Obsessive-Compulsive Disorder (OCD) Latest Facts: Types, Causes, Symptoms and Treatments

What is OCD?

We’ve all experienced that feeling of doubt that makes us go back and double-check if we turned off the stove. You’ve also probably had an unpleasant or even violent thought from time to time that makes you wonder where it came from. But people with obsessive-compulsive disorder experience obsessive thoughts like this followed by compulsive behaviors so frequently and intensely that it interferes with their daily life.

Washing Hands

OCD falls under the umbrella of anxiety disorders and it is characterized by unwanted, uncontrolled thoughts and repetitive, ritualized behaviors that people feel forced to perform. People are aware of the irrational nature of these thoughts and behaviors, but they feel like they are unable to control and resist them.

Obsessions and compulsions – a vicious cycle

Obsessions are thoughts, images, or impulses that occur involuntarily. They are unpleasant and feel forced, i.e. the person doesn’t have control over them. People don’t want to experience these thoughts, they are often disturbing and distracting, but they feel powerless to stop them from occurring continually.

Read Also: Mental Health During Childhood and Adolescence Influences Health and Life Expectancy in Adulthood

Compulsions are behaviors or rituals usually performed to eliminate obsessions. People feel driven to do certain things repeatedly and excessively to make intrusive thoughts go away. For example, if a person is terrified that they might cause a fire and burn down their building, they can develop a compulsion of checking their stove over and over again. They feel certain relief when they perform the act, but that feeling usually does not last for long. Obsessive thoughts come back and people often feel even more compelled to perform the ritual or behavior. This makes the person even more anxious because obsessions and compulsions take more energy and can become very time-consuming. This is called a “vicious cycle of OCD”.

Symptoms

People suffering from OCD can experience obsessions, compulsions, or a combination of both. Usually, the symptoms interfere with daily life and personal performance at work, in school, and in personal relationships.

Common obsessions

1. Contamination
Germs and/or disease
Household chemicals
Body fluids (feces, urine)
Environmental contaminants (radiation, asbestos)

2. Perfectionism
The pressure that things need to be even or exact
Worry of losing an important item or forgetting important information when they throw something out
Difficulty deciding whether to keep things or discard them
Worry of losing things

3. Losing control – fear of:
Harming oneself
Harming other people
Disturbing and violent mental images
Saying insults or vulgarities out loud
Stealing something

4. Harm – fear of:
Being the cause of a terrible event (for example, causing a fire or burglary)
Harming others by their negligence (for example, infecting someone with germs if they touch them)

5. Religious obsessions
Fear of offending God and blasphemy
Extreme attention to morality and worry about right and wrong

6. Undesired sexual thoughts
Inappropriate or perverted sexual ideas and images
Inappropriate or perverted sexual impulses concerning others
Taboos involving children or incest
Thoughts about violent sexual behavior

7. Other
Concerns about personal sexual orientation
Fear of getting sick not by contamination (for example, getting cancer)
Superstitions about (un)lucky numbers, colors, etc.

Read Also: Thyroid Inflammation May Be One of the Causes of Anxiety According to Ukrainian Study

Common compulsions

1. Cleaning
Washing hands excessively or in a certain manner
Showering, tooth-brushing, etc. excessively
Cleaning household or other items excessively
Other acts to prevent or remove contaminants

2. Checking
Checking if they harmed others or themselves
Checking that nothing terrible happened
Checking that they did not make a mistake

3. Repeating:
Routine activities (for example, going through the doors)
Body movements (touching, crossing, stepping, etc.)
Activities certain amount of times (for example, turning lights on and off three times in a row)

4. Mental compulsions
Going over events mentally to prevent harm to others or themselves
Praying or other religious rituals to prevent harm
Counting items or counting while doing something until they feel “right”
“Cancelling” or “undoing” (for example, saying a good word after a bad one to cancel it out)

5. Other
Arranging things in order until they feel “right”
Avoiding triggering situations

People usually begin experiencing symptoms in their teen or young adult years, but OCD can start even in early childhood. Symptoms typically develop over time and they vary in frequency and severity throughout life. Specific obsessions and compulsions can also vary and change as time passes. Symptoms usually become worse when a person experiences a lot of stress. OCD is often a lifelong struggle for people, but there are treatment options out there to help manage the disorder.

If your symptoms are affecting your ability to function on a daily basis, you should consider seeing a doctor or mental health professional.

Read Also: Simulating Exposure to Feces to Treat OCD Shows Promise

Causes

Professionals do not fully understand how and why OCD develops. There are several theories about what causes the disorder:

  • Biological – OCD is a result of a change in brain chemistry or function.
  • Genetic – Obsessions and compulsions have a genetic component, but specific genes have not been identified yet.
  • Learning – Fears and behaviors associated with OCD can be learned over time or by watching people close to us.

Scientific research supports each theory to some degree, so it is likely that we need to consider multiple factors when it comes to the development of OCD. Further research is needed to bring us closer to understanding the causes of this disorder.

Risk factors

There are certain factors to be considered because they may increase the risk of developing OCD. Some of them are:

  • Family history – having biological relatives with OCD increases the risk of developing it.
  • Life events – stressful and traumatic events can cause emotional distress, which can act as a trigger for intrusive thoughts and repetitive behaviors typical for OCD.
  • Other mental health issues – it is possible that OCD can be related to other disorders like anxiety, depression, tic disorders, or disorders with substance abuse.

Treatment options for OCD

Psychotherapy, medication, or a combination of the two are the most common options to treat OCD. Most patients respond well to treatment, however, there are cases in which symptoms persist after getting treated.

An important thing to consider when making decisions regarding treatment is the presence of other mental health disorders.

Read Also: Deep Sleep Reduces Anxiety Levels Considerably During The Day, UC Berkeley Study Shows

Psychotherapy

Research shows that some types of psychotherapy, such as cognitive-behavioral therapy (CBT) and others related to CBT (for example, habit reversal training) are more effective than others when it comes to OCD treatment. CBT appears to be as effective as medication for many patients, according to research.

The most effective type of CBT for compulsive symptoms reduction is called Exposure and response prevention. The process of this approach includes exposure to triggering situations (for example, touching dirty items) and being prevented to act out the compulsive behavior that usually follows that situation (washing hands). It appears that even patients who did not respond to medication therapy benefit from this approach.

Medication

Medications used to treat and reduce obsessive-compulsive symptoms are called serotonin reuptake inhibitors. This class of medication is used to treat depression as well, but doses are usually higher when treating OCD and may take eight to twelve weeks before patients start to notice the difference in symptoms. Sometimes, if a patient does not respond well to this type of treatment, professionals prescribe antipsychotic medication. Research shows that this approach can help manage symptoms of OCD, but there are mixed results when it comes to research about the effectiveness of antipsychotics on this disorder.

Read Also: Researchers May Have Found A New Cure For Anxiety

Treatment should be personalized with most mental health disorders. The same goes for OCD as well. The process might begin with medication or psychotherapy only, and the other option can be an add-on treatment to assure a better outcome for the patient.

References

https://iocdf.org/about-ocd/
https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

 

 

 

 

 

 

NYC Youth Struggling with OCD Face Compounded Challenges in Pandemic

‘I don’t know that the diagnostic incidents of OCD has gone up, but the symptom occurrence and the severity has exacerbated with the pandemic,’ says Theresa Hsu-Walklet, a psychologist and the assistant director of the Pediatric Behavioral Health Integration Program at Montefiore Medical Center.

Adi Talwar

Teresa Hsu-Walklet, PhD, is an attending psychologist for the Behavioral
Health Integration Program (BHIP) at Children’s Hospital at Montefiore.

A teen of color, overwhelmed by fears of contamination, closed themselves in their bedroom at the start of the COVID-19 crisis. As time went on, they became increasingly depressed and disconnected from the world, alarming family members.

Another adolescent of color attended therapy on their parent’s phone but was not able to look into the camera; they were too afraid to touch the phone. 

Both of these young people live in New York City and suffer from Obsessive Compulsive Disorder (OCD), in which a person experiences obsessions, which are intrusive and unwanted thoughts that cause distress, and/or urges to perform compulsions, which are behaviors or thoughts a person uses to avoid or reduce anxiety or get rid of an obsession. While in the U.S., the acronym OCD is often used as a synonym for characteristics like “detail-oriented” or “organized,” experts say the actual disorder is highly distressing and sometimes debilitating. 

Read our coverage of
New York City’s
Coronavirus crisis.

For several reasons, the pandemic has been particularly challenging for OCD patients. Scientists and news reports have found that many sufferers of OCD—both children and adults—experienced exacerbated symptoms. Clinicians who spoke with City Limits mentioned isolation, stress, or a lack of access to normal coping mechanisms as factors that could have contributed to this worsening. In addition, while OCD can appear in many forms, fear of contamination and germs is a common type, and some sufferers have struggled with excessive worry about COVID-19 contamination and spreading the illness. These, in turn, can manifest in a rise in compulsions, such as excessive cleaning. Some people have also experienced other types of OCD exacerbated by the pandemic, such as somatic obsessions or health OCD (concern with fearing something is wrong with the body) and harm OCD (fear one will be responsible for something terrible happening).

“I don’t know that the diagnostic incidents of OCD has gone up, but the symptom occurrence and the severity has exacerbated with the pandemic,” says Theresa Hsu-Walklet, a psychologist and the assistant director of the Pediatric Behavioral Health Integration Program at Montefiore Medical Center in the Bronx. She adds that the pandemic has led to new complexities for therapists providing treatment.

“Pre-pandemic, we might ask youth to stop washing hands as part of treatment…but due to COVID19, we want our patients to be safe and don’t want them to stop washing their hands completely,” she wrote in an email. “Moreover, the media, parents, and schools are now reinforcing the idea of washing hands, which makes treatment harder when the severity of compulsions is greater.” While in the past, a psychologist might ask a youth to touch a public doorknob and not wash their hands, now they might aim to limit the number of times a young person washes their hands once they are already in their home, she explains.

Dr. Rebecca Berry, a licensed psychologist who coordinates the intensive OCD treatment at the  Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, says she didn’t see worsened contamination symptoms at the very start of the pandemic, but as the pandemic progressed and children were left isolated and without access to pleasurable activities, many patients’ OCD worsened, with some experiencing contamination fears but others experiencing different obsessions and compulsions. Many also became more depressed.

“For some youth, it was sort of like, which is [it], the chicken or the egg? Did the OCD contribute to a worsening depression during the pandemic, or did depression intensify the OCD?” says Berry. “I don’t think we can necessarily answer that.”

Experts say genes likely play a role in the development of the disorder, but that it can be triggered and exacerbated by stress. OCD often begins either between the ages of 8 and 12 or in late adolescence to early adulthood. At any given time there are roughly one in 100 adults and at least one in every 200 children living with OCD in the United States. To put the latter in context, this is less than the rate of children who experience anxiety (seven in every 100) and depression (three in every 100) but comparable to the rate of children who suffer from diabetes.

Much has already been written on the mental health crisis facing New York City’s youth—particularly its Black and brown children, who lost parents during the pandemic at twice the rate of white children, and who, prior to the pandemic, were twice as likely to live below the poverty line.

Yet there’s little public information available on how OCD impacts the city’s young residents. The New York City Health Department Epiquery database reports that 3 percent of parents with a child between the ages of 2 and 12 answered yes when asked if a health professional had ever said their child had “anxiety problems,” but the database doesn’t offer data about OCD specifically.

At the same time, for low-income youth and youth of color, there are compounded barriers to receiving treatment for this disorder.

When OCD meets racism

Experts acknowledge that the typical media representation of an OCD sufferer isn’t a non-white child.

“A pretty common public perception is that the OCD sufferer is a white male who has a certain level of exactness in their behavior and whose diagnosis is probably more appropriate to call OCPD [Obsessive Compulsive Personality Disorder, a different illness],” says Dr. Dean McKay, a professor of psychology at Fordham University who runs the Compulsive, Obsessive, and Anxiety Program (C.O.A.P.).

Before 2008, there were few published studies focused on the presentation or treatment of OCD in African Americans and a low rate of participation in OCD studies by non-white Americans, writes psychologist Monnica Williams, a professor at the University of Ottawa and an expert researcher in OCD among Black Americans. She says that to her knowledge, there are still no studies truly focused on African American children with OCD, and that it’s difficult for researchers to obtain funding for studies of depression and anxiety-related disorders in the Black community.

“Black people specifically are often stereotyped as being strong and sturdy and impervious to pain,” says Williams, who adds this stereotype has its roots in rationalizations of slavery.”That stereotype also extends to emotional pain,” she says, adding that research funders “aren’t looking for problems like depression and anxiety, because of the stereotypes of what the problems actually are.”

But it’s not just funders: overwhelmed mental health clinics in disenfranchised communities struggling with violence sometimes treat people who suffer from anxiety or depression as a low priority for care, according to Williams.

While Black American adults and white Americans have a similar chance of getting OCD in their lifetimes, Black Americans are more likely to have a more severe case and stay ill longer, Williams says. (One study found similar severity rates among all populations, but that minority populations were less likely to get treatments.)

People of color with OCD are also often misdiagnosed with other illnesses, including schizophrenia and psychosis—disparities in care that help fuel distrust in the mental health care system, experts say. “I think there’s a certain measure of awareness in some communities of color and low income communities [of this]. Not only is there a stigma around mental illness, but also there’s a hazard that they could be given a course of treatment that is inappropriate or may even be harmful,” says McKay.

Of course, for any person regardless of race, OCD is not always easy to diagnose. Sufferers’ obsessions and compulsions can be quite heterogeneous, and some are easier to identify than others.

“The compulsions associated with OCD can manifest in different ways. Whereas some compulsions are easily observable (e.g., excessive hand washing, tapping a certain number of times), internal compulsions are more difficult to detect. For example, a child or teen may repeat a reassuring statement or count to a specific number internally,” wrote Dr. Michelle Fenesy, a postdoctoral fellow at the Washington Heights Youth Anxiety Center, in an email.

OCD sufferers may also try to hide their OCD symptoms. “In regards to OCD specifically, children and teens may experience shame related to some obsessions (e.g., harming others) and therefore not disclose having these intrusive thoughts,” Fenesy continued. In one form of OCD, a sufferer may have intrusive sexual or violent thoughts along with a fear of acting impulsively, even though the sufferer has no desire to act upon the thoughts.

Some argue for greater cultural awareness to the range of racially and culturally specific manifestations of OCD symptoms. McKay worked with one child who feared a classmate’s touch would turn the child into a zombie. Though this might have seemed strange to many practitioners, the child was of Haitian descent, and this was simply an obsession focused on the zombie of Haitian cultural mythology.

Williams also says therapists need a better understanding of the impact of racism on their clients. Her study found that both material hardship (the degree to which an individual cannot meet basic expenses) and exposure to racial discrimination were positively correlated with the exacerbation of OCD symptoms. She also writes that, “OCD symptoms may be influenced by negative racial stereotypes.” Take, for instance, the false and racist stereotypes about Black Americans being unclean and violent. These stereotypes might cause some Black people predisposed for OCD to worry excessively about presenting as clean, or about having intrusive violent thoughts. Concern over such stereotypes might also cause Black patients with OCD to not share and get treatment, for fear of being seen as unclean or violent by others. Therapists need to invest extra time into ensuring their clients of color understand their obsessions and compulsions are quite normal for OCD, Williams says, and they also have to take seriously the stress their clients face from living in a racist society.

“Experiences of racialization may be embedded into the client’s symptoms, but when therapists dismiss or minimize challenging race-based experiences, they can do more harm than good,” wrote Williams in an online editorial.

Stigma and community access

There are multiple other barriers that can prevent a family from seeking treatment.

“Systemic barriers that prevent youth with OCD from accessing treatment are not largely different from barriers that prevent access to mental health treatment for common disorders like anxiety or depression,” wrote Carolina Zerrate, medical director of the Washington Heights Youth Anxiety Center, in an email. “There is still significant stigma about having mental illness and receiving psychological or psychiatric treatment. Students in the public schools we serve in upper Manhattan mostly identify as Latines, black, or mixed race. Stigma is not exclusive though highly prevalent among BIPOC communities.”

Other barriers in marginalized communities can include limited knowledge about mental health disorders and how to get treatment as well as language barriers and cultural beliefs, such as a reliance solely on religious solutions. Furthermore, even if a family has obtained affordable health insurance, other financial hurdles can hinder a family from seeking treatment for their child, such as the cost of subway rides or the price of internet to access telehealth appointments.

Many communities still lack information about OCD. While in 2017 New York State passed a law mandating that mental health issues be incorporated into the curriculum for grades K-12, there is some variability by school in the implementation of the law, and most school curriculums likely don’t go into much depth about OCD specifically, according to John Richter, director of public policy at the Mental Health Association in New York State.

“What would be useful … is if there was some outreach to schools, particularly in some low-income communities and other communities of other under-represented people and communities of color, to disseminate some information about OCD,” says McKay, “and also, in consultation with members of those communities, to develop an understanding of culturally relevant symptoms.”

There can also be varying levels of knowledge about the disorder among health care professionals themselves, including medical practitioners, school counselors and others who interact regularly with children. OCD experts say the more these professionals know about OCD, the better, as they can play a crucial role in helping families overcome stigma and other barriers to care.

In response to a request for comment on how schools are supporting students with OCD, the city’s Department of Education emphasized that every student currently has access to either a social worker, a guidance counselor or a mental health clinic, and that the DOE has additional partnerships with Health + Hospitals to provide clinical mental health care.

“Through deep investments in services and resources, we’ve put mental health at the core of our work with young people,” said Nathaniel Styer, a DOE spokesperson, in an email. “They are trained to work with children to identify issues like OCD, and to develop a plan that identifies appropriate next steps and supports, like supplementary aids or tailored in-school supports.”

The number of social workers in the city’s public schools has increased over the past decade, and in December the de Blasio administration announced it would hire an additional 150 new social workers and expand the community school program in the 27 neighborhoods hit hardest by the pandemic. Still, teachers say far more school mental health professionals are needed.

Asked to comment on how the city was working to address barriers to treatment for OCD, the Health Department referred City Limits to its Community Supports and Services web page, which lists hotlines, resource centers, and programs for families and children pertaining to multiple mental health conditions.

Affording the best treatment

Even though New York City is known as a home for many of the nation’s preeminent mental health specialists, it can be difficult to find practitioners who can properly treat OCD. Many therapists are focused on psychodynamic therapy, which emphasizes gaining insight about oneself through a longer-term process of discovering an underlying emotional narrative. For OCD patients, however, another form of treatment is widely thought to be more effective: Cognitive Behavioral Therapy, which aims to immediately identify negative thinking patterns and create new thinking skills to change feelings and behaviors.

The type of cognitive therapy considered the most important for treating OCD is Exposure and Response Prevention (ERP) therapy, which requires patients to purposefully expose themselves to things that make them anxious. According to McKay, not enough therapists undertake the intensive training needed to become a practitioner of ERP, and some psychodynamic therapists are uncomfortable with the idea of pushing clients to be uncomfortable. “[ERP] has a lingering public relations problem,” he says. “Fortunately, that seems to be changing.”

To add to the problem, many ERP specialists do not accept health insurance. “I think the challenge in the therapy world is the reimbursement rates to take insurance are just abysmal. It’s really difficult for a practitioner to make it [if they take insurance],” says Dr. Eric Storch, a psychologist who oversees the Cognitive Behavioral Therapy for OCD and related disorders program at Baylor College of Medicine in Texas.

City Limits used the Psychology Today website to search for therapists within 30 miles of central Manhattan who treat OCD and use ERP, retrieving 185 results. Filtering those searches to psychologists who take Medicaid reduced those results to three, plus a telehealth therapist in Rochester. Filtering instead to psychologists who take Healthfirst, a no-to-low-cost health insurance and a Medicaid managed care organization, reduced results to five psychologists.

City Limits also called the NYC Well hotline developed under the city’s ThriveNYC initiative to see if the city could provide referrals to ERP specialists who accept health insurance, but the hotline database is unable to filter according to treatment method, leaving callers to comb through lists of clinics that offer treatment for OCD to see if any offer ERP.

“This is a training problem, and we need to be able to disseminate the treatment more widely because it does require a level of expertise that’s not usually present in Medicaid or Medicare-based settings,” says McKay.

There’s reason to have hope; Williams, who is the co-founder of the diversity council for the International OCD Foundation (IOCDF), says the organization has begun offering scholarships to clinicians of color to participate in trainings, and she’s working on an initiative to bring trainings lead by OCD specialists of color to more communities of color.

There are also certain places that do accept patients with insurance and Medicaid. For instance, Hsu-Walker at Montefiore works in a primary care setting, so patients can walk down the hall to get mental health treatment, with Montefiore itself eating the insurance cost difference. In addition, some university externs will see patients for a reduced fee.

Health insurance companies are actually required under New York law to provide treatment for patients with OCD, so patients can try petitioning their insurance company to cover a specialist who is out-of-network, says McKay, though he notes some companies are more amenable than others. Williams finds insurance companies are often not willing to reimburse for two 90-minute sessions per week—the golden standard treatment for OCD. “There needs to be a lot more priority given to what the clinician says…rather than barriers and roadblocks to actually getting that treatment,” she says.

One silver lining of the pandemic for OCD patients is increased access to telehealth medicine in New York State, which has allowed OCD patients to seek specialists beyond the city’s limits. ERP is also often more effective when done in the space of the home.

“Telehealth practice has allowed for exposure to be done in ways that are more relevant to the individual,” says McKay. “You can walk around the house! You can be on a secure network via telehealth-based intervention and the [therapist] can guide you right there in real time.”


Are you or someone you know seeking treatment for OCD? Here are some suggestions for New Yorkers seeking help.

  • Use the Psychology Today search engine to find a therapist, specifying your health insurance, disorder, age range, and the specific treatment you are seeking.
  • Use the IOCDF database to find a therapist or practice. You can’t search by your specific insurance, but you can narrow by those who take private insurance, Medicare or Medicaid, a sliding fee, etc, and you can search by specialty, age, and other criteria.
  • Some hospitals are also affiliated with OCD clinics or specialists who accept some, or many, insurance types.
  • You might also find universities that are conducting studies that offer treatment for free.
  • Check out New York specialty practices that say they don’t accept insurance or only as an out of network provider, but do provide a sliding scale of fees, especially if you’re working with an extern, masters or doctorate student.

City Limits’ series on behavioral health and NYC’s children is supported by the Citizens’ Committee for Children of New York. City Limits is solely responsible for the content and editorial direction.

Encouraging Women to Report Perinatal-Specific Symptoms of OCD and Using DSM-5 Leads to Higher Prevalence Estimates

Point prevalence of perinatal obsessive-compulsive disorder (OCD) gradually increases and peaks at close to 9% at about 8 weeks postpartum before declining, researchers found in a study published in the Journal of Clinical Psychiatry.

The researchers collected data from February 2014 through February 2017 from 580 women living in British Columbia, Canada. Women completed online questionnaires and a telephone interview in late pregnancy (mean=36.89 weeks, standard deviation (SD)=1.96) and twice postpartum: at a mean of 9.9 weeks (SD=1.94) and at a mean of 21.27 weeks (SD=3.83). They were followed from late pregnancy (at 32 weeks gestation or later) through up to 38 weeks postpartum.

Of the 580 participants, 270 provided data for 3 interviews, 182 for 2 interviews and 122 for only 1 interview. Diagnostic data were collected retrospectively for 101 patients who missed the prenatal interview and 49 who missed the early postpartum interview.

They were assessed for OCD using the Structured Clinical Interview for DSM-5 (SCID-5).

Researchers asked participants about OC symptoms they had experienced in the past 2 weeks at each interview. Participants also were asked to identify the 2-week period during pregnancy or afterward when their OC symptoms were the most intense. They were asked about infant-related harm thoughts and associated behaviors postpartum.

Estimated point prevalence of OCD diagnosis from the model was 2.6% (95% CI .4-4.8) at 6 weeks prior to delivery, 8.3% (95% CI 5.4-11.2) at 10 weeks postpartum and 6.1% (95% CI 3.3-8.8) at 20 weeks postpartum. Estimated average point prevalence during the prenatal period was 2.9% (95% CI 2.7-3.2) and 7.0% (95% CI 6.9-7.2) during the postpartum period. Weighted period prevalence during pregnancy (n=375) was estimated at 7.8% (95% CI 5.1-12.0).

At the beginning of the postpartum period, 93 of 535 participants had a diagnosis of OCD. The period prevalence through the final postpartum interview at 38 weeks was estimated with logistic regression as 16.9% (95% CI 14.0-20.2). Period prevalence through 8.8 weeks was 6.9%. Up to 13 weeks, it was 7.8%.

Incidence of new OCD diagnoses was estimated at 4.7 (95% CI 3.2-6.1) new cases per 1,000 women per week postpartum, with a total of 49 new cases reached by 22 weeks postpartum. The average person time of follow-up was 18 weeks. Cumulative incidence of new cases of OCD was 5% for 4 weeks, 6% for 8 weeks, 7% for 12 weeks, and 8% for 16 weeks postpartum, respectively. By 6 months postpartum, cumulative incidence rose to 9%.

Of the 100 women who reported symptoms during the perinatal period that were consistent with a diagnosis of OCD, 60 reported that clinical levels of OCD began during the pregnancy or postpartum.

These prevalence estimates are higher than those found in previous studies, which the researchers attributed to more comprehensive evaluation of perinatal-specific OC symptoms and differences between DSM-IV and DSM-5 diagnostic criteria. This study was the first to use DSM-5 diagnostic criteria.

Limitations included the fact that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts and that the history of OCD prior to participation was collected only for participants who experienced OCD symptoms.

The study authors said, “Our study suggests that when women are encouraged to report their perinatal specific symptoms, and current diagnostic criteria are applied, estimates for perinatal OCD may be higher than previously believed.”

Reference

Fairbrother N, Collardeau F, Albert AYK, et al. High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psychiatry. Published online March 23, 2021. doi: 10.4088/JCP.20m13398

The impact of anxiety disorders and how to manage them

Alice Bertoldo, psychologist (GGZ, NIP) and psychosomatic psychotherapist, trained in Cognitive Behaviour Therapy and Psychodrama, tells us how to deal with an anxiety disorder.

Anxiety disorders are among the most common mental health conditions. Often, they are paired with other mental health issues, such as major depressive disorder or personality disorders. Most people who are experiencing anxiety disorders try to cope with life using alcohol or drugs.

Cognitive schema

A cognitive schema is a mental framework that helps individuals to process and organise information. Cognitive schemas come from Core Beliefs; the way we see the world, ourselves and our future. When Cognitive schemas are biased they process ambiguous stimuli from the environment as a “catastrophe” or as a “threat”. Thus, the mind perceives as ‘dangerous’ stimuli that otherwise might be neutral.

How an anxiety disorder can impact your life

Anxiety disorders can impact life in a variety of ways, such as:

  • You avoid feared places and situations
  • You can’t sleep, suffer from insomnia
  • You postpone tasks
  • You isolate yourself socially
  • You suffer from indecisiveness
  • You overthink everything
  • You have difficulty trying new things

Key factors

There are several factors that play a part in developing anxiety such as:

  • Genes
  • Chemical imbalance in the brain
  • Trauma
  • Social media and isolation
  • A lifestyle that does not suit your needs and wants

Four types of fear

Anxiety can be grouped into four different conceptualisations of fear:

1. Catastrophic

The fear that something very negative and catastrophic like the “worst-case scenario” is going to happen. It includes separation anxiety, arachnophobia (the fear of spiders), ophidiophobia (the fear of snakes).

2. Evaluation

The fear of being watched and judged, such as in social anxiety, selective mutism and glossophobia (fear of public speaking).

3. Losing control

The fear of losing control (panic attacks and agoraphobia).

4. Uncertainty

Feeling uncertain (generalised anxiety disorder and obsessive-compulsive disorder).

How to overcome and manage anxiety

Let’s have a look at the different ways you can help overcome and manage anxiety:

Cognitive Behaviour Therapy (CBT)

This is particularly useful to treat anxiety disorders. In particular, exposure techniques (in-vivo or imaginal) have proven to be highly effective.

Psycho-education

This is the very first step to help the person realising that avoidance of feared situations and places maintains anxiety.

Mindfulness

This can help as it will teach you to pay attention to the present moment, to accept thoughts and feelings without judging them and focusing on breathing.

Bodyscan

When you lay or sit comfortably, close your eyes and start to scan your body from your toes to your head and whenever you feel tension, relax that spot. Focus on your breathing and on the present moment.

Walking meditation

While you walk, slowly focus on the sensations you are experiencing while walking. Focus on your toes, and feet and your legs’ movement. Do this for 15 minutes.

Deep breathing

This is a fantastic tool to thin out the “white fog” (anxiety) in your mind and to feel grounded. Sit comfortably and breathe for six seconds, making sure that your stomach fills in with air. Leave your shoulders and chest still and relaxed. Let the air in via your stomach only. Breathe out the air from your stomach and then breathe in again. 

Sports

Exercising can reduce anxiety.

Walks in nature

Exercising while being in nature can help reduce anxiety even more.

Alcohol smoking

Limit your intake of alcohol (especially in the evening) and smoking.

Do something fun and creative!

Use your passions to momentarily distract yourself from the problem. Do activities in which you can use your hands such as painting for instance.

Don’t be afraid to seek professional help

In conclusion, to overcome anxiety disorders, it’s advisable to ask for professional help. Therapy allows you to get to know yourself and your vulnerabilities and acquire a different and more healthy perspective of yourself. Moreover, there are several ways through which it’s possible to manage anxiety, for instance with mindfulness, sports, art, and by surrounding yourself with nice people.

Alice Bertoldo, psychologist and psychosomatic psychotherapist, offers in-person and online therapy sessions to treat anxiety disorders, depression and trauma. 

Seeking Help: My Orthorexia Journey

I thought I was done with the dating game when I met my husband Matt in 2010. I was wrong! Make no mistake, we’re happily married. What I’m talking about is finding a therapist. When my primary care physician diagnosed my anxiety, obsessive-compulsive disorder and an unspecified eating disorder, I figured he would provide me with several resources. At this point, I thought I had already taken the biggest step forward by admitting I needed help. I didn’t know what that help would look like and apparently neither did my doctor. He advised me to just “look online” for resources.

Having never looked for a therapist before I told myself it couldn’t be that hard. I’ll just do what I always do, turn to Google. However, when you type in “male therapist for eating disorders, OCD and anxiety,” you don’t really find what you need. There were several local eating disorder clinics for in-patient care, their websites were painted with images of women, who spoke about their battles with anorexia and bulimia but none of this was relatable to me.

I was a 34-year-old male with an eating disorder that didn’t even have a label. I often questioned whether or not I actually had an eating disorder since I was still eating food and not purging. I didn’t see the need for in-patient care but what other options were there? Nothing matched my needs, plus I had no idea exactly what I even needed at that point.

Talk about feeling lost! I was frustrated, angry and alone. I felt invisible to our country’s mental health care system, especially as a guy who has some weird relationship with food. Already at my lowest point mentally, physically and emotionally, I gave up my search for a couple of days. I couldn’t handle it. Finding a therapist felt like the straw that broke the camel’s back. Maybe I would just have to face the fact that I’m just not fixable. Perhaps, I’m sentenced to this hell I’ve been living in for so long. And who knows, this unspecified eating disorder thing sounds made up so maybe I’m not really that sick.

I didn’t want to waste mental health resources on my situation when there are other people out there a lot worse off than me. Man, talk about being unable to see the gravity of my own situation. This disillusionment was the result of two major factors: being a male with one of the “other” eating disorders and the simple lack of available mental health resources.

I resumed my search after a couple of days. My results revealed I was only going to be able to address some of my issues with a therapist. So I focused on my anxiety and OCD first. I’ve later learned this was the right decision for my specific situation but I stumbled across that revelation on my own, not with any medical guidance. I sent out over twenty messages to prospective therapists, but the majority resulted in the following responses:

“We’re currently not accepting new patients.”

“We can schedule you for a consultation in 3 months.”

“We’re unable to help you with regards to your specific conditions.”

At least they responded because some of these therapists never even returned my message. Then one day, a counselor named Sean replied. We connected over video chat for a 15-minute consultation. His approach felt like the perfect fit for my anxiety and OCD issues, which ultimately stemmed from unresolved pain during my adolescence. Sean admitted he hadn’t dealt with many eating disorder cases but was still willing to work with me. I am forever grateful for his willingness to grow with me.

We reconnected the following week for my first appointment. Match.com could not have made a better connection. A few sessions into therapy with Sean, my anxious and obsessive thoughts were starting to subside. My mind cleared just enough for me to tackle the next obstacle in my way, that unspecified eating disorder.

I started looking for nutritionists in my area. The eating disorder recovery clinics just were not a fit for me. Again, I felt like I wasn’t sick enough to go plus I felt I didn’t meet their demographic. I was a guy with an “other” eating disorder, whatever that is. I knew I was sick. I was at my lowest weight ever, always cold with a low pulse and constant body pain. Yet, I couldn’t wrap my mind around what was wrong with me, which escalated when it seemed professionals couldn’t either.

The first nutritionist I spoke with seemed well-versed in sports nutrition. She could develop a nutrition plan to build muscle but she was clueless when it came to my eating disorder. Her focus was macronutrients and lots of protein, not the disordered mind. Yes, I needed someone who was going to help repair my body but I also needed someone who held the basic human compassion to understand my mental turmoil around food.

I thanked her for the consultation and resumed my search. I repeatedly told Matt how tired I was of this. Maybe I’ll just work with my therapist on the other issues and hope the eating disorder fixed itself. Then one day I stumbled across my RDN’s website. I liked her approach to intuitive eating and set up a consultation. She seemed like the perfect match for me. She knew her nutrition but she was always willing to work through me and my orthorexic thoughts. Kassandra is not a therapist, but she is a human. I knew her and Sean were my dynamic duo.

One catch, though, the nutrition program costs thousands out of pocket. Insurance wouldn’t cover it. Don’t even get me started on that!

I instantly flung myself on the bed in a fit of tears. I didn’t want to put that financial strain on us for some stupid non-descript eating disorder. Matt, like he always does, reassured me that I was worth it. He said, “The most important thing is helping you get better.” The next day I enrolled in my nutrition program with Kassandra who has been by my side each step of the way. She has helped to restore me physically while Sean has helped repair my mind and soul.

Admitting I needed help was hell. I initially felt like a failure to myself and those around me. Finding help was even harder. This time I felt invisible or unimportant to the system. I’ve seen several friends struggle with finding help but I constantly reassure them that they can’t give up hope. They’re worth it, just like I am.

Our mental health professionals are overwhelmed and I worry the situation will worsen. We must change the narrative and make sure everyone’s voice is heard and understood so nobody has to feel invisible or like their problems don’t matter. Mental illness does not discriminate. We are always told to embrace our uniqueness. My hope is that we can fully live up to that expectation so that one day we can live in a world where everyone feels worthy of help and most importantly, can find it!

 

Previously Published on orthorexiabites.com

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Living with OCD in a post-Covid world

Govind Sekhar is a Bengaluru-based digital marketing specialist. He also has Obsessive-Compulsive Disorder (OCD), an anxiety disorder due to which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Such repetitive behaviour can significantly interfere with a person’s daily activities and social interactions.

For him, and many others living with the disorder, the pandemic was a huge trigger. “The news alone was triggering. My partner’s brother was in China and when he picked him and came from the airport, it was extremely difficult,” he says.

Increasing numbers

Dr Naveen Jayaram, consultant psychiatrist, says that many people who had obsessive-compulsive personality have, over the course of the past year, developed OCD. The signs can be hard to miss as they simply indulge in behaviour that could be misconstrued as simply following the guidelines.

So how does one define ‘excessive’? “How much time is the person spending on worrying about this? Have they become fixated on the virus and following precautionary methods. Yes, wash your hands, but if they are washing it 10 ten times, it is a problem,” he says. 

The compulsiveness does not simply have to be in terms of indulging in behaviour to help prevention but can also be seen in terms of an obsessive fear of contracting the virus.

“While most people have become more careful than before, people with OCD will clearly overdo it. And, they are always aware that the behaviour is hampering their day-to-day life,” he says.   

Nithya J Rao, co-founder, Heart It Out says that about 20 – 30 per cent of their clients came with a diagnosis of OCD and most of them fall within the 25-39 age group.

“For some people, it’s a temporary trigger, which probably will worsen and then revert back to a healthy amount of anxiety when the environment becomes safer, but for some, the situation has deepened the symptoms,” she says. 

The biggest struggle, she observes, is the knowledge that it’s irrational. “People with OCD know that their fears aren’t true. But, because they are being exaggerated by the news, and there is constant fear-mongering on social media, they can’t now just brush it off as a stray thought,” she says. The self-doubt coupled with the compulsions takes away from their time being used productively and efficiently as well as causes emotional distress. 

Share the struggle

For many, sharing their struggles have become difficult because of people have co-opted the term ‘OCD’, taking away from the people that actually
struggle.

“I met a couple recently. The wife was obsessed with following the precautionary measures and would force everyone in the family to do so. Initially, everyone obliged because they thought she was being careful. After a point, however, they couldn’t comply,” says Dr Jayaram. In most cases, people started seeking help after the lockdown as others in their life started to show irritation over their obsessive behaviour.

“Awareness is important. You need to take note of the small things so people can get the needed help earlier,” he says. 

Govind made it a point to stay away from news and unfollow social media pages or people who constantly kept posting about the pandemic.

“I went to a couple of close friends for legitimate information and didn’t get lost in the clutter that gets shared on platforms,” he says.

While the guidelines that asked people to follow basic hygiene routine and sanitise proved to be a source of relief for him, for others the way they have been communicated didn’t help.

“They mostly only deal with what to do and what not to do. There is no reassurance, or information about where to seek help, or how to deal with it after one tests positive. It gives no information on emotionally coping with the situation, which makes it all the more confusing and worse,” adds Nithya.

Ask for help 

Guidelines and safety precautions are important, especially with the increasing numbers.

“Safety is difficult to define. If you feel distressed that the precautionary methods are taking over their life, reach out for help. Mindfulness and meditation help,” says Dr Jayaram.

Keeping himself occupied helped Govind during this time. “I started a company, which was something I have always wanted to do. I devoted all my time to it, which helped. I also kept my therapist close and got help to any employee that required it through a friend,” he says.

 

Signs to watch out for

Very often signs that point out the condition can go unnoticed as many are unaware. Nithya J Rao, co-founder, Heart It Out, lists out some things to watch out for:

Compulsively checking the news

Agitation

Compulsive hoarding of pamphlets and information

Hypervigilance

Impulsivity

Meaningless repetition of one’s own words

Repetitive movements

Ritualistic behaviour such as repeated sanitising

Social isolation

Increased anxiety

Apprehension

Guilt

Panic attacks

Lack of motivation

Anger outbursts

Meltdowns

Food aversion

Nightmares

Repeatedly going over thoughts. 

Here are some tips she suggests for someone with OCD, who may be struggling to cope during this time:

Create a reasonable safety plan.

Be in touch with a therapist that can help manage flareups.

Limit news consumption

Limit listening to other people’s opinions on what’s right to do.

Practice self-compassion

Develop healthy distractions such as hobbies that consume time (example: carpentry, puzzles, gaming)

Ask for support

Share with peers

Tingling tongue and anxiety: Causes, treatment, and more

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When a person is anxious, their body prepares them for a fight-or-flight response, triggering a wide range of physical changes. One of these changes is that the blood vessels constrict. This constriction reduces blood flow, which can cause numbness and tingling, especially in the feet and hands. It is also possible to experience tingling in the tongue.

A tingling tongue is a relatively common oral symptom. Although it can sometimes be due to physical issues, such as nerve damage, anxiety can also lead to tingling.

A 2015 case study reports on a 32-year-old man who had experienced tingling on the tip and right side of his tongue for 5 months. An examination revealed no physical cause.

Based on the man’s other symptoms, doctors diagnosed him with psychogenic lingual paresthesia, which is tingling in the tongue for psychological reasons, along with mixed anxiety and depressive disorder. The tongue sensation resolved after he began taking an antidepressant.

Sometimes, anxiety causes tics, which are sudden, uncontrolled, repetitive movements. Some tics, such as chewing or sucking motions, can injure the tongue.

Some injuries may lead to numbness, pain, or tingling. Although anxiety is ultimately the cause, it is important to seek medical treatment for the injury.

How to Incorporate Videoconferencing Into OCD Treatment

Evidence-based treatments for obsessive-compulsive disorder (OCD) such as exposure therapy and psychopharmacology are often unavailable to people with OCD. Faculty at the Center for OCD and Related Disorders, located in the Columbia University Medical Center in New York, have studied digital health approaches such as videoconferencing to improve access to OCD treatment. They found 5 useful ways to incorporate the technology.

1. Hybrid EX/RP: Exposure with response/ritual prevention delivered in a hybrid format that includes both in-person and videoconferencing, can be effective. Therapists can use video to conduct home visits, which eases travel burden. Therapists could also start therapy in person and plan transition to video if the sessions go well. This also reduces travel burden and can make scheduling easier.

2. Fully remote EX/RP: Fully remote therapy is cost-effective and accommodates patients who are home-bound, live in rural areas, or lack access to OCD treatment facilities. Patients with “substantial shame” about their symptoms may be more amenable to remote treatment, the researchers state. Because patients are at home, exposures could promote “independent skill development and generalization of learning to real-life contexts.”

3. Videoconferencing-assisted psychopharmacology: This option expands consult and treatment beyond metro centers where most programs are located. Patients may also appreciate having the option to pursue medication, EX/RP, or both. Therapists would not be able to perform in-person neurological exams, which is a limitation of this option.


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4. Virtual support groups: This solution compliments EX/RP and psychopharmacology. Participant surveys suggest support groups can reduce loneliness, isolation, and stigma while reinforcing CBT techniques. The ability to see one another makes this option more engaging than phone support groups.

5. Videoconferencing-assisted clinical supervision: A shortage of experienced clinicians limits access to evidence-based OCD treatments. Videoconferencing helps increase access. In addition, supervisors can view trainees’ recorded treatment sessions and provide feedback. They can also listen in on trainees’ sessions and offer solutions when trainees get “stuck.”

Limitations include the fact thatthere is limited research on outcomes for fully remote EX/RP and none for video-assisted psychopharmacology. In addition, virtual support groups and video-assisted supervision need refinement and testing before broad implementation.

“Although digital health technologies such as videoconferencing are unlikely to replace

in-person OCD treatment, they are quickly becoming important tools to increase access and improve care for this debilitating, undertreated condition,” the researchers conclude.

Disclosure:Dr HB Simpson has received research support from Biohaven Pharmaceuticals, royalties from Cambridge University Press and UpToDate, and a stipend from the American Medical Association for her role as associate editor at JAMA Psychiatry.

Reference

Kayser RR, Gershkovich M, Patel S, Simpson HB. Integrating videoconferencing into treatment for obsessive-compulsive disorder: Practical strategies with case examples. Psychiatr Serv. Published March 26, 2021. doi:10.1176/appi.ps.202000558

Spit samples uncover genetic risk factors for paediatric obsessive-compulsive disorder

When Sam was 14 years old, his mind was so full of fear, he couldn’t think about anything else.

“I had really bad tendencies,” says Sam, now 17. “I would dehydrate myself to prevent going to the bathroom. I was very picky about things being sanitary. It was getting in the way of everything.”

After school he would shower for up to two hours, using two bars of soap. He would then worry that the books he had brought home weren’t clean enough to bring in the house. Sam says that when things were at their worst, he was diagnosed with obsessive-compulsive disorder (OCD).

Researchers at the University of Calgary and The Hospital for Sick Children (SickKids), in Toronto, have discovered genetic risk factors for OCD that could help pave the way for earlier diagnosis and improved treatment for children and youth.

“Our group made the first finding of a genome-wide significant risk gene relevant to childhood OCD,” says Dr. Paul Arnold, MD, PhD, co-principal investigator, a professor and director of The Mathison Centre for Mental Health Research and Education at the Cumming School of Medicine. “We’ve known that OCD runs in families, but we hadn’t identified and validated specific genetic risks of OCD symptoms in children and youth until now.”

Paul Arnold

The research drew on the Spit for Science study, a research project led by SickKids looking at how genes interact with the environment to impact physical and mental health. Participants from the community were recruited via an innovative research design run out of the Ontario Science Centre, which has generated a diverse sample of 23,000 participants thus far. Participants provide a DNA sample through their saliva, do a cognitive task, and complete questionnaires on their health, lifestyle and behaviours.

Genetic variant in the gene PTPRD linked to greater risk

In this study, saliva samples from over 5,000 children and youth were scanned and compared to participant responses using the Toronto Obsessive-Compulsive Scale (TOCS). The TOCS is a questionnaire used to evaluate obsessive-compulsive traits developed by Dr. Arnold and the team at SickKids. After looking across millions of genetic variants from the saliva samples, the team identified that children and youth with a genetic variant in the gene PTPRD had a greater risk for more obsessive-compulsive traits. The findings were published in Translational Psychiatry on Feb. 3, 2021.

“Discovering the genes involved in OCD is critical to help improve patients’ lives. It is still early days, but our hope is these findings will lead us to understand the causes of OCD, which in turn could help identify people with OCD sooner and develop better treatments,” says Dr. Christie Burton, PhD, lead author and research associate in the Neurosciences and Mental Health program at SickKids.  

Christie Burton, Jennifer Crosbie and Russell Schacha

The research team, which also includes co-principal investigators, Drs. Jennifer Crosbie, PhD, clinical psychologist at SickKids, and Russell Schachar, MD, psychiatrist at SickKids, highlight that a greater understanding of the underlying genetics may eventually be an important complement to clinical assessment and could help guide treatment options in the future.

OCD can present very differently and at various ages in each individual, adding to the challenge of treatment and diagnosis,” says Crosbie, who is also an associate scientist in the Neurosciences and Mental Health program at SickKids. “Studies like this one are an important step towards developing precision medicine approaches for mental health.”

OCD diagnosis surprised Sam and his family

With therapy and medication, Sam has been able to face his obsessions and compulsions, ride out the anxiety and control his actions. Looking back at his childhood, Sam says he had some OCD tendencies as early as elementary school, but neither he nor his family realized he had a mental illness. The researchers hope that by understanding the genetics of OCD, they can develop better treatments, improve outcomes and diagnose youth like Sam earlier.

“At first I wasn’t sure what to do with the diagnosis, it was very foreign, I didn’t want to perceive myself as having a mental health issue,” says Sam. “But, knowing I have OCD helped me overcome the challenges. With therapy and medication, I’ve stopped OCD from overtaking my life and taken back control of my thoughts.”

Sam is a real teenager, but Sam isn’t his real name. He says due to the stigma around OCD he would prefer to remain anonymous.

This study is supported by the Canadian Institutes of Health Research and SickKids Foundation.

What Are the Different Types of Anxiety?

There are several different types of anxiety or anxiety disorders. Here are some of the more common types according to the National Institute of Mental Health.

Generalized anxiety disorder (GAD)

If you have generalized anxiety disorder (GAD), you’ll likely experience excessive worry that’s difficult to control. This worry often takes the form of rumination, or spending time excessively thinking or mulling over different events in the future — how they may play out and how you may deal with them.

It’s not uncommon to have symptoms and not be able to explain why. For people with GAD, symptoms like those listed above are present most days and for at least the past 6 months.

Social anxiety disorder/social phobia

Social anxiety disorder, also referred to as social phobia, is a fear of being embarrassed, humiliated, or criticized in a public setting like school or work.

You may have trouble talking to people or being in a large group. It’s not uncommon to avoid the places and situations that trigger this phobia.

Panic disorder

Panic disorder is characterized by recurring, unexpected panic attacks.

They often happen without warning and result in physical symptoms like chest pain, shortness of breath, sweating, shaking, and dizziness. They also may involve feeling dissociated from reality or having a sense of impending doom.

In general, an attack lasts less than 20 minutes.

Phobias

Phobias and specific phobias involve an irrational, overwhelming, and excessive fear of a place, situation, or object. Some of the more common phobias include:

  • acrophobia (fear of heights)
  • claustrophobia (fear of tight spaces)
  • aerophobia (fear of flying)
  • hemophobia (fear of blood)
  • trypanophobia (fear of needles)
  • hydrophobia (fear of water)

Separation anxiety disorder

Separation anxiety disorder is most commonly diagnosed in kids, especially young children. However, adults can also experience this type of anxiety if they have extreme fear about something bad happening to a person in their life.

In children, the symptoms of fear, panic, worry, and anxiety surface when they’re separated from a parent or loved one. Adults may have extreme fear and worry about something tragic happening to a family member or loved one, even when they’re together.

Agoraphobia

Agoraphobia often occurs in response to panic attacks. If you have agoraphobia, you feel extreme fear or anxiety about having a panic attack or fear that something bad may happen in a specific place — usually outside the home.

You may avoid that place, usually confining yourself to the home, in order to stave off the possibility of something bad happening where you can’t access support or help.

You’ll often avoid feared places and situations at all costs.

Other types of anxiety

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) also lists other, less common types of anxiety, including:

  • selective mutism
  • substance- or medication-induced anxiety disorder
  • anxiety disorder due to another medical condition

Some mental health conditions are commonly referred to as anxiety disorders and may have once been classified as one, but now have a separate diagnostic category in the DSM-5.

These include:

  • Obsessive-compulsion and related disorders (OCRDs), which includes obsessive-compulsive disorder (OCD)
  • Adjustment disorders, such as post-traumatic stress disorder (PTSD)

People with trauma exposure at increased risk for obsessive-compulsive symptoms

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Trauma exposure appeared significantly associated with obsessive-compulsive symptoms among a community sample, according to a presentation from the Anxiety and Depression Association of America annual conference.

These findings aligned with those of prior research efforts into obsessive-compulsive symptoms following trauma exposure.

“Research back into the 1990s suggests endorsement of trauma is significantly, independently associated with OCD symptoms,” Rose Luehrs, MA, MS, a clinical psychology doctoral candidate at Suffolk University in Boston, said during the presentation. “Some individuals may be at an increased risk for developing comorbid PTSD plus OCD following trauma exposure compared with others. OCD and PTSD symptoms following trauma can be difficult to distinguish from traditional PTSD given the conceptual overlap.”

Leuhrs and colleagues aimed to assess the potential relationship between diagnosis of PTSD and obsessive-compulsive symptoms among the general population. They analyzed data included in the restricted access National Comorbidity Survey Replication (NCS-R) dataset, since this version allowed the researchers to observe various types of traumatic events that individuals had endorsed. The first part of the NCS-R included 9,282 participants who comprised a nationally representative sample aged 18 to 74 years. The second part included 5,692 participants. A total of 1,808 were assessed for OCD. Luehrs and colleagues selected for analyses PTSD and obsessive-compulsive symptom data that had been assessed via the WHO World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI).

Results showed participants’ worst traumatic event, on average, occurred at age 24.1 years. Participants endorsed an average of 11.5 PTSD symptoms, and 6.8% of the sample met criteria for lifetime PTSD and 1.6% for obsessive-compulsive symptoms at the clinical threshold. Further, bivariate correlation showed lifetime PTSD was significantly and positively associated with several obsessive-compulsive symptoms, including recurrent concern about germs and washing; recurrent impulse to check things; recurrent impulse to arrange and order things; urge to save unneeded things; recurrent disturbing thoughts about sexuality or religion; recurrent unpleasant thoughts about morality or sin; recurrent concern about doing something terrible; and recurrent concern about being seriously ill.

The researchers also noted significant, positive associations between type of trauma exposure and obsessive-compulsive symptoms, including experiencing a natural disaster and concern with dirt/germs and excessive washing; being mugged, held up or robbed and recurrent impulse to order or arrange things; and having a child with a life-threatening illness and excessive concern with dirt/germs. Participants who learned about a traumatic event happening to a loved one were more likely to exhibit recurrent impulse to order and arrange things, compulsion to collect unneeded things and excessive concern with dirt/germs.

“The literature both from a clinical and research standpoint would really benefit from having some more rigorous investigations on the relationship between trauma and OCD and PTSD for specifically treatment-seeking samples,” Luehrs said. “We really need research in these areas to clearly distinguish the theoretical differences between potentially overlapping symptoms in PTSD and OCD. We have difficulty differentiating symptoms of OCD from PTSD following trauma, and this may contribute to a lack of clarity around terminology and intervention planning.”

Reference:

Luehrs R, et al. The relationship between trauma, OCD and PTSD: Translating research into practice. Presented at: The Anxiety and Depression Association of America Annual Conference; Mar. 18-19, 2021 (virtual meeting).

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Social Anxiety and Obsessive-Compulsive Disorder Are Common Among Persons With Multiple Sclerosis at King Abdulaziz Medical City, Riyadh

This article was originally published here

Cureus. 2021 Feb 28;13(2):e13619. doi: 10.7759/cureus.13619.

ABSTRACT

Background Multiple sclerosis (MS) is associated with a physical disability and disturbed psychosocial functioning in young people. Many psychological and psychiatric comorbidities have been reported in MS. Objective To determine the frequency of social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) among MS patients and their relation to MS severity. Methods A cross-sectional survey was conducted in an adult MS cohort. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Social Phobia Inventory (SPIN) were used to determine the presence and severity of OCD and SAD. The Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY) was used for statistical analysis. The Mann-Whitney U test and logistic regression were used to assess the association of the two diseases with the severity of MS. Results A total of 145 persons with MS (pwMS) were studied. The mean age was 33.5 (±8.5) years; the mean duration of MS was 7.2 (± 5.1) years. The majority (74.1%) were women; 57.3% were married; 63% had a college education; 50% belonged to the higher middle-class socioeconomic strata. Relapsing-remitting multiple sclerosis was the most common type of MS (92.2%). The mean Expanded Disability Status Scale (EDSS) score was 2.24 (±2.19). SAD was reported by 26.9%, and OCD was reported by 31% of the cohort. PwMS with walking difficulty but not wheelchair-bound had a statistically significant increased risk of SAD (p = 0.036). There was no direct association between MS-related disability and OCD. However, pwMS with SAD were more likely to have concomitant OCD (t=4.68, p-value 0.001, 95% CI: 0.47-1.16). Increasing disability was associated with higher chances of developing social anxiety and, in turn, OCD (t=3.39, p-value 0.001, 95% CI: 0.66-2.52). Conclusions Social anxiety and obsessive-compulsive disorders were present in nearly one-third of pwMS. Impaired walking but not wheelchair dependence was associated with social anxiety. PwMS with SAD were more likely to have obsessive-compulsive disorder.

PMID:33816018 | PMC:PMC8010157 | DOI:10.7759/cureus.13619