Face touching or pinching associated with multiple causes

Dear Dr. Roach • I have a grandson who pinches his face. He just graduated from high school and will be going to college in the fall. He does not like to be around people, and when I ask him where or what would he like to go or do, he says nowhere. He does play a lot of games on his phone and TV. I have watched him and am very concerned. He does it several times a day. — D.F.

Answer • Many conditions are associated with repeatedly touching the face, and I can’t guess reliably what his might be. The list is fairly long, and includes anxiety disorders, obsessive-compulsive disorder, ADHD, Tourette’s syndrome and autism spectrum illnesses. The fact that he has done so well at school is reassuring.

If I were the physician seeing him, I would want much more information about his developmental history, school evaluations and any psychological assessments that might have been done. Interviewing his family could be very helpful. If it weren’t clear to me at that point, I would recommend a psychiatric evaluation.

Dear Dr. Roach • Earlier this year, my 59-year-old brother was diagnosed with atrial fibrillation. He underwent a cardioversion successfully, and the cardiologist put him on an anti-arrhythmia drug (amiodarone) and a blood thinner (Xarelto) indefinitely.

After four months, he suffered a major GI bleed event. A colonoscopy showed diverticulosis, which they concluded was what caused the event. He was recommended for lifelong medication.

Can a person with diverticulosis be on a blood thinner like Xarelto without a major risk of GI bleeding? Also, if the cardioversion got his heart beating normally again, and he is on an anti-arrhythmic drug, must he be on a blood thinner? — A.J.F.

Answer • There always is a risk of a serious GI bleed in someone taking an anticoagulant such as warfarin or one of the newer drugs, like Xarelto. However, for many people, there is less risk of a major bleed than there is of a stroke.

One tool for doing so is the CHA2DS2-VASc (pronounced “chads-vasc’’) score, which estimates the risk for stroke in someone with atrial fibrillation.

This does not look at the risk of bleeding, but a history of diverticulosis is not considered a major risk for bleeding. More than 80 percent of people who had a stroke with atrial fibrillation were not getting the recommended treatment.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from rbmamall.com.

Generalized Anxiety Disorder Comorbidities – News

To feel anxious at times is normal, and all people experience it now and then. However, showing extreme, unreasonable, and constant anxiousness and fear about things is a psychiatric illness, medically termed as an anxiety disorder.

Anxiety disorders include obsessive compulsive disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder, and so on. The most common anxiety disorder is generalized anxiety disorder (GAD). Many people are affected by more than one anxiety disorder concurrently, known as comorbidity. Surveys have shown that GAD is the most comorbid of anxiety disorders.

The coexistence or overlap of disorders increases the complexities of diagnosis and treatment for both the psychiatrist and the patient.

Comorbidities of GAD

The most common comorbidities of GAD are major depressive disorder (MDD), bipolar disorder (BD), and substance use disorder (SUD), due to the similar symptoms of these disorders.

GAD and Major Depressive Disorder

GAD presents with uncontrolled and persistent worry about a range of things like job, family, and financial status. It is a kind of floating condition, where the person drifts from one worry to the next without end in such as way that it has an impact on their normal activities. MDD, often simply referred to as depression or clinical depression, is a serious mood disorder that also affects normal life. Patients with anxiety from a very young age, displaying low self-esteem, pessimism, and severe stress is accompanied by perpetual feelings of sadness or loss of interest over a long duration of time (more than 2 weeks in order for a diagnosis to be made).

Patients at both initial and severe stages of GAD have episodes of depression (MDD). Longitudinal studies have found variations in the appearance of MDD in patients with GAD. In these studies, (a) one-third of patients showed signs of GAD leading to MDD; (b) one-third had symptoms of MDD leading to GAD; and finally (c) one-third of them had the onset of both GAD and MDD simultaneously. More than 70% of patients with lifetime GAD are also found to have lifetime MDD. Studies of twins have revealed that the same genetic factors of risk have a hand in both GAD and MDD. However, whether the patient develops GAD or MDD first depends on how they react to the environmental stressors in their life.

GAD and Bipolar Disorder

Formerly called manic depression, bipolar disorder is characterized by extreme mood variations, from high to low; at high, the patient is over-exultant, while at low he may harbor suicidal thoughts for no particular reason. It has been found that 51% of patients with BD have another anxiety disorder, which actually worsens the illness. Due to this comorbidity, BD patients tend to have:

  • Younger age of onset
  • Lower quality of life
  • Lower chance of recovery
  • Increased risk of substance abuse, and, most importantly
  • Greater lifetime suicidal tendencies

The average period of euthymia (normal positive state of mind) in BD with comorbid GAD is found to be less than half of that in patients with BD alone. Surveys have shown suicide attempts of 62% and 53% in BD and current and lifetime GAD comorbidity patients, respectively, as opposed to 22% in patients with BD alone.

Impulsiveness tends to be heightened in BD and current GAD patients, even after adjustments are made for age, gender, and presence of other comorbid anxieties.

GAD and Substance Use Disorder

Research studies have shown a significant link between patients of GAD and substance use or abuse. Most people with GAD are unaware of their illness and try to ease their anxiety by self-medication using alcohol or drugs.
One-third of individuals with GAD are victims of SUD, though they are mostly known to use and not abuse substances. A mutual pattern exists between these two disorders, which follow three pathways:

  • Anxiety leading to substance use
  • Substance use/abuse leading to anxiety
  • Genetic risks that are central to both GAD and SUD.

A survey carried out in the USA had an odds ratio of 9:5 for dependence on drugs in the presence of GAD.

Future Directions

In spite of the extremely high rate of comorbidity, only half of the patients with GAD receive treatment, suggesting that the other half is probably resorting to self-medication. According to estimates, in the USA alone about 3.1% of adults met the criteria for GAD in 2016. More women are said to be affected by GAD, though the reason for this is unknown.

Psychiatrists are still at crossroads as to how they should approach treatment considerations, and whether to treat each disorder separately or in parallel? Should treatment for one be completed and then the next one started? Future research on the standard clinical care for comorbidities of anxiety disorders should be undertaken to explore this issue further.

Reviewed by Yolanda Smith, BPharm

Further Reading

  • What is Generalized Anxiety Disorder?
  • Anxiety Disorders in Children
  • Generalized Anxiety Disorder Diagnosis

For years Leominster woman endured OCD. Support made all the difference

quot;If people feel comfortable, they should talk about this because there are more people out there that we dont even know about,quot; said Lisa

“If people feel comfortable, they should talk about this because there are more people out there that we don’t even know about,” said Lisa Cormier of Leominster, who lives with Obsessive Compulsive Disorder. SENTINEL ENTERPRISE / JOHN LOVE

Sentinel and Enterprise staff photos can be ordered by visiting our SmugMug site.

LEOMINSTER — There were nights where Lisa Cormier would finally pull into her garage hours after leaving work and frantically check the front of her car for dents or drops of blood.

“I’d think I injured somebody or even killed somebody,” she said. “I’d first have to go back and check and check and check. I’d think ‘OK, there’s nobody in the road, but what if I hit them and they went into the woods?’ Then I’d say ‘What if somebody’s watching me and they got my license plate number and there’s a murder and now they’re coming after me?'”

There never was any murder, and no one has ever been hit by Cormier’s Honda CRV. The only thing she ever ran over were the potholes on Litchfield Street, which frequently triggered her severe obsessive-compulsive disorder.

For Lisa Cormier, OCD incidents were at their height seven years ago, when her symptoms were most severe. With help from a mix of treatments she now feels

For Lisa Cormier, OCD incidents were at their height seven years ago, when her symptoms were most severe. With help from a mix of treatments she now feels that she has the strongest control she’s ever had over her illness, and has since transformed herself into a resource for other sufferers. SENTINEL ENTERPRISE / JOHN LOVE

Sentinel and Enterprise staff photos can be ordered by visiting our SmugMug site.

Obsessions like these are common with people diagnosed with OCD and can be frequently trigged by everyday occurrences like a bump in the road.

For Cormier, these incidents were at their height seven years ago, when her symptoms were most severe. With help from a mix of treatments she now feels that she has the strongest control she’s ever had over her illness, and has since transformed herself into a resource for other sufferers.

“It might not make sense to others, but to me, it’s like if I don’t do something a certain amount of times, my son’s going to get killed while he’s away at college,” she said. “I’ve been to so many therapists and psychiatrists for medication, but I actually now feel like I’ve got a grip on it.

Cormier explained that she first began exhibiting symptoms of OCD, and the depression and anxiety it creates, when she was about 12 years old, but it wasn’t until she was in her 20s that she was actually diagnosed.

Though many associate the disorder with stereotypes of germaphobia or compulsive neatness, Cormier’s illness manifests itself through repeated behaviors or mental rituals. The nagging worry everyone experiences over turning off the stove or closing a window could derail her entire day. When the disorder was at its worst, Cormier was traveling back and forth between her house and the hair salon she works at 10-15 times to make sure she locked the door, stretching an ordinarily 10-minute commute into two hours.

About seven years ago she also started having to deal more with a mental ritual of worrying that her younger sister, who was in perfect health, would suddenly pass away.

“Basically it was a lot of phone calls and worrying about me or obsessing that something was going to happen. And I’m perfectly fine,” said Linda Vitone, Cormier’s sister.

Vitone said this kind of ritual had been going on for years but had worsened around the time of her divorce. Following Cormier’s treatment in the psychiatric facilities of McLean Hospital in Belmont, Vitone said she’s noticed a noticeable change with her sister.

“She’s doing a lot better, but we still have to take it day by day,” she said.

Cormier spent several weeks at McLean Hospital in 2010, where treatment of her and other obsessive-compulsive patients focused on immersing them in their fears and rituals.

“There was a young boy I remember who was afraid of door handles. He would have to sit there for two hours and hold a door handle, which sounds so mean, but they had to do it,” she said.

Other patients included a woman whose compulsive handwashing ritual had turned her skin to a raw red from her fingertips to her biceps and another woman who was staying in the shower for seven hours a day because she never felt clean enough.

“She was still there when I left, and I often think of her,” Cormier said.

To stop obsessing over the idea of her sister’s death, Cormier was required to write about what it would be like if her sister actually did die, writing up the details of a fictional narrative for four hours every day.

“At first I had written it very general, but then I was told to write what her kids would wear at the funeral like it was really happening,” she said. “It was exhausting.”

The treatment freed Cormier of that particular ritual and helped her develop coping mechanisms for the other ones. She said she’s also had some recent success with transcranial magnetic stimulation, a noninvasive procedure that uses magnetic fields to simulate nerve cells in the brain and improve symptoms of depression. 

Apart from the medical treatments she has received, Cormier also credits her family and friends with getting her to a more confident and comfortable place.

“It’s always had its ups and downs, but we get through it. You just need to have a little patience,” said her husband, Steven.

As her condition has improved, Cormier has turned her attention to helping those just being diagnosed with obsessive-compulsive disorder. She started writing about her experiences through social media and eventually had people reaching out to her to ask for advice.

“To my surprise I’ve had many, many people messaging me, either asking to meet me at Panera Bread to talk or wanting to know about magnetic treatments or what doctors I’ve seen,” she said. “The first thing I always say is that I’m not a doctor and I’m not a nurse, but I have had many different experiences.”

A lot of times Cormier will put together packets of information for the newly diagnosed that list treatment options, support resources, and doctors she’s found helpful.

She’s also become an active fundraiser and participant in the annual 1 Million Steps 4 OCD Walk, which promotes awareness of the disorder and raises money for the International OCD Foundation. Last December she was featured in McLean Hospital’s Deconstructing Stigma exhibit at Logan International Airport, which depicted images of mental health patients and information on their roads to recovery.

“If people feel comfortable, they should talk about this because there are more people out there that we don’t even know about,” Cormier said. “What I’ve learned is that nobody should suffer alone.”

Follow Peter Jasinski on Twitter @PeterJasinski53

Free Course for Parents of Children with Mental Health Challenges

The Sussex County affiliate of the National Alliance on Mental Illness (NAMI), in partnership with Family Partners of Morris Sussex, will offer the “NAMI Basics” course on Wednesday evenings beginning October 11.  NAMI Basics is a free six-session course for parents/guardians of children and teens with emotional, behavioral or mental health challenges.  The course will be held Wednesdays, 6:30-9:00 p.m., at Family Partners of Morris Sussex, 67 Spring Street, Newton, NJ.

The course will be taught by two parents who have experienced mental health and behavioral challenges with their own children.  The comprehensive curriculum covers Attention Deficit Disorder, Major Depression, Bipolar Disorder, Conduct Disorder, Oppositional Defiant Disorder, Anxiety Disorders, Obsessive Compulsive Disorder, and Childhood Schizophrenia.  Parents of children on the autism spectrum may also find the course helpful.

Course participants will gain empathy and insight into the emotional experience of the child living with mental health and behavioral challenges.  As caregivers, they will learn more effective listening, communication and problem-solving skills.  Acknowledgment of the stresses and strains on the family, including siblings, will be an important component of the course.  

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Current research related to the biology of mental health challenges is covered in the course, along with how to get an accurate diagnosis for a child.   Treatment options are discussed, including how medications work and their pros and cons in the treatment of children.  Families will learn how to find supports and services within the school system and the community.

A theme of the NAMI Basics course is that “No one should have to face this journey alone!”  

For more information, or to register for the course, call 201-532-2267 or 973-214-0632 or email nami.sussex@gmail.com.  Class size is limited to 15.  Interested parents/guardians are urged to register as soon as possible.  

For more information about NAMI Sussex, visit www.nami-sussex-nj.org.  For more information about Family Partners of Morris and Sussex, visit www.familypartnersms.org.

The signs of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don’t make sense, they are often unable to stop them.

Symptoms typically begin during childhood, the teenage years or young adulthood, although males often develop them at a younger age than females. More than 2 percent of the U.S. population (nearly 1 out of 40 people) will be diagnosed with OCD during their lives.


Most people have occasional obsessive thoughts or compulsive behaviors. In an obsessive-compulsive disorder, however, these symptoms generally last more than an hour each day and interfere with daily life.

Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them.

Examples of obsessions include:

• Thoughts about harming or having harmed someone

• Doubts about having done something right, like turning off the stove or locking a door

• Unpleasant sexual images

• Fears of saying or shouting inappropriate things in public

Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don’t make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.

Examples of compulsions include:

• Hand washing due to a fear of germs

• Counting and recounting money because a person is can’t be sure they added correctly

• Checking to see if a door is locked or the stove is off

• “Mental checking” that goes with intrusive thoughts is also a form of compulsion


The exact cause of obsessive-compulsive disorders is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have an obsessive-compulsive disorder, there’s close to a 25 percent chance that another immediate family member will have it.


A doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illegal drugs, medications, another mental illness, or by a general medical condition. The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing of these symptoms.

To be diagnosed with OCD, a person must have:

• Obsessions, compulsions or both

• Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day


A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.

• Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.

• Psychotherapy is also helpful in relieving obsessions and compulsions. In particular, cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.

Though OCD cannot be cured, it can be treated effectively.

This article was supplied by members Mental Health America of Daviess County with information from the National Alliance on Mental Illness www.nami.org. For more information on Mental Health America of Daviess County or to learn about mental health resources available in the area, call 812-254-2423 or visit dcmha47501.wixsite.com/dcmha.

Children can experience anxiety disorders

This is the third article in a series about anxiety.

Q: What are anxiety and anxiety disorders in children?

A: Anxiety often arises during childhood. Research suggests biology and environment can be factors in the development of anxiety. Early traumatic events can reset the normal fear-processing so that it is overly reactive to stress.

Generalized Anxiety Disorder frequently starts in adolescence or young adulthood. Children and teens worry excessively when they have GAD. They worry about their grades in school and their performance in sports. They also worry about catastrophes, such as war or earthquakes. Children with GAD can experience physical symptoms that make it difficult to function and interfere with their daily lives. The above information is from a National Institute of Health 2016 revision.

On the website, very well-known author Katherine Lee addressed the question of anxiety disorders in children. The first type is Generalized Anxiety Disorder. Children with GAD have constant, excessive and uncontrollable fears. The fears are about grades, family problems, sports, being on time and natural disasters (as mentioned previously). These children with GAD often are perfectionists. They can have trouble sleeping, experience irritability and find it hard to concentrate in school.

Another anxiety disorder common in toddlers is Separation Anxiety Disorder. It can occur initially when a parent or caregiver leaves the room. As children who are older attend daycare, preschool or kindergarten, they can experience separation anxiety. Separation anxiety usually goes away as children become familiar with a new environment.

However, even in grade school, children might experience excessive fear and anxiety when separated from a parent. Children in grade school with separation anxiety can be reluctant to attend school or to sleep alone. Lastly, children with SAD might fear something bad will happen to them or their parents when they are separated.

Children with Obsessive-Compulsive Disorder have repeated thoughts they cannot control called obsessions. They might feel driven to perform rituals and routines, called compulsions, to control their thoughts and lessen their anxiety. A child who has OCD spends a lot on time or rituals such as hand washing, counting, repeating words or repeatedly checking and rechecking things like door locks to control unpleasant image, thoughts or feelings.

Post Traumatic Stress Disorder can develop after children witness or experience a life-threatening event such as a car accident. Many children recover quickly following a traumatic episode. However, those children who experienced the event directly or those children who lack strong support symptoms can develop PTSD. They can continue to have nightmares, flashbacks, insomnia, depression, and intense anxiety and fear. Children can re-enact the traumatic event when playing. Children might withdraw and avoid people, places and activities for months following the traumatic event.

Children with phobias have intense, irrational fears about something specific, such as dogs, needles, thunderstorms, flying and heights. Children with phobias are less likely to be able to put their fears in perspective or realize their fears are unrealistic, whereas adults are more able to rationalize their phobias into proportion.

Early diagnosis and treatment are important for effective treatment of children’s anxiety disorders. When anxiety disorders in children are untreated, they have a detrimental effect on children and can lead to problems in developing friendships, problems in school and low self-esteem.

The following information has been written by William L. Mace, Ph.D., a clinical psychologist in private practice. He noted a recent program on television in which mental health experts spoke about childhood anxiety. Beginning at age 4, 9 percent of preschoolers had developed Childhood Anxiety Disorder. By age 6, children presented with Separation Anxiety. By age 10, some children had Generalized Anxiety Disorder with an overlay of Social Anxiety.

There is some evidence childhood anxiety disorders can lead to adult mental disorders. One in every five young adults between 18 and 28 reported an anxiety event in the previous 12-month period. The inability to deal effectively with anxiety gets greater over time because any maladaptive coping mechanism must be dealt with first before addressing the underlying anxiety.

Experts found the only social stigma associated with Childhood Anxiety came from parents who refused to acknowledge it. Children can have Childhood Anxiety for one to seven years before parents accept the problem and then they might begin to comfort and overprotect the child, thus preventing the child from learning to cope. Childhood symptoms can include stomach aches before school, too much time spent playing computer games and avoidance of many everyday social encounters.

Behavioral therapies either with or without medication have proven effective in treating anxiety, especially anxiety in children. One of the significant reasons for the spike in anxiety among teens is the increase in the use of technology. An example is the device called a “fidget spinner.” Originally made to help children with anxiety, ADHD and autism, sales have been explosive, particularly among children, teens and young adults.

Smartphones, computers, video games and other technical devices have a mesmerizing or hypnotic effect on users. Children become addicted to technology, and any attempts to dislodge them or disrupt their use results in their anxiety. One of the main problems with technology is it tends to replace time spent in independent, creative play, time spent outdoors and interactive socialization with other children.

• Next week’s article will begin a discussion of anxiety disorders in adults.

Judy Caprez is professor emeritus at Fort Hays State University.

Mental Illness on Martha’s Vineyard: My anxiety disorder – The …

—Matthew C. Kramer

What word should I say? “Big” or “large”? Have I turned off the stove? Did I leave the door open? Is it locked at night? Am I wearing the “right” sweater? Did I drive down the “right” road or the “wrong” road?

When in the grip of anxiety, I have questioned my every single thought and action.

My anxiety is a feeling wrought with nervousness — constant and relentless doubt.

I worry I will do something “wrong.”

I know being reduced nearly to tears in the madness of trying to decide whether to turn left or right on a walk. The nervousness and doubt interfere with my ability to make a decision. I have walked back and forth for 10 minutes between the two options, with my hands holding my head — left? Right?

I fear the “wrong” choice. The wrong choice may lead to a bad or unwanted consequence. A left turn may be safety. A right turn may lead to total and utter devastation. This feeling of uncertainty is incredibly discomforting.

I used to cope with my anxiety by diverting attention — say a few words, crack a joke, looking to someone else. This strategy worked. But it also undermines one’s self.

It submitted me to my doubt.

Where it started

Looking back, I realize my anxiety began in high school.

I was shy and sensitive as a child, But I do not think I suffered from anxiety. I was one of the neighborhood gang of friends. I was popular in my school. I did well in my studies.

In eighth grade, I started to stutter. I could barely choke a sentence out reading aloud in class. I was humiliated and upset. I could barely look at my classmates.

I told my mother after school that day. She arranged for speech therapy, and after a few months I was able to speak and read aloud again.

My stutter would continue to dog me, though. My shyness became more of a nervousness in high school.

I was unsure of myself. Would I stutter, then would my voice and body quaver and shake when attention was on me? Would I fumble the shot in lacrosse? Would I hold my own in social situations with the opposite sex? The only place where I lacked all anxiety was on the cross-country course.

I had a lot of friends in high school. I was an athlete in two sports. We partied more than we should. We were just kids and did not know better. I went to the library and did my homework.

I did not speak much in class — especially French class.

In French class, we always had to read and speak aloud. I worried about stuttering. My junior year, I briefly ran for class president. My voice shook in my nomination appeal. I was embarrassed. My presidential bid ended.

I skipped our junior class party and hung out with some friends instead. We smoked pot. I reasoned at the time that I was too cool for the party. In truth, I now know, I was intimidated by the whole thing. I was afraid of the social expectations of the occasion — conversing and being confident and witty.

At the time, I did not know the cause of my doubt. I knew I was nervous in social situations. I knew I was self-conscious. I did not know I suffered from “anxiety.” I felt personally at fault. My lack of confidence was a weakness.

My anxiety really accelerated in college.

My doubt was no longer something that just surfaced now and then. It was full-throttle — a fully conscious and ever-present thought. I was amidst all of these young people growing into men and women. I felt like I was not one of them. I lacked confidence. I was a kid by comparison.

During my first semester, I was called on in geology class. All the students and the professor looked at me, waiting. I could barely handle it. My whole body shook. My voice shook. I was mortified. I knew what people were thinking: “The baby.”

I talked to my mother during my winter break that year, and she found a counselor for me. The counselor was a nice woman. We talked. But that was it. She gave me some meditation techniques and sent me on my way. I needed more.

One solution to my anxiety was to stick close to my buddies. I did not feel anxious in small groups of friends. Often, I had one really good friend and would let that person take the lead. I could forget my anxiety when I was with my pals.

We had fun in college. We had a good group of friends. We joined a fraternity. We went out to parties and hosted our own. Maybe not always the best use of our time. We relished our freedom.

I had a way of drinking too much on occasion. It went from fun to no longer fun. It was a way to keep up. Often I would become wretchedly sick.

College went along, and I managed. I kept up with my classes and coursework. I played some pool and a lot of foosball. I participated in the governance of the fraternity. I found a comfort zone. I had a girlfriend for a few years. She brought some joy into my life.

My stutter and fear of group settings were always at the back of my mind.

Without fully realizing, other than having talked to a counselor and my mother, I kept my anxiety buried. It surfaced in limited social situations and public speaking. I mostly could avoid these triggers.

My senior year, I stepped back from the partying and moved off-campus, renting a small house on the nearby lake with a few friends. I focused on my honors thesis in history, and had some success in my studies. I was manager for the crew team. How I wish I had run cross-country in college! I was a talented runner, and I think it would have given me some of the confidence I lacked.


After college

After college, I took on a variety of interests and endeavors. I worked on a presidential campaign. I sailed the ocean, working on tall ships and catamarans. I attended and did well in graduate school. I had a girlfriend and a few good friends. I later married and began a career.

I continued to experience doubt and nervousness.

I kept my anxiety at bay as best I could. I stayed under the radar, and avoided some social situations. It was easier that way. I did not have to feel or confront the uncomfortable and embarrassing nervousness. I did not fully realize what I was doing.

But it was impossible to keep the anxiety totally at bay. There were cocktail and dinner parties with folks I did not always know. I would be very nervous. I would feel a lack of confidence. I would envision myself stuttering, and a nervous tic in my lip twitching out of control. The other folks at the party would be humiliated for me.

Four years after grad school, I moved to the Vineyard with my wife and new daughter. I was excited to be in a new place with my family.

The move turned out to be difficult.

I had serious struggles with paranoia — unrealistic fears of a conspiracy to ruin me — that left me estranged from all of my family and friends. (My children were the only people in the entire world I did not include in the conspiracy.)

Ultimately, given my erratic behavior, my wife asked me to leave the house, and filed for a divorce. I moved in with my parents. I spent most of my time in my room writing a book. I had regular visitation with my children that I never missed.

I had left work and existed in this paranoid world for about five years.

Then I had my first intrusive thought. Intrusive thoughts are unwanted thoughts — symptoms of obsessive-compulsive disorder (OCD). They cover the most terrifying territory the mind can conjure. Whatever is the most disquieting thought in a given situation will be the thought a sufferer of this form of OCD will have.

Intrusive thoughts may be that you are going to harm yourself or someone else. They may appear as images in your mind of horrible things happening to yourself or the ones you love. Doomsday scenarios appear in your mind.

The scientific research — based on evidence-based studies — is clear: Intrusive thoughts do not increase one’s likelihood of acting on the thoughts. But that does not matter to the one suffering. The feelings are real, and they are terrifying.

For a while, I did pretty well, and my wife took me back. I managed OK for a while. But over the course of a year, the intrusive thoughts gradually took over.

In the depths of my illness, the grocery store and the Post Office were impossible. There were too many people in too small a space. I would be on the highest level of alert. I was afraid I might somehow hurt someone in passing.



I had one of my worst episodes walking around West Chop one day.

I thought I was going to throw myself in front of every passing car and truck. I felt in my mind jumping out into the road, the violent impact of the hood of the oncoming car crushing my body, and life leaving me. It took all the energy and control I could summon not to jump.

The effort left me exhausted. I descended into a state of madness. Whereas I had been hanging on — working on my book, doing chores and errands, having family suppers — I could now no longer cope at the most basic level. I was terrified by the intrusive thoughts and paranoia. I wanted nothing more than to not cause harm.

I isolated myself and ruminated over my fears.

I spent entire days in my bedroom. I skipped family suppers. I stayed away from the Post Office and grocery store. I withdrew emotionally. I lost my ability to have a conversation. I could not have a relationship — with my spouse, my kids, my siblings, my parents. I slowly and completely withdrew from the world.

My deterioration and my inability to function or participate in the household, and the roller-coaster experience of my illness, became too much for my wife. She asked me to leave the house, and renewed her request for a divorce.

Confronted with this loss, I finally agreed to try medication. For years, I had resisted medications, as I believed a goal of the “conspiracy” was to impair my abilities by putting me on potent medications that I did not need. But with the help of a counselor and the support of my parents, I was able to take the leap of faith necessary.

The medications helped. The impulsive feelings and the paranoid world I had created receded. After some time, I could converse again and interact with people. It was not easy. I spiraled into a major depression along the way. The depression was horrifying, and lasted about eight months. I did not want to live. But eventually the depression did lift, and I did have a return to some normalcy.

My recovery has been ongoing — with expected bumps — for about 10 years. I am no longer afraid of the Post Office or the grocery store. I can sit down to supper. I can have relationships again with my family and friends. (That has been my greatest reward for taking medications.) I can and do walk around West Chop. I have a job.

‘If you broke your leg, would you see a doctor or try to walk on your own?’

Anxiety remains. I experience severe doubt. I am afraid I will do something and lose my job and be ostracized. No one will be my friend. I realize intellectually these fears are unreasonable, but it still does not matter.

There is no medication that cures OCD. (My medication is more for paranoia.) I received a treatment called cognitive behavioral therapy (CBT).

CBT exposes one to their feared situations and teaches one to tolerate the anxiety. It is very effective. As you learn to tolerate the anxiety, the level of anxiety diminishes. (See the sidebar for information on getting help.)

Now I more often confront my anxiety, rather than trying to unload it elsewhere. I do not like how the anxiety feels. But it is my burden, and I know from experience that the anxiety will go away. I know tolerating the anxiety is the healthy choice.

I have a counselor. Counseling has enabled me to succeed again in a job in the community. A person with mental illness carries a burden that folks without mental illness do not. A counselor helps shoulder that burden. There is no shame in seeking help.

If you broke your leg, would you see a doctor or try to walk on your own?

Read another anxiety story, about a boy who couldn’t speak. 

What the professionals say

What the professionals say about anxiety disorder

Anxiety, according to the National Alliance for Mental Illness (NAMI), is a disorder that causes one to be overwhelmed with feelings of intense fear and worry in situations that are not threatening to people without anxiety. For many people, according to Dr. Charles Silberstein, head psychiatrist for Martha’s Vineyard Hospital, anxiety prevents their ability “to work, to play, to live, to have relationships.”

Anxiety disorders, according to NAMI, are the most common mental illness in the U.S., with an estimated 40 million adults, or 18 percent of the population. This would mean approximately 2,550 Islanders have a form of anxiety. Approximately 8 percent of children and teenagers experience anxiety. Most people develop symptoms of anxiety disorders before age 21, and women are 60 percent more likely to be diagnosed with an anxiety disorder than men.

Anxiety is no stranger to the Vineyard. More than 800 community members — parents, teachers, students — attended intensive workshops for parents on anxiety and children led by Lynn Lyons, a noted expert and author on anxiety, in December 2015. Ms. Lyons returned to the Island in December 2016 at the invitation of the Island Wide Youth Collaborative to lead three more workshops.

There are different types of anxiety. Generalized anxiety disorder, says Dr. Silberstein, is where worries become excessive. A trigger could be something as innocuous as a phone call not being returned.

“Oh my God, have I done something wrong?” may be the thought of a person with anxiety. Symptoms could be butterflies in the stomach, sweaty palms, and explosive diarrhea.

Panic disorder is another type of anxiety. Panic attacks, Dr. Silberstein explains, are discrete episodes that last from seconds up to two hours. The symptoms may be a racing heart, shortness of breath, a feeling of impending doom, and a need to escape but being unable to escape. “It’s intensely distressing, and often accompanied by a feeling they are going to die or have a stroke,” Dr. Silberstein says.

Some people have phobias. A phobia disorder is when certain things or situations cause severe discomfort or irrational fear. Phobias may be flying, public speaking, snakes, spiders, even gooey substances, according to Dr. Silberstein.

Social anxiety disorder involves intense fear of social situations and a worry of social humiliation. Folks with social anxiety might not speak in class and might isolate themselves, according to NAMI.

Obsessive-compulsive disorder (OCD) is another type of anxiety. Someone with OCD might check to see if the stove is turned off 10, 20, 30 times. Or, says Dr. Silberstein, “they might wash their hands until they’re raw and cracked because they feel they might be contaminated.”

Post-traumatic stress disorder (PTSD) is the “granddaddy of all anxiety disorders,” according to Dr. Silberstein, though it has less of a genetic component. It is characterized by reexperiencing trauma as much as 30 years later. For example, women who had been in concentration camps might wake up and smell the ovens. Other symptoms of PTSD can be hypervigilance, flying into a rage when someone triggers the memory of a trauma, or emotional numbing and shutting down.

All types of anxieties can interfere with a person’s ability to function day to day. “Each [anxiety] in their own way destroys life if it’s severe enough,” Dr. Silberstein says.

Scientists believe that factors such as genetics and one’s environment cause anxiety disorders. Anxiety can be treated with psychotherapies, medications, and stress and relaxation techniques such as mindfulness and meditation.


How to get help

For more information on cognitive behavioral therapy, OCD, and intrusive thoughts, one should talk to their doctor, or read one of the many books on the topics.

NAMI Massachusetts (namimass.org)

Martha’s Vineyard Community Services Island Counseling Center provides support for those struggling with mental illness, addiction, or crises.
508-693-7900, ext. 290

Intake form: bit.ly/mvcsINTAKE

Island Wide Youth Collaborative provides support to families and children in crisis.
508-693-7900, ext. 400

M.V. Psychotherapy: Listing of psychotherapists on Martha’s Vineyard.

Lynn Lyons is an excellent resource (not Island-based, but lots of great info online): lynnlyonsnh.com


Be Local: Escambia NeuroPsychiatric Center works to reduce opioid addiction

Since 2000, Escambia NeuroPsychiatric Center has been providing Pensacola specialized and urgent mental health and psychiatric services. The team, made up of a doctor, an advanced registered nurse practitioner and a counselor, treats mood disorders, depression, anxiety, memory disorders, obsessive-compulsive disorder, post-traumatic stress disorder, Parkinson’s disease, Alzheimer’s disease and opioid drug dependency.

Dr. K. Shams is the medical director of the private practice and has a focus on neuropsychiatry and specializes in adult and geriatric psychiatry. Nicole Mosely began as a registered nurse and went back to school for her doctorate in nursing and is board-certified in psychiatric mental health. Max Soelzer is a counselor with a focus in cognitive behavioral therapy of depression, anxiety, substance abuse and mood disorders.

More: Small businesses can team build while volunteering: Be Local

One area of focus for the practice is substance abuse, particularly opioid abuse.

“It is an epidemic,” said Mosely, who primarily treats patients addicted to opioids.

Mosely said addiction is a multi-faceted and complex disease.

“It’s not related to a person’s willpower or moral failure,” she said. “It is a disease.”

Patients often have an underlying psychiatric condition that makes them more likely to abuse, and if they have anxiety or depression, Mosely said they are more likely to become dependent on opioids.

Escambia NeuroPsychiatric Center utilizes a suboxone program to treat the addiction.

“It’s a medication that is used for opioid dependence and abuse,” Mosely said. “It works like an opioid, but it’s not an opioid.”

She further explained the medication has two primary ingredients — one is in opioid antagonist and the other blocks opioids. It relieves the symptoms and cravings of withdrawal, and by blocking the opioid, the person does not experience the high they would normally get from the drug.

While suboxone helps treat the physical dependence of opioid abuse, there are often underlying disorders that led to the addiction. Mosely often refers her patients to Soelzer for counseling.

Mosely has seen more people getting treatment, adding, “I think more people are getting treatment because more people are learning about it.”

She also said there is a difference between dependence and abuse.

More: Be Local: Any surface and any size, Cabinets Direct can create your custom paint

“A person with chronic pain may need to take a painkiller every day, so they are dependent; abuse happens when you take it for a longer period of time than needed and you have a drive to acquire more opioids,” she said. “There’s a lot of factors that contribute to someone becoming addicted — anxiety or other issues. They are not bad people, it is not a choice, it is a disease.”

She has seen the suboxone program be a lifesaver for people. After she began working at the center, she saw how the treatment helped save many people’s lives, leading her to continue with a focus in the treatment.

“It is a dramatic improvement — seeing how it affects a lot of people. It is so multi-faceted, it’s a big puzzle and a challenge to figure it out. I like helping all types of people figure out how to navigate their lives,” Mosely said. “I like the holistic aspect of mental health.”

For more information on Escambia NeuroPsychiatric Center’s treatments and fees, visit escambiacenter.com or call 850-432-3334.

Be Local is a partnership between small businesses in Northwest Florida and the Pensacola News Journal.

Virtual Reality Aids Psychological Treatment

virtual reality aids psychological treatment
Photographee.eu | Shutterstock.com

Behavioral therapists are starting to use VR to expose their patients to sources of distress without leaving the office.

Exposure therapy, a technique within behavioral therapy, ensures a structured, repeated and progressive confrontation between the subject and stimuli that usually triggers inadequate behavioral or emotional responses.

Behavioral therapists use VR as a tool in exposure therapy.Click To Tweet

The process often involves revisiting places and situations with traumatic memories, but what if therapists can expose their patients to stimulus virtually?

Virtual Exposure Therapy

Exposure therapy is used by cognitive-behavioral therapists. Exposure allows patients to see for themselves that what they fear is less serious than they think.

In addition, through this therapy, they also get to know how to react in anxiety-filled situations.

They learn which behavior to adopt in the face of common sources of anxiety, or how to manage certain social situations if they suffer from social phobia.

Exposure therapy is used for most anxiety disorders, such as obsessive-compulsive disorder, post-traumatic stress disorder, and different phobias.

Thanks to the development of digital technologies, it is now possible for therapists to get novel tools in their arsenal.

VR is no longer just for video games. Digital companies are working to make them mental therapy tools, to treat phobias, anxiety, depression and all sorts of addictions.

One of the principles of cognitive psychotherapies is to gradually expose the patient to their fears (heights, spiders, airplane, claustrophobic places, and etc.) in order to help them dedramatize these situations.

With a VR app and a headset, therapists can put their patient in a digital environment, and immerse them in the dreaded situation, virtually and safely.

If, for example, the patient is afraid to speak in public, they’ll find themselves in front of a room filled with people, and they’ll have the chance to train virtually before confronting the same situation in the real world.

VR to Improve Mental Healthcare

In the past, these practices were carried out by the imagination, or through practical yet costly means. Now, several startups have embarked on the discovery of new therapeutic avenues using VR.

This is the case of Limbix, a VR therapy start-up, which develops digital solutions and VR apps for psychotherapists.

Limbix offers VR exposure therapy app through a headset (Daydream View), which has been tested by some therapists and proven to be effective in treating patients with acute anxiety.

Limbix is not alone in this niche. Other U.S. startups are also working on VR therapy apps, such as Applied VR.

The convenience of VR apps for mental health care is apparent.

Of course, it’s up to the therapist to monitor the patient and guide the session. A VR headset doesn’t supplement for a skilled and practiced clinical psychologist.

VR apps can also be used for relaxation or meditation sessions in a bucolic landscape.

Virtually exposing the person to their phobias or fears is done in a particularly gentle manner because the therapist can control the parameters and make the exposure progressive–they won’t just shove someone with battle-induced PTSD into a firefight.

The physician can choose the appropriate environment: for example, a person with vertigo will be put inside an elevator hanging on the side of a skyscraper–yet without leaving the couch.

What would you use VR therapy for?

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‘I washed my hands til they bled’: Genevieve’s OCD struggle began at age 10

At 10 years of age, Genevieve Mora had a nightly “checking routine”. She’d look under her bed and behind her door, and make sure her bedroom windows were locked.

It sounds like a perfectly harmless, even practical habit, but it was motivated by an unsettling thought: Genevieve was convinced that if she didn’t do all her checks, she was going to be killed.

This was one of the early presentations of obsessive compulsive disorder (OCD), an anxiety disorder that affects two per cent of people here in Australia.

While the now-22-year-old’s OCD was manageable at first, she developed more rituals and compulsions over time.

“I started washing my hands ‘til they bled, and turning doorknobs a certain number of times convinced that if I didn’t myself or someone I loved would die … I had to do everything in the number four,” Auckland-based Genevieve tells 9Honey. 

Genevieve’s mental health issues began when she was just 10. (Image: supplied)

“I was aware of how irrational it sounded, but it was easier to give into the compulsion than sit with the anxiety and fear that perhaps someone would die.”

Genevieve traces her years-long battle with mental illness back to the fear of death she developed at age 10.

“I clearly remember walking into the kitchen one night and catching a glimpse of the news. They were reporting a murder that had taken place in quite a lot of detail,” she recalls. 

By the age of 12, Genevieve’s OCD had reached a point where she couldn’t leave the house – and if she did, she’d require a one-hour warning so she could complete all her rituals first.

“I actually had to drop out of mainstream school as my day was consumed with rituals and I was missing classes because I had so much to do, compulsion wise,” she recalls.

Video: Researchers discuss new findings around clinical depression.

Genevieve says the frightening reality of OCD, and the power of the mind, is impossible to understand unless you’ve experienced it first-hand. 

“Your mind plays tricks with you … Nobody chooses to wash their hands till they bleed,” she says.

“I heard a radio segment the other day [that asked listeners to] ‘Call up with your OCDs’. I sat there thinking, ‘This illness nearly took my life. It’s not something to joke about’.”

Although Genevieve’s family sought professional help for her early on, she went on to develop an eating disorder – something she believes her OCD largely contributed to.

“My mind had full control of everything and I felt a need to gain that back. So I started controlling what I ate and how much I exercised,” she says. 

“I would wake up in the morning and wish I hadn’t.” (Image: supplied)

“I felt power again and felt like I had achieved something. Little did I know it was the beginning of a whole new battle.”

By this point, Genevieve’s mental illness consumed her life. She’d spent as much time sleeping as possible, because it was the only time her mind would get a break.

“I would wake up in the morning and wish I hadn’t because the day ahead was so daunting. I was so over life,” she recalls.

At age 12, Genevieve was admitted to an outpatient mental health service, followed by the Eating Disorder Service. In 2010, she was rushed to the Children’s Hospital in a medically unstable state, a moment she sees as the beginning of her recovery.

“I was in there 12 weeks and was required to gain 1kg a week. When I left I still had a way to go, but was in a better physical state than when I was admitted,” she says.

These days, Genevieve says she’s feeling “so well”. (Image: supplied)

From there, Genevieve underwent two years of inpatient and outpatient treatment, supported each step of the way by her family, friends, school and medical team.

“We all worked together to get my life back on track,” she says.

These days, the 22-year-old is living in Auckland and working part-time in a primary school as she works out her next step. 

“I eat freely again and my OCD no longer rules my life … I feel so lucky to be free again. It was a tough battle but worth the fight,” Genevieve says.

While she still experiences anxiety, her years of treatment have given her the tools to manage it.

“Whenever I am faced with a challenge that scares me, I tell myself that I have fought through so much more, I am SO strong and I can fight anything that is thrown at me,” she adds.

Genevieve and Jazz are using their experiences to help others. (Image: supplied)

Alongside her friend Jazz, who has also fought a tough battle with mental illness, Genevieve launched an online community called Voices of Hope. 

Using their own experiences, the two young women want to help other people living with mental illness feel less alone and show them that recovery is possible. 

“To someone who is fighting a battle, my advice to you would be to take it one day at a time. Remind yourself that you are not your illness and it will not define you,” Genevieve says.

“It takes a lot of hard work, a few steps forward, a few steps back, but as long as you keep heading in the right direction and fighting the voice in your head you will get there.”

You can visit Voices of Hope’s website and Facebook page. You can also watch Genevieve Mora’s story in video form here

Increasing use of technology can increase chances of anxiety

This is the second article in a series about anxiety.

Q: What is additional information about anxiety and other feelings or emotions?

A: In an article from the Anxiety and Depression Association of America, there is a differentiation between everyday worry and anxiety disorders.

Everyday worries include the following:

• Worry about important life events, such as getting a job.

• Embarrassment in an awkward social situation.

• Case of nerves before a presentation or performance.

• Realistic fear of a dangerous place, object or situation.

• Anxiety, sadness or problems sleeping after a traumatic event.

Anxiety disorders include the following:

• Constant anxiety that causes distress and interferes with daily life.

• Avoiding social situations for fear of being embarrassed or judged.

• Panic attacks and preoccupation with the fear of having another one.

• Irrational fear or avoidance of object, place or situation that poses little or no threat.

• Recurrent nightmares of flashbacks about a traumatic event that occurred months or years before.

Depression and anxiety disorders are among the most common psychiatric disorders in the United States. Although 40 million Americans experience anxiety disorders, only approximately one-third receive treatment, although anxiety disorders are treatable. With depression, 3 percent to 5 percent percent of adults suffer from depression.

The following information is from the Mayo Clinic. In diagnosing anxiety problems, doctors need to look for underlying medical problems if a person meets the following criteria: does not have blood relatives with anxiety disorders; didn’t have an anxiety disorder as a child; does not avoid things because of anxiety; has a sudden onset of anxiety that seems unrelated to life events and has no previous history of anxiety.

In a University of Maryland Medical Center publication, there is an explanation of how anxiety disorders are associated with different physical illnesses. Anxiety is associated with several heart risks that include unhealthy cholesterol levels, thick blood vessels and high blood pressure. Anxiety is associated with worst outcomes following heart surgery. Cholesterol that is excessive contributes to atherosclerosis as blood cholesterol levels increase.

Gastrointestinal disorders frequently have anxiety components, particularly irritable bowel syndrome. Pain and muscular tension are common in persons with anxiety disorders. Tension headaches and migraine headaches are associated with anxiety.

Studies show an association between persons with respiratory conditions such as asthma, emphysema, and chronic bronchitis, and anxiety. Such persons have more frequent relapses.

Regarding obesity, anxiety disorders can lead to obesity and the reverse also is true. Anxiety disorders are associated with many allergic conditions, such as hay fever, hives, eczema, food allergies and conjunctivitis.

There are some conditions that are associated with anxiety that are less well-known. Persons with obsessive-compulsive disorders can experience skin problems from excessive hand washing, injuries from repetitive physical acts and loss of hair from repeated hair pulling, called trichotillomania.

Children who experience anxiety disorders also have physical symptoms, such as stomachaches. Anxiety predisposes children for a higher risk for sleep disorders. These include restless leg syndrome, frequent nightmares and bruxism, which is the grinding and gnashing of teeth while asleep.

In an article titled “The Anxiety Epidemic,” Larry D. Rosen, Ph.D., professor of psychology at California State University, points out that anxiety now is more common than depression among college students, whereas depression always has been the leading mental health disorder among college students. The National Institute of Health reports 26 percent of boys and 38 percent of teenage girls have anxiety disorders, according to author Alex Williams.

In 2014, Dr. Nancy Cheever published a study about an experiment with college students and smartphones. The research compared 163 subjects and divided them into three groups: those who used their smartphones the least; those who used them moderately; and those students who used smartphones the most. Those students with the highest use showed the most distress with no phones; those with moderate use had moderate anxiety; those with the least use had the least anxiety when deprived of their smartphones.

FOMO is a particular form of anxiety among college students. FOMO is an abbreviation for Fear of Missing Out. FOMO directly predicted more smartphone use daily, more preference for multitasking, and more nighttime wakings to check a phone, which predicted sleep problems. Furthermore, FOMO predicted lower grades, more daily smartphone use, shorter attention span when studying, and a lack of classroom attention due to distraction by technology which, in turn, was predictive of poorer grades.

Smartphones have been a significant part of life for the last decade. That, and other technological devices, have a harmful effect on people. People get anxious when deprived of their technical devices. Whether the anxiety is FOMO or some other form of anxiety is an open research question. In a study monitoring smartphone use, the typical college junior/senior checked their phones 60 times a day for total of 220 minutes.

Rosen recommends people try to decrease their incessant use of technology, which appears to be related to the development of increased anxiety.

• Next week’s article will discuss anxiety and anxiety disorders in children.

Judy Caprez is professor emeritus at Fort Hays State University.

What is obsessive compulsive disorder? OCD causes, symptoms and treatment – all you need to know

MANY of us will feel like we know what OCD is, and some of us may even make jokey comments about being “a little OCD” from time to time – but in reality OCD is a serious issue for those who suffer with it.

Here is everything you need to know about the mental health condition, from how it presents itself to how to seek treatment.

 There are differing obsessions you can suffer from as well as differing strengths within them
There are differing obsessions you can suffer from as well as differing strengths within them

What is Obsessive Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder, commonly referred to as OCD, is a severe anxiety disorder that affects 12 in every 1000 people.

The disorder doesn’t discriminate between age, race or gender and according to the charity OCD-UK, it can be so debilitating that the World Health Organisation (WHO) has ranked OCD among the top ten when it comes to the most disabling illnesses of any kind – in terms of lost earnings and lessened quality of life.

There are two aspects to OCD – obsessions and the compulsions.

Obsessions are thoughts, ideas and urges which feel impossible to ignore by sufferers – and they can be very persistent.

 Obsessions can cause a huge amount of anxiety
Obsessions can cause a huge amount of anxiety

Obsessions can cause a huge amount of anxiety, particularly if they are distressing thoughts about harm coming to someone you love.

On the other hand, compulsions are the ritual sufferers perform to rid themselves of the anxiety felt from the obsessive thoughts.

How will I know if I have OCD and what are the common obsessions?

Most OCD sufferers recognise that their obsessions and compulsions are irrational but they can’t stop acting on it and feel they need to do it “just in case” – this often makes it harder for them to seek help.

While OCD tends to develop slowly over a long period of time, stressful life events  can also act as triggers, including bereavement, illness, a new relationship, retirement, money woes, family issues, and childhood abuse or neglect.

Sufferers find themselves in a cycle of obsessions and compulsions, and because both are involuntary it can be very hard to stop.

Common obsessions include:

  • Fear of deliberately harming yourself or those around you
  • Fear of harming yourself or others by mistake – eg. fear you may set the house on fire by leaving the oven on
  • Fear of contamination by disease
  • An urge for symmetry or order


 Compulsions are the ritual sufferers perform to rid themselves of the anxiety felt from the obsessive thoughts
Compulsions are the ritual sufferers perform to rid themselves of the anxiety felt from the obsessive thoughts

What are the symptoms of OCD?

OCD affects different people in different ways, but usually appears as a particular pattern of behaviours.

These include four main steps:

  1. Obsession – where an unwanted, intrusive thought or urge repeatedly enters a person’s mind.
  2. Anxiety – the unwanted obsession then provokes a feeling of intense anxiety or distress.
  3. Compulsion –  as a result of feeling anxious, a person will carry out repetitive behaviours or mental acts that they feel driven to perform to better the situation.
  4. Temporary relief – the compulsion will offer temporarily relief to the OCD sufferer’s anxiety – but the obsession soon returns, causing the cycle to begin again.

While it is possible to just have obsessive thoughts or just have compulsions, most sufferers will contend with both.

Common types of compulsive behaviour in people with OCD include:

  • Cleaning and hand washing
  • Checking – such as checking doors are locked or that the gas is off
  • Counting
  • Ensuring order and arranging things ‘perfectly’
  • Hoarding
  • Thinking “neutralising” thoughts to counter the obsessive ones
  • Avoiding certain places and situations that they feel could trigger obsessive thoughts

How is Obsessive Compulsive Disorder treated?

While many sufferers may be reluctant to seek help, OCD is unlikely to get better on its own.

Treatment and support is available and will manage symptoms – meaning the sufferer will be able to enjoy and improved quality of life as a result.

 Those with OCD shouldn't feel afraid to seek help - as it may greatly improve their quality of life
Those with OCD shouldn’t feel afraid to seek help – as it may greatly improve their quality of life

If you feel you are suffering with OCD, you should try and speak to a counsellor or therapist who can provide the help and support you need to regulate your compulsions and can help you understand the reasons behind your OCD.

If you need help managing your OCD without seeking outside assistance, there are a few things that can help:

Talk to someone

Seek out a trusted friend or family member to share your worries with.

Having someone close to you understand what you are going through can help you feel as though you’re not alone.


Just 30 minutes of exercise a day can help to refocus your mind and will also release feel-good endorphins – helping ease feelings of anxiety.

Read self-help guides

These can offer you with structured programmes to follow.

Relaxation techniques, such as mindfulness

Practising these can help reduce stress, which in turn, can lessen the impact of OCD symptoms.

What are the different types of OCD?

  • Contamination – feeling the need to clean due to the fear of something being unclean.
  • Checking – feeling the need to check things in order to prevent damage.
  • Hoarding – feeling as though you can’t part with certain items – even if useless.
  • Religion – feeling as though you need to recite prayers a certain amount of times to restore your faith after having anti-religious thoughts.
  • Violence and sex – feeling guilty over disturbing thoughts. This type of OCD is known as ‘pure-O’ and ends with the obsessions – people with this ‘pure-O’ tend not to carry out compulsive acts.

OCD can be a difficult condition to deal with, but it is improvable and there is help on offer to those who need it.

Remember, you’re not alone and even just speaking to someone about your condition can greatly improve your quality of life.

Contact your GP or care team immediately if you ever feel you can’t go on. You can also phone the Samaritans on 116 123, or you can call one of these helplines or support groups or NHS 111.