Tag: obsessive anxiety disorders

Control is an important construct in the fields of psychology and psychopathology, particularly as it relates to anxiety and obsessive-compulsive disorders (OCD). Losing control, however, is a fear clinical psychologists observe in many patients but one that remains understudied and little understood.

A new paper published in the Journal of Behavior Therapy and Experimental Psychiatry presents a new perspective on this fear, with rich implications for future treatment and research. Adam Radomsky, the paper’s author and a professor in the Department of Psychology, outlines some recent work and thinking about these fears and beliefs around the loss of control. He also addresses how this knowledge can be used to study, assess and treat patients with diverse psychological issues.

“I think this fear is very likely trans-diagnostic, meaning that it’s seen in patients suffering from multiple different disorders,” he says. “But what they fear losing control over, or what the consequences of losses of control might be, will of course vary from person to person.”

Radomsky, a core member of the Centre for Clinical Research in Health, hopes the paper will promote increased interest to foster new research that can be carried out and later applied in clinical settings.

Seen across disorders

Radomsky says he developed his interest in the idea after hearing anecdotal evidence of this fear of losing control from multiple clients in his clinical practice. As a cognitive behavioural therapist, Radomsky treats patients with social anxiety disorder, OCD, panic disorder and other problems.

He says his clients do not necessarily tell him they fear losing control as a primary concern. Rather, they voice fears about making fools of themselves in public or that they are losing control of their minds or bodies and bodily functions. Others express fears of losing control of their belongings or surroundings.

“It’s something that can sit underneath the sorts of fears people bring into the clinic,” he notes.

To assess the levels of fears his patients are exhibiting, Radomsky and his students are building on techniques that use precise, experimental, questionnaire- and interview-based lines of inquiry.

“There are strategies we use in cognitive behaviour therapy that can help people think differently about losing control and to act differently,” he says. “The research will help us explore how far we can expand on that.”

Radomsky says that asking people to try to lose control often leads them to be puzzled and to question how losses of control might work.

“If they can’t lose control even when they are trying to lose control, maybe it just doesn’t work that way,” he says. “Maybe control is not something you need to pursue because it is already there.”

Thinking carefully

Radomsky suspects that what many people call losses of control are in fact different ways of thinking about past decisions: It may be easier for people to call poor decisions made impulsively as losses of control, although this is an open scientific question.

“People will commonly say, ‘I lost my temper’ or ‘I was drunk and said something that I now regret.’ But on careful examination, what people are likely to say is that they wanted to act that way at the time,” he explains. “Is that losing control? I think — at least sometimes — that is being in control and then later realizing you made a mistake, perhaps by not thinking carefully about the consequences of your actions.”

This approach has clinical implications as well, Radomsky notes. With a deeper understanding of what leads to a patient’s choices, a therapist can help them make better ones in the future.

“I think that is much more in the scope of our work than trying to help people stay in control, which is likely to cause more problems,” he says. “If you are constantly trying to stay in control, odds are you’ll find that causes more problems than focusing on other issues.”

This work was supported by an Insight Grant from the Social Sciences and Humanities Research Council of Canada

Read the cited paper: “The fear of losing control.”

Imagine growing up tormented by fears and life-consuming rituals that make no sense to you or those around you. Then imagine the shame of being told by mental health providers that, because you understand that your behaviours are illogical but keep doing them anyway, you must want to stay sick.

One of my patients, Moksha Patel, who is a doctor himself, endured this from childhood until his early 30s. In September 2021, Patel underwent deep brain stimulation surgery, a rare neurosurgical procedure that can be used for severe obsessive-compulsive disorder, or OCD, when it has been resistant to less invasive treatments.

Patel has consented to this publication of his medical information. He shares his story publicly to combat stigma and to provide hope for other sufferers that relief is possible.

The term OCD is thrown around casually, often by someone joking about how organized they are: “I’m so OCD.” But true obsessive-compulsive disorder is debilitating and leads to significant suffering.

I lead a team that treats people with OCD using evidence-based approaches. I am also co-director of the OCD surgical program at the University of Colorado, Anschutz campus, and UC Health, a nonprofit health care system in Colorado.

Our surgical program is one of the few academic centers in the U.S. that offer deep brain stimulation for the treatment of OCD. My experience and research have given me insight into how a rare procedure can be used in real-world settings to provide relief to those who suffer from OCD when other less invasive treatments have not been successful.

What Does Ocd Feel Like For A Sufferer?
A brain with OCD is primed to detect any signs of potential danger. Many people with OCD wake up every day with a sense of dread and an expectation of bad things happening. Daily life is overshadowed by ever-present guilt, shame, fear and doubt. As a result, they carry out compulsive and repetitive activities to attempt to forestall disaster and manage the painful emotions.

OCD fears most often involve the things and people that matter the most to the sufferer, such as their values, loved ones or purpose in life. For example, someone who values kindness and compassion might fear that they will offend, betray or somehow hurt the people they care about.

Sometimes what is hardest for someone who suffers with OCD is a recognition that the fears and behaviors are illogical – insight that provides no relief.

And because other people usually don’t understand, those with OCD do their best to hide their illness so they won’t be judged as ridiculous or “crazy,” which often leads to long delays in diagnosis and treatment. This is a painful and lonely life for the approximately 1%-2% of the world population with OCD.

Current OCD Treatment Options
The best initial treatment for OCD is a type of mental health therapy called exposure and response prevention. During these sessions, OCD sufferers are supported in gradually confronting their fears while also limiting the behaviors they have come to associate with providing safety.

For instance, someone with a fear of harming others might start by sitting near a butter knife and work their way up to holding a sharper knife to their therapist’s throat. They either learn that their fear does not play out, or – in the case of fears that cannot be disproved – that they can tolerate their anxiety or distress and move forward even in the absence of certainty.

The primary medications used to treat OCD are serotonin reuptake inhibitors, or SRIs/SSRIs, which are commonly prescribed for treatment of depression and anxiety. But when used for OCD, these medications are typically prescribed at much higher dosages.

Unfortunately, OCD is a chronic condition for most; studies show that only 65% of people with OCD respond to standard treatment, which is a combination of therapy and medication, and only about 35% recover completely. About 10% of individuals with OCD remain severely impaired, regardless of how intensively they are treated.

The Potential Of Deep Brain Stimulation

For this small group of individuals with severe and persistent OCD, deep brain stimulation – a procedure that fewer than 400 people with OCD have undergone worldwide – provides hope.

Patel, an internal medicine doctor, first came to my office in 2019. He is one of 13 patients I’ve worked with to provide deep brain stimulation for OCD and other psychiatric illnesses.

He has suffered with OCD since the age of 4 or 5, with obsessive fears about germs, contamination and social interactions, among other things. He learned to function and succeed by shaping his life around his rituals – for example, by not consuming water or food at work so that he would not need to use public restrooms.

Patel, like many others with OCD, is conscientious, thorough and compassionate, traits that contribute to his success as a physician. However, before deep brain stimulation, most of his life outside of work was occupied by painful, consuming rituals. These included scrubbing himself with harsh chemicals for hours.

He had explored every treatment he could find, seeing 13 mental health providers since high school and participating in years of exposure therapy. He had tried at least 15 different medications, all with little benefit. Then he learned that deep brain stimulation was available at the hospital where we both work.

How Deep Brain Stimulation Works

Deep brain stimulation requires a neurosurgical procedure to place thin electrodes into deep structures of the brain, specifically a region known as the ventral capsule/ventral striatum. These electrodes deliver electrical currents to the brain. The current is produced by pulse generators in the chest that look much like cardiac pacemakers. They are connected to the electrodes in the brain by wires tunneled beneath the skin.

We researchers do not yet have a precise understanding of exactly how deep brain stimulation works, but we do know that it normalizes the communication between parts of the brain responsible for taking in information and those responsible for acting on this information. These areas are hyperconnected in people with OCD, leading to a reduced ability to make thoughtful, value-driven decisions and an over-reliance on reflexive or habitual behaviors. And the changes induced by deep brain stimulation correlate with a reduction in OCD symptoms.

This type of neurostimulation is most commonly used to manage symptoms of Parkinson’s disease, a movement disorder that leads to tremors and body rigidity. OCD is the only psychiatric disorder that currently has approval from the Food and Drug Administration for deep brain stimulation treatment.

But deep brain stimulation has been investigated in other conditions, including major depression, Tourette syndrome, schizophrenia, substance use disorders, post-traumatic stress disorder and eating disorders.

Deep brain stimulation is a procedure of last resort for patients with OCD. Because of the invasive nature of brain surgery and the potential for serious adverse effects such as infection or hemorrhage, individuals need to try standard, less invasive treatments first and meet the criteria for severe and persistent OCD, which have been established based on OCD and brain stimulation research.

But for those who do undergo the procedure for OCD treatment and receive ongoing stimulation, up to 70% have a good long-term response. “Good” is considered to be a 35% reduction in OCD symptoms based on a standardized scale for obsessive-compulsive behaviour that experts in our field rely on.

This, for example, could mean that someone goes from spending more than eight hours per day on OCD behaviours and not leaving the house at all to spending four hours per day and being able to go to school with significant support. Such progress is remarkable, given how ill these individuals are.

Barriers And Stigma

There aren’t very many treatment centers anywhere in the world, so patients who need this procedure may have trouble getting to one. Additionally, as our team has described in published research, getting insurance coverage for the procedure is often time-consuming and sometimes prohibitive.

Another barrier is the stigma associated with brain surgery for psychiatric illness. The reasons behind this stigma are complicated, and some factors have historical roots. In the early to mid-1900s, destructive, dangerous and not very effective brain surgeries such as lobotomies were performed routinely for mental illness without regulation, ethical guidelines or regulatory oversight.

A Way Forward

After I worked with Patel for about a year, including trials of six additional medications and ongoing exposure and response prevention therapy, his symptoms remained severe. I recommended he begin the extensive evaluation process for deep brain stimulation surgery.

Three weeks after his surgery, I turned on electrical stimulation, and we began the intensive programming procedure to determine the optimal settings. This process takes several hours a day over the course of several days, with fine-tuning in the following weeks and months.

Patel recalls that early on, during programming, he experienced a roller coaster of feelings, shifting between “giddiness and sadness.” Most individuals experience gradual improvement over the course of six to 12 months. At first, they feel happier and less anxious, and weeks to months later they experience a decrease in OCD symptoms.

Most commonly, stimulation is constant, 24 hours a day. But the treating psychiatrist may give the patient the ability to turn it off, such as at night if the stimulation causes problems with sleep.

Since surgery, Patel has continued weekly therapy sessions. Research shows that deep brain stimulation is most effective when people continue to engage in exposure and response prevention therapy. Electricity alone will not break years of hard-wired habits, but it can be the catalyst that allows for new neural pathways to be established and new behaviors to be learned. Likewise, most individuals need to continue medication. Though the effects of deep brain stimulation can be remarkable, it is not a cure.

Patel has experienced a 54% reduction in his OCD, according to the standardized scale. This means that his symptoms decreased from the “extreme OCD” to the “moderate” range.

He can now eat and drink at work and use public restrooms. He has more social connections, seeks less reassurance and spends less time decontaminating himself and his belongings. While sleep was previously his only respite, Patel is now intentional about finding meaningful activities to fill the hours that are no longer occupied by rituals.

Most importantly, he is beginning to feel hopeful that it just might be possible to build a life driven by purpose and intention, rather than by fear.

(This PTI was syndicated via The Conversation)

Anxiety disorders are extremely common. According to the National Institute of Mental Health, just over 31% of American adults experience an anxiety disorder at some point, and the World Health Organization estimates that the global prevalence of anxiety and depression increased by 25% in the first year of the COVID-19 pandemic.

Evidence for Effective Treatment

In drafting a recommendation, the USPSTF relied on the anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, including

• generalized anxiety disorder,
• social anxiety disorder,
• panic disorder,
• agoraphobia,
• specific phobias,
• separation anxiety disorder,
• selective mutism,
• substance/medication-induced anxiety disorder,
• anxiety disorder due to another medical condition and
• anxiety not otherwise specified.

Overall, the task force found that while the direct evidence for anxiety screening was extremely limited and did not suggest a benefit, it focused on just a limited number of widely used screening tools, many initially designed for other purposes. The task force also pointed out that screening tools alone are insufficient to diagnose anxiety without confirmation from diagnostic assessment and follow-up.

There was broad evidence that treatment for anxiety is effective, with cognitive behavioral therapy shown to reduce the severity of symptoms in some patients. Antidepressants and benzodiazepines also improved anxiety and other outcomes; in particular, antidepressants appeared to help people with generalized anxiety disorder, social anxiety disorder and panic disorder.

While there were no harms associated with screening, and limited evidence on harms associated with treatment, the task force also noted that in 2020 the FDA warned that benzodiazepines can lead to misuse, abuse and addiction, even at recommended doses. The FDA issued a separate warning in 2016 on the dangers of combined use of benzodiazepines with opioid medicines and other central nervous system depressants, which can result in slowed breathing, difficult breathing and death.

Resources for Family Physicians and Patients

Along with the draft recommendation, the USPSTF developed a consumer guide on screening for anxiety, depression and suicide risk in adults.

The AAFP also offers members several resources on anxiety and other mental health issues specifically for family physicians, including a collection of American Family Physician journal articles on anxiety disorders and a patient care webpage on mental health and well-being that addresses depression, suicide prevention and more.

Physicians can also find materials to share with patients on familydoctor.org, including articles on generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and social phobia.

Data Gaps on Populations and Benefits

The task force called for more research on

• the effects of screening and treatment in other populations as defined by sex, race and ethnicity, sexual orientation and gender identity;
• the accuracy of screening tools, especially for older adults and those who are pregnant or postpartum;
• the effectiveness of treatments in older adults and those who are pregnant or postpartum; and
• the direct benefits and harms of screening compared with no screening or usual care.

CHICAGO, Oct. 06, 2022 (GLOBE NEWSWIRE) — Compass now offers Virtual Reality Care in its Adult Obsessive-Compulsive Disorder (OCD) and Complex Anxiety Programs across in-person locations and through Compass Virtual. Through virtual reality care, it can further support and elevate Exposure and Response Prevention Therapy (ERP) by placing the individual in specific environments that challenge their anxiety. 

In practice, ERP involves purposefully and repeatedly encountering fears, such as thoughts, situations, and physical sensations, without the use of anxiety-reducing tactics. Virtual Reality Care can be used as a gradual stepping stone to real-life exposures and allows for exposure to situations that are not easily accessible, for example taking a flight, being on the ledge of a high building, driving on a highway while raining or at night, and more.

Individuals enrolled in Compass’s OCD and Complex Anxiety Programs for adults ages 18 and over are paired with a trained and licensed exposure therapist who is an expert on evidence-based treatment modalities and can integrate skills and strategies into exposure work using Virtual Reality Care. Program participants can also access Virtual Reality Care from home by using a designated headset or their cell phones. Virtual Reality Care is meant to be a creative way for individuals to enhance treatment effectiveness for certain types of anxiety disorders and OCD while participating in Compass’s Partial Hospitalization (PHP) and Intensive Outpatient (IOP) program curriculum.

“The goal of the OCD and Complex Anxiety programs across Compass is to craft exposures that are challenging for the patient, that match real-life experiences, and that are meaningful experiences for the patients. Virtual reality exposures allow patients to experience feared situations therapists couldn’t simulate without VR programs, such as speaking in front of large crowds or driving on a snowy highway. This allows patients to have more ‘real’ fear experiences during exposure, increasing their ability to learn more about their fear and how they relate to their fear,” said Joe Serio, LCPS, Chief Clinical Officer, Compass Health Center. “Ultimately, this allows patients to get back to the things in life they value but have sacrificed in order to avoid their feared situations. Simply put, this lets patients get better faster. We’re excited about this addition to our treatment repertoire.”

While most other OCD and anxiety programs focus on habituation (the process of anxiety naturally reducing over time due to repeated exposure to a stressor), Compass’s program focuses on inhibitory learning (the process of generating and integrating new information associated with a given stressor). This means that individuals at Compass are learning new information that competes with their original fears and makes stressors more ambiguous when confronted in the future. Often, this results in a reduction in distress. 

Where a typical exposure session would focus on tracking the level of distress with the goal of reducing it over time, Compass takes the time to discuss the context around the stressor and helps build reflections or takeaways that help the patient change their relationship with the stressor going forward. This process increases a patient’s ability to more effectively tolerate anxiety and stress so that functioning and ability to go about their daily lives is not impeded. This creates longer-lasting, more generalizable beliefs that allow individuals to face their fears with more willingness and confidence and to more fully engage in and enjoy activities and situations that they would have otherwise avoided and missed.

Learn more about Compass’s OCD and Complex Anxiety Program here.

Amelia Virtual Care Sample Videos:

• Flight (https://youtu.be/LfuOh4CCnfA)
• Dogs (https://youtu.be/RtwGwS3X2zs)
• Heights (https://youtu.be/9CydvEtQ2r4)
• Driving (https://youtu.be/MLS0q637eiM)
• Public speaking (https://youtu.be/zmPeJC8Dkp0)

Contact Information:
Britt Teasdale
Associate Director, Brand Management, Compass Health Center
bteasdale@compasshealthcenter.net
Phone 216-926-0550

Related Images

Image 1: Virtual Reality for mental health

This content was issued through the press release distribution service at Newswire.com.

Attachment

• Virtual Reality for mental health

Most obsessions in OCD can be put into one of four main categories, as described in an article in Psychopathology. The first is fear of contamination. The second is related to doubt — for instance, someone doubts they locked their doors despite checking numerous times. 

The third type of obsession is taboo-related. These obsessions are often of a sexual, violent, or religious nature. Examples include thoughts of molesting children, disrespecting religious figures, and thoughts of physically hurting others. Anyone can have such thoughts, but generally they are fleeting and can be brushed off. However, someone with OCD finds them very distressing and hard to control. Those with OCD typically have no history of violence toward others, nor do they act on their thoughts (per Psychopathology). But according to a study in the Journal of Obsessive-Compulsive and Related Disorders, obsessions with taboo content tend to be more stigmatized than the other types — thus people who have them are less likely to talk about them.

The fourth type of obsession is related to symmetry and order. Being a “neat freak” does not necessarily mean you have OCD, says psychologist Jon Abramowitz (via the Anxiety Depression Association of America). According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), in order to qualify as a symptom of OCD, the need for tidiness would have to cause extreme distress, get in the way of living an aspect of life, or take an exorbitant amount of time. For instance, someone with OCD may spend a couple of hours arranging their office before being able to sit down to work.

EAST PROVIDENCE — Manny Padilla was about 8 years old when he began to experience symptoms of obsessive-compulsive disorder.

“I started having so much anxiety and I would just be like throwing up, having stomach aches, nose bleeds, all that stuff,” he said. “I thought there was something physically wrong with me. I thought I had something that was not treatable.”

RI children in crisis:Why doctors have declared a mental health emergency

Some of his anxiety involved his mother, Lori Padilla.

“My mom would go out for 10 seconds and I’d be, like, Where is she? What happened? What’s going on?”

At school, Lori recalled, “he wasn’t able to focus, he wasn’t able to write, he wasn’t able to talk to anybody. Kids were not understanding. He was getting bullied. He wanted to be part of the kids yet he couldn’t.”

Deep brain stimulation can halve the symptoms of severe obsessive-compulsive disorder, or OCD as it is commonly known, finds a pooled data analysis of the available evidence, published online in the Journal of Neurology Neurosurgery Psychiatry.

And two thirds of those affected experienced substantial improvement within two years, finds the analysis.

OCD is characterised by intrusive and persistent obsessive thoughts along with dysfunctional and ritualised behaviours. It is thought to affect up to 3% of people.

It often begins early in life and is frequently accompanied by severe depression/anxiety.

Those affected often find it difficult to go to school or work.

Drugs and cognitive behavioural therapy (CBT) can be very effective, but in around 1 in 10 cases, these approaches don’t work.

Deep brain stimulation, which involves implanting electrodes within certain areas of the brain to regulate abnormal electrical impulses, has emerged over the past few decades as a potential treatment for those with severe symptoms.

While various studies have suggested that the technique can be effective in people with OCD, they have not always quantified the impact of potentially influential factors.

In a bid to account for this, and to update the existing body of evidence, the researchers systematically reviewed and pooled the results of 34 clinical trials published between 2005 and 2021, with the aim of critically assessing how well deep brain stimulation alleviates OCD and associated depressive symptoms in adults.

The 34 studies included 352 adults with an average age of 40, and severe to extreme OCD, the symptoms of which had not improved despite treatment. In 23 of the studies, participants were required to have had persistent symptoms for 5 or more years before consideration for surgery.

Of the remaining 11 studies, one had a requirement of more than a decade of symptoms and two or more years of failed treatment; another required at least one year of failed treatment; and five didn’t specify any requirements.

On average, symptoms had persisted for 24 years. Coexisting mental health issues were reported in 23 studies and included major depression (over half of participants), anxiety disorder, and personality disorder. The average monitoring period after deep brain stimulation was 2 years.

The final pooled data analysis, which included 31 studies, involving 345 participants, showed that deep brain stimulation reduced symptoms by 47%, and two thirds of participants experienced substantial improvement within the monitoring period.

Secondary analysis revealed a reduction in reported depressive symptoms, with complete resolution in nearly half of participants and partial response in a further 16%.

Some 24 of the studies reported complete data on serious side effects, including: hardware-related complications; infections; seizures; suicide attempts; stroke; and the development of new obsessions associated with stimulation. Overall, 78 participants experienced at least one serious side-effect.

The findings prompt the researchers to conclude that there’s “a strong evidence base” in support of the use of deep brain stimulation for the treatment of severe persistent OCD and associated depression.

But the caution: “While these results are encouraging, it is important to remember that [deep brain stimulation] is not without its limitations.

“First and foremost, it requires chronic implantation of hardware and carries the associated risk of complications. Furthermore, although we report a less than 1% incidence of de novo obsessions involving the [deep brain stimulation] patient programmer or the device itself, it remains a significant barrier to the effective implementation of [deep brain stimulation] for OCD in certain patients.”

And they add: “Successful application of [deep brain stimulation] requires a close therapeutic alliance between patient, neurosurgical and expert psychiatrist teams in centres that specialise in implantation and programming of the device.”

Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by repeated, uncontrollable thoughts and actions that interfere with daily life.¹ The intrusive thoughts are known as obsessions. The behaviors performed to reduce anxiety from those obsessions are called compulsions. Obsessions and compulsions can be different for each person. There is also a range of symptom severity—from mild OCD symptoms to severe.²

OCD Symptoms

Someone with OCD might have obsessions, compulsions, or both. A cornerstone of the diagnosis is interference with daily life. This can mean that the obsessions or compulsions take up a lot of your time—at least an hour a day—or that they affect aspects of your life such as work, school, relationships.²

Obsessions

Repetitive thoughts, urges, or mental images that trigger anxiety all fall under the umbrella of obsessions.³ You may or may not be able to recognize that your obsessions are irrational. Even if you do recognize this, the disorder prevents you from being able to stop them on your own.²

Common obsessions typically fall under the following categories:

Contamination

You may be worried about coming into contact with substances like germs, dirt, and household chemicals out of fear the substances will contaminate you.⁴ You might also worry that you will contaminate other people. Besides physical substances, you might also worry that someone you consider to be a bad or immoral person can contaminate you.²

Aggression

You might fear harming yourself or others. You might also replay violent images in your mind.²

Sexual

You might have repeated thoughts of inappropriate, violent, or taboo sexual behavior. This might include thoughts of you acting sexually inappropriate toward others, including children and family members, and animals.⁵

Religious/Moral

You might be excessively concerned over right or wrong and what the consequences of doing wrong will be.² You might also be overly concerned with offending God or being blasphemous.⁴

Symmetry and Exactness

You might have the need to constantly do things in a particular order.² Things might need to be perceived as being even, perfect, exact, symmetrical, or correctly aligned.⁴’⁶

Superstition

You might consider certain numbers or colors “bad” and fear them because of it.²

Responsibility

You might fear causing something horrible to happen. You might also worry about harming others because you were not careful enough in your actions. Specifically, you might fear acting on impulse and the consequences of it.²

Correctness/Completeness

You could have a fear of making mistakes or an obsessive concern over correctness. If something is incorrect or incomplete, you might worry how it will affect other people.²

Compulsions

People with OCD may perform compulsions. Compulsions are repetitive behaviors or mental rituals meant to ease the anxiety stemming from an obsession. Over time, the compulsions become an automatic response to the obsession. Not being able to perform the compulsion would cause distress.⁵

Common compulsions include:²’⁴

Cleaning or washing

Whether you’re scrubbing your hands or scouring your countertops, if your behavior is excessive or involves particular, meticulous steps, it could qualify as a compulsion. The same goes for efforts made to avoid contact with contaminants, an urge that commonly stems from a fear of germs, making others sick, or of being impure or immoral.

Checking things

If you feel obliged to make sure you’ve locked the front door or turned off the oven more than once or twice, your habit could be classified as a compulsion, possibly driven by a fear of getting hurt or being irresponsible.

Counting or repeating

Repeating certain everyday activities in multiples—like getting out of your chair three times before moving on with your day or tapping on count with the goal of ending on what you consider to be a good, right, or safe number—could qualify as a compulsion, particularly if it is driven by a superstition or the fear of you or someone else getting hurt.

Ordering and arranging

Making sure things are put in a particular way could be in response to an obsession of needing things to be symmetrical and exact.

Praying

Particularly if you have religious-based obsessions and think you’ve acted immorally, you might feel the need to pray as a way of asking for forgiveness. You might also seek out reassurance from others.

When to See a Healthcare Provider

Having distressing thoughts or a regular routine is not uncommon. But if you’re experiencing obsessions and find yourself performing compulsive behaviors that take so much time that they interfere with your daily activities, consider bringing it up with a healthcare provider.⁷ You might also want to seek help if you are avoiding certain situations as to not trigger symptoms.²

To determine whether they should perform further diagnostic steps for OCD, the provider might ask you questions like:²

• Do you wash, clean, or check things a lot?
• Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
• Does it take you a long time to complete your daily activities?
• Are you concerned with putting things in a certain order, or does messiness upset you?
• Do these problems trouble you?

If you answer “yes” to answer any of these questions and have distress over the symptom, the provider might suspect OCD and order further evaluation. If OCD is ultimately diagnosed, they can develop a treatment plan to help you cope with your OCD symptoms based on severity—whether they are mild, moderate, or severe.²

Treatment typically involves cognitive behavior therapy such as exposure and response prevention. Exposure and response prevention is a kind of therapy that exposes you to scenarios that provoke your obsession while preventing you from practicing compulsive behaviors in response.³’⁸

A practitioner might also prescribe a selective serotonin reuptake inhibitor, or SSRI. The drug can take two to three months to work, but it’s aim is to eventually reduce symptoms.³

Summary

OCD is a mental health condition that is characterized by obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Examples of obsession include the fear of contamination or violence toward others. To provide temporary relief from the anxiety, you might form compulsions. Compulsions are repeated behaviors and can include cleaning, checking, and or counting.

OCD causes distress and affects everyday life, with the thoughts or actions taking up more than an hour of your day.

If you’re concerned that obsessions or compulsions are getting in the way of you living your best life, talk to a healthcare professional. They can ask you questions about your symptoms and figure out whether further evaluation is needed. If diagnosed, OCD can be managed with therapy, medication, or a combination of the two.

Sources:

1. MedlinePlus. Obsessive-Compulsive Disorder.
2. Fenske JN, Petersen K. Obsessive-Compulsive Disorder: Diagnosis and Management. Am Fam Physician. 2015;92(10):896-903.
3. National Institute of Mental Health. Obsessive-Compulsive Disorder.
4. International OCD Foundation. About OCD.
5. Wetterneck CT, Siev J, Adams TG, Slimowicz JC, Smith AH. Assessing Sexually Intrusive Thoughts: Parsing Unacceptable Thoughts on the Dimensional Obsessive-Compulsive Scale. Behav Ther. 2015;46(4):544–556. doi:10.1016/j.beth.2015.05.006
6. Lochner C, McGregor N, Hemmings S, et al. Symmetry symptoms in obsessive-compulsive disorder: clinical and genetic correlates. Braz J Psychiatry. 2016;38(1):17–23. doi:10.1590/1516-4446-2014-1619
7. American Psychiatric Association. What Is Obsessive-Compulsive Disorder?
8. International OCD Foundation. Exposure and Response Prevention (ERP).

Hours after the shooting at Robb Elementary School in Uvalde, Texas, my mind raced as I drove to pick up my daughters, 6 and 3, from school and daycare in Nevada. I envisioned my girls trapped and terrified in an active shooter situation in their own classrooms. The excruciating scenario replayed over and over in my mind, becoming more gruesome with each passing minute. By the time I reached the school — where my children were safe and happy — I was actively fighting back tears and my heart was racing. My obsessive-compulsive disorder had gotten the best of me.

Being a parent with OCD is especially difficult right now. I’m not talking about being “so OCD,” a phrase most people misuse when what they really mean that they are conscientiously neat and organized. Actual OCD is a condition that interferes with the day-to-day moments of people who live with the disorder. It’s often called the “doubting disease” because it feeds on the smallest sliver of uncertainty. Obsessive-compulsive disorder causes regular distress, not just a momentary inconvenience. When I say I have OCD, this is what I mean. It’s a mental illness that I’ve struggled with since I was a child.

In addition to the obsessions revolving around my own well-being, I am constantly plagued with intrusive thoughts concerning my children’s safety. A little parental anxiety is normal. When kids jump on the furniture, sit too high on a teetering pile of toys, or play too rough in the bathtub, any parent worries that they may injure themselves. These concerns differ for me because I obsess over them. I ruminate on various nightmarish scenarios, giving them too much time and ceding control that determines how I parent. Roughhousing in the bathtub makes me fear for hours that my children will dry drown, compelling me to sometimes check on them after they’ve fallen asleep to make sure they’re breathing.

My mind operates in the extremes.

The possibility of injury while playing leads to a series of intrusive thoughts that replay in my mind in violent detail. I fight against performing specific behavior patterns, or rituals, that I lean on to counteract my worst fears from happening. My mind operates in the extremes.

Being in constant crisis mode as a global community doesn’t make it any easier as a parent with OCD. National and global news events are like kindling to my obsessive-compulsive disorder. Once I accepted that every cold and stomachache wasn’t going to be fatal to my children, the coronavirus pandemic began. When far-right political groups grew more active, parading down the streets with their guns, I became paranoid about the pro-police father who illegally carried his gun into the educational facility my children attend. I reorganized our pick-up and drop-off schedules so that we avoided him and thus, reduced our chances of being shot.

The recent decision by the Supreme Court of the United States to overturn Roe v. Wade invigorated one of my greatest obsessions: being taken away from my kids. I stood in the wake of SCOTUS’ ruling worried about parenting with OCD. With this loss of reproductive rights and bodily autonomy, I saw all the ways that this decision could impact fundamental parental rights. What if someone decides that my mental acuity is unfit? What if being diagnosed with OCD means that I could be considered a threat to my children’s safety? How long will it be until they take my kids away from me?

Even as I am writing this essay, I am battling OCD. Admitting particular inabilities or “deficiencies” as a parent means inviting unwanted scrutiny. To be frank, sometimes I resist talking about my mental health struggles even with family because I don’t want anyone to challenge my parental fitness or express a lack of confidence in my mothering. I struggle with incessant mental images of people chastising me in public — I don’t need that to be my reality.

Yet, here I am, sharing this with you because one way to stop my obsessions and expose them as unwarranted is to confront them. And one way to demonstrate that parents with mental health conditions can still care for their children is to openly discuss how we do it.

Playing with my girls grounds me and gives me a bit more perspective. I am able to pull myself up from the thoughts that are trying to overwhelm me.

It’s not easy.

First, when obsessional thoughts about my children begin cascading, piling on top of one another until it seems like doom is inevitable, I reassess my surroundings. I remind myself of where I am in the moment, what security measures are in place, and what specifically my children are doing. I get down where they are on the floor and immerse myself with them in the moment. Playing with my girls grounds me and gives me a bit more perspective. I am able to pull myself up from the thoughts that are trying to overwhelm me.

I’ve also started doing immediate risk assessment. If the news reports a disaster or mass casualty event, I research how close it is to me. Will it affect me immediately? Should I be worried about it right now? Sometimes turning my attention away from the news altogether and waiting until I’m less stressed or anxious helps me, too.

Most importantly, I am in constant conversation with my daughters about what’s going on in the world around them. The details I share vary based on their ages and understanding, but I’ve learned that informing them to some degree helps to reduce fear, build trust, and increase their preparedness. This also gives me another way to process what’s happening and how it realistically impacts our family.

While these methods help me stave off obsessions, they aren’t fool-proof. There will always be events beyond my control as a parent.

Six weeks after the school shooting in Uvalde, my oldest daughter was attending a summer camp at a school across town. The campus was gated with many visible security measures. I hadn’t even considered the possibility of something bad happening there. About an hour after I picked her up in the fifth week of camp, the school was evacuated. Someone had made a credible threat against the students and staff. With over 300 school shootings in the U.S. since the start of 2022, this threat was real and more immediate than most scenarios I had ruminated on in the past. Thankfully, my intrusive thoughts didn’t overwhelm me in the moment. When it came down to it, my main concern was my child’s well-being.

Whenever I talk to people without kids or parents whose own children are adults, they most often say some version of, “I can’t imagine having to raise kids now.” I can’t imagine it either, but I’m doing it. So many of us are. The stakes seem higher now, but we manage to give it our all. We can’t always control what happens to our children, but we have to let them go if we want them to thrive. We cannot let our fears or our obsessions keep us from raising those who need us the most.

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI (6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP (4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or call 911.

This article was originally published on Sep. 29, 2022