I Have Relationship Obsessive Compulsive Disorder – Ask the Therapist

Answered by Kristina Randle, Ph.D., LCSW on 2020-01-4Link

This is precisely the problem with untreated anxiety. It breeds more anxiety. Normally, research and information can be good for learning and understanding. With most any other problem, learning more is a good thing. However, that is not necessarily true for people with untreated anxiety. They tend to become more anxious as they learn more information about their condition. Perhaps that’s because anxious people tend to fear the worst-case scenarios. They tend to latch onto extreme ideas which then become a source of even more anxiety. In this case, perhaps less information is better than more information.

As I’ve said many times, in this column, one of the most common questions that I receive comes from persons with untreated anxiety, who research anxiety and come to believe that their symptoms are indicative of schizophrenia. It is one of the most common fears among people with anxiety. That is possibly because schizophrenia is a very severe and misunderstood disorder.

Schizophrenia and anxiety are two very different disorders. Schizophrenia is a thought disorder that involves having breaks with reality. Having a break with reality means that you can no longer determine the difference between reality and non-reality. It’s a very disconcerting and frightening experience. Only about 1% of the population has a diagnosis of schizophrenia.

Anxiety is a mood disorder. Individuals with generalized anxiety disorder (GAD), for instance, experience chronic worry about many issues. This can be an unpleasant state of being since the anxiety tends to be fairly broad and consistent. Uncontrolled anxiety tends to worsen over time. This out-of-control feeling can make people believe that they have a more extreme condition like schizophrenia.

People with schizophrenia hear voices and see things that aren’t there. The voices they hear are not their own. People with anxiety tend to hear their own voice. People with schizophrenia hear the voices of other people. That’s a major and important distinction. If you’re hearing a voice that is your own but it’s simply saying harsh things about you, that’s likely a sign of anxiety. If you’re hearing voices outside yourself, voices that you don’t recognize, who are saying mean things about you, that may be indicative of schizophrenia.

Nothing you’ve written in your letter would indicate schizophrenia. Please do not mistake that statement with a diagnosis. It is impossible to provide a diagnosis over the Internet which is why I always recommend an in-person evaluation. Much of what you’re concerned about has to do with whether or not you love your girlfriend. That type of worry is more consistent with anxiety than schizophrenia. If, you thought that your girlfriend was an alien from another planet, who was here to harm you, then you might be demonstrating ideas consistent with schizophrenia but that is not the nature of your issues. You are concerned about things that seem wholly in the realm of anxiety and not schizophrenia.

The best solution to this problem is to consult, in-person, a professional. That can make all the difference. Professionals receive training about how to treat mental health problems like the one you have described. Anxiety is something they know how to treat. They can help you. I hope that my response convinces you to seek professional help. There’s no reason to suffer with treatable problems. Please take care.

Dr. Kristina Randle


Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.


Post festive season anxiety


Dr Ade Oderinde



Last year, Mr CHS travelled to the village as usual, full of excitement for the thrilling activities lined up for the season.


He went ‘’loaded’’ having saved what he thought was more than enough over the months. He had 5 burial ceremonies, 3 house warming parties and 4 age grade meetings to attend; all involved a huge financial burden but he was ready for it, he ‘’proved’’ he was one of those to be ‘’reckoned’’ with but at a great cost!



When he embarked on the spending spree he gave little thought to the new term school fees of his 3 daughters, the shop rent renewal and the house rent renewal, all to be paid in January.


He was swept off by self glorification of the moment. The ominous signs were there right before he left the village as he had to lend money to pay for his fare back to Lagos.


Immediately, the bus zoomed off, he was jerked backed to reality, he started having uncontrolled palpitations , dizziness….


All these continued into the mid year and had to sink himself into more and more debt…almost drowned by it.


He had none but himself to blame! What it is Anxiety is “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”



Stress and anxiety are two sides of the same coin. Stress is the result of demands on the brain or body. It can be caused by an event or activity that makes one nervous or worrisome.


Anxiety can be a reaction to stress, but it can also occur in people who have no obvious stressors. Occasional anxiety is an expected part of life.


One might feel anxious when faced with a problem at work, before taking an examination, or before making an important decision.



Anxiety is more than just feeling stressed or worried.


While stress and anxious feelings are a common response to a situation where we feel under pressure, they usually pass once the stressful situation has passed, or ‘stressor’ is removed.



Anxiety is when these anxious feelings don’t go away, that is when a person regularly feels disprowith portionate levels of anxiety, it m becomes a medical disorder.


These disorders alter how a person processes emotions and behave, also causing physical symptoms.


Types of Anxiety disorders


1. Generalized Anxiety Disorder: Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.


2. Obsessive-Compulsive Disorder (OCD): Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions).


Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.


3. Panic Disorder: Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.



4. Post-Traumatic Stress Disorder (PTSD: This is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.


5. Social Phobia (or Social Anxiety Disorder): Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.


Causes Possible causes include:


• environmental stressors; such as financial burden, difficulties at work, relationship problems, or family issues


• genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves


• medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery


• brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain


• withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes Symptoms (of Generalised Anxiety Disorder)


People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances.


The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.


Generalized anxiety disorder symptoms include:


• Feeling restless or on-edge


• Excessive worry


• Being easily fatigued


• Having difficulty concentrating; mind going blank

• Being irritable


• Having muscle tension


• Difficulty controlling feelings of worry


• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep


• Cold, sweaty, numb or tingling hands or feet • Shortness of breath Treatment Usually via Psychotherapy and medications




1. Set realistic targets of achievements


2. Avoid financial pressure by spending wisely no matter the situation



3. Take care of your body by eating a wellbalanced diet. Include a multivitamin when you can’t always eat right


4. Limitalcohol, caffeine, andsugarconsumption


5. Take time out for yourself every day.


Even 20 minutes of relaxation or doing something pleasurable for yourself can be restorative and decrease your overall anxiety level.


6. Trim a hectic schedule to its most essential items, and do your best to avoid activities you don’t find relaxing


7. Keep an anxiety notebook.


Note the events during which you felt anxious and the thoughts going through your mind before and during the anxiety.


Keep track of things that make you more anxious or less anxious.

SEPAC, Darien Library offer talk on youth anxiety Wednesday

  • SEPAC Photo: Contributed



    Photo: Contributed

  • photo





Photo: Contributed

Darien SEPAC and Darien Library are offering presentation on Social Anxiety Generalized Anxiety Disorder by national expert Jerry Bubrick, PhD. on Wednesday, Jan. 8, 12 to 1:30 pm, in the Darien Library Community Room. Dr. Bubrick, a senior clinical psychologist at the Child Mind Institute, has been featured in mainstream media and the highly-acclaimed films Like and Angst.

Dr. Bubrick will explain the signs and symptoms of generalized anxiety disorder and social anxiety – from worrying about everyday stressors to being intensely self-conscious and terrified by others’ perceptions. He will describe the importance of understanding and addressing anxiety when it interferes with performance and relationships. Dr. Bubrick will also explain anxiety as a primary disability or comorbidity to another disability. In addition, Dr. Bubrick will share proven strategies for managing anxiety and how to get the help your child needs.

Bubrick is a senior clinical psychologist in the Anxiety Disorders Center and director of the Obsessive-Compulsive Disorder Service at the Child Mind Institute in New York City. Widely recognized for developing one of the world’s most intensive pediatric programs for OCD, he is a pioneer in using cognitive-behavioral therapy (CBT) to treat children and teens with OCD and related anxiety disorders.

Featured in media such as Newsweek, The Washington Post and ABC Primetime, Dr. Bubrick is a sought-after expert and speaker. A dedicated advocate for children and their families, Dr. Bubrick is a significant public voice educating parents and teachers about the fear at the roots of anxiety — and how it’s effectively treated.

What it’s like to suffer with OCD throughout pregnancy

Illustration of two pregnant women standing back to back
It took a couple of weeks for the news to sink in, but once it did, I fell in love (Picture: Ella Byworth for Metro.co.uk)

When I first found out I was pregnant I was confused. It was unplanned, I’d previously been told it would be unlikely that I could have children because of abdominal surgery, and I hadn’t even been with my partner for a year yet.

It was as though my life had flashed before my eyes. A baby was something I’d never prepared for. I’d envisioned a life without children, a life focused solely on my career, and now everything was changing.

It took a couple of weeks for the news to sink in, but once it did, I fell in love.

From seeing my baby’s heartbeat flutter for the first time on the screen at six weeks, to seeing him wave at me at his dating scan and finding out he was a little boy at my anomaly scan, the love I have for this tiny human growing in my belly is unimaginable. I have never loved anything or anyone as hard as I love this little boy.

But throughout my pregnancy, my love for this baby has come at a price – as I have been suffering with something called perinatal OCD.

Obsessive compulsive disorder is a common mental illness that affects both men and women. If it affects a woman during pregnancy or after birth, it is called perinatal OCD.

While pregnancy can trigger the disorder, I have had OCD for years – mainly in the form of checking (routine rituals), intrusive thoughts and false memory.

For those who aren’t sure exactly what OCD is, there are three main parts: you have thoughts or images that keep coming to your mind, called obsessions. These obsessive thoughts then cause extreme anxiety. And you then perform other thoughts or actions to try to reduce your anxiety, which are called compulsions.

Illustration of a woman holding her baby bump, with flowers a pair of children's shoes and a balloon that says 'baby' in the background
I just want to protect my baby (Picture: Ella Byworth for Metro.co.uk)

Unfortunately, however, compulsions only soothe the anxiety for a short time, before the obsessions come back once again. It’s simply temporary relief.

My pregnancy so far has been filled with anxiety. The first trimester was spent having anxiety about miscarriage, and my second has been spent panicking about pre-term labour, which can result in premature birth.

I am now 22 weeks pregnant and the anxiety has not let up, nor have my compulsions to soothe it.

After seeing my baby on the screen for the first time, my anxiety set in about things that could go wrong.

I would panic so much about miscarriage during the first trimester that I became hyper-sensitive towards signs and symptoms. I would worry about every little pain or twinge or ache, and I would be straight onto Dr Google to ask what was going on.

When it comes to pregnancy, you shouldn’t take any chances, so I also went to the early pregnancy assessment unit quite a lot – and was always told it was just normal pains from a growing, healthy baby.

The early pregnancy unit became my safe place during my first trimester. It became almost a compulsion to me.

I would obsess over things going wrong, head down to the early pregnancy assessment unit, and come out feeling better. But it would only last a few days or a week or so before I headed down again.

People kept telling me that once I was into the second trimester, my anxiety wouldn’t be so bad and I wouldn’t worry so much. But in actual fact, things have gotten much worse.

Baby in the Womb
I’ve finally sought help (Picture: Ella Byworth for Metro.co.uk)

My mind is currently stuck on the 24-week viability rate. A baby can survive at 24 weeks. They have a 20-35 per cent chance of survival if they are born this early. Every single day my mind has been set on this, begging my body to just let me reach this point.

I’m not religious but I’ve even prayed for my baby to just make it past this point.

I’ve not been told I’m at risk for pre-term labour, when my cervix has been checked it’s always closed, which is good, but it’s like there’s this switch in my brain that I can’t turn off.

I’ve obsessed over it so much that I’ve watched videos, read stories, scoured Mumsnet for threads and joined pregnancy groups to read other people’s experiences of pre-term labour.

I can be going about my day normally and suddenly an intrusive thought about early labour will pop into my head and I will have this surge of adrenaline as my body goes into fight or flight mode with panic.

I’ve invented ritualistic thoughts in my head to promise myself that nothing bad will happen.

I also obsess over everything I could’ve done wrong throughout my pregnancy. And I feel guilt. There are so many little things that baby sites will tell you not to do that you may have done in early pregnancy when you weren’t aware you were even pregnant, and even these things can make you feel like the worst person in the world.

I remember panicking after eating a medium rare steak and panicking that it would hurt the baby because there is a risk of toxoplasmosis, even though the NHS does make it clear that this is very rare.

Or the time I dyed my hair and washed it out in the bath, and I was convinced the dye would cause some sort of infection even though I was only in the water for a short while and research suggests it is safe to colour your hair when pregnant.

I felt guilty for not being smart enough not to do these things, as though I was already a bad mum before my baby was even born.

And I can’t just sit with the anxiety, either. My compulsion is professional contact and private scans, even if I know deep down I don’t need it. It brings a relief that I can’t get from anyone or anything else.

I’ve lost count of the amount of scans I have had already. I remember having one the day after my 12-week scan because I was sure something could have gone wrong in those 24 hours.

I even had one a few days after my 20-week scan – when everything was fine – simply because my anxiety was playing up and I needed some reassurance.

Having had OCD for quite some time, I know that what I am doing is wrong. OCD isn’t helped by giving into the compulsions. A lot of the time it is recommended that you just have to sit with the anxiety it causes.

I know this, but it’s still hard, because it’s not just about me anymore – I am protecting the health of my child.

I can’t go on the way I am, because it’s not healthy to be this panicked all the time. And so I have actually sought help from the perinatal mental health team.

I have an appointment in just a few days and I plan on opening up to them about everything that I am struggling with.

I know that it is scary to be so vulnerable when you are pregnant, but I need to focus on the wellbeing of myself and my baby.

Having spoken to my midwife already about what is going on, she has assured me they will be able to help – and I’m going to let them.

One task I have set myself however is to stop booking the private scans whenever I have that sense of doom. Because I know that deep down, I will know when something is really wrong and I will know to go to the hospital.

I just have to stop letting OCD taking control of me, and take some control myself.

If you’re pregnant and have found yourself in a similar situation to me, please follow in my footsteps and speak to your midwife and ask to see the perinatal mental health team.

It’s the best thing you can do for you and your baby, and I wish I’d done it sooner.

MORE: How to talk to your partner about an unplanned pregnancy

MORE: Woman told she would never have kids found out she was pregnant on Christmas Day

MORE: What to do if your friend is pregnant and you’re not happy about it

Our Fear Facer Makes a New Friend

“The Daily” is made by Theo Balcomb, Andy Mills, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Alexandra Leigh Young, Jonathan Wolfe, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Adizah Eghan, Kelly Prime, Julia Longoria, Sindhu Gnanasambandan, Jazmín Aguilera, M.J. Davis Lin, Dan Powell, Austin Mitchell, Sayre Quevedo, Monika Evstatieva, Neena Pathak and Dave Shaw. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Stella Tan, Julia Simon and Lauren Jackson.

Sharp rise in number of pets suffering mental health issues including anxiety and depression

Sharp rise in number of pets suffering mental health issues including anxiety and depression is revealed by 50 per cent surge in insurance claims

  • Pet insurance firms paid out £750,000 this year for pet mental health problems
  • Owners have claimed for their animal’s anxiety, depression or even its OCD
  • One owner sent dog on two £275 ‘neurological sessions’ to treat its agoraphobia

It may sound barking mad – but a rising number of dogs, cats and even rabbits are being treated for mental health problems.

Pet insurance firms have seen soaring claims for tackling psychiatric disorders, including anxiety, depression and obsessive compulsive disorders.

Payouts to treat the problems have hit £750,000 this year, a 50 per cent rise on 2018, according to The Sunday Times. 

Pet insurance firms have seen soaring claims for tackling psychiatric disorders, including anxiety, depression and obsessive compulsive disorders [File photo]

Pet insurance firms have seen soaring claims for tackling psychiatric disorders, including anxiety, depression and obsessive compulsive disorders [File photo]

Common problems for dogs include jumping up at people, while cats scratch and many rabbits repeatedly bite the bars of their run or hutch.

Dog owner Lesley Church-Burrows, 65, from Epping Forest, Essex, last month sent Marlie, her Great Dane, for two neurological sessions costing £275 each after believing the pampered pet had developed agoraphobia – a fear of leaving a safe space.

The three-year-old, who sleeps on a memory foam mattress and lives off chicken from Marks Spencer, was diagnosed with a possible anxiety-induced obsessive-compulsive disorder. 

She said: ‘People ask me how a dog can have anxiety and tell me the idea is as daft as a box of frogs.’

Children who grow up with a family dog can see their risk of developing schizophrenia later in life drop up to 55 per cent, a US study has found. 

Having a pet cat, however, offers little benefit.

rising number of dogs, cats and even rabbits are being treated for mental health problems. Pet insurance firms have seen soaring claims for tackling psychiatric disorders [File photo]

rising number of dogs, cats and even rabbits are being treated for mental health problems. Pet insurance firms have seen soaring claims for tackling psychiatric disorders [File photo]

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OCD Isn’t a Thought Problem, It’s a Feeling Problem

It is not uncommon to hear an OCD sufferer make a comment such as “OCD thoughts are ruining my life,” or “I have to get rid of these thoughts!” This refrain is echoed by many of my clients who lament their unwanted, intrusive thoughts and the seemingly endless struggle to suppress, neutralize, and explain away their thoughts.

The common belief, whether explicit or implicit, is that the presence and content of the thoughts are the problem, and getting rid of them will restore hope, confidence, and happiness.

But OCD is not a thought problem — it’s a feeling problem. In other words, if the thought did not have the accompanying painful feeling, you would ignore the thought, call it “weird,” and simply move on without compulsions or a second thought.

Allow me to unpack this as it may seem like what I’m saying is controversial or missing some important point about OCD.

Obsessive Compulsive Disorder is a condition marked by a pattern of unwanted, intrusive thoughts, feelings, images, sensations, or urges that take the form of a Feared Story. This story tells the sufferer of a potential, and as of yet fictional, outcome or truth about their actions, intentions, character, or future. This story, being completely unwanted, makes the sufferer feel an overwhelming sense of anxiety.

To deal with this anxiety and to get back to a sense of normalcy, confidence, and comfort, the OCD sufferer will then engage in overt or covert compulsive behaviors as an anxiety management strategy. Compulsions can include avoidance, reassurance seeking, mental review, rituals, and other repetitive acts. Once done, the sufferer gets a false sense of security that unfortunately reinforces the anxiety cycle.

Photo by David Matos on Unsplash

OCD’s deception is that you have to struggle with and resolve the content of the thought. You have to clarify, rectify, and examine the thoughts to determine whether they are true or false. For example, the contamination OCD sufferer believes he must be sure that his hands are fully clean, or at least clean enough, before they can interact with anyone.

In the brief overview of the OCD cycle above, you likely noticed that I mentioned thoughts and feelings. Wouldn’t this suggest that OCD is both a thought and a feeling issue? Yes, but in practice not really. People with OCD often get wrapped up in three potential issues; the trigger, the feared story, and the feeling. Ultimately, freedom from OCD requires you to face down the feeling, because OCD is a feeling problem.

The Trigger

OCD can be triggered by almost anything, including things we see, random thoughts we have, sensations we experience, and objects we encounter. Everything that you and I will ever encounter, think, feel, or experience is neutral until we place some value upon it. Meaning it is neither good nor bad, right nor wrong. Is a knife good or bad? It can be used to open to letter, but it can also be used to open a person. How about therapy? It is both good and bad. It can bring about profound positive life transformation, but it can also be emotionally draining, time-consuming, and costly.

Likewise, triggers to one’s fears are also neutral. Yet those with OCD and anxiety disorders exaggerate the meaning and importance of triggering thoughts or images as they relate to the Feared Story.

Each fear has any number of neutral associations. Remember the knife example? It doesn’t have just one meaning or significance. A knife can conjure thoughts of cooking shows. It can cause someone to think of their dad’s fishing knife or Julius Caesar. The thought of a knife can also spark thoughts of suicide, harm, or crime.

If you blame the trigger (i.e. the feared thought or object) and label it as the problem, you are being misdirected. OCD, and the history of repeated compulsions, exaggerate the importance of a select number of mental associations. Over time, the other neutral or positive associations are downplayed or ignored leaving the feared associations as seemingly the only associations for these thoughts or experiences.

When you scapegoat the trigger as the problem, you believe minimizing your contact with it will make the obsession about it go away. Unfortunately, avoiding the trigger leads to isolation and reinforces the false notion that the trigger is the problem, resulting in greater fear of the trigger and the feared story it spawns.

The Feared Story

Our brain tells us stories all day. Some we like. Some we don’t. OCD tells us stories too, and they are catastrophic, threatening, and at odds with who we are. These Feared Stories are a combination of distorted thoughts and mental images about the result of actions, one’s character, or an inevitable future that concludes in something terrible.

Some people blame the Feared Story as the problem within OCD. They think that if they were to simply get rid of the thoughts, think the opposite of the thought, prove that the thought is wrong, or simply “just think right” that their OCD would evaporate. They believe OCD is a thought problem.

To their point, treatment for OCD and anxiety disorders commonly begins by challenging the feared story using rational thought to develop a broader, reality-based view of the fear. This exercise helps the sufferer develop confidence that their intrusive thoughts are likely irrational, overvalued, and not deserving of excessive and exhausting compulsive responses.

When I challenge the Feared Story in session, my clients are quick to point out how their Feared Story is wrong. They usually say, “I know this doesn’t make sense,” then proceed to point out all the reasons why it doesn’t make sense, and they are right!

For example, a client with Pedophile OCD (POCD) might say, “I’m not a pedophile because I’ve never been attracted to a child in the past. I’ve never wanted to do anything sexual with a child. Whenever I have the thought about molesting a child, I always get anxious and have never felt feelings consistent with my typical feelings of attraction when I think about adults.”

Generally speaking, people with OCD are capable of combating their feared thoughts with rational alternatives. However, compulsions exist because a feared thought comes with, or takes the form of, an uncomfortable and unwanted feeling that overwhelms the sufferer.

Despite developing a list of rational observations and objections to the Feared Story, it does nothing long term because the issue has never been a matter of “right thinking,” but of an intolerance of the feeling brought on by the Feared Story.

The Feeling

Here is the actual problem of OCD. The feeling. More specifically, it is the feeling that makes you engage in compulsive behavior, which subsequently reinforces the OCD cycle. Chasing down and embracing that feeling with a welcoming and accepting posture desensitizes you to the feeling over time. Conversely, if you are unwilling to feel the feeling, but instead rely on compulsions and avoidances, desensitization cannot happen.

Remember, we are able to acknowledge that the trigger is neutral, and has a number of alternative associations. Additionally, we are very capable of telling ourselves why the Feared Story is irrational and wrong. However, we are unable to convince ourselves to not feel something because feelings are largely out of our control.

While not bad or wrong, feeling anxiety in an OCD moment is unwanted. Typically speaking, we say anxiety feels bad, but it by itself is not “bad.” It is an unwanted feeling state at the moment you’re feeling it. When we ride a roller coaster or see a horror movie, we expect to feel butterflies in our stomach, feel our heart racing, and feel jumpy. You know, anxiety feelings. But in this context, we paid good money for the experience! So, the feeling itself is not bad, just unwanted at that moment and inconsistent with the level of actual risk.

Similarly, when it comes to OCD, sometimes the feeling isn’t just anxiety, but sadness, loneliness, anger, apathy, or emptiness.

The goal of Exposure and Response Prevention treatment is to intentionally feel this feeling, acknowledge this inconsistent emotional response, and let it remain without compulsive behaviors until it passes. Remember, it will always pass.

Counterintuitively, your job in Exposure and Response Prevention is to engage the feeling. It’s the enemy and the problem. The solution is to show that you’re stronger than it by calling its bluff that the feeling is heralding in something terrible and that you are not strong enough to shoulder the uncomfortable experience. You are strong enough, and the terrible outcome probably is not coming. Stand firm and let the storm pass.

Feel the Pain, See the Results

If you are not ready to do this, you are going to have a hard time overcoming your anxiety. But you can start small, and progressively work up. If you are consistent and keep pushing yourself, you will eventually find more mental and emotional strength and freedom.

7 Different Types Of Anxiety Disorders

Often people confuse nervousness for anxiety and anxiety for nervousness. Both are completely different feelings. While feeling anxious once in a blue moon is normal, having a diagnosis for an anxiety disorder is a grave concern.

You cannot call anxiety mere nerves or stress. It is a mental disorder with even physical symptoms such as shortness of breath, heart palpitations, nausea, panic, excessive worry, trouble sleeping, chills, tingling, numbness, dizziness, and muscle tension.

Anxiety comes in many varieties. To give you an idea, here is a look at some common anxiety disorders:

1 – Generalized anxiety disorder

Generalized anxiety disorder or GAD is an anxiety disorder in which the sufferer feels constant worry or uneasiness even at the littlest of things that don’t even matter in the eyes of a normal person.

2 – Social Anxiety

This type of anxiety refers to the fear of social situations. There can be varying degrees of social anxiety. Some people feel anxious in response to a specific social situation while for others it is so bad that they feel anxious in almost every social situation. This makes social interactions, even the smallest ones, difficult for them.

3 – Specific phobias

To have an excessive fear of a particular situation falls under the category of phobia. For instance, some people have a phobia of flying. This means they feel anxious and uncomfortable when in the air, as in when travelling in a plane.

4 – Post-traumatic stress disorder

PTSD results from a particularly traumatic event which a person cannot forget. Flashbacks of the event, insomnia from thoughts of it, etc. are some characteristics of PTSD. Such an anxiety disorder occurs when an event that harms one personally or is violent in nature occurs. This includes accidents, attacks, and military combat.

5 – Panic disorder

This type of anxiety disorder is such that it comes with several episodes of panic attacks. These attacks occur because of sudden and intense fear. Panic attacks also have physical symptoms such as increased heartbeat, sweating, shortness of breath, etc.

6 – Obsessive compulsive disorder

OCD is also a type of anxiety. In obsessive compulsive disorder, a person has obsessive thoughts, and then to combat them, he does compulsive actions. The thoughts and actions are both repetitive in nature. The obsessive thoughts are unwanted and disturbing while the compulsory behaviors that follow are only for temporary relief.

7 – Separation anxiety disorder

This type of anxiety is when a person feels anxious on the separation of someone he or she is attached to. For instance, children may experience anxiety disorder when their mother is away for a few days. Adults can also experience separation anxiety disorder.

Note that anxiety can be treated. Some ways to combat anxiety include practicing healthy habits such as quitting smoking, not drinking alcohol or caffeine too much, exercising, and eating a healthy diet. If your condition is severe, consider connecting with a professional and getting therapy.

Paul Hollywood health: Great British Bake Off star’s secret battle – the symptoms

Medicine can also be recommended. The healthy body advises: “Usually a type of antidepressant medicine called selective serotonin reuptake inhibitors (SSRIs) which can help by altering the balance of chemicals in your brain.”

Causes of OCD

The exact cause of OCD is not known, but a number of different factors may play a part.

This can include if you have a family member with OCD or if a life event, such as bullying, abuse or neglect, has affect you.

A neat, meticulous, methodical person with high personal standards may also be more likely to develop OCD.

Here’s why I’m planning to use exercise to battle OCD, depression and a personality disorder

I’m on a mission to get emotionally fit using the power of exercise this New Year.

Since my teens, I’ve been battling anxiety, depression, a personality disorder and obsessive compulsive disorder (OCD), which can make day-to-day life hard to manage.

Adam and Kimberley Badat run fitness studio, AK Active, in Lostock Hall.

Adam and Kimberley Badat run fitness studio, AK Active, in Lostock Hall.

A person with OCD experiences obsessive thoughts and compulsive behaviours while someone with a personality disorder thinks, feels, behaves or relates to others very differently from the average person. Like anxiety and depression, experts believe both OCD and personality disorders can be partly managed through regular exercise.

That’s why I’ve tried my hand at a group fitness class at AK Active in Watkins Lane, Lostock Hall.

Leyland personal trainer Kimberley Badat, who runs AK Active with her husband Adam, said: “Most of our members suffer with mental health issues. Fortunately, it’s now not as much of a taboo subject anymore!

“Our motto is, ‘Health, confidence, fitness’ and we truly believe you can’t get fit until you’re healthy, both body and mind.”

Adam and Kimberley believe you cannot get physically fit until you are mentally healthy.

Adam and Kimberley believe you cannot get physically fit until you are mentally healthy.

There are many ways that exercise can help us emotionally, according to the experts. It can give you more energy, help you sleep better and releases a hormone call cortisol which can help us regulate stress. And then there’s the sense of achievement that boosts self-esteem after meeting your goals.

Kimberley has seen this transformation over and over as her clients become more confident and willing to do things that scare them.

“Just the other day a member who suffers with anxiety and depression took her first driving lesson, after years of not being confident enough to drive. Her husband had to bring her to sessions and after a session she told me she was going to call a driving instructor,” she added.

“Now that’s the most amazing feeling in the world. Not only are we changing bodies, we are changing minds, giving confidence!”

The pair have seen many of their clients overcome mental illness thanks to group exercise.

The pair have seen many of their clients overcome mental illness thanks to group exercise.

Exercising seems like a silver bullet in the fight against mental illness. But it’s not so simple. For those who lead a busy lifestyle, staying fit can often find itself at the bottom of a to-do list.

One possible solution is short and intensive training, like the metafit class I tried at AK Active. Metafit sessions comprise 30-minute high-intensity interval training designed to boost your metabolism during periods of rest.

“Short, intensive training works best for our members as we don’t want to impact their day too much,” Kimberley added.

“Our group sessions are above and beyond what we wanted them to be. From beginners to advanced, each members help and support each other from the word ‘go’. The hardest part is walking in the door.

“AK is the least judgement place out there! We help change lifestyle, not just fitness!”

That element of support is another reason I’m considering forgoing the gym in favour of exercising in a group, which seems to not only offer a potent weapon for fighting emotional distress, but the shield too. That’s because a group can offer a place in a community that helps encourage and motivate you to reach your goals.

I was buzzing after the metafit session, not only because of the pain-relieving endorphins coursing through my brain but also because of the joy of meeting new people in a supportive and friendly environment.

Personally, there’s nothing quite as powerful in the battle against depression than making positive connections with people and feeling part of a big family. Plus, the group session was a lot more fun than knackering myself out at the gym on my own.

Kimberley said: “Members being part of a like-minded community means they can be themselves and also be an inspiration for the next person who walks through the door.”

As a trainer, Kimberley is warm and welcoming, offering a bucket load of encouragement to help keep you motivated, and I felt such a boost of self-esteem when the rest of the members clapped for me at the end of the session. It was lovely!

In the past, my OCD and personality disorder have led me to diet and exercise obsessively. That’s a worry for me when hitting the gym. Left to my own devices, I could easily see myself spiralling into a chaotic pattern of overdoing it then shaming myself for not doing enough.

So perhaps being part of a group could help me tame that obsessive streak and laugh at myself when I make mistakes while also learning to correct them with the help of both an instructor and other members.

It’s clear that friendships have been formed at AK Active and I imagine seeing your mates smash their targets and achieve the seemingly impossible is not only inspiring but a joy in itself.

Why My OCD Went Undiagnosed for 25 Years

Danielle Kosecki

Credit: Science Photo Library/Getty Images

InIn early 2012, my mental health eroded. I was going through a break up, had a cancer scare, and was unexpectedly laid off from a job I loved. The resulting depression wasn’t a surprise (I’d been on an antidepressant off and on for most of my adult life), but the skin picking was. Suddenly I had an unavoidable urge to scratch and pinch the center of my neck where it meets my collarbone.

Even after the depression subsided, I kept at it. So much so that three years later, a colleague asked what had happened to my neck. Embarrassed, I made a joke about it being from stress and then quickly changed the subject. But the interaction cemented what I already suspected: This behavior was not normal.

Worse, the skin picking wasn’t my only “tic;” it was just the newest and most obvious. I also air-typed random words — moving my fingers as if using a keyboard — and had to scratch the exact center of my palms, sternum, and belly button until they felt just right multiple times a day, every day. As far back as middle school, I can remember needing to repeatedly check that my alarm clock was set correctly. I began to worry that I might have obsessive-compulsive disorder (OCD), a mental health condition characterized by uncontrollable, recurring thoughts (obsessions) and/or behaviors (compulsions) that an individual feels the urge to repeat over and over.

In 2015, I finally mustered the courage to broach the subject with a psychiatrist during an unrelated appointment. She asked if I was spending more than an hour a day performing these tics and whether they significantly impaired my day-to-day life. I told her no, and that I was stressed and burned out, sure, but who in New York City wasn’t? By most measures I was doing okay: I was healthy, holding down a high-profile job, and had recently gotten married.

My symptoms were too mild to be classified as OCD, she explained, but increasing the dosage of my antidepressant might help (it didn’t). And that was it. She never mentioned my symptoms again — during that appointment or any subsequent visits.

But still, I wondered: If I didn’t have OCD, then why did I get these urges so frequently. And why wasn’t I able to ignore them? So this year, four years after seeing that doctor, I started researching subthreshold OCD, i.e. OCD symptoms that aren’t severe enough to crack the diagnostic threshold.

And that’s when I discovered that symptoms like mine are not only valid, they may hold the key to preventing what some researchers refer to as “full-blown” OCD.

As far as Dan Collins, 57, knows, he’s always had obsessive-compulsive tendencies. His late parents used to tell him stories about how, as a kid, he would be up at 3 a.m., crying, trying to redo a project or retype a paper because something was “off.” At the time, Collins says he thought, “well that’s just because I’m a perfectionist or because I’m just very detail-oriented.” But according to Collins, his mild symptoms started to snowball when in 1991, at age 29, he dialed a 900 number, hung up before anyone answered, and then mentally spiraled out of control.

“In my mind I had done something that I thought was morally wrong,” says Collins, referring to when he called the paid entertainment line and hung up. “All this rumination began, like, What else might I do? I’m going to become addicted to these numbers. I’m going to be calling them all the time. I’m going to have to move to Australia and live in the outback where I won’t have access to a phone. It sounds silly. But at the time, it was hell on earth because the thoughts wouldn’t stop. It’s like a song in your head that you can’t get out. Imagine hearing ‘deck the halls with boughs of holly’ over and over and over and over and over and over again.”

In 1991, when Collins was diagnosed with OCD and depression, the diagnostic criteria for OCD were especially strict. Both the revised third edition of the American Psychiatric Association’s 1987 Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) — considered psychiatry’s “bible” — and the DSM-IV published in 1994 stated that in order for a person to be diagnosed with OCD, the obsessions and/or compulsions should cause “marked distress” and exist for “at least one hour per day” or “significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.” In comparison, most other psychiatric disorders only require that the disorder cause suffering, or disturb a person’s social or occupational functioning.

“OCD patients can present themselves in a relatively healthy way compared to other psychiatric disorders,” writes psychiatrist Dr. Carla Hagestein-de Bruijn, director of Parnassia Group Academy in the Netherlands, in a 2010 study. “The current diagnostic criteria do not diagnose these subthreshold subjects, which carries the risk of withholding adequate treatment or reimbursement of treatment-related expenses.”

Hagestein-de Bruijn’s paper was not the only one advocating for reform. The same year, leading OCD researchers made a number of recommendations in a paper commissioned by an American Psychiatric Association (APA) working group charged with reviewing the scientific advances that would inform the DSM-V.

In the paper, lead study author Dr. James F. Leckman, professor of child psychiatry, psychiatry, psychology, and pediatrics at Yale University in New Haven, Connecticut, echoed Hagestein-de Bruijn’s concerns and also pointed out that there is no data supporting the requirement that obsessions and compulsions occur for one hour a day.

But unfortunately, therein lies the rub. Research shows that up to 25% of the general population experience obsessions and compulsions as defined by the DSM-IV, but only 2% to 3% meet the full diagnostic criteria for the disorder. So where do you draw the line? At what point do these idiosyncrasies become a disorder?

Researchers are still trying to figure that out. “We are not aware of any evidence-based suggestions for how to improve this criterion for OCD,” wrote Leckman. Instead, he and his co-authors recommended that the APA consider tweaking the criterion’s wording to be a bit more inclusive — like making the hour-a-day benchmark an example rather than a requirement — which the APA did when they published the DSM-V in 2013 (you can see the changes side by side here).

Has the new language led to an increase in diagnoses? It’s too soon to tell.

“It finally got to the point where I couldn’t do anything, I couldn’t do my job. I didn’t know if it was like a brain tumor or something so I was just trying to get help from anywhere I could.”

Like Collins, Taylor Villanueva’s obsessive-compulsive symptoms started early — possibly at age three, although her first memories of it are later.

“When I was, I think, six I would always have to start walking with my left foot and end walking with my right foot,” says Villanueva, who’s now 25. “And in school, I was always the last person to finish a test because I would have to check all my answers, but like in a certain way. And if I didn’t I would get really stressed out.”

Around five or six years old, Villanueva’s father accidentally left the family’s stove on before leaving the house. Since then she’s had to confirm that every stove she sees is off, even if it’s not hers. At first, it just made her nervous if she didn’t check. But then she started having terrible thoughts like: if I don’t check, then my home will catch on fire and my dog will die.

“It finally got to the point where I couldn’t do anything, I couldn’t do my job,” says Villanueva. “I didn’t know if it was like a brain tumor or something so I was just trying to get help from anywhere I could.”

Around age 23, Villanueva saw a few different therapists before she found one with OCD expertise who was able to confirm that the mild obsessions and compulsions Villanueva had experienced since she was a child had indeed developed into full-blown OCD (she was also diagnosed with severe anxiety and depression).

Villanueva’s experience is fairly common. According to a 30-year study, children who report obsessions and compulsions at age 11 are significantly more likely to meet the diagnostic criteria for OCD in adulthood 20 years later.

But there are also risks for people like me, whose symptoms stay subthreshold. Research shows that we suffer similar consequences as those with full-blown OCD — more distress, a lower quality of life, and a higher risk for related disorders like anxiety and depression — just to a lesser extent.

The higher risk of psychiatric conditions rings true. I developed an eating disorder in college and have dealt with anxiety and depression for my entire adult life. Knowing what I know now about OCD, I can’t help but wonder whether I could have avoided those conditions if, back in middle school, I recognized and dealt with the thing inside my brain that was making me repeatedly check my alarm clock.

Turns out, that’s what OCD researchers want to know, too.

It took Villanueva roughly 20 years to get diagnosed, Collins 21 or so, and for me it will probably take about 25. Unfortunately, that’s not unusual.

Most adults with OCD have been suffering for more than 10 years before effective treatment is initiated — one of the longest durations of untreated illness of any serious mental disorder. Multiple studies show that the longer a person endures OCD before getting treated, the more likely they are to suffer in the ways mentioned above and the less likely they are to respond positively to treatments like cognitive behavioral therapy (CBT) or prescription medication.

“Early intervention is critical,” says Dr. Eric Hollander, director of the Autism and Obsessive Compulsive Spectrum Program at Albert Einstein College of Medicine in New York City. Hollander was part of the research group that recommended new diagnostic language for the DSM-V and was also one of 25 OCD experts who published a consensus statement in April 2019, calling for a greater emphasis on early intervention in OCD care.

“If [someone] has had symptoms for, on average, 14 years, the problem is that the symptoms are going to be a lot more ingrained and they are going to be less responsive to treatment,” he says.

There are a number of reasons why it takes so long for OCD to be diagnosed: shame, stigma, not knowing (or believing) your symptoms represent illness, racism, and poor access to psychiatric professionals with OCD expertise. But a big one is the disorder’s average age of onset.

Research shows that 76% of all OCD cases surface during pre-adolescence at the average age of 11, with subthreshold symptoms starting as early as age two. Kids this young may not recognize or be able to articulate what they’re experiencing, and how long a person goes untreated is one of the strongest predictors of whether their OCD will persist over time.

“I am a staunch supporter of proactive prevention of OCD,” says Tamar E. Chansky, PhD, a psychologist and the author of Freeing Your Child from Obsessive-Compulsive Disorder. Chansky works with a lot of families of young children who are showing early signs of OCD and says her best-case scenario involves parents contacting her when their kids are four or five and just starting to show signs of OCD — lining up their toys, refusing to wear a shirt that gets soiled, or insisting on saying goodnight a certain way, for example.

“In and of themselves, those could be ordinary things that kids do,” says Chanksy. “And there absolutely are things that kids grow out of. The distinguishing characteristic is distress versus a sense of mastery or pride in these patterns. If within a few weeks your child’s getting more intense about this, more upset about it, or has more things like this that are now on their to-do list, that’s a child growing into the OCD or the anxiety, not growing out of it.”

No long-term studies have examined whether effective early intervention reduces long-term disability from OCD or improves a child’s ability to meet developmental milestones (a study like this is unlikely because adequate treatment would have to be withheld from some of the subjects), but experts believe arguments in favor of early intervention are strong.

Villanueva, for one, thinks it could have helped her. “When I got to my worst,” she says, “I would always get mad at my parents and tell them that I wish they figured it out when I was younger and kept it from getting really bad.”

Currently, when someone seeks help for OCD, there’s no standard level of care. Depending on who they see, they might not even be properly evaluated for the disorder.

“In general, there’s not much screening done in primary care practices or by non-specialists,” says Hollander. “Even psychiatrists and psychologists may not systematically screen for OCD and it’s probably more the case in those individuals with subclinical symptoms.”

To help combat this, many experts, including Hollander, support developing a staging model, aka stepped care, for OCD. Proposed models vary, but in general, this treatment approach starts people with the most effective and least expensive and time-consuming treatment (like attending a one-time CBT workshop) and only moves them onto more intensive options (like starting therapy) if their symptoms fail to improve.

Staging models are already applied to other psychiatric conditions, like schizophrenia — but they have yet to be proven out for OCD. Initial research, though, is promising, with one study showing that stepped OCD care can significantly reduce treatment costs without sacrificing efficacy or patient satisfaction.

But there are risks as well. Using a stepped approach could delay the most optimal treatment for an individual. Conversely, because not all at-risk people will go on to develop OCD, using this approach could also create “false positives” that lead to unnecessary treatments and stress, especially among children.

If applied early, however, there may be a way around the latter: Therapists can teach parents how to handle their children’s behavior and how to reinforce different ways of thinking. “Often by catching it early, the kids may not even need to come into a therapist’s office,” says Chansky. “A recent study found that training parents how to respond differently to anxiety symptoms can be as effective as the child being treated directly. This shows promise for OCD as well, given how involved parents usually are in their child’s rituals”

But before stepped care is ready for primetime, researchers will have to determine how to classify people onto the different steps and which treatments are most effective at each level. “One of the problems in a lot of the treatment guidelines is that they are based on data that may or may not have been accumulated from randomized clinical trials where most of the patients in the real world — people with comorbid conditions and medical problems — are excluded,” says Hollander. As a result, clinicians don’t really know how most treatments affect the typical person with OCD.

Hollander is currently planning a five-center study that will begin to tease out those answers. “Our study will [help] us better understand, what’s the best treatment to start with? Who’s going to have an early response? If they don’t see full remission, which treatment would be the next best?” says Hollander. Right now, “clinicians don’t have adequate information to be able to make some of these decisions.”

Changes could be on the horizon for OCD.

In addition to the diagnostic tweaks made in the DSM-V, OCD was also — controversially — moved out of the Anxiety Disorders category and into its own diagnostic class — Obsessive-Compulsive and Related Disorders — to “help clinicians better identify and treat individuals suffering from these disorders,” among other things, according to the APA.

“I think that’s important because it highlights that OCD is a significant issue that occurs in a much bigger percentage of the population,” says Hollander. “One of the problems is that there has been relatively little to no funding from the National Institutes of Health and other federal agencies because it used to be thought that this was a rare disorder. I would hope that making this change, there will be more funding going into this area.”

The APA, to its credit, is ready to review that research if and when it’s available: At the end of 2016, the association announced that proposed changes to the DSM-V can now be submitted on the APA website, making the DSM-V a “living document.”

As far as my suspected OCD goes, I’m not going to wait for another diagnostic update. I’m currently being screened for admittance into a clinical trial that’s testing a new fast-acting drug and am searching for a therapist with the expertise to diagnose and treat me.

Learning about OCD has made me much more aware of how key aspects of the disorder — rigid thinking, perfectionism, an inflated sense of personal responsibility — have informed my past and continue to dictate how I function in the world today. Regardless of whether or not I get an official diagnosis, I’m happy this exploration inspired me to start piecing together the story of my personal mental health history. It’s empowering to know I’m prepared to advocate for myself in any future appointments.

If you’re experiencing obsessions and/or compulsions and are wondering whether they warrant treatment, don’t wait years to see a specialist. Let Hollander’s advice guide you: If it causes distress or interferes with functioning, ask for help. A good clinician will go over the risks and benefits of any treatment so you can make an informed decision together.

A Large Genetic Study of Anorexia May Begin Yielding Clues to Treatment

Anorexia nervosa ravages bodies. The well-known eating disorder tricks people into thinking they’re overweight — to the point that they starve themselves, sometimes to death.    

“It’s a mammoth effort to be able to do that,” says Cynthia Bulik, a psychiatric researcher at the University of North Carolina. “Most bodies rebel against it.” Bulik co-led a genome-wide analysis that revealed genetic links between anorexia and other psychiatric disorders. 

Anorexia was long seen as an affliction of vanity that mostly affected white, upper-middle class teenage girls. But although more women than men are diagnosed with the condition, it can affect anyone.

Worldwide, anorexia has the highest mortality rate of any psychiatric disease: Only 30 percent of sufferers fully recover. People with the disease can push themselves to a body mass index in the single digits — normal BMI falls between 18 and 24. Such dramatic caloric restriction brings gastrointestinal problems and other health issues. 

There’s no medicine that helps anorexia, and treatment usually consists of psychotherapy and feeding hospitalized patients. But a new study could explain how the disease strikes, including why the bodies of patients allow them to lose so much weight and resist regaining it.

The Anorexia Nervosa Genetics Initiative and the eating disorders workgroup of the Psychiatric Genomics Consortium used GWAS, a genome-wide association study, to look for connections between anorexia and specific genes. The team analyzed almost 17,000 anorexia patients of European ancestry and compared them with over 55,000 individuals of similar background without the condition. 

The team identified eight spots on the genome, called risk loci, that were associated with the disease. Some of these loci had known connections to anxiety disorders and depression. The strongest association for anorexia was the genetic overlap with obsessive compulsive disorder, according to the study published in Nature Genetics in July.

The researchers also found links to genes related to metabolism, including those that decrease the risk for Type 2 diabetes and high BMI, says Bulik.

These metabolic connections could explain some of anorexia’s more puzzling symptoms. For instance, people with the disorder tend to be extremely active, a symptom associated with their ability to push their damaged bodies to exercise. Their metabolism can also shoot into overdrive during treatment: Sometimes hospitalized patients need 6,000 calories — over three times the normal recommended daily allowance — per day to restore a healthy BMI, and the minute they are discharged, says Bulik, their weight starts dropping again. 

Bulik says the research is revealing not only the genetics underpinning anorexia, but how it may be connected to other disorders — and how complex a disease it really is. “For so long,” she says, “parents and patients have been saying there is more to this than meets the eye, that it’s not just about eating.”