The 2 Major Types of OCD—and How to Recognize Them

Obsessive-compulsive disorder (OCD) is a mental health condition that involves compulsive recurring thoughts and/or behaviors. The Diagnostic and Statistical Manual of Mental Disorders doesn’t classify OCD into subtypes, so there aren’t formally agreed upon categories of OCD. However, many psychologists can agree that there are two broad types of OCD from the perspective of what drives the disorder.

“In the broadest sense, I think about OCD in terms of types that involve fear versus types that involve nervous system discomfort,” Kristin Bianchi, PhD, a licensed clinical psychologist who specializes in treating obsessive-compulsive spectrum disorders like OCD, tells Health.

Here’s what to know about those two major types of OCD—and how they might manifest.

RELATED: 15 Things People With OCD Want You to Know

OCD driven by fear

With fear-driven OCD, obsessive or compulsive behaviors, called rituals, are performed because the person strongly believes that if they don’t do them, the things they fear will actually happen. For example, someone whose OCD manifests as obsessions with harm may constantly fear that harm will come to them or their loved ones, and may therefore check things repeatedly.

“It could be the fear that if they don’t check all of their appliances and light switches, the house will catch fire while they’re at work,” Bianchi says. “And before they leave the house, they will do things like turn the stove and light switches on and off repeatedly until they’re certain they are off.”

Other people with OCD may have obsessions with health from a fear of sickness. These folks are frightened that they or people around them will fall ill if they don’t take certain actions. Obsessive fears of contagion like this are often accompanied by compulsive cleaning of surfaces because of the belief that the germs on it could make people sick.

Still other people with fear-driven OCD battle intrusive thoughts that constantly occupy the mind. “Intrusive thoughts that involve harming others or oneself or breaking rules are common,” Bianchi says, as are “upsetting thoughts and doubts revolving around romantic relationships.” A person with OCD may have intrusive thoughts involving “deviant sexual themes like incest, bestiality, pedophilia, and sexual aggression,” she adds.

Anyone can have these thoughts fleetingly, but with OCD, there is a strong fear that these thoughts represent who a person truly is.

To gain relief from their distress, people with intrusive thoughts will sometimes engage in certain actions repeatedly like people with harm obsessions. Other times, they’ll take up mental rituals, like counting or repeating certain words in their heads. Cases like these, when there are no overt behavioral rituals, may be referred to as “primarily obsessional” OCD or “pure” OCD, Bianchi says.

RELATED: How to Deal With OCD—From 4 People With the Diagnosis

OCD driven by nervous system discomfort

In 2005, researchers from the Behavior Therapy Center of Greater Washington observed that there are people with OCD who have some symptoms related to those of Tourette syndrome. With Tourette syndrome, problems with the nervous system make the people who have it experience involuntary tics—sudden, short, and often repetitive movements or sounds.

So they hypothesized that Tourettic OCD, as the researchers called it, could also be driven by the nervous system. People with this type of OCD may feel the need to do some rituals over and over without there being any particular reason why—other than it’s really, really uncomfortable not to do them.

“People with this kind of OCD usually don’t know why something bothers them, and they’ll often describe it as just feeling not quite right,” Bianchi says. “It’s not so much that they’re afraid that something bad will happen.”

RELATED: 6 Thoughts People With OCD Have—According to Women Diagnosed With This Mental Health Condition

How these OCD types show up

No matter what drives a person’s OCD, there are some common ways in which OCD obsessions and compulsions are expressed.

  • Checking compulsions: The need to constantly and repeatedly check things.
  • Orderliness and symmetry compulsions: The need to constantly arrange and rearrange objects until they are perfectly in order or symmetrical.
  • Cleaning compulsions: The need to clean or wash things or surfaces over and over.
  • Counting compulsions: The need to count to certain numbers or to count items or steps.

The rituals involved in these compulsions are done to relieve feelings of distress, whether that distress is from a fear that something bad will happen otherwise or because it feels really uncomfortable not doing it.

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What is ‘Pure O’, the form of obsessive compulsive disorder at the centre of Channel 4’s Pure?

Marnie, the 24-year-old woman at the centre of Channel 4’s new comedy drama Pure, suffers from intrusive and distressing sexual thoughts.

At her parents’ wedding anniversary, her head is invaded with visions of her own family having sex. On the tube, she imagines all the passengers naked and writhing together. She tries to blink away the images, but they won’t leave her mind.

Marnie is suffering from ‘Pure O’, a form of obsessive compulsive disorder.

Channel 4’s strikingly bold new series is a fictionalised adaptation of Rose Cartwright’s memoirs about her experience of a very real, but little-known, condition.

Find out more about the illness below – and discover why Cartwright described the adaptation of her book as the “best therapy” she’s ever had.

What is Pure O? 

Pure obsessional OCD, nicknamed Pure O, is a form of obsessive-compulsive disorder in which people experience obsessions without necessarily having external compulsions.

The condition manifests itself in distressing, intrusive thoughts or mental images, which tend to revolve around themes including: harm to self and others; worries about sexual orientation and relationship decisions; fear of doing something illegal; paedophilia; and over-concern for honesty or religious purity.

Although most people experience fleeting unwanted thoughts from time to time, they are able to dismiss them as uncomfortable and move on. Sufferers of Pure O, on the other hand, become anxious about these thoughts and can begin to obsess over them, unable to get them out of their head.

Pure O, therefore, is not the experience of having intrusive thoughts – but the reaction to them and the inability to make them go away.

Charly Clive as Marnie in Pure (Channel 4)

Rose Cartwright’s website, Intrusive Thoughts, further explains that many Pure O sufferers are perfectionists and have a high standard “for what their brain ‘should’ be thinking”.

Pure O sufferers “spend time analysing why they are having these thoughts and what the thoughts say about them as a person… failing to meet this standard of control over their own brain will lead them to conclude that they are a bad person or a monster”.

The writer of Channel 4’s Pure, Kirstie Swain, also refers to the anxiety that intrusive thoughts can create which leads sufferers to question who they really are and what their desires are. “Sometimes you don’t know where a mental disorder ends and you begin,” she says.

According to the mental health charity Mind, people with Pure O show “no external signs of compulsions” such as checking and washing, but they still experience mental compulsions: for example checking their emotions or checking whether they are aroused by a particular intrusive thought.

Is Pure O easily diagnosed? 

“This is something that people live with in secret, that they’re deeply ashamed of, that they feel they can’t talk about,” says Rose Cartwright. “When I was 15 and I first started experiencing this, this definition didn’t exist in the public eye.”

Because of the shame attached to intrusive thoughts and common misconceptions about OCD, many sufferers go years without seeking help, therefore not being diagnosed.

In the Channel 4 show, Marnie mistakenly presumes she must be a sex addict, even though the thoughts she is having are distressing as opposed to arousing.

She then discovers she has OCD, but the show’s writer Kirstie Swain says that “even if you get the label you’re looking for, that doesn’t solve your problem”.

“You still have to deal with the fact you have this mental illness,” she explains. “Marnie’s so sure that finding a label for herself is going to solve the problem but actually for a while it makes things worse….

“OCD is so repetitive: it doesn’t have a beginning, middle and end. It has a beginning and a middle and a middle and a middle and it goes on without an end in sight.” 

Is Pure O treatable?

Exposure therapy is “remarkably effective” in treating OCD, according to the Intrusive Thoughts site. This treatment involves purposefully provoking unwanted, distressing thoughts and images while simultaneously resisting the urge to seek relief.

Cartwright’s website also recommends medications such as selective serotonin uptake inhibitors (SSRIs).

What was it like for Rose Cartwright to have her memoirs adapted?

Cartwright, who still has OCD but has been through effective therapy so that she can “catch myself when I’m going down those compulsive spirals”, speaks abut the catharsis of making Pure.

She says: “Just being involved in a project like this has become part of my healing process. I’ve had a lot of therapy and this is definitely the best therapy I’ve had.”

Cartwright describes the experience of visiting the set of Pure while an intrusive thought sequence was being filmed with naked extras.

“It was the ‘Beast from the East’ so it was snowing, which is terrible for naked extras. And I was like, ‘What have I done?’ and I turned the corner in Shoreditch and I looked down the street and it was just floodlights, and 60 guys in high vis jackets. I was like, ‘Wow, this is incredible.’

“Then I got closer and they were actually shooting an intrusive thought, down the alley way, and I heard someone shout, ‘OK, we’re going to do the intrusive thought now.’ And they pulled up these big privacy screens and the guys in the salon down the alley had to be briefed that there might be some nudity happening outside just in case their clients got offended. It was like, ‘What is my life?’

“It was such a privilege, because people pay hundreds of pounds for that kind of exposure therapy and here I am, I had this thing I’d kept secret and was so ashamed of. But going down to set and just seeing it discussed so openly and for storytelling to be such a healing tool, I was just like, ‘This is alright, I don’t regret this.’”

Pure begins at 10pm on Wednesday 30th January on Channel 4

What is separation anxiety disorder in adults?

 Separation anxiety is when someone is afraid of being separated from a particular person, persons, or even a pet. While many people associate separation anxiety with children, adults can experience the condition as well.

A person develops extreme anxiety as a result of the separation. A person may also manifest physical symptoms related to separation anxiety. These can include:

• nausea

• headache

• sore throat

Separation anxiety often occurs in children, especially those younger than 2 years old. A child does not yet understand, at this time, that when a parent goes away, they are still nearby and coming back.

Sometimes, a person with separation anxiety as an adult may have had the condition as a child. Others may experience it only in adulthood.

What are the symptoms?

Separation anxiety is an anxiety disorder. Other examples of anxiety disorders include agoraphobia and panic disorder.

The American Psychiatric Association’s diagnostic manual for mental health conditions, the DSM-5, defines separation anxiety as when a person has several of the following symptoms:

• unusual distress about being separated from a person or pet

• excessive worry that another person will be harmed if they leave them alone

• heightened fear of being alone

• physical symptoms when they know they will be separated from another person soon

• excessive worry surrounding being alone

• needing to know where a spouse or loved one is at all times

These symptoms can last for 6 months or more in adults. Their symptoms can cause them significant distress that affects their social, occupational, or academic functioning.

What causes separation anxiety in adults?

An adult’s separation anxiety can stem from a parent, partner, or a child who moves away. Their anxiety may also be related to another underlying mental health condition. These may include delusions from psychotic disorders or fear of change relating to an autism spectrum disorder.

On occasion people may categorize an adult with separation anxiety disorder as being controlling or overprotective. However, their actions are often an adult’s way of expressing their fears in regard to separation.

Risk factors

Those with obsessive-compulsive disorder or OCD are more likely to experience separation anxiety as an adult, according to an article in the journal Personality and Mental Health.

Those with separation anxiety often have other co-existing conditions, such as social phobias, panic disorders, or agoraphobia (fear of going outdoors).

Other risk factors for separation anxiety, in addition to pre-existing mental health conditions, include:

• being female

• childhood adversity, such as the death of a family member

• history of childhood traumatic events, such as abuse

Sometimes a significant life change, such as a divorce or a child leaving home and going to college, can cause a person to develop adult separation anxiety.

According to The American Journal of Psychiatry, an estimated 43.1 percent of people who experience separation disorder other than as children, develop the condition after 18 years of age.

How is it diagnosed?

In the past, the DSM-5 only considered separation anxiety to be a condition that lasted until a person was 18 years old. In more recent versions, however, the definition has expanded to include adults.

A doctor will diagnose separation anxiety by asking about the symptoms a person is experiencing. A mental health expert will use the criteria, including those used in the latest DSM-5 to make a diagnosis of separation anxiety in adults.

Treatment and management options

Doctors treat separation anxiety primarily through psychotherapy.

Cognitive behavioral therapy (CBT)

This therapy aims to help a person identify their thoughts and behaviors that are making their separation anxiety worse.

Parents may also learn additional parenting techniques that can reduce their separation anxiety.

Sometimes an individual can benefit from group therapy and family therapy.

Anti-anxiety medication

Doctors may also temporarily prescribe anti-anxiety medications to help a person through their most acute symptoms of separation anxiety. These drugs, however, are not always long-term solutions to the underlying disorder, and some types of anti-anxiety medications can be addictive.

A person should engage in therapy so they can begin to change their ways of thinking to reduce the incidence of separation anxiety.

Support groups

A person may also wish to seek out a support group for those with anxiety and separation anxiety. People who join these groups can gain help with learning techniques for reducing separation-related anxiety.


While adult separation anxiety is not as common as when a child experiences this condition, it is still possible that a person can have separation anxiety as an adult. The anxiety can be so intense that it is hard for someone to function in daily life due to fears and worries about separating from another person.

People should see a mental health professional if they are not sure if their fears are related to separation.

Through therapy and, in some instances, medications, people can reduce their separation anxiety symptoms.

Rachel Nall, RN, BSN, CCRN

Postpartum depression vs. perinatal mood and anxiety disorders

Heather King’s first delivery was challenging. It took several days for her labor to progress and by the time baby Payton arrived, both were exhausted and had infections. King was happy Payton was healthy, but she also experienced loads of unexpected emotions.

The new mom felt nervous all the time. She couldn’t sleep. She never allowed her husband to drive with Payton; she was too worried they might be hurt. When her maternity leave ended, she kept calling in sick because she felt paralyzed by fear. When she talked to her doctors, they said everything she was experiencing was normal.

“I was (written) off because I was a new mom,” King, 30, of Lawrenceburg, Kentucky, told TODAY. “My doctor said, ‘You know, you’re a mom now. All moms worry.’”

Since having her first child, Heather King has struggled with postpartum anxiety.Courtesy of Heather King

King’s instincts told her it was more than just new mom nerves, and she switched doctors.

“My new doctor said, ‘No, that is not normal. It is not normal to lose sleep or not let your husband drive because you’re afraid he will be in a terrible accident,’” King recalled.

King has postpartum anxiety. While awareness of postpartum depression has increased in recent years, few understand that the postpartum period can include several disorders, including anxiety, obsessive compulsive disorder or psychosis. This is exactly why some are urging a change in terminology from “postpartum depression” to “perinatal mood and anxiety disorders.”

“Even the term ‘postpartum depression’ is a bit of a misnomer because we know it actually starts in the third trimester,” Dr. Priya Gopalan, chief of psychiatry at UPMC Magee-Womens Hospital in Pittsburgh, told TODAY. “What ends up happening is we pigeonhole people into postpartum depression. … That really is going to miss a proportion of women.”

Gopalan said that anywhere from 15 percent to 20 percent of women have postpartum depression, and almost the same percentage of women have postpartum anxiety. Some women experience both at the same time. While medications, such as selective serotonin reuptake inhibitors (SSRIs), can help with depression, women with other conditions aside from depression feel they are being overlooked.

“There is a movement in the patient advocacy community, which is very important, to change the terminology,” Samantha Meltzer-Brody, director of the Perinatal Psychiatry Program at UNC Center for Women’s Mood Disorders, told TODAY. “A lot of people think that ‘postpartum depression’ is too restrictive.”

King agreed.

“No one mentions that you might not even like the baby,” she said. “We talk a lot about the birth but not what it is like when you get home.”

Understanding perinatal mental health

Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), a manual by the American Psychiatric Association that experts use to diagnose mental illness, only includes “postpartum depression” as a subset of depression. The manual doesn’t include postpartum anxiety, obsessive compulsive disorder, psychosis or perinatal mood and anxiety disorders.

“Some patients are saying, ‘PPD is not capturing what I am feeling,’” Meltzer-Brody explained. “But, it is a challenge because there is no such thing in the DSM-5 as ‘perinatal mood and anxiety disorders.’”

This means some clinicians and insurance companies don’t recognize perinatal mood and anxiety disorders. Using this term instead of “postpartum depression” might cause an insurer to deny treatment or cause a family medicine doctor to misunderstand a patient.

“You would like to have consensus,” Meltzer-Brody said. “It is an important place to start.”

But that doesn’t mean women should be silent about what they’re experiencing. Programs addressing perinatal mental health during pregnancy are becoming more common. Meltzer-Brody said patients specifically visit the program at UNC because of its comprehensive look at maternal mental health.

“Having pregnant and postpartum women engaged in these conversations, and being educated that postpartum mental health is one of the greatest complications of childbirth, will push the field forward,” Meltzer-Brody said.

Increasing awareness

Michelle Maggio and her husband were married for a decade before they had their baby boy, Enzo. After having him, she felt stunned by what she was feeling. She had heard of postpartum depression, but she experienced something different: excessive worry. Her anxiety was so intense that she had a hard time eating.

“When my husband would get ready for work, that was when the worst anxiety hit because I would be there alone with the baby,” Maggio, 37, of Pittsburgh, told TODAY. “I had to take care of him and I didn’t want to. I didn’t bond with him.”

Maggio asked for help, and doctors prescribed medication and intensive therapy.

“I couldn’t feel like this anymore,” she said. “There is no way I could have sat and suffered in silence. I would have killed myself.”

Now that her son is 16 months old, Maggio feels so much better. She’s raising awareness of postpartum depression and anxiety through the Alexis Joy Foundation, a nonprofit dedicated to helping women deal with mental health issues as well as pregnancy and infant loss. While she thinks a more inclusive name like “perinatal mood and anxiety disorders” might help women, she said being open makes the biggest difference.

“It needs to be talked about,” Maggio said. “Moms need to not feel like they have to be perfect and do it all.”


Find more information and resources on the Postpartum Support International website, They have a 24-hour, national hotline: 1-800-944-4773. Call it and within two hours you can get a call or text back from a trained volunteer who can help.

If you’re having thoughts about suicide or feel like you might harm yourself, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Help is out there, and you can get better.

Related video:

Meghan Holohan

Researchers reveal new risk factor for poor mental health

A new study has found that some people exposed to a certain toxic metal as children may face poor mental health as adults. This finding may have far-reaching implications for all populations exposed to this risk factor.

Lead exposure during childhood may influence mental health in adulthood, a new study suggests.

Lead is a type of metal that people throughout the world have used in the construction of water pipes, added into paint to prevent corrosion, and put into gasoline to maintain engine durability.

However, over the years, researchers have concluded that lead is toxic and can be extremely dangerous.

According to the World Health Organization (WHO), “there is no known level of lead exposure that is considered safe.” In time, ingested lead particles tend to accumulate in a person’s bones, brain, and other organs, increasing the risk of health problems, including high blood pressure, and damage to the kidneys.

Lead that accumulates in the body can also disrupt the central nervous system, and some studies have linked lead exposure during childhood with behavioral and intelligence deficits.

Now, new research from Duke University in Durham, NC, also suggests that exposure to lead during childhood can affect how an individual’s personality develops and predispose them to mental health problems in adulthood.

The research findings, which appear in JAMA Psychiatry, indicate that people who had high levels of lead in their blood when they were young are more likely to experience mental health issues by the time they turn 38. The study also indicates that they are also more likely to have developed unhealthy personality traits, such as neuroticism.

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‘High lead levels were viewed as normal’

The research team looked at the data of 1,037 participants, all born in born in 1972 and 1973 in Dunedin, New Zealand. Then, New Zealand was one of the countries who added the highest levels of lead to gasoline.

Of the total number of participants, 579 children received blood tests to measure their level of exposure to lead when they were 11 years old. The results showed that 94 percent of these children had lead levels higher than 5 micrograms per deciliter of blood (ug/dL).

Nowadays, when a child has blood lead levels of 5 (ug/dL), they will immediately receive a referral for special medical attention. However, this did not use to be the case decades ago.

“These are historical data from an era when lead levels like these were viewed as normal in children and not dangerous, so most of our study participants were never given any treatment for lead toxicity,” says the study’s senior author, Terrie Moffitt.

Throughout the study, the participants also took part in regular mental health assessments, with the most recent assessment taking place when the volunteers were 38 years old.

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The researchers assessed the participants’ psychopathology factor (p-factor), which is a mental health measurement. They determined the factors by looking at 11 disorders: alcohol misuse, dependence on cannabis, tobacco, and hard drugs, conduct disorder, major depression, generalized anxiety disorder, phobias, obsessive-compulsive disorder, mania, and schizophrenia.

After looking at the p-factor in conjunction with blood lead levels, the researchers concluded that, while lead exposure’s impact on mental health may be modest, it may have far-reaching effects.

Lead exposure’s “effects really can last for quite a long time, in this case, 3 to 4 decades,” according to study coauthor Jonathan Schaefer.

“Lead exposure decades ago may be harming the mental health of people today who are in their 40s and 50s,” Schaefer warns.

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Effect on personality?

Besides upping the mental health risk, it appears that lead exposure during childhood also affects individuals’ adult personalities.

When quizzing friends and family members about the participants’ personalities, the researchers found that the ones with evidence of the highest lead exposure seemed to present more neurotic tendencies, were less agreeable, and less conscientious compared with participants with lower lead exposure in childhood.

The researchers note that having unhealthier personality traits can affect a person’s adaptability to different life situations, impacting their relationships and levels of job satisfaction. Negative personality traits, the investigators add, are also associated with poorer mental health, overall.

“For folks who are interested in intervention and prevention, the study suggests that if you’re going to intervene on a group of kids or young adults that have been lead exposed, you may need to think very long-term when it comes to their care,” Schaefer explains.

Moreover, although the current study focused specifically on a population from New Zealand, the investigators emphasize that their findings could be relevant across cohorts since many countries across the globe used leaded gasoline in the past.

When we see changes that may be the result of lead exposures in New Zealand, it’s very likely that you would have seen those same impacts in America, in Europe, and the other countries that were using leaded gasoline at the same levels at the same time.”

Study coauthor Aaron Reuben

The research team would also like to find out whether lead exposure in childhood could also influence the development of neurodegenerative diseases, such as dementia, and the development of cardiovascular problems.

What Is OCD? An Expert Explains Obsessive Compulsive Disorder

Nearly everyone has heard about obsessive compulsive disorder (OCD), but not many people truly understand this mental health condition. OCD is perhaps the most-joked-about mental illness in pop culture—Joan Crawford in Mommie Dearest, frantically cleansing her skin every morning, comes to mind. Yet what’s portrayed is a far cry from what people with OCD actually experience.

About 2.2 million adults in the U.S. (1% of the population) have OCD, and it’s a chronic disorder that can consume a person’s life. As the National Institute of Mental Health reported, more than half of adults with OCD stated that their condition severely impaired their functioning when it came to their work or school responsibilities, home/family life, and social life. So it’s beyond time for the rest of the population to realize OCD is no joke.

HelloGiggles asked psychologist Dr. Jenny Yip every question about OCD that we could think of in hopes of wiping away some of that stigma and misunderstanding. Dr. Yip is a specialist in OCD who founded the Renewed Freedom Center in Los Angeles, an OCD and anxiety-focused treatment facility. Along with providing patient treatment, Dr. Yip shares her expertise on social media and in her podcast, The Stress-Less Life, to help end the stigma surrounding mental illness. Our conversation with her not only provides information about this commonly misrepresented condition, it also highlights why education about OCD is so essential.

Whether you know someone with OCD, want general information, or have (or think you may have) OCD yourself, this QA with Dr. Yip outlines all the basics you need to know about this mental health disorder.

What is obsessive compulsive disorder?

“OCD is a type of mental illness. It affects at least 1 in 100 people, yet it’s one of the most misunderstood conditions. OCD has two parts: obsessions and compulsions. It can affect anyone, at any time, regardless of age, gender, race, or socioeconomic status.”

How are obsessions and compulsions defined?

“Obsessions are unwanted, intrusive thoughts, images, or sensations that repeatedly appear in your mind against your will. It is similar to a nightmare that keeps replaying like a broken record, completely involuntarily.

Compulsions are actions that we perform, whether behaviorally or mentally, in order to escape from the discomfort that the obsessions produce. The relief is only temporary before another obsession quickly returns that requires the sufferer to perform further compulsions. Giving into these compulsions can be crippling, and severely impair daily life.

The cycle between obsessions and compulsions becomes stronger and stronger over time, to the point that it becomes very difficult to break.”

What are the symptoms of OCD?

“Signs that you or a loved one may be suffering from OCD can include anxiety, guilt, depression, intense fear, or having ruminating thoughts. There are physical symptoms, too, such as severe fatigue, restlessness, lack of concentration, insomnia, avoiding certain foods, and nausea.”

What are some common obsessions and compulsions?

“Common obsessions tend to be fears of the following: germs, illness, harming yourself or others, acting socially inappropriate, making mistakes, inappropriate religious thoughts, and forbidden sexual thoughts. Obsessions can also involve a need for symmetry, exactness, order, or having things ‘just right.’

Common compulsions can include washing, cleaning, checking, repeating, counting, arranging things in a particular order, hoarding, praying, retracing past memories, and seeking reassurance.”

Are there different types of OCD, and what are they?

“There are many subtypes of OCD, many of which are outside the most ‘common’ forms, which is why it can be a difficult mental illness to diagnose. Obsessions can manifest in unpredictable ways, not just as the hand-washing behavior most of us have seen in the movies or on TV.

A few types of OCD include: scrupulosity, which involves fear of sin and obsessions over morality; symmetry and evenness OCD, involving the need for exactness and order; harm OCD, in which the sufferer has fears of causing harm to themselves or others; counting and ordering OCD, characterized by the need for things to feel ‘just right.’”

Is it common to have other mental disorders accompany OCD? What are they?

“Yes, there are many mental disorders that can often accompany OCD, some of which include depression, social anxiety, panic disorder, trichotillomania [compulsive hair pulling], body dysmorphic disorder (BDD), and olfactory reference syndrome (ORS) [unfounded belief that you’re emitting an offensive body odor].

In children, OCD often co-occurs with separation anxiety, school refusal, tics, behavioral disruption or oppositional defiance, ADHD, and autism.”

Are there other mental disorders that may seem like OCD but aren’t?

“Many anxiety disorders may seem like OCD. For example, generalized anxiety disorder (GAD) can often be confused with OCD in the sense that both conditions involve experiencing intense anxiety. The difference between GAD and OCD is that OCD involves involuntary, intrusive thoughts that are often irrational along with compulsions that serve as relief from these thoughts. Someone who has GAD, on the other hand, usually will have intense worries and anxiety about everyday life without specific compulsive behaviors to gain relief.

OCD is often mistaken and misdiagnosed for attention-deficit/hyperactivity disorder (ADHD) because from the outside, symptoms can often appear similar. Someone with OCD can appear unfocused, forgetful, and have impaired ability to make decisions because obsessions and compulsions can be extremely distracting. Imagine needing all the pencils and papers on your desk to be aligned perfectly before starting a paper, for example. That would take a lot of time and would certainly be distracting! The difference is that a person with OCD will often be extremely cautious and need to perform rituals according to a specific set of rules, whereas someone with ADHD is generally more impulsive and struggles to focus on details.”

How can OCD impact a person’s day-to-day life?

“I think what a lot of people don’t understand about OCD is how debilitating it can be. It can completely deteriorate a person’s life and daily activities. A sufferer is no longer able to function. He or she can’t go to school or work. OCD can get so bad that the sufferer begins to avoid family, friends, social experiences—everything.

OCD has been minimized for years and years as a ‘joke.’ A lot of movies depict OCD as a light, comical disorder. What the audience sees is just the external behavioral presentation of the compulsions—for example, they see a character going back and forth, repeating themselves, or acting in quirky ways. It might seem funny on the outside, however, the audience isn’t privy to the struggles and internal torment that the person has to keep reliving, again and again. It’s a constant invisible battle inside a sufferer’s mind.”

Do we know what causes OCD? Is it genetic?

“Researchers don’t know the exact cause of OCD. What we do know is that it has to do with a chemical imbalance involving serotonin in the brain. Although OCD does run in families and genes play a role, environmental factors such as having an illness or undergoing stress also contribute to the onset of OCD.”

Is there a way to prevent OCD?

“There is no way to prevent OCD.”

What are some signs that I should speak to a medical professional?

“If you feel that your symptoms are taking over your life and preventing you from enjoying daily activities, it’s time to seek professional help. More signs include withdrawal from social situations, repeated thoughts of death, and feelings of hopelessness. Getting treatment as soon as possible for OCD is crucial. Especially for children, early intervention is so important because it’s easier to learn how to manage OCD at an early age before symptoms become worse over time. At any age, however, seeking help from an OCD specialist is crucial because OCD is a treatable mental illness and can be overcome.”

What are some common treatments?

“The evidence-based treatment for OCD is exposure and response prevention (ERP), which is a form of cognitive behavior therapy (CBT). This is not simply the traditional talk therapy or play therapy. In CBT, you learn specific tools that you must practice to become skilled at defeating OCD thoughts and behaviors. Part of CBT involves recognizing the faulty thinking patterns that fuel the fears of OCD. Like any new skill, you will learn by practicing CBT to discredit distorted thinking patterns so that your thoughts will reflect reality more accurately. It’s like exercise for your brain.

A patient going through ERP treatment will be introduced to exposures to the thoughts, images, or fears that trigger anxiety and start the cycle of compulsions. This trains you to confront fears gradually, so you learn that they’re actually not so threatening. You also learn to disobey OCD rules in order to weaken the compulsive behaviors. Rather than giving into your fears, in ERP, you’ll be able to recognize the irrational urges to engage in compulsions and, under the guidance of an OCD therapist, make the choice to not give into compulsive behaviors.”

What should I look for in a therapist?

“First, find a licensed therapist who has experience treating OCD successfully. An OCD specialist will have specific training and experience in utilizing ERP. Be forewarned that not every CBT therapist knows ERP, which is a very specific type of treatment. An experienced OCD therapist will initially conduct an evaluation to determine the exact triggers to your anxiety and resulting compulsions, and formulate a hierarchy of exposures in your treatment plan. Unlike talk therapy, effective OCD treatment is usually short-term, lasting months with follow-up maintenance. Interview therapists and ask questions to find the right fit for you. Not every therapist is right for every person, and again, but be sure they are trained in treating OCD.”

How can medication help OCD?

“Patients who take medication for OCD often show some improvement, however, when you’re solely dependent on medication as a solution for OCD, symptom reduction is often minimal. Medication can reduce anxiety, but it doesn’t take away obsessions. Rather than putting a Band-Aid on the problem, the recommendation by OCD experts is to engage in CBT and ERP treatment alone or in combination with medication for the most effective benefit. The treatment process can be extremely challenging while you’re learning to confront OCD fears, however, experiencing the short-term discomfort has a long-term, lasting payoff.”

Are there ways to manage my OCD on my own?

“It depends on the severity of your OCD, although generally I recommend seeking treatment in order to receive the best recovery possible. Plus, the sooner you learn the tools to defeat OCD, the less opportunity there will be for OCD to become stronger and worsen. If you have OCD, you will have intrusive thoughts your whole life. The difference is whether you choose to act on the thoughts or not. It takes time and practice to recover from OCD, but there are many supplemental tools available, like the nOCD app, that can help you beat the OCD Monster while going through treatment.”

I’m worried I may hurt myself or others. What should I do?

“The most important thing to do is seek help. To start, it can be as simple as looking online to learn more. There are plenty of professional resources available with information about OCD, anxiety, and mental health in general, a few of which include the International OCD Foundation, the Anxiety and Depression Association of America, the Association for Behavioral and Cognitive Therapies, the Child Mind Institute, and the Renewed Freedom Center.”

Will my OCD ever go away?

“OCD is a lifelong, genetic disease, however, that doesn’t sentence you to a lifetime of suffering. When you are able to gain the tools and learn how to manage OCD, you can break the chains that OCD has on your life. OCD can be overcome by going through ERP treatment and with practice, symptoms will minimize and be manageable.”

Are there things I should avoid if I have OCD?

“No—avoiding your fears only gives credence and reinforces your fears more. Under the guidance of a trained therapist, the battle against OCD can be overcome by slowly exposing yourself to your fears.”

What should I do if I think a loved one has OCD?

“If you think someone you love has OCD, approach them from a position of compassion, yet learn to set appropriate boundaries so that you’re not also imprisoned by their OCD. They may not be able to recognize the signs themselves, or they may be aware and feel too afraid to talk about it. There are many resources from the websites above that you can download and share with your loved one. Approach the topic from a positive, supportive point of view. Tell them how much you care about their health and well-being, and how you want to help.”

How can I support a friend or family member who has been diagnosed?

“The most important part of supporting a friend or family member is to establish boundaries. Let your loved one know that you care for them and are there to support them—not their OCD.

Your loved one may constantly seek reassurance from you and ask questions: ‘Did I check the stove?,’ ‘Was my hair straightener off?,’ ‘Could I have cancer?’ Don’t placate them by reassuring them that they turned off the stove, unplugged the hair straightener, or that they don’t have cancer. The person with OCD will seek absolute certainty, which doesn’t exist. As Benjamin Franklin once said, the only certainty in life is ‘death and taxes.’ The best thing you can do is help him or her tolerate the uncertainties of life instead of giving into their doubts.”

What are some common assumptions about OCD that aren’t true?

“All too often, society makes OCD into a joke. Sometimes it’s the phrase, ‘I’m sooo OCD,’ or sometimes it’s a Christmas sweater that reads, ‘Obsessive Christmas Disorder.’ The fact is, we wouldn’t put cancer, diabetes, or autism on a sweater and laugh about it. We can’t do that with OCD. Making light of a serious illness that debilitates millions only makes it more difficult for sufferers to have the courage to seek help.”

I’m ashamed to talk about the fact that I have OCD. Is there any reason to feel embarrassed?

“There’s no reason to feel embarrassed about having OCD, and in fact, OCD is way more common than we realize. The fact is, the stigma surrounding OCD is what prevents so many from speaking out about their experience and seeking the help they need. It can take 14 to 17 years for someone suffering to receive an accurate diagnosis and effective treatment.”

How can I make people understand my diagnosis—and me—better?

“While you can’t ‘make’ anyone understand OCD, what you can do is talk to the people you trust in your life and share your experience with them. You can also try sharing an informative news article, social media post, or something else if you feel it accurately represents your experience. Remember that although your friends or family in your life may not understand the struggle you’re going through, they can empathize and express support. In fact, they might even surprise you by how much they truly empathize and understand. And the reality is that many of us know at least one person in our lives with OCD. Imagine the change we can make in these sufferers’ lives if we were all more open to sharing our experiences.”

Facts About CBD Anxiety? Does It Really Work?

CBD has been around since the 1940’s but more recently is becoming a modern way to help with anxiety and other mental health struggles. What a lot of people are wondering is does it really work? They have CBD Anxiety.  Won’t that get me high? Can it help with my depression or anxiety? What even is that stuff?

CBD is an extracted compound from marijuana plants. Out of the 85+ compounds in marijuana, Cannabidiol is the main component. CBD itself virtually contains no THC and if it does it’s less than .3%, so it won’t give you a euphoric high and it won’t make you paranoid but it does have plenty of healing benefits.

In 2015 a report from an author for the  Neurotherapeutics found that yes, there is promise found in CBD. When tested it was found to work well for things like post traumatic stress disorder, generalized anxiety, social anxiety and even obsessive compulsive disorder.

There was a survey conducted in 2011 in which nearly 62% of participants actually said that they use CBD for it’s healing properties for things such as pain, depression and anxiety.

The National Institute on Drug Abuse even found that taking CBD was shown to help reduce stress and generalized anxiety disorder found in animals. In the same year, there was a human test done where they found that after taking 400mg  of CBD orally versus a placebo, the patients who took the CBD had reduced anxiety. CBD is the 21st centuries most popular natural go-to for anxiety relief.

Anxiety disorders are the number one concern when it comes to mental health concerns. It is estimated that 25% of teenagers and 30% of adults struggle with anxiety. So if you do, you’re definitely not alone.

When you already have anxiety trying to find what helps alleviate that can be a daunting task and can even add more worry into your life. CBD oil is a natural alternative for easing anxiety and can help with so much more like physical body pain, sleep disorders and depression.

There are so many articles and so much constant research being done to learn about CBD. Studies have shown that CBD affects the two parts of the brain associated with anxiety in turn increases the activation of the prefrontal cortex and  lowers the activity happening in the amygdala.

There has also been evidence that CBD works with the hippocampus to produce new, stronger neurons.

CBD is a inhibitor of FAAH which is an enzyme in the body which breaks down anandamide. Anandamide actually promotes anti-depressant and anti-anxiety effects in the body. So when you take CBD in whatever form you prefer, it’s literally telling your body to release anti-anxiety effects into your body. How cool is that?

When taken in high dosed CBD activates what is called the 5-ht1a receptors. These receptors help your body regulate things like sleep, pain perception, addiction and yes, anxiety. So you might be thinking that this sounds like something you’d like to use to help alleviate life’s’ worries and the anxieties you may harbor.

CBD OIL For Anxiety: Does it Work?

CBD oils are oils that contains high concentrations of CBD. Depending on what you prefer and the severity of what you’re using it for, the concentration levels will vary. After ingesting CBD oil, which is generally taken by placing the drops under the tongue and letting it be absorbed,  you may notice it start to work in as little as 20 minutes if taken on an empty stomach. See, when you take the oil, it triggers the brain receptor called CB1. This is why CBD oil for anxiety is a great remedy to try.

The CB1 receptor is thought to help your body respond to the CBD by creating and heightening your serotonin levels. If you don’t know serotonin is basically your bodies “happy” chemical.

When you have low serotonin levels that is when you can see depression and anxiety rise. So by the CBD oil helping the CB1 receptor kick into gear and up those serotonin levels, you in turn should feel happier and less anxious after consuming CBD oil.

If taking the whole dose at once is intimidating, split the doses up throughout the day if needed. You can also start with a smaller dose and increase that with time.

One of the great things about CBD is the amount of different forms it’s available in. You can find anything from tinctures, pills, joints, gummies and even topical lotions and rubs. Since it’s one of the most used treatments in western culture you can find CBD oil in most forms in local dispensary and online. Check your state law and regulations in regards to CBD oil. It is highly advised to check online or within your state to see if taking CBD is legal, before purchasing products.

Taking it in oil form is the most popular way to consume CBD for most first timers. Most companies have different flavors added to the oil for a more pleasant experience for the user, vanilla and peppermint being the most commonly used.

Some CBD oils that are known for helping anxiety in no particular order are: Green Roads World, Pure Kana, CBD Pure, CBD Essence and Elixinol. It is highly suggested across the board to do plenty of research on the brand and dosage before making a decision on one particular brand.

Most people with anxiety reading this could be wondering if there are any side effects and if so, what they are. CBD is generally considered safe but please note that some people have reported side effects such as fatigue, dry mouth, dizziness, sleeping difficulties and mood changes. CBD is often used as safe, natural alternative to prescription drugs and you will see your symptoms decrease overtime, along with your anxiety.

The studies over the past several years have shown that CBD helps alleviate generalized anxiety, social anxiety, depression and many other mental health struggles.

Don’t miss out on the latest news and information.

Proven Techniques For Improving Your Performance Psychology

Reaching your peak. Photocredit: GettyGetty

In the fields of clinical and counseling psychology, there are many evidence-based techniques that help people overcome mood problems, anxiety, anger issues, addictions, and much more. But what about people who don’t have diagnosable clinical and counseling issues?  Can psychology help them perform more effectively at home and in their work?  In this post, we will explore a powerful principle and see how psychological methods can benefit all of us.

The Principle Of Continuity

Most people–including mental health professionals–think of problems as distinct entities. The DSM system of diagnosis is based on this framework: either we possess a psychological/psychiatric problem or we don’t. A different framework locates these problems along a continuum, from normal everyday life challenges to difficult emotional disorders. Let’s take the example of depression. We may feel depressed because of a loss that we experience, such as the passing of a loved one. We could also feel depressed on a more ongoing basis, as part of a chronic, inherited disorder. In that event, we might seek the assistance of medications as well as longer-term therapies. In everyday life, the dynamics of depression can also affect us, taking the form of discouragement and negative thinking. These dynamics are not as severe as the more “clinical” manifestations, but they share important characteristics.

Similarly, a person might have an anxiety problem in social situations, making it difficult to meet people. A more challenging anxiety problem would be an obsessive-compulsive disorder that interferes with broad areas of life. At the workplace, we might observe similar dynamics of anxiety, as performance pressures lead us to make impulsive and suboptimal decisions. The trader in financial markets, for example, who displays a “fear of missing out” when chasing a moving market experiences an anxiety problem, but not one that would be diagnosed by a clinician.

Anger, too, exists on a continuum. It may be episodic and lead to arguments and difficulties in a marriage, or it could be part of a more pervasive syndrome associated with rage and violent behavior. In the performance situation, anger manifests itself as frustration, as events interfere with the achievement of our goals. A portfolio manager may become frustrated when days of intensive research fail to pay off, thanks to a random tweet that moves the market. That frustration can also lead to undesirable behavior, albeit not as dramatically as in the clinical situation.

In all of these cases, we observe continuity. The problems and challenges that we face in day to day life are not wholly different from those that affect people with diagnosable emotional disorders. They exist on a continuum and display similar dynamics. For this reason, the techniques that have been found to be effective in counseling and clinical situations possess tremendous relevance to our day-to-day performance challenges. This suggests that some of the most powerful “coaching” techniques for peak performance are adaptations of “clinical” methods that have been studied and applied for decades.

Two Promising Methods For Improving Our Performance

In a recent podcast, psychologist Seth Gillihan, Ph.D. and I explored applications of evidence-based therapy for performers in financial markets: traders, portfolio managers, and investors. Specifically, we focused on two evidence-based methods: behavioral and cognitive. Behavioral techniques are based on the notion that what we do impacts how we think and act. By changing our behaviors, we create new patterns that we internalize and ultimately extend. Cognitive approaches seek change by helping us alter our ways of thinking about problems, opening the door to fresh solutions. Here are some noteworthy examples:

  1.  Behavioral Methods: Using Feedback To Change Performance – I recently purchased and started using a device that provides continuous readings of blood sugar levels. The idea is to keep levels within an ideal range, much as a runner on a treadmill might sustain a target heart rate. In order to achieve that range, it’s necessary to alter eating patterns: what one eats, how one eats, and when one eats. Those changes to eating patterns have resulted in weight loss, and the combination of improved blood sugar levels and weight loss have led to better energy levels during the day and greater productivity. As in the use of monitoring devices such as Fitbit, the feedback leads to change in behavior, which in turn fuels self-mastery and fosters wider levels of change. Such feedback can also help performers master such skills as meditation, as in the case of the Muse device that monitors brainwave patterns in real time. Mike Bellafiore at SMB Capital has found that breathing and meditation skills help traders gain control over their decision-making by facilitating mindfulness and rule-following. Once again, this leads to wider psychological changes associated with improved confidence and risk-taking. Changing individual behaviors can ultimately change our psychology–and our performance.
  2. Cognitive Methods: Using Preparation To Change Self-Talk – From a cognitive perspective, our construing impacts our doing: how we think about situations shapes how we respond to them. Most performers, whether in athletics, performing arts, or financial markets, go through warm-up periods prior to engaging in competition. This preparation helps get them in the right mindset for putting their practice into practice. In my work with high-performing money managers, we have dedicated a portion of the preparation period to a rehearsal of self-talk. Specifically, the performer focuses his or her attention on the problem patterns that have negatively impacted decision-making and visualizes those patterns as an enemy. The idea is not only to think of those patterns as self-defeating, but to actually summon the emotions associated with a hated enemy who stands between oneself and success. When performers actually feel a degree of hate and disgust toward their problem patterns, it triggers a competitive response: a desire to defeat the enemy. In shifting the self-talk from battling markets to battling one’s worst tendencies, traders feel empowered.  This directs one of their greatest strengths–their competitive drive–constructively.
  3. Combining Behavioral And Cognitive Methods: Creating Better Work Processes – A valuable performance practice is to identify your best practices–what you do when you are most successful–and turn these into repeatable processes. One way of accomplishing this is to combine behavioral methods with cognitive techniques. In an insightful video, Peter L. Brandt walks listeners through his daily process, from generating trading ideas to managing existing positions. What is clear from his presentation is that his daily routine truly is a routine. In reviewing many charts and distilling the list to a few areas of opportunity, he has found ways to make sense of markets and achieve a high degree of consistency to his investing. The creation of routine is itself a behavioral method that reinforces patience and discipline. During his routine, Brandt rehearses a way of thinking about markets that reduces pressure by emphasizing that not having a position in markets is itself a position: it is OK to be uncertain. In following his process, Brandt conducts both behavioral and cognitive “therapies”, giving him greater control of his work efforts and a mindset favorable to proper decision-making.

The beauty of these methods, behavioral and cognitive, is that they are skill-based. As Dr. Gillihan notes in his book, the techniques can be learned, rehearsed, and “made simple” in the course of daily life. Moreover, it is possible to achieve changes in a relatively short period of time through repetition. Research in outcomes in psychology suggests that it is much easier to initiate change than to sustain it. All of us are prone to relapse. When we engage in skill practice on a daily basis, we develop new habit patterns that become ongoing parts of us–and our performance. As James Clear has illustrated in his book on habit formation, it doesn’t take a life-shattering experience to create significant life changes. We can reach peak levels of performance one thought and one behavior at a time.

Sudbury-area man who twice got girl pregnant jailed 50 months

A now 31-year-old man who got a 14-year-old girl pregnant, and then while out on bail, got her pregnant again despite a no-contact order, has been given a 50-month jail sentence.

“We as a society owe it to our children to protect them from the harm caused by offenders like the appellant,” said Ontario Court Justice Vanessa Christie, in her decision released in mid-December. “Our children are at once our most valued and our most vulnerable assets. Throughout their formative years, they are manifestly incapable of defending themselves against predators like the appellant and as such, they make easy prey.

“People like the appellant know this only too well and they exploit it to achieve their selfish ends, heedless of the dire consequences that can and often do follow … To summarize, I am of the view that as a general rule, when adult offenders, in a position of trust, sexually abuse innocent young children on a regular and persistent basis over substantial periods of time, they can expect to receive mid to single digit penitentiary terms.

“When the abuse involves full intercourse, anal or vaginal, and it is accompanied by other acts of physical violence, threats of physical violence, or other forms of extortion, upper single digit to low double digit penitentiary terms will generally be appropriate. Finally, in cases where these elements are accompanied by a pattern of several psychological, emotional and physical brutalization, still higher penalties will be warranted.”

The man – who cannot be identified due to a publication ban protecting the identity of the teenager – pleaded guilty on Aug. 4 to charges of touching a minor for a sexual purpose with a part of his body (penis) between Jan. 1, 2015 and Jan. 1, 2016, in a community west of Greater Sudbury, and three counts of breach of recognizance – two for having contact with the teenager while on a bail order that included a no-contact condition, and one for having contact with the teen and her mother while under a bail condition not to do so.

Christie issued a total 50-month sentence. As the man had been in custody for 189 days, he received pre-trial custody credit of 315 days or just shy of 11 months. That leaves him with 39 months to serve.

Christie also issued a DNA order, 10-year firearms ban, and ordered that the man be listed on the national sex offenders’ registry for 20 years.

As for the Crown’s request for a Community Supervision Order that would prevent the man from visiting places where children attend such as schools and daycares, Christie did issue a two-year order preventing the man from holding a job or being in a position of trust with minors, and restricting the man from having contact with the teenager except through a family court order or lawyer for the purpose of having contact with his two children in the presence of or through a mutually agreed third party.

The Crown had sought a six-eight year jail term. The man’s lawyer had pushed for a jail sentence of 12-15 months on the sexual interference conviction, and 90 days jail for the three bail breaches.

The court had heard that the man moved into the teen’s home sometime in 2014, as he was a friend of her mother. The teen and the man knew each other before the move.

The teen and the man then spent a lot of time together and had regular, consensual sexual intercourse, which produced a baby in 2016. A short time later, the man was arrested and charged for an alleged assault on the teen’s mother. While he was not to have any contact with the teen’s mother and the teen through an undertaking, the man continued to have contact with the teenager and sexual activity continued.

In January 2017, the man was arrested and charged for the sexual activity that produced the baby. But while out on bail and not to have any contact with the teen, the man and teen continued to have contact and sexual relations.

The man was subsequently charged with breaching his bail and later released with the same condition not to have any contact with the teen. But in June, the man and teen met and he was arrested again for breaching his bail.

The man obtained bail again. A second child was born in late 2017.

The man was re-arrested in June of 2018 and has remained in jail since.

At a hearing last fall, the Crown sought to prove that the man and the teen’s mother were in a domestic relationship and therefore he played a parental role to the teenager while living there. Christie ruled in early October that the man did not play any fatherly or parental role toward the teen.

When the sentencing hearing continued in late November, it dealt with a psychological assessment of the man prepared by Dr. Paul Valiant. Tests conducted on the man, testified Valiant, found he performed in the borderline range of intelligence as far as his cognitive abilities were concerned, and that he was in the low risk range for future sexual violence.

The hearing heard that the man suffers from delusions, anxiety disorder, obsessive-compulsive disorder, narcissism and paranoia.

Valiant recommended that the man be referred for treatment at the St. Lawrence Valley Correctional Treatment Centre. The psychologist explained the man was somewhat narcissistic and delusional, and that he believed that being involved with a 14-year-old girl was acceptable because his intentions were good and that he would someday marry her.

In her victim impact statement, the teen said she now has major anxiety and trust issues, mostly with males, has trouble trusting family and friends, has difficulty eating and sleeping, and has trouble coping with things such as school, work and taking care of her two children.

“My life will never be the same,” she said. “I cannot get back to who I was. I hope that you can take ownership of what you have done and get some help so you do not do this to another family.”

The teen’s mother, in her victim impact statement, said what the man did resulted in the loss of her relationship with her daughter.

“I would like to be a big person and forgive you, but I can’t and you don’t deserve forgiveness, you have hurt so many people,” said the mother.

Twitter: @HaroldCarmichae

OCD and Emetophobia

The fear of vomiting, or emetophobia, affects people of all ages. It is often seen in childhood and if left untreated, can become debilitating. It is also known to develop during adulthood, perhaps after an associated experience such as a severe stomach illness or episode of vomiting. The consequences of vomit phobia can be extreme, leading to such things as school refusal, social isolation, and job loss. Emetophobia can also take away any joy in life, hindering travel and leisure activities, romantic relationships, and even pregnancy (afraid of morning sickness).

To be clear, emetophobia is not just being afraid of throwing up. Rather it is an excessive or irrational fear about the possibility of vomiting. In fact, says Dr. Steve Seay, most of the people he treats for emetophobia have symptoms of other conditions such as social anxiety, agoraphobia or obsessive-compulsive disorder (OCD). This post will focus on emetophobia and OCD.

First, it is important to discuss some examples of behavior that present with all types of emetophobia:

  • Avoidance behaviors such as not eating certain foods (severe cases could lead to anorexia), not going to specific places, or not participating in certain events you might associate with vomiting (could be something as simple as avoiding parties with food).
  • “Health-conscious” behaviors such as refusing to shake hands with others in case they are/were sick, excessive handwashing, and unreasonable amounts of time and attention paid to food selection, preparation and cleanliness.
  • “Checking” behaviors to detect early signs of illness, such as being hypervigilant with your own health (taking your temperature 5 times a day), as well as being keenly aware of the health of others (watching other people eat to make sure they are not or don’t get sick).
  • Actions done specifically to reduce the possibility of throwing up, such as the performance of rituals (If I repeat “I won’t throw up” over and over in my head, then I won’t throw up).

For those with OCD who suffer with emetophobia, symptoms are also likely to include the concern that vomiting signals something much worse than it typically is, such as indication of a deadly disease. People with obsessive-compulsive disorder also might believe that if they do vomit, they will not be able to cope with the situation. Not surprisingly, those with OCD and emetophobia demonstrate more cleaning and checking rituals than others with emetophobia. While they know intellectually these rituals make no sense, they are not able to control them.

As with all types of OCD, exposure and response prevention (ERP) therapy is needed to battle emetophobia. For example, a child who will only eat certain foods because she is afraid of vomiting might be asked to eat something different, and then feel the subsequent anxiety. Another exposure might include watching videos over and over of people vomiting, sitting with the anxiety and not engaging in avoidance. With more exposures (and no rituals) the person with OCD will get used to the idea of vomiting, lessening the hold of OCD and emetophobia. This is known as habituation.

I think it’s safe to say that nobody enjoys vomiting. But if the fear of it is overtaking your life, please seek help. With a competent therapist, emetophobia, with or without OCD, is absolutely treatable.

Distinguishing Between OCD and GAD in Children

As many parents of children with obsessive-compulsive disorder (OCD) will tell you, getting the right diagnosis is half the battle. Getting the right treatment is the other half.

It’s true that OCD can be tough to diagnose, especially in children. Rituals are an important part of a healthy childhood, and it’s often difficult to know when they should be a cause for concern. This article can help you sort out “normal” rituals from behaviors that should raise a red flag.

Even if you and your healthcare providers recognize that your child is dealing with anxiety issues, it’s not always easy to differentiate between OCD and Generalized Anxiety Disorder (GAD). Both can be characterized by rumination, increased vigilance, and an intolerance of uncertainty. Experts in OCD and anxiety disorders should be able to distinguish between the two, but for others it can be quite difficult. To make matters even more confusing, the two disorders can also occur together.

A study published online in October 2018 in Depression Anxiety aims to make it easier to properly diagnose these two disorders. The study looked at participants’ abilities in certain cognitive domains to determine if this information might be helpful in diagnosing OCD and GAD.

The children involved in the study had either been diagnosed with OCD, GAD, or neither (control group). None were diagnosed with both OCD and GAD. The breakdown included 28 study participants diagnosed with OCD only, 34 diagnosed with GAD only, and 65 diagnosed with neither. This last group of children were the typically-developing controls (TDC). Cambridge Neuropsychological Automated Battery (CANTAB) tests were administered to compare the following cognitive performances:

  • Working memory
  • Visuospatial memory
  • Planning ability and efficiency
  • Cognitive flexibility

The results were interesting. The participants with obsessive-compulsive disorder required more turns overall to complete multi-step problems than the other two groups, while those with Generalized Anxiety Disorder were more likely to make reversal errors than those with OCD or the control group. Those with GAD also took longer to identify visual patterns.

Although those with OCD and those with GAD demonstrated significantly worse cognitive functioning compared with the control group, the children’s cognitive impairments and difficulties with specific skills depended on which disorder they’d been diagnosed with. Children with generalized anxiety disorder struggled more with mental flexibility and visual processing, and those with obsessive-compulsive disorder displayed poorer planning abilities.

These results show promise in helping to diagnose OCD and GAD in children. More research is needed, however. For future research, the study authors suggested the use of parent-reporting forms as well as self-reporting forms. Neuroimaging and other types of assessments measuring the same cognitive skills examined in the study discussed here would be helpful as well.

One of the reasons I find this research so interesting is the fact that, as many of us know, the earlier obsessive-compulsive disorder is diagnosed, the sooner it can be properly treated — before it becomes deeply entrenched. The same is true for Generalized Anxiety Disorder — the sooner the better. The more we can differentiate between these two disorders, the better chance we have for more timely diagnoses.