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Pioneering patient with extreme OCD sees success with new psychosurgery

TORONTO —
A pioneering patient with extreme obsessive-compulsive disorder (OCD) is championing a new treatment which uses targeted ultrasound on the brain to treat the condition.

“It saved my life,” Jeffrey Kotas said in an exclusive TV interview with CTV National News.

The 32 year old from Toronto had over time become imprisoned by anxious and repetitive thoughts about perfection and cleanliness.

“Any surface, whether a bit of dirt or sweat got on it I’d feel overwhelmingly guilty, I would feel like I’d damaged the world,” said Kotas.

He dropped out of university because he became worried his textbookswere contaminated and was throwing them out, replacing them weekly.  Writing assignments was torturous because everything had to be perfect.

“I was constantly writing the page over and over. The same page I would write and attempt to write hundreds of times  and so I would be  up all night and I still wasn’t satisfied with the way it was.”

He barely slept and rarely went out on his own

An estimated one in 40  Canadians will display symptoms of obsessive-compulsive disorder in their lifetime — intrusive repetitive thoughts that cause anxiety and stop them from living a normal life. Obsessions can be mild, and are often accompanied by “rituals” that need to be performed, such as obsessive handwashing or repetitive behaviours like checking that doors are locked.

Counselling and medications help some people but there are cases where the condition becomes so severe, the person’s life is in danger.

THE TREATMENT

That’s what happened In Kotas’s case – therapy and more than 30 medications didn’t help, leaving him depressed and suicidal.

“The entire day I would feel just in so much pain. It  felt like it would never stop and I knew that my fears or concerns were irrational but that didn’t help the suffering,” he said.

But things changed when he became the first OCD patient in North America treated with focused ultrasound as part of a 10-person study underway in Toronto and Calgary. 

Doctors at Toronto’s Sunnybrook Health Sciences Centre targeted a small part of the brain thought to trigger the unrelenting worry at the root of many cases of OCD, using ultrasound energy to kill the tissue.

The treatment is not invasive and it’s done while the patient is laying down in an MRI unit, allowing doctors to see images of the brain and provide precise delivery of the ultrasound.

The pilot study is designed to find out if this new treatment is safe – with doctors saying so far, it is. They add there are signs that it works too.

“In some of our patients, at one year when we follow them, there is significant reduction in their anxiety surrounding their OCD,” said Dr. Nir Lipsman, the neurosurgeon at Sunnybook who treated Kotas.

Doctors stress the treatment doesn’t cure obsessive compulsive disorder. But with a patient’s anxiety reduced, they can return to  counselling and treatment.

“We’ve seen quite a number of individuals report really meaningful improvements, given how bad their illness was,” said Dr. Peggy Richter, who heads the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook.

“I think focused ultrasound for OCD is an exciting option because it gives us a new way to target illness for people with severe disability,” Richter added.

“People who have been suffering for years, if not decades, and who have not responded, this offers them big promise. Not infallible but it helps.”

After the ultrasound treatment, Kotas enrolled in a nine-week intensive residential program at the anxiety disorders centre, where Richter noticed a change.

“Following  the focused ultrasound Jeffrey was now able to sit with disturbing thoughts, and challenge things in a way that wasn’t possible before,” she said.  “After the focused ultrasound he was just different.”

‘FIRST PIECES OF A NORMAL LIFE’

Now, nearly three years since starting the ultrasound treatment, Kotas said his life has changed for the better.

“It gave me the first pieces of a normal life,” Kotas said.

Normal for him means walking his dog, going shopping and no longer obsessively cleaning. He is making plans to return to university full time.

“It felt like it would never stop and I knew that my fears or concerns were irrational but that didn’t help the suffering,” Kotas explained.

“Even though I was very determined to get better, with so many false attempts to get better I did start losing all hope and each time it didn’t work it was so much more painful.This has been extremely important to me.”

Psychosurgery has been used to treat OCD since the 1960s, when doctorsphysically removed part of the brain during surgery. There were significant risks involved.

Some patients experienced permanent complications including paralysis on one side of the body and cognitive impairment.

Focused ultrasound is non-invasive with fewer complications. But doctors stress it is a last ditch option only for patients who have failed everything else.

Kotas told CTV News he wasn’t scared to be the first person to receive this new treatment.

“Because I studied science and math in university I had always hoped to be on the cutting edge of scientific research, this had just fallen into my lap and I felt it was my purpose,” he said.

Cognitive behavioral therapy associated with moderate anxiety symptom reductions up to one year after trea …

Cognitive behavioral therapy for anxiety-related disorders is associated with improved outcomes compared with control conditions up to one year after treatment completion, according to new research published in JAMA Psychiatry.

“About 1 out of 10 individuals have an anxiety-related disorder at some point in their lives. Having such a disorder often seriously impairs daily functioning and quality of life. Cognitive behavioral therapy (CBT) is currently the treatment of choice for anxiety-related disorders, but its long-term effectiveness is relatively unknown,” said study author Evi-Anne van Dis, a PhD candidate at Utrecht University.

After analyzing data from 69 randomized clinical trials that included 4,118 participants, the researchers found that CBT was associated with moderate symptom reductions up to 12 months after treatment.

“​Our meta-analysis has shown that CBT for anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder is generally effective up to one year following treatment completion. Yet, its effectiveness on the longer term and relapse rates remain unclear,” van Dis told PsyPost.

​”We should bear in mind that our findings are average effects. This means that CBT may generally work, but not necessarily for all people. Future research should clarify who does and who does not benefit.”

After 12 months, effects were small to medium for generalized anxiety disorder and social anxiety disorder, but remained large for PTSD.

More high-quality randomized clinical trials on long-term treatment effects are needed, as only a few studies conducted follow-up assessments after one year. Van Dis and her colleagues were also “surprised to find only a very few number of studies that addressed the long-term effects of CBT for obsessive-compulsive disorder.”

The study, “Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis“, was authored by Eva A.M. van Dis, Suzanne C. van Veen, Muriel A. Hagenaars, Neeltje M. Batelaan, Claudi L. H. Bockting, Rinske M. van den Heuvel, Pim Cuijpers, and Iris M. Engelhard.

What It’s Really Like To Live With Obsessive Compulsive Disorder, According To People Who Have OCD

It’s very misunderstood.

By Dylan Brethour

People just don’t get OCD. Since I’ve started talking about my diagnosis publicly, I’ve been surprised by the number of well-meaning people who are happy to let me know that they have it too.

No, they haven’t been diagnosed, and no, they aren’t actually struggling. 

But really, aren’t we all just a little bit OCD? The answer to that is an emphatic no.

RELATED: If You’ve Ever Thought These 7 Things, You Might Have Relationship OCD

OCD is a well-recognized mental illness which affects roughly 1-2 percent of the population. But despite being one of the more common mental illnesses, it remains badly misunderstood.

People miss that symptoms of OCD tend to be pervasive, rather than a single contained compulsion. They miss how symptoms mutate over time and, perhaps most of all, how impossible the illness can be to live with. 

OCD is also often misidentified as an anxiety disorder, despite occupying a separate category in the DSM-V since 2013. What’s common to all experiences of OCD are distressing, repetitive, and intrusive thoughts. These are followed by repetitive compulsions, either physical or mental, to try and relieve the distress of that obsession.

The contents of symptoms are hugely personal, ranging from the mundane to the wildly esoteric. The illogic of OCD means that both are likely to cause equal distress.

Understanding Obsessive Compulsive Disorder By Meesha Haorongbam – E

Understanding Obsessive Compulsive Disorder

Dr Meesha Haorongbam *

We’ve all heard of obsessive compulsive disorder (OCD) and we presume we know what it is: cleanliness, maintenance of symmetry etc. We generally associate it with our pet peeves. We have also come across numerous jokes about OCD. E.g. “I have CDO. It’s OCD only in alphabetical order, the way it should be” or “The first rule of OCD Club is that there is a second rule so we have an even number of rules.”

170 million people across the world suffering from OCD have had their illness reduced to a careless joke. This has cheapened a mental illness which is highly debilitating and has even led to the most lethal of all consequences- suicide.

We all have that one friend or relative who prides in being a perfectionist- the one who gets annoyed by, let’s say, misaligned tiles on the floor. But when their desire for perfection adversely affects their behaviour i.e they are unable to enter a room with misaligned tiles on the floor, then they might have OCD.

OCD, as mentioned earlier, is a serious psychiatric disorder that is frequently misunderstood by society and healthcare professionals alike. As its names suggest, it has two components- obsessions and compulsions.

Obsessions are repetitive and intrusive thoughts, impulses or images while compulsions are “acts” people engage in to relieve anxiety caused by the distressing obsessions. For example, people might engage in excessive cleaning to relieve the obsessive thoughts of germs and contamination.

Those who are obsessed with safety may repeatedly check their doors before leaving their house. Others engage in certain rituals or repetitive acts because of the fear that something bad will happen if they don’t carry out those rituals. Some have only obsessions while others have only compulsions. But the vast majority of those with OCD have both components.

As simple as this sound, OCD can be difficult to understand even by those who have it, because obsessions rarely make much sense, rituals can be hard to explain, and they struggle to express their symptoms.

Individuals with OCD tend to hide their symptoms for fear of embarrassment or being called crazy. This often leads to OCD being undiagnosed for years.

People affected have little to no control over their obsessive thoughts and compulsive behaviours which tend to be time-consuming and interfere with their work and social life to the point of causing significant distress. This “distress” is what separates OCD from those who may only be meticulous.

Many with OCD understand the relationship between their obsessions and compulsions. The fact that they are aware of their irrationality and yet can’t control them is what makes it distressing. They often report feeling as if they are losing their mind for experiencing anxiety based on irrational thoughts and finding it difficult to control them.

The symptoms of OCD include but are not limited to:
1. Obsessions about dirt and contamination. Eg. Fear of contracting illness

2. Obsessive need for order or symmetry or hoarding or saving e.g. refusal to throw away anything because it “may be needed in future”

3. Obsessions with Sexual Content e.g. fears that one may be homosexual

4. Repetitive Rituals e.g. repeating routine activities for no logical reason

5. Religious Obsessions e.g. blasphemous thoughts

6. Obsessions with Food and Weight e.g. not letting foods touch on plate

7. Superstitious Fears e.g. lucky or unlucky numbers

8. Compulsions about Having Things Just Right e.g. need for symmetry

9. Checking Compulsions e.g. repeatedly checking to see if a door is locked

10. Other Compulsions e.g. the need to avoid stepping on cracks in sidewalk or a feeling of dread if some arbitrary act is not performed

OCD has an early age of onset and it spares no gender, ethnicity or social status. Around 3% of the population around the world have OCD.

It affects men and women equally though females have a later age of onset. So what causes OCD? The frustrating answer is that we really don’t know for sure. It is generally believed to occur due to interaction between the following factors:

1. Genetic: OCD is a familial disorder with close relatives of people with OCD significantly more likely to develop OCD themselves. So far, no single gene has been proven as the “cause” of OCD.

2. Autoimmune: OCD in children may be due to Group A streptococcal infections which cause dysfunction in certain parts of the brain.

3. Behavioural: OCD sufferers’ brains are hardwired to associate certain objects or situations with fear. They avoid those things or learn to perform “rituals” to reduce the generated fear. Once the connection between an object and the feeling of fear becomes established, they begin to avoid that object and the fear it generates, rather than confronting or tolerating the fear.

4. Cognitive: We sometimes have unwelcome or intrusive thoughts. While we tend to shrug them off, people with OCD misinterpret and exaggerates those thoughts. As long as those thoughts are misinterpreted as cataclysmic and true, they continue the avoidance and ritual behaviours.

5. Neurological: Researchers have implicated three regions of the brain which are variously involved in social behaviour and complex cognitive planning, voluntary movement, and emotional and motivational responses. OCD is also associated with low levels of a neurochemical called serotonin which helps regulate vital processes such as mood, aggression, impulse control, sleep etc.

The good news is that there are effective treatments. If left untreated, it usually develops into a chronic condition with episodes where symptoms seem to improve. Without treatment, remission rates are low, at around 20 percent. Treatment for OCD depends on how much the condition affects the person’s ability to function.

Some may be started on medications while others may receive both medication and behavioural therapies. Resistant cases might also be taken up for electroconvulsive therapy or surgical procedures such as deep brain stimulation.

OCD is a big fat lie. It’s difficult to believe that one’s own thoughts can be lies but OCD makes you believe that. It can be agonizing to know that your own brain is lying to you as well as leaving you unable to resist its commands. OCD is a terrible monster that can be crippling. While there is no magic wand to make it all go away, you definitely can beat it. Thousands have done it and so can you.


* Dr Meesha Haorongbam wrote this article for The Sangai Express

The writer is M.D. Psychiatry and can be reached at meeshahao(AT)gmail(DOT)com

This article was webcasted on January 04, 2020 .


Deep Brain Stimulation Effective for Treatment-Resistant OCD

An open study of 70 consecutive patients treated with deep brain stimulation for refractory obsessive-compulsive disorder (OCD) confirms the treatment’s effectiveness and safety in a clinical setting, researchers concluded in a study published online in The American Journal of Psychiatry.

“Deep brain stimulation is an effective treatment option for patients with refractory obsessive-compulsive disorder. However, clinical experience with deep brain stimulation for obsessive-compulsive disorder remains limited,” researchers wrote, explaining the impetus for their study.

The 70 patients included in the analysis received bilateral deep brain stimulation of the ventral anterior limb of the internal capsule between April 2005 and October 2017. The study followed each patient for 12 months.

OCD Linked to Educational Underachievement

Between baseline and 12-month follow-up, participants’ average scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) showed significant drops: 40% on the Y-BOCS, 55% on the HAM-A, and 54% on the HAM-D, according to the study.

 

At the 12-month follow-up, 52% of patients were categorized as responders, with a 35% or greater Y-BOCS score decrease from baseline, researchers reported. Another 17% of patients had their Y-BOCS score decrease between 25% and 34% and were considered partial responders. Meanwhile, 31% of patients were categorized as nonresponders because their Y-BOCS score decreased by less than 25%.

Common side effects included transient symptoms of hypomania, agitation, impulsivity, and sleeping disorders, according to the study.

—Jolynn Tumolo

References

Denys D, Graat I, Mocking R, et al. Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients. The American Journal of Psychiatry. 2020 January 7;[Epub ahead of print].

Patients with treatment-resistant OCD found to improve after deep brain stimulation. Psychiatric News Alert. January 7, 2020.

Mental health problems


Mental illnesses in Pakistan are shrouded in obscurity. Though, the past few decades have witnessed a notable change in attitudes surrounding the topic.

From a meagre starting point in 1947, when only a total of three mental hospitals existed in Lahore, Peshawar and Hyderabad, the mental health system has seen a substantial shift. Off course, we still have a long way to go before parallels can be drawn with countries that have excelled in the field.

According to the World Health Report (2001), one in four people will experience a mental illness once in their lifetime, and approximately 450 million people suffer from mental disorders worldwide, putting it at par with other major illnesses. In Pakistan, specifically, 10-66 percent of people experience some degree of mental illness in moderate to severe intensities (Mumford et al., 1997).

Mental illnesses, once left untreated, can have devastating consequences not only for individuals and families, but also for economies that will experience increasing expenditures and loss of productivity. Mental illnesses are also bound to affect society through increasing rates of crime, violence and substance abuse.

Such unfavourable prospects necessitate immediate action, but its progress is largely dependent upon the cultural and religious milieu. Mental illnesses are predominantly unacknowledged and disregarded across the country, and mentally ill patients have to experience not only their own disorders, which undoubtedly lead to distress and turmoil, but also face the stigma attached to these disorders.

Stigmatisation of mental health is an important cause of concern because the derogatory labels associated with these disorders restrict people from reentering their lives. Mental illnesses are chiefly understood through various cultural and religious explanations. Such explanations, for example, include the influence of black magic and evil eye, possession by demons, effect of visitations to graveyards, and the consequences of being exposed to a solar eclipse. Other explanations include the toxic effect of “Western” medications or simply God’s way of testing people. Rather than seeking professional help, most people, especially those in rural areas with little to no education, solicit faith healers or religious figures to find solutions for their problems. Somewhat impractical, spiritual healing does not get to the root cause of the psychological problem and cannot provide the benefits proffered by treatment interventions like psychotherapy and psychiatric medication.

A range of mental disorders prevail throughout Pakistan, with some having higher incidences than others. Depression and anxiety seem to be pervasive, followed by schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Depression is a pressing, albeit unrecognised, issue in developing countries like Pakistan, and is considered to be the main cause of disability across the world (World Health Organization, 2019). Depressive disorders can cause persistent sadness and loss of interest in activities previously enjoyed. Anxiety disorders, on the other hand, lead to intense fear and unrelenting worry, and include illnesses like generalised anxiety disorder, panic attacks, and social anxiety disorder.

Akin to anxiety disorders are obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). OCD involves recurrent distressing thoughts like fear of contamination and the urge to mitigate those thoughts through compulsions like excessive hand washing. PTSD, which includes symptoms of flashbacks, anxiety, and nightmares, tends to develop when an individual experiences a traumatic event such as sexual assault, warfare, or child abuse.

Bipolar disorder is another mental illness that causes severe mood swings ranging from extreme depression to uncontrollable mania. Schizophrenia, on the other hand, causes sufferers to lose touch with reality and undergo symptoms like hallucinations and delusions.

Akin to geriatric mental illness is child psychopathology which is also understood poorly in Pakistan. Various disorders are seen among children in Pakistan, including anxiety, depression, conduct disorders, ADHD and pervasive developmental disorders like autism.

Mental health is overlooked in Pakistan, but this is especially true of marginalised populations like women and Afghan refugees, for example. Social norms, values, and cultural practices are partly responsible for women’s deteriorating health in Pakistan. Women face a plethora of difficulties and obstacles in daily life such as violence, sexual harassment, marital distress and inequality. Such predicaments only increase as focus is shifted from urban to rural areas. A five-year survey conducted by the University Psychiatry Department at Aga Khan University revealed that out of all participants with mental disorders, 65 percent were women (Zaman, 1996). A study assessing suicidal patients revealed high rates of women in the group, with 80 percent of women reporting marital distress as the main cause for their suicidal ideation (Niaz, 1994).

Afghan refugees are another group among a profusion of marginalised populations in Pakistan. Having experienced war, torture, and persecution in their own country, and then being forced to leave their lands and possessions behind, a majority of these refugees (in Pakistan) suffer from some degree of mental health difficulties. Frequently reported conditions include PTSD, depression and anxiety, as well as psychosomatic concerns. A study conducted in Peshawar revealed high rates of PTSD among Afghan refugees (Naeem et al., 2005). Another research found that among 160 female Afghan participants, 81 percent reported mental health concerns and 97 percent reported experiencing depression (Eun-Myo, 2002).

An additional issue that is often pushed aside is geriatric mental health. Depression is common in old age, especially in patients with medical illnesses and cognitive deficits, which leads to severe distress for both patients and their families. Some causes of geriatric depression include financial instability, bereavement, cognitive impairment, sleep disruption, chronic illness, isolation, and dependence on family members.

Pakistan hosts 6.16 million people who are above the age of 65 (DeSa, 2013), and a study by Ganatra et al. (2008) concluded that one in five Pakistani elders suffer from depression.

Akin to geriatric mental illness is child psychopathology which is also understood poorly in Pakistan. Various disorders are seen among children in Pakistan, including anxiety, depression, conduct disorders, ADHD and pervasive developmental disorders like autism. A range of risk factors contributing to child psychopathology include lack of education, child labour, poverty, and malnutrition.

Mental health is also stigmatised in children, with several parents refusing to seek professional help. Furthermore, there is a dearth in mental health resources and facilities that are specifically tailored for children with psychiatric illnesses. For example, autism is treated by various health workers such as physicians, neurologists, psychologists, speech therapists and pediatricians who have little to no expertise and specialisation in child psychiatry.

Taking everything into account, the state of mental health in Pakistan is still in its infancy. With an unfortunate lack of licensed psychologists and licensing bodies, it is unsurprising that stigma is widespread, awareness is at a low ebb, and treatment interventions are limited.

To summarise the entire situation on an interesting note, one can look at somatoform disorders. Such disorders, although unknown in Pakistan, affect a wide range of people from both urban and rural areas. Patients with somatoform disorders present physical symptoms that have no physiological basis.

The intensity of symptoms is often linked to the patient’s mental distress; however, patients with such disorders tend to deny the psychological roots of their problems. Somatoform disorders can be upsetting for patients, especially when they are not able to achieve a medical diagnosis. Interestingly, some people in Pakistan fail to differentiate feelings of anxiety and depression from physical symptoms because they are conditioned to communicate their stresses in somatic ways. For example, someone experiencing anxiety might interpret their problem as palpitations.

Somatoform disorders and their prevalence in Pakistan can be understood through the stigmatisation of mental health. Individuals are reluctant to seek help from psychiatrists, thereby limiting themselves to other specialists who cannot understand the psychological bases of their problems. By and large, this is the ultimate problem that we face in Pakistan and one that should be tackled to ensure a more productive and healthy society.


The writer is a psychologist and researcher based in Lahore

When compulsions take control

By Dr Anjana Kannankara

Obsessive Compulsive Disorder, or OCD, is one of those terms that some people misuse as a way to describe people who like things super-clean or arranged meticulously. But if you have the actual condition that is identified as obsessive-compulsive disorder, the manner in which it affects your life is very real.
OCD usually does not happen all at once. Symptoms start small and to the affected person they seem to be normal behaviours. They can be triggered by a personal crisis, abuse or something negative that affects you drastically, like the death of a loved one or severe family problems. It is more likely if people in your family have OCD or another mental health disorder, such as depression or anxiety.
OCD can be explained as a mental condition where excessive thoughts called obsessions lead to repetitive behaviours termed as compulsions. It is characterised by unreasonable thoughts and fears that lead to compulsive behaviours and rituals.
More than 1 million cases per year is reported in India. It is a bit more common in women than in men.
There are some facts about OCD which everyone should know. The disorder can be treated but cannot be cured. Chronic cases can last for years or be lifelong. OCD requires a medical diagnosis and laboratory tests or imaging is not required.

Warning signs

Everyone has habits or thoughts that repeat sometimes. But OCD can be suspected in an individual when thoughts or actions.
• Take up at least an hour a day or more
• Are beyond the person’s control
• Aren’t enjoyable but causes distress
• Interfere with work, social life, or other areas of life

Symptoms

People may experience:
Behavioural symptoms: Agitation, compulsive behaviour, compulsive hoarding, hypervigilance, impulsivity, meaningless repetition of own words, persistent repetition of words or actions, repetitive movements, ritualistic behaviour, or social isolation
Mood: Anxiety, apprehension, guilt, or panic attack
Psychological symptoms: Depression or fear
Others: Aversion to food, nightmares, repeatedly going over thoughts or ruminating

Categories of OCD cases

Most people with OCD fall into one of the following categories:
• Washers: They are afraid of contamination from germs or dirt. They usually have cleaning or hand-washing compulsions.
• Checkers: They repeatedly check things whether stove is turned off, door is locked, etc. that they associate with harm or danger.
• Doubters and sinners: They are afraid that if everything isn’t perfect or done in right way, something terrible will happen and they or their loved ones will be punished.
• Counters and arrangers: They are obsessed with order and symmetry. They may have superstitions about certain numbers, colours, or arrangements.
• Hoarders: They fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
Doctors aren’t sure why some people have OCD though genetic and other factors like difference in brain activity have been pointed out by researches. Stress can make symptoms worse. Symptoms often appear in teens or young adults but may become evident later also.
OCD symptoms mainly include obsessions, compulsions, or both.
An obsession is an uncontrollable thought or fear that causes stress. A compulsion is a ritual or action that someone repeats a lot. Compulsions may offer some relief, but only for a little while. If you find yourself helpless with time consuming thought process and rituals that distress you considerably then you are in trouble.
Most people have superstitions or rituals, or fear that they left the door unlocked or the oven on before leaving for work or vacation. If one can control those thoughts or think about them logically, it is probably not OCD. If he or she cannot control them, or they take up pretty much time of the day and cause problems in life, it is a sign that it is time to get help.
Many individuals who have OCD are aware that their thoughts and habits do not make sense. They don’t do them because they enjoy them, but because they cannot quit. And if they stop, they feel so bad that they start again.
Obsessive thoughts can include worries about self or other people getting hurt; constant awareness of blinking, breathing, or other body sensations; and suspicion that a partner is unfaithful, with no reason to believe it. Compulsive habits can include doing tasks in a specific order every time or a certain number of times; needing to count things, like steps or bottles; and fear of touching doorknobs, using public toilets or shaking hands.
Common obsessions often have a theme like fear of germs or dirt where one might be scared to touch things other people have touched, like doorknobs or wouldn’t want to hug or shake hands with others.
One can have extreme need for order and feels stressed when objects are out of place. It’s really hard to leave home until things are arranged in a certain way.
There is also fear of hurting self or someone else or excessive doubt or fear of making a mistake. In the second case, the individual needs constant encouragement or reassurance from others that what he is doing is right.
Some have fear of embarrassment and become afraid that they might yell out curse words in public or behave badly in social situations.
There is also fear of evil or hostile thoughts, including sexual acts or religion where the person imagines troubling sexual or disrespectful scenarios.
Common compulsions also have common themes and symptoms like washing or cleaning where the person washes hands, showers, or takes a bath over and over, or else he feels discomfort and guilt.
Sometimes one checks repeatedly to make sure kitchen appliances are turned off or the door is locked when he leaves home or before sleep.
Some individuals say out loud or to oneself numbers in a certain pattern. Some also feel the need to eat certain foods in a specific order. They arrange all the clothes or kitchen items or furniture in a specific way. Collecting or hoarding is also a common compulsion where an individual cannot stop buying things unnecessarily.
These repetitive routines usually may not have anything to do logically with the obsession the person is trying to fix and can take hours to do.

Diagnosis

The diagnosis process will likely include a physical exam to see if the symptoms are due to a health condition; blood tests to check the blood count, how well thyroid works, and any drugs or alcohol in the system; a psychological test or evaluation about the individual’s feelings, fears, obsessions, compulsions, and actions.

Treatment

There’s no cure for OCD. But it might be possible to manage how the symptoms affect a person’s life. Treatments include psychotherapy, relaxation, medication and neuromodulation.
The reassurance and support of the family and friends is most needed for OCD sufferers. They themselves struggle to get out of the situation but find it impossible which increases the anxiety and stress considerably. Never scold, blame or ignore them since they are not voluntarily doing this to cause discomfort to others. The negative approach of the loved ones will result in tremendous stress and loneliness that in turn will result in worsening the condition and resentment towards life. The family needs to understand the issues that the person has encountered and acknowledge their mistakes if any in the occurrence of such terrible situations. With constant support, the condition can be managed well in most cases.
There is a fine line between helping and enabling our loved ones with OCD. The best way to help and not enable is to learn everything we can about the disorder and the proper way to respond to it.
It is also essential to remember that it’s okay to feel angry, annoyed, frustrated, and overwhelmed, as long as these feelings are directed toward the OCD and not the person we care about. OCD sufferers need the understanding, acceptance, compassion and love of their families, and they deserve no less than that.

(The author is director, TGL
Foundation, and chairperson, CSA)

Anxiety is different for kids

You know how to do CPR and have a fully stocked first aid kit. At home and in the car. But it’s not enough. Today’s parents need to know how to deal with their kids’ mental health as well as their fevers and grazed knees.

According to statistics from the National Institute of Mental Health, around a third of adolescents have an anxiety disorder, which can come in various guises (including panic disorder, social anxiety disorder, obsessive-compulsive disorder, and separation anxiety disorder) and is characterized by excessive anxiety and related behavioral disturbances.

In the midst of what’s arguably one of the biggest public health challenges of all time, we’re all more aware of the prevalence of anxiety and other mental health issues, more clued-up about how mental illness can present itself, and what we can do to help both ourselves and others. But there’s an important qualifier when talking about kids with anxiety: They don’t display it in the same way adults do.

“Typically, when a child is anxious, you’ll see a change in their behavior,” says New York-based therapist Dana Carretta-Stein, M.S., LMHC, LPC.

That child could be the 8-year-old who throws the epic sort of tantrums you’d expect from a toddler. Or the 10-year-old who’s snappy and irritable every single day, for no apparent reason. Or the 12-year old who gets a stomach ache every morning before school, without fail. It manifests itself in a range of ways, Carretta-Stein says. “While every child is different, some kids may become more aggressive (which is the fight in the fight/flight response), whereas other children may become very shy (the flight response),” she explains.

Kids with anxiety may be clingy or tearful, reluctant to go to school, take part in activities, or be separated from their parent, says Michigan-based therapist Carrie Krawiec, LMFT. They may have persistent headaches or stomach aches, or display obsessive-compulsive or rigid behaviors, like being in distress when something isn’t a certain way or checking something over and over.

All behavior serves a function, Carretta-Stein notes, so changes in your child’s behavior shouldn’t be ignored. But that doesn’t mean you react to it. Carretta-Stein prefers the term “mindfully respond.” She teaches parents the “‘STOP” technique to deal with a child with anxiety.

“STOP stands for Stop, Think, Observe, and Plan,” she explains. “Stop and resist the urge to react to your child with emotion. It only adds fuel to the fire and will not help alleviate the anxiety. In fact, it can make it worse. Next, think about what your child is currently feeling. Then observe their behavior and consider what’s at the root of the issue. Finally, plan how you would like to respond.”

For many parents, that might be the difficult part. It’s one thing to notice something is up; another thing to know how to try to make things better. But don’t overthink it. Like most parenting matters, it’s best to keep it simple.

“You could say to your child, ‘I notice you’re acting differently. Is something bothering you? Or are you nervous?'” Carretta-Stein suggests. “Even if you’re wrong, it will help your child feel seen by validating their emotional experience.”

Another parenting truth: Kids learn what they see. “Parents should evaluate their own anxiety and make sure they’re not modeling any excessively anxious thoughts or behaviors,” Krawiec says. “Of course, some anxiety is good, keeps us safe, and helps us to know right from wrong, but too much of it can be limiting psychologically, socially, and developmentally. Kids can learn anxious responses, and interpret anxiety, from their parent — trauma reactions can be passed through generations.”

There’s a name for this in psychology: social referencing. “This refers to the idea that children look to adults to understand how to regulate and manage their own emotions, says licensed clinical psychologist Melanie English, Ph.D., MSW.

“An adult might imagine being on an airplane with some turbulence; we might look around at other passengers to see if they are concerned or not with the turbulence,” she says. “If those passengers aren’t bothered we might feel fine; if we see others becoming upset, we might also feel upset. Like this example, our children will look to us to interpret a situation and how to react to it.”

If parents can positively address the negative feelings they experience (anxiety, stress, conflict, etc.), they can mirror that their kids — and you have a potentially life changing teaching moment right there. “Our children will inevitably see our anxieties, struggles, conflicts, bad days, and worst moods (welcome to life!), but we can identify and model to them why we might feel that way and how we handle it,” English says. “In turn, they will understand that there are sometimes uncomfortable feelings and emotions in this world but there are tools to try and address them.”

Like all mental health issues, anxiety is complex and can mirror other things, English adds. For instance, your child might think they feel anxious about an upcoming event, but they’re actually excited. Or they might think they feel anxious about a test, but really they feel unprepared.

“Anxiety is typically future-based and can be addressed in kids similarly to how adults address it: talking it out, knowledge, self-care, having fun, exercising, creating structure, etc.,” English says. “Encourage your child to describe what they are feeling, then try to come up with ways to reduce or eliminate that feeling.”

Additional complications may be diet, lack of sleep, family problems, friend problems, health issues, and numerous organic, biological components. In those cases, English recommends exploring individual or family therapy (there are professionals who specialize in controlling for anxiety), medication, or other mechanisms.

And remember, asking for help does not mean you’re an inadequate parent; it means you have your kid’s back.

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A Classic ‘Fake Hand’ Illusion That Tricks The Brain Could Be Used to Treat OCD

A new approach to treating some of the intrusive thoughts in obsessive–compulsive disorder (OCD) is taking inspiration from a classic illusion that tricks our brain – and it could mean a pathway to a treatment method that’s less stressful than the current approaches available.

OCD can cause a number of unhealthy fixations and intrusive thoughts. One such compulsion can relate to excessive cleanliness, and treatment options are often difficult, leading patients to experience more distress.

Enter the rubber hand illusion, a classic cognitive science trick that has been investigated in multiple studies over the years. Here’s how it works: under certain conditions, if your hand is hidden from view and replaced by a dummy hand, your brain can start to register the fake rubber hand as your own.

The trick usually works if both the real hand and the dummy hand are touched at the same time, such as being stroked with a paintbrush, for example.

(Divya Kumar)

However, previous research has found that in people with schizophrenia or body dysmorphic disorder, the stroking doesn’t necessarily have to be in sync for the illusion to take effect.

These findings suggest that some people with mental health disorders might be more susceptible to this rubber hand illusion, and it could therefore be used in place of exposure therapy – a treatment method where patients are gradually exposed to their fears. For people with OCD compulsions that involve cleanliness, this could mean getting the dummy hand dirty, instead of the person’s real hand.

“If you can provide an indirect treatment that is reasonably realistic, where you contaminate a rubber hand instead of a real hand, this might provide a bridge that will allow more people to tolerate exposure therapy or even to replace exposure therapy altogether,” says neuroscientist Baland Jalal from the University of Cambridge in the UK.

To test the hypothesis, Jalal and colleagues put 29 volunteers with OCD through the rubber hand illusion. For 16 of the group, the rubber hand and real hand were stroked together; for the other 13, they were stroked asynchronously.

After five minutes, fake faeces was then smeared on the rubber hand while the participants had a damp cloth rubbed on their real hand (to simulate the same sensation). The volunteers were then asked to rate their disgust, anxiety, and handwashing urge levels.

In both groups – both synced and unsynced stroking – the subjects reported similar levels of feeling for the hand being real, and for it being contaminated. The trick worked.

The experiment continued for another five minutes, before these ratings were taken again. This time it was the volunteers who had the synced stroking applied who felt the biggest effects from the contamination.

When the participants then had their real right hands covered in fake faeces, again it was the group with the synchronised stroking patterns that had the highest levels of disgust, anxiety, and handwashing urge.

“Over time, stroking the real and fake hands in synchrony appears to create a stronger and stronger and stronger illusion to the extent that it eventually felt very much like their own hand,” says Jalal. “This meant that after ten minutes, the reaction to contamination was more extreme.”

“Although this was the point our experiment ended, research has shown that continued exposure leads to a decline in contamination feelings – which is the basis of traditional exposure therapy.”

In other words, by first fooling the brains of patients into thinking the dummy hands were real, the standard exposure therapy techniques – where those with OCD would be asked to leave their hands dirty for longer and longer periods of time – could be applied in a less direct, less stress-inducing way.

OCD is estimated to affect around 2-3 percent of the general population. Some people with OCD are simply unable to face exposure therapy, so it’s not an ideal solution for trying to tackle some of the compulsive behaviour that’s happening.

Next, the researchers want to test their hypothesis with a larger group of people, and in direct comparison to other types of treatment – it’s early days, but the signs are good that a trick of the brain could help to give some relief to those living with OCD.

“Whereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease,” says Jalal.

“It is also straightforward and cheap compared to virtual reality, and so can easily reach patients in distress no matter where they are, such as poorly resourced and emergency settings.”

The research has been published in Frontiers in Human Neuroscience.

IT man with OCD spends 10 hours bathing every day

An obsession to literally overuse soap has cost a Bengaluru IT professional a lot. A divorce, loss of social life and skin conditions are just a few of the side effects he has faced. 

For someone who is suffering from Obsessive Compulsive Disorder (OCD), the obsession is such that it cannot be stopped. Hasan (name changed) a Bengaluru-based middle-aged man could not stop himself from bathing so much that his family had to take him to a psychiatrist. 

His daily expenses included using three full soap bars a day, no less than a dozen plastic bags and large quantities of water. All this was done to keep up a 10-hour bathing schedule in one day.

A pale man with evidently dry skin with deposits under his nails and residue in the hair – this is how he looked when he first entered the clinic. 

Dr Satish Ramaiah, senior psychiatrist at People Tree Hospital, Yeshwanthpur, spoke about the case. “His day would begin and end with bathing,” Ramaiah said. “He spent no less than 10 hours a day in the bathroom. He did all this out of a fear that he would contact infections if that kind of hygiene was not maintained.”

Hasan’s day would begin at 3 am. “He would hit the bathroom that early in the morning and start bathing. It took him three full soap bars. He would be out only post 6 am, get ready for office and leave .” 

This was not it. A minimum of four hours would be reserved in the evening for bathing again. 

“When he came to me, he explained that he used several plastic covers in the process. He would use these as gloves in the bathroom. One set to open the door, another to handle soap, another for the shower and a few for operating taps,” said Dr Ramaiah. Although this provided Hasan temporary relief, it would not last long. Only at work did he feel distracted from the problem. 

His problems grew worse when his wife tried to help him but failed. “His mother got him to the hospital. She was depressed looking at the condition of her son. The patient did not have a father. His bathing ritual was such a compulsive act that he eventually had to face a divorce. His mother told me that his wife had tried to help him get out of it but had failed,” said the doctor. 

With stress, his condition had worsened, after which the psychiatrist was consulted. It was a habit that persisted for seven months before the family had realised that he needed support. 

“He came to me until recently. He required to be put on medication and also cognitive-behavioural therapy,” said Ramaiah, stating that OCD was a manifestation of one of the forms of an anxiety disorder and could worsen with stress. “In his case, there were also financial constraints as he was the breadwinner after losing his dad at an early age. He also had taken loans for studies,” said Ramaiah. 

Ramaiah said that he sees three to four cases of OCD in a week. However, none of the cases were as severe as Hasan.

How the ‘rubber hand illusion’ may help those with OCD

New research shows how the use of a multisensory illusion may help treat obsessive-compulsive disorder (OCD). The new method could bypass the disadvantages of exposure therapy.

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Contamination fears may cause people with OCD to wash their hands excessively.

In 1998, researchers Matthew Botvinick and Jonathan Cohen of the University of Pittsburgh, PA, detailed an experiment that people would later refer to as the “rubber hand illusion” (RHI).

In the experiment, 10 people sat down, resting their left arm on a table. A screen hid each participant’s arm from view, and instead, they could see a life-sized rubber hand model.

The researchers placed the hand right in front of the person so that they could see it from the same angle as they would their own hand.

After asking each participant to fix their gaze on the rubber hand, the experimenters used two small paintbrushes to stroke the rubber hand and the participant’s actual hand at the same time.

After 10 minutes, the participants reported feeling the rubber hand as though it were their own.

Now, new research has used the RHI to help people with contamination-related OCD overcome their fears.

Baland Jalal, a neuroscientist in the department of psychiatry at the University of Cambridge, United Kingdom, is the first author of the new paper, which appears in the journal Frontiers in Human Neuroscience.

In contamination-related OCD, the fear of touching a doorknob, for example, may cause people with the condition to spend hours washing and scrubbing their hands to an excessive degree afterward.

Doctors and mental health professionals often recommend “exposure therapy” to treat this and other forms of OCD.

Exposure therapy encourages people with OCD to start touching potentially contaminating surfaces without washing their hands afterward.

However, says Jalal, “exposure therapy can be very stressful and so is not always effective or even feasible for many patients.”

This limitation is what made him and his colleagues want to explore other options, such as contaminating a fake hand instead.

Using a fake hand to treat OCD

The new research builds on previous RHI experiments that Jalal carried out together with fellow neuroscientist Vilayanur S. Ramachandran, who is a co-author of the new study.

In these previous studies, Jalal and Ramachandran contaminated the fake hand with fake feces, and the participants reported feeling disgusted in the same way that they would if they had used their own hand.

For the new study, the researchers recruited 29 people with OCD from the McLean Hospital Obsessive Compulsive Disorder Institute in Belmont, MA.

Of these participants, 16 experienced the paintbrush stroking on both their real hand and the dummy hand at exactly the same time, whereas 13 controls experienced the stroking out of synch.

After 5 minutes, the experimenters asked how real the dummy hand felt to the participants. Then, they used a tissue to smear the dummy hand with fake feces while simultaneously touching the real, hidden hand with a damp paper towel to mimick the feeling of them having feces on their hand.

The experimenters again asked the participants to rate their level of disgust, as well as how anxious they were and how strongly they felt the urge to go and wash their hand.

RHI may ease OCD contamination fears

At first, both groups reported feeling the illusion, regardless of whether or not the stroking of the two hands was simultaneous.

Then, the researchers took away both the clean paper towel and the fake feces tissue, leaving fake feces on the dummy hand. After this, they stroked the rubber hand and the real hand for another 5 minutes, still either synchronously or asynchronously.

In this condition, the participants in the intervention group reported feeling more disgusted than those in the control group.

In the next step, the stroking stopped, and the researchers placed fake feces on the real right hand of each of the participants.

This time, the people in the control group rated their anxiety, disgust, and urge to wash at seven on a 10-point Likert scale, whereas the intervention group reported these factors as a nine.

“Over time, stroking the real and fake hands in synchrony appears to create a stronger and stronger and stronger illusion to the extent that it eventually felt very much like their own hand,” reports Jalal.

“This meant that after 10 minutes, the reaction to contamination was more extreme.”

Although this was the point our experiment ended, research has shown that continued exposure leads to a decline in contamination feelings — which is the basis of traditional exposure therapy.”

Baland Jalal

Replacing traditional exposure therapy

In other words, the researcher believes that it is safe to conclude from these findings that after 30 minutes, participants would experience a drop in feelings of anxiety, disgust, and washing urge, based on the proven success of exposure therapy.

“If you can provide an indirect treatment that is reasonably realistic, where you contaminate a rubber hand instead of a real hand, this might provide a bridge that will allow more people to tolerate exposure therapy or even to replace exposure therapy altogether,” continues the scientist.

He adds, “Whereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease.”

“It is also straightforward and cheap compared to virtual reality, and so can easily reach patients in distress no matter where they are, such as poorly resourced and emergency settings.”

In the near future, the researchers plan to compare this technique with existing treatments in randomized clinical trials.

Ramachandran agrees that the findings are strong, but also points out that more research is necessary before moving on to clinical trials.

“These results are compelling but not conclusive,” he says. “We need larger samples and to iron out some methodological wrinkles.”

Contaminating Fake Rubber Hand Aids People to Overcome Obsessive-Compulsive Disorder (OCD) – News

Obsessive-compulsive disorder (OCD) is a mental health condition wherein people are caught in a cycle of obsessions, which are unwanted and intrusive thoughts triggering distress, and compulsions, which are coping mechanisms to reduce distress. The rubber hand illusion therapy, whereby fake rubber hands are contaminated with feces, maybe the key in helping people overcome their fears of touching contaminated surfaces, a new study suggests.

Image Credit: ImagePointFr/Shutterstock.com

For many OCD-stricken people, the condition can be extremely debilitating, taking a toll on their lives. At present, treatments and therapies are not always straightforward. The current recommended treatment includes a combination of medication such as Prozac and a form of cognitive-behavioral therapy or talking therapy, which are collectively dubbed as exposure and response prevention.

Exposure therapy can be stressful for OCD patients. This involves letting them touch contaminated surfaces such as the toilet and preventing them from washing their hands. People with OCD can develop extreme fears, even from simple things such as touching a doorknob or being exposed to a dirty environment.

Developing a new therapy

To overcome the problem and in the hope to help OCD patients, an international team of researchers formulated a new therapy, known as multisensory stimulation therapy whereby instead of letting patients contaminate their own hands, they will use a fake hand instead.

The therapy was based on a famous trick called the rubber hand illusion, wherein a person puts both hands on a table, either side of a division such that they can’t see their right hand. To the left of the partition, they see a fake right hand. The illusionist will stroke both the fake hand and the hidden right hand using a paintbrush. After stroking for several minutes, the person will report feeling as if the fake hand is their own.

In the study, published in the Frontiers in Human Neuroscience, the researchers used a fake hand and let the patient watch this being stroked until they developed a sensation it was their own. Then, the rubber hand was smeared with feces, whilst the real hand was dabbed with a damp tissue to copy the feeling of feces touching the skin.

The researchers asked the participants to rate their anxiety, disgust, and handwashing urge levels, along with an observation of the participant’s expression of disgust. They found that the participants in both the two groups – experimental and control, felt a good and strong rubber hand illusion, which meant they felt as if it was their real hand.

Way of treating OCD patients

The researchers believe that the new method can be a way to treat OCD patients, without exposing them to high levels of stress that they encounter in exposure therapy. Providing an indirect treatment that is realistic but will not cause distress, can help in treating OCD patients and can provide a bridge for people to withstand exposure therapy, or even replace it.

Whereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease. It is also straightforward and cheap compared to virtual reality, and so can easily reach patients in distress no matter where they are, such as poorly resourced and emergency settings,”

Baland Jalal, Department of Psychiatry, University of Cambridge.

The researchers plan to conduct clinical trials to compare the new method to existing therapies since the results are promising but still not conclusive. Obtaining larger samples can help in determining the effectiveness of the method, seeing if it can replace exposure therapy.

Jalal, B., McNally, R., Elias, J., Potluri, S., and Ramachandran, V. (2019). Fake it till You Make it”! Contaminating Rubber Hands (“Multisensory Stimulation Therapy”) to Treat Obsessive-Compulsive Disorder. Frontiers in Human Neuroscience. https://www.frontiersin.org/articles/10.3389/fnhum.2019.00414/full

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