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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

hcarmichael@postmedia.com

Twitter: @HaroldCarmichae

OCD and Emetophobia

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

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

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

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

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

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

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

Distinguishing Between OCD and GAD in Children

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

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

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

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

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

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

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

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

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

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

What is OCD? A psychologist answered all of our questions about this misunderstood disorder

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

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

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

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

What is obsessive compulsive disorder?

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

How are obsessions and compulsions defined?

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

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

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

What are the symptoms of OCD?

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

What are some common obsessions and compulsions?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do we know what causes OCD? Is it genetic?

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

Is there a way to prevent OCD?

“There is no way to prevent OCD.”

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

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

What are some common treatments?

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

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

What should I look for in a therapist?

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

How can medication help OCD?

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

Are there ways to manage my OCD on my own?

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

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

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

Will my OCD ever go away?

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

Are there things I should avoid if I have OCD?

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

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

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

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

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

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

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

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

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

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

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

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

Why ‘PMAD’ Is Replacing ‘Postpartum Depression’ as the Catch-All for Maternal Mental Health

taking care of their minds and bodies in real life.

“A little worry is normal,” other moms would tell me, assuring me I’d feel better when I got used to motherhood. But I didn’t feel normal — I felt like I was suffocating.

Juggling my newborn son’s around-the-clock demands with my own physical and emotional needs — all the while sleep deprived — made me feel like I couldn’t breathe. His stirring in the bassinet was enough to propel me into a full-blown panic attack that would keep me up all night, worrying about his well-being or mine.

But I never thought to bring up my struggles to my midwife at postpartum check-ups, since I didn’t fit the bill for postpartum depression. I wasn’t sad or tearful, and I hadn’t had any thoughts about harming myself or my baby. These things made it easy for me to fly under the radar, all while fear consumed my life.

It’s clear to me half a decade later that I had postpartum anxiety, a disorder that affects an estimated 10 percent of new moms. Though postpartum anxiety disorder is diagnosed at nearly the rate of postpartum depression, which affects an estimated 15 percent of women after giving birth, the latter condition tends to receive more attention from media and the medical community. Worrying is often dismissed as a “normal” aspect of pregnancy and new motherhood, to the detriment of moms like me, who may need medical intervention. It’s likely that the actual number of new moms who experience this condition is much higher than we think.

Mom and her newborn

perinatal mood and anxiety disorders (PMAD) to address the spectrum of mod changes that may occur during or after pregnancy, rather than simply applying “postpartum depression” as an imprecise catch-all.

In addition to depression, the term “PMAD” encompasses mood disorders like bipolar disorder, along with anxiety disorders like generalized anxiety, panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder. Reports estimate that up to five percent of women experience postpartum OCD and between four and 10 percent of women experience postpartum panic disorder.

Melissa Whippo, a Licensed Clinical Social Worker at the University of California, San Francisco and the creator of Afterglow, a San Francisco-based postpartum support group, says this small shift in language is a step in the right direction for better diagnosing and supporting moms.

“How we talk about things indicates how we treat and support people going through it,” Whippo tells Brit + Co. “A woman suffering from anxiety during her pregnancy isn’t going to feel understood or helped by a discussion around postpartum depression,” she says. “’PMAD’ helps increase awareness that mood concerns can occur for women at any stage of pregnancy, not just the postpartum setting.”

Whether symptoms are surfacing for the first time or an existing mental illness is worsened by reproductive change, many women also experience mood and anxiety disorders during their pregnancies that may or may not continue into the postpartum months.

Alexandra Sacks, a reproductive psychiatrist whose co-authored book, What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood, will be released in April 2019, says a combination of physiological and social factors contribute to maternal mental health during and after pregnancy.

While hormonal changes and sleep deprivation during pregnancy and postpartum can be disruptive to mood, social changes that come with the transition to motherhood can also profoundly affect PMADs.

“Many people go off their medication or stop prior treatment when they get pregnant, or they might stop activities that are stress-relieving, like exercise, or feel socially isolated because they’re not going out with friends or participating in hobbies or rituals that are important to them,” says Sacks.

Whippo says a more complete assessment process — one that screens for anxiety and mood disorders while factoring other potential stressors — is important in helping women suffering from PMADs. For instance, it’s worth considering whether a woman’s distress stems from factors like a difficulty in her partnership, or concerns about financial constraint. Once a woman is accurately screened, a more personalized treatment plan can then be put into place.

“In our treatment protocol at UCSF, we often believe that a combination of individual therapy, support group, sometimes medication and sometimes meditation and yoga, are the most helpful to provide complete support for women,” says Whippo.

Sacks shares Whippo’s optimism about the way ‘PMAD’ will cultivate awareness of the landscape of maternal mental health — especially among women like me, who may not think to ask for help when they need it.

“The shift in language may orient physicians differently, but it also orients the general population differently,” Sacks says. “It’s helpful to people who have anxiety disorders so they feel included in the community of advocacy, and for people who are potential patients to open up the possibility of going to go get help.”

What do you think of the change in language about maternal mental health? Tell us @BritandCo!

(Photo via Getty Images)

OCD and the Need to Be in Control

In my previous post, I discussed 6 common themes in obsessive-compulsive disorder. Starting with today’s entry, in a series of 5 posts, I will be discussing additional aspects of obsessive-compulsive disorder, and will end with reviewing one of the most effective treatments for this condition.

Let me begin with defining obsessive-compulsive disorder.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a psychological disorder consisting of obsessions and compulsions.

Obsessions are recurrent impulses, images, and thoughts which cause anxiety. Compulsions are repetitive behaviors or mental rituals performed in response to obsessions.¹

An example of an obsession is having the impulse to scream obscenities in church.

An example of a compulsion is saying 77 Hail Marys to “undo” the urge to shout obscenities.

The relationship between obsessions and compulsions

Sometimes compulsions are directly related to obsessions.

For instance, a certain individual obsessed with the possibility of catching a fatal disease takes a shower each time she comes home, even if having gone out only for a few minutes. This behavior is obviously excessive, but does it make sense? Yes, because we can see the logical connection between fears of catching an illness and compulsive need for cleanliness.

Sometimes compulsions are not directly related to obsessions. For instance, I once read about a young man who, fearing he would die in a car accident, would try to “neutralize” these fears by counting from 1 to 26. How does counting prevent accidents? And why up to 26? I could see no clear logical connection in this case.

Consequences of obsessions and compulsions

People with OCD often experience high levels of impairment. There are different reasons for that. For instance:¹

1. The time taken up by obsessions and compulsions. A person with OCD might spend hours obsessing and performing compulsive rituals; this leaves her little time and energy to initiate or maintain relationships, hold a job, and engage in other activities or hobbies.

2. Avoiding circumstances that may provoke obsessions or compulsions. An individual who worries about contamination might refuse to work in settings where he could be exposed to germs. Or he may avoid going to the hospital to get a much-needed medical treatment for fear of catching a rare and dangerous illness when in the hospital.

Need for control

I like to talk about three additional aspects of OCD, but due to limited space, I will explain the first aspect (i.e. lack of control) in this post and leave the other two for the following posts in this series.

So let me consider humans’ need for control.

Life can be unpredictable. Despite all precautions taken, we (or people we love) are sometimes severely or irreversibly harmed.

While the possibility of a specific terrible thing happening to you (or your loved ones) is extremely small, the likelihood that something terrible will happen is high because even small odds can add up to a big number.

This is the reality we all need to face. We can do everything right and yet be harmed (or harm others). For instance, sometimes religious people commit sins, loving parents harm their children, caring doctors harm their patients, and careful people hurt themselves.

OCD and control

People with obsessive-compulsive disorder find it more difficult to accept the reality of life’s unpredictability. Why? They might feel a lower sense of control or have a greater desire for control.²

Here is an example. A person once told me about her sister, whose OCD had worsened after she gave birth. She constantly worried she would accidentally make her infant ill (e.g., by not washing her hands often enough). One day, when she got home, she left the baby on the table and rushed to the bathroom to wash her hands. Her baby fell off the table.

Luckily, the baby received only minor injuries. But had this person been less preoccupied with certain prevention of only one kind of harm (from dirty hands), she might have been able to prevent her baby’s fall.

The problem is that some power, predictability, or control, is rarely enough for a person with obsessive-compulsive disorder. Nothing short of full certainty will do. “Clean enough,” or “safe enough” is no good. God-like perfection feels like a necessity.

However, that is impossible. We are human beings. Which means demanding perfection in one area of harm prevention means we may not have the time, attention, or energy, to prevent other kinds of harm.

I hope the woman above learned a lesson from the incident involving her infant. From what her sister was telling me, she was a great mother. What she experienced (the worsening of her OCD symptoms) after the birth of her child is not unusual. Many people with OCD react to stressful situations with a greater attempt at gaining control. If you have OCD, it helps to be mindful of that, and to seek support during such times.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

2. Moulding, R., Kyrios, M. (2007). Desire for control, sense of control and obsessive-compulsive symptoms. Cognitive Therapy and Research, 31, 759–772.

Prevalence and associated factors of comorbid anxiety disorders in lat | NDT

Chawisa Suradom,1 Nahathai Wongpakaran,1 Tinakon Wongpakaran,1 Peerasak Lerttrakarnnon,2 Surin Jiraniramai,2 Unchulee Taemeeyapradit,3 Surang Lertkachatarn,4 Suwanna Arunpongpaisal5

1Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Department of Psychiatry, Songkhla Rajanagarindra Psychiatric Hospital, Songkhla, Thailand; 4Department of Psychiatry, Prasat Neurological Institute, Bangkok, Thailand; 5Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Purpose:
The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors.
Patients and methods: This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis.
Results: Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive–compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated.
Conclusion: The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Keywords: generalized anxiety disorder, depressive disorder, elderly, risk factors

Dr. Deb’s Mental Health Vitamin: Obsessive-Compulsive Disorder


Dr. Deb Wade

By Dr. Deb Wade
GCU Vice President, Counseling and Psychological Services

I once had a client who entered my waiting room and could not find a seat. Oh, there was ample seating available in the waiting area  She came in and she chose one. After a few seconds, she got up and moved to another seat; again, in a few seconds, she got up and sat in a different one.

This action was repeated until it was her time to come into my office. Once in the office, she actually changed seats twice during the session. Why? Because she was living with Obsessive-Compulsive Disorder. It is a real diagnosis, can be very debilitating, and the one who is afflicted can feel powerless to change things.

Obsessive-Compulsive Disorder (OCD) can be the “go-to response” for many who are frustrated, overwhelmed, and scattered. They might say, “Oh, I’m so OCD today.” 

However, when the diagnosis is present, it is not a sometime thing; it’s an all-the-time thing.

Of course, virtually everyone has experienced worries, doubts, or fears at one time or another. And … it’s natural to worry about life issues such as one’s health, the wellbeing of someone you love, paying bills or what lies ahead. Likely, too, everyone has had an intrusive thought – even a “bad” one – but none of that is OCD.

OCD is characterized by obsessive thoughts, impulses or images and compulsions (either overt or mental rituals) that are difficult to suppress and take a considerable amount of time and energy away from the living of a normal, healthy life.  

Back to my client: Not only did she exhibit ritualistic and repetitive behaviors in my office (the rapid changing of seats and being uncomfortable in each of them); her work life was also greatly impacted by her condition.

She worked as a teller in a bank, which required that she “balance her drawer” every evening before leaving. She described to me, through much emotional pain and tearfulness, that she was “so afraid that I’ll get fired” because most nights she would check, re-check, re-check and re-check – even if the drawer balanced – because she could not trust herself enough to believe that she was free to go home.

Many nights she was there late enough to walk out of the building with the night custodian only after his task of cleaning the bank was complete.

Furthermore, her compulsions did not stop there – once home, she was involved in a “checking ritual.” She would repeatedly check the locks on the doors and make sure that her oven, stove and coffee pot were turned off.

Many times, she would not get sound sleep because she was in the compulsive ritual of getting out of bed repeatedly to “check” these items. Needless to say, she was physically and emotionally drained!

If any of this sounds familiar, let’s examine the symptomatology of Obsessive-Compulsive Disorder:

Obsessions – Intrusive, irrational thoughts or impulses that repeatedly occur. People who are afflicted know these thoughts are irrational but are afraid that somehow they might be true. Examples include:

  • Doubts about something being done right, such as turning off the stove or locking a door
  • Unpleasant sexual images
  • Fear of saying or shouting inappropriate things in public
  • Recurrent, persistent thoughts, urges or images that cause significant anxiety or distress

Compulsions – Repetitive acts that temporarily relieve the stress brought on by the obsession. People afflicted know that these rituals don’t make sense but must perform them to relieve anxiety and, in some instances, to prevent something bad happening. Examples include:

  • Excessive hand washing because of a fear of germs
  • Counting and recounting money
  • Reading a passage over and over because of a fear that something bad will happen
  • Walking in a specific pattern in order to prevent serious harm to a loved one

If any of this sounds familiar to you or you’ve witnessed a loved one engage in these behaviors, there is help for this.

My client worked extremely hard to understand the illogical nature of her thoughts with cognitive-behavioral therapy (CBT) but also was willing to be “flooded” with opportunities in which she then denied herself the engagement of her ritual behaviors (Exposure and Response Prevention – ERP).

It was a painful process – one in which she failed a few times before she succeeded – but, ultimately, she was able to break free and now lives a healthy life. Oh … and she did leave the bank job – she found something much less anxiety-provoking so that she could get a fresh, clean start.

If my client’s story is familiar, please get help. A licensed mental health professional can help you break the chains of bondage with this disorder! The time you dedicate to the therapy needed is a very sound investment! The powerful payoff?  Freedom … which never felt so good!

Gray Matters: Hoarding conference slated for early 2019

The Area 1 Agency on Aging was recently awarded a grant from the Humboldt County Department of Health and Human Services-Mental Health Prevention and Early Intervention to host “Dispelling Stigma: Hoarding Education, Treatment and Prevention Conference” at the Sequoia Conference Center in Eureka. On Friday, March 8, 2019, we will bring together mental health and social service professionals, licensed clinicians, private businesses and governmental entities who are impacted by hoarding, people who hoard, and families of people who hoard.

Our presenters will be Mark Salazar and Julian Plumadore from the Mental Health Association of San Francisco’s Hoarding Task Force as well as Dr. Robin Zasio, a nationally known talk show host, clinician and former member of the “Hoarders” TV series team.

Two self-help support groups will be established following the conference — one for people who hoard and one for their friends and families. The groups would initially be led by a paid facilitator then continue as peer led groups after the grant ends. The conference will encourage development of a local task force to address hoarding in a coordinated way.

It is estimated that between 2 and 6 percent of the population has hoarding disorder. Hoarding symptoms are almost three times more common in older adults (55-plus) than younger adults, although symptoms can appear as early as 11 to 15 years old. Symptoms tend to worsen with age, usually after a divorce, death of a spouse, family member or another personal crisis.

About 75 percent of people who hoard have a co-occurring mental health condition, the most common are major depressive disorder, social anxiety disorder/social phobia and generalized anxiety disorder. About 20 percent of people who hoard also have Obsessive Compulsive Disorder.

Severe clutter threatens the health and safety of those living in or near the home, causing health problems, structural damage, fire and even death. San Francisco Task Force on Compulsive Hoarding’s 2009 report captured actual costs due to compulsive hoarding and cluttering behaviors in San Francisco of over a million dollars a year ($1,166,105) incurred by a portion of service providers ($502,755) and landlords ($663,350).

The report noted that while they were unable to estimate costs to individuals or all identified providers and landlords, a conservative estimate of costs to providers and landlords was $6.43 million a year. While smaller than San Francisco, the costs to Humboldt County, both financial and human, are still too high.

Mental health professionals have previously viewed compulsive hoarding as a specific manifestation of obsessive-compulsive disorder. A 2004 study published in the American Journal of Psychiatry concluded that people affected by compulsive hoarding differ from people affected by OCD in several important respects. People who hoard have a relative lack of awareness regarding the condition’s real-world impact, a greater decline in overall mental function, and an increased likelihood of having co-occurring mental health conditions.

People who hoard need professional support and time to accept the removal of their things, followed by ongoing emotional support and care after the clean-up occurs. Attempts to provide “help” by spending a day or two “cleaning it up” may trigger a traumatic emotional response and will rarely result in a successful, long term outcome.

Most people don’t understand this illness, the toll it takes on people with the disorder or that ongoing treatment and support is needed.  Unfortunately, resources do not currently exist to provide the coordinated, compassionate, dignified, and knowledgeable support these people need to move forward.

Learning about successful treatment options and creating an informed service sector to help people who hoard will result in better health and emotional outcomes, as well as cost savings. We hope this conference will reduce the stigma associated with hoarding and increase our willingness and resources to support people with the illness.

Conference brochures will be available in mid-January at www.a1aa.org and at our office at 434 Seventh St., Eureka, 95501.

Maggie Kraft is the executive director of the Area 1 Agency on Aging.

 

 

OCD one of the most common mental disorders in Singapore

SINGAPORE: Obsessive compulsive disorder (OCD) is one of most common mental health conditions here, according to findings from a nationwide study released on Tuesday (Dec 11).

The disorder affected one in 28 people in their lifetime, making it the third-most prevalent condition after major depressive disorder and alcohol abuse. The illness is commonly characterised by recurrent and persistent thoughts, impulses or images, and when severe, impedes a person’s ability to function.

Younger people aged 18 to 34 were more likely to have the condition than those aged 50 and above, said researchers from the Institute of Mental Health (IMH) and Nanyang Technological University (NTU), citing the findings from the second Singapore Mental Health Study.

The study also found that those who had a monthly household income of between S$2,000 and S$3,999 were less likely to have the condition than those with a household income of less than S$2,000.

IMH’s Professor Chong Siow Ann said that one symptom of OCD is the fear of contamination and could manifest in excessive washing. The condition causes “tremendous impairment” to a person’s functioning, he said.

While the term “OCD” is loosely used in Singapore, and some people may even take pride in saying that they have OCD as it denotes a certain discipline, Prof Chong said that the clinical definition of the illness is different.

Such terms being loosely used could sometimes be a problem, said IMH chief executive Chua Hong Choon.

“That relates to the stigma and issue of what we understand of these disorders,” he said.

OCD COULD START OFF MILD

Associate Professor Mythily Subramaniam also said that the 6,126 participants surveyed were asked if they had had recurring thoughts or concerns about order or symmetry, which is related to OCD.

“It’s a very neglected disorder,” said Assoc Prof Mythily. 

When it starts off, it could be mild, she said, adding that it could get worse over time, interfering with a person’s life. She gave the example of a person who could start off washing his hands more frequently, but who could end up repeating the action so frequently that daily activities are interrupted and he suffers from infections. 

She gave examples of a person showering for two hours or taking an hour to wear shoelaces as signs of a person who has OCD.

Given that it could start off mild, the delay in seeking treatment by those with OCD was the longest among those who sought help for mental disorders.The estimated median number of years it took a sufferer to seek help was 11 years, compared those with other disorders such as alcohol abuse, which took four years.

Prevalence of lifetime OCD and OCD in the most recent one-year period in Singapore was higher than in South Korea, Australia and New Zealand.

SIGNIFICANT INCREASE IN MENTAL HEALTH DISORDERS

Overall, one in seven people in Singapore has experienced a mood, anxiety or alcohol use disorder in their lifetime, according to the study spearheaded by IMH in collaboration with the Ministry of Health (MOH) and NTU.

This is a significant increase from 2010, when the study was last done, Assoc Prof Mythily said. The recent one was initiated in 2016 and completed in one-and-a-half years.

The most common condition was major depressive disorder, experienced by 1 in 16 people.

Younger people in the 18 to 34 age group were more likely to have major depressive disorder than those aged 50 and above. Those who were divorced and separated were also more likely to experience the condition in their lifetime.

Alcohol abuse was the next most prevalent, affecting 1 in 24 people.

Other conditions that were surveyed were bipolar disorder and generalised anxiety disorder and alcohol dependence.

The 2016 study found that the majority of people, three-quarters, with a mental disorder in their lifetime, did not seek any professional help. This proportion is similar to the proportion of people who did not seek help in the 2010 study. 

However, those who sought help for their mental illness did so much earlier than what was observed in the last survey, researchers found. 

OCD: ‘It’s not about being fussy or tidy’

Iestyn WynImage copyright
Iestyn Wyn

Image caption

Iestyn Wyn says it took him eight years to be correctly diagnosed with OCD

People should stop linking obsessive-compulsive disorder (OCD) with being fussy or tidy, says a man who has the “terribly misunderstood” condition.

Iestyn Lewis, from Anglesey, admitted he used to make throwaway comments about being “a little bit OCD” but that changed after he was diagnosed.

The condition sees people having unwanted and repeated thoughts that can lead to obsessive behaviour.

Charity OCD Action said better awareness was needed.

Mr Lewis, 25, said he believes that a lack of understanding about OCD leads to some individuals having to deal with symptoms for years without knowing the true reason behind them.

“OCD is seen as one of the 10 most disabling illnesses by the World Health Organisation, why then do we use such a serious illness to describe the way some people like being tidy or organised?” he said.

“The result of playing down the severity of OCD is dangerous.

“As a society we are much more open when it comes to discussing mental health issues, but we must go further – the battle is not over.”

Media captionLily Bailey busts myths about obsessive-compulsive disorder.

He added: “The worst thing about OCD is that it throws the worst possible thoughts at the individual, and as a result that person has to neutralise this anxiety by performing certain actions,” he said.

“It took me almost eight years before being correctly diagnosed. Why? A lack of personal understanding? Professional workers failing to recognise the symptoms? Embarrassment for having such thoughts? It was a mixture.”

According to the charity OCD-UK, around 36,000 people in Wales had OCD in 2017 – and around 1-2% of Britain’s population is believed to live with the condition.

The thoughts and behaviours of individuals living with OCD can often be seen as unreasonable, but cannot be ignored.

The severity of the condition can vary, but with care and support it is treatable – without treatment there is a danger of symptoms deteriorating, according to OCD-UK.

The charity added that the NHS does offer two types of treatment for the condition, but many find it difficult to receive adequate treatment and often have to wait a long time to be seen.

Image copyright
Kristina Banholzer

Image caption

Elis Derby is a Welsh-language singer and an OCD sufferer

Elis Derby, 22, from Y Felinheli, near Bangor in Gwynedd, who also has OCD, said: “I remember even since primary school that I felt compelled to keep everything in a certain way just to keep my mind at ease – but I started showing some more obvious symptoms during my preparations for my GCSE exams.

“I remember one time, when I had to get a taxi back to my flat after numerous ‘bad turns’. As I was pointing to my destination the driver got angry and thought that I was wasting his time – because it was so close.

“I didn’t want to make him feel bad by explaining the true reason behind me needing his services, so I said nothing. This is one example but it made me feel down for some time afterwards.”

A spokesman for OCD Action said: “OCD is widely misunderstood, and unfortunately, it’s common to hear people misusing it as an adjective to describe someone who is neat and tidy, but the reality for those living with OCD couldn’t be more different.

“These false portrayals can stop people who are genuinely affected by the condition seeking help, often due to a fear that they will not be taken seriously.

“They also contribute to a greater lack of understanding which can cause people affected to suffer unknowingly in silence.”

we all know social media can seriously harm your mental health, so what now? – i

This article originally appeared in i-D’s The Superstar Issue, no. 354, Winter 2018

“I wouldn’t go on that if I were you, you won’t be able to handle it,” my brother warned. It was 2006 and I’d joined this new thing called Facebook. A website where you could see photos of everyone’s lives. I wanted to join so I could ascertain whether my boyfriend at the time had cheated on me at university. I was desperate for ‘the truth’. The ability to see behind walls and into nights out that I hadn’t been on. A few clicks in and I found what I was looking for: several pictures of him with the girl (so much prettier than me) I had always suspected he liked. And so began my unhealthy relationship with social media.

I have always had generalised anxiety disorder and obsessive compulsive disorder. Facebook felt like a beast bespoke-designed to feed my insecurities and anxieties, plant new irrational fears in my mind, create masterful user journeys for my obsessional thinking. My brother knew this when he warned me against Facebook, but there was no way I was overcoming the temptation. 12 years later, certain Silicon Valley rebels are confirming that Facebook was actually designed to stir these emotions and feelings.

In December 2017, Facebook’s Director of Research, David Ginsberg, and Moira Burke, a research scientist, published a blog post admitting that the social network was having a negative impact on people’s mental health. They described how social media “might lead to negative social comparison – perhaps even more so than offline, since people’s posts are often more curated and flattering.” Facebook (who also own Instagram) admitting this was a relief, but it did grossly underestimate the scale of the problem.

In a recent article in The Telegraph, Chief Executive of the NHS, Simon Stevens, described the effect of social media and online addiction on young people’s mental health as “an epidemic”. A recent survey of 14 to 24-year-olds by The Royal Society for Public Health and the Young Health Movement showed that image-based apps in particular deepen young people’s feelings of inadequacy and anxiety, with Instagram listed as the worst app for mental health, followed by Snapchat and Facebook. All fuel anxiety, depression, poor sleep, loneliness, bullying, body image issues and FOMO.

Earlier this year, Apple CEO Tim Cook admitted he doesn’t allow his nephew to use social media. And no one has gone further in the exposing of Silicon Valley than former Google Design Ethicist Tristan Harris; described by The Atlantic magazine as “the closest thing Silicon Valley has to a conscience”. Harris left Google in 2016 and started the non-profit organisation Time Well Spent, which aims to hold tech companies and app creators to account for their impact on young people’s wellbeing. In a recent interview, released on the 5th of July 2018 on YouTube, Harris detailed the real-life Black Mirror world of social media app creators. “When I was in college at Stanford, I studied at a persuasive technology lab that basically taught a lot of young engineering students the principles of persuasive psychology. You learn about clicker training for dogs, you learn how casinos manipulate and shape the choice-making environment that gets people to play slot machines… My friends in that class were the founders of Instagram. The narrative that’s so common is that Facebook is just a tool, it’s just a hammer, and it’s up to us how we use it. But that’s not true at all. Behind the screen there are 100 engineers who know exactly how your psychology works.”

“Social comparison plagues me the most on social media. It’s not the influencers or models or celebrities that get to me – it’s the acquaintances and friends of friends. When all you know about a person is their perfect pout on a night out, their most recent work success, it’s all too easy to assume that that is their reality.”

Social comparison plagues me the most on social media. It’s not the influencers or models or celebrities that get to me – it’s the acquaintances and friends of friends. It’s the people who I very rarely see in real life that I compare myself to most, and constantly come up short. When all you know about a person is what their dazzling smile looks like on a pristine beach, their perfect pout on a night out, how amazing their midriff looks in a crop top and their most recent work success, it’s all too easy to assume that’s their reality.

Advertising has sold us beautiful people and aspiration since there have been things to sell, but this peripheral social scene is new. “It’s never before been true in human history that when I wake up in the morning and I turn this screen over, I can see photo after photo of evidence that my friends’ lives are better than my life,” Tristan Harris says. “I can see photo after photo of my friends having the time of their lives without me. That’s a new experience for humans.”

As a woman in her early 30s, Marianne Mikhail MSc of 5th Avenue Counselling is one of the few councillors I’ve come across who is an active user of social media, which gives her a unique perspective when working with young clients. “I’ve had clients as young as 14 suffering greatly from comparing themselves to each other on Instagram, Facebook and Snapchat. Young people are seeing their friends presenting themselves in a way that seems gloriously attractive but totally unattainable for them, leading their own self-image to be dashed and diminished, their self-worth shattered.” Mikhail refers to social media as “a stage for many people’s insecurities to be exposed and potentially exacerbated, providing an opportunity to create a visible online persona, which can be edited and adapted to eliminate negative realities.”

Jayne Hardy is the founder of The Blurt Foundation, a digital community which provides peer support for those battling mental illness. She believes in honest representation online. “I want my social presence to be a realistic window into my life: the good, the bad and the ugly,” she tells me. “There’s this horrible notion that vulnerability is a sign of weakness, but in my experience, when I’ve opened the door of vulnerability, it’s made it much easier for others to share their experiences.” After her #WhatYouDontSee campaign went viral, with people tagging their experiences of mental health, Jayne was invited to give a talk at TEDx, a platform she used to share her personal experiences of the depression that swallowed up her twenties. Hardy also struggles with social comparison. “We have front row seats to the ins and outs of other people’s lives,” she says. “We get to see what projects they’re working on and what opportunities might have come their way and it’s so easy to feel as though you don’t, and won’t, match up. But I always remind myself that social media is never the full story, it’s a snapshot of a second in time that doesn’t share the pain, the compromise, the sacrifice, their hard work, their insecurities, their anything. We take the images at face value but there’s so much that leads up to that point in time.”

Last summer was the lowest point in my mental health history. I was sleeping two hours a night, I felt dizzy from exhaustion, like nothing was real. I started a ritual of listing every feature I hated about myself over and over and comparing them to other people’s features on Instagram. I even hit myself a few times out of frustration. During this period, I went to the pub and saw a friend there I hadn’t seen for a while. He said “How are you mate? Well, I already know from Instagram, you’re having the best time ever. I don’t think anyone in London is having as good a summer as you.” I looked back over my posts that summer: Glastonbury, Notting Hill Carnival, a press trip on a private jet, countless humble brags about work successes. I had projected this ultimately happy person online. It was far from my reality.

“Realising I was part of the problem, when Mental Health Awareness Week came around this year, I decided to tell the truth and posted a list of my conditions and medications alongside mantras that help me cope.”

Realising I was part of the problem, when Mental Health Awareness Week came around this year, I decided to tell the truth and posted a list of my conditions and medications alongside mantras that help me cope with OCD, such as ‘You are not your thoughts, and your thoughts are not facts.’ That post got more likes than any exotic holiday pic, and 66 comments of empathy and support.

@mytherapistsays is a meme account with 2.7 million followers including everyone who works in fashion, run by two friends Nicole Argiris and Lola Tash who draw on their own experiences in therapy and with anxiety. The account posts funny memes about not wanting to get out of bed, only wanting to socialise with dogs, self-loathing, loneliness and the great lengths people go to to hide how they’re really feeling. “Having this account has definitely helped us laugh at some of the more questionable moments in our mental health history,” Nicole and Lola tell me, “but at the same time, spending so much time on our phones and turning it into a business has increased… not anxiety… but responsibility.” Being able to joke about these feelings comes from having experienced them. “We constantly compare ourselves to people on Instagram too; when we observe how somebody has transformed themselves with the help of plastic surgery or filters, we can’t help but be affected by what we see, not what went into it.” After three years spent articulating these complex feelings, Nicole and Lola have become wise to the problems – “You should always strive to be the best version of yourself,” they advise, “that should be your only source of comparison.” They also point to the positives of sharing dark feelings in the digital space – “We’re so incredibly grateful to the people who relate, reach out, and live out our memes with us. It’s always a nice reminder to know you’re not alone.”

Hardy also emphasises the mass power that social media can have in providing support. “Social media has been incredibly helpful for my mental health,” she says. “Especially when I was unwell with depression and isolated – it was my window into the outside world. It connected me with people who understood what I was going through and were incredibly kind. I was able to use their hindsight as my foresight and learnt more about depression from their experiences of it than I had from any book.”

Social media can be a dangerous game, but it can also provide friends and community support, a blue-light window in a dark room. So whatever measures the NHS, the government or Silicon Valley app creators put in place to tackle the epidemic of mental illness in young people, it mustn’t interfere with the positive aspects of online communication.

“I think it’s good self-care to understand ‘why’ in all that we do and to listen to how things make us feel,” Hardy offers. “If we’re having a visceral reaction to something and it’s leaving us feeling down, then it’s a good idea to take stock.” Mikhail also suggests building in time for reflection. “Put away your devices, pull out a journal, and give yourself space to reflect and process your thoughts and feelings. Writing something down on paper can give perspective and make it easier to challenge unhelpful thoughts. If you find yourself writing negative things about yourself, ask yourself what you would tell a friend who was saying these things about themselves. Use facts and logic to counteract the irrational negative thoughts. The likelihood is that the reality is not as perfect as the post.”

Replacing self-sabotage with self-care, talking to yourself like a friend, and trying to see the bigger picture on everyone else’s posts is a start. Personally, since that comment in the pub, I’m much more conscious of what I post, because the last thing I want is to get so obsessed with presenting the very best version of myself online, that I trigger someone else’s insecurities in my peripheral social scene. Change starts with your own profile.