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

Psychologist shares skills to help families cope when a loved one has OCD

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Credit: The Guilford Press

New York, NY–When a loved one has Obsessive-Compulsive Disorder (OCD), it’s a constant struggle. It hurts to see your spouse so anxious or your teen spending so much time alone. This is especially true right now, as the COVID-19 panic has exacerbated OCD symptoms for many people who struggle with the disorder.

Psychologist Jonathan Abramowitz is an internationally recognized expert on OCD and anxiety disorders. Over the course of his 25-year career, he has come to believe that OCD isn’t an individual issue; it is a family issue.

The key to successfully helping your loved one? First you must focus on your own behavior and learn to reduce patterns of “family accommodation,” such as helping with rituals, tolerating avoidance of triggers, or looking the other way as the person with OCD performs obsessive-compulsive rituals.

“I’ve worked with countless families affected by OCD. And I’m here to tell you that it doesn’t have to be this way. You can turn things around. You don’t have to walk on eggshells. You don’t have to argue…The solution is to provide the kind of consistent support that helps your relative develop the confidence and skills to manage OCD in a healthier way and without needing to lean so much on you or others,” Dr. Abramowitz writes in his new book, The Family Guide to Getting Over OCD.

Use the ‘SMART method’ to reduce family accommodation and help your loved one with OCD

Dr. Abramowitz recommends using the acronym SMART to help you optimize your goals and maximize your likelihood of success. Here’s how it works:

S is for SPECIFIC — Make your goals as detailed and specific as possible. Simply saying “My goal is to stop accommodating” is too hazy. Instead, use “I will no longer help Ariel check the doors and appliances before bed.” Try to choose goals that rest solely on your own actions (for example, “I will leave the house regardless of whether Brandon is ready to go” vs. “Brandon will stop preforming rituals that make us late.”) You’ve got a better chance of meeting goals when they’re fully under your control. Keep the focus on changing your own behavior.

M is for MEASURABLE — Your goals for reducing accommodation also need to be measurable so that you know when you have succeeded. Choose concrete goals that you can keep track of. “Stop throwing away items Antonio has deemed ‘contaminated'” provides a specific target to be measured: whether or not you’ve thrown anything away. On the other hand, “Do a better job of not accommodating Antonio’s OCD” is not measurable: How will you decide if you’ve done a better job? Setting goals to change observable behaviors (that someone else would be able to see) is your best bet for making sure your goals are measurable.

A is for ACHIEVABLE — Your goals should challenge you to stay focused and committed
to your program, but at the same time they need to be realistic. If you set goals that stretch you (and your loved one with OCD), you will continue to put in the effort to achieve them. On the other hand, you probably won’t stay committed to goals that are too far out of reach. For example, “I will never reassure my sister again” is probably unattainable, especially if you’ve become accustomed to providing reassurance and your sister is clever about getting it from you. Instead, “I will stop answering my sister’s texts when she asks for reassurance” is probably a more reasonable (and also a more specific) goal.

R = RELEVANT — Without an emotional tie to your goals, you’ll lose the motivation to stick with them. In this case, they should obviously relate to (1) helping your loved one develop self-confidence and the ability to manage anxiety on her own, (2) reducing your involvement in her OCD symptoms, and (3) improving your and your family’s quality of life. Tying goals to one or more of these things will build your commitment to success.

T is for TIME BOUND — Finally, your goals should have a time frame. This means stipulating when you’ll begin changing your behavior–for example, “beginning tomorrow.” By specifying a time frame, you make your goal a priority, which increases motivation. Goals without specific time frames are less likely to be met because you feel you can put them off.

Overcoming family accommodation of OCD is not easy. “But remember,” says Dr. Abramowitz, “by gently but firmly encouraging the person you care about to face their fears, you can stop being controlled by their OCD. Ultimately your relationship will grow stronger, and your whole family will grow more confident and hopeful.”

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OCD among new mothers more prevalent than previously thought

Obsessive compulsive disorder (OCD) among those who have recently given birth is more common than previously thought, and much of this can be attributed to thoughts of harm related to the baby, new UBC research has found.

The researchers also learned that OCD can go undetected when new parents aren’t asked specifically about infant-related harm.

OCD is an anxiety-related condition characterized by the recurrence of unwanted, intrusive and distressing thoughts. If left untreated, it can interfere with parenting, relationships and daily living.

The study estimates that eight per cent of postpartum women report symptoms that meet criteria for a diagnosis of OCD at some point during pregnancy, and 17 per cent do so in the 38 weeks after delivery. Prior research had estimated the prevalence of OCD at about 2.2 per cent over the pregnancy and postpartum period.

“What really matters now is that we screen for and assess OCD among perinatal women with perinatal-specific questions and assessment methods. It is especially important that we include questions about intrusive thoughts of infant-related harm. This ensures that perinatal women suffering from OCD are not missed and can be directed toward appropriate treatment,” said Dr. Nichole Fairbrother, a clinical associate professor in the UBC department of psychiatry who was lead author of the study. “Perinatal OCD is common and we have a responsibility to identify those who experience it and ensure they receive timely, evidence-based treatment.”

The study is one of the first to use newly updated criteria for diagnosing OCD which somewhat lowers the threshold for a diagnosis

However, the researchers also believe they uncovered more OCD by asking the right questions. New mothers appear not to recognize their infant-related thoughts in the standard questions asked during OCD assessments. By including specific questions about harm to the baby, the researchers were better able to uncover symptoms.

“The traditional questions are framed in a way that doesn’t really help women connect to the intrusive thoughts they’ve had about their baby.” said Fairbrother. “If they don’t recognize their experience in the questions that are asked, they may be underreporting.”

Fairbrother and her team from UBC, the University of Victoria, the Women’s Health Research Institute and King’s College London surveyed 580 women in British Columbia during their third trimester of pregnancy and for six months afterward. Participants completed online questionnaires and interviews designed to assess the presence and severity of OCD symptoms.

The prevalence of OCD among new mothers peaked approximately eight weeks after delivery at nearly nine per cent. The study data suggests that it resolves naturally among some women as they become used to parenting, but for others it persists and may require treatment.

It’s important for care providers to know when women are most at risk, because they may be reluctant to report their symptoms.

“When mothers have these kinds of thoughts they might think, ‘There’s something wrong with me and I can’t tell anyone because there could be terrible consequences for me and my baby,’ Fairbrother said.

Education for both women and their care providers is needed, she said. If care providers are able to distinguish between thoughts that are perfectly normal, those that might indicate a need for treatment, and those that might signal a threat to the baby, they are less likely to err on the side of caution in a way that would have consequences for women and their babies.

The study was published today in the Journal of Clinical Psychiatry.

OCD patients with comorbidities respond well to deep brain stimulation

AURORA, Colo. (March 31, 2021) – A new study published in Frontiers in Psychiatry finds that patients with Obsessive Compulsive Disorder (OCD) as well as other psychiatric comorbidities, such as autism spectrum or tic disorders, may respond well to Deep Brain Stimulation (DBS).

DBS is a minimally invasive neurosurgical procedure that uses coordinates to target certain areas of the brain, implanting electrodes that can help regulate abnormal brain activity. DBS procedures are rare for OCD in the United States; only a couple hundred patients have received this treatment for OCD management since its FDA approval in 2009 via a Humanitarian Device Exemption. The effectiveness of DBS for OCD has been well-documented in literature, but the interplay with comorbid disorders has not been as thoroughly explored.

“This study helps us understand more about real-world use of DBS for OCD,” says Rachel Davis, MD, associate professor in the CU Department of Psychiatry and study principal investigator. “Most patients seeking treatment don’t only have OCD, comorbidities are more the rule than the exception. So it’s important to understand how this life-changing procedure can benefit our more typical patients.”

Davis and clinicians at the University of Colorado Anschutz Medical Campus retrospectively examined five patients seeking DBS for OCD between 2015 and 2019. Patients exhibited comorbidities including substance use disorder, eating disorder, autism spectrum disorder, major depression, ADHD, and tic disorder. Three patients were awake during DBS surgery, allowing clinicians to check for response to stimulation (improved mood, increased energy, and reduction in anxiety), an additional way to confirm correct electrode placement. After surgery, Davis assessed response and determined the correct settings by asking patients about changes in mood, energy, and anxiety. Improvement in these areas tend to be associated with reduction in OCD symptoms later on. Change over time was monitored with a variety of IRB-approved questionnaires, gauging changes in mood, anxiety, depression and other quality of life elements affected by OCD.

Overall, these patients experienced significant improvement in OCD and mood symptoms. A standard scale for assessing symptom severity and treatment response in OCD, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), measures degree of distress and impairment caused by obsessions and compulsions. A good clinical response is considered to be greater than a 35% reduction. In this study, patients averaged a 44% reduction on this scale; four out of five experienced full response with the fifth having a partial response, with approximately 25% reduction in OCD symptoms. Patients also reported an average of 53% reduction in depression symptoms.

“For these treatment-refractory OCD patients, our Psychiatric DBS program, led by Dr. Davis, is finally providing relief,” says John Thompson, PhD, associate professor of neurosurgery at the University of Colorado School of Medicine and one of the co-authors on this manuscript. “While DBS for OCD is rare, this study is a glimpse at its potential. There is much yet to be learned about the complex interplay between circuit modulation and co-morbid symptom management in OCD patients treated with DBS.”

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About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, together we deliver life-changing treatments, patient care, professional training, and conduct world-renowned research. For more information, visit http://www.cuanschutz.edu.

Psychologist offers a family guide to help a loved one with OCD – News

When a loved one has Obsessive-Compulsive Disorder (OCD), it’s a constant struggle. It hurts to see your spouse so anxious or your teen spending so much time alone. This is especially true right now, as the COVID-19 panic has exacerbated OCD symptoms for many people who struggle with the disorder.

Psychologist Jonathan Abramowitz is an internationally recognized expert on OCD and anxiety disorders. Over the course of his 25-year career, he has come to believe that OCD isn’t an individual issue; it is a family issue.

The key to successfully helping your loved one? First you must focus on your own behavior and learn to reduce patterns of “family accommodation,” such as helping with rituals, tolerating avoidance of triggers, or looking the other way as the person with OCD performs obsessive-compulsive rituals.

“I’ve worked with countless families affected by OCD. And I’m here to tell you that it doesn’t have to be this way. You can turn things around. You don’t have to walk on eggshells. You don’t have to argue…The solution is to provide the kind of consistent support that helps your relative develop the confidence and skills to manage OCD in a healthier way and without needing to lean so much on you or others,” Dr. Abramowitz writes in his new book, The Family Guide to Getting Over OCD.

Use the ‘SMART method’ to reduce family accommodation and help your loved one with OCD

Dr. Abramowitz recommends using the acronym SMART to help you optimize your goals and maximize your likelihood of success. Here’s how it works:

S is for SPECIFIC — Make your goals as detailed and specific as possible. Simply saying “My goal is to stop accommodating” is too hazy. Instead, use “I will no longer help Ariel check the doors and appliances before bed.” Try to choose goals that rest solely on your own actions (for example, “I will leave the house regardless of whether Brandon is ready to go” vs. “Brandon will stop preforming rituals that make us late.”) You’ve got a better chance of meeting goals when they’re fully under your control. Keep the focus on changing your own behavior.

M is for MEASURABLE — Your goals for reducing accommodation also need to be measurable so that you know when you have succeeded. Choose concrete goals that you can keep track of. “Stop throwing away items Antonio has deemed ‘contaminated'” provides a specific target to be measured: whether or not you’ve thrown anything away. On the other hand, “Do a better job of not accommodating Antonio’s OCD” is not measurable: How will you decide if you’ve done a better job? Setting goals to change observable behaviors (that someone else would be able to see) is your best bet for making sure your goals are measurable.

A is for ACHIEVABLE — Your goals should challenge you to stay focused and committed to your program, but at the same time they need to be realistic. If you set goals that stretch you (and your loved one with OCD), you will continue to put in the effort to achieve them. On the other hand, you probably won’t stay committed to goals that are too far out of reach. For example, “I will never reassure my sister again” is probably unattainable, especially if you’ve become accustomed to providing reassurance and your sister is clever about getting it from you. Instead, “I will stop answering my sister’s texts when she asks for reassurance” is probably a more reasonable (and also a more specific) goal.

R = RELEVANT — Without an emotional tie to your goals, you’ll lose the motivation to stick with them. In this case, they should obviously relate to (1) helping your loved one develop self-confidence and the ability to manage anxiety on her own, (2) reducing your involvement in her OCD symptoms, and (3) improving your and your family’s quality of life. Tying goals to one or more of these things will build your commitment to success.

T is for TIME BOUND — Finally, your goals should have a time frame. This means stipulating when you’ll begin changing your behavior–for example, “beginning tomorrow.” By specifying a time frame, you make your goal a priority, which increases motivation. Goals without specific time frames are less likely to be met because you feel you can put them off.

Overcoming family accommodation of OCD is not easy.

But remember, by gently but firmly encouraging the person you care about to face their fears, you can stop being controlled by their OCD. Ultimately your relationship will grow stronger, and your whole family will grow more confident and hopeful.”

Dr. Jonathan Abramowitz, Psychologist

Guilford Press

Mental Illness: Definition, Types, Diagnosis, Treatment

A mental illness is a health condition involving changes in thinking, emotion, or behavior leading to distress or problems functioning in social, work, or family activities. Mental illness is quite common: In 2019, nearly one in five U.S. adults experienced a mental illness, while one in 20 U.S. adults have a serious mental illness. It is estimated that 46% of people who died by suicide had a diagnosed mental health condition and 90% of individuals who died by suicide had shown signs of a mental health condition.

Many people develop a mental illness early on in life, with 50% of all lifetime mental illness beginning by age 14 and 75% by age 24. Its impact on the healthcare system is substantial: Mental illness and substance use disorders are involved in one out of eight emergency room visits.

There are many different types of mental illness—referred to as mental disorders—with different causes, symptoms, and treatments. Some may involve a single episode, while others are relapsing or persistent. To ensure the correct diagnosis and a standardized treatment plan, mental disorders are diagnosed based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) issued by the American Psychiatric Association.

Sad woman suffering from depression

Ivan Pantic / Getty Images


Types

The DSM-5 categorizes major types of mental disorders by Diagnostic Criteria and Codes.

Anxiety Disorders

Anxiety disorders are the most common mental health concern in the United States, affecting 19.1% of the population. People with anxiety disorders have excessive fear and anxiety and related behavioral disturbances. Their anxiety symptoms can worsen over time, interfering with their ability to function in their daily life. It also leads to attempts to avoid situations or triggers that worsen symptoms.

Anxiety disorders are a group of related conditions, each having unique symptoms. Types of anxiety disorder include:

Bipolar and Related Disorders

Bipolar disorder causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with this disorder experience extremely high and low moods, known as mania and depression. They may have distinct manic or depressed states, but may also have long periods without symptoms. A person with bipolar disorder can also experience both extremes simultaneously or in rapid sequence. It affects 2.8% of the U.S. population, and 83% of cases are classified as severe.

Bipolar disorders can be categorized into four types, including:

  • Bipolar I disorder 
  • Bipolar II disorder 
  • Cyclothymic disorder or cyclothymia
  • Bipolar disorder, “other specified” and “unspecified”

Depressive Disorders

People with depressive disorders, commonly referred to as simply depression, experience a sad, empty, or irritable mood accompanied by physical and cognitive changes that are severe or persistent enough to interfere with functioning. Some will only experience one depressive episode in their lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

Those with depression lose interest or pleasure in activities and have excessive fatigue, appetite changes, sleep disturbances, indecision, and poor concentration. Suicidal thinking or behavior can also occur.

There are many types of depression, including:

  • Major depressive disorder
  • Bipolar depression 
  • Perinatal and postpartum depression
  • Persistent depressive disorder or dysthymia
  • Premenstrual dysphoric disorder
  • Psychotic depression 
  • Seasonal affective disorder (major depressive disorder with seasonal pattern)

Dissociative Disorders 

Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociation refers to a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is. Symptoms of dissociative disorders can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body and loss of memory, or amnesia. Dissociative disorders are frequently associated with previous experience of trauma. It is believed that dissociation helps a person tolerate what might otherwise be too difficult to bear.

There are three types of dissociative disorders:

  • Dissociative identity disorder
  • Dissociative amnesia
  • Depersonalization/derealization disorder

Feeding and Eating Disorders

People with feeding and eating disorders experience severe disturbances in their eating behaviors and related thoughts and emotions. They become so preoccupied with food and weight issues that they find it harder and harder to focus on other aspects of their life. Over time, these behaviors can significantly impair physical health and psychosocial functioning. Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. 

There are three main types of eating disorders:

  • Anorexia nervosa 
  • Bulimia nervosa 
  • Binge eating disorder 

Gender Dysphoria

Gender dysphoria refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. It often begins in childhood, but some people may not experience it until after puberty or much later.

Transgender people are individuals whose sex assigned at birth does not match their gender identity. Some transgender people experience gender dysphoria, and they may or may not change the way they dress or look to align with their felt gender.

Neurocognitive Disorders

Neurocognitive disorders refers to decreased cognitive functioning due to a physical condition. People with this condition may have noticeable memory loss, difficulty communicating, significant problems handling daily tasks, confusion, and personality changes. Neurocognitive disorders can be caused by a wide range of conditions, including Alzheimer’s disease, vascular disease, traumatic brain injury, HIV infection, Parkinson’s disease, and Huntington’s disease.

Types of neurocognitive disorders include:

  • Delirium
  • Major neurocognitive disorder
  • Mild neurocognitive disorder

Neurodevelopmental Disorders 

Neurodevelopmental disorders are a group of disorders in which the development of the central nervous system is disturbed. This can include developmental brain dysfunction, which can manifest as neuropsychiatric problems or impaired motor function, learning, language, or non-verbal communication.

Types of neurodevelopmental disorders include:

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). These repetitive behaviors can significantly interfere with a person’s daily activities and social interactions. Not performing the behaviors commonly causes great distress. people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions. This disorder is estimated to affect 2% to 3% of U.S. adults.

Disorders related to OCD include:

  • Hoarding disorder
  • Body dysmorphic disorder 
  • Body focused repetitive behaviors like excoriation (skin-picking) disorder and trichotillomania (hair-pulling disorder)

Personality Disorders

People with personality disorders have persistent patterns of perceiving, reacting, and relating that are maladaptive and rigid, causing distress and functional impairments. The pattern of experience and behavior begins by late adolescence or early adulthood, and causes distress or problems in functioning. People with personality disorders have trouble dealing with everyday stresses and problems, and they often have stormy relationships with other people.

There are 10 types of personality disorders:

  • Antisocial personality disorder
  • Avoidant personality disorder
  • Borderline personality disorder
  • Dependent personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder
  • Obsessive-compulsive personality disorder
  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Schizophrenia Spectrum and Other Psychotic Disorders

People with schizophrenia spectrum and other psychotic disorders lose touch with reality and experience a range of extreme symptoms that may include hallucinations, delusions, disorganized thinking and speech, and grossly disorganized or abnormal behavior. Schizophrenia affects less than 1% of the U.S. population.

Other psychotic disorders include:

  • Brief psychotic disorder
  • Delusional disorder 
  • Schizoaffective disorder
  • Substance-induced psychotic disorder

Sleep-Wake Disorders

Sleep-wake disorders, also known as sleep disorders, involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. They often occur along with medical conditions or other mental disorders, such as depression, anxiety, or cognitive disorders.

There are several types of sleep-wake disorders:

  • Insomnia
  • Obstructive sleep apnea
  • Parasomnias
  • Narcolepsy
  • Restless leg syndrome.

Substance Abuse Disorders

Substance abuse disorders, also called substance use disorder, occurs when a person’s use of alcohol or another substance like drugs leads to health issues or problems at work, school, or home. People with this disorder have an intense focus on using a certain substances to the point where their ability to function in day-to-day life becomes impaired, and they keep using the substance even when they know it is causing or will cause problems.

Trauma-Related Disorders

Trauma-related disorders occur after exposure to a stressful or traumatic event, which can include exposure to physical or emotional violence or pain,abuse, neglect, or catastrophic event. Trauma-related disorders are characterized by a variety of symptoms, including intrusion symptoms (flashbacks),avoidance, changes in mood such as anhedonia (inability to feel pleasure) or dysphoria (dissatisfaction with life), anger, aggression, and dissociation.

Types of trauma-related disorders include:

  • Post-traumatic stress disorder
  • Acute stress disorder
  • Adjustment disorder
  • Reactive attachment disorder
  • Disinhibited social engagement disorder
  • Unclassified and unspecified trauma disorders

Diagnosis

Doctors diagnose mental illness by using the criteria outlined in the DSM-5. Many conditions require all criteria to be met before a diagnosis can be made. Others, like borderline personality disorder, require only a set number of criteria from a larger list to be met. 

Many disorders are further classified by severity and specifications that can help doctors determine the appropriate course of treatment for an individual patient. For example, someone being diagnosed with an obsessive-compulsive disorder will also be categorized based upon their level of insight as to whether their OCD beliefs are true and whether or not they present with a current or past history of tic disorder.

About half of people with one mental illness have a comorbid substance use disorder (co-occuring disorder present at the same time or one right after the other). As such, the likelihood of a mental and substance use disorder dual diagnosis is high due to common risk factors and the fact that having one condition predisposes a person to the other. 

It is also common for people to have more than one mental illness at a time. Common comorbidity examples include: 

  • Borderline personality disorder: Other personality disorders, major depression, bipolar disorders, anxiety disorders, and eating disorders
  • Social anxiety disorder: Other anxiety disorders, major depression, and alcohol use disorder
  • Eating disorders: Anxiety, substance use disorder, obsessive compulsive disorder, depression, and post-traumatic stress disorder

It is best for primary care physicians and mental health professionals to work together because a diagnosis as defined by the DSM requires exclusion of other possible causes, including physical causes and other mental disorders with similar features. For example, paranoid delusions can be caused by Huntington’s disease, Parkinson’s disease, stoke, or Alzheimer’s disease, and other forms of dementia.

Treatment

Due to the wide variety of mental illnesses, many different health professionals may be involved in the treatment process, including:

  • Psychologists
  • Therapists
  • Social workers
  • Psychiatrists
  • Primary care physicians 
  • Pharmacists

Treatment may include one or more of the above professionals and one or more methods (e.g. counseling combined with medication). Treatment-resistant disorders may require further interventions.

Psychotherapy

Psychotherapy is used to treat a broad range of mental illnesses by helping a person control their symptoms in order to increase functioning, well-being, and healing. 

Common types of psychotherapy include:

  • Cognitive behavioral therapy (CBT): Helps you identify and change maladaptive behaviors
  • Dialectical behavioral therapy (DBT): A form of psychotherapy that uses aspects of CBT along with other strategies including mindfulness that helps you regulate emotions such as those related to suicidal thinking and teaches new skills to change unhealthy and disruptive behaviors
  • Supportive therapy: Helps you build self-esteem while reducing anxiety, strengthening coping mechanisms, and improving social functioning

Medication

Medications may be used to reduce symptoms and restore functioning. They are often used in conjunction with psychotherapy.

Four major types of psychotropic drugs include:

  • Antidepressants such as SSRIs, SNRIs, and bupropion are used to treat depression and anxiety, pain, and insomnia. They may also be used to treat ADHD in adults. 
  • Anxiolytics are anti-anxiety medications and are used to treat symptoms ranging from panic attacks to feelings of extreme worry and fear.
  • Antipsychotics are used to treat symptoms of psychosis including delusions and hallucinations. They are often used with other medications to help treat delirium, dementia, and other conditions, including eating disorders, severe depression, and OCD. 
  • Mood stabilizers such as lithium can be used to treat bipolar disorder and mood swings associated with other disorders and also to help with depression. 

Procedures

Brain stimulation procedures like electroconvulsive therapy (ECT), transcranial magnetic stimulation, and vagus nerve stimulation are used in cases of treatment-resistant and severe depression.

During ECT, electrodes are placed on the head to deliver a series of shocks to the brain to induce brief seizures while the patient is under anesthesia. For transcranial magnetic stimulation, magnets or implants are used to stimulate cells associated with mood regulation.

Ketamine infusion or nasal spray therapy offers another option for people with treatment-resistant major depression. It works rapidly and helps reduce suicide ideation.

Lifestyle

Lifestyle changes help promote overall well-being. Healthy lifestyle choices include:

  • Exercising for at least 20 minutes a day
  • Practicing mindfulness in meditation or yoga
  • Avoiding smoking
  • Avoiding substance use (including alcohol)
  • Eating a well-rounded diet that limits fats and refined sugars
  • Having a support system 
  • Maintaining a regular seven- to nine-hour sleep routine
  • Practicing positive thinking

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database

A Word From Verywell

It’s understandable if you’re feeling a little overwhelmed, confused, and even scared when it comes to mental illness. It is possible to live a healthy life with mental illness, and the first step is often the hardest: telling someone about your concerns. Early diagnosis and treatment often improve overall outcome, and talking about it helps further reduce stigma. Remember that there are a lot of ways to manage your mental illness and prevent it from interfering with your daily life.