OCD patients with comorbidities respond well to deep brain stimulation

AURORA, Colo. (March 31, 2021) – A new study published in Frontiers in Psychiatry finds that patients with Obsessive Compulsive Disorder (OCD) as well as other psychiatric comorbidities, such as autism spectrum or tic disorders, may respond well to Deep Brain Stimulation (DBS).

DBS is a minimally invasive neurosurgical procedure that uses coordinates to target certain areas of the brain, implanting electrodes that can help regulate abnormal brain activity. DBS procedures are rare for OCD in the United States; only a couple hundred patients have received this treatment for OCD management since its FDA approval in 2009 via a Humanitarian Device Exemption. The effectiveness of DBS for OCD has been well-documented in literature, but the interplay with comorbid disorders has not been as thoroughly explored.

“This study helps us understand more about real-world use of DBS for OCD,” says Rachel Davis, MD, associate professor in the CU Department of Psychiatry and study principal investigator. “Most patients seeking treatment don’t only have OCD, comorbidities are more the rule than the exception. So it’s important to understand how this life-changing procedure can benefit our more typical patients.”

Davis and clinicians at the University of Colorado Anschutz Medical Campus retrospectively examined five patients seeking DBS for OCD between 2015 and 2019. Patients exhibited comorbidities including substance use disorder, eating disorder, autism spectrum disorder, major depression, ADHD, and tic disorder. Three patients were awake during DBS surgery, allowing clinicians to check for response to stimulation (improved mood, increased energy, and reduction in anxiety), an additional way to confirm correct electrode placement. After surgery, Davis assessed response and determined the correct settings by asking patients about changes in mood, energy, and anxiety. Improvement in these areas tend to be associated with reduction in OCD symptoms later on. Change over time was monitored with a variety of IRB-approved questionnaires, gauging changes in mood, anxiety, depression and other quality of life elements affected by OCD.

Overall, these patients experienced significant improvement in OCD and mood symptoms. A standard scale for assessing symptom severity and treatment response in OCD, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), measures degree of distress and impairment caused by obsessions and compulsions. A good clinical response is considered to be greater than a 35% reduction. In this study, patients averaged a 44% reduction on this scale; four out of five experienced full response with the fifth having a partial response, with approximately 25% reduction in OCD symptoms. Patients also reported an average of 53% reduction in depression symptoms.

“For these treatment-refractory OCD patients, our Psychiatric DBS program, led by Dr. Davis, is finally providing relief,” says John Thompson, PhD, associate professor of neurosurgery at the University of Colorado School of Medicine and one of the co-authors on this manuscript. “While DBS for OCD is rare, this study is a glimpse at its potential. There is much yet to be learned about the complex interplay between circuit modulation and co-morbid symptom management in OCD patients treated with DBS.”

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About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, together we deliver life-changing treatments, patient care, professional training, and conduct world-renowned research. For more information, visit http://www.cuanschutz.edu.

Psychologist offers a family guide to help a loved one with OCD – News

When a loved one has Obsessive-Compulsive Disorder (OCD), it’s a constant struggle. It hurts to see your spouse so anxious or your teen spending so much time alone. This is especially true right now, as the COVID-19 panic has exacerbated OCD symptoms for many people who struggle with the disorder.

Psychologist Jonathan Abramowitz is an internationally recognized expert on OCD and anxiety disorders. Over the course of his 25-year career, he has come to believe that OCD isn’t an individual issue; it is a family issue.

The key to successfully helping your loved one? First you must focus on your own behavior and learn to reduce patterns of “family accommodation,” such as helping with rituals, tolerating avoidance of triggers, or looking the other way as the person with OCD performs obsessive-compulsive rituals.

“I’ve worked with countless families affected by OCD. And I’m here to tell you that it doesn’t have to be this way. You can turn things around. You don’t have to walk on eggshells. You don’t have to argue…The solution is to provide the kind of consistent support that helps your relative develop the confidence and skills to manage OCD in a healthier way and without needing to lean so much on you or others,” Dr. Abramowitz writes in his new book, The Family Guide to Getting Over OCD.

Use the ‘SMART method’ to reduce family accommodation and help your loved one with OCD

Dr. Abramowitz recommends using the acronym SMART to help you optimize your goals and maximize your likelihood of success. Here’s how it works:

S is for SPECIFIC — Make your goals as detailed and specific as possible. Simply saying “My goal is to stop accommodating” is too hazy. Instead, use “I will no longer help Ariel check the doors and appliances before bed.” Try to choose goals that rest solely on your own actions (for example, “I will leave the house regardless of whether Brandon is ready to go” vs. “Brandon will stop preforming rituals that make us late.”) You’ve got a better chance of meeting goals when they’re fully under your control. Keep the focus on changing your own behavior.

M is for MEASURABLE — Your goals for reducing accommodation also need to be measurable so that you know when you have succeeded. Choose concrete goals that you can keep track of. “Stop throwing away items Antonio has deemed ‘contaminated'” provides a specific target to be measured: whether or not you’ve thrown anything away. On the other hand, “Do a better job of not accommodating Antonio’s OCD” is not measurable: How will you decide if you’ve done a better job? Setting goals to change observable behaviors (that someone else would be able to see) is your best bet for making sure your goals are measurable.

A is for ACHIEVABLE — Your goals should challenge you to stay focused and committed to your program, but at the same time they need to be realistic. If you set goals that stretch you (and your loved one with OCD), you will continue to put in the effort to achieve them. On the other hand, you probably won’t stay committed to goals that are too far out of reach. For example, “I will never reassure my sister again” is probably unattainable, especially if you’ve become accustomed to providing reassurance and your sister is clever about getting it from you. Instead, “I will stop answering my sister’s texts when she asks for reassurance” is probably a more reasonable (and also a more specific) goal.

R = RELEVANT — Without an emotional tie to your goals, you’ll lose the motivation to stick with them. In this case, they should obviously relate to (1) helping your loved one develop self-confidence and the ability to manage anxiety on her own, (2) reducing your involvement in her OCD symptoms, and (3) improving your and your family’s quality of life. Tying goals to one or more of these things will build your commitment to success.

T is for TIME BOUND — Finally, your goals should have a time frame. This means stipulating when you’ll begin changing your behavior–for example, “beginning tomorrow.” By specifying a time frame, you make your goal a priority, which increases motivation. Goals without specific time frames are less likely to be met because you feel you can put them off.

Overcoming family accommodation of OCD is not easy.

But remember, by gently but firmly encouraging the person you care about to face their fears, you can stop being controlled by their OCD. Ultimately your relationship will grow stronger, and your whole family will grow more confident and hopeful.”

Dr. Jonathan Abramowitz, Psychologist

Guilford Press

Mental Illness: Definition, Types, Diagnosis, Treatment

A mental illness is a health condition involving changes in thinking, emotion, or behavior leading to distress or problems functioning in social, work, or family activities. Mental illness is quite common: In 2019, nearly one in five U.S. adults experienced a mental illness, while one in 20 U.S. adults have a serious mental illness. It is estimated that 46% of people who died by suicide had a diagnosed mental health condition and 90% of individuals who died by suicide had shown signs of a mental health condition.

Many people develop a mental illness early on in life, with 50% of all lifetime mental illness beginning by age 14 and 75% by age 24. Its impact on the healthcare system is substantial: Mental illness and substance use disorders are involved in one out of eight emergency room visits.

There are many different types of mental illness—referred to as mental disorders—with different causes, symptoms, and treatments. Some may involve a single episode, while others are relapsing or persistent. To ensure the correct diagnosis and a standardized treatment plan, mental disorders are diagnosed based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) issued by the American Psychiatric Association.

Sad woman suffering from depression

Ivan Pantic / Getty Images


Types

The DSM-5 categorizes major types of mental disorders by Diagnostic Criteria and Codes.

Anxiety Disorders

Anxiety disorders are the most common mental health concern in the United States, affecting 19.1% of the population. People with anxiety disorders have excessive fear and anxiety and related behavioral disturbances. Their anxiety symptoms can worsen over time, interfering with their ability to function in their daily life. It also leads to attempts to avoid situations or triggers that worsen symptoms.

Anxiety disorders are a group of related conditions, each having unique symptoms. Types of anxiety disorder include:

Bipolar and Related Disorders

Bipolar disorder causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with this disorder experience extremely high and low moods, known as mania and depression. They may have distinct manic or depressed states, but may also have long periods without symptoms. A person with bipolar disorder can also experience both extremes simultaneously or in rapid sequence. It affects 2.8% of the U.S. population, and 83% of cases are classified as severe.

Bipolar disorders can be categorized into four types, including:

  • Bipolar I disorder 
  • Bipolar II disorder 
  • Cyclothymic disorder or cyclothymia
  • Bipolar disorder, “other specified” and “unspecified”

Depressive Disorders

People with depressive disorders, commonly referred to as simply depression, experience a sad, empty, or irritable mood accompanied by physical and cognitive changes that are severe or persistent enough to interfere with functioning. Some will only experience one depressive episode in their lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

Those with depression lose interest or pleasure in activities and have excessive fatigue, appetite changes, sleep disturbances, indecision, and poor concentration. Suicidal thinking or behavior can also occur.

There are many types of depression, including:

  • Major depressive disorder
  • Bipolar depression 
  • Perinatal and postpartum depression
  • Persistent depressive disorder or dysthymia
  • Premenstrual dysphoric disorder
  • Psychotic depression 
  • Seasonal affective disorder (major depressive disorder with seasonal pattern)

Dissociative Disorders 

Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociation refers to a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is. Symptoms of dissociative disorders can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body and loss of memory, or amnesia. Dissociative disorders are frequently associated with previous experience of trauma. It is believed that dissociation helps a person tolerate what might otherwise be too difficult to bear.

There are three types of dissociative disorders:

  • Dissociative identity disorder
  • Dissociative amnesia
  • Depersonalization/derealization disorder

Feeding and Eating Disorders

People with feeding and eating disorders experience severe disturbances in their eating behaviors and related thoughts and emotions. They become so preoccupied with food and weight issues that they find it harder and harder to focus on other aspects of their life. Over time, these behaviors can significantly impair physical health and psychosocial functioning. Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. 

There are three main types of eating disorders:

  • Anorexia nervosa 
  • Bulimia nervosa 
  • Binge eating disorder 

Gender Dysphoria

Gender dysphoria refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. It often begins in childhood, but some people may not experience it until after puberty or much later.

Transgender people are individuals whose sex assigned at birth does not match their gender identity. Some transgender people experience gender dysphoria, and they may or may not change the way they dress or look to align with their felt gender.

Neurocognitive Disorders

Neurocognitive disorders refers to decreased cognitive functioning due to a physical condition. People with this condition may have noticeable memory loss, difficulty communicating, significant problems handling daily tasks, confusion, and personality changes. Neurocognitive disorders can be caused by a wide range of conditions, including Alzheimer’s disease, vascular disease, traumatic brain injury, HIV infection, Parkinson’s disease, and Huntington’s disease.

Types of neurocognitive disorders include:

  • Delirium
  • Major neurocognitive disorder
  • Mild neurocognitive disorder

Neurodevelopmental Disorders 

Neurodevelopmental disorders are a group of disorders in which the development of the central nervous system is disturbed. This can include developmental brain dysfunction, which can manifest as neuropsychiatric problems or impaired motor function, learning, language, or non-verbal communication.

Types of neurodevelopmental disorders include:

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). These repetitive behaviors can significantly interfere with a person’s daily activities and social interactions. Not performing the behaviors commonly causes great distress. people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions. This disorder is estimated to affect 2% to 3% of U.S. adults.

Disorders related to OCD include:

  • Hoarding disorder
  • Body dysmorphic disorder 
  • Body focused repetitive behaviors like excoriation (skin-picking) disorder and trichotillomania (hair-pulling disorder)

Personality Disorders

People with personality disorders have persistent patterns of perceiving, reacting, and relating that are maladaptive and rigid, causing distress and functional impairments. The pattern of experience and behavior begins by late adolescence or early adulthood, and causes distress or problems in functioning. People with personality disorders have trouble dealing with everyday stresses and problems, and they often have stormy relationships with other people.

There are 10 types of personality disorders:

  • Antisocial personality disorder
  • Avoidant personality disorder
  • Borderline personality disorder
  • Dependent personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder
  • Obsessive-compulsive personality disorder
  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Schizophrenia Spectrum and Other Psychotic Disorders

People with schizophrenia spectrum and other psychotic disorders lose touch with reality and experience a range of extreme symptoms that may include hallucinations, delusions, disorganized thinking and speech, and grossly disorganized or abnormal behavior. Schizophrenia affects less than 1% of the U.S. population.

Other psychotic disorders include:

  • Brief psychotic disorder
  • Delusional disorder 
  • Schizoaffective disorder
  • Substance-induced psychotic disorder

Sleep-Wake Disorders

Sleep-wake disorders, also known as sleep disorders, involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. They often occur along with medical conditions or other mental disorders, such as depression, anxiety, or cognitive disorders.

There are several types of sleep-wake disorders:

  • Insomnia
  • Obstructive sleep apnea
  • Parasomnias
  • Narcolepsy
  • Restless leg syndrome.

Substance Abuse Disorders

Substance abuse disorders, also called substance use disorder, occurs when a person’s use of alcohol or another substance like drugs leads to health issues or problems at work, school, or home. People with this disorder have an intense focus on using a certain substances to the point where their ability to function in day-to-day life becomes impaired, and they keep using the substance even when they know it is causing or will cause problems.

Trauma-Related Disorders

Trauma-related disorders occur after exposure to a stressful or traumatic event, which can include exposure to physical or emotional violence or pain,abuse, neglect, or catastrophic event. Trauma-related disorders are characterized by a variety of symptoms, including intrusion symptoms (flashbacks),avoidance, changes in mood such as anhedonia (inability to feel pleasure) or dysphoria (dissatisfaction with life), anger, aggression, and dissociation.

Types of trauma-related disorders include:

  • Post-traumatic stress disorder
  • Acute stress disorder
  • Adjustment disorder
  • Reactive attachment disorder
  • Disinhibited social engagement disorder
  • Unclassified and unspecified trauma disorders

Diagnosis

Doctors diagnose mental illness by using the criteria outlined in the DSM-5. Many conditions require all criteria to be met before a diagnosis can be made. Others, like borderline personality disorder, require only a set number of criteria from a larger list to be met. 

Many disorders are further classified by severity and specifications that can help doctors determine the appropriate course of treatment for an individual patient. For example, someone being diagnosed with an obsessive-compulsive disorder will also be categorized based upon their level of insight as to whether their OCD beliefs are true and whether or not they present with a current or past history of tic disorder.

About half of people with one mental illness have a comorbid substance use disorder (co-occuring disorder present at the same time or one right after the other). As such, the likelihood of a mental and substance use disorder dual diagnosis is high due to common risk factors and the fact that having one condition predisposes a person to the other. 

It is also common for people to have more than one mental illness at a time. Common comorbidity examples include: 

  • Borderline personality disorder: Other personality disorders, major depression, bipolar disorders, anxiety disorders, and eating disorders
  • Social anxiety disorder: Other anxiety disorders, major depression, and alcohol use disorder
  • Eating disorders: Anxiety, substance use disorder, obsessive compulsive disorder, depression, and post-traumatic stress disorder

It is best for primary care physicians and mental health professionals to work together because a diagnosis as defined by the DSM requires exclusion of other possible causes, including physical causes and other mental disorders with similar features. For example, paranoid delusions can be caused by Huntington’s disease, Parkinson’s disease, stoke, or Alzheimer’s disease, and other forms of dementia.

Treatment

Due to the wide variety of mental illnesses, many different health professionals may be involved in the treatment process, including:

  • Psychologists
  • Therapists
  • Social workers
  • Psychiatrists
  • Primary care physicians 
  • Pharmacists

Treatment may include one or more of the above professionals and one or more methods (e.g. counseling combined with medication). Treatment-resistant disorders may require further interventions.

Psychotherapy

Psychotherapy is used to treat a broad range of mental illnesses by helping a person control their symptoms in order to increase functioning, well-being, and healing. 

Common types of psychotherapy include:

  • Cognitive behavioral therapy (CBT): Helps you identify and change maladaptive behaviors
  • Dialectical behavioral therapy (DBT): A form of psychotherapy that uses aspects of CBT along with other strategies including mindfulness that helps you regulate emotions such as those related to suicidal thinking and teaches new skills to change unhealthy and disruptive behaviors
  • Supportive therapy: Helps you build self-esteem while reducing anxiety, strengthening coping mechanisms, and improving social functioning

Medication

Medications may be used to reduce symptoms and restore functioning. They are often used in conjunction with psychotherapy.

Four major types of psychotropic drugs include:

  • Antidepressants such as SSRIs, SNRIs, and bupropion are used to treat depression and anxiety, pain, and insomnia. They may also be used to treat ADHD in adults. 
  • Anxiolytics are anti-anxiety medications and are used to treat symptoms ranging from panic attacks to feelings of extreme worry and fear.
  • Antipsychotics are used to treat symptoms of psychosis including delusions and hallucinations. They are often used with other medications to help treat delirium, dementia, and other conditions, including eating disorders, severe depression, and OCD. 
  • Mood stabilizers such as lithium can be used to treat bipolar disorder and mood swings associated with other disorders and also to help with depression. 

Procedures

Brain stimulation procedures like electroconvulsive therapy (ECT), transcranial magnetic stimulation, and vagus nerve stimulation are used in cases of treatment-resistant and severe depression.

During ECT, electrodes are placed on the head to deliver a series of shocks to the brain to induce brief seizures while the patient is under anesthesia. For transcranial magnetic stimulation, magnets or implants are used to stimulate cells associated with mood regulation.

Ketamine infusion or nasal spray therapy offers another option for people with treatment-resistant major depression. It works rapidly and helps reduce suicide ideation.

Lifestyle

Lifestyle changes help promote overall well-being. Healthy lifestyle choices include:

  • Exercising for at least 20 minutes a day
  • Practicing mindfulness in meditation or yoga
  • Avoiding smoking
  • Avoiding substance use (including alcohol)
  • Eating a well-rounded diet that limits fats and refined sugars
  • Having a support system 
  • Maintaining a regular seven- to nine-hour sleep routine
  • Practicing positive thinking

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database

A Word From Verywell

It’s understandable if you’re feeling a little overwhelmed, confused, and even scared when it comes to mental illness. It is possible to live a healthy life with mental illness, and the first step is often the hardest: telling someone about your concerns. Early diagnosis and treatment often improve overall outcome, and talking about it helps further reduce stigma. Remember that there are a lot of ways to manage your mental illness and prevent it from interfering with your daily life.

Cannabis may have some beneficial effects on symptoms of obsessive-compulsive disorder

An analysis of a large dataset of medical cannabis users has indicates that many people with obsessive-compulsive disorder report that their symptoms are reduced after smoking the substance.

The preliminary study, published in the Journal of Affective Disorders, found that cannabis use was associated with reductions in compulsions, unwanted thoughts and anxiety, highlighting the need for additional clinical trials.

“While many studies have examined the acute effects of cannabis on other mental health conditions — such as anxiety, depression, PTSD, and psychosis — there has been almost no research on acute effects of cannabis on symptoms of obsessive-compulsive disorder (or OCD) in humans,” explained study author Carrie Cuttler, an assistant professor at Washington State University.

“We have previously found that acute cannabis use is associated with reductions in anxiety as well as intrusive thoughts characteristic of PTSD. Further, previous research using a rodent model of compulsive behavior indicates that CBD — which is the second most common constituent in the cannabis plant — reduces compulsive behavior. Therefore, we suspected that cannabis may have acute effects on OCD symptoms in humans.”

For their study, the researchers analyzed data collected by Strainprint Technologies, a medical journaling app in which patients report changes in symptom severity in response to consuming different strains and doses of cannabis. Cuttler and her colleagues were particularly interested in 1,810 cannabis sessions that 87 individuals self-identifying as having OCD had logged into the Strainprint app.

After cannabis consumption, users with OCD reported it reduced the severity of their compulsions by 60%, intrusions by 49%, and anxiety by 52% on average. Only a small number of sessions were associated with a worsening of these symptoms.

“We also found that higher concentrations of CBD were associated with larger reductions in compulsions specifically, which is consistent with previous research in rodents. Also, higher doses of cannabis were associated with larger reductions in compulsions,” Cuttler told PsyPost.

“Finally, we found that as people continued to use cannabis over time the cannabis-related reductions in intrusions became somewhat smaller, suggesting people may start to develop tolerance to the acute effects of cannabis on intrusions. In contrast, it appeared that the cannabis-related reductions in compulsions and anxiety remained pretty constant over time.”

But the researchers noted that their dataset likely did not include many people who found cannabis to be ineffective. The study is also limited by its lack of a placebo control group.

“It is important to note that we relied on a self-selected sample of cannabis users who use cannabis to manage their symptoms of OCD and there was significant variability in the results, suggesting the not everyone will find cannabis equally beneficial in reducing OCD symptoms,” Cuttler explained.

“Further, the sample self-reported having OCD and we couldn’t verify their diagnoses. Moreover, we were not able to obtain a placebo control group so some of the reductions in symptoms may be a function of expectancy effects, that is it is likely that people’s expectations of the effects of cannabis on these symptoms may be driving at least some of their perceived symptom change.”

“Indeed, shortly before our paper was published a rather small clinical trial was published that revealed that the reductions in OCD symptoms were no larger after cannabis use than placebo use,” Cuttler added. “We really need larger sized clinical trials that examine these effects in a longitudinal manner, but the restrictions that the schedule I classification of cannabis imposes on researchers makes this difficult.”

Strainprint’s app is intended to help users determine which types of cannabis work the best for them, but the company provided the researchers access to users’ anonymized data for their study.

“This research was only possible because of the generous support of Strainprint, who provided us with the anonymous data from their medical cannabis app to analyze,” Cuttler said. “This is one of five papers we have published using Strainprint app data to examine the acute effects of cannabis on various mental health conditions and pain.”

The study, “Acute Effects of Cannabis on Symptoms of Obsessive-Compulsive Disorder“, was authored by Dakota Mauzay, Emily M. LaFrance, and Carrie Cuttler.

ADHD and OCD: They Can Occur Together

These two disorders share certain symptoms and cause similar problems. And both disorders have a genetic connection.

Here are some of the other similarities between them.

Both conditions involve the same brain areas

Brain scans show that ADHD and OCD both produce atypical activity in the same neural pathway in the brain — the frontostriatal area.

This circuit is involved with a number of important cognitive and behavioral abilities such as:

  • attention-shifting
  • flexibility
  • habits
  • goal-directed behaviors

When the frontostriatal circuit isn’t working as it should, it can be harder for you to:

  • make decisions
  • remember things
  • plan
  • switch from one task to another

Both can interfere with academic and career success

ADHD is well known for the disruption it causes at school and work.

People with ADHD often have a hard time:

  • managing time
  • keeping up with supplies
  • remaining focused
  • completing complex tasks

They may be late to class or to work, and inattention can cause them to make frequent mistakes.

Similarly, the time involved in carrying out rituals, checking behaviors, and other compulsions can make people late to school or work.

Obsessions, compulsions, and the anxiety they cause can affect the ability to focus and follow through on tasks. Both conditions can affect grades, attendance, and performance.

Both disorders can affect your ability to pay attention

One of the chief characteristics of ADHD is the inability to pay attention for longer periods of time. If someone calls your name, you might not hear it because you’re distracted by something else.

OCD can also make you seem inattentive but for a different reason. You might be so preoccupied by an obsession or a compulsion that you’re not focused on what’s happening around you.

Both impact relationships with family, friends, and others

ADHD and OCD both require extra support from the people in your life. Family members may be involved in helping you seek treatment or carry out a treatment plan.

They may be instrumental in helping you learn coping skills. Ideally, they will go the extra mile to make sure you feel loved and supported — and they may sometimes feel stressed, frustrated, or worried about you, too.

Both can trigger anger, anxiety, and depression

Stress can make the symptoms of ADHD and OCD worse. And by the same token, living with the symptoms of these conditions can increase your anxiety to unhealthy levels.

In some cases, ADHD and OCD may lead to depression.

People with both conditions also feel intense surges of anger and persistent irritability, which can sometimes provoke aggressive behavior.

Both are associated with sleep problems

Some studies show that as many as 70 percent of people with OCD also have insomnia and other sleep disorders.

Similarly, people with ADHD often experience:

  • restless leg syndrome
  • disrupted circadian rhythms
  • obstructive sleep apnea
  • insomnia

When you don’t get enough good sleep, the symptoms of OCD and ADHD may get worse or be harder to tolerate.

Both are associated with gastrointestinal (GI) issues

Studies show that people with OCD are more likely than the general population to experience irritable bowel syndrome. People with ADHD are also more likely to have chronic constipation and irritable bowel syndrome.

Both may be caused or worsened by trauma

A growing body of research looks at the connection between childhood trauma and the emergence of developmental conditions like ADHD and OCD.

A history of childhood trauma is common among people with an OCD diagnosis.

And ADHD symptoms in children, which become ongoing symptoms in adults, can be brought on by traumatic events, especially child abuse and neglect.

Expert Tips for Understanding OCD, and How to Treat It

Many of us have made a casual comment about obsessive-compulsive disorder, as in “I’m so OCD about washing vegetables.” But for those who suffer from the disorder, obsessions (like a fear of germs) and compulsions (like disinfecting) can be debilitating. OCD may be especially challenging at a time like this, when public health messages intended to protect us from COVID-19 can reinforce germophobia—or amplify feelings of uncertainty, a component of the illness. “Studies are underway to determine how difficult the pandemic has been for those with OCD, but it’s safe to say that some people with the disorder are really struggling right now,” says Elna Yadin, PhD, an OCD specialist on the clinical faculty at the Perleman School of Medicine at the University of Pennsylvania.

8 Things You Should Know About Anxiety Medicine

Anxiety disorders are common. Here’s what you need to know about medications.

Most everyone feels anxious at some point — especially during a pandemic — but also in “normal” times. Usually, that anxiety goes away with time. When it doesn’t, it could signal a clinical anxiety disorder.

Anxiety disorders are the most common form of mental illness, according to the National Institutes of Health. They affect more than 25 million Americans. There are five major types of anxiety disorders:

— Generalized anxiety disorder.

Obsessive-compulsive disorder.

— Panic disorder.

Post-traumatic stress disorder.

— Social phobia (or social anxiety disorder).

While each is different, they share many symptoms and methods of treatment, including medication. Here are eight things you should know about anxiety medications.

There are four common types of anxiety medications.

There are four main classifications, or types, of medication that doctors prescribe for anxiety. You may recognize some as treatments for depression as well:

— Selective serotonin reuptake inhibitors, or SSRIs.

— Serotonin-norepinephrine reuptake inhibitors, or SNRIs.

— Benzodiazepines.

— Tricyclics.

Anxiety medications help you control your symptoms and allow you to function better in your daily life. But they cannot cure the cause of anxiety.

Anxiety medications are usually safe and effective when prescribed and monitored by your doctor. These meds may be prescribed for short- or long-term relief.

They work by affecting brain chemicals.

Both depression and anxiety are thought to relate to chemicals in the brain called neurotransmitters that affect attention span, sleep and, especially, mood. These medications regulate neurotransmitters, leaving more “happy” chemicals available to the brain, but they do so in different ways.

— SSRIs slow the reuptake of serotonin.

— SNRIs inhibit serotonin and norepinephrine reuptake.

— Benzodiazepines increase the effectiveness of the neurotransmitter gamma-aminobutyric acid, or GABA, which slows down an anxious brain and nervous system.

— Tricyclic antidepressants prevent serotonin and norepinephrine from binding with receptors on the nerves, leaving more for the brain.

There are also other medication options.

Along with those four main classes, there are a few others that your doctor may try to treat anxiety.

Anxiolytics. These drugs work on regulating brain chemicals that may cause anxiety; Buspirone is a popular example of an anxiolytic.

Monoamine oxidase inhibitors, or MAOIs. These drugs are Food and Drug Administration-approved to treat depression, but many doctors also use them for anxiety, specifically panic disorder and social phobia. Examples of MAOIs include phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate) and selegiline (Emsam).

Beta blockers. Known better for treating high blood pressure and other cardiovascular conditions, beta blockers may be prescribed for social anxiety. They block the effects of norepinephrine, a brain chemical associated with high arousal, and are good at relieving physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling and blushing, the NIH says.

It takes time to find the right medication.

Patients respond differently to these different medications. And each may be better suited to a different issue.

For example, if anxiety is due to a specific, short-term event, like flying in an airplane or giving a big speech, the best choice might be a benzodiazepine, according to Dr. Michael Thase, professor of psychiatry and chief of the Division of Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania.

Long-term anxiety may be better treated with one of the antidepressants in the SSRI and SNRI classes, Thase says. Even within these classes, each patient might respond better to one medication over another. So it’s not unusual for a patient to try more than one drug before finding the best treatment.

Medications work best with psychotherapy.

For most long-term or chronic anxiety, providers will prescribe psychotherapy along with medication, to help treat the cause of your illness.

The NIH lists the following types of psychotherapy for anxiety:

Cognitive behavioral therapy, which helps people think and behave differently when faced with a triggering situation.

Cognitive therapy, which helps people notice and combat unhealthy or distorted thinking.

Exposure therapy, which helps people face their fears and get past them so they can pursue activities they have avoided.

Some medications may be habit-forming.

SSRI and SNRI antidepressants may be taken long term if needed, without risk of dependence. This isn’t the case with a benzodiazepine.

“You should try to avoid staying on a benzodiazepine for longer than a few weeks if you can. After that, there is a small risk of dependence and tolerance,” Thase warns. “Benzodiazepines also may inhibit the progress of some kinds of psychotherapy.” Some research has found that these meds, for unclear reasons, reduce the effectiveness of therapy for PTSD patients.

Stopping too quickly is dangerous.

Medications prescribed for anxiety (and depression) should be taken exactly as prescribed. That includes when you’re trying to wean off them. Stopping too quickly can cause withdrawal symptoms and serious health risks, among them suicidality, which is having thoughts of self-harm.

With an SSRI, for example, “withdrawal feels like electrical tingling in the hands and arms — ‘zaps’ as they call them,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University.

Other symptoms include dizziness or vertigo when moving your head, he says. These symptoms usually pass in one to two weeks, but you should contact your doctor when you experience any side effects of these medications.

The best medication may be no medication.

While moderate to severe anxiety most likely benefits from interventions like medication and psychotherapy, mild or occasional anxiety may be better treated with lifestyle changes:

Diet. Avoiding stimulants like caffeine, depressants like alcohol and high-sugar, high-fat foods can reduce anxiety, says Ramsey, founder of the Brain Food Clinic and author of the book “Eat to Beat Anxiety and Depression: Nourish Your Way to Better Mental Health in Six Weeks.” Chamomile, in either tea or supplement form, also has been shown to help reduce generalized anxiety.

Exercise. The Anxiety and Depression Association of America reports that exercising for just 10 minutes can elevate your mood.

Sleep. While anxiety can interfere with sleep, the opposite is also true: Poor sleep can contribute to anxiety. Improving sleep habits can improve mental well-being.

Mindfulness. Meditation, yoga, deep breathing exercises and other relaxation techniques help calm the worried mind.

Aromatherapy. Essential oils like lavender also can help reduce anxiety, according to a study published in Evidence-Based Complementary and Alternative Medicine journal.

Here are eight things to know about anxiety medications.

— There are four common types of anxiety medications.

— They work by affecting brain chemicals.

— There are also other medication options.s

— It takes time to find the right medication.

— Medications work best with psychotherapy.

— Some medications may be habit-forming.

— Stopping too quickly is dangerous.

— The best medication may be no medication.

Anxiety Disorders Treatment Market Cost Estimation, Sales, Expenses Analysis – The Bisouv Network

WMR-Western Market Research has recently published a comprehensive and exclusive research report, which is an intelligent study covering all key segments. This research report provides breakthrough inputs and insights on market related factors like size, competition, trends, analysis, forecasts etc. The study encompasses primary and secondary data sources along with quantitative and qualitative practices thus assuring data accuracy.

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The anxiety disorders market is estimated to represent a global market of USD 18,234 million by 2025 with growth rate of 2.2%.

Anxiety is defined as an excessive fear of a normal situation or an exaggerated response to a fear. Anxiety is one of the fast spreading disorder across the globe, majorly among young population. However, people often live with anxiety problem for years before they diagnose or treat with the condition which would in turn hamper the market growth to some extent. According to the American Psychiatric Association, anxiety can be categorized into phobias, acute stress disorder, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder. Increasing prevalence of anxiety related disorders has led to high clinical urgency for adoption of various therapies and therapeutics available in the market, which is anticipated to fuel growth over the coming years. As per World Health Organization (WHO), anxiety and other form of depressions are one of the most common mental disorders affecting more than 300 million people worldwide. The number is projected to increase at constant rate during the forecast period.

In terms of drug category, the market is divided into Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants (TCAs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Monoamine oxidase inhibitors (MAOIs), Anticonvulsants, and Others. Among which, SSRIs and SNRIs are contributed to largest market share, capturing almost 60% share of the global market. Furthermore, segments such as beta blockers, SSRIs and others are considered to be the highest growing market segment during the coming years. This upsurge is a consequence of high stress and competitive work environment coupled with unprecedented shift in the lifestyle, such as drinking, smoking, consumption of unhealthy food, etc.

Based on therapy category the market is analysed into Transcranial Magnetic Stimulator, Electroconvulsive Therapy (ECT), Cognitive Behaviour Therapy (CBT), Fischer Wallace Stimulator, and Others. Fischer Wallace Stimulator, and Transcranial Magnetic Stimulator are the largest revenue generating segment. Collectively, these two segment recorded over USD 1,500 million revenue and are projected to dominate the market growth during the forecast period. High efficiency coupled with increasing demand of these therapies in developed regions such as North America and Europe led the market growth.

Regionally, developed countries of North America and Europe dominated the market, captured more than 70% share of the global market. Boost in research and development activities by key operating companies to introduce novel anxiety therapeutics and therapies coupled with surge in demand for effective anxiety therapeutics among end-users drives the market growth.

Furthermore, large number of therapeutics under clinical investigation in North America Europe further support the market growth. For example, Switzerland based Adde Therapeutics initiated multi-centric, double-blinded, Phase II tiral of ADX71149 in adults affected with major depressive disorder in collaboration with Janssen Pharmaceuticals, Inc. These types of initiatives will support the market growth to great extent.

The market size and forecast for each segment has been provided for the period 2014 to 2025, considering 2015 as the base year. The report also provides the compounded annual growth rate (% CAGR) for the forecast period 2016 to 2025 for every reported segment.

The years considered for the study are:
Historical Year-2014 2015
Base Year-2015
Estimated Year-2016
Projected Year-2025

TARGET AUDIENCE
Hospitals
Manufacturers
Traders, Distributors, And Suppliers
Government and Regional Agencies and Research Organizations
Consultants
Distributors
SCOPE OF THE REPORT
The scope of this report covers the market by its major segments, which include as follows:
MARKET,BY DRUG CATEGORY
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic Antidepressants (TCAs)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Monoamine oxidase inhibitors (MAOIs)
Anticonvulsants
Others

MARKET,BY THERAPY
Transcranial Magnetic Stimulator
Electroconvulsive Therapy (ECT)
Cognitive Behaviour Therapy (CBT)
Fischer Wallace Stimulator
Others

MARKET,BY REGION
North America
Europe
Asia Pacific
Rest of the World
MARKET,BY COUNTRY
Further Breakdown of The North America Market
S.
Canada
Further Breakdown of The Europe Market
Germany
France
Rest of Europe
Further Breakdown of The APAC Market
India
China
Rest of APAC
Further Breakdown of The Rest of the World Market
Middle East and Africa
Latin America

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https://westernmarketresearch.com/market-report/340724/Anxiety Disorders Treatment Market, by d

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When OCD and ADHD Coexist: Symptom Presentation, Diagnosis, and Treatment

Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are among the most commonly diagnosed neuropsychiatric disorders. The two conditions, which have overlapping symptoms and are thought to share underlying deficits, also have substantial comorbidity rates. Despite this prevalence and documented overlap, ADHD is often missed in patients with OCD — and vice versa — often due to symptom presentation.

To ensure an accurate diagnosis and effective treatment, clinicians must understand the unique interplay between OCD and ADHD, including how ADHD tends to present in patients with OCD. They must also acknowledge common barriers to proper assessment, as well as the most frequent diagnostic errors. Finally, while a strong understanding of similarities is helpful, also fundamental is a solid foundation on the innate differences between OCD and ADHD.

What Is OCD?

OCD, as suggested in the name, is characterized by having obsessions and/or compulsions.

Obsessions can include recurrent, persistent thoughts, visions, and impulses that are experienced as intrusive and inappropriate, and which cause marked anxiety and distress to the individual. Other hallmarks of OCD obsessions include:

  • Thoughts, impulses, and mental images are not simply excessive worries about real-life problems.
  • The individual often attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
  • The individual recognizes that the obsessive thoughts, impulses, or images are a product of their own mind (not imposed from without as in thought insertion)

Compulsions can include repetitive behaviors (e.g., hand washing, ordering objects, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.

[Read: Could I Have OCD? Unpacking Symptoms]

The repetitive behaviors or mental acts are aimed at preventing or reducing distress, or at preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or they are clearly excessive.

The OCD spectrum covers a collection of disorders and conditions that have a genetic, underlying trait of obsessionality and compulsivity. They include:

OCD and ADHD: Comorbid Considerations and Characteristics

OCD-ADHD Prevalence and Background

The comorbidity of ADHD and OCD is much more common than generally thought. Most research has studied the prevalence of ADHD in patients with OCD rather than the inverse, with diagnosis rates mostly falling around 30 percent.1

Comorbid OCD and ADHD enhance the symptoms of each other, though the presence of OCD may attenuate hyperactivity in some ADHD patients. OCD also has an earlier onset when ADHD is present.

[Read: What Does OCD Look Like in Adults?]

Research reveals abnormal activity in certain regions of the brain for both ADHD and OCD. OCD is associated with increased activity in frontal and striatal regions. However, ADHD is associated with decreased activity in similar regions.

Genetically, dopaminergic genes are implicated in ADHD, while OCD is linked to serotonergic genes. The two disorders are also heritable. Family history studies show an OCD-ADHD association – compared to an individual without ADHD, an individual with ADHD is more likely to have someone in their family with OCD.

How ADHD Presents in OCD

Comorbid ADHD often gives rise to certain conditions and presentations under the OCD umbrella, including

  • Pure obsessionality (Pure-O), which refers to individuals with OCD who have the obsessive thoughts component, but not the compulsive behaviors. (Pure-O, while in the family of OCD disorders, is often misidentified as anxiety)
  • Tics and Tourette’s disorder, both characterized by impulsivity

Hoarding in Patients with ADHD and OCD

Recent research has linked hoarding behaviors to poor executive function, which is also at the core of ADHD. Hoarding can also look different when ADHD is present compared to OCD alone.

  • Acquisition differences: Many hoarders with ADHD may acquire material due to a cycle of impulse buying. In classic OCD, on the other hand, the individual tends to save items, but impulsive behavior is not a problem.
  • Ego dystonic vs. ego syntonic: Individuals with ADHD who have hoarding issues tend to be bothered by it – the behavior is often seen as inconsistent and unacceptable to their attitudes and sense of self (ego-dystonic). The clutter may also distract the individual with ADHD and even aggravate their symptoms. In contrast, individuals in the classic OCD spectrum are not as bothered by clutter (ego-syntonic).
  • The motivations behind hoarding are different. Individuals with ADHD tend to be driven to hold on to items in case they are needed at a later time, and to save some “executive bandwidth.” On the OCD-side, these individuals tend to be motivated by the idea of not ridding oneself of things. Objects also tend to hold much sentimental value.
  • Sense of morality and personification of objects: Individuals with OCD tend to equate throwing things out with wastefulness, and thus an attack on their character. In the most severe cases, individuals also tend to personify objects.

Body-Focused Repetitive Behaviors in Patients with ADHD and OCD

With ADHD, the function of BFRB is mainly to provide stimulation and arousal:

  • A repetitive behavior can start with a distraction the individual is rejecting, like a blemish on the face or an uneven nail.
  • The sensory nature of these behaviors can be very appealing for individuals with ADHD, and can also provide some stress relief as well as a fidget for focus.
  • A behavior can be goal-oriented and coupled with accomplishment (like hair pulling), which can be reinforcing for people with ADHD.

OCD and Executive Functions

OCD is also an executive functioning disorder. When an individual has obsessive thoughts and compulsions, it leads to executive overload, leaving little room to attend to anything else. Compared with ADHD, however, the reasons behind the executive dysfunction are different. Individuals with OCD experience the following:

  • Difficulty with planning and with working memory deficits, due to trouble filtering out irrelevant data while feeding a need for completeness
  • Selective attention deficit to what is threatening or distressing. With ADHD, attention is directed to what is stimulating
  • Impaired inhibition as an element of compulsivity
  • Decision-making problems due to excessive over-thinking, compared to individuals with ADHD who may be more impulsive
  • An inflated sense of responsibility and perfectionism, which can make taking actions and making decisions much more profound than they need be

OCD and ADHD: Diagnostic Concerns

It is helpful to think of OCD and ADHD as opposites on a spectrum, where similar, overlapping behaviors and symptoms are explained by contrasting drivers. But this also explains why ADHD is routinely missed in patients with OCD, and vice versa.

Why ADHD is Missed in OCD Patients

  • ADHD is rarely assessed in clinical settings, especially in adults. A patient hospitalized for an episode, for example, may be assessed for a history of mood and anxiety disorders, but seldom for ADHD.
  • ADHD and OCD symptoms can intertwine, even though the basis and motivation for the behaviors may differ.
  • Myths and stereotypes about ADHD (hyperactivity, school performance, etc.) can lead to bias, especially against females and adults.
  • Perceived compulsions might be based in ADHD more than OCD, as individuals with ADHD often have to create specific environments and structures to function.
  • Distractibility can be seen as a positive in light of obsessive thoughts and compulsions.
  • Sensory sensitivity and defensiveness could be mistaken for perfectionist tendencies.
  • Hyperfocusing could be mistaken for over-focusing, which is very different.

Why OCD is Missed in ADHD Patients

  • Myths about OCD (that the condition only relates to hygiene and cleanliness, for example) can make for a simplistic, inaccurate picture.
  • Over-focusing can be mistaken for hyperfocus, and can sometimes be reinforcing for people with ADHD.
  • Individuals with OCD often feel shame around their “irrational” symptoms, so they are less likely to discuss them in clinical settings.
  • Delays and incomplete tasks can be mistaken for lack of follow-through/cognitive fatigue.
  • Need for perfectionism can be labeled as sensory defensiveness, executive dysfunction, and/or stubbornness.

OCD and ADHD: Treatment Considerations

Psychopharmacology

Patients with OCD and ADHD likely need a combined pharmacotherapy treatment plan comprising both SSRIs and stimulants to treat both disorders. While the medications do not have to interact with one another, there can be significant reactions. Stimulant treatment for ADHD, for example, may exacerbate OCD symptoms. As stimulants increase attention and focus, they may also lead an individual with comorbid OCD to focus more on the obsessive thought. However, there are cases when stimulants can help treat OCD, especially if symptoms are triggered by inattentiveness and other ADHD symptoms. The same can apply to SSRIs for OCD – when symptoms are in check, that tends to calm the ADHD.

Untreated, unmanaged ADHD may adversely impact OCD treatment, which is why it’s important for clinicians to assess for ADHD.

Behavioral Therapy

Exposure Plus Response Prevention (ERP) is the first-line treatment for OCD. It involves exposure to the obsessive thoughts that create anxiety, and inhibiting the compulsive behavior associated with the trigger. With OCD and ADHD:

  • Coaching the patient is essential for motivation and accountability
  • Therapy may need to begin with a high-stress trigger due to a high stimulus threshold
  • Distractibility may delay anxious feelings during exposure, which needs to be accounted for
  • Self-directed ERP should be planned with specific dates and times to promote follow-through
  • Patients can be expected to miss sessions, show up late, or have a hard time paying attention. This can easily be misconstrued for resistance to treatment
  • Therapy sometimes causes a phenomenon in patients where decreasing OCD symptoms may lead to the appearance of other symptoms or even ADHD impulsivity

The content for this article was derived from the ADDitude Expert Webinar “The OCD-ADHD Link: What You Should Know When You Have Both” [Video Replay Podcast #343] with Roberto Olivardia, Ph.D., which was broadcast live on February 11, 2021.

OCD and ADHD: Next Steps


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Sources

1Geller, D. A. et al (2002). Attention-deficit/hyperactivity disorder in children and adolescents with obsessive compulsive disorder: Fact or artifact?. Journal of the American Academy of Child Adolescent Psychiatry, 41, 52-58.


Updated on March 18, 2021

Anxiety disorder symptoms, impacts, and treatments

If anxiety occurs frequently or has a significant impact on a person’s well-being, support and treatment are available.

People can speak with a healthcare professional about their symptoms, or they can contact a therapist.

It is also important to speak with a doctor if anxiety is affecting a person’s physical health.

Stress and anxiety trigger the “fight, flight, freeze, or fawn” response, which is the body’s way of preparing for danger. During this response, the body produces stress hormones such as cortisol and noradrenaline.

If a person is frequently anxious, they may have chronically elevated stress hormone levels, which can affect sleep, digestion, hormone health, blood pressure, and more.

With treatment, a person can lower their anxiety levels, improve their quality of life, and alleviate symptoms or health conditions that may worsen due to stress.

Learn about some free and low cost therapy options here.

People with OCD are finding community and support on TikTok – i

The last 11 months have been incredibly hard and isolating for so many of us. Though few would need convincing of this fact, a survey conducted by YoungMinds at the end of last year found a staggering 67% of people aged 13 to 25 felt the pandemic will have a long-term negative effect on their mental health.

Throughout lockdown, discussions about mental health have become a central feature on TikTok, with many, including therapists, gravitating to the platform to find and offer support and solidarity with those trying to cope with symptoms made worse by isolation. This is particularly true for those of us living with Obsessive Compulsive Disorder (OCD). At the time of writing, TikTok’s #OCD hashtag stands at around 650 million views.

Everyone knows it by name, but there are so many common misconceptions about OCD. It’s become shorthand for describing someone who is tidy, clean or well organised. Anyone who watched the high school musical drama Glee in the late 2010s might remember teacher Emma Pillsbury, who regularly performed her cleanliness compulsions — such as cleaning her food — with a large smile across her face. More recently, celebrities have self-diagnosed as having OCD, like Khloe Kardashian, who refers to her cleanliness as ‘KHLO-CD’. The reality is, of course, far more complex than these depictions. Defined by the NHS as “a mental health condition where you have recurring thoughts and repetitive behaviours that you cannot control,” for many with OCD, there is actually no fixation with cleanliness, or any outward sign of suffering. Instead, it is a daily battle inside one’s head.

Ainslie, an 18-year-old better known on TikTok as @ace.of.skates, first started talking about OCD in her videos in April of last year, around the beginning of the first lockdown. She wanted to give people a glimpse into what it is like to live with the condition each day, and dispel some of the myths and misunderstandings around it. “The term ‘OCD’ is often taken completely out of context,” she says. “People are always saying, ‘I’m so OCD!’ or ‘I’m a little OCD today’.” 

For Ainslie, her OCD manifests in feeling a need to complete a series of compulsions before she can start her day, all of which she details in her most-watched TikTok video. Before she gets out of bed she must blink, rub her eyes and then her eyebrows eight times each. Sitting on the edge of the bed, she then taps each foot onto the floor, before stomping on the ground a further eight times. Finally, she must clench and unclench her fists and stroke her cat before she can start her day. These repetitive behaviours – the ‘compulsive’ aspect of the anxiety disorder, are repeated until Ainslie feels she has done it ‘right’, often taking up to half an hour a day. 

Compulsions like this are performed in order to temporarily relieve or neutralise unpleasant feelings of dread and panic. This could be counting, hand-washing, cleaning, tapping or needing reassurance. But many people’s obsessions involve the presence of unwanted thoughts, images or memories that immediately trigger anxiety. Fear of contamination, as we well know, is one, but many are plagued by a fear of hurting someone, or themselves, or the existence of unwanted sexual or violent thoughts in their mind. 

These are actually entirely normal thoughts that run, in various forms, through the minds of everyone. The difference with OCD sufferers is that a particular thought, one that provokes an overwhelming sense of anxiety, will play on a loop, like the brain is stuck. The compulsions temporarily stop the loop, but in the long run they actually intensify the anxiety, making the obsessions worse. 

Maia Kinney-Petrucha, 25, from New York, is a self-described “intrusive thot”, who was diagnosed with severe OCD at four years old. “All my life I struggled to find ways of explaining what was going on in my head,” she says. “It wasn’t until I found other folks who suffered with OCD that I became more open to talking about my experience.” The pandemic inspired Maia to start creating content in a similar vein to Ainslie via her TikTok @jambamaia, in order to dispel some of the common mistakes people make about the condition. “I knew people like me must have been struggling, because suddenly there was a very real contamination threat,” she says. “I started with one simple TikTok about the misconceptions of what OCD is and it got a lot of traction.” 

My own OCD centres around a fear of bad things happening to those who I love, so COVID has really exacerbated my worries, and the extra time at home has increased how long I am stuck in patterns of negative thinking and behaviour. Watching people on TikTok speak so candidly about their experiences, feels like a weight has been lifted off my shoulders. I no longer feel as alone or as burdened by shame. This has allowed me to seek professional help after hiding my OCD for 15 years.

Clinical psychologist and OCD specialist, Dr Tatyana Mestechkina, believes that these kinds of online communities can be extremely valuable. “When people are open about their experiences, they can start to accept their condition and work on overcoming shame,” she says. “These online spaces can allow people to feel validated, understood and less alone.” 

However, TikTok videos about mental health issues do have the potential to be harmful. “It can perpetuate misinformation, minimise the condition, and trigger others with OCD, even becoming a source of unhelpful reassurance which can exacerbate OCD symptoms,” she says. “There is also a risk that people may turn to these videos as a way of compulsively checking their progress against others, which can further fuel the condition.”

The #OCD thread certainly has the capacity to platform inaccurate and misleading content. One particularly successful thread of videos sees users line up aesthetically pleasing items in a perfect row, or hoover perfect vacuum lines into the carpet, or colour coordinate their food, and caption them ‘cured’ in relation to supposed OCD. “OCD is not an adjective,’ Dr Mestechkina warns. “If people misuse it in TikTok videos to refer to tendencies of being clean or organised, it can be very invalidating to people who experience great pain from it.”

OCD specialist Dr Lauren McMeikan believes TikTok has the ability to bring levity and humour to a very challenging subject, but has noticed a spread of misinformation about OCD across social media platforms. “I’ve seen uncredentialed OCD coaches tout ‘cures’ for OCD and, even recently, someone suggested that heavy metals can cause OCD. Unfortunately, anyone can get a following, even if they aren’t qualified.”

It is crucial to be aware that TikTok users are rarely trained experts. No matter how relatable their content, it is particularly important to be wary about taking advice–in regard to medication and therapy–as professional expertise will always be the most valuable. 

Ultimately the best spaces for these discussions, whether on TikTok or other platforms, are ones that are moderated by someone who has expertise in OCD. Dr McMeikan advises to be aware that TikTok – or any social media – is not a stand-alone resource. She suggests it is used in conjunction with other recovery support like books, articles by specialists, support groups and therapy. For me, seeing that there are others out there who really understand what I’m going through has helped me feel less alone. Alongside professional help, a virtual OCD community has been an important step towards finding the courage to tell my friends and family what I have been going through.