work talk about dieting, which triggers anorexia thoughts and behaviours

What did the study show?

The researchers looked at 16,992 people with anorexia and 55,525 people without the disease, from 17 countries.

All their DNA – the blueprint for the human body – was analysed to find mutations in genetic instructions that were more common in anorexia patients.

The study, published in Nature Genetics, found some mutations also presented in other psychiatric disorders such obsessive-compulsive disorder, anxiety, and schizophrenia.

But they also found mutations in the instructions that control the body’s metabolism, particularly those involving blood sugar levels and body fat.

“There is something in those systems that has gone awry,” Prof Janet Treasure, from the Institute of Psychiatry at King’s College London, told BBC News.

Media captionAnnabelle developed anorexia when she was a teenager

The researchers – at King’s and the University of North Carolina at Chapel Hill – say anorexia should now be considered a “metabo-psychiatric disorder” as it is a disease of mind and body.

How does metabolism affect the risk of anorexia?

The researchers have not fully explored the role played by the genetic instructions they discovered.

However, they suspect the mutations allow people to starve their bodies for longer.

When most people lose weight, there are signals in the body that push back, stimulating the appetite..

“These are very important in controlling the set-point of weight,” Prof Treasure told BBC News.

“It’s possible that when people lose weight with anorexia nervosa, they haven’t got such strong drivers getting the set-point back to normal.”

How important are these findings?

“It’s very significant because there’s been difficulty knowing what sort of disorder anorexia is,” Prof Treasure told BBC News.

“There have been swings in our understanding

“Now, we know it’s a complex mixture of aspects from the body and the mind that interact and cause this complex disorder.”

Knowing anorexia was a mix of the physical and the mental could persuade patients to have treatment, she added.

What do the experts say?

Andrew Radford, the chief executive of Beat, said: “This is groundbreaking research that significantly increases our understanding of the genetic origins of this serious illness.

“We strongly encourage researchers to examine the results of this study and consider how it can contribute to the development of new treatments so we can end the pain and suffering of eating disorders.”

Follow James on Twitter.

Greater Disease Severity With Comorbid OCD, Bipolar Disorder

Patients with obsessive-compulsive disorder (OCD) and comorbid bipolar disorder (BD) appear to have more severe disease, with a higher risk for suicide, and need specific treatment strategies, according to study results published in the Journal of Affective Disorders.

Mariana S. Domingues-Castro, MD, MS, of the Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, University Estadual Paulista, Brazil, and colleagues conducted a cross-sectional study involving 955 adult patients with OCD from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. They used the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structure Clinical Interview for DSM-IV Axis I Disorders to evaluate disease characteristics and severity in patients.

The lifetime prevalence of BD in the patient cohort with OCD was 7.75% (n=74). Of patients with BD, 42% presented with type I and 53% with type II; 5% had unspecified BD. Patients who suffered from both disorders had poorer insight, experienced more frequent sensory phenomena, and had greater severity of anxiety and depressive symptoms. These patients also were more likely to report suicidal ideation, suicide plans and attempts, and to have a more extensive family history of affective symptoms. Patients with both OCD and BD reported more psychotherapy and greater use of oxcarbazepine, sodium valproate, topiramate, lithium, clozapine, and olanzapine. The OCD/BD group also presented more frequently with anxiety disorders, including generalized anxiety disorder and panic disorder with agoraphobia. In addition, they were more likely to have eating disorders; impulse control disorders such as pathologic gambling, compulsive buying, compulsive sexual disorder, and skin picking; alcohol abuse and dependence; body dysmorphic disorder; and attention-deficit/hyperactivity disorder.

After logistic regression analysis, features that remained associated with BD in these patients were panic disorder with agoraphobia, impulse control disorders, and suicide attempts.

Although the study population was large, it came from a tertiary treatment center, where patients generally had more severe disease. Thus, these results may not be generalizable to the larger population.

Researchers suggested that clinicians should investigate impulsive behaviors in patients with OCD and comorbid BD. They further recommended that in patients with OCD and panic disorder/agoraphobia comorbidity, possible symptoms of BD should be evaluated and treated appropriately. Furthermore, patients should be monitored closely for suicide risk.

Reference

Domingues-Castro MS, Torresan RC, Shavitt RG, et al.  Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: prevalence and predictors. J Affect Disord. 2019;256:324-330.