Mia Stephany, 13, of Westerville, works with a psychologist to tame her anxiety disorder. “You have to talk back to OCD,” she says, “but your family can’t do it for you.”
Fear and anxiety — the forces behind untold numbers of sleep-deprived nights and before-school
stomachaches — pop up occasionally along the journey through childhood and adolescence.
But for some children, the worry won’t stop. It grows into an anxiety disorder that can wreak
havoc on their home, school and social lives.
“Parents hear about autism, and they hear about ADHD a lot more. Anxiety disorders are the
things that are often overlooked, and they’re actually incredibly common,” said Amy Przeworski, a
psychologist and assistant professor at Case Western Reserve University in Cleveland.
She and psychologist Rebecca Hazen, also an assistant professor at Case Western, will speak to
families, caregivers and professionals in Columbus on Oct. 29 during the annual Children’s Mental
Health Conference sponsored by Mental Health America of Franklin County. They want to help families
learn to distinguish between typical and problem worrying. Researchers say anxiety-spectrum
disorders affect about 1 in 8 children at some point in their lives, making them the most-prevalent
mental-health disorder in children and teens.
Generalized anxiety disorder, social anxiety, separation anxiety, obsessive-compulsive disorder,
panic attacks and phobias can be present in varying degrees of severity.
“Sometimes, people don’t come in for treatment until it’s really causing problems,” Hazen said. “
When anxiety is starting to interfere with daily activities, or cause a lot of daily stress for
kids, that’s a red flag that they might need some help.”
Carrie Stephany and her 13-year-old daughter, Mia, say the signs of Mia’s obsessive-compulsive
disorder were becoming clear by the time she turned 6. For her birthday party that year, Mia
insisted on a menu of plain corn muffins and sugar-free Italian ice. She couldn’t have cake because
the thought of eating a sugary treat, even in moderation, worried her sick. “I just thought, ‘
Sugar, bad,’ ” Mia said. “Then I became afraid of the sun. I thought I’d get skin cancer.”
Obsessive worry about germs, headaches and throwing up began to plague Mia, too. She couldn’t
wash her hands enough, and her family unwittingly made matters worse by trying to reassure her.
Tending the compulsions and paying them lots of attention usually just makes them grow big — it’s
kind of like watering a thirsty plant, Stephany said.
Mia’s psychologist at Nationwide Children’s Hospital’s Child Development Center helped the
Westerville family settle on the best treatment. Mia said books, too, have made it easier to see
her obsessive-compulsive disorder as a third party she needs to ignore.
One story portrayed OCD as “OC flea,” a pesky creature that overtook animals and made them think
they had to do certain things.
“You have to talk back to OCD,” Mia said. “But your family can’t do it for you. They can be your
cheerleader on the sidelines.”
Mia has great grades, is active in extracurricular activities and has helped other children who
struggle with anxiety disorders.
Przeworski said the exact cause of an anxiety disorder might not be known, but both genetic
predisposition and experiences can be factors.
“These days, there’s so much pressure on kids to succeed,” Przeworski said. “That’s only going
to lead to an increase in anxiety diagnoses.”
What is anxiety? In her 2008 book, A Brief History of Anxiety, author Patricia Pearson describes anxiety as a fear that is “unbearably vivid, yet insanely abstract.” Simply put, anxiety is worrying about something that is yet to happen.
Remember the tight clench of your stomach before your Maths paper? The knot would ease after the exam, but resume before the next paper. By the end of the exams your anxiety would have vanished, only to reappear later at the time of the results. But as a mental disorder, anxiety never leaves.
The term that doctors use for the most common kind of anxiety disorder is called Generalised Anxiety Disorder. GAD is marked by excessive worry in several areas of life — work, relationships, finance — even when there is little cause for concern.
Then there are specific forms of anxiety. Social anxiety is the irrational fear and avoidance of social gatherings, born out of concern that others may view you negatively. Separation anxiety disorder is, as the name suggests, a fear of separation from the comfort of your home, or parents.
And then there is the anxiety that is masked by other issues like depression, Obsessive Compulsive behaviour, and Post Traumatic Stress Disorder (PTSD).
Dr Kersi Chavda, past president of the Bombay Psychiatric Society, says that more often than not, people approach a doctor only after they’ve had a panic attack — where they have anxiety so acutely that they blanked out, broke into a cold sweat or had palpitations.
When anxiety wears a mask In the case of Obsessive Compulsive Disorder, recurrent, irrational fears are assuaged to a degree when the person engages in a repetitive behaviour. PTSD develops in the wake of a terrifying event, which results in feelings of extreme helplessness, horror and fear. Anxiety is couched in the sense of numbness, dissociation and hyper-vigilance when the person re-experiences that fear. While it is easier to diagnose OCD, PTSD takes time to diagnose, because symptoms take time to show up. Meanwhile, research on this condition, which was known as shell shock during World War I, still continues. The distinction between simple and complex PTSD, for instance, was only made in the 1990s.
In these cases, anxiety is intrinsically linked to the condition, so it isn’t treated separately, but as part of a larger issue. Further, people who have been diagnosed with a chronic, life-threatening ailment are also susceptible to anxiety. Often, hospitals recommend psychiatric sessions for such patients.
“There are gradations of anxiety,” says Chavda. “There is good stress, which makes a person productive, and there is bad stress, or distress, that causes trouble. There are more than 100 neurotransmitters in the body. One develops a condition depending on which neurotransmitter is affected.”
Sunnybrook’s pioneering work in anxiety-disorder care and research is getting a $10-million boost.
The gift from Frederick Thompson, thought to be the largest-ever private donation focused on obsessive compulsive disorder (OCD), will create the Frederick W. Thompson Anxiety Disorders Centre within Sunnybrook’s Brain Sciences Program.
“This gift makes a bold statement and represents a real turning point in the research and treatment of anxiety disorders,” says Dr. Peggy Richter, director of Sunnybrook’s Clinic for OCD and Related Disorders.
“This centre will address the spectrum of anxiety disorders, and will focus on the treatment of OCD and its related conditions – and no other centre in Canada offers such specialized care for these disorders. This gift truly establishes Sunnybrook as a leader in treatment and research in this important field.”
The centre will attract international experts who will collaborate with Sunnybrook’s world-class scientists and will be an epicentre for anxiety-disorder research across Canada.
MS PATIENTS AND DEPRESSION
Can exercise improve the moods of multiple sclerosis (MS) patients who are suffering from depression?
That’s one of the questions a team of Sunnybrook researchers hopes to answer with its research into the mental well-being of these patients, thanks in part to a $263,000 grant from the Multiple Sclerosis Society of Canada.
Half of MS patients suffer from depression and half suffer from cognitive dysfunction. When a patient faces both at once, it can be difficult to manage their health, says Dr. Neil Rector, director of research in the department of psychiatry at Sunnybrook.
The grant will be used to fund a study, led by Dr. Rector and Dr. Anthony Feinstein, director of Sunnybrook’s neuropsychiatry program, examining whether non-drug treatments can improve depression and cognitive dysfunction in MS patients.
Patients will be divided into three groups: patients who only receive cognitive behavioural therapy (CBT), patients who only exercise and patients who receive a combination of both.
Because many of the patients will be taking antidepressants, the study results will also clarify the extent to which CBT and exercise can benefit MS patients.
Sunnybrook doctors have launched a study to determine whether “keeping it cool” in ambulances is best for cardiac arrest patients. Cooling a patient’s body temperature after a cardiac arrest has been shown to reduce the chances of severe brain damage and death, but the treatment is usually only provided in hospitals. Lowering the patient’s body temperature by 3 to 5 degrees Celsius slows the brain’s need for oxygen, which can reduce the patient’s chances of severe brain damage caused by lack of blood flow during cardiac arrest.
“We know we can prevent brain damage and save more lives by cooling a patient,” says Dr. Damon Scales, the trial’s principal investigator and a staff physician in Sunnybrook’s Department of Critical Care Medicine.
Since the trial launched in July, paramedics have treated a patient in the field using cooling, a first in Ontario.
Funded by the Canadian Institutes of Health Research, the trial is expected to last for two years and involve more than 1,000 patients.
MICROBUBBLES VS. TUMOURS
Sunnybrook researchers have shown they may be able to boost the tumour- destroying power of radiotherapy by using ultrasound in a new way. “This is definitely a world-first happening at Sunnybrook,” says Dr. Greg Czarnota, radiation oncologist and lead on this research.
The process involves injecting tiny microbubbles into the blood stream. Researchers found the otherwise harmless microbubbles bounce and expand when heated with focused ultrasound, straining the blood vessels of the tumour. The cancer cells become leaky and weak. When a tumour is targeted this way before radiation in pre-clinical models, the radiation destroys up to 40 per cent of the tumour within 24 hours.
The research received a $1-million boost from the Breast Cancer Society of Canada this year. “This support will allow us to scale up these treatments and move them out of the laboratory and into breast cancer patients in the next three to five years,” Dr. Czarnota says.
WHAT IS MELANOMA`S X-FACTOR?
A Sunnybrook scientist is trying to determine why women with melanoma have a better chance of recovery than men. Melanoma is an aggressive skin cancer with a poor outlook for survival once it spreads to other parts of the body. But women with melanoma, even at an advanced stage, have a far better prognosis than their male counterparts. Researchers have found no evidence female hormones contribute to this phenomenon; they believe the gender difference has a genetic basis.
Dr. Teresa Petrella, a clinician-scientist at Sunnybrook, is trying to understand the female advantage and uncover drivers of the disease. She and her colleagues will do in-depth analyses of X-chromosome genes in melanoma to identify potential new therapeutic targets to improve survival.
They say two things are certain in life: death and taxes.
A Sunnybrook study has found the two often go together; for U.S. motorists, income tax deadline day increases the risk of a fatal road crash.
Using road safety information from the National Highway Traffic Safety Administration from 1980 through 2009, Sunnybrook researcher Dr. Don Redelmeier and colleague Christopher Yarnell from the University of Toronto examined the number of fatal crashes on each tax deadline day as well as on the same weekday one week before and after.
They found the risk of being involved in a fatal crash was 6 per cent higher on income tax deadline day.
“The increased risk could be the result of stressful deadlines leading to driver distraction and human error,” says Dr. Redelmeier. “Other possibilities might be more driving, sleep deprivation, lack of attention and less tolerance toward hassles. Another contributor could be decreased law enforcement as the police, themselves, might be busy with their own tax deadlines.”
And why is this finding significant? The study’s authors say these risks could be mitigated through driver education.
BUILDING TOWARDS A BETTER BIOPSY
An easy and painless prostate cancer biopsy? Most men will say there’s no such thing – but some Sunnybrook researchers are perfecting a high-tech imaging procedure that allows them to see prostate tumours much more clearly, and in some cases detect tumours missed with past biopsies.
Dr. Masoom Haider is leading a group to advance image-guided prostate cancer detection and biopsy. With Dr. Laurent Milot and the team at Sunnybrook’s Gelato Cup Golf Early Detection Centre, prostate tumours are targeted with great precision in a needle biopsy, a procedure in which a small tissue sample is removed from the prostate gland. With the cutting-edge technique, doctors only need two to four samples – far less than the 12 or more samples that are traditionally required.
“The current paradigm of prostate cancer detection with prostate-specific antigen and biopsy does not show us where the cancer is located in the prostate,” Dr. Haider says. As a result, men endure multiple random needle biopsies. Tumours can be easily missed, prompting painful repeat biopsies.
Sunnybrook’s experts fuse a magnetic resonance image of the prostate tumour with real-time ultrasound imaging obtained during biopsy, providing a clear picture of the tumour.
And by finding tumours otherwise missed, they are saving lives by ensuring men are treated early in their disease.
Every year fire kills 400 people in Canada, and most of these deaths occur at home. A new Sunnybrook study will look at the health-care costs of house fires, including the costs of burn care, and whether automated sprinklers in homes have an impact on the health, safety and economic outcomes of house fires in Canada.
Over the next three years, researchers will look at literature and statistics on fires and their associated costs to homeowners, insurance companies, fire services and society as a whole. The research will focus on Canada, but also extend to other parts of the world.
IMAGING RESEARCH GETS $6.9 MILLION BOOST
Dr. Greg Czarnota, left, examines images as part of his research using high-intensity focused ultrasound.
Imagine checking into a hospital to have a tumour removed, being discharged that same day and back at work the next. This is the vision of scientists at Sunnybrook Research Institute (SRI), who are working on image-guided focused ultrasound surgery, a minimally invasive procedure.
That vision has just received a tremendous boost; the Federal Development Agency for Southern Ontario has invested $6.9 million into this and three other innovative imaging research projects led by SRI scientists.
The other projects include using magnetic resonance imaging to guide and monitor treatments to correct an irregular heartbeat or unclog blocked arteries; technology that reveals early whether chemotherapy has been effective in cancer patients; and a hybrid catheter that combines optical and ultrasound imaging to treat blocked coronary arteries.
The agency’s contribution, matched by 19 industry partners, will allow SRI and its academic partner, Western University, to develop and commercialize therapy and monitoring systems for cancer and heart disease.
It is anticipated the initiative will create high-value jobs and economic growth across southern Ontario.
Dear Dr. K: The term OCD is used so casually these days. How can you identify someone who truly has obsessive-compulsive disorder?
Dear Reader: There’s a little bit of what is called “psychiatric illness” in most of us. For example, at one time or another we may all feel compelled to line up our pencils or double-check that we’ve locked the door.
In contrast, a person with OCD who has the obsession that his front door is unlocked may feel the compulsion to check the lock 10 or 20 times each night. He remembers that he’s already checked it many times, and it definitely was locked. But he still worries that somehow it got unlocked since the last time he checked. It’s not rational; it’s just a mental pressure that a person with OCD must respond to.
The two defining symptoms of OCD are obsessive thoughts and compulsive rituals.
Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts. They intrude into a person’s consciousness.
Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts.
In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming. They may interfere with personal relationships, and performance at work or school.
The most effective treatment for OCD is a combination of psychotherapy and medication. Ongoing treatment may be necessary.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. They include sertraline (Zoloft) and citalopram (Celexa). Tricyclic antidepressants also may be effective, particularly clomipramine (Anafranil).
A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy (CBT) can help a person with OCD recognize the unreasonableness of fearful, obsessive thinking. The therapist sometimes teaches specialized techniques that can help extinguish the compulsions.
So OCD is a matter of degree. If your obsessive thoughts or compulsive behaviors occur repeatedly throughout the day, and interfere with life at home or at work, you’ve got a problem — and several possible solutions.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. Go to his website, www.AskDoctorK.com, to send questions and get additional information.
Early results from a trial by researchers into treating people with Obsessive Compulsive Disorder (OCD) through an online therapy program are showing positive outcomes.
The research is being conducted at Swinburne University of Technology’s Brain and Psychological Sciences Research Centre and National eTherapy Centre
OCD is an anxiety disorder that affects more than 450,000 Australians, and those with OCD can be besieged by intrusive and unwanted thoughts, images or impulses, and are compelled to perform behavioural and mental rituals.
Professor Michael Kyrios, Director, Brain and Psychological Sciences Research Centre, said researchers have found that online treatment for a range of anxiety disorders, including social anxiety and Post Traumatic Stress Disorder, can be as effective as face-to-face therapy.
Early results indicate that this trial will follow the trend and demonstrate that online therapy is an effective form of treatment for OCD.
“Obsessions and compulsions are distressing, exhausting and time consuming, and cause significant interference in the sufferer’s family and social relationships, daily routines, and their capacity to fulfil their goals in employment and education,” Professor Kyrios said.
“Initial results from the trial so far have been positive, indicating that people who have completed the treatment do as well as those who undergo face-to-face treatment.”
Participants in the trial, which is funded by a $320,000 grant from the National Health and Medical Research Council (NHMRC), have access to free online treatment including assistance in the form of email contact with a qualified therapist.
The 12-week program is delivered through Anxiety Online, an online assessment and treatment clinic run by Swinburne’s National eTherapy Centre.
“We wanted to find out who did well, who was experiencing symptom improvement and who didn’t, who dropped out because it didn’t do anything for them, who didn’t respond,” Professor Kyrios said.
“These are the questions that are tied up in this trial and will be important in helping us develop this into the future.”
Professor Kyrios said access to online therapy services can benefit not only those living in remote and regional Australia, but those living in cities who are poor or may not have adequate access to mental health services.
“OCD is actually quite prevalent in our society, however, the sad fact is that many people either don’t have access to effective mental health treatments or aren’t comfortable seeking help face to face due to the social stigma associated with mental illness, so they opt for online treatment” Professor Kyrios said.
Participants in the trial are randomly assigned to one of two groups, those undertaking a cognitive behavioural treatment program called Systematic Treatment of Obsessive Compulsive Phenomena or OCD-STOP, and those completing Progressive Relaxation Training. Irrespective of which program they are assigned, all individuals will be given the opportunity to take the alternative treatment at no cost. The trial is confidential and participants can still see their own psychologist while taking part.
Researchers are looking for more people with OCD to take part in the trial, which finishes in late 2013. If you are interested in participating go to the website and send an email
SHE’S just seduced a man 10 years her junior in Coronation Street but actress Kate Ford’s nerves on the set had nothing to do with the age gap.
Kate, 35, who plays toxic Tracy Barlow, says she was anxious about doing the intimate scenes simply because she’s out of practice kissing men other than her husband.
And if Kate isn’t careful, anxiety can plunge her into a nightmare of panic attacks and even, as she reveals today, obsessive compulsive disorder which turns life into a constant repeat of ritualised tasks and checks.
In the soap, she’s bedding cobbles hunk Ryan Connor, played by Sol Heras, 25, and she admitted: “I was quite nervous. I’ve been married for six years and not kissed anyone else. You feel out of that whole thing.”
Her life with TV director husband Jon Connerty, the father of her four-year-old son Otis, has changed her outlook and reduced her tendency towards panic attacks.
“A few years back Tracy seduced David Platt, but at that stage in my life I was dating. I’d only just met Jon,” she said. “So I was kind of into that whole thing of going out and snogging people. The age difference made it slightly embarrassing too – I’m in cougar territory now!”
Not that Kate is against age-gap relationships. “I had a younger boyfriend once,” she said. “I was 28 and he was 21. It lasted six months but it was more of a fling.
“My grandad was younger than my gran. He lied about his age after writing to her when he was in the Army at 19 and he said he was six years older because he wanted gran to take him seriously.
“He even persuaded friends to throw a 25th birthday party when he was 19. They had a cake and everything. He didn’t tell her his age until after they married. She was furious. They’ve passed away but they were happily married for 60 years.”
Kate and Jon live in south London and juggle work with looking after Otis. Yet, as happy as they are, Kate is honest about the impact of a child on a relationship.
“It doesn’t make it easier, if anything it makes it harder,” she said candidly. “We row a lot more now. We bickered every day until Otis reached two, because we were so tired. We never used to argue in quite the same way.
“I don’t think children necessarily bring couples closer. People imagine that will happen but most divorces are in the first two years of a child’s life.
“I think you have to really work at things once you have a child but then it does give you a different dimension to your relationship, because you’ve got so many more shared experiences.”
Otis started school last month and Kate took two weeks off to settle him. There are no immediate plans for child No2.
“I think I’d like another one, maybe in a year or two,” she said cautiously. “At first Jon was like, ‘Oh, I think we’ll just stick to one,’ because children are quite tiring – you don’t realise until you’ve got one. But then the other day he said maybe he would like another.”
Kate divides her time between London and Manchester’s Coronation Street studio. She is a devoted mum but admits she has always been a worrier.
In the past, she has talked openly about her experiences with anxiety and panic attacks, but now she reveals she also suffers from OCD.
“In my 20s I did have really bad OCD,” she said. “I’d check things continually. I could check the oven 20 times before going to bed and all the sockets had to be turned off. It’s like your brain gets stuck in a loop. I do still have a bit of OCD.
“When I’m in Manchester, I do this thing on the phone with Jon every single night, where I go through a checklist of things he needs to do before he goes to bed.
“I say, ‘Have you checked the oven’s off? Have you checked you’ve locked the back door? Is the car locked? Is the intercom on to hear Otis? Is the alarm on?’
“I do it every night – I’ve never missed. I have to do it. One time I couldn’t get in touch with him and I couldn’t get to sleep.
“Jon indulges me in it. He probably hates it and I don’t know whether he’s really checked or not, but he says yes.”
Now Kate tries to keep her anxiety under control with a healthy diet and lots of sleep. “Now when I check things just once, I feel I’ve done really well,” she said.
“If you’re tired, you’re more prone to it. I’ve had problems with anxiety and panic attacks in the past and if I’m not looking after myself, not getting enough exercise, eating the wrong things and drinking too much, I’m worse.
“So I’m trying to swim two or three times a week and I don’t eat junk food. I’ve never eaten a McDonald’s in my life.”
Cheerful, self-deprecating, funny and open, Kate has little in common with her scheming alter-ego Tracy Barlow.
She had a happy childhood, growing up in Salford, Manchester, and then the Lake District before moving to London to study at the Webber Douglas Academy of Dramatic Art.
She joined Coronation Street in 2002 and left five years later to pursue other roles. Tracy was written out – jailed for the murder of boyfriend Charlie Stubbs. She returned in 2010, freed after a miscarriage of justice, and has been causing trouble since.
Even her fling with toyboy Ryan is partly motivated by a wicked desire to annoy his mum Michelle Connor, who is now dating Tracy’s ex-husband Steve McDonald.
“Ryan put the idea in her head when he started flirting with her,” Kate said.
“Then she saw his mum Michelle in the doorway and realised that he was doing it to get at her.
“So then she thinks it’s a really good idea,” Kate laughed. “She throws herself at him actually! I don’t mean to be blunt but she’s liking the sex.
“For him it’s more of a relationship but for her it’s a bit of fun – she really fancies him and enjoys getting at Michelle.”
To add to Michelle’s horror, Tracy announces this week she is pregnant. Ryan, not surprisingly, is shellshocked, while Michelle is convinced Tracy has only done it to spite her and Steve.
Later Tracy takes great pleasure in announcing in the pub that she is going to be the mum of Michelle’s grandchild. Not surprisingly, with such great plots, Kate is happy to stay on the cobbles.
“Definitely for the next few years, if they’ll have me,” she said. “I used to get itchy feet, but my priorities have changed. I love Coronation Street. I need to make money for my family and I know which side my bread is buttered.”
Dear Doctor K: The term OCD is used so casually these days. How can you identify someone who truly has obsessive-compulsive disorder?
Dear Reader: The two defining symptoms of OCD are obsessive thoughts and compulsive rituals.
Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts. They intrude into a person’s consciousness. Here are some common ones: fear of contamination; fears related to accidents or acts of violence; and fears concerning disorder or asymmetry.
Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts. Examples include repeated washing or bathing; refusal to shake hands or touch doorknobs; repeated checking of locks or stoves; compulsive counting of objects; over-organizing work or household items; and repeating specific words or prayers.
In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming. They may interfere with personal relationships, and performance at work or school.
The most effective treatment for OCD is a combination of psychotherapy and medication. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. They include sertraline (Zoloft) and citalopram (Celexa). Tricyclic antidepressants also may be effective, particularly clomipramine (Anafranil).
A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy (CBT) can help a person with OCD recognize the unreasonableness of fearful, obsessive thinking. The therapist sometimes teaches specialized techniques that can help extinguish the compulsions.
So OCD is a matter of degree. If your obsessive thoughts or compulsive behaviors occur throughout the day, and interfere with life at home or at work, you’ve got a problem – and several possible solutions.
Write Dr. K at www.AskDoctorK.com or c/o Universal Uclick, 1130 Walnut, Kansas City, MO 64106
As a child, Larry Sargent remembers biting his nails until they bled.
“It wasn’t just the nails. Sometimes it would be the skin,” says Sargent. “I think it was likely a reaction to stress. There was a release because it took your mind away from what your problems were.”
Biting your nails isn’t just a bad habit. It’s now being reclassified as a full-blown psychiatric disorder.
A proposed move by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) is expected to include nail-biting as a form of obsessive compulsive disorder (OCD) when it is revised for 2013.
Nail-biting joins hair pulling and other pathological grooming habits in the OCD classification. Previously, the DSM put nail-biting in the “not otherwise classified” section of disorders.
The manual is considered the bible of the trade, a classification of mental disorders used by mental health professionals that contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. health-care system.
“I think when it becomes problematic, it takes so much time that it takes away from and starts to impact your life,” says Sargent, who is a volunteer for Obsessive Compulsive Anonymous, a Toronto based self-help group that meets at the Centre For Addiction and Mental Health once a week.
Sargent says he eventually outgrew nail-biting, but that led to other compulsions, including constant ritualistic checking and eventually hoarding.
OCD is one of the top 10 mental disorders globally. Traits of OCD include common compulsions such as washing, checking, repeating words, hoards, tapping or touching. Obsessions might include superstitious or magical thinking, contamination fears, a worry about throwing things away or thoughts of doing harm to oneself or others, according to the Ontario Obsessive Compulsive Disorder Network.
“There is a wide spectrum from an occasional nail-bite to something that can be considered an illness,” says Debbie Sookman, director of the Obsessive Compulsive Disorder Clinic at McGill University Health Centre. “You have to look at among other things, how much of a compulsion it is, how much time in the day it takes away from that individual, and the impact on health.”
In general, if the compulsion takes more than an hour out of the day or “causes significant distress,” then it is considered more serious. Sookman says the DSM is the “gold standard” for classifying illness.
Psychiatrists have over the years been building a case for nail biting, also known as onychophagia, as a genuine disorder.
In a 2009 study by the departments of psychiatry and dermatology at Wroclaw Medical University in Poland, the authors concluded that “nail-biting is an under-recognized problem.”
Nail-biters were frequently referred to dermatologists, but the authors said in severe cases they should be referred to psychiatrists.
“Psychiatric evaluation of co-occurring psychopathological symptoms in these patients, especially those with chronic, severe or complicated onychophagia may be helpful in making a choice of individual therapy.”
Habitual nail-biting is a common behaviour of children and young adults and normally diminishes by the age of 18, according to the study. It has been associated with high anxiety and low self-esteem.
One patient evaluated in the study had “destroyed” both her thumb nails from biting.
Her symptoms were alleviated with drug treatment and painting her nails with lacquer. She also put false nails over her own nails as a deterrent.
Sookman says a variety of treatment options, ranging from the pharmaceutical to psychological, are possible.
One issue she says is getting accurate diagnosis and access to best practices treatment for patients across Canada.
“This is a very specialized field and the sooner patients get treatment, the better the results.”
He was happy to just be back on the court after the swell of national media attention sparked by his request to the team.
“Trying to get back in the swing of things,” White said. “It went as good as it could go.”
Houston held its first week of practice in McAllen, home of its developmental league affiliate. The Rockets were back at the Toyota Center on Monday, and coach Kevin McHale said White was noticeably behind in his conditioning and his familiarity with Houston’s plays.
“He’s got to catch up on what we’re doing,” McHale said. “It’s always hard when you’re a young guy and you miss early camp practice, when you’re trying to establish your principles and what you’re doing. But he’ll be fine.”
White’s off-the-court issues were no secret. NBA teams still wanted to talk to him after his one spectacular season at Iowa State. White was the only Division I player to lead his team in scoring (13.4 points per game), rebounds (9.3 per game), assists (five per game), steals (1.2 per game) and blocks (0.9 per game) and led the Cyclones to their first NCAA tournament appearance in seven years.
The Rockets decided he was too good to pass up. And over the summer, White flew with the team to Las Vegas and to the rookie orientation in New York City, suggesting that he had a handle on his aerophobia.
As training camp approached, though, White felt apprehensive about starting his first NBA season without a plan to cope with his disorder. He contacted the Rockets through his agent and the two sides negotiated their arrangement.
“I’m excited,” White said. “It’s a different plan than I’ve ever had going into a season. I’m happy that the Rockets are willing to work with me, and I’m excited to see what I can do under new circumstances.”
McHale, who played 13 seasons in a Hall of Fame career with the Boston Celtics, acknowledged concern for how White was going to navigate through the travel demands of the league schedule.
“Royce is going to have a little bit of a different path in the NBA,” McHale said. “If your choice is to have a 10-hour bus ride, or an hour flight, everyone would want to take an hour flight. He’s just going to have to work his way through all that stuff.
“We’re here to help him and support him as much as we can,” McHale said, “but he eventually has to be responsible to your team and your teammates. That’s the biggest thing.”
On Monday, White easily answered questions in front of a throng of media. If anything, White said going public with his personal struggle has been cathartic.
“In a lot of areas, we’re actors,” White said with a smile. “The camera doesn’t frighten me. Planes do.”
He hopes the attention his situation has generated creates more awareness for mental-health issues and treatment.
“It helps for me, just to be honest,” he said. “One of the things that comes with anxiety is trying to hide from what you’re scared of and oftentimes, that is the spotlight. Being honest and having good feedback obviously helps me out.”
His teammates seemed happy to have White back, greeting him with high-fives and encouragement when practice began. If White can blossom, the Rockets think he can provide a strong — and much-needed — inside presence.
“He has a unique skill set,” point guard Jeremy Lin said. “We don’t really have anybody who can do what he can do. More importantly, we’re thankful that he’s healthy and with the team. He learned a lot today. He didn’t look like he missed too much.”
White seems willing to do whatever is necessary to get up to speed on the court.
“I just stay goal-oriented,” White said. “I want to be a good teammate, and I want to be a part of this organization. I have other goals and aspirations and I just stick to those, focus on those. I’m just ready to do whatever they ask me to do.”
Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Royce White will rejoin the Houston Rockets for practice on Monday in Houston. White and the Rockets have agreed on a deal that will allow him to travel by bus for a huge part of the season to manage his mental illness.
White has suffered from an anxiety disorder as well as panic attacks and obsessive compulsive tendencies for years. He has spoken out about mental health and wants to raise awareness for kids who have it. He doesn’t want to hide from the truth and has been very honest with the Rockets organization and their fans from day one.
Royce will supply the bus that he will ride in for much of the season. He said he wants to make the bus his home away from home to feel comfortable traveling and so that he can focus on the task at hand. He will have to travel overnight on most days but said that its’ “no problem at all.”
“We’ll go forward in a good faith deal between me and Rockets, and I’m totally comfortable with that. We can find a way to get it into writing at some point. We do have a letter between us. It’s an agreement, not in contract form, but those are technicalities.”
“What the Rockets are doing is astronomically appreciated by me and should be by the mental health community.”
“One of the things that I know is this is my responsibility. I had a letdown. In my defense, these things are unprecedented. To travel by way of bus or doing some of the things I did at Iowa State to head off anxiety, it was indicated to me through the draft process, sometimes in a joking way, that most teams wouldn’t allow that.”
“My health is actually great right now. I want to keep it that way. The unknown of the season or the schedule can decrease that health. We don’t need something negative to happen. A lot of guys don’t have a stance to attack mental illness on the front end. Some don’t know they have it until something happens. The negative consequences can come. It’s just too risky.”
“It was at that point the decision was made, I just have to ask,” White said. “That’s why you see Tweets that I had to stop hiding. It’s one thing to talk about my situation. It is another to ask for what I need.”
“I don’t want to make excuses, but it has shown itself a number of times that the perception of mental illness is not friendly. You see it now with people saying ‘he gets special privileges,’ like this is something I’m doing for myself. It’s a disability. Its disability qualified. You’re starting the race behind.”
“I just reached the point I said, ‘The hell with it. I have to ask.”
It’s good to see that White and the Rockets are working together with this difficult situation. The illness that White has is very serious and should always be taken seriously. It’s something that he has to work through and manage on his own. The Rockets standing by him speaks volumes of how great they are with their players. Many teams passed on White specifically to avoid situations like this. The Rockets knew that White was too talented to pass on and have embraced who he is as a person. White now has all the tools he needs to succeed.
Stacey Kuhl Wochner, LCSW, of the OCD Center of Los Angeles discusses resistance and certainty-seeking in OCD and related anxiety based conditions. Part one of a two-part series.
Resisting our unwanted thoughts, feelings, and sensations is a futile task that is doomed to fail.
When treating clients with Obsessive-Compulsive Disorder (OCD) and other anxiety based conditions, two of the most important topics we discuss are “resistance” and “certainty-seeking”. People suffering with these conditions often have unpleasant and unwanted thoughts, feelings, and bodily sensations, and resistance to these experiences is a normal, natural reaction. Simply put, when faced with something uncomfortable or painful, we humans instinctively resist it, and quickly look for ways to reduce our discomfort through avoidance. But unfortunately, while resistance may internally feel like the correct response to our uncomfortable thoughts, feelings and sensations, it actually serves to inflame them.
For most people, it seems counterintuitive to reduce resistance and allow uncertainty to remain in the face of these uncomfortable internal experiences. Many are likely to think something along the lines of “I must find a way to keep this thought, feeling, or bodily sensation from happening again.” But this philosophy of resistance in regards to our unwanted internal experiences will actually cause them to become more powerful. As illogical as it may seem, oftentimes the best solution is to lower our resistance, surrender, and accept what is being offered.
If you encountered a mountain lion while on a hike, what would you do? Your natural, instinctual inclination would be to respond to the message that your body is sending you. Your sympathetic nervous system would respond and your body would begin to release hormones including adrenaline, to prepare you to perform optimally if you need to fight or flee. You would experience physiological reactions such as shortness of breath, rapid heart rate and trembling associated with these changes. Every cell in your body would be screaming for you to turn and run to safety.
But responding to these physiological messages could actually get you killed. The Mountain Lion Foundation of California explains that you should make direct eye contact with the animal, stand up as tall as you can, wave your arms, speak slowly and firmly, and throw rocks or branches at it. Under no circumstances should you turn your back to it and run or crouch down. If you become panicked and respond with fear, it will trigger the animal’s natural instinct to chase you. You will become prey and the mountain lion the predator.
In order to make the decision to respond in a different and more effective way than your body is telling you to, you must use meta-cognition. The simplest definition of meta-cognition is “thinking about thinking.” We have thoughts, and we have thoughts about our thoughts. Meta-cognition is the process that is at work when we are using Mindfulness Based Cognitive Behavioral Therapy. It allows you to notice the space that exists between receiving information (“OMG, there is a mountain lion!”) and responding to that information (“Do I want to listen my body and run, or should I stand my ground and throw my water bottle at this wild, vicious creature?”). You can then make the decision to maintain your composure and do the illogical action, because you understand that it will save your life.
When dealing with the unwanted thoughts, feelings and sensations experienced in OCD and related anxiety conditions, resistance to your situation is not the answer. Mindful acceptance is almost always a better way to respond to these uncomfortable internal experiences. There are many other examples that I use with clients that reiterate this theme. Imagine you are driving in a car and the traffic suddenly stops in front of you. You glance in your rear-view mirror and realize that the person behind you is not paying attention and is about to slam into you. In this situation, it is wise to allow your body to roll with the impact and avoid tensing your muscles to brace for it. It has been said that the reason that drunk drivers are the ones who survive car accidents is that they are more relaxed and do not anticipate the collision.
This is also what the expression, “roll with the punches” means – accepting the punch that is being presented to you as a means of diffusing it. The phrase was derived from the boxing technique where one would lean back or to the side when being hit by an opponent in order to better absorb the punch and avoid receiving the full force of the blow.
If you were in a body of water and didn’t know how to swim, to avoid drowning your natural tendency would be to wave your arms, yell for help, and perhaps splash around in the water. But it is actually the depletion of oxygen and energy that cause people to drown, and these intuitive activities would get you there sooner. A better idea is to fill your lungs with air and to lay face down in the water so that you can create buoyancy. The best way to survive is to completely surrender to the situation rather than resisting and struggling.
All of these analogies illustrate how resistance may seem like the correct response, but ends up making the situation worse. If you choose to simply allow your thoughts, feelings and bodily sensations to run their natural course, they will rise and fall on their own. When it comes to OCD and anxiety, you can draw upon the imagery of these analogies to encourage yourself to be courageous in making a counterintuitive decision. Feel free to comment below with your own analogies for resistance, as it would be great to hear more examples that have helped people.
I understand that you may be in doubt about whether your thoughts, feelings, and bodily sensations are real or OCD. You may be saying, “If I only knew for certain that they were just thoughts, then I would be willing to stop resisting.” Part two of this series will discuss “certainty-seeking”, which is the other main strategy that is crucial to discontinue when learning to better manage OCD and anxiety.
•Stacey Kuhl-Wochner, LCSW, is a Licensed Clinical Social Worker at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. She can be contacted firstname.lastname@example.org.
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