Fear of Getting Sick (Nosophobia): Symptoms, Treatment

Nosophobia is an intense, persistent fear of getting sick.

While many people experience anxiety about their health, people with nosophobia can’t control their fear. They’re often afraid of developing a specific disease or condition, such as heart disease, cancer, or sexually transmitted infections (STIs).

Learn more about the fear of getting sick, including traits, symptoms, causes, and how to seek treatment when necessary.

A male patient in a hospital gown looks up at a physician in scrubs, who is holding a tablet and explaining something in a doctor's office.

A male patient in a hospital gown looks up at a physician in scrubs, who is holding a tablet and explaining something in a doctor's office.

Jose Luis Pelaez Inc / DigitalVision / Getty Images


Definition

Nosophobia is a marked and ongoing fear of getting sick or fear of disease. It’s a kind of specific phobia under the umbrella category of anxiety disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A specific phobia involves an overwhelming fear of an object or situation.

Examples of other specific phobias are the fear of heights (acrophobia) and the fear of small spaces (claustrophobia).

Someone with nosophobia might be immediately triggered by something that reminds them of their health-related anxiety. For example, a news story about a particular disease could cause them to have a panic attack (sudden, intense fear along with physical symptoms). They might also engage in avoidance behaviors, such as staying home from social gatherings for fear of acquiring illness. They might also feel extremely distressed when they hear about someone who gets sick.

Nosophobia vs. Illness Anxiety Disorder

Nosophobia is sometimes confused with illness anxiety disorder, which was previously known as hypochondria or hypochondriasis. In fact, some mental health professionals use the terms interchangeably. While they may overlap, there can be some differences between the two conditions.

People with nosophobia tend to fear a specific, well-known disease or disorderm while people with illness anxiety disorder tend to be afraid of sickness in general. They might think they’re sicker than they are when they have few or minor symptoms. They might also rush to their healthcare provider, assuming they’re sick when they have no symptoms at all.

If you suspect you have either nosophobia or illness anxiety disorder, your healthcare provider can help you reach the correct diagnosis.

Symptoms

Most of the symptoms of nosophobia, like other specific phobias, are similar to symptoms of other anxiety disorders. The symptoms of nosophobia may include:

  • Panic attacks
  • Shortness of breath
  • Dizziness
  • Difficulty sleeping
  • Lack of productivity or difficulty concentrating, often due to insomnia (inability to fall asleep or stay asleep)
  • Persistent worries that interfere with daily life
  • Avoidance behaviors, such as staying away from social gatherings to avoid getting sick
  • Rapid heart rate
  • Nausea
  • Excessive sweating
  • Nightmares

Diagnosis

A qualified mental health professional can diagnose you with nosophobia based on the criteria for specific phobias in the DSM-5. To be considered a specific phobia, your fear of getting sick must meet the following conditions:

  • Your fear of illness is lasting, not situational or temporary, with anxiety persisting for six months or more.
  • The fear of getting sick interferes with other aspects of your daily life, such as work, school, or relationships.
  • Your fear and anxiety are disproportionate to the actual risk involved. For example, if someone actually is at high risk of developing a disease, they might not have nosophobia.

Ruling Out Alternatives to Nosophobia

Before you seek treatment from a mental health professional for nosophobia, your healthcare provider should rule out any possible physical illness. If you’re having symptoms that worry you, you can talk to your healthcare provider about your concerns. 

Causes

There are various possible causes for the development of nosophobia, including comorbid mental health conditions (occurring simultaneously with nosophobia), environmental factors, and personal history. Here are some of the most common causes of nosophobia:

  • Past sicknesses or a family history of sickness or disease can lead someone to develop nosophobia later on in life. For example, someone who was seriously ill at one point in childhood might develop intense anxiety about getting sick as an adult.
  • People with other mental health conditions, such as anxiety, depression, or obsessive-compulsive disorder (OCD), are more likely to develop an intense fear of getting sick than the general public.
  • Exposure to news stories or other media about current widespread health problems, such as the COVID-19 pandemic, can trigger anxiety in some people and cause them to develop nosophobia.
  • There is some evidence that medical students, researchers, and others who spend a lot of time reading about various diseases for work or school might develop greater anxiety about their own health.

Treatment

Cognitive behavioral therapy (CBT), a type of psychotherapy, or talk therapy, is usually the preferred treatment for nosophobia. A therapist can help someone with nosophobia identify negative thought patterns about their health in order to change them. They can also help to target unwanted behaviors, such as avoidance behaviors, and change them over time.

Since nosophobia is an anxiety disorder, treating someone’s underlying anxiety through other methods can also help. For example, prescription antianxiety medication or antidepressants may provide relief.

Coping

In addition to mental health treatment, there are other coping methods that can help you manage your intense fear of getting sick. These methods may include:

  • Relaxation techniques: Relaxation techniques can help you manage your anxiety when panic sets in. Try breathing exercises or listening to soothing white noise or music.
  • Mindfulness techniques: Many specific phobias, including nosophobia, involve a fear of the future. Try to stay grounded and present with mindfulness techniques like yoga, walking, and meditation.
  • Exercise and nutrition: If you’re worried about possible illnesses, it can help to take proactive steps to stay as healthy as possible. Exercise regularly, and make sure you’re eating a balanced diet with all the vitamins and nutrients you need.
  • Good sleep habits: If you have insomnia due to your fear of getting sick, try practicing healthy sleep habits, such as turning off your devices an hour before bedtime and sleeping in a dark, cool room. A good night’s sleep can also help you manage your anxiety during the day.
  • Support groups: There are plenty of peer support groups available, both in person and online, to help you manage your specific phobia or any other anxiety disorder. Talking to others with similar fears can help you find support, perspective, and valuable advice.

Summary

Nosophobia is a lasting and intense fear of getting sick. It’s a type of anxiety disorder known as a specific phobia, which is a persistent fear of a certain object or situation. You might have nosophobia if you experience symptoms such as panic attacks and insomnia for six months or more in response to your fear of a specific illness or disease.

The causes of nosophobia might include past traumatic medical events, exposure to media coverage of epidemics or other serious health problems, and/or reading about medical conditions at work or in school. People with generalized anxiety disorder (GAD) and other mental health conditions are also at risk of developing nosophobia. The most common treatment for nosophobia is CBT.

A Word From Verywell

Some people who suspect they have nosophobia or other specific phobias might avoid seeking treatment out of a sense of shame. Others may think their fear of getting sick will lead therapists to doubt them.

But there is effective treatment available for you if you feel distressed about an illness or disease. If you think your fear of getting sick is interfering with your daily life, don’t be afraid to talk with your healthcare provider, who can refer you to a mental health professional, if needed.

Pandemic Anxiety Is Fueling OCD Symptoms—Even for People Without the Disorder

Rosalyn (not her real name) had no idea what she intended to do with the three boxes of spaghetti she had just dumped into her shopping cart. She didn’t want them—she certainly didn’t need them—but never mind, she had to buy them. And the spaghetti boxes weren’t the only unwanted items she picked up in the grocery store that day during the first year of the COVID-19 pandemic. If she so much as grazed one item while she was reaching for another, into the shopping cart it went.

“Everything my hand touched I had to buy,” she said. “I didn’t feel I had a choice. There was too great a chance that I had somehow contaminated the item, and then it would hurt another unsuspecting customer who bought it.” So she left the store with a bulging load of shopping bags—and a lot of guilt, too. “Once I had bought so much, I worried there wouldn’t be enough food left for other people.”

Rosalyn is one of the 2.3% of American adults diagnosed with obsessive-compulsive disorder, or OCD, according to the National Institute of Mental Health. OCD is caused principally by excessive activity in the amygdala, a walnut-sized structure at the base of the brain that processes fear, danger and the fight-or-flight response. The disorder can manifest as compulsive, repetitive behaviors; an anxiety about getting ill or spreading germs; or an excessive sense of responsibility, and an intense fear of causing risk to others, as in Rosalyn’s case. Even people without an official diagnosis are affected; about 25% of Americans will exhibit at least some obsessive-compulsive behavior at some point in their lives, according to a 2008 study published in the journal Nature.

The pandemic has made life much worse for people with OCD symptoms. New research shows that OCD symptoms have gotten more severe for many people during the pandemic, and new diagnoses have increased. More and more people are turning up in doctors’ offices with new cases of the condition. “Studies have consistently shown that people without OCD have scored higher on our OCD assessments than they did before the pandemic,” says Andrew Guzick, a clinical psychologist at the Baylor College of Medicine. “They are exhibiting more OCD-like behaviors and reporting more intrusive fears characteristic of OCD.”

It’s no wonder: A global pandemic is a perfect breeding ground for anxiety. OCD is a disorder of doubt. Was that door knob contaminated? Did I leave the stove on? Did I hear the doctor correctly when she told me that that freckle on my arm is really just a freckle? Refract this kind of pre-existing uncertainty through the lens of a pandemic that to date has infected more than 327 million people worldwide, killed 5.5 million and can strike anyone, and people who are already clinically anxious are going to experience even more anxiety.

“OCD thrives on intolerance of uncertainty and a perceived need to prevent harm, especially as it relates to contamination, so it is no surprise that it has been a difficult time for people struggling with the disorder,” says Guzick. His meta-analysis, published in October 2021 in Current Psychology Reports, found that 32% of people with OCD experienced a worsening of symptoms during the pandemic.


More from TIME


OCD is a contextual condition, growing worse in times of personal or environmental stress and easing back when circumstances grow calmer. Since COVID-19 first emerged, a flurry of research in addition to Guzick’s has been conducted looking at the exacerbation of symptoms in people with the condition, and the findings have been troubling. A September 2020 study in the International Journal of Environmental Research and Public Health, for example, surveyed more than 6,000 people with OCD and found that 60% reported a worsening of existing OCD symptoms or an onset of new ones from the earliest days of the pandemic in late 2019 through the end of March 2020. A November 2021 meta-analysis of 21 studies published in Neuroscience Behavioral Reviews found that up to 65% of respondents reported a worsening of their OCD during the pandemic. Yet another 2020 study, published in BMC Psychiatry in October, focused on young people ages 7-21 and found that nearly 45% experienced a worsening of overall OCD symptoms within the first pandemic year.

Read More: 5 Ways to Feel Happier During the Pandemic, According to Science

For people suffering with OCD involving contamination, the pandemic has been something of a validation—a “told-you-so” to all of the people who had scolded them that their compulsive need to wash their hands and socially distance before the pandemic was excessive and unhealthy. “Welcome to my world!” memes have popped up all over the internet from OCD sufferers as the population at large began to adopt exactly the same precautionary habits they had long practiced. But that kind of satisfaction is short-lived—and comes with a long-term price.

“There are some folks who are saying, ‘I’m actually having an amelioration of symptoms, or I feel validated in my concerns,’” says Michael Wheaton, assistant professor of psychology at Barnard College, and the lead author of a June 2021 study in the Journal of Anxiety Disorders showing that 72% of people with OCD had worse symptoms since the onset of the pandemic.

The problem is, people without OCD respond to pandemic-era guidelines very differently than people with the disorder. Washing your hands once for 20 seconds after entering the house may have become common practice for most people in the age of COVID-19; washing your hands multiple times for 20 minutes at a time is too often the response of people with OCD. It’s that kind of overreaction that clinicians are worried is becoming too prevalent.

“For somebody with contamination issues, we would talk to them about hand washing upon entry of the home, but no other hand washing once you’re in the confines of your home. We tell them we’re going to operate by CDC [the U.S. Centers for Disease Control and Prevention], not OCD,” says clinical psychologist Anthony Pinto, program director of the Northwell Health OCD Center on the campus of Long Island Jewish Medical Center. Pinto also suggests that those with OCD “practice touching [potentially contaminated] objects in the home after washing.” Re-exposing patients to perceived dangers like picking up mail or unwashed groceries and then resisting the urge to decontaminate—a treatment approach known as exposure and response prevention (ERP)—was a pillar of all OCD treatment long before the pandemic.

Read More: An N95 Is the Best Mask for Omicron. Here’s Why

The problem with ERP in the era of the pandemic is that, at least at first, it was unclear if the exposure part of the process was actually dangerous or not. In the early days of COVID-19, we opened doors with our elbows, pushed shopping carts with our sleeves pulled down over our hands, bumped elbows in greeting and stayed at least six feet apart. Even now—especially with the rise of Omicron—no psychologist treating an OCD patient would recommend wading unmasked and untested into crowds of people whose viral status is unknown, just to toughen a patient’s psyche against the anxiety caused by OCD.

What’s more, ERP is traditionally meant to be practiced in the supportive presence of a clinician—a context that isn’t necessarily comfortable or even available for many during the pandemic. But ERP practitioners have adapted; telehealth sessions via Zoom and other platforms have exploded over the past two years, and plenty of exercises can be done virtually and just as supportively on-screen as in person. If a patient is afraid to sit on their bed after being outside, for example, “we can work with that patient online to go outside and then come back in and sit on their bed, then lay on the bed with their street clothes on,” says Pinto. “This is really geared towards experiential learning—having the patient ride through that uncomfortable experience.”

Things get trickier for people with the responsibility form of OCD—the fear not of putting themselves in danger, but of harming others—like Charles. Before home tests became available, every sniffle Charles (not his real name) heard from his three-year-old son was an alarm signal to rush the boy to the doctor for yet another COVID-19 test involving an uncomfortable deep-nose probe. Charles argued for the tests, but his wife resisted. When the boy didn’t get tested, Charles suffered inwardly.

“I, predictably, imagine doomsday scenarios whereby we wipe out his entire nursery school because we were cavalier about minor cold symptoms,” he says.

Stress exacerbates OCD in whatever form it takes, and the greater anxiety becomes, the more people seek a perverse kind of comfort in their rituals. “We see in students who have OCD, when it comes time for final exam period, they’re stressed and sometimes OCD symptoms get worse,” says Wheaton. “They have developed this habitual response that when I’m anxious and stressed out, I turn to compulsions, because it’s sort of a learned behavior to give me a sense of control.”

Ultimately, the pandemic will end, but for many people with OCD, the anxiety and precautions may not. “The driving force in OCD is the amygdala’s distress signal; it’s not driven by new information from society,” says Steven Phillipson, founder and director of the Center for Cognitive-Behavioral Psychotherapy in New York City. Two years of contamination validation could take a long time to undo. Pinto worries that even as the rest of the world at last discards masks and forgets about social distancing, people with OCD will continue to cling to old pandemic habits. “Those individuals were going to have a hard time adapting or trying to return to some normal activity because they want some assurance of 100% safety,” he says. “The only way to have that assurance would be to remain shut down.”

For some people, however, the trial by viral fire has actually been instructive, forcing them to deal with their OCD in ways they hadn’t before. “The COVID era has exacerbated my OCD symptoms, but it’s also been something of an opportunity,” says Charles. “I have a long history with cognitive behavioral therapy, and there has certainly been no shortage of chances to sharpen those skills. The added stress has also led me to seek out a psychiatrist and a prescription for medication, which has been a big help as well.”

“But in the end,” he adds with a rueful laugh, “would I do it all again? Hell no.”

Write to Jeffrey Kluger at jeffrey.kluger@time.com.

Top Mental Health Disorders: A Mental Illness List

Mental illness is defined as changes to an individual’s behavior, emotional response, or thinking that lead to distress or problems functioning in social situations, work, or family life. Mental health issues are common, with millions of people affected each year. Experts estimate that 1 in 5 U.S. adults experience mental illness each year.

There are many different types of mental illnesses, ranging from anxiety and depressive disorders to obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). These mental disorders are diagnosed and treated based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) issued by the American Psychiatric Association.

This article will outline the most common mental health disorders in a comprehensive list.

Woman contemplating

Woman contemplating

Martin Dimitrov / E+ / Getty Images


What Causes Mental Illness?

There is no singular cause of mental illness. Instead, mental illness can usually be attributed to multiple factors, including brain chemistry, developmental experiences, and environmental causes.

Some common factors that have been linked to increased risk of mental illness include:

  • Genetics: Mental illness tends to run in families. Research has shown that children of parents with mental illness are at increased risk of developing mental illness. However, genetics alone do not explain all the risks. Added environmental factors can make someone more susceptible. For example, genetic risk for major depression alone may not result in the development of major depression, but a traumatic event on top of genetic risk may make someone more susceptible. Epigenetics looks at how genes and the environment interact to cause mental illness.
  • Physical environment: The environment in which a person lives also affects mental illness risk. Studies have shown that living in an urban area is a risk factor for mental illness. However, researchers note that urban environments may be a proxy for other underlying risk factors. For example, people living in urban environments may have greater exposures to pollutants or toxins or higher costs of living that lead to chronic stress.
  • Social environment: Stressful life events can significantly impact mental health. Stressful life events vary widely, but significant personal conflicts, such as within an unhealthy relationship, are one example that has strong associations with anxiety and depression.

A Mental Illness List: Types of Mental Health Disorders

There are several different types of mental health disorders that each have a certain set of criteria. Details on each mental illness are found in the DSM-5, which healthcare providers and mental health professionals use to diagnose a mental health issue.

Mental health disorders can generally be grouped into categories. Some of the most common include:

  • Anxiety disorders
  • Eating disorders
  • Mood disorders
  • Personality disorders
  • Trauma- and stressor-related disorders
  • Psychotic disorders

Anxiety Disorders

Anxiety is generally characterized by feelings of tension, worrisome thoughts, and physical bodily sensations such as sweating or increased heart rate.

People who have an anxiety disorder often deal with recurring intrusive thoughts. Intrusive thoughts are unwanted, automatic thoughts that get stuck in your mind and cause great distress and anxious thinking, which can be extremely difficult to escape.

There are some major types of anxiety disorders:

  • Generalized anxiety disorder (GAD): Chronic worry about a variety of concerns and other symptoms of anxiety often without a particular trigger
  • Obsessive-compulsive disorder (OCD): Now in its own diagnostic category, this involves recurring, unwanted thoughts and repetitive behaviors (such as cleaning, hand washing, or tapping), often performed to try and alleviate the distress caused by the intrusive thoughts
  • Panic disorder: Repeated episodes of intense fear or panic attacks, leading to physical symptoms such as chest pain, heart palpitations, and shortness of breath
  • Social anxiety disorder (or social phobia): Overwhelming anxiety around social situations

Eating Disorders

An eating disorder is characterized by significant and persistent disturbances in eating behaviors and is often associated with unhealthy preoccupations with one’s body. These disorders can potentially lead to serious medical consequences.

Though it is a mental health condition, it is also a physical one, since severe disturbances in eating patterns impact physical health. For example, severe restriction of calories, as is the case with anorexia nervosa, can cause a decrease in bone mineral density, increasing the risk of fractures.

There are several types of eating disorders:

  • Anorexia nervosa: Intense fear of gaining weight or becoming fat, leading to self-starvation
  • Bulimia nervosa: A cycle of binge-eating and purging behaviors such as self-induced throwing up
  • Binge eating disorder: Eating a large amount of food in a short period of time, often accompanied with feelings of lack of control and shame
  • Other specified feeding and eating disorders: Any other eating disorder that causes distress and impairs the ability to function at home or work
  • Avoidant restrictive food intake disorder: A condition that is characterized by extremely picky eating that results in nutritional deficiencies
  • Pica: Recurring episodes of eating of non-food objects, such chalk, metal coins, pebbles, or paper
  • Rumination disorder: Repeatedly regurgitating food (bringing swallowed food back up), to rechew and re-swallow it

Mood Disorders

Mood disorders cover a variety of depressive and bipolar disorders. While everyone feels sad or depressed from time to time, a mood disorder is different. Mood disorders are very intense and persistent, and they significantly affect everyday life.

The following are the most common types of mood disorders:

  • Major depressive disorder: Feeling sad, hopeless, losing interested in one’s normal activities, along with other physical and mental symptoms that last two weeks or longer
  • Persistent depressive disorder (formerly known as dysthymia): Chronic depressive symptoms that last two years or longer
  • Bipolar disorder: A condition generally marked by alternating periods of depression and feelings of mania or elevated moods
  • Substance-induced mood disorder: When alcohol, drugs, or medication causes depression or other mood disorder

Personality Disorders

Personality disorders are characterized by long-term maladaptive patterns of thought and behavior that may make it difficult to start or maintain relationships as well as deal with everyday stress in both personal and work life.

People with a personality disorder might not realize they have a mental illness.

There are many personality disorders, which can be classified into three major categories, each with its own set of personality disorders:

  • Cluster A: Odd or eccentric behavior
  • Schizoid personality disorder: Lifelong pattern of indifference toward others and social isolation
  • Paranoid personality disorder: High degree of suspicion and mistrust of others without adequate cause
  • Schizotypal personality disorder: A pattern of odd or eccentric behaviors and difficulty connecting in relationships
  • Cluster B: Dramatic, emotional, or erratic behavior
  • Antisocial personality disorder: Long-term pattern of manipulating or exploiting others without remorse
  • Borderline personality disorder: Ongoing pattern of impulsive behavior, varying moods, unstable self-image, and problems with relationships
  • Narcissistic personality disorder: Extreme sense of self-importance and lacking empathy for others
  • Cluster C: Anxious fearful behavior
  • Avoidant personality disorder: Extreme social inhibitions marked by fear of rejection and feelings of inadequacy
  • Dependent personality disorder: Symptoms may include feelings of helplessness, submissiveness, or an inability to make simple decisions or take care of oneself
  • Obsessive-compulsive personality disorder: Preoccupation with orderliness, rule-following, control, and perfection

Trauma- and Stressor-Related Disorders

Post-traumatic stress disorder (PTSD) is the central disorder in this category. It is a psychiatric disorder where a past traumatic experience, witnessed or experienced, causes severe distress and disruption to everyday living. A natural disaster, serious accident, war, rape, and sexual violence are examples of traumatic events that may lead to PTSD.

People with PTSD experience intense and disturbing thoughts and feelings that are related to the traumatic event, even if it happened a long time ago. They may avoid situations that might trigger a memory of the traumatic event or react strongly to ordinary things that bring them back to that traumatic time.

Post-traumatic stress disorders are sometimes differentiated into the following types, though they are not included in the DSM-5:

  • Complex PTSD: PTSD that develops after prolonged, repeated trauma (such as long-term sexual or physical abuse) rather than an isolated traumatic event
  • Delayed expression PTSD (formerly called delayed-onset PTSD): PTSD that develops more than six months after the trigger event
  • Dissociative PTSD: Exhibition of prominent dissociation, or derealization and depersonalization, when recalling the traumatic experience

Psychotic Disorders

Psychotic disorders are mental illnesses that cause abnormal thoughts and perceptions that, in turn, cause someone to lose touch with reality.

Delusions and hallucinations are common. Psychotic disorders can cause great distress and functional challenges in everyday life.

Types of psychotic disorders include the following:

  • Schizophrenia: Characterized by hallucinations, delusions, unusual behavior, and withdrawal
  • Schizoaffective disorder: Combination of psychotic features such as delusions and mood symptoms like depression
  • Schizophreniform disorder: Schizophrenia episode that lasts longer than one month but less than six months
  • Delusional disorder: Experiencing delusions without the other symptoms or unusual behavior seen with schizophrenia
  • Brief psychotic disorder: Short-term episode of psychosis lasting less than one month
  • Substance-induced psychotic disorder: Psychosis causes by the short- or long-term effects of certain drugs such as LSD
  • Psychotic disorder due to a medical condition

Diagnosis and Treatment for Mental Illness

Mental illness is generally diagnosed by a mental health professional, who uses the DSM-5 to evaluate whether someone meets the criteria for a certain mental illness. Sometimes it can take seeing more than one healthcare provider to make a formal diagnosis, and it often starts with talking with a primary care physician who can refer you to a mental health specialist.

Diagnosis may involve a medical evaluation to rule out any underlying physical causes that might be contributing to the mental illness. For example, a doctor may order bloodwork to rule out anemia or thyroid problems before diagnosing persistent depressive disorder. A psychiatrist or psychologist will ask about symptoms and family history and may use psychological evaluation tools, such as a questionnaire, to determine a diagnosis.

The good news: Mental illnesses are treatable and there are several treatment options for mental illness, with medication and psychotherapy being most common. Sometimes they are used in combination or it may be that just psychotherapy is needed. Psychotherapy can be particularly effective as it involves tools and techniques for combating unhelpful thoughts and behaviors that can help an individual cope long-term.

Summary

There are many types of mental illnesses, which range in severity and how they impact everyday life. There is no single cause for mental illness, and it is commonly caused by multiple factors, many of which are out of an individual’s control. Diagnosis requires a healthcare professional, who can also advise on treatment options.

A Word From Verywell

Mental illness still holds a lot of stigma. But the more that awareness of mental health increases, the more we are able to reduce the stigma around each individual’s personal struggles and create more opportunity for everyone to get the help they need.

If you or someone you love are struggling with thoughts, behaviors, or emotional distress related to a mental illness, it can be scary and isolating. However, our hope is that by knowing more about the types of mental illnesses and having resources for learning more about them, you feel more empowered to reach out to a mental health professional, support group, or friend for help.

While mental illness can be caused by things out of your control, learning more about mental illness and seeking help doesn’t have to be.

Nail Biting: Causes, Consequences, Treatment

Nail biting typically starts in childhood and continues into adulthood. While nail biting is a common problem, it can be caused by a number of behaviors that range from stress to anxiety.

Although the behavior may seem simple to stop, many individuals who have attempted to break the habit have not succeeded. They instead experience not only unsightly nails, but also damage to the skin and soreness surrounding the nail bed. 

This article will discuss the behaviors that lead to nail biting, from anxiety to mental health disorders, how to refrain from biting your nails, and when to see a healthcare provider.

Nail biting

Nail biting

Getty Images / JGI/Jamie Grill


What Causes Nail Biting?

Nail biting, or onychophagia, is also known as pathological grooming. It can also be a behavior of certain obsessive-compulsive disorders (OCDs) like trichtotillomania (hair pulling) and dermatillomania (skin pricking). Nail biting can also be caused by stress and anxiety, boredom, and mental health disorders.

Stress and Anxiety

The behaviors stated above may be triggered by events that cause stress and anxiety. Unlike physical reactions, like a pounding heart or hyperventilating, which can result in the fight-or-flight response, nail biting is a way of releasing stress and anxiety because it feels good. 

Boredom

A Scientific American article published in 2015 states that stress is not the only reason for compulsion disorders, but, rather, boredom and frustration can also trigger the need to do something instead of nothing. This type of behavior can be brought on by a perfectionist personality.  

Mental Health Disorders

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes that nail biting is a body-focused repetitive behavior disorder listed under obsessive-compulsive disorder.

According to the American Psychiatric Association, obsessive-compulsive disorder is when an individual has “unwanted thoughts, ideas, or sensations (obsessions) that make them driven to do something repetitively (compulsions).”

Behaviors of this type can interrupt a person’s day-to-day activities and personal interactions. Not acting out on the compulsive behavior causes more distress than relief. In the case of compulsive nail biting, it feels good and releases stress.

Other disorders the nail biter may have include:

Genetics

Some studies indicate that if you’re a nail biter it’s most likely that you picked up the habit from your parents, not by observation, but from genetics. 

If the nail biter has obsessive-compulsive disorder, family aggregation studies indicate that the disorder is genetic; results from twin studies show that the familiality is in part because of genetic factors. To date, only three genome-wide linkage studies have been completed that suggest some evidence, but don’t provide definitive results.

Side Effects and Risks of Nail Biting

Nail biting has many physical and psychological side effects, which include: 

  • Damage to the cuticle and surrounding skin; redness and soreness
  • Possible bacterial infection in your nail beds and mouth
  • Dental issues
  • Psychological issues with self-esteem, shame, depression
  • Problems with relationships

Long-term, habitual nail biting can disrupt normal nail growth and result in deformed nails. In some cases, extreme nail biting down to the nub can be caused by obsessive-compulsive disorder. 

How to Stop Nail Biting

To break the nail-biting habit or to treat long-term nail biting that results from psychological disorders, several solutions from cutting nails short to cognitive behavioral therapy (CBT) may help.

Cut Them Short

The easiest solution is to simply cut your nails short, which may motivate you to not bite them. However, if you often experience stress and anxiety, or have obsessive-compulsive disorder, even short nails may not deter you from biting them or chewing on cuticles or hangnails.

Get a Manicure or Trim Often

Investing the time and expense in a manicure or trimming nails often may be enough incentive to not bite your nails. Another option is to wear gloves to prevent nail biting.

Keep Your Hands Busy

An easy and efficient way to keep your fingers away from your mouth is to keep your hands busy. There are many creative activities you can try to distract you from nail biting, such as:

  • Cooking
  • Crocheting
  • Knitting
  • Painting
  • Sculpting
  • Clay work

Use Bitter Nail Polish

You can find bitter-tasting nail polish at a local pharmacy and apply it to your nails. If you’re unable to locate this type of nail polish, another option is to spray a bitter apple mixture on your hands. You can make it using white vinegar, apple cider vinegar, and water.

Manage Stress and Anxiety

One method to stop nail biting is to learn the triggers that make you anxious, stressed, or bored. If you’re unable to stop, and nail biting becomes more and more habitual, talk to your healthcare provider to get a referral to a therapist. With therapy, you can learn cognitive behavioral therapy methods to identify or modify your behavior. If you have a disorder, you may need to be treated appropriately with medication.

When to See a Healthcare Provider

An occasional nibble on your nails may not require a visit to the doctor, but if your nail beds are infected and the infection has spread to your mouth, you will need to see a healthcare provider to be treated with antibiotics. If your nail biting has reached a point that you can’t stop and it is affecting your self-esteem and relationships, ask for a referral to see a therapist.

Summary

Nail biting usually starts in childhood and may continue into adulthood. Although a common habit, nail biting can be triggered by stress and anxiety, but it may also be an obsessive-compulsive disorder. To stop the habit, you may take benign approaches like keeping your hands busy, but if you feel your habit is out of control, you may need to consider therapy to determine what is triggering the activity. 

A Word From Verywell

Although nail biting is not a life-threatening habit, it can cause distress. If you are a habitual nail biter and want to stop, consider the options offered above. If your habit is causing you even more stress, speak to your healthcare provider for a referral to see a therapist. 

Frequently Asked Questions

  • It can be deemed as an obsessive-compulsive disorder according the American Psychiatric Association.

  • It depends. If you bite your nails on occasion, they will grow back normally. But if you’re a habitual nail biter, you can get infections on the nail bed and, ultimately, your nails may grow back abnormally.

  • Being under a great deal of stress and anxiety may lead to persistent nail biting. Learn the triggers that lead to nail biting and take appropriate measures to stop the habit. These may include keeping your hands busy, using bitter nail polish, or trimming your nails short.

DNA study untangles the genes underpinning obsessive-compulsive disorder

Obsessive-compulsive disorder is a stigmatized and little-understood mental health condition. People with OCD are often reduced by popular culture to neurotic caricatures, repeatedly seen washing their hands. There’s rarely any larger discussion of the intrusive thoughts, anxiety, and other features of the condition that interfere with daily life. But just as pop culture is missing the point, so too are scientists lacking in information to help understand, diagnose, and treat OCD — but a new study offers some light.

What’s new — A study published this week in the journal Science Advances expands our collective understanding of OCD by shedding light on its genetic underpinnings.

The study, conducted in families where a child has OCD but the parents don’t, reveals how rare, de novo genetic mutations in four genes may tip a person toward an OCD diagnosis. A de novo mutation is a genetic mutation that occurs for the first time in a child’s genes, or in the egg or sperm. In other words, the parents don’t carry this mutation.

Song and his colleagues performed whole-genome sequencing on 53 families — specifically the parents without the diagnosis and their children with the diagnosis — and found four de novo mutations linked to OCD. The mutations are all related to chromatin loops, which are critical to regulating transcription, in which the code of the DNA is written into actual protein in cells.

“These mutations are highly relevant to OCD pathology,” Weichen Song says. Song is a co-author on the new study and a researcher at the Shanghai Jiao Tong University.

Why it matters — The genes pinpointed in this study are also associated with other mental health conditions that can come hand-in-hand with OCD, including anxiety, depression, and anorexia.

This discovery brings us a little closer to understanding the link between genetic mutations and OCD. While this finding doesn’t bring any definitive conclusions, its importance lies in helping illuminate how OCD develops.

“In previous genetic studies of OCD, researchers mainly focus on neurotransmitter genes that directly control brain functions,” Song explains. “Our finding showed that chromatin modification is also an important player, although it is not directly linked to neuronal functions.”

Ultimately, identifying these risk genes may help researchers both diagnose OCD more precisely and may one day lead to drugs that target these genes.

Digging into the details —To the researchers’ knowledge, this is the first time whole-genome sequencing was performed to identify rare de novo variants and changes to genes in families whose children have OCD. Fifty-two of the families were two parents, neither affected by OCD, with one child affected. In one case, there were two unaffected parents with two affected children.

Specifically, the de novo mutations occurred at a higher proportion in parts of genes called promotor-anchored chromatin loops. Chromatin loops are critical to regulating gene transcription, in which the code of the DNA is written into actual protein in cells. They also found de novo mutations in regions associated with distinct gene transcription states, called histone marks.

“Our analysis using public brain RNA data showed that chromatin modification genes could indirectly regulate neurotransmitter genes, and this regulation is disturbed in the brain of OCD patients,” Song explains.

The genes are:

  • KDM3B
  • ASXL3
  • SETD5
  • FBL

These are all protein-coding genes, so if there’s an anomaly with chromatin binding, then this gene can’t properly transcribe proteins. While it’s important to note how mutations can alter how proteins are transcribed, this study also underscores the importance of chromatin modification as a potential cause of OCD.

What’s next — As critical as this study is for continuing to investigate OCD, it opens up a world of questions on which other neurodevelopmental disorders are affected by chromatin mechanisms. Little by little, we get closer to understanding this sometimes debilitating, often misunderstood condition.

In Song’s case, his team has used both mice models and cellular models to try and tease out how two genes — SETD5 and KDM3 — may influence behavior.

“These experiments help us better understand what will be the consequence of the disruption of SETD5 and KDM3B in the central nervous system,” he says.

“We also try to find the pathways and networks that SETD5 and KDM3B make their impact on OCD, and the targets that could be inhibited by chemicals would be the potential drug target for future OCD drug discovery.”

Abstract: Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder with a substantial genetic basis and a broadly undiscovered etiology. Recent studies of de novo mutation (DNM) exome-sequencing studies for OCD have reinforced the hypothesis that rare variation contributes to the risk. We performed, to our knowledge, the first whole-genome sequencing on 53 parent-offspring families with offspring affected with OCD to investigate all rare de novo variants and insertions/deletions. We observed higher mutation rates in promoter-anchored chromatin loops (empirical P = 0.0015) and regions with high frequencies of histone marks (empirical P = 0.0001). Mutations affecting coding regions were significantly enriched within coexpression modules of genes involved in chromatin modification during human brain development. Four genes—SETD5, KDM3B, ASXL3, and FBL—had strong aggregated evidence and functionally converged on transcription’s epigenetic regulation, suggesting an important OCD risk mechanism. Our data characterized different genome-wide DNMs and highlighted the contribution of chromatin modification in the etiology of OCD.

Rare De Novo Mutations Identified in Obsessive Compulsive Disorder Study

Obsessive-compulsive disorder (OCD) is a psychiatric disorder affecting one percent of the U.S. population, but the underlying causes of OCD remain relatively unknown. However, recent research has highlighted potential biological causes of this psychiatric outcome.

Characterized by chronic anxiety, depression, compulsive behavior, and a difficult quality of life, an understanding of OCD is important to help treat individuals who suffer from this disorder. A new study reporting the identification of rare de novo genetic mutations in OCD patients allows for a greater understanding of this disorder and might provide information for the development of new therapies.

brain
Mapping the brain. Genome-wide de-novo mutation profiling of families of trios with obsessive compulsive disorder (OCD) allowed researchers to compare de novo mutation patterns in OCD-affected individuals with Tardive Dyskinesia (TD), which exhibit several similarities. The researchers observed more gene overlaps between these disorders than expected. However, the research showed that genes harboring these mutations are differentially expressed in the brain. [Hendra Su/Getty Images]

Recent research suggests that genetic variation can constitute as a risk factor for OCD development. Previous genome-wide association studies (GWAS) alluded to a “de novo paradigm” hypothesis, suggesting that rare genetic variants might contribute to OCD development. In a new study, Guan Ning Lin, PhD, and colleagues at Shanghai Jiao Tong University in China investigated this hypothesis in order to identify specific de novo genetic mutations across the genome as an OCD risk factor. Their findings are published in an article in the journal Science Advances entitled, “De novo mutations identified by whole-genome sequencing implicate chromatin modifications in obsessive-compulsive disorder.” The authors claim this study to be the first genome-wide de-novo mutation profiling of families of trios with OCD.

Previous GWAS have suggested a connection between OCD heritability and de novo genetic mutations, or genetic alterations that are present for the first time due to a variant in a parental germ cell (sperm or egg). Lin and coworkers sought to identify which specific de novo variants predispose an individual to develop OCD.

Through sequencing genomic DNA of 53 unrelated parent-offspring families, the researchers found a subset of de novo genetic mutations implicated in the regulation of chromatin modification play a significant part as an OCD risk factor. As chromatin modification and regulation impact prenatal and postnatal development, chromatin-modifier genes are known to be associated with various neurodevelopmental disorders.

The studied de novo genetic mutations were found to be contributors to OCD pathology and neurotransmitter pathway modification. In the new article, the researchers state that de novo mutations in three high-confidence chromatin modifiers—SETD5, KDM3B, and ASXL3—are suggestive of “OCD candidate risk genes,” due to their ability to regulate neurotransmitter expression by epigenetic modification.

“We found that the overall expression between KDM3B and dopamine genes was significantly altered between OCD cases and controls,” the authors write. “In contrast, the overall co-expression between ASXL3 and glutamate and between ASXL3 and serotonin were marginally disrupted, [and] the co-expression between SETD5 and the serotonin gene HTR1D was significantly changed.”

A de novo structural variation

Moreover, a de novo structural variation within the genome of OCD-affected individuals alluded to a heterozygous de novo deletion of the FBL gene, resulting in an OCD phenotype. The research found that the “co-expression between FBL and dopamine gene SV2C significantly changed.”

The researchers state that these rare de novo mutations were “significantly enriched in the promoter-anchored chromatin loops… [and have] a significantly higher mutation occurrence within regions of zinc finger genes and repeated, which is characterized by high frequencies of histone marks H3K9me3, H4K20me3, and H3K36me3, and relatively low frequencies of other marks.” Moreover, the researchers observed that “de novo mutation genes were significantly more mutation tolerant than controls, consistent with the hypothesis that de novo mutations might be a significant risk factor for OCD.”

The genomic sequencing of these OCD trios allowed the researchers to compare de novo mutation patterns in OCD-affected individuals with Tardive Dyskinesia (TD), which exhibit several similarities. The researchers observed more gene overlaps between these disorders than expected, they note, stating that “we observed a strong positive correlation between enrichments of the two disorders…indicating that a number of functional biological pathways are shared between the two disorders.” This finding allows for an understanding of why OCD and TD often co-occur.

However, the research showed that genes harboring these mutations are differentially expressed in the brain: the OCD mutation genes are enriched in the dorsal thalamus and in astrocyte cells, while TD mutation genes are enriched in the occipital cortex and in GABAergic neurons. Through the analysis of OCD and TD, the researchers conclude that, “there are clear, distinct developmental patterns that separate these two disorders.”

“These results suggest that chromatin modifications involving SETD5, KDM3B, ASXL3, and FBL may be upstream regulators of neurotransmitter system expression, which controls necessary neurocognitive functions. Disruption of any part of this cascade may lead to abnormal obsessive phenotypes,” conclude the researchers.

“It feels like your mind is betraying you” – The Reality of Living With Obsessive Compulsive Disorder (OCD)

Here in the UK, three-quarters of a million people are thought to be living with Obsessive-Compulsive Disorder (OCD) but despite the figures and recent strides in mental health awareness, it’s still misunderstood by those who haven’t experienced it firsthand.

Although many of us might question if we’ve locked the car or turned the hob off, these thoughts are manageable, not obsessional, and don’t impact our day-to-day lives, jobs or social interactions. Living with OCD goes far beyond perfectionism, cleanliness and next-level organisation skills, and to suggest ‘being a bit OCD’ is a personality quirk is undermining the severity of the disorder. A clean home, perfectly styled rainbow bookcase or carefully curated Kardashian cookie jar is an interior styling choice, if anything, not a mental health disorder. 

Even if they know their obsessions are not realistic, people with OCD have difficulty disengaging from their obsessive thoughts and compulsions, making it a particularly isolating experience often accompanied with an element of shame and secrecy. The anxiety caused by OCD makes it difficult to resist the urge to carry out a compulsion once an obsession is triggered. 

What is OCD?

OCD is a serious anxiety-related condition that affects 1-2% of the UK population (OCD Action), with around half of those cases falling into the severe category. It is typically characterised by two components – recurring intrusive thoughts referred to as obsessions, and compulsive behaviours arising as a result of the anxiety caused by the intrusive thoughts.

Despite how it’s portrayed in the media and in popular culture, it can present itself in many different forms, not just frequent hand washing and checking light switches. According to OCD UK, there are five main categories but it’s possible for obsessions and compulsions to differ from the below or overlap, depending on the individual and the severity of their disorder. 

  • Checking
  • Contamination / Mental Contamination
  • Symmetry and Ordering
  • Ruminations / Intrusive Thoughts
  • Hoarding 

OCD is often referred to as the secret problem, so it isn’t always easy to spot due to the misconceptions surrounding the disorder and the very nature of it being a mental health condition. Some people with Obsessive Compulsive Disorder contend with mental chatter and ruminations, alongside rituals such as repeating words or numbers in their mind until they feel safe to resume, rather than physical compulsions. Pure O (Purely Obsessional), for example, is a type of OCD in which a sufferer has obsessions and mental as opposed to external compulsions, such as trying to stop the thoughts, avoidance or trying to replace unwanted intrusive thoughts with good thoughts.  

The average time between the onset of OCD and treatment is 12 years, namely due to the stigma associated with mental health disorders but once diagnosed, OCD can be managed effectively with Cognitive Behaviour Therapy, medication and support groups. 

Professor David Veale, one of the Founders of OCD Action and Consultant Psychiatrist in Cognitive Behaviour Therapy explains, “The first treatment for OCD is Cognitive Behaviour Therapy that includes exposure. This means having a good understanding of how your current solutions are maintaining your distress. You then go on to face your fears, to tolerate your anxiety and to test out your expectations. For example, if you have unacceptable thoughts about harming children, it means being with children without any checking that you have not harmed a child or trying to undo a harm that you think you might have done. It also means helping you to reclaim your life.

“As your OCD improves, it’s important to ‘fill the void’ left, deepening your connection with others, and engaging in the work, education and interests that are important to you. Sometimes medication in the form of a SSRI may be helpful in more severe forms of OCD.”

In this interview, we speak to people with OCD to understand what living with the mental health disorder is really like. From how they manage their obsessions and compulsions, seeking professional help and the myths vs reality of having an incredibly misunderstood mental health condition. 

Image Credit: @ObsessivelyEverAfter

Darcey’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I’ve had OCD symptoms since around age 8 I believe, I remember quite clearly as a child constantly having the need to put my tongue to the roof of my mouth and it used to really frustrate me that I couldn’t stop, I now know this was a form of compulsion. I wasn’t actually diagnosed with OCD though until I was 20, I had always been diagnosed with anxiety, although anxiety and OCD quite often go hand-in-hand.

I attended a CBT course for anxiety and said to the woman running it that this course helped but it didn’t pinpoint everything I was feeling, like the need to do a ritual otherwise something bad would happen, even small things like if the volume on the TV was on an odd number I’d be convinced something terrible would happen if I didn’t change the volume to an even number, which meant either I had to change it or I had to vocalise my discomfort to the person controlling the volume. After this, I was quite quickly diagnosed with OCD after discussing more of my compulsions etc, but to be honest even reading up online prior I knew I had it, but I didn’t want to self-diagnose.

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

My OCD seemed to develop over time and quite slowly, so it began when I was younger having this need to do small compulsions like touching the roof of my mouth and not knowing why I was doing them. Then as I got older I constantly checked things, if I unplugged my straighteners, did I leave the hob on, did I lock the door. I had to check these things multiple times otherwise I’d convince myself something awful would happen and it would be all my fault. This is kind of just like anxiety too, so I think this is why it didn’t get recognised in me sooner.

It was only really in my late teens / early 20’s that I started to feel the full force of OCD. I’d have such distressing thoughts and imagery in my mind of stuff I would never want to do to anyone or myself. This would be towards people I love, my friends, children, animals and even strangers, the thoughts would circle in my mind so much I convinced myself I was a terrible person.

Mentally it is so incredibly draining as it feels like your mind is betraying you, why am I thinking these things? This led to compulsions like doing ‘touchwood’ repetitively in order to feel safe from these thoughts or making a wish at 11:11 every day in order to keep me and my family safe. It really started to affect my daily life as I spent hours thinking about these images, being upset by them and feeling like I couldn’t tell anyone because I was worried about what people would think. OCD also caused me to completely mistrust myself, to the point I’d question my religious views, my sexuality, who I am as a person, how do people view me if I can’t even view myself properly? I know deep down my beliefs and who I am, but OCD makes you question EVERYTHING. 

Are there certain triggers for your obsessions/compulsions?

When I’m having a bad spell of OCD anything that is even remotely related to my intrusive thoughts can trigger them, TV, books, daily life. I went through a stage of avoiding things in order to stop the thoughts, but that’s not healthy and really it makes you think about it more. I still, to this day, can’t pick up a kettle without envisioning me spilling the boiling water on me, same with a pan of boiling rice or pasta. I also can’t have volume on an uneven number as it still fills me with fear, but luckily these thoughts don’t affect me as much after a lot of therapy. 

Are there certain times or situations when your symptoms worsen?

My symptoms are usually worse when I am having a bad anxious period, this is when the fear behind the intrusive thoughts creeps back in and therefore I find I start to slip back into doing compulsions. 

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

My OCD has improved greatly due to two main things;

1) I went through a really traumatic period when my Mum was diagnosed with terminal cancer, after this happened I realised that any compulsion I gave into didn’t stop bad things happening to me, especially like making a wish at 11:11. Awful circumstances but since that day we found out I’ve never made a wish at 11:11 or touched wood in order to calm myself and these compulsions took over my life prior.

2) I went to therapy and have been for over a year now, it took quite a while to open up about my intrusive thoughts due to fear of being judged but once I had spoken about them, they instantly began to lose their power. Anyone struggling with OCD, please don’t underestimate how freeing it will be once you speak to a professional. 

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

I think most of my compulsions were within my mind (except for touching wood / my head if there was no wood around ha). I know a few people with OCD who find the ruminating about things the hardest, the thoughts and then the more thoughts about how terrible you must be if you are having those thoughts, they circle around your head for hours. I think that’s the real reality for OCD for most people. 

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

This is the misconception I find the most frustrating! It’s perpetuated by celebrities like Khloe Kardashian who is super organised and tidy, so says she’s super OCD. Of course, I don’t know her medical history, but OCD is so debilitating and exhausting, so when someone makes light of it, you usually know they probably aren’t really experiencing it. The media is to blame as well, with cleaning programmes having people with OCD tidying messy houses. Don’t get me wrong, cleaning and contamination is a real side of OCD, but it’s the tip of the iceberg. 

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

I’d really like large platforms speaking more openly about the less ‘glamorous’ side of OCD. I think seeing others speak about their own experiences is so helpful for others suffering. I found so much peace when I found Instagram and Tik Tok accounts from other people with OCD and realised we all had the same thoughts, I cried for hours after seeing a random video on Tik Tok pop up from someone talking about their experience as I just felt so reassured and heard by it. If it was more openly spoken about, more people would get the help they need from professionals, but because the nature of our thoughts can be so scary and horrendous, people keep it a secret, I certainly did for a while.

Image Credit: @ObessesivelyEverAfter

Lauren’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I was officially diagnosed with OCD at age 15, but I was struggling with symptoms of OCD many years before I even knew what it was. I was “functioning” with my OCD for more than two years before I hit a “crisis point” when I needed medical intervention, as I was no longer able to function in my everyday life. Once I had my diagnosis, I was put on medication and partook in CBT (Cognitive Behavioural Therapy). Since then, my condition has been very manageable.

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

My symptoms include a variety of obsessions, compulsions and associated mental health conditions, including depression, anxiety, and some disordered eating. My obsessive thoughts include an irrational fear of harming others by mistake, and a subsequent fear of contamination, an illogical fear that I am unwanted by my friends and family and a large fear of failure. These obsessions lead to compulsions, such as repeatedly checking appliances, hand washing, asking for reassurance and avoiding people or places that may “trigger” my obsessive thoughts.

Currently, my everyday life is largely unaffected by OCD (though I still have some relapses, especially during the pandemic), but before my diagnosis, I would try and neutralise my obsessive thoughts with compulsive behaviour many times every day.

Are there certain triggers for your obsessions or compulsions? Are there certain times or situations when your symptoms worsen?

Unfortunately, the pandemic is a trigger for my obsessive thoughts about contamination. I think that a lot of people with this specific aspect of OCD have been greatly affected by this very uncertain time in our lives. Being in isolation, without any social interaction, worsens my symptoms as I do much better mentally when I am busy. Furthermore, exams are a big trigger for my obsessive thoughts about failure and thus exam periods would be very difficult for me! Luckily, I’m at the stage in my life where I no longer must do exams.

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

I manage my depression, a by-product of my OCD, through medication. I have explored CBT and to a lesser extent, DBT (Dialectical Behavioural Therapy), both of which I have found to be very helpful. I find breathing techniques, and distraction to be useful management techniques for my anxiety. I am very lucky that I have a support network of loved ones that I can talk to if I need any help.

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

One of the hardest parts of living with OCD, for me, is living with something called “intrusive thoughts”. In my case, these involved horrible thoughts of my family and friends being harmed and thus makes me start worrying that I am not doing enough to protect my family. The burden of having to live with these thoughts without knowing what they were or being able to tell anyone (pre-diagnosis) was extremely mentally taxing. Going to school and socialising with friends became something incredibly stressful, rather than a normal part of life to be enjoyed.

One compulsion I had regarding my intrusive thoughts was to think about the thought a lot as if to “neutralise” it. It was as if the more I thought about it, the less scary the thoughts would be. As this part of my illness is invisible, no one knew that I was struggling on a day-to-day basis.

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

I try to be understanding when I hear things like this, as I know how easy it is to say silly things accidentally. I think the misconception that OCD is about having an incredibly tidy desk is, thankfully, not as commonplace as it used to be. While it is a little frustrating that some people assume that having OCD is just about turning light switches on and off, the thing that frustrates me most is ignorance in the face of education. If you listen to people’s experiences and learn from what they are saying, you are doing everything right, in my opinion.

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

While I have been lucky in the sense that I have always had a positive and professional experience when talking to doctors about my condition, I have had negative experiences with mental health professionals in schools. When I was 17, I had a lot of my support system for exams removed, as I seemed on the surface to not need it. This was against the advice from my doctor. I found this to be devastating as I did not feel like the invisible nature of my condition was understood by these professionals. More education and funding for supporting young people with OCD in schools should be a priority. If you are unsure how best to support someone with OCD, don’t be afraid to ask. With the right support and treatment, people with OCD can (and do) live a very full and happy life.

Ellie’s Story

How long have you had OCD and what was the road to diagnosis like for you?

While I was only recently diagnosed (early September), I’ve struggled with OCD symptoms since I was fourteen years old. I found it hard talking about my symptoms – intrusive thoughts compulsions were rarely spoken about in the media I was consuming! It was only when I turned seventeen that I started to read up on what could be causing these distressing thoughts. I put getting professional help off for a while, shrugging it off as being ‘not important enough’ (reality check: any mental health problem, big or small, is important!) but thankfully, with the support of loved ones, I reached out to medical professionals a cognitive behavioural therapist – and that was that. 

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

OCD for me is a very subtle invisible mental illness. It was very easy for me to put on a brave face perform as if all was ok, when in reality, it wasn’t. Inside my head were intrusive thoughts that genuinely scared frightened me. Thoughts of loved ones or myself in danger or in harm’s way seemed to lurk around each corner. My main struggle was compulsions. Whenever I’d have an intrusive thought, I’d compulsively have to tap anything five to twenty-five times. It was exhausting – I can’t explain where it came from or why it eased the thoughts, but deep down I knew it wouldn’t prevent anything. If I didn’t do it, I’d panic. It was like my body was forcing me! 

Are there certain triggers for your obsessions or compulsions?

I had certain triggers – horror movies being my biggest one. For some reason, in my head, I would replace the characters I was watching on screen experiencing these terrible fates with myself, and people I knew in real life. It was nasty (having a horror-obsessed boyfriend wasn’t helping!) honestly, made me feel more childish than I was. I had to be SO weary of the media I was consuming. So frustrating! Hearing of any sad event in someone’s life made me automatically think ‘that will happen in my life’ and happy events made me think ‘this is too good to be true – something bad is ought to happen’. 

Are there certain times or situations when your symptoms worsen?

Thankfully I could go a while sometimes without experiencing my compulsions. Periods of high stress or emotion made everything so much worse, which is to be expected. As an anxious person in my day to day life, I would often become overwhelmed and have a short burst of constant intrusive thoughts and tapping things over and over. 

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

Living with OCD now is much easier than it was, now that I’m aware of it. It’s not this monster without a face anymore, it’s something I can name and talk about. My therapist taught me to recognise that I am not my thoughts, no matter how awful they are. These intrusive thoughts do not make me a horrible person for thinking them, nor do they represent what I truly want in life. Finding the evidence for my thoughts (usually there would be none!) and evaluating the true likelihood of them becoming reality was hard to master, and much easier said than done – yet once I did, it truly changed my life. 

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

Having OCD was an emotional rollercoaster. The frustration guilt was the awful part. When you experience thoughts of bad things happening to those you truly love, it changes the way you view yourself as a person. While the thoughts didn’t define me as a person, I thought I was evil and inhumane. How dare I think these things? Why am I thinking these things? Am I a bad person? It was like having the little devil on your shoulder – yet they aren’t whispering as they do stereotypically, they’re shouting screaming. 

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

“I’m a bit OCD.” We’ve all said it. Whether you like things in colour order, hate mess or must have your shoes in a particular order, this phrase is more common than it ever should have been. It takes the importance away from this mental illness and instead turns it into this adjective to be used for enjoying things that most of us like – organisation cleanliness. It almost belittles the issue and brushes it under the carpet. Never to be spoken about. 

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

I wish more people would try to understand. It’s hard, I appreciate that. But little steps change the most! If people could be more open-minded about OCD, that would do a whole world of good. People I’ve spoken to about intrusive thoughts have genuinely said things like “gosh, that’s a bit freaky of you”. While it’s a lot to take in and understand, us intrusive thoughts compulsions – having humans can’t control them! We’re not freaks our thoughts and compulsions don’t make us strange or any different from you.

We need support and we need compassion from others. I’ve found that OCD is one of the least spoken about mental illnesses, especially in secondary schools. If it ever is mentioned or represented in the media, it’s almost always the same type. More diverse representation and more education to provide a better understanding of OCD would be an absolutely amazing thing for everyone. 

Image Credit: @ObsessivelyEverAfter

Olivia’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I have had OCD for about 8 years now. I started experiencing symptoms in January 2014 and did not get diagnosed until 10 months later. I was only 16. The road to diagnosis was a hard one, I think this was primarily because of my family’s lack of knowledge around mental illness and our finances at the time. When it first started I didn’t really understand what was happening to me, I thought I was going crazy. At the time I didn’t feel comfortable talking to anyone about it so I ended up self-diagnosing from researching how I felt online. My parents eventually brought it up with me and we decided I should see someone about it, by that time it had gotten so severe I couldn’t hide it anymore. Mental health care professionals can be really expensive so it took time for my parents to find the money for me to see one. Eventually, I saw a psychologist and she diagnosed me with OCD, General Anxiety, Sleep Apnea and insomnia.

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

My symptoms really change depending on the context and how I am feeling internally. Because I have had OCD for 8 years now I am pretty good at knowing what places and situations trigger me, but it can be hard to communicate those needs to other people. If I am having a particularly hard day with it I will just stay home and avoid people because it is most controllable in a familiar space. I know that when I am stressed or tired I will feel it the worse so I always have to prepare myself mentally for days like that. I do have some friends who are great with me about it but whenever I do have to explain it to someone it gets worse because I feel totally insane describing what I feel!

Are there certain triggers for your obsessions or compulsions?

My biggest trigger is with anything that lathers or foams, so washing my hands, showering, brushing my teeth and household cleaning takes a lot longer than what’s typically normal. I will always opt for sanitiser over washing my hands and will only wash my hair when I have to. Walking on surfaces that have lines or cracks can be difficult too, I always try not to look at my feet when I am walking in case I get trigged. I also tend to develop obsessions about the placement of my hands when I’m sitting or how my feet are placed when I’m standing. Honestly though, when my OCD is at its worse anything and everything will trigger me, I just have to look at something and I’ll develop an obsession!

Are there certain times or situations when your symptoms worsen?

I am currently doing my master’s degree and I know that when an assessment or exams are coming up I’m going to feel it. Avoiding stress and emotional distress are key for me to contain my OCD. In 2020 I lost three of my grandparents in one year and when I was dealing with that grief my OCD got worse. But totally avoiding negative stress and emotions is impossible so for me it’s all about preparing myself mentally and self-compassion!

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

I think for a long time I didn’t manage it, I just went every day being pushed to my mental limit. I didn’t find that the first psychologist I saw helped me so I was pretty sceptical about trying another therapist. However, in 2020 I found a Counsellor who really helped me deal with the trauma which caused me to develop OCD and in the process, I have been able to get a handle on my OCD rather than it having a hold on me! Exposure therapy has also been key for me, fighting my compulsions has helped reduce the severity of them over time. I also use a CBT app which helps me feel in touch with my emotions and body.

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

Living with OCD can definitely be really hard, especially if you are doing it alone. Before I got treatment for it there were days where I didn’t think I could do it anymore. It’s like constantly having a voice in your head telling you to do something that is totally crazy and unnecessary but is the only thing that will make you feel better. Dealing with my past trauma was definitely key to overcoming the emotional battle I was having because of my OCD, it allowed me to develop self-compassion for why I had OCD in the first place and a sense of gratitude toward myself for finding a way to cope in a time that was really terrible! 

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

Yes! I think that phrase is the easiest way for someone to make a person with OCD feel small and even more crazy than they already do! comments like that can really hurt someone battling it; especially if they don’t have the voice to correct them. But the biggest misconception I find frustrating is when people limit what OCD can look like, OCD isn’t just about washing your hands or organising how some books look! OCD can look a myriad of ways and ultimately looks like whatever it does to the person who has it!

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

I would love to see more therapists specialise in helping people with OCD, especially becoming aware of the different types of OCD and the non-medical options people have to overcome it. A lot of people who have OCD are prescribed medication and are never told what other treatment options there are! It would also be great to see some tools developed to help people explain what OCD is like to friends and family easier!

Caitlin’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I’ve had OCD for (I think) about 7 years now, as I started to experience it while I was at college. It started with checking and hand-washing compulsions, and it was actually something my mum pointed out to a doctor when I was at an appointment for something else. I was then referred to a mental health specialist, who talked to me about what I was experiencing and gave me information on OCD. This wasn’t something I’d even thought I could have, despite looking up information on things like OCD and anxiety online, so it was quite the shock! I also had to fill in both the general mental health questionnaire and also one called the OCI (Obsessive Compulsive Inventory) which gave the specialist more of an idea about which type(s) of OCD I had. I’ve not tried medication for it, but I’ve done Exposure and Response Prevention, which is the gold standard treatment, and this worked well for me! I’m actually not sure how the diagnosis and support system works, but I’ve been treated for OCD on several different occasions both privately and on the NHS, and also declared it to my uni while I was there. I’ve never applied for disabled students allowance or anything like that though, so I can’t offer any insight on that, although I know that students with OCD were encouraged to at my uni.

Symptoms of Obsessive Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

My OCD was noticed because it manifested in quite a physical way – I washed my hands so much that it made them really dry and cracked, especially on the back, around my wrist. At my worst, during my first year of uni, I was spending a shocking amount of time washing my hands – I would soap up and rinse them over 30 times, and this meant my new friends would often have to wait for me so we could go to eat dinner together. I would go through a bottle of liquid hand soap a week, and also used a lot of hand sanitiser while I was out and about. I would also have to use lots of hand creams to try and stop my hands from being damaged. I’m doing a lot better now, even with COVID, but I still wash my hands a lot. I often worry that people will judge me at work for it, and I’ve only ever admitted to having ‘a bit of a thing about germs’ because I’m worried it’ll affect my job if people know.

It also manifested as a lot of checking – sometimes this would involve checking ‘sensible’ things like doors being locked, or the stove being off, but I was also incredibly afraid of having posted something unpleasant on social media/email without knowing about it so I would get caught in a vicious cycle of checking and refreshing everything (usually at night, so it started to affect my sleep). It got to a point where I avoided almost all social media for several years, but I’ve slowly introduced almost everything back into my life. I still sometimes check things, both the ‘sensible’ and the social media, and can still find myself compulsively screenshotting things I’ve posted ‘just in case’.

Are there certain triggers for your obsessions or compulsions?

 I’m most often triggered by things not feeling/being ‘clean’ – if I’ve touched something I would have to wash my hands before touching my face, or eating/preparing food. This is somewhat ironic to me, considering my job at the moment involves a lot of mud! If I see a fly land on my food or glass, that’s quite upsetting to me. COVID has also been quite a big trigger, but I was always careful about washing my hands (etc) anyway, and I try to follow the rules about social distancing and masks as best I can.

I can also be triggered by social media – by feelings of something not being ‘right’, or when I want to go to sleep I might still feel the need to check. For this reason, there are certain social media sites I avoid. I’m also really frightened by the idea of computer viruses or accounts being hacked, so I can be really wary of things my friends send me (youtube/tiktok links etc).

On one very memorable occasion, OCD was used in the crime show Criminal Minds (which I used to be a big fan of), and this upset my OCD as it caused me to worry that I, like the character with the disorder, would commit some horrible crime. This is because OCD is something that goes against your values – it wants to convince you that you’re a horrible person and are putting people in danger. I often worry about things happening to my friends or family for this reason, and OCD convinces me I’m responsible for ‘preventing’ the bad things.

Are there certain times or situations when your symptoms worsen?

It seems that my OCD has been at its worst when I’ve gone through a big life change – like starting uni, for example. This is something that goes into the plan you make at the end of a limited course of therapy sessions – you talk about and note down anything that might trigger the OCD and/or cause it to worsen. I would definitely count the pandemic as one of these times – there was a point where I could barely get dressed during lockdown due to the thought of germs being on my clothes and my hands/feet, and the constant messages on TV/social media about washing hands wasn’t helpful either! I think that a breakup might also be one of those times, especially if I’ve been hiding my OCD from the person, but with that it’s more about coping with feelings of being ‘unlovable’ or ‘a freak’ – it’s easy to blame mental health for these things, even if it’s just a case of being incompatible. On a smaller scale, my symptoms can be worse before important events or dates – I used to worry about getting sick before or on the day of trips/exams (etc) and I also find I worry about becoming ill at work, so I get more wary of certain foods (e.g. not eating a lot of dairy as large amounts can make me ill) and food safety.

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

I’ve tried a lot of things over the years, from meditation and yoga (fun and relaxing, but not specifically helpful for my OCD) to Cognitive Behavioural Therapy and Exposure and Response Prevention. CBT and ERP are considered ‘gold-standard’ treatments, and I’ve been able to manage my OCD really well (with the help of a therapist) using them, but it’s a lot of homework – there’s no easy fix, but it’s worth it. I had tried a support group in the past, which helped me to feel less alone, and there was a student-run support group at my uni that was absolutely invaluable during that first year, but I found one-on-one treatment more effective when I could access it. In terms of everyday stuff, I’ve tried to push myself outside of my comfort zone by getting a job, but I’ve also found video games, books, writing and general fandom culture to be a really helpful distraction and form of stress relief. Getting my job was something I tried to just do, rather than overthinking it and avoiding it like the OCD would want – it was a lot to adjust to, but I was fortunate enough to be in a place where I could handle it and it provided great opportunities and distractions. It’s also really nice to have friends and family that try their best to understand my OCD without enabling it or ‘feeding’ it, but on balance there are lots of people that don’t know, especially at work, and that can be hard.

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

I’m fortunate that my OCD began in a way that was externally visible and pretty stereotypical, but it’s not always been like that. One of the main emotional things I’ve struggled with over the years is that feeling of being a ‘freak’ or a ‘bad person’ – it can be hard to explain obsessions and compulsions, and sometimes the thoughts can be so horrifying that you worry about admitting them in case you’re treated like a criminal or a ‘crazy person’. Of course, these are thoughts and images specifically created by the OCD to get a reaction from you (like a bully) – they’re ‘egodystonic’ which means they go against your values, and attack the things that are important to you such as your friends, family, health and reputation. It would have taken me a lot longer to find help if my OCD only consisted of those thoughts and images, as this isn’t something many people associate with the disorder due to the ‘clean and organised’ stereotype. People with OCD might worry that they’ll cause physical or emotional harm, or that they’re a bad person, due to thoughts that go against their morals/religions – I worry sometimes that I’ve said something awful to a friend or stranger, even though it’s something I would never do.

Some days it’s difficult to accept that I have OCD, and that it’s something that’ll be a part of me forever – however, I know that with a bit of work I can (and do) manage it, so it’s not all doom and gloom! It also feels rarer than, say, depression or anxiety, so sometimes it feels a bit harder to find people I can relate to. That being said, one of my best friends was recently diagnosed with OCD, so it’s good to know that we’ll be able to support each other through it.

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

The “I’m/you’re a bit OCD” thing really annoys me, as it trivialises the condition and stops people that are being seriously harmed by the disorder from seeking help. I’ve seen it thrown around as an insult on pages meant to be for cleaning tips, and at my first job back in college I was told “don’t be OCD about this task”…that was fun to hear as someone coming to terms with actually having OCD! Hearing it constantly referred to in an insulting or negative light can really add to the feelings of isolation and self-loathing, those feelings of being ‘a freak’.

The ‘clean and organised’ stereotype can also do a lot of harm, as it means people suffering with other types of OCD such as harm OCD or Pure O don’t even associate their symptoms with the disorder. Sometimes it’s a little awkward for me to admit to the germaphobic aspect of my OCD as it can fuel the stereotype, but I can tell you now that my room is not nearly as clean or organised as you might expect! Indeed, even with the most stereotypical form of OCD, I didn’t realise I had it, so anything that perpetuates misconceptions can be really harmful.

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

I think having more awareness of how OCD can be for real people is important (I’m really happy to see Zoella looking into this, and happy to help out!). There are a lot of social media accounts run by trained therapists and people with OCD that are really informative as well which helps (though of course you have to be careful about misinformation). Charities like Mind and OCD Action are really useful too, as they can provide information and support for the sufferer and also friends/family, and it’s quite easy to access and understand. Depictions of OCD in TV/film that are realistic and not treated as a joke can also be helpful, and can give people characters to look up to (similarly, celebs being honest about their experiences of the disorder can be positive too). It’s a big ask, but I’d love to see the end of “I’m/you’re a bit OCD” – it’s not helpful and it really gets on my nerves, even if the person means well!

I also think that an awareness of OCD would be helpful at the college/university level, and in the NHS – my main barrier to help was that I got kind of…funneled through the university and NHS systems in a way that pointed me to the wrong kind of treatment initially (one that was more general, made to deal with general uni stresses and anxieties), when I should have been on a more specific form of treatment that actually worked really well when I got to it! One of the most helpful things during that difficult first year was simply feeling seen and cared for by the student welfare team at my uni – they made sure I made and went to appointments, and helped me to feel less alone. Indeed, I was able to poke fun at a shared OCD experience with one of them, a fellow sufferer, because we could connect and understand how truly strange OCD can be.

Caitlin’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I’ve had OCD for (I think) about 7 years now, as I started to experience it while I was at college. It started with checking and hand-washing compulsions, and it was actually something my mum pointed out to a doctor when I was at an appointment for something else. I was then referred to a mental health specialist, who talked to me about what I was experiencing and gave me information on OCD.

This wasn’t something I’d even thought I could have, despite looking up information on things like OCD and anxiety online, so it was quite the shock! I also had to fill in both the general mental health questionnaire and also one called the OCI (Obsessive Compulsive Inventory) which gave the specialist more of an idea about which type(s) of OCD I had. I’ve not tried medication for it, but I’ve done Exposure and Response Prevention, which is the gold standard treatment, and this worked well for me! I’m actually not sure how the diagnosis and support system works, but I’ve been treated for OCD on several different occasions both privately and on the NHS, and also declared it to my uni while I was there. I’ve never applied for disabled students allowance or anything like that though, so I can’t offer any insight on that, although I know that students with OCD were encouraged to at my uni.

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

My OCD was noticed because it manifested in quite a physical way – I washed my hands so much that it made them really dry and cracked, especially on the back, around my wrist. At my worst, during my first year of uni, I was spending a shocking amount of time washing my hands – I would soap up and rinse them over 30 times, and this meant my new friends would often have to wait for me so we could go to eat dinner together. I would go through a bottle of liquid hand soap a week, and also used a lot of hand sanitiser while I was out and about. I would also have to use lots of hand creams to try and stop my hands from being damaged. I’m doing a lot better now, even with COVID, but I still wash my hands a lot. I often worry that people will judge me at work for it, and I’ve only ever admitted to having ‘a bit of a thing about germs’ because I’m worried it’ll affect my job if people know.

It also manifested as a lot of checking – sometimes this would involve checking ‘sensible’ things like doors being locked, or the stove being off, but I was also incredibly afraid of having posted something unpleasant on social media/email without knowing about it so I would get caught in a vicious cycle of checking and refreshing everything (usually at night, so it started to affect my sleep). It got to a point where I avoided almost all social media for several years, but I’ve slowly introduced almost everything back into my life. I still sometimes check things, both the ‘sensible’ and the social media, and can still find myself compulsively screenshotting things I’ve posted ‘just in case’.

Are there certain triggers for your obsessions or compulsions?

I’m most often triggered by things not feeling/being ‘clean’ – if I’ve touched something I would have to wash my hands before touching my face, or eating/preparing food. This is somewhat ironic to me, considering my job at the moment involves a lot of mud! If I see a fly land on my food or glass, that’s quite upsetting to me. COVID has also been quite a big trigger, but I was always careful about washing my hands (etc) anyway, and I try to follow the rules about social distancing and masks as best I can.

I can also be triggered by social media – by feelings of something not being ‘right’, or when I want to go to sleep I might still feel the need to check. For this reason, there are certain social media sites I avoid. I’m also really frightened by the idea of computer viruses or accounts being hacked, so I can be really wary of things my friends send me like YouTube/TikTok links etc.

On one very memorable occasion, OCD was used in the crime show Criminal Minds (which I used to be a big fan of), and this upset my OCD as it caused me to worry that I, like the character with the disorder, would commit some horrible crime. This is because OCD is something that goes against your values – it wants to convince you that you’re a horrible person and are putting people in danger. I often worry about things happening to my friends or family for this reason, and OCD convinces me I’m responsible for ‘preventing’ the bad things.

Are there certain times or situations when your symptoms worsen?

It seems that my OCD has been at its worst when I’ve gone through a big life change – like starting uni, for example. This is something that goes into the plan you make at the end of a limited course of therapy sessions – you talk about and note down anything that might trigger the OCD and/or cause it to worsen. I would definitely count the pandemic as one of these times – there was a point where I could barely get dressed during lockdown due to the thought of germs being on my clothes and my hands/feet, and the constant messages on TV/social media about washing hands wasn’t helpful either! I think that a breakup might also be one of those times, especially if I’ve been hiding my OCD from the person, but with that, it’s more about coping with feelings of being ‘unlovable’ or ‘a freak’ – it’s easy to blame mental health for these things, even if it’s just a case of being incompatible. On a smaller scale, my symptoms can be worse before important events or dates – I used to worry about getting sick before or on the day of trips/exams (etc) and I also find I worry about becoming ill at work, so I get warier of certain foods (e.g. not eating a lot of dairy as large amounts can make me ill) and food safety.

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

I’ve tried a lot of things over the years, from meditation and yoga (fun and relaxing, but not specifically helpful for my OCD) to Cognitive Behavioural Therapy and Exposure and Response Prevention. CBT and ERP are considered ‘gold-standard’ treatments, and I’ve been able to manage my OCD really well (with the help of a therapist) using them, but it’s a lot of homework – there’s no easy fix, but it’s worth it. I had tried a support group in the past, which helped me to feel less alone, and there was a student-run support group at my uni that was absolutely invaluable during that first year, but I found one-on-one treatment more effective when I could access it. In terms of everyday stuff, I’ve tried to push myself outside of my comfort zone by getting a job, but I’ve also found video games, books, writing and general fandom culture to be a really helpful distraction and form of stress relief.

Getting my job was something I tried to just do, rather than overthinking it and avoiding it like the OCD would want – it was a lot to adjust to, but I was fortunate enough to be in a place where I could handle it and it provided great opportunities and distractions. It’s also really nice to have friends and family that try their best to understand my OCD without enabling it or ‘feeding’ it, but on balance, there are lots of people that don’t know, especially at work, and that can be hard.

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

I’m fortunate that my OCD began in a way that was externally visible and pretty stereotypical, but it’s not always been like that. One of the main emotional things I’ve struggled with over the years is that feeling of being a ‘freak’ or a ‘bad person’ – it can be hard to explain obsessions and compulsions, and sometimes the thoughts can be so horrifying that you worry about admitting them in case you’re treated like a criminal or a ‘crazy person’. Of course, these are thoughts and images specifically created by the OCD to get a reaction from you (like a bully) – they’re ‘egodystonic’ which means they go against your values, and attack the things that are important to you such as your friends, family, health and reputation. It would have taken me a lot longer to find help if my OCD only consisted of those thoughts and images, as this isn’t something many people associate with the disorder due to the ‘clean and organised’ stereotype. People with OCD might worry that they’ll cause physical or emotional harm, or that they’re a bad person, due to thoughts that go against their morals/religions – I worry sometimes that I’ve said something awful to a friend or stranger, even though it’s something I would never do.

Some days it’s difficult to accept that I have OCD and that it’s something that’ll be a part of me forever – however, I know that with a bit of work I can (and do) manage it, so it’s not all doom and gloom! It also feels rarer than, say, depression or anxiety, so sometimes it feels a bit harder to find people I can relate to. That being said, one of my best friends was recently diagnosed with OCD, so it’s good to know that we’ll be able to support each other through it.

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

The “I’m/you’re a bit OCD” thing really annoys me, as it trivialises the condition and stops people that are being seriously harmed by the disorder from seeking help. I’ve seen it thrown around as an insult on pages meant to be for cleaning tips, and at my first job back in college I was told “don’t be OCD about this task”…that was fun to hear as someone coming to terms with actually having OCD! Hearing it constantly referred to in an insulting or negative light can really add to the feelings of isolation and self-loathing, those feelings of being ‘a freak’.

The ‘clean and organised’ stereotype can also do a lot of harm, as it means people suffering with other types of OCD such as harm OCD or Pure O don’t even associate their symptoms with the disorder. Sometimes it’s a little awkward for me to admit to the germaphobic aspect of my OCD as it can fuel the stereotype, but I can tell you now that my room is not nearly as clean or organised as you might expect! Indeed, even with the most stereotypical form of OCD, I didn’t realise I had it, so anything that perpetuates misconceptions can be really harmful.

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

I think having more awareness of how OCD can be for real people is important (I’m really happy to see Zoella looking into this, and happy to help out!). There are a lot of social media accounts run by trained therapists and people with OCD that are really informative as well which helps (though of course, you have to be careful about misinformation). Charities like Mind and OCD Action are really useful too, as they can provide information and support for the sufferer and also friends/family, and it’s quite easy to access and understand. Depictions of OCD in TV/film that are realistic and not treated as a joke can also be helpful, and can give people characters to look up to (similarly, celebs being honest about their experiences of the disorder can be positive too). It’s a big ask, but I’d love to see the end of “I’m/you’re a bit OCD” – it’s not helpful and it really gets on my nerves, even if the person means well!

I also think that an awareness of OCD would be helpful at the college/university level, and in the NHS – my main barrier to help was that I got kind of… funnelled through the university and NHS systems in a way that pointed me to the wrong kind of treatment initially (one that was more general, made to deal with general uni stresses and anxieties), when I should have been on a more specific form of treatment that actually worked really well when I got to it! One of the most helpful things during that difficult first year was simply feeling seen and cared for by the student welfare team at my uni – they made sure I made and went to appointments, and helped me to feel less alone. Indeed, I was able to poke fun at a shared OCD experience with one of them, a fellow sufferer, because we could connect and understand how truly strange OCD can be.

Image Credit: @ObsessivelyEverAfter

Violet’s Story

How long have you had OCD and what was the road to diagnosis like for you?

I’ve officially had OCD for nearly 4 years, however, I personally think I have had it for around 5/6. The road to diagnosis for me was difficult, I went through CAMHS which did take a while (as most people know) but 2020 was the year I finally got to the top of the list and started to receive therapy.

Symptoms of Obsessive-Compulsive Disorder (OCD) vary from person to person, what does OCD look like for you and how does it affect your day-to-day life?

For me, my OCD was mainly Reassurance, Germ and Ritual OCD. This means I was washing my hands habitually almost every hour. After using the toilet I’d spent at least 5 minutes at the sink making SURE they are clean. From this, my OCD stemmed to ritual OCD in which where I would have to do something a certain amount of times, this was things from light switches to locking the doors. This is where the Reassurance OCD came in and I would stay up after everyone else and spend at least 20 minutes a night making sure all doors are locked and switches are off, this was all reassuring me that my family would be safe which was a big part of my OCD.

A lot of my OCD was family-based. My main trigger would be dripping taps, this is because I didn’t want to waste any money, and later figured that I’d been told as a child that “every drip is worth a penny, so make sure the tap is OFF”, which every child gets told, to make sure they turn off the tap as it wastes water! However in my head, the OCD took this information and twisted it, so I would make sure the tap is definitely off because I didn’t want my mum (who is a single parent and works so hard for her children) to waste money on a drippy tap. Additionally, I also had intrusive thoughts, this came in the forms of “if I don’t do this then something bad will happen”.

Are there certain triggers for your obsessions or compulsions?

I suffer from depression as well, so a low mood is a huge trigger. Right now there are very few triggers for me. One big one was obviously COVID, having had OCD before COVID, when the virus came around my OCD was probably at its peak and the fact a deadly virus was going around didn’t help! My main trigger was the dripping tap. Any time I would see a tap drip, I’d have to keep checking it’s off, keep touching it so it stays off.

Are there certain times or situations when your symptoms worsen?

When around lots of people, being in places I don’t know are clean. Fatigue and tiredness.

How do you manage living with OCD? Have you explored psychological treatment, support groups or anxiety management techniques?

I’ve received CBT via CAMHS. The therapy lasted around 6 months. Through the therapy I was taught so many techniques, one of the ones I still use is ERP. ERP is Exposure Response Prevention. Although it may seem weird, one of my targets was to simply sit in front of the sink and watch the tap drip. By doing this once and seeing after that in fact nothing bad did happen, I began to see things a lot differently!

Whilst there are some external, physical signs symptoms of OCD, it can also be an invisible mental illness. Can you talk to us about the emotional struggle of living with OCD and how some compulsions are not always quite so obvious?

For me personally, my OCD had a huge impact on my emotions and general mental health. I’d hear a lot of the time people saying at school and college “oh I’m so OCD” and “omg you’re triggering my OCD” and I’d think to myself how little they actually know, I’d think how they have no idea that I was counting how many people touched the door handle, and how I would be about to ask to go to the toilet just to wash my hands again but most of all, how I was about to go home and the compulsions would start all over again and it would mean another restless night. It became difficult as well to tell some of my friends, I’d tell them that I have been diagnosed with OCD and I distinctly remember one moment, where I felt so insignificant and silly for telling them, a friend said “oh well yeah everyone’s a bit OCD”. I remember after she said that I smiled and agreed and went home later and cried a lot.

Many people use the phrase “I’m a bit OCD” to describe themselves but there’s an acute difference between, say, liking an organised desk and having OCD. What common misconceptions or assumptions do you find particularly frustrating?

This leads on nicely from what I was just saying! For me a huge misconception is people thinking and assuming that OCD is just being super clean and organised. It really is not. Of course for some, part of their OCD is being really organised (me included) but anyone can be organised. A good way I like to explain it is that, anyone can organise their pens in colour order, but those with OCD may do this over and over and over until they feel satisfied.

The lack of understanding, even amongst professionals, can be particularly isolating. What changes would you like to see to ensure those living with OCD are seen, understood and supported?

For me, I’d like to see a bigger focus on the understanding of the indirect impact that OCD can have on an individual and their loved ones. For example, my OCD at one point meant that my mum struggled to sleep most nights as she was awake making sure I wasn’t washing my hands for too long, or wasn’t checking the doors too much.

Personally, I think OCD is one of the few disorders that people do not know enough about. I personally believe there is definitely a lack of professionals who know what and how to help OCD. Additionally, something I really think is necessary is for mental health to be taught in schools, for children and young people to learn what different mental health conditions mean and how they can identify and help them.

If you’re struggling with OCD, you can get help here at ocduk.org  or ocdaction.org.uk

Depression and OCD: Understanding the Connection

The short answer is yes. Because depression often begins after OCD symptoms develop, researchers think the difficulties of living with OCD can lead to depression symptoms.

Depression can develop because of:

  • the nature of your compulsive thoughts
  • difficulties caused by compulsive actions
  • the problems OCD causes in your life and relationships

Obsessions and depression

OCD sparks repetitive, unwanted, and upsetting thoughts. For many people, the very nature of the thoughts is enough to cause shock, fear, and eventually depression. Here’s an example of how that progression can work.

A new parent might have sudden, unwanted thoughts of harming the baby. About half of all parents (fathers and mothers) have intrusive thoughts exactly like these.

The thoughts can be frightening and cause enormous shame, even though the baby may never be in any actual danger. A parent who doesn’t realize how common these thoughts are might feel that something is wrong with them.

OCD causes intrusive thoughts like these and others. Not all intrusive thoughts involve violent imagery, but most are disturbing or unsettling.

Still, intrusive thoughts do not automatically indicate an increased risk of harm. But that risk may increase if the thoughts occur along with anxiety, depression, and OCD.

Distressing thoughts can also lead to depression over time because an individual having intrusive thoughts may feel out of control of their mind, which can be quite depressing and debilitating.

Studies from 2018 also show that ruminating — thinking the same worrisome, depressing, or negative thoughts over and over — is a key contributor to depression and OCD.

In a 2017 study, researchers asked people with OCD and depression questions to determine whether they were prone to anxious or depressing thoughts. Researchers found that having anxious and depressing thoughts was common in people with these two disorders.

In an older study, researchers found that people with OCD experienced fewer depression symptoms when they showed three common patterns:

  • thought their actions could change an outcome
  • thought themselves capable of taking those actions
  • thought they had control in a given situation, so they could take the necessary action

Compulsions and depression

In response to intrusive thoughts, people with OCD usually perform specific actions in the mistaken belief that their behaviors will either make the thoughts go away or prevent something bad from happening.

These compulsive behaviors must be performed flawlessly every time — a standard that is hard to meet.

Researchers say this kind of relentless perfectionism, the hallmark of OCD, is also a key factor in depression.

Functioning and depression

OCD and depression can adversely impact your ability to function in a healthy way. Obsessions affect your state of mind. Compulsions can interfere with your schedule.

When your relationships, social life, therapy, and performance on the job or in school are affected, you may begin to experience symptoms of depression. Researchers have found that the more severe obsessions and compulsions are, the more they impact your daily functioning, worsening depression symptoms.

25 Famous Women on Dealing With Anxiety

During the last two (pandemic) years, the number of women experiencing anxiety has skyrocketed. Millions of people worldwide have anxiety disorders, and women are twice as likely as men to be diagnosed in their lifetime, which is also true of depression. Back in 2020, when the world was first in lockdown, many people spoke out about how the isolation was affecting their mental health. Celebs like Selena Gomez took to Instagram to share diagnoses, and athletes like Naomi Osaka and Simone Biles took time off to care for their mental health. Below, we’ve rounded up sage advice from famous women who have lived through low moments and aren’t afraid to talk about it.

Read on to hear from Lady Gaga, Zendaya, Kerry Washington, Selena Gomez, and others on coping mechanisms, the importance of asking for and accepting help, and the necessity of speaking out about anxiety and mental health struggles.

1. Simone Biles
“My perspective has never changed so quickly from wanting to be on a podium to wanting to be able to go home, by myself, without any crutches. You know, there have been highs, there have been lows. Sometimes it’s like, yeah, I’m perfectly okay with it. And then other times I’ll just start bawling in the house. If I still had my air awareness, and I just was having a bad day, I would have continued, but it was more than that. Say up until you’re 30 years old, you have your complete eyesight. One morning, you wake up, you can’t see shit, but people tell you to go on and do your daily job as if you still have your eyesight. You’d be lost, wouldn’t you? That’s the only thing I can relate it to. I have been doing gymnastics for 18 years. I woke up — lost it. How am I supposed to go on with my day?” — the Cut, 2021

2. Selena Gomez
“Recently, I went to one of the best mental hospitals in America, McClean Hospital, and after years of going through a lot of different things, I realized that I was bipolar. And so when I get to know more information, it actually helps me. It doesn’t scare me once I know it. I think people get scared of that, right? They’re like, ‘Oh!’ And I’ve seen some of it in my own family, where I’m like, ‘What’s going on?’ I’m from Texas, it’s just not known to talk about mental health. You’ve got to seem cool. And then I see anger built up in children and teenagers or young adults because they are wanting that so badly. I just feel like when I finally said what I was going to say, I wanted to know everything about it. And it took the fear away.” — Instagram Live with Miley Cyrus, April 2020

3. Chika
“I’ve seen so much pain and so much realness in other people. Exposing my own almost feels like second nature. It doesn’t feel like if I say ‘Hey, I’ve been suicidal before’ someone could use that against me. I don’t feel vulnerable when I’m saying these things … It almost feels like having a superpower — of having iron just on me. Nothing penetrates that.” — the Cut, September 2020

4. Mara Wilson
“I’ve basically been an anxious person all my life. I have suffered from anxiety, I have Obsessive Compulsive Disorder, I’ve dealt with depression. I’ve been dealing with it for a very long time, for most of my life. I was an anxious kid and I’m still kind of an anxious adult. I wish somebody had told me that it’s okay to be anxious, that you don’t have to fight it. That, in fact, fighting it is the thing that makes it worse. That pushing it away is really what it is — it’s the fear of fear. And that, you know, it’s okay to be depressed. And also … that it’s not a romantic thing. You don’t have to be depressed. You don’t have to suffer with it. You can get help. You can reach out. Also, sort of on the flip side of that, being anxious and fighting that anxiety is actually just going to make it worse. I wish that I had fought my depression and not fought my anxiety as much. When you face anxiety, when you realize what it is, when you understand that it’s just this false alarm in your body, then you can work with it. Then you can overcome it.” — Project UROK, April 2015

5. Zendaya
“My anxiety first started when I was younger and I had to take a test at school. I remember panicking, and my teacher had to walk me out of the room and say, ‘Calm down, deep breaths.’ I don’t think it really came up again until I was about 16, when I was working and there was a project I had turned down. That was kind of my first time dealing with the internet, and it made me feel sick. I deleted everything and stayed in my room. Live performing really gave me anxiety too. I think a lot of it stems from the pressure I put on myself, wanting to do my best and not make a mistake. I definitely don’t have it under control yet. I don’t have the key, so if anybody does, let me know! I do find that talking about it is helpful, and that can often mean calling my mom in the middle of the night. Sometimes I make her sleep on the phone with me like a frickin’ baby.” — InStyle, August 2020

6. Lady Gaga
Reflecting on her rape and subsequent PTSD and anxiety: “My diaphragm seizes up. Then I have a hard time breathing, and my whole body goes into a spasm. And I begin to cry. That’s what it feels like for trauma victims every day, and it’s … miserable … I always say that trauma has a brain. And it works its way into everything that you do.” — SELF, September 2018

7. Summer Walker
After cutting her first and last tour short in November 2019: “Unfortunately, I’m not going to be able to finish this tour because it doesn’t really coexist with my social anxiety and my introverted personality. But I really hope that people understand and respect that at the end of the day that I’m a person — I have feelings, I get tired, I get sad, and it’s just a lot … I want to give you all what I can, so I’m going to keep making music and I might do a few shows, but I can’t finish.” — Instagram, 2019

8. Gloria Steinem
“I myself cried when I got angry, then became unable to explain why I was angry in the first place. Later I would discover this was endemic among female human beings. Anger is supposed to be ‘unfeminine’ so we suppress it — until it overflows. I could see that not speaking up made my mother feel worse. This was my first hint of the truism that depression is anger turned inward; thus women are twice as likely to be depressed.” — My Life on the Road, October 2015

9. Aparna Nancherla
“I have a lot of anxiety. Sometimes when you tell people you have anxiety, they’re like, ‘Well, you know, there’s nothing to fear but fear itself.’ It’s like, ‘Okay, have you checked out some of fear’s work? Pretty much turning out solid-gold hits, making some great points, rarely misfires.’ I would describe it as there is an edgy improv group in your brain, and it just needs a one-word suggestion to spin countless scenarios.” — The Half Hour, 2016

10. Emma Stone
“Before I went into second grade, I had my first panic attack. It was really, really terrifying and overwhelming; I was over at a friend’s house, and all of a sudden I was absolutely convinced the house was on fire and it was going to burn down. I was just sitting in her bedroom, and obviously the house wasn’t on fire — but there was nothing in me that didn’t think we weren’t going to die. I couldn’t go to friends’ houses; I had deep separation anxiety with my mom … We truly thought I wasn’t going to be able to move out of the house and move away ever. How would I go to college? How would I do any of this if I couldn’t be at a friend’s house for five minutes? … [It’s] healing to just talk about it and own it and realize that this is something that is part of me, but it is not who I am. And if that can help anybody … if I can do anything to say ‘Hey, I get it, and I’m there with you, and you can still get out there and achieve dreams and form really great relationships and connections,’ then I hope I’m able to do that.” — Child Mind Institute fireside chat, October 2018

11. Amy Tan
“Whatever it is that causes it, I think it’s just always going to be there. Part of it is having had a suicidal mother and maybe the things that have happened in my life … Like a lot of people, I had a resistance [to taking antidepressants], thinking that emotional or mental problems are things that you can deal with other than through medication. I also didn’t want anything to affect me mentally. But what a difference! And I thought, ‘Boy, what a different childhood I might have had had my mother taken antidepressants.’” — Time, March 2001

12. Samantha Irby
On dedicating her book Wow, No Thank You to Wellbutrin: “I do often wonder how sustainable it is to memorialize all of these bad thoughts. These books don’t go away, they’re permanent. But then I’m like, Well, if someone else can relate or connect, then it’s fine, it’s useful. And I still feel like we’re in on the joke together. I know myself well enough to know when it gets to a point of crossing that very thin line. It’s funny because we’ll say, ‘You’re so open. Is there anything you don’t share?’ Uh, yeah, the real shit that makes me feel bad. I don’t want to put anything in a book that I can’t shout out into the street.” — HuffPost, April 2020

13. Kristen Bell
“When I was 18, [my mom] said, ‘If you start to feel like you are twisting things around you, and you start to feel like there is no sunlight around you, and you are paralyzed with fear, this is what it is and here’s how you can help yourself.’ And I’ve always had a really open and honest dialogue about that, especially with my mom, which I’m so grateful for. Because you have to be able to cope with it. I mean, I present that very cheery bubbly person, but I also do a lot of work, I do a lot of introspective work and I check in with myself when I need to exercise and I got on a prescription when I was really young to help with my anxiety and depression and I still take it today. And I have no shame in that because my mom had said if you start to feel this way, talk to your doctor, talk to a psychologist and see how you want to help yourself. And if you do decide to go on a prescription to help yourself, understand that the world wants to shame you for that, but in the medical community, you would never deny a diabetic his insulin. Ever. But for some reason, when someone needs a serotonin inhibitor, they’re immediately crazy or something. And I don’t know, it’s a very interesting double standard that I often don’t have the ability to talk about but I certainly feel no shame about.” — Off Camera With Sam Jones, April 2016

14. Willow
“There’s shame. There’s guilt. There’s sadness. There’s confusion. And then you don’t even want to talk about it because you’re like, I feel crazy. I feel crazy for feeling this way, and I don’t want them to think I’m crazy, so I’m just not going to say anything.” — Red Table Talk, December 2020.

15. Elizabeth Gilbert
“When you’re lost in those woods, it sometimes takes you a while to realize that you are lost. For the longest time, you can convince yourself that you’ve just wandered off the path, that you’ll find your way back to the trailhead any moment now. Then night falls again and again, and you still have no idea where you are, and it’s time to admit that you have bewildered yourself so far off the path that you don’t even know from which direction the sun rises anymore. … I took on my depression like it was the fight of my life, which, of course, it was. … I tried so hard to fight the endless sobbing. I remember asking myself one night, while I was curled up in the same old corner of my same old couch in tears yet again over the same old repetition of sorrowful thoughts, ‘Is there anything about this scene you can change, Liz?’ And all I could think to do was stand up, while still sobbing, and try to balance on one foot in the middle of the living room. Just to prove that — while I couldn’t stop the tears or change my dismal interior dialogue — I was not yet totally out of control: at least I could cry hysterically while balanced on one foot.” — Eat, Pray, Love, February 2006

16. Naomi Osaka
“Hey everyone, this isn’t a situation I ever imagined or intended when I posted a few days ago. I think now the best thing for the tournament, the other players, and my well-being is that I withdraw so that everyone can get back to focusing on the tennis going on in Paris. I never wanted to be a distraction, and I accept that my timing was not ideal and my message could have been clearer. More importantly, I would never trivialize mental health or use the term lightly. The truth is that I have suffered long bouts of depression since the U.S. Open in 2018, and I have had a really hard time coping with that. Anyone that knows me knows I’m introverted, and anyone that has seen me at the tournaments will notice that I’m often wearing headphones as that helps dull my social anxiety. Though the tennis press has always been kind to me (and I want to apologize, especially to all the cool journalists who I may have hurt), I am not a natural public speaker and get huge waves of anxiety before I speak to the world’s media. I get really nervous and find it stressful to always try to engage and give you the best answers I can. So here in Paris, I was already feeling vulnerable and anxious, so I thought it was better to exercise self-care and skip the press conferences. I announced it preemptively because I do feel like the rules are quite outdated in parts, and I wanted to highlight that. I wrote privately to the tournament apologizing and saying that I would be more than happy to speak with them after the tournament as the Slams are intense. I’m gonna take some time away from the court now, but when the time’s right I really want to work with the Tour to discuss ways we can make things better for the players, press, and fans.” — Instagram, May 2021

17. Miley Cyrus
“I feel like I was going to have a panic attack. I want to tell you about the experience. Like everyone else, for the last year and a half, I have been locked away and isolated, and it is very stunning to be back in a place that used to feel like second nature. Being on stage used to feel like home, and it doesn’t anymore because of how much time I spent at home locked away. The pandemic was startling and terrifying, and coming out of it is slightly terrifying. So I just wanted to be honest with how I’m feeling because I think by being honest about that, it makes me less afraid.” — During a show, September 2021

18. Elizabeth Wurtzel
“That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal — unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.” — Prozac Nation, 1994

19. Kerry Washington
On seeing a therapist: “I say that publicly because I think it’s really important to take the stigma away from mental health. … My brain and my heart are really important to me. I don’t know why I wouldn’t seek help to have those things be as healthy as my teeth. I go to the dentist. So why wouldn’t I go to a shrink?” — Glamour, April 2015

20. Kristen Stewart
“Between ages 15 and 20, it was really intense. I was constantly anxious. I was kind of a control freak. If I didn’t know how something was going to turn out, I would make myself ill, or just be locked up or inhibited in a way that was really debilitating … At one point, you just let go and give yourself to your life. I have finally managed that and I get so much more out of life. I’ve lived hard for such a young person, and I’ve done that to myself — but I’ve come out the other end not hardened but strong. I have an ability to persevere that I didn’t have before. It’s like when you fall on your face so hard and the next time, you’re like, Yeah, so? I’ve fallen on my face before.” — Marie Claire, August 2015

21. Cara Delevingne
“This is something I haven’t been open about, but it’s a huge part of who I am. All of a sudden I was hit with a massive wave of depression and anxiety and self-hatred, where the feelings were so painful that I would slam my head against a tree to try to knock myself out. I never cut, but I’d scratch myself to the point of bleeding. I just wanted to dematerialize and have someone sweep me away … I thought that if I wanted to act, I’d need to finish school, but I got so I couldn’t wake up in the morning. The worst thing was that I knew I was a lucky girl, and the fact that you would rather be dead … you just feel so guilty for those feelings, and it’s this vicious circle. Like, how dare I feel that way? So you just attack yourself some more.” — Vogue, July 2015

22. bell hooks
“Isolation and loneliness are central causes of depression and despair. Yet they are the outcome of life in a culture where things matter more than people. Materialism creates a world of narcissism in which the focus of life is solely on acquisition and consumption. A culture of narcissism is not a place where love can flourish.” — All About Love: New Visions, January 2001

23. Ariana Grande
“I’ve been open in my art and open in my DMs and my conversations with my fans directly, and I want to be there for them, so I share things that I think they’ll find comfort in knowing that I go through as well. But also there are a lot of things that I swallow on a daily basis that I don’t want to share with them, because they’re mine. But they know that. They can literally see it in my eyes. They know when I’m disconnected, when I’m happy, when I’m tired. It’s this weird thing we have. We’re like fucking E.T. and Elliott. I’m a person who’s been through a lot and doesn’t know what to say about any of it to myself, let alone the world. I see myself onstage as this perfectly polished, great-at-my-job entertainer, and then in situations like this I’m just this little basket-case puddle of figuring it out. I have to be the luckiest girl in the world, and the unluckiest, for sure. I’m walking this fine line between healing myself and not letting the things that I’ve gone through be picked at before I’m ready, and also celebrating the beautiful things that have happened in my life and not feeling scared that they’ll be taken away from me because trauma tells me that they will be, you know what I mean?” — Vogue, July 2019

24. Kate Moss
“I had a nervous breakdown when I was 17 or 18, when I had to go and work with Marky Mark and Herb Ritts. It didn’t feel like me at all. I felt really bad about straddling this buff guy. I didn’t like it. I couldn’t get out of bed for two weeks. I thought I was going to die. I went to the doctor, and he said, ‘I’ll give you some Valium,’ and Francesca Sorrenti, thank God, said, ‘You’re not taking that.’ It was just anxiety. Nobody takes care of you mentally. There’s a massive pressure to do what you have to do. I was really little, and I was going to work with Steven Meisel. It was just really weird — a stretch limo coming to pick you up from work. I didn’t like it. But it was work, and I had to do it.” — Vanity Fair, October 2012

25. Tavi Gevinson
“There are a lot of different kinds of sadness, but the two broadest categories are the kind that can be beautiful and cathartic and you’re crying and listening to music and it feels kind of good actually, and the kind where it just sucks and you don’t want to get out of bed and you feel completely trapped. And my methods for both are different. For the beautiful one I just try to see it for what it is, and use it to get out a good cry and enjoy an album or whatever, or spoon with a friend. And with the other kind … the good thing is that these days, nothing feels like the end of the world anymore, whereas in the earlier years of high school, and throughout middle school — and elementary school, actually — that stuff was really hard.” — Rookie, January 2014

Group Says Some Government Funded Mental Health Experts Being Redeployed To Fight Omicron Leaving “S …

KAWARTHA LAKES-The Canadian Perinatal Mental Health Collaborative (CPMHC) is urging the federal government to keep its promise to ensure timely access to perinatal mental health services as it develops its response to the Omicron variant.

“At a time when everyone is feeling a loss of hope from yet another lockdown, we cannot forget our most vulnerable families: pregnant and postpartum women and birthing people who are already struggling with a mood or anxiety disorder,” CPMHC co-executive director, Patricia Tomasi said. “This population needs timely access to perinatal mental health services, as the federal government promised to provide in its platform and recent mandate letter.”

The CPMHC says it is not disputing the need for measures to help ease the burden on health care facilities and health care providers, they believe measures must also be taken to ensure the mental well-being of families during this difficult time.

“We are hearing from moms, dads, partners and birthing persons that they are at their breaking point and do not know where to turn for help,” CPMHC co-executive director, Jaime Charlebois said. “Time is of the essence. Struggling parents need help now.”

Officials say government-funded, specialist perinatal mental health care providers such as specially trained psychiatrists, nurses, and social workers exist in a handful of urban hospitals across Canada, but waitlists are long, and many are being redeployed in the wake of the Omicron crisis, leaving serious gaps in service.

“We believe that access to specially trained perinatal mental health care providers (such as those listed on the Postpartum Support International Canadian directory – www.psidirectory.com) should be ensured – regardless of an individual’s ability to pay.” says the group.

Perinatal mental illness includes prenatal and postpartum depression, anxiety, obsessive compulsive disorder, bipolar disorder, and psychosis according to CPMHC.

In Canada and worldwide, 20% of women and 10% of men suffer from a perinatal mental illness. Perinatal mood and anxiety disorders are the most common obstetrical complication making it a significant public health concern.

 

Paranoia vs. Anxiety: Understanding the Differences

Accurate diagnosis is important for any mental health condition, especially when it comes to conditions that share some similarities, like paranoia and anxiety.

Diagnosis is a layered process in order to rule out any other conditions.

Paranoia

Before making any kind of diagnosis, your doctor will do a complete physical exam to rule out any underlying medical conditions that could be causing paranoia, like dementia.

They will also document your personal history to collect information about your health, behaviors, and lifestyle. This information may be an important factor in paranoia. For example, drug use may cause paranoia.

Your doctor may also order blood tests to check for any medical conditions that could be causing your symptoms.

They may also do some interviews or assessments in order to understand your thought processes and use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria to make a diagnosis of a paranoid-type disorder.

Anxiety

A physical exam is typically done in order to rule out illnesses that may be causing your anxiety. The doctor will also take a personal history to get more information about your:

  • symptoms
  • functioning
  • health behaviors
  • lifestyle

They may order a variety of tests to also rule out other medical conditions with symptoms that mimic anxiety symptoms.

The DSM-5 has certain criteria for anxiety disorders, and you may be given some questionnaires or tests that will then be reviewed. These can include:

Your healthcare professional will also use the DSM-5 to evaluate your symptoms to make an informed diagnosis.

Symptoms of patients with personality disorders worsened during COVID-19 lockdown

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Patients with personality disorders experienced worsened symptoms, some of which have not improved, during the COVID-19 pandemic, according to an observational retrospective study published in Psychiatry Research.

“Subjects affected by personality disorders (PDs) resulted to be more compromised in terms of general psychopathology than depressed and anxiety/[obsessive-compulsive] ones and showed more severe anxiety symptoms than [schizophrenia] patients,” Alice Caldiroli, MD, of the University of Milan, and colleagues wrote.

Caldiroli and colleagues designed the study to compare the change in severity of psychiatric symptoms in different diagnostic groups during the first wave of the COVID-19 pandemic. Between Nov. 12, 2020, and Jan. 31, 2021, 166 patients aged 18 to 65 years (mean age, 49.22 years) from the Monza district in Northern Italy were routinely evaluated during psychiatric visits to assess changes in their psychopathological status throughout the pandemic. A total of 39.8% of the patients had schizophrenia, 17.5% bipolar disorder, 21.7% major depressive disorder, 10.2% anxiety or obsessive-compulsive disorder and 10.8% personality disorders.

The researchers divided the study into three time points: T0, representing the outbreak of the pandemic (January or February 2020), T1 as the lockdown period (March or April 2020) and T2 as reopening (May or June 2020), with the changes and developments among the individuals being assessed in all three. The researchers divided the patients into five groups (schizophrenia, bipolar disorder, MDD, anxiety disorders or OCD and personality disorders) and used linear regression models to determine whether change over time in psychometric scores differed between diagnostic groups. They performed descriptive analysis on the entire sample and used the Brief Psychiatry Rating Scale (BPRS), Clinical Global Impression scale (CGI-S) and the Hamilton Anxiety Rating scale (HAM-A) to assess the individuals at T0, T1 and T2.

Caldiroli and colleagues noted significant worsening of psychometric scores during the lockdown restrictions, followed by mild improvement in symptoms at the reopening for general psychopathology, global severity and functioning, anxiety, disability and depressive symptoms in patients with affective disorders. Those with personality disorders reported overall more severe anxiety than patients with schizophrenia during the first 6 months of the pandemic.

“Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2,” Caldiroli and colleagues wrote. “Only psychopathology in schizophrenia patients and obsessive-compulsive symptoms did not significantly improve at T2.”

The authors noted that despite psychiatric hospital visits dropping in T1 across Northern Italy, BPRS and CGI-S scores showed that psychiatric symptoms, particularly for patients with MDD and anxiety/OCD, worsened globally. The study’s findings that OCD symptoms showed “poor improvement” at T3 are supported by other studies, according to the authors.

“In conclusion, subjects affected by [personality disorders] require specific clinical attention during COVID-19 pandemic,” Caldiroli and colleagues wrote. “Moreover, the worsening of [schizophrenia] and OCD symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures.”

 

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