Multiple diagnoses are the norm with mental illness; new genetic study explains why

More than half of people diagnosed with one psychiatric disorder will be diagnosed with a second or third in their lifetime. About a third have four or more.

This can make treatment challenging and leave patients feeling unlucky and discouraged.

But a sweeping new analysis of 11 major psychiatric disorders offers new insight into why comorbidities are the norm, rather than the exception, when it comes to mental illness. The study, published this week in the journal Nature Genetics, found that while there is no gene or set of genes underlying risk for all of them, subsets of disorders—including bipolar disorder and schizophrenia; anorexia nervosa and obsessive-compulsive disorder; and major depression and anxiety—do share a common genetic architecture.

“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” said lead author Andrew Grotzinger, an assistant professor in the Department of Psychology and Neuroscience.

Andrew Grotzinger

Andrew Grotzinger

The finding could ultimately open the door to treatments that address multiple psychiatric disorders at once and help reshape the way diagnoses are given, he said.

“If you had a cold, you wouldn’t want to be diagnosed with coughing disorder, sneezing disorder and aching joints disorder,” Grotzinger said. “This study is a stepping stone toward creating a diagnostic manual that better maps on to what is actually happening biologically.”

How the study worked

For the study, Grotzinger and colleagues at University of Texas at Austin, Vrije Universiteit Amsterdam and other collaborating institutions analyzed publicly available genome-wide association (GWAS) data from hundreds of thousands of people who submitted genetic material to large-scale datasets, such as the UK Biobank, 23 and Me, IPsych, and the Psychiatric Genomics Consortium.

They looked at genes associated with 11 disorders, including: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder, Tourette syndrome, post-traumatic stress disorder, problematic alcohol use, ADHD and autism.

In addition, they looked at data gathered via wearable movement tracking devices, and survey data documenting physical and behavioral traits.

Then they applied novel statistical genetic methods to identify common patterns across disorders.

Linked diagnoses

They found 70% of the genetic signal associated with schizophrenia is also associated with bipolar disorder. That finding was surprising as, under current diagnostic guidelines, clinicians typically will not diagnose an individual with both.

They also found anorexia nervosa and obsessive-compulsive disorder have a strong, shared genetic architecture, and that people with a genetic predisposition to have a smaller body type or low BMI (body mass index), also tend to have a genetic predisposition to these disorders.

Not surprisingly, as the two diagnoses often go together, the study found a large genetic overlap between anxiety disorder and major depressive disorder.

When analyzing accelerometer data, the researchers found disorders that tend to cluster together also tend to share genes that influence how and when we move around during the day.

For instance, those with internalizing disorders, such as anxiety and depression, tend to have a genetic architecture associated with low movement throughout the day. Compulsive disorders (OCD, anorexia) tend to correlate with genes associated with higher movement throughout the day, and psychotic disorders (schizophrenia and bipolar disorder) tend to genetically correlate with excess movement in the early morning hours.

“When you think about it, it makes sense,” said Grotzinger, noting that depressed individuals often present as fatigued or low energy, while those with compulsive disorders can have difficulty sitting still.

In all, the study identifies 152 genetic variants shared across multiple disorders, including those already known to influence certain types of brain cells.

For instance, gene variants that influence excitatory and GABAergic brain neurons—which are involved in critical signaling pathways in the brain—appear to strongly underly the genetic signal that is shared across schizophrenia and bipolar disorder.

What’s next

While much more needs to be done to determine exactly what the identified genes do, Grotzinger sees the research as a first step toward developing therapies that can address multiple disorders with one treatment.

“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses and in some instances those medicines can have side effects,” he said. “By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions.”

Meantime, just understanding the genetics underlying their disorders may provide comfort to some.

“It’s important for people to know they didn’t just get a terrible roll of the dice in life—that they are not facing multiple different issues but rather one set of risk factors bleeding into them all.”

All about Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

Symptoms Obsession

Obsessions are usually extravagant versions of concerns and worries that most people have at some time. Common obsessions include:
• fear of contamination from germs, dirt, poisons, and other physical and environmental substances
• fear of harm from illness, accidents, or death that may occur to oneself or to others. This may include an excessive sense of responsibility for preventing this harm
• intrusive thoughts and images about sex, violence, accidents, and other issues
• excessive concern with symmetry, exactness, and orderliness
• excessive concerns about illness, religious issues, or morality

Symptoms of Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person’s distress related to an obsession. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Typical compulsions:

• Excessive or ritualized hand washing, showering, brushing teeth, or toileting
• Repeated cleaning of household objects
• Ordering or arranging things in a particular way
• Repeatedly checking locks, switches, or appliances
• Constantly seeking approval or reassurance
• Repeated counting to a certain number

Treatment

As for each person with OCD, every case is unique and has specific needs.
To determine if you have OCD, a mental health professional will consider several factors. First, your clinician will ask if you are experiencing any of the common obsessions and compulsions associated with OCD. The clinician will also want to know if your obsessions or compulsions are negatively affecting the way you function day-to-day.

Other factors your clinician will consider include other psychiatric conditions you might have, your family history, and any environmental, social, or physical problems you might be having that could contribute to your anxiety.
Working with an OCD specialist or someone well versed in the signs and symptoms of OCD is critical to obtaining a proper diagnosis. After receiving a diagnosis of OCD, you must have a care team that can help craft the proper treatment plan that works for you and your OCD, whether through talk/behavioural therapy, medication, or a combination of treatments.

Behavioral Therapy

Behavioral therapy involves a one-on-one relationship between a patient and a therapist. The most effective approach used to treat anxiety disorders and OCD is cognitive behavior therapy or CBT. The goal of CBT is to help the patient learn to think and behave differently when they experience fear or anxiety. CBT may also teach social skills. A clinician may recommend a specific type of CBT, depending on the diagnosis.

Exposure and Response Prevention

Many patients benefit from a specific type of CBT known as exposure and response prevention therapy, or ERP. This is often referred to as the gold-standard behavioural therapy approach for OCD.

This treatment, which is well supported by research, involves exposing the patient to triggers that cause their anxiety and teaching them to no longer respond to the exposure with rituals or compulsions. A specific treatment plan is created for each individual. ERP should be used with an OCD specialist.

Medication

Several different medications can be used to help relieve the symptoms of OCD. Medication is typically prescribed by a physician or psychiatrist. Examples of medications that may be used to treat OCD include beta-blockers, antidepressants, and anti-anxiety medications.

Stress Management

Research shows that self-care and relaxation techniques may help people with anxiety disorders like OCD to experience fewer symptoms. Examples of stress management techniques include regular exercise, yoga, meditation, and deep breathing. Getting plenty of sleep, focusing on nutrition, and limiting consumption of alcohol and caffeine are also recommended.

Self-help tips for people living with OCD

There are many ways that you can help yourself in addition to seeking therapy. Some suggestions are:
• Refocus your attention (like doing some exercise or playing a computer game). Being able to delay the urge to perform a compulsive behaviour is a positive step.
• Write down obsessive thoughts or worries. This can help identify how repetitive your obsessions are.
• Take care of yourself. Although stress doesn’t cause OCD, it can trigger the onset of obsessive and compulsive behaviour or make it worse. Try to practice relaxation (such as mindfulness meditation or deep breathing) techniques for at least 30 minutes a day.

OCD and Thoughts of Suicide: What Does It Mean?

Most people have random intrusive thoughts every now and again. But, if you have OCD, these tend to be persistent. It might be hard to let go of them, too.

With OCD, you might be so disturbed by an intrusive thought that you keep thinking about it. Thoughts, images, and urges can become increasingly persistent and disturbing. Persistent, disturbing thoughts are considered obsessions.

With OCD, those obsessions can take on different “themes.” This means you tend to have the same or very similar obsessions.

Common OCD themes include:

Suicidal OCD can be considered a kind of harm OCD.

Someone who has obsessions about ending their life doesn’t necessarily want to act on those thoughts. In fact, suicidal thoughts become an obsession because the person finds these thoughts so distressing they can’t stop thinking about them.

It’s not always easy to distinguish between suicidal ideation and suicidal obsessions. Discussing these images and thoughts with a mental health professional can help you understand them better and come up with ways to manage them.

What is pure-O OCD?

Pure-O OCD, or pure obsessional OCD, involves both formal symptoms of OCD: obsessions and compulsions.

Compulsions are rituals or repetitive actions that people with OCD do to relieve some of the distress obsessions cause. Compulsions might involve mental rituals, mentally repeating mantras, or self-reassurance.

In pure-O OCD, however, compulsions tend to be less obvious or less frequent, while obsessions are dominant.

Postpartum OCD: Symptoms, Causes, and Treatment

It’s normal for new parents to fret about the health and well-being of their baby. However, if these thoughts become intrusive (unwelcome and involuntary) and begin to affect your functioning, you may be suffering from postpartum obsessive-compulsive disorder (pOCD). 

In about 2.5% of women and some men, OCD symptoms can become worse during pregnancy or childbirth. When this happens, it’s called postpartum OCD or perinatal OCD. Luckily, treatments such as cognitive behavioral therapy can help. 

This article discusses postpartum OCD, including OCD symptoms, treatments, and how to help a loved one with this condition. 

Asian mother and baby.

Asian mother and baby.

rudi_suardi/Getty Images


What Is Postpartum OCD?

Postpartum OCD is an obsessive-compulsive disorder that emerges in the year after a person gives birth. OCD symptoms can also emerge during pregnancy. This is known as perinatal OCD. These conditions are treated similarly and are collectively known as pOCD.

Like OCD, pOCD is characterized by these two sets of symptoms:

  • Obsessions are intrusive thoughts, impulses, or beliefs that cause distress.
  • Compulsions are actions and rituals undertaken to try to control, prevent, or avoid obsessions.

Examples of Postpartum OCD

Understanding the symptoms of postpartum OCD can help you identify if you or a loved one is dealing with pOCD. Here’s what the symptoms might look like. 

Obsessive Thoughts

Obsessions can include:

  • Fear of accidentally harming your baby
  • Worry or obsession that someone else has harmed the baby
  • Intrusive thoughts about the baby dying
  • Intrusive thoughts about shaking, drowning, or harming the baby, even when this horrifies you 
  • Worry about the baby getting sick
  • Fear that you put the baby somewhere dangerous or forgot the baby 
  • Worry about SIDS (sudden infant death syndrome, the unexplained death of a seemingly health infant during sleep)

Although obsessive thoughts can be disturbing, research shows that they are normal, and mothers with pOCD are extremely unlikely to harm their infants.

Compulsions

In order to deal with obsessions, people with pOCD develop compulsions. These can include:

  • Checking on the baby excessively
  • Insisting on having another adult present when you’re with the baby
  • Not allowing others to watch or hold the baby
  • Avoiding activities like bathing, carrying the baby on stairs, or leaving the house
  • Handwashing and sanitizing in excess 
  • Not sleeping for fear of something happening to the baby

Other Symptoms of Postpartum OCD

While obsession and compulsions are the main symptom sets of OCD, they can lead to other symptoms. You may:

  • Feel depressed
  • Question your ability to parent
  • Hide your symptoms for fear that someone will take you away from the baby
  • Have trouble caring for or bonding with your infant
  • Experience distress in other relationships, like with your spouse

Postpartum OCD vs. Postpartum Anxiety

Postpartum and perinatal mood disorders can be difficult to tell apart because there is a lot of overlap with conditions like postpartum anxiety, depression, and OCD. Because of this, the medical community thinks that pOCD is likely underdiagnosed. 

Postpartum OCD differs from postpartum anxiety because it features both obsessions and compulsions. Still, OCD can cause anxiety, and anxiety can fuel OCD. It’s possible to have more than one postpartum mood disorder at once.

Whenever you’re experiencing symptoms of a mood disorder in the postpartum or perinatal period, it’s best to talk with an experienced health professional who can get you an accurate diagnosis. 

Causes and Risk Factors

Healthcare providers don’t know what causes postpartum and perinatal mood disorders, including postpartum OCD. It’s believed that hormonal changes and lack of sleep play a role. Postpartum OCD is most common in the birthing parent, but partners who did not give birth can also experience pOCD. 

People who have previously been diagnosed with a mood disorder are at higher risk for developing pOCD. Between 25% and 75% of people with OCD will have a recurrence after they give birth.

In addition, pOCD also occurs alongside other mood disorders. More than 70% of people with pOCD also experience depression and more than 27% also experience an anxiety disorder. If you’re getting treatment for postpartum depression or anxiety, but still experience symptoms of OCD, talk with your healthcare provider about whether you might also have postpartum OCD. 

Treatment for Postpartum OCD

Treatment for pOCD is similar to treatment for OCD. Cognitive behavioral therapy (CBT) is the first-line treatment for postpartum OCD. During CBT sessions, you’ll learn that intrusive thoughts are normal and not dangerous. This allows you to change how you interpret your thoughts, and eventually change or eliminate your compulsive behaviors. 

In addition, medications known as serotonin reuptake inhibitors (SSRIs) can help control symptoms of OCD. These are safe for most pregnant and breastfeeding people, although you should talk to your healthcare provider about your specific circumstances. 

It’s important to get help for postpartum OCD as soon as possible. Postpartum OCD often comes on suddenly and can be severe. Taking medication and attending therapy—even with your baby in tow— can help you feel healthy again.

Summary

Postpartum OCD is an obsessive-compulsive disorder that emerges or worsens in the first year after giving birth. It can also emerge during pregnancy, which is known as perinatal OCD. The condition is characterized by intrusive thoughts, such as worrying about the baby’s safety, and compulsions, like watching the baby sleep. Therapy and medication can both help control symptoms. 

A Word From Verywell

Many new parents anticipate that bringing home a baby is going to be a time of great joy. When you or your partner experiences postpartum mood disorders like postpartum OCD, it can be devastating. Remember that these conditions are normal complications of childbirth. Ask for help. Treatments are available that will have you feeling back to normal in no time. 

Frequently Asked Questions

  • It’s normal for new parents to experience some obsessive or intrusive thoughts. However, if these last longer than two weeks or interfere with your ability to care for your baby, they are considered postpartum OCD. It’s unclear how long postpartum OCD lasts, but it’s important to get treatment as soon as possible. 

  • Yes, postpartum OCD is related to postpartum depression. These two conditions can coexist and make each other worse. If you’re dealing with a postpartum mood disorder, talk to your healthcare provider about all your symptoms. 

  • Postpartum OCD is characterized by obsessions and compulsions. You might have intrusive thoughts of violence, like seeing yourself shaking the baby, but you know these are wrong. Postpartum psychosis is much rarer. It’s characterized by hallucinations and delusions, where you truly believe things that are false. For example, someone with postpartum psychosis might believe their baby is possessed and must be harmed.

  • The best way to help a loved one with postpartum OCD is to connect them with an experienced mental health professional. Assuring them that everything will be fine or downplaying their obsessions can actually make matters worse. Remember, postpartum OCD is a medical condition that requires medical treatment.

Real Event OCD: What It Is and How to Cope

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive thoughts (obsessions) and engages in specific actions (compulsions) to relieve anxiety caused by the obsessions. The compulsions are often unrelated to the nature of the obsession, and the adverse consequences are almost always imagined and irrational.

Unlike most manifestations of OCD, real event OCD centers around an actual event that occurred in the past, instead of imagined expectations of future events. While everyone experiences guilt or regret, people with real event OCD become fixated on an experience that makes them question their character or morals, engaging in thoughts and actions that seek to reassure themselves.

Read on to learn more about real event OCD and its treatments.

A woman sits with her head resting on her hand. She has a concerned expression on her face.

A woman sits with her head resting on her hand. She has a concerned expression on her face.

Jamie Grill / Getty Images


What Is Real Event OCD?

People with real event OCD (also called real-life OCD) become fixated on actual events or past experiences that caused them to question their morality, making them feel as though they aren’t a good person. They may replay the event over and over in their minds, analyzing all the details, and scrutinizing their role in it and any harm they may have caused through their actions.

They may worry about potential consequences of the event, such as losing a relationship with a loved one. They are also likely to take actions to reassure themselves, though this reassurance is short-lived.

The event can be something minor such as a rude remark to a customer service representative, something major like drinking and driving, or anything that makes them fear they are a bad person.

They may be focused on a recent event or something well in the past, such as an item they stole from a store as a child decades ago.

Trauma-Related OCD

OCD symptoms may also be triggered by real-life experiences, like trauma. Traumatic experiences can include abuse, neglect, or other disruptions to family life.

Examples and Signs of Real Event OCD

Real event OCD is made up of the following three components:

  • Event: What really happened
  • Obsession: Intrusive thoughts about what happened, often irrational or exaggerated
  • Compulsions: Actions taken to try to gain temporary reassurance

For example, a person with real event OCD might experience:

  • Event: You encouraged a school friend to try recreational drugs, which made them feel paranoid. Years later, they were diagnosed with schizophrenia.
  • Obsession: You become convinced the person’s schizophrenia was caused by the drugs and, therefore, it was your fault. You then believe that this makes you a bad person.
  • Compulsions: You research schizophrenia and its causes, ask others who were there when the person took the drug (and if they thought the person seemed reluctant to try it), replay the details of the event in your mind to see if you had pressured the person, and try to remember if you noticed any previous signs of mental health illness in the friend.

Common Obsessions

Real event OCD obsessions can arise from anything that causes the person concern about their moral character, such as whether they are a good person, or potential future fallout stemming from the event.

These obsessions may include:

  • Worrying they said or did something bigoted or offensive
  • Fearing they have acted inappropriately
  • Fearing consequences, such as punishment or being “cancelled,” or worrying about getting caught
  • Worrying their actions have caused others harm
  • Feeling they may have been critical, inauthentic, or unfair
  • Worrying their thoughts or actions make them a bad person
  • Having intense, overwhelming feelings of shame, guilt, or embarrassment

People with real event OCD tend to overestimate the importance of their actions. For example, they may ruminate regularly on a hurtful thing they said to a classmate in elementary school, worrying it caused them lasting harm, when their classmate doesn’t remember the incident.

If they can’t clearly remember every detail of the event, they are likely to assume something bad happened.

These obsessions cause anxiety that creates an urgent need to seek answers or reassurance.

Common Compulsions

A person with real event OCD will try to relieve the anxiety caused by their obsessions through compulsive actions. These might include:

  • Seeking punishment for their actions
  • Repeatedly going over past behaviors, looking for wrongdoings and evaluating their actions
  • Confessing or unnecessarily apologizing for their perceived wrongdoings (often after a long time has passed)
  • Seeking reassurance from friends and family either that they didn’t do anything bad or that they aren’t a bad person, sometimes using progressive hypothetical situations
  • Looking for ways to prove to themselves that they are a good person
  • Calling authority figures to inquire about potential consequences from past actions
  • Reimagining the event the way they would have liked it to go

The relief brought on by these compulsions is usually temporary. The intrusive thoughts seep back in, and the cycle begins again.

Treatment for Real Event OCD

First-line treatment for OCD is behavioral psychotherapy (talk therapy). Medication can be helpful for some people in combination with therapy.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) involves identifying problematic thought and behavior patterns and gradually changing them into healthy ones.

The main form of CBT used for OCD is exposure and response prevention (ERP).

Under the guidance of a mental health professional, people with OCD are exposed to their fears at gradually increasing intensities. For a person with real event OCD, this might mean:

  • Allowing intrusive thoughts to arise
  • Exposing themselves to things, such as music or images, that make them think of the event or experience
  • Writing stories or songs, or creating artwork about the event or the feared consequences of it
  • Visiting the location of the event
  • Engaging in actions that trigger the obsessive thoughts

During this exposure, the person is urged to resist doing any compulsions or actions to try to reduce the anxiety.

Over time and repeated exposures, the person builds an increased capacity to resist the compulsions and, ideally, the obsessions reduce.

Medication

Medication like antidepressants may be used to help manage symptoms, particularly along with therapy to strengthen the effectiveness of both treatments. Sometimes, other types of medications are used to increase the benefit of antidepressants.

Antidepressant medications that may be prescribed include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Prozac (fluoxetine)
  • Paxil (paroxetine)
  • Celexa (citalopram)
  • Luvox (fluvoxamine)
  • Zoloft (sertraline)
  • Lexapro (Escitalopram)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

  • Pristiq (desvenlafaxine)
  • Effexor (venlafaxine)
  • Cymbalta (duloxetine)

Tricyclic Antidepressant

  • Anafranil (clomipramine)

Mindfulness

Mindfulness involves allowing thoughts to come and go without assigning them judgment.

Acceptance and commitment therapy (ACT) is a type of psychotherapy that integrates aspects of mindfulness that can be used to teach people with OCD to accept their intrusive thoughts, rather than reacting or responding to them.

One of the goals of ACT is to separate the intrusive thoughts from the thinker, allowing them to be seen as separate entities and taking actions based on a person’s values, not their obsessions. This way, they can acknowledge the thought as an “OCD thought,” not as a fact.

Thoughts can also be reframed. For example, instead of thinking, “I am a horrible person,” they might think, “I feel bad that I did that.” Labeling the action—not the person—allows room for positive change.

From there, the person can take actionable steps to make the situation better now and/or avoid repeating the behavior in the future. This helps to move past the situation in a healthy, productive way, instead of being caught in an obsessive-compulsive cycle.

OCD Support Groups

Support groups are not a substitute for professional treatments like therapy, but they can be very valuable. Talking to others who understand your experiences firsthand is a great way to foster community, share resources, and offer and receive support.

The International OCD Foundation offers great information on how to find (or start) support groups.

Diet and Lifestyle Changes

OCD cannot be treated with lifestyle changes alone, but developing healthy habits is important for overall health and can be a great support for traditional treatments.

Healthy habits worth adopting include:

  • Eating nutritious foods
  • Moving your body regularly
  • Getting enough quality sleep
  • Practicing relaxation exercises, such as yoga, mindfulness, or meditation
  • Avoiding/limiting tobacco, caffeine, and alcohol
  • Following your treatment plan
  • Engaging in activities you enjoy
  • Fostering and maintaining positive relationships

Summary

Real event OCD is a form of OCD in which a person becomes consumed by thoughts and feelings of guilt about a real event that happened sometime in the past. These thoughts cause them to question their own morality. Compulsive actions follow in an effort to manage the anxiety triggered by the obsessions.

Real event OCD is typically treated with medication and/or behavioral therapy. Healthy lifestyle habits and mindfulness may also be beneficial.

A Word From Verywell 

Feeling a degree of guilt over an action that you believe caused harm is normal and can even be healthy. But if that guilt becomes consuming, is disproportionate to the actions, or you can’t seem to stop fixating on it, see a healthcare provider or mental health professional. They can help you find healthy ways to manage your feelings and move past the experience.

Obsessive-Compulsive Disorder Market: Rise in prevalence of people with OCD to drive the market

Albany NY, United States: Global Obsessive Compulsive Disorder Market: Overview

Obsessive-compulsive disorder (OCD) may be defined as an anxiety disorder that is characterized by unreasonable and uncontrollable thoughts and fears that lead an individual to perform repetitive behaviors. Obsessive-compulsive disorder compels a person to get stuck on a particular thought or fear. For example, a person afraid of contamination may wash his/her hands repetitively in an order to make sure his/her hands are clean. Likewise, a person may check a gas stove multiple times to be sure that it’s really turned off. Usually people affected with obsessive-compulsive disorder possess both obsessions as well as compulsions; however, in many cases individuals may have either obsessions or compulsions.

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Some common thoughts that usually pop up in mind of people with obsessive-compulsive disorder are fear of being contaminated by germs or dirt, excessive thinking about religious or moral ideas, superstitions, having things orderly or symmetrical, doubts that stove is turned off and thoughts of hurting oneself or others. These thoughts cause people with obsessive-compulsive disorder to perform actions like repeatedly checking of things such as locks and switches; repeatedly reciting certain words with intent to reduce anxiety, ordering or arranging things and accumulating wastes like newspaper, wine bottles or empty food containers. The exact causes of OCD are not known, however, some possible reasons may include differences in brain structure and genetic factors.

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The treatment involves psychotherapy as well as medication. Cognitive behavior therapy (CBT) is a specific type of psychotherapy that has been useful in treating people with OCD. Cognitive behavior therapy (CBT) teaches a person multiple ways of thinking, reacting and handling a particular situation. Most commonly used medications for treating OCD include antidepressants and anti-anxiety medications. A child suffering from PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is prescribed antibiotics for treating strep infections and SSRI medicines (citalopram, escitalopram, fluoxetine, sertraline and paroxetine).

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Global Obsessive Compulsive Disorder Market: Trends

The market for obsessive-compulsive disorder (OCD) is expected to grow globally under the influence of high prevalence of OCD and life style changes causing changes in thinking processes. According to International OCD Foundation, approximately 2-3 million adults are living with OCD in the United States. The International OCD Foundation also states that nearly 500,000 American children have OCD. A large number of cases of OCD go unreported as many people are not aware that there is any such specific disease. Also, many people hide their illness in order to avoid embarrassment.

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Global Obsessive Compulsive Disorder Market: Regional Outlook

Geographically, the market for obsessive-compulsive disorder (OCD) has been segmented into North America, Europe, Asia-Pacific and Rest of the World (RoW). North America was the largest regional market in 2013, followed by Europe, Asia-Pacific and Rest of the World (RoW). One of the major factors responsible for North America’s leading position in this particular market is well established health coverage in the region and high level of awareness regarding the illness. In Asia-Pacific and Rest of the World (RoW) regions, the market is expected to grow in coming future owing rise in prevalence of people with OCD and increasing wareness regarding the disease. Japan, China, India, Australia and New Zealand are the most potential markets in the Asia-Pacific region.

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Global Obsessive Compulsive Disorder Market: Key Players

Some major companies and research institutions that are extensively engaged in the development, manufacturing and marketing of OCD drugs include Abbott Laboratories, Pfizer Ltd., Merck Co., Sanofi, Novartis AG, University of South Florida, Ortho-McNeil Janssen Scientific Affairs, LLC and Indiana University.

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What is driving anxiety? Causes, symptoms, and treatment

For some people, driving anxiety may result from being in a road accident or witnessing one. However, according to the Anxiety and Depression Association of America (ADAA), most driving phobias are not related to an experience with an accident.

Below are some common fears and causes of anxiety about driving.

Past negative experiences

A person may remember past negative experiences they have had in a vehicle and worry that a similar scenario will play out again. Examples include:

  • driving through bad weather, such as a storm, snow, or fog
  • being a victim of road rage
  • having a panic attack while driving
  • getting lost

Existing anxiety disorders

People who have an anxiety disorder may experience symptoms while driving. For example, GAD may cause someone to have difficulty concentrating or making decisions while driving. This may lead to a person losing confidence in their driving ability.

Additionally, someone who is experiencing significant stress or life changes may be susceptible to driving anxiety.

Driving alone in an unfamiliar place

Some people may fear getting lost while driving, breaking down, or running out of gas. They may worry that their phone will have no signal, and they will not be able to get help if they need it.

Additionally, people may feel unsafe driving alone at night or worry that they cannot see potential hazards clearly when it is dark outside.

Fear of dying in an accident

Fear may cause a person to consider worst-case scenarios and not trust their own or other drivers’ abilities.

Even though someone may not have directly experienced a car accident, their imagination may make them feel anxious about the possibility of dying in an accident.

Being trapped and having a panic attack

People with existing anxiety about being trapped, such as claustrophobia, may become anxious while stationary in traffic. Additionally, people who have had a previous panic attack may fear that they will have one again while driving.

Losing control of the vehicle

Physical symptoms of anxiety, such as a racing heartbeat and sweating, may lead someone to believe they will lose control of their car and cause an accident. A person may feel highly stressed and uncomfortable, clutching at the wheel and worrying about what other drivers might be thinking.

Trichotillomania in Children: Why Kids Pull Hair Out

The exact cause of trichotillomania isn’t well understood.

Trichotillomania was once classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4). However, in 2013, the DSM-5 began classifying it as a condition related to obsessive-compulsive disorder (OCD).

Sometimes, trichotillomania can be a symptom of certain mental health conditions in children. It may also be a coping mechanism for your child to deal with stress.

Obsessive-compulsive disorder (OCD)

OCD is a mental health condition in which a person repeatedly has intrusive or distressing thoughts (obsessions) and rituals (compulsions). OCD may make you feel like you have no control over your life.

The DSM-5 groups trichotillomania as a condition related to OCD.

Hair pulling can be a symptom of OCD, but the two conditions are distinct from one another.

Many people with OCD pull their hair because it gives them a sense of gratification. But, a person with trichotillomania may not experience that same feeling when they pull out their hair, especially children.

Doctors don’t necessarily recommend the same treatment for both conditions. However, selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for both OCD and trichotillomania.

Anxiety and depression

People with trichotillomania often also receive a diagnosis of anxiety or depression.

Anxiety can be characterized as feelings of fear, dread, or uneasiness. Other symptoms of anxiety include:

  • sweating
  • restlessness
  • rapid heart rate

Some common symptoms of depression can be:

  • persistent feelings of sadness or hopelessness
  • not enjoying things you used to like
  • trouble focusing
  • irritability
  • changes in your appetite or sleep habits

According to 2019 research, it’s common for people with trichotillomania to have another mental health condition as well. The researcher found that 50% of people with trichotillomania also have depression, anxiety, or both. But only an estimated 26% have an OCD diagnosis.

Children with anxiety may subconsciously pull out their hair in response to feelings of anxiety. Often, they may not recall the actual pulling out of their hair.

Coping mechanism

There are indications that trichotillomania occurs because of the gratification felt from the activity. Others may simply have the urge to do it. But, another possibility is your child may be pulling their hair to cope with stress or worry.

Grooming disorder

Grooming disorders are common and include hair pulling with skin picking and nail-biting. These acts are repetitive and can harm the body.

Your child may have feelings of shame since they can’t control the behavior. But you may be able to help them avoid feelings of shame by explaining the instinct behind hair pulling.

Your child may also feel an urge to remove parts of their body and become triggered when they see hair growing in specific places on their body.

If they see hair as an imperfection, they may pull the hair as a way to groom. A sense of relief usually follows.

One 2009 study found that 1 out of 3 people with OCD has a grooming disorder. Additionally, if your child experiences trichotillomania, they may be more likely to pick their skin or bite their nails.

May is National Mental Health Awareness Month

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Millions of Americans every day face the reality of living with a mental illness, and national Mental Health Awareness Month each May raises awareness of those living with mental or behavioral health issues and helps reduce the unfortunate stigma so many experience.
Mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the identical diagnosis.
Mental illness deeply impacts day-to-day living and may also affect the ability to relate to others.  If you have — or think you might have — a mental illness, the first thing you must know is that you are not alone. Sadly mental health conditions are far more common than many of us think, mainly because people don’t like to, or are scared to, talk about them.
According to the National Alliance on Mental Illness, 1 in 5 U.S. adults experience mental illness each year, and 1 in 20 U.S. adults annually experience serious mental illness. In addition, 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year, and 50% of all lifetime mental illness begins by age 14, and 75% by age 24.
The most common mental illnesses in the U.S. include anxiety disorders, major depressive disorder, bipolar disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and eating disorders.
There are a variety of catalysts for mental illness such as genetics, environment and lifestyle that influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events. Biochemical processes and circuits and basic brain structure may play a role, too.
A possible contributing factor in the nation’s rise in mental illness could be the increasing use of social media. Online interaction has taken precedence over face-to-face communication, which promotes isolation and loneliness. Physical appearance is also heavily stressed on social media and other online platforms. Growing trends on apps like Instagram and TikTok influence users to look and dress a certain way.
General comparisons and unrealistic expectations of physical appearances often affect users, particularly females, which can contribute to depression, anxiety and eating disorders. Those who are frequently online are also more likely to experience cyber-bullying, which is linked to depression and suicidal behaviors. Considering the constant changes and trends introduced on online social platforms, it’s no wonder why the number of adults between the ages of 18 and 25 who experienced psychological distress increased between 2008 and 2017.
There is no fault assigned with mental illness, and for many people, recovery — including meaningful roles in social life, school and work — is possible, especially when you start treatment early and play a strong role in your own recovery process.
Sandra Eskenazi Mental Health Center, Indiana’s first community mental health organization, provides comprehensive care for all types of emotional and behavioral problems, including severe mental illness and substance abuse. It offers both inpatient and outpatient services in multiple locations throughout Indianapolis and often integrates treatment into a patient’s primary care treatment plan.
The primary mission of Sandra Eskenazi Mental Health Center is to serve individuals with serious mental illness and chronic addiction and seriously emotionally disturbed children and their families. Patients of all ages are welcomed, from children to seniors, with a philosophy of care that stresses strength-based and family-and community-centered treatment utilizing the Recovery Model of treatment.
Utilizing best practices resulting from ongoing research and medical advancements, care decisions are team-based and emphasize family and client participation. All clients are treated with dignity, confidentiality and respect.
For more information or to request an appointment with the Sandra Eskenazi Mental Health Center, visit: https://www.eskenazihealth.edu/mental-health

By Nydia Nunez-Estrada, family medicine specialist with Eskenazi Health Center North Arlington

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Non-Invasive Brain Stimulation Effective for the Treatment of Obsessive-Compulsive Disorder

A systematic review and meta-analysis found that repetitive transcranial magnetic stimulation (rTMS) was an effective treatment for obsessive-compulsive disorder (OCD). These findings were published in Psychiatry Research.

Investigators at the First Affiliated Hospital of Harbin Medical University in China searched publication databases through March 2021 for studies of noninvasive brain stimulation treatments for OCD.

A total of 18 studies were included in this analysis. Most studies (n=18) evaluated rTMS and 4 evaluated transcranial direct current stimulation (tDCS). The primary outcome in all studies was change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and sham stimulation was used as the comparator.

Overall, active stimulation was favored over sham stimulation (standardized mean difference [SMD], -0.62; 95% CI, -0.88 to -0.36; P .00001; I2, 49%).

Stratified by type of intervention, active rTMS stimulation (SMD, -0.72; 95% CI, -1.06 to -0.37; P .0001; I2, 58%) and tDCS stimulation (SMD, -0.39; 95% CI, -0.72 to -0.07; P =.02; I2, 0%) were favored over sham treatment.

Stratified by high- and low-frequency rTMS, both the high frequency (SMD, -0.62; 95% CI, -1.00 to -0.25; P =.0010; I2, 18%) and low frequency (SMD, -0.69; 95% CI, -1.21 to -0.17; P =.009; I2, 71%) interventions were favored for the treatment of OCD.

For the subset of studies (n=11) which targeted the dorsolateral prefrontal cortex, active treatment was favored (SMD, -0.70; 95% CI, -0.96 to -0.45; P =.00001; I2, 29%). The studies (n=4) which targeted the supplementary motor area did not find an effect of noninvasive brain stimulation (SMD, -0.76; 95% CI, -1.78 to 0.26; P =.14; I2, 83%).

This analysis was limited by the significant study heterogeneity observed among some of the comparisons.

The study authors concluded, “In summary, noninvasive brain stimulation is effective for obsessive-compulsive disorder, especially the rTMS. In subgroup analysis, a better response trend of stimulating the dorsolateral prefrontal cortex was observed compared to that of the supplementary motor area. There was no statistical difference between the high frequency and the low-frequency stimulation. However, further investigations are still required regarding the best stimulation site and frequency.”

Reference

Gao T, Du J, Tian S, Liu W. A meta-analysis of the effects of noninvasive brain stimulation on obsessive-compulsive disorder. Psychiatry Res. 2022;312:114530. doi:10.1016/j.psychres.2022.114530

Repetition compulsion: Causes, theories behind it, and more

Some possible causes of repetitive compulsion behaviors include:

Rigid defenses

People may have a rigid or inflexible way of defending themselves against experiencing a repetition of their trauma, but having these mechanisms can inadvertently result in the reenactment occurring anyway.

For example, a person who experiences abandonment in their childhood may act possessively in relationships later on in life to avoid the past feelings of loneliness or neglect. However, the person may risk losing their partner if they behave in this way and may end up feeling those emotions anyway.

Affective dysregulation

Affective dysregulation relates to having poorly regulated emotional reactions in response to negative stimuli. For example, people who experience frequent, harsh disapproval from a parent or caregiver may have low self-esteem. They may also be very sensitive to criticism. Consequently, in later relationships, these people may consider criticism harsh, even when it is not, and respond with hostility.

Ego deficits

Ego deficits can refer to a limitation in mental resources. This limitation might manifest as various psychosocial problems in a person.

Long-term abuse may result in psychosocial effects that can include:

  • self-abusive behavior
  • low self-esteem
  • substance use disorders
  • inability to trust
  • difficult interpersonal relationships

For instance, a person with a history of growing up in an abusive environment may feel reluctant to leave an abusive partner later in life. This reluctance may stem from the inability to trust others to provide the necessary help.

Obsessive Compulsive Disorder Associates With Elevated Resting Heart Rate

Patients with obsessive-compulsive disorder (OCD) were found to have increased sympathetic and decreased parasympathetic activity compared with healthy controls. These findings were published in Clinical Neurophysiology.

Untreated patients (n=51) with OCD were recruited from the University Hospital Leipzig in Germany and age- and gender-matched healthy controls (n=28) were recruited from the university’s psychiatry department between 2009 and 2014. Study participants were evaluated by a 15-minute resting-state electrocardiogram to determine heart rate variability (HRV) and symptoms of OCD were assessed using the Clinical Global Impression (CGI) instrument. Response to treatment was evaluated at 3 to 6 months after serotonin reuptake inhibitor and/or psychological therapy.

The OCD and control cohorts were aged mean 34.0 (SD, 10.5) and 35.2 (SD, 12.5) years and 41.20% and 40.00% were men, respectively. Stratified by treatment response, nonresponders (n=19) were older (P =.01) and had higher CGI severity of illness scores (P =.01) compared with responders to treatment.

The only HRV marker that differed between OCD and control cohorts was mean heart rate, which was elevated among the patients with OCD (mean, 72.7 vs 66.43 bpm; P .001).

Using only HRV markers, OCD could be predicted among 76.6% of study participants. The prediction model had an 88% sensitivity, 57% specificity, and an area under the curve (AUC) of 83%.

Among the OCD group, nonresponders had a lower log of high-frequency power (mean, 2.4 vs 2.77 ms2; P =.03). High-frequency power was correlated with CGI efficacy index scores (r, -0.41; P .01).

Using only HRV parameters, treatment response was predicted correctly among 79.6% of participants in a model with an 87% sensitivity, 67% specificity, and 88.2% AUC.

This study may have been limited by not stratifying patients by OCD symptomology or by OCD treatment.

“In conclusion, this study showed that OCD patients suffer from a higher heart rate during rest in comparison to healthy controls. However, a lowered parasympathetic tone was positively associated with treatment response,” stated the study authors.

Reference

Olbrich H, Jahn I, Stengler K, Seifritz E, Colla M. Heart rate variability in obsessive compulsive disorder in comparison to healthy controls and as predictor of treatment response. Clin Neurophysiol. 2022;138:123-131. doi:10.1016/j.clinph.2022.02.029