Postpartum OCD Is Real and We Need to Talk About It | SELF

It’s normal to worry about your baby, I assured myself as I stood in the dark, hand resting on my sleeping baby, carefully counting the rise and fall of her chest in sets of five. I was exhausted and on edge. According to the superstitious creature in my otherwise rational mind, my precious baby might perish while I slept, and it would be all my fault if I didn’t check her breathing.

I envisioned the fallout vividly: walking to the crib to find her cold, the futile attempts to wake her, the screaming, the agony, and the unbearable act of breaking the news to loved ones. After several minutes, the creature temporarily appeased, I stumbled back to bed only to rise minutes later and do it all again.

It wasn’t normal worry. The realization dawned gradually after weeks of around the clock counting of breaths, checking of locks and stove knobs, knocking on wood, and other seemingly necessary rituals, all of which made leaving home with my baby an ordeal of epic proportions. I mostly avoided going out, trapped in the prison inside my head.

Checking and counting are just two of many types of compulsions, the C in OCD, which stands for Obsessive Compulsive Disorder. Performing the compulsion temporarily relieves distress from the obsessive thought, the O in OCD—in my case, horrific images of harm coming to my daughter. Despite common stereotypes, the disorder is not a cute, “I’m so OCD about cleaning my kitchen” quirk. It’s a miserable, vicious cycle. OCD is a chronic or long-term anxiety disorder that ebbs and flows with life’s challenges. It’s thought to affect 1-2 percent of the U.S. population, according to the National Institute of Mental Health (NIMH).

While not causal, stressful life events can trigger or worsen symptoms in those predisposed to OCD, according to the Anxiety and Depression Association of America (ADAA). For me, the birth of my daughter, whom I love as unfathomably as any parent loves her child, was a major trigger. In retrospect, I suspect I’ve had OCD since my teenage years, but never as intensely as in the months following new motherhood. I started medication for anxiety following the birth of my daughter in 2011, but I didn’t receive an official OCD diagnosis until 2014, nearly a year after my son was born. Jenny Yip, Psy.D., a clinical psychologist, institutional member of the International OCD Foundation, and a mother who suffered a flare of her own OCD symptoms postpartum, tells SELF that “OCD thrives on what you care about in the moment, so it makes sense that new mothers and fathers could experience the overwhelming, excessive fears that occur with OCD.”

There are a lot of studies on OCD, but there is little data on postpartum OCD, which is an unofficial term for OCD that manifests, in both moms and dads, during the postpartum period. Experts “think that many people with postpartum depression also have OCD but they don’t want to talk about their obsessional thoughts because of fear associated with them,” Jonathan Abramowitz, Ph.D., professor of psychology and neuroscience at University of North Carolina at Chapel Hill and Editor-in-Chief, Journal of Obsessive-Compulsive and Related Disorders, tells SELF. “We don’t know the exact prevalence, but it’s definitely under-diagnosed and under-recognized.”

Worrying about your child is normal, especially during the postpartum period. “It’s even normal to have all sorts of strange and very unpleasant thoughts,” says Dr. Abramowitz. “Most people recognize these kinds of thoughts are senseless”—he calls them “brain farts”—and just move on. So how can a parent tell if worries are excessive? “[A]sk yourself these questions,” says Dr. Yip. “Are you doing more than what most parents would be doing? Are your family members noticing your fears and worries?”

Everyone double checks things sometimes, but according to the National Institute of Mental Health, people with OCD can’t control their thoughts and behaviors, spend more than an hour a day performing compulsions, derive temporary relief but no enjoyment from the compulsions, and experience significant problems in daily life due to the disorder. If you spend hours sanitizing, checking, avoiding activities, or engaging in other rituals at the expense of sleep or time with your baby, you may have OCD.

Like others with OCD, new parents suffering from the disorder can benefit from psychotherapy, medication, or a combination of the two. Cognitive behavioral therapy (CBT), a type of psychotherapy that trains the mind to react differently to intrusive thoughts, and a class of medications known as selective serotonin reuptake inhibitors (SSRIs), are the recommended first-line treatments for OCD. Drs. Abramowitz and Yip advise consulting with your doctor if you’re breastfeeding and considering an SSRI. In my case, my doctor and I decided that the benefit of taking an antidepressant while breastfeeding far outweighed any risk to each of my children.

Untreated OCD was a horrible way to live. My kids are now six and four, and the superstitious creature still lives in my mind and occasionally rears its head. The medication I started in 2011 helped dampen my symptoms, and regular CBT sessions since my diagnosis in 2014 have armed me with tools to keep them at bay. I learned to recognize the underlying cognitive distortions spurring OCD thought patterns, like a sense of inflated responsibility—the belief that I could cause or prevent negative outcomes simply by performing irrational rituals or being “extra careful.”

Rather than give in to compulsions, my therapist taught me to tolerate temporary distress in favor of long-term wellness. So, despite how uncomfortable I may be while fighting the urge to check the locks tens of times in multiples of five throughout the night, it allows me to recognize the following morning that—despite ignoring the impulse—my loved ones didn’t burn alive overnight. These realizations reshaped the way I think and act, freeing me from the prison in my mind.

If you suspect you have postpartum OCD, don’t hesitate to see a medical professional. “It’s important to remember that the postpartum period is also about self-care,” says Dr. Yip. “You can only help your baby the most if you’ve taken care of yourself, too.”

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Anxiety Disorders in Children – News Medical – News

Anxiety is a common reaction to stress or anticipated danger. It helps individuals to prepare for and take action to avoid the source of threat or handle the situation that is likely to arise. However, in some people, anxiety becomes intense and acute, or lasts well beyond the time when it is useful.

This can actually negatively affect the individual’s daily life and reactions at which point it becomes anxiety disorder. Such conditions include separation anxiety, social anxiety, obsessive-compulsive disorder and various phobias. Anxiety disorders are among the most common of pediatric mental health conditions in the US.

Causes of Anxiety in Children

Among other reasons, children may develop anxiety for any of the following:

  • Trouble within the domestic environment
  • Traumatic life events
  • Loss of loved family members or friends
  • School-related anxiety, including academic worries or bullying

Signs of Anxiety Disorder

Children may show signs of anxiety disorder such as:

  • Difficulty in concentration
  • Sleep problems, including waking with nightmares
  • Loss of appetite or changes in food habits
  • Frequent complaints of illness
  • Mood changes, including tearfulness or irritability for no apparent reason
  • Feelings of fear or panic

Common Types of Anxiety Disorder in Childhood

Children and adolescents may experience any of the following types of anxiety disorder:

  • Fears or phobias
  • Separation anxiety
  • Generalized anxiety disorder
  • Social anxiety

Fears or phobias of particular situations may develop due to entities, such as monsters, bogeys, water and strange animals. The difference between fear of unknown or known negatively-experienced events or objects, and a phobia, is that a normal fear can be overcome and does not overwhelm the rest of one’s life. In contrast, a phobia is consuming and may eventually occupy the whole of one’s thoughts and determine the reactions.

Separation anxiety refers to the fear that some children display when they are separated from their parents or regular care-givers, usually around 6 months of age. If it persists and intensifies, children are likely to find their first preschools or daycare facilities a source of great anxiety. At times, separation anxiety may indicate the presence of family difficulties or changes.

Generalized anxiety disorder refers to a pervasive and unreasonable sense of anxiety, which is distinguished from fear or worry by the absence of any clear cause or time period. It is a rather long-term condition and affects one’s thinking about a wide array of life situations and problems rather than any specific situation, which one is actually going through or is likely to face soon. If a child with this condition is counseled about one issue, worry about another situation will manifest at once, and so the anxiety is not allayed.

A child may be shy, but may still look forward to spending time with friends or in a social setting where the activity is likely to be enjoyable. However, children with social anxiety will always hesitate to go out of their comfort zones, whether in their homes or just their rooms. Shopping, answering the phone, going to school, traveling by public transport, or meeting friends is always anxiety-arousing irrespective of the others involved in the activity. This anxiety is real, gut-wrenching fear rather than a mild apprehension, and restrains the child from any public interaction whatsoever.

Post-traumatic stress disorder and obsessive compulsive disorder are other rarer forms of anxiety disorder in children.

Consequences

The presence of long-term anxiety in childhood is a trying and consuming process, which can cause extreme stunting of the person’s emotional growth, social development, academic fulfilment, family life and overall development. These disorders are likely to persist into later life and plague the child throughout adult life. They may induce full-fledged mental disorders in adolescence or early adulthood, such as depression, alcohol abuse, drug addiction and suicidal tendencies.

Treatment

Anxiety disorders are varied and therefore a wide range of options is offered to children in order to treat them. These include modalities, such as medication, counseling and cognitive-behavioral therapy, depending on the type of disorder.

Medication

Medications are used only in cases of severe anxiety disorder not treatable by counseling or other interventions. They may take up to 4 weeks to produce a clinical effect and therefore this period of time should be allowed to pass before asking for a change in the type or dosage of medication.

Counseling

Many children suffering from anxiety disorder may not be able to find a sympathetic hearer or understanding person to confide in or ask advice. For such children a professional counselor can offer help or a neutral place to unload their worries and fears, with the knowledge that their families are not involved in the conversation. They find it easier to talk over some things with another person who is not related to them or part of their day-to-day environment. Professional counselors can help work out ways to cope with the source of the anxiety.

Cognitive Behavioral Therapy

Cognitive behavioral therapy or CBT is also called talk therapy. It is offered by professionals who can help children with anxiety to work through their thoughts and actions. They analyze the behavior of these children to bring about desired and productive changes in them.

References

Reviewed by Jonas Wilson, Ing. Med.

Further Reading

  • What is Anxiety?
  • Anxiety Causes
  • Anxiety Symptoms
  • Anxiety Diagnosis
  • Anxiety Treatments
  • What is Generalized Anxiety Disorder?
  • Pins and Needles and Anxiety
  • ow to Ease Anxiety in Children

Obsessive-Compulsive Disorder Is No Joke

The biggest lie about Obsessive-Compulsive Disorder is that it’s funny, though it is, at times. I laugh when I remember running for the school bus barefoot every morning, brandishing my shoes and socks to flag down the driver, because I had to button and unbutton my uniform so many times — in multiples of four — that I could never quite find the time to clothe my feet.

Still, I never manage to laugh when someone tells me about their alphabetized bookshelf, and how they’re “just so OCD” about those books.

The second biggest lie is that OCD is only about compulsions. Only rituals, continued indefinitely, like washing your hands or flicking a light switch on and off or, indeed, like blinking or buttoning and unbuttoning a shirt. The rituals, people know. The intrusive thoughts that motivate them, they consider less. They can’t conceive of primarily obsessional obsessive-compulsive disorder, where the worries never transmute into a physical compulsion but balloon instead inside the brain. Or of the false memory, the Frankenstein’s monster of an intrusive thought, one ruminated over so long that it solidifies into a grotesque imitation of the truth. Or of trichotillomania, the disorder so often co-morbid with OCD that compels me to pull out my hair.

I’ve written and rewritten my own history of OCD, in notebooks and diaries no one will ever read. Each account I’ve squirreled away, for fear it’s too self-involved or too angry or too melodramatic. I’ve been actively writing it since I was sixteen. It started playing out long before I knew it had a name.

Related

My OCD assumed a recognizable form the first time around. By the time I was fourteen I was touching every item in my bedroom, while repeating a nonsensical phrase before I could go to sleep or leave the house. I ate, showered, and slept according to strict patterns, all governed by the number four. I couldn’t wear new clothes or allow a new item into my bedroom. Instead, I balled them into plastic bags and hid them under my mam’s bed. We screamed at each other every time she found them, because I didn’t know how to explain.

I ate exactly four Cheerios for breakfast. I tucked in every chair at the dining table four, sixteen, thirty-two times. I wore the same too-short school trousers every day, to the endless amusement of two snickering boys on my bus. I repeated every number I ever saw sixteen times. Before long, I could recite by heart the phone number from every real estate agent’s placard in my hometown.

After a brief round of cognitive behavioral therapy, my OCD returned, newly metamorphosed. I became acutely paranoid, compelled to ask every classmate if they were talking about me — which pretty soon they were, because I was demonstrably mental. Two years after I left that school, a boy sent me a mocking Facebook message, telling me he’d heard someone talking about me on the bus. I deleted the message. Then deactivated my account. And then I cried.

The third, and worst, iteration of my illness was primarily obsessional OCD, which bloomed like mold when I was twenty. My anxiety zeroed in on the Internet. I scoured Facebook for entire days, searching for half-remembered status updates that inexplicably made my brain itch. I messaged classmates I barely knew when we took math together, let alone six years later, and begged them to delete photos where I appeared only as a dim shape in the background. I lost friends because I couldn’t explain why I needed an ancient wall post gone — not to them or to myself. I felt as though something else was steering the ship; as though every day I woke up to a mind that was less and less my own.

I feared, too, that I was a bad person, who might have hurt people like childhood bullies had once hurt me. I agonized over things I’d said, and how they could have been interpreted. On the worst days, I tortured myself over things I’d never said at all.

On one metro journey into the center of town, a teenage girl sat down opposite me, and I noticed a small pink pimple bubbling on her right cheek, almost exactly mirroring the one on my left. The train pulled away from the station, but I felt another engine rumble into action. Imagine if you pointed it out, said my brain. Imagine if you laughed at her. Imagine if you called her ugly. Imagine if you stood up, and pointed at her, and called her ugly, and shouted it over and over and over until she cried. The topic exhausted, the train veered onto another track. What if you did call her ugly, and you’ve just forgotten? said my brain, thunderous even as I turned up the volume of my headphones, knowing already that it wouldn’t work. Are you sure you didn’t say anything? She looks sad. Are you sure you didn’t call her ugly? I got off the train three stops early and hyperventilated on the platform, pressing my hands into my temples as if to squeeze out the thoughts.

Obsessive thoughts calcify. Played on repeat, they settle into the crevices of the mind, occupying space reserved for memories. The worst ones become impossible to distinguish from the truth. I truly believed that I’d stood on a train and screamed at a teenage girl with a pimple. I emailed a writer I’d never met, apologizing for something I knew I’d never said. Whenever a celebrity died, I knew that it was the result of something I did or said, and I’d just forgotten how exactly I was involved.

I took a year out of university and spent it imploding. When I returned, I graduated thanks to two factors. The first was a medication and therapy combination that finally, impossibly, seemed to work. The second, the ceaseless tenacity of my mam, who took a four-hour train to Oxford every weekend just to make sure I was eating and leaving my bedroom. Shakily, I stepped onto an upward trajectory, one I still tentatively ascend today.

I can’t hate anyone for making OCD jokes, partly because it’s an unfortunate part of our lexicon — whether I like it or not — and partly because I’d have to hate most of the people I know. And I worry that I’m oversensitive, and that the twist in my gut when I hear a person described as “psycho,” or the erratic city weather as “bipolar,” is just an overreaction. I’m tired of being angry. I’ve been angry for far too long.

But still I wonder, if mental illness wasn’t so widely perceived as a joke, whether I would have taken so long to tell my parents I was faltering. Whether it would have been quite so easy for the kids at school to take the piss out of me. Or whether, after I told a doctor that I couldn’t survive in this mind any longer, he would have sent me away with a generic antidepressant prescription and a flippant comment about how long the waiting lists for therapy were. I saw him again the same week, in the hospital, after swallowing every pill he had prescribed for me.

The paramedics who put me in an ambulance left a plastic thermometer cap in my university bedroom. I kept it there for weeks. Whenever the obsessive thoughts threatened to overwhelm me again, I touched it, and tried to remind myself that this was an illness. That medical professionals had been here, in my room. That the doctors and the medication were the truth, and the clamoring in my head was not. To me, one of the cruelest tricks of mental illness is its ability to convince the sufferer that it isn’t there at all.

Read the full essay on The Big Roundtable.

Watching others wash their hands may relieve OCD symptoms

Hands being washed under a running tap
Doesn’t matter who the hands belong to, as long as they’re cleaned

JGI/Jamie Grill/Getty

People with obsessive-compulsive disorder (OCD) may get relief simply from watching someone else perform their compulsive actions. If the finding holds up, we may be able to develop apps that help people with OCD stop needing to repeatedly wash their hands or pull their hair.

When we watch someone else perform an action, the same parts of our brains become active as when we do the action ourselves. This is called the mirror neuron system, and it is thought to help us understand the actions and feelings of others.

Baland Jalal at the University of Cambridge wondered whether this system could be used to help people with OCD. Working with his colleague Vilayanur Ramachandran, at the University of California, San Diego, he studied 10 people with OCD symptoms, who experience disgust when touching things they consider even mildly contaminated. The anxiety this causes forces them to wash their hands compulsively.

Touch and go

First, Jalal and Ramachandran showed each participant something to make them feel disgusted – either an open bag of vomit, a bowl containing blood-soaked bandages or a bedpan of faeces and toilet paper. The participants were unaware that each stimulus was in fact fake.

In a variety of conditions, either the participant or a researcher touched the bag, bowl or bedpan for 15 seconds while wearing latex gloves. The participants were then asked to rate how disgusted they felt, before being allowed to wash their hands, or watch the researcher do the same. They then rated how relieved they now felt.

All 10 people with OCD felt strong disgust after watching other people touch the faked objects. But they experienced significant relief just by watching a researchers’ handwashing – even if they themselves had been the one to touch the object.

“To our surprise, subjects would dictate how the experimenter’s cleansing ritual should be performed,” says Jalal. “They would say things like, ‘wash more on this side’, or ‘pour more water between these fingers’.”

Virtual treatment

Jalal says the results are very preliminary, and should be interpreted cautiously given the small size of the study. But if the finding is confirmed in larger placebo-controlled trials, he thinks this kind of “vicarious exposure” could lead to new therapies for people who have OCD.

“Watching a video of someone washing their hands might be enough to reduce the urge to perform the action in real life,” he says. “We could put these videos into an app.”

Exposure therapy is a popular treatment for OCD, and involves people experiencing their obsessive trigger without being allowed to perform the compulsion that makes them feel better. Jalal says that an app may make it possible to do this kind of treatment virtually, rather than with a therapist in a clinic, making it easier and accessible to more people.

At the very least, such an app could be a less harmful substitute for individuals who have compulsions that are bad for their health, he says: “For instance, we might be able to give people who pull their hair out obsessively relief from their urge by watching a video of themselves doing it instead. It might at least act as a kind of benign substitute that’s used alongside more conventional treatments.”​ The trial needs to involve at least 50 people with OCD and a credible control treatment to really test the efficacy of this idea, says Jon Abramowitz, a clinical psychologist at the University of North Carolina at Chapel Hill. “Conceptually, my guess would be that such an intervention might be helpful for some people, but not for others,” he says. “OCD is very heterogeneous and people would likely respond differently to this.”

Jalal says that not all people seem to respond to the vicarious relief equally and he wants to find out more. He has now begun two larger trials at Harvard and Cambridge. “One of the trials has finished and the results are really promising,” he says.

Journal reference: Neurocase, DOI: 10.1080/13554794.2017.1279638

Read more: Brain’s inability to see that something is safe causes OCD

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How to ease the suffering of anxiety

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Anxiety comes in many forms and diagnoses, and it is the No. 1 mental health diagnosis in the world. Medicine and psychology, however, have found both separate and combined ways to relieve the suffering of anxiety.

Medications are an important first step in treating certain forms of anxiety.

Benzodiazepines (Xanax and Klonopin) can provide relief of certain anxiety symptoms. They can also be used on an as-needed basis. They are useful for a person who has an extreme fear of social situations. Alternative forms of psychological treatment include cognitive behavior therapy and exposure therapy. Often, the most effective form of treatment is a combination of drugs and psychological treatment.

Some prescribing guidelines caution about the use of benzodiazepines for PTSD and panic disorder, and in the long-term treatment (greater than 4 weeks) of a generalized anxiety disorder.

Selective serotonin reuptake inhibitors (SSRI) and serotonin and noradrenaline reuptake inhibitors (SNRI) are considered the first line of treatment for a generalized anxiety disorder. Usual starting doses are lower than those used for the treatment of depression. Psychological help (therapy, CBT, exercise, relaxation and mindfulness therapy) are also very helpful tools.

Those individuals with an obsessive-compulsive disorder (OCD) are very pleased when they are prescribed an SSRI (or clomipramine as a first-line treatment.) They are glad when their ‘loud’ obsessive thoughts are quieted. Some have related the experience to the taking of morphine during a prior medical procedure.

Combined drug and psychological treatment can make the treatment of OCD even more effective. OCD is a disorder that often waxes and wanes, bringing some relief with time.

Guidelines suggest that body dysmorphic disorder first be addressed with CBT; an SSRI and buspirone may be added.

In the past, I have found that certain patients had a significant thinking/reasoning disorder with their intense anxiety. Both aspects were reduced by a medical prescription of an anti-psychotic. My addition of CBT, and relaxation and breathing techniques added to the efficacy of the prescribed medications.

Medication has been found to be helpful in more rare forms of anxiety, such as excoriation (skin-picking disorder) and trichotillomania (hair-pulling.) Research studies have found that the antioxidant, N-acetylcysteine, has been helpful in bringing relief.

Panic disorder is a frightening experience for the individual who suffers from it. Short-term use of a benzodiazepine can have a rapid effect of relief, but the panic symptoms return once the drug is withdrawn. A long-term effective treatment plan for panic disorder includes an SSRI, CBT and self-help anxiety techniques. Some guidelines question the consistent helpfulness of combined medical and psychological treatments, but a patient in a panic state would welcome all forms of treatment that could bring relief. Research studies have suggested that the length of treatment may be from 8 months to 3 years.

Not all relief of anxiety comes from a mental health professional. It can come from a religious advisor. There are also many self-help books on the market that can bring relief from mental suffering, such as anxiety and sadness. I highly recommend The Little Book of Inner Peace, by Ashley Davis Bush. It contains many techniques to relieve stress and attain an inner sense of peace.

Finally, the 10th edition of Your Perfect Right, by Alberti and Emmons, can help those shy individuals with social anxiety become more assertive. The two books are inexpensive and available on Amazon.

Philip Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a post-doctoral degree in clinical psychopharmacology (the use of drugs to treat mental disorders.) His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

Stigma still exists about anxiety disorders

I urge employers to show patience and kindness toward those with anxiety disorders. I have obsessive-compulsive disorder. Obsessions are intrusive thoughts, images or feelings. Compulsions are used to get rid of the obsessions.

It drove me mad as I tried to reach perfection in the workplace. Employers have fired me in two days because I didn’t catch on quickly enough. I became so focused on performing a task perfectly, it slowed me down. I could feel the tension in the managers’ voices as they became impatient and frustrated.

More than anything, I wanted to please my managers and customers. I wished they understood how hard I was trying, how much I strived to succeed.

A stigma still exists toward anxiety disorders. They are not always visible to the eye. It’s a build-up of emotions, a constant fear of waiting for something to go wrong every day. Anxiety is the voice in your head saying that’s not good enough, but it doesn’t have an off button.

Here’s the thing: It is embarrassing to say you have a disorder. I feared if I told my employer, it would be seen as an excuse. So I kept my mouth shut to be fired two days later.

The stigma needs to end. Those with anxiety are often the most conscientious, detail-oriented people I have met. Albert Einstein, Howie Mandel and Charles Darwin all had or have OCD.

Look what they accomplished. Einstein gave us the theory of relativity, Mandel is on TV and Darwin gave us the theory of evolution.

So, employers, please be patient with us. If you give us a chance and forgo the initial judgment, we have the potential to be the Einstein, Mandel or Darwin of your company.

Cheyenne Keith

Indiana

Maternal Instinct, or OCD?

No one knows exactly what causes these communication errors — studies suggest that brain chemistry and genetics play a role — but psychiatrists do know how to treat them. Many people with O.C.D. do not get treated for it, but for those who do, medication and cognitive behavioral therapy can benefit about 70 percent. My psychiatrist prescribed both.

In therapy, I learned how to separate myself from my obsessions, ignore my compulsions and refocus my attention elsewhere. I did exposure therapy, sitting amid the soap scum in a bathtub and trying not to hyperventilate. Slowly my anxiety subsided. I still preferred a tidy bathroom, but I no longer panicked at the sight of a few hairs on the floor tile. I began to think of O.C.D. as a problem I’d solved.

Fifteen years later, I had a baby.

I spent the first few weeks after my son’s birth washing my hands over and over. (What new parent doesn’t?) I developed elaborate rituals for wiping the sink. (Who knew what germs were left over from last night’s chicken?) My mind hummed with a tinnitus of dread. (What parent isn’t nervous?)

“Things are fine,” my husband told me. “Try to relax.”

“I can’t relax. Every second I’m thinking: ‘Where is the baby? What’s the baby doing? Is he breathing? Is he O.K.?’”

“Well, that’s good. That’s what all new moms think.”

Research backs him up. Studies show that most new parents — mothers especially — can’t go more than a minute or two without thinking about their newborns.

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In research by Nichole Fairbrother, a clinical psychologist and assistant professor in the University of British Columbia department of psychiatry, all new mothers had intrusive thoughts of accidental harm befalling their infant — a symptom commonly associated with O.C.D.

“I think there has to be an evolutionary component,” Dr. Fairbrother said. “We can see how the accidental thoughts are protective: What if I trip down the stairs? What if I get too close to the balcony? They impel us to behave in a very cautious way.”

Dr. James Leckman, a professor of child psychiatry, psychology and pediatrics at Yale who studies postpartum O.C.D., said he has experienced these thoughts firsthand.

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“When we were expecting our first child, my wife and I changed,” he recalled. “We became much more focused on making sure everything was perfect and just right. I needed to wash under the refrigerator in our apartment. I needed to check and repaint the room.”

He added: “I often tell my friends and colleagues when they’re expecting a child, they may not be prepared for the transformative experience and the level of preoccupation that is typically associated with parenting.”

This preoccupation can feel a lot like mental illness to even the healthiest parents: a maddening blend of near-constant anxiety, sleep deprivation and stress. So where is the line between normal parental instinct — that natural drive to keep our children safe — and true mental disorder?

“We can administer diagnostic interviews and determine if the symptom causes significant distress or impairment in functioning,” Dr. Fairbrother said.

But what newborn doesn’t impair functioning? How do I make sense of my compulsions, now that they come dressed as maternal instinct?

“If you look for reassurance and you get it, that feeds into the symptoms,” Dr. Leckman said. “On the other hand, it makes sense to ensure your baby’s O.K.”

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Dr. Leckman said that parents who are overwhelmed by preoccupations generally don’t talk to their babies as much as other parents do. They don’t respond to their child’s subtle cues. They may even avoid contact with their children to save themselves the discomfort of anxiety and intrusive thoughts.

It seems contradictory that such concerned parents might be worse parents, but it’s true. I think of all the times I’ve taken my eyes off the road to check on my child in the back seat. All the times I greeted my son with stony silence because I was lost in a fog of my own anxiety. My obsession with safety isn’t helping me keep him safe — it’s becoming a dangerous distraction.

For me, it turns out that motherhood is just a continuing education course in my mental illness. What I thought I’d conquered has come back in an altered form. If I want to be a good parent, I must find a better balance. I must be attentive to the risks, but also present for my son. I must face my fears and resume exposure therapy. This time, though, I’m not exposing myself to a grimy bathroom. I’m exposing myself to the world.

Now when I’m reminded of all the horrible things that could happen to my son — the accidents, the illnesses, the hot cars — I no longer push my feelings away. I sit with the dread, feel my adrenaline rise, try to welcome this newfound appreciation that I am not in control.

It’s excruciating, but it helps me keep my eyes on the road. It’s getting easier over time. And when I’ve reached my destination and am gathering my things to leave, I allow myself one quick glance in the rearview mirror to check the back seat. Just once. Just to be sure.

Kelly Kautz, a writer based in Lancaster, Pa., is working on a memoir.


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Kids face fears at camp

UF Health hosted Fear Facers Day Camp to allow kids aged 6 to 14 to challenge their anxieties in a fun, safe environment.

It was hot and bright as 11 children gathered into three groups at the Veterans Memorial Park. One brave soul in each group placed a small plastic colander on his or her head.

The rest of the kids started throwing eggs at the colander. Some eggs broke on the ground, while some cracked on their target. 

Yellow yolks oozed through the colanders and onto kids’ hair and scalps. They smelled as raw eggs do, their odor not benefiting from Wednesday’s summer heat. Then, it was the other kids’ turn. 

Fear Facers Day Camp is not your traditional day camp. This weeklong camp put 6- to 14-year-olds in uncomfortable, but safe, situations.

Situations like having yolk drip down your hair.

“I hear that’s a natural conditioner,” one camp counselor joked as eggs splattered on the grass.

The camp, hosted by UF Health, brought together kids with anxieties and anxiety disorders and pushed the boundaries of their comfort zones.

“It can be really hard to face a fear, in particular in isolation,” said Dr. Carol Mathews, a psychiatrist at UF Health who started the camp this year.

One 12-year-old, Nicholas Ladwig, was diagnosed with obsessive-compulsive disorder five years ago. His obsessions focus on the safety of himself and his family members, and he compulsively picks at his skin.

“He’s been for years dying to meet another kid with OCD,” said Crystal Ladwig, his mother, who homeschools both her sons and is an adjunct professor at Saint Leo University.

At the camp, Nicholas and his camp-mates do exposures, or, as Nicholas explained, “You, like, do something that the OCD doesn’t want you to.”

Although exposures to children’s fears initially heighten their anxiety, camp counselors do activities to allow the students to face their fears in a safe place, where they’re not alone.

“I relate to them, and we can go through it together,” Nicholas said. 

The camp screens participants to ensure they have anxieties that can be helped by the camp, Mathews said. The camp costs $200, not including therapy costs, which can be billed to insurers. Mathews said she’s looking for funding to allow those with fewer financial resources to attend. 

UF psychology graduate students volunteer as therapists for the participants, who get individual or group therapy sessions in the morning. Activities that include exposures, like the egg toss, or that give some relief, like a water balloon toss, happen in the afternoon.

The therapists recommend exposures for the participants, and camp counselors, who are UF undergraduate students interested in psychology and psychiatry, help the kids carry out the exposures.

The egg toss pushed kids with contamination-based fears. (They were able to wash their hands after picking up egg shells off the grass.)

One day, participants played baseball with a ball that was smothered in maple syrup and hair gel. Each time the ball whacked against a bat, goop plopped on the ground.

And one day, UF’s entomology department brought a bug zoo, complete with tarantulas and hissing cockroaches. Nicholas enjoyed that activity, Ladwig said.

Wednesday, a girl carried a rubber snake with her throughout the afternoon, spinning with it during a break.

“I don’t think I could do that,” Ladwig said, seeing the girl rest the snake across her neck.

“I think you could,” said Robyn Nelson, the camp’s assistant administrator.

Nelson, who works fulltime as a UF psychiatry research coordinator, came up with games to mimic camp games appealing to all ages but with an anxiety-inducing twist. She cheers on the students as they challenge their anxieties. During the water balloon toss, she suggested everyone take off their shoes, partly so their shoes wouldn’t get wet, and partly because one participant is usually uncomfortable having his bare feet touch the ground.

But she doesn’t leave the kids hanging. She took off her shoes, too, and got wet from water balloons.

“It gives me a sense of satisfaction seeing the kids face their fears because I know it’ll help them down the road,” Nelson said. 

“Each one has their own struggle,” she added.

Her 9-year-old daughter, Elizabeth, gets nervous speaking in public. One of her exposures was playing “Watch Ya’ Mouth,” a game that comes with plastic contraptions to keep one’s lips wide open while saying various phrases, and others have to guess what’s said.

She kept the plastic in her mouth during a break, where the students grabbed snacks and played inside.

The camp, she said, is “really fun,” she said. “It’s cool.”

Earlier, her therapists recommended she purposefully trip and fall in front of other camp participants. Three others tripped and fell with her before she did it on her own.

“It was OK,” she said.

Nicholas was in public school before he was homeschooled. Ladwig said he would come home exhausted from trying to hide his anxiety from others.

But at the camp, kids were together in tackling their anxieties, and there was no reason to hide.

“It feels so good,” Nicholas said. “Lots of times no one understands.”

Anxiety comes in many forms for 40 million Americans

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If one looks closely, one can find anxiety everywhere.

Anxiety is the number one diagnosed mental health condition in the world. In our country, the government tells us that there are 40 million Americans (18 percent), who are diagnosed with an anxiety condition.

Before psychology and medicine took over the domain of anxiety, philosophers wrote of anxiety and worry in different ways: “dread” (Kierkegaard), “angst” (Heidegger), and “nausea” and “anguish” (Sartre.)

Today, anxiety comes in many different psychiatric diagnoses because it mimics and reflects so much of our daily possible human existence. Anxiety can be found throughout the human life-span.

The very young child can have a “separation anxiety disorder,” where intense, developmentally inappropriate anxiety comes from being apart from those adults to whom the child is most attached.

“Selective mutism” is seen in children who refuse to speak in social or educational settings that arouse anxiety, often around achievement issues.

Children and adults can exhibit anxiety in the form of “specific phobias,” where there is marked fear of a specific object or situation. Objects can be animals (spiders, snakes, dogs), the natural environment (heights and storms), medical procedures (needles), situations and places (airplanes, shopping malls) or other things (clowns, costumes.) Many phobias begin in early childhood.

Some exhibit a “social anxiety disorder”, which involves a marked fear about social situations, especially if one feels that he or she will be exposed to possible scrutiny. This disorder is so severe that individuals may wait 10 years or more before seeking help.

Perhaps, no anxiety disorder is more upsetting than a “panic disorder”, which is often accompanied by intense physical symptoms (heart palpitations, feelings of choking or being smothered, shortness of breath, a fear of dying and many others.) Unfortunately, panic disorders are often found in individuals with a major depression.

“Agoraphobia” is the marked anxiety some feel in open spaces, while using public transportation, standing in line or being in an enclosed space (elevators.)

The reader will notice that many of the anxiety conditions, noted so far, involve the individual being isolated from others and from both the ‘business’ and the ‘pleasures’ of daily life with others.

A “generalized anxiety disorder” involves excessive, pervasive anxiety that seems to almost lack a precipitant. Difficulty with sleep, as well as fatigue, irritability, muscle tension, restlessness and difficulty concentrating. This disorder affects woman twice as much as men.

Anxiety may be induced by substance abuse, a medical condition or it may be the side effect of a prescribed medication. Endocrine, cardiovascular, respiratory and neurological disorders can induce anxiety.

Anxiety is also an important element in “obsessive compulsive disorder,” with its recurrent, persistent thoughts and repetitive compulsive behaviors. One-third of this disorder’s population begins in childhood.

Anxiety is also part of a “body dysmorphic disorder.” This anxiety disorder involves an intense preoccupation with what one considers to be flaws in their physical appearance. “Trichotillomania” (recurrent hair pulling), “excoriation disorder” (recurrent skin picking that results in lesions,) “hoarding disorder” (an inability to discard or part with possessions) and “post-traumatic stress disorder” are mental health disorders that have anxiety as an important component.

Finally, clinicians know that depression is often intertwined with anxiety, adding another aspect of suffering to this universal mental disorder.

Next week’s column will look at treatment options for anxiety.

Philip Kronk, M.S., Ph.D. is a child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a post-doctoral degree in clinical psychopharmacology. His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

Cellular roots of anxiety identified


Cellular roots of anxiety identified
Research from Washington University School of Medicine in St. Louis sheds light on what might be happening in an anxious brain. A new study has identified a group of neurons that become active when an animal is faced with the possibility of an unpleasant event. Credit: Washington University School of Medicine in St. Louis

From students stressing over exams to workers facing possible layoffs, worrying about the future is a normal and universal experience. But when people’s anticipation of bad things to come starts interfering with daily life, ordinary worry can turn into an anxiety disorder. About one in four adults will struggle with anxiety at some point in their lives, making it one of the most common mental disorders in the United States.

Now, new research from Washington University School of Medicine in St. Louis sheds light on what might be happening in an anxious brain. A new study has identified a group of neurons that become active when an animal is faced with the possibility – but not the certainty – of an unpleasant event.

The study is published July 26 in Nature Communications.

“We found a population of neurons that activated specifically when monkeys thought something bad or annoying – like a puff of air to the face – might be coming, but not when they knew for certain it was,” said Ilya Monosov, PhD, an assistant professor of neuroscience and of biomedical engineering and the study’s author. “These neurons did not activate when the animals thought they might get something good, like a sip of sweet juice. Only an uncertain bad experience activated these cells.”

The research provides opportunities for understanding the roots of anxiety and may eventually lead to new treatments for the disorder.

Monosov studied a part of the brain known as the anterior cingulate cortex, an area on the outer layer of the brain that lies deep inside the groove where the brain’s two hemispheres fold in to meet each other.

Differences in the have been found that distinguish healthy people and people with mental disorders such as anxiety, obsessive-compulsive disorder, attention deficit and depression, suggesting that the area plays a role in mental illness. However, the cells involved in these brain differences and their consequences are not well understood.

To study how the brain responds to uncertainty, Monosov turned to rhesus monkeys, which have anterior cingulate cortices similar to those of people. He trained two monkeys to recognize three geometric designs, one indicating they were about to get an annoying puff of air to the face, one that meant they had a 50-50 chance of getting an air puff, and one indicating nothing would happen.

Then, Monosov recorded the activity of individual neurons in the anterior cingulate while monkeys were shown these geometric images. When the animal knew the odds were even (50-50) that a puff of air was coming its way, a group of neurons started firing rapidly. These cells were not active when an air puff was guaranteed to happen, only when it might happen, which means the cells were not responding to the unpleasantness of the experience, but to the uncertainty of it.

Monosov also trained the monkeys to recognize geometric designs indicating the certainty or possibility of getting something good: a sip of juice. He identified an entirely different group of cells that changed their activity in response to the possibility or certainty of getting the treat. As with the air puff experiment, the neurons that responded when the animals knew they had the chance of a sip were different than the ones that responded when the juice was guaranteed.

These findings shed light on the cellular underpinnings of complex mental processes. How the responds to the possibility that something bad – or good – might happen is rooted in our .

“Now that we know which cells are active when an animal is faced with the uncertainty of a bad experience, we can try to disrupt the activity of these ,” Monosov said. “It opens up avenues of research, which may one day lead to new ways to treat such as anxiety and depression.”


Explore further:
Study identifies neural circuits involved in making risky decisions

More information:
Ilya E. Monosov. Anterior cingulate is a source of valence-specific information about value and uncertainty, Nature Communications (2017). DOI: 10.1038/s41467-017-00072-y