Clenching and counting: how I get through the holidays with OCD

It is a few weeks until Christmas. I’m sitting at a table with my hands clasped at my chin. I probably look like I’m meditating, praying, or just deep in thought. But I’m gripping and releasing, gripping and releasing my hands in rhythm with clenching my jaw as I think about the lists I need to make and the events I must control to get through holidays.

I remind myself to try to enjoy the season, let happier thoughts diffuse the seriousness and the desperate gripping. But this is life with obsessive compulsive disorder. Every person with OCD has a unique experience, but for me it boils down to obsession with order and correctness, intrusive thoughts about catastrophe, and rituals to maintain an illusion of control.

The holidays are a soup of stress that stirs up and intensifies the components of my OCD because of travel anxiety, being away from home, more socializing, pressure to make holidays special and obsession with holiday catastrophes. Holiday catastrophes make for headlines that become legendarily tragic because of their proximity to the “most wonderful time of the year”.

These are actual headlines from last Christmas:

Plane makes emergency landing on Alabama highway.

Fire kills woman and three holiday houseguests.

Community mourns loss of family members in tragic Christmas Day crash.

While I was thinking about tragic holiday headlines to include in this piece, a friend I was texting back and forth with suddenly wrote that there was an emergency and he had to run. So now my OCD will make me think I have created whatever emergency he suddenly had to go handle by just thinking about those headlines.

To spend Christmas with extended family, my husband, two kids and I will drive about 1,500 miles round-trip. During those trips, I won’t be able to escape hours and hours of intrusive thoughts that we will be the next headline: “Family of four killed in fiery interstate crash on Christmas Eve.” (I just knocked three times on the floor to un-jinx writing that. Then I deleted it and restarted my computer to really clean it out. And I rewrote the sentence. Because I can’t tell this story without stirring up the fear. Now I’m gripping my hands again, hoping we will be safe this year.)

Intrusive thoughts are a bully determined to ruin our fun. I call my bully Zephyrus, Greek god of the west wind. He blows chaos and stirs up fear. He smirks over a festive family scene of torn wrapping paper and scattered boxes. He whispers in my ear so I can only see the disorder, not the joy. I fight Zephyrus, fight being childish, irritable and difficult like he is.

Planning, counting, listing and reassurance seeking are the tools (compulsions) I use to create the illusion of control. To prepare for our trip, I will make packing lists and task lists to complete before packing can even start. First all of the laundry has to be washed, folded and put away. Only when everything is in its place and in order can I start to pack our bags with the “correct” items. Packing prep drags on for days. The lists give birth to sublists that are never really completed because time comes to hit the road.

I’ll try to impose order inside the car to counteract malicious fates that could be traveling with us. I’ll keep a strict schedule of stopping every two hours to stretch and refuel while pretending it’s all spontaneous and I haven’t been counting the minutes. My husband knows I have a secret schedule and that I will get more anxious if we veer from it. The kids just look forward to each stop as a new adventure and a chance to get a treat. For me, it is a chance to unclench my teeth. Focusing on “the plan” helps to blur the near constant violent images of our mangled car flying off a bridge.

I won’t mention the imagined car crashes out loud because naming them could tempt the fates too far (and infect my family with the same disturbing images). Instead, I’ll seek reassurance in smaller ways, asking the kids: “Do you feel OK? How are you? Do you need something? Are you having fun? Are you warm enough?”

I’ll ask my husband: “How are you doing? Do you need to stop? Do you think we remembered everything? Are you sure you saw both of our cats before we left? And there’s plenty of water for them? Did you hold the mail? Do you think there will be a hailstorm that causes enough roof damage to flood the house while we are gone?”

“Anna, we have insurance,” he says, sounding a little exhausted. He is used to this routine.

I was a preteen when compulsions snuck into my life. I liked to play solitaire, but first I had to be sure the cards were perfectly random so I would shuffle seven times for a perfectly mixed deck. A magic number, a concrete ritual. (I do love cards and how they contain both order and chaos.)

I probably just looked like a kid who liked fidgeting with cards. But this was a compulsion. I had to check the cards by flipping each one and counting “ace, two, three, four …”, looking for cards to match my counting. The longer I had to search for the card as I counted, the more bad luck accumulated.

Counting rituals carried over into adulthood. I count while I wash dishes, I count while I fold laundry. Load 10 dishes on the bottom rack, load 10 dishes in the top rack, repeat. Fold 10 pieces of laundry, put the stack away, repeat. Doing things the “right” number of times – usually 10 – is a balm on my constant fear that things are disintegrating around me.

I was 30 before I learned these things fell under the clinical umbrella of OCD. At the end of a session, my therapist Ellen said, casually: “I’m concerned about your obsessions and compulsions. Let’s talk more about it next time.” Obsessions? Compulsions? No, I thought, these are just the things I have to do to keep everything fair and safe and right. Oh.

I have practiced exposure and response prevention, lying on my “dirty” kitchen floor, forcing myself to stare into the grimiest corners and measuring my anxiety until it peaked and then subsided. I have used meditation for travel anxiety to counteract the car crash images in my head. Cognitive behavioral therapy and antidepressants help too. With all of these tools and treatments, my OCD is now merely annoying and not debilitating.

The illusion of control is an attractive deception, a slick conman. No amount of organization, planning or counting will prevent my house from burning down, or the cats dying, or a burglary while we are away. No ritual (except maybe extra handwashing) will prevent a family member from being seriously ill during the holidays. That magical time of fun, family, peace and joy is the worst magical time to be injured or ill. The worst-case scenario intrudes again.

The worst-case scenario already kind of happened anyway, when my husband was admitted to the hospital with pneumonia right after Christmas three years ago. I watched my invincible bear of a husband collapse in a parking lot, coughing up blood. Our return home was delayed by a week while he recovered, and it was all totally out of my control. With nothing to control, I just sat with him in the hospital and actually relaxed. It was a case of unintended exposure therapy, and it actually worked. I’ll try to remember that going into this year’s trip. But right now, I have to go. There’s laundry to do and traveling routes to go over. There are lists to be made. There are lists to re-check, as I try to remember not to grip my hands too tightly.

Side effects of pediatric medications for anxiety, OCD

Dr. Jeffrey Strawn, associate professor in the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine, and Jeffrey Mills, associate professor in the Department of Economics at the UC Lindner College of Business, published a study in the Journal of the American Academy of Child Adolescent Psychiatry looking specifically at side effects that impact children and adolescents being treated for anxiety disorders and obsessive-compulsive disorder (OCD).

Strawn says this is one of the first studies examining side effects of these medications in youth that doesn’t just focus on suicidal thinking or discontinuation of medication.

“For youth with anxiety disorders and OCD, these medications improve symptoms and functional outcomes,” he says. “Over the past two decades, selective serotonin reuptake inhibitors, known as SSRIs, and serotonin-norepinephrine reuptake inhibitors, known as SNRIs, have become the standard medication treatments for pediatric patients with these conditions.”

The UC study assessed quality-of-life issues.

“Evaluations of antidepressant tolerability focus almost entirely on discontinuation of the medicine or suicidality. We wanted to examine side effects commonly reported in pediatric patients treated with antidepressants, including agitation, nausea, abdominal pain, insomnia, headache and fatigue, in addition to suicidality and discontinuation of medication.”

SSRIs increase levels of serotonin in the brain. SNRIs block the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain.

In this study, Mills and Strawn looked at academic peer-reviewed articles through March 1, 2019, and identified SSRI and SNRI studies in patients under 18 with OCD and anxiety disorders, specifically noting side effect rates.

They used statistical tools known as Bayesian hierarchical models created by Mills that enable results from different studies to be combined while taking into account variations across patients and those studies.

“Out of 18 trials, which included more than 2,500 patients who were treated and then compared to patients taking a placebo, SSRIs produced more side effects; agitation was more common with SSRI use,” Mills says.

“SSRIs and SNRIs were not associated with suicidal thoughts. This finding is consistent with earlier studies that suggest that suicidality relates to the condition being treated,” Strawn adds. “Medication side effects are important for clinicians to consider, particularly in light of data suggesting these medications also differ in terms of how effective they are. SSRIs are a better option compared to SNRIs and are the treatment of choice for children and adolescents with anxiety.”

Rising Kashmir


Obsessive compulsive disorder (OCD) is a type of anxiety disorder. Anxiety disorder is the experience of prolonged, excessive worry about circumstances in one’s life. OCD is characterized by distressing repetitive thoughts, impulses or images that are intense, frightening, absurd, or unusual. These thoughts are followed by ritualized actions that are usually bizarre and irrational. These ritual actions, known as compulsions, help reduce anxiety caused by the individual’s obsessive thoughts. Often described as the ‘disease of doubt,’ the sufferer usually knows the obsessive thoughts and compulsions are irra­tional but, on another level, fears they may be true.


Almost one out of every 40 people will suffer from obsessive-compulsive disorder at some time in their lives. The condition is two to three times more com­mon than either schizophrenia or manic depression, and strikes men and women of every ethnic group, age and social level. Because the symptoms are so distressing, sufferers often hide their fears and rituals but cannot avoid acting on them. OCD suf­ferers are often unable to decide if their fears are realistic and need to be acted upon. Most people with obsessive-compulsive disorder have both ob­sessions and compulsions, but occasionally a person will have just one or the other. The degree to which this condition can interfere with daily living also varies.

Some people are barely bothered, while others find the obsessions and compulsions to be profound­ly traumatic and spend much time each day in com­pulsive actions.

Obsessions are intrusive, irrational thoughts that keep popping up in a person’s mind, such as ‘my hands are dirty, I must wash them again.’ Typical obsessions include fears of dirt, germs, contamina­tion, and violent or aggressive impulses. Other obsessions include feeling responsible for others’ safety, or an irrational fear of hitting a pedestrian with a car. Additional obsessions can involve exces­sive religious feelings or intrusive thoughts. The patient may need to confess frequently to a religious counselor or may fear acting out the strong anti social thoughts in a hostile way. People with obses­sive-compulsive disorder may have an intense pre­occupation with order and symmetry, or be unable to throw anything out.

Compulsions usually involve repetitive rituals such as excessive washing (especially hand wash­ing or bathing), cleaning, checking and touching, counting, arranging or hoarding. As the person performs these acts, he may feel temporarily bet­ter, but there is no long-lasting sense of satisfac­tion or completion after the act is performed. Often, a person with obsessive-compulsive disor­der believes that if the ritual isn’t performed, something dreadful will happen. While these compulsions may temporarily ease stress, short-term comfort is purchased at a heavy price—time spent repeating compulsive actions and a long-term interference with life.

The difference between OCD and other compulsive behavior is that while people who have problems with gambling, overeating or with substance abuse may appear to be compulsive, these activities also provide pleasure to some degree. The compulsions of OCD, on the other hand, are never pleasurable. OCD may be related to some other conditions, such as the continual urge to pull out body hair (tricho­tillomania); fear of having a serious disease (hypo­chondriasis) or preoccupation with imagined defects in personal appearance disorder (body dysmorphia). Some people with OCD also have Tourette syndrome, a condition featuring tics and unwanted vocaliza­tions (such as swearing). OCD is often linked with depression and other anxiety disorders.

Causes and symptoms

While no one knows for sure, research suggests that the tendency to develop obsessive-compulsive disorder is inherited. There are several theories behind the cause of OCD. Some experts believe that OCD is related to a chemical imbalance within the brain that causes a communication problem between the front part of the brain (frontal lobe) and deeper parts of the brain responsible for the repetitive behavior. Research has shown that the orbital cor­tex located on the underside of the brain’s frontal lobe is overactive in OCD patients. This may be one reason for the feeling of alarm that pushes the patient into compulsive, repetitive actions. It is possible that people with OCD experience over activity deep within the brain that causes the cells to get ‘stuck,’ much like a jammed transmission in a car dam­ages the gears. This could lead to the development of rigid thinking and repetitive movements common to the disorder. The fact that drugs which boost the levels of serotonin, a brain messenger substance linked to emotion and many different anxiety dis­orders, in the brain can reduce OCD symptoms may indicate that to some degree OCD is related to levels of serotonin in the brain.

Recently, scientists have identified an intriguing link between childhood episodes of strep throat and the development of OCD. It appears that in some vulnerable children, strep antibodies attack a cer­tain part of the brain. Antibodies are cells that the body produces to fight specific diseases. That attack results in the development of excessive washing or germ phobias. A phobia is a strong but irrational fear. In this instance the phobia is fear of disease germs present on commonly handled objects. These symptoms would normally disappear over time, but some children who have repeated infections may develop full-blown OCD. Treatment with antibiotics has resulted in lessening of the OCD symptoms in some of these children. If one person in a family has obsessive-compulsive disorder, there is a 25% chance that another immediate family member has the condition. It also appears that stress and psy­chological factors may worsen symptoms, which usually begin during adolescence or early adulthood.


People with obsessive-compulsive disorder feel ashamed of their problem and often try to hide their symptoms. They avoid seeking treatment. Because they can be very good at keeping their problem from friends and family, many sufferers don’t get the help they need until the behaviors are deeply ingrained habits and hard to change. As a result, the condition is often misdiagnosed or under diagnosed. All too often, it can take more than a decade between the onset of symptoms and proper diagnosis and treat­ment. While scientists seem to agree that OCD is related to a disruption in serotonin levels, there is no blood test for the condition. Instead, doctors diagnose OCD after evaluating a person’s symptoms and history.


Obsessive-compulsive disorder can be effectively treated by a combination of cognitive-behavioral therapy and medication that regulates the brain’s serotonin levels. Drugs that are approved to treat obsessive-compulsive disorder include fluoxetine, fluvoxamine, paroxetine, and sertraline, all selec­tive serotonin reuptake inhibitors (SSRI’s) that affect the level of serotonin in the brain. Older drugs include the antidepressant clomipramine, a widely-studied drug in the treatment of OCD, but one that carries a greater risk of side effects. Drugs should be taken for at least 12 weeks before deciding wheth­er or not they are effective.

Cognitive-behavioral therapy (CBT) teaches pa­tients how to confront their fears and obsessive thoughts by making the effort to endure or wait out the activities that usually cause anxiety without compulsively performing the calming rituals. Even­tually their anxiety decreases. People who are able to alter their thought patterns in this way can lessen their preoccupation with the compulsive rituals. At the same time, the patient is encouraged to refocus attention elsewhere, such as on a hobby. In a few severe cases where patients have not re­sponded to medication or behavioral therapy, brain surgery may be tried as a way of relieving the un­wanted symptoms. Surgery can help up to a third of patients with the most severe form of OCD. The most common operation involves removing a section of the brain called the cingulate cortex. The serious side effects of this surgery for some patients include seizures, personality changes and less ability to plan.


Obsessive-compulsive disorder is a chronic dis­ease that, if untreated, can last for decades, f luc­tuating from mild to severe and worsening with age. When treated by a combination of drugs and behavioral therapy, some patients go into complete remission. Unfortunately, not all patients have such a good response. About 20% of people cannot find relief with either drugs or behavioral ther­apy. Hospitalization may be required in some cases. Despite the crippling nature of the symp­toms, many successful doctors, lawyers, business people, performers and entertainers function well in society despite their condition. Nevertheless, the emotional and financial cost of obsessive com­pulsive disorder can be quite high.

Niall Horan health: One Direction singer’s mild condition – the symptoms

The health body adds: “The compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

“It’s possible to just have obsessive thoughts or just have compulsions, but most people with OCD experience both.

Treatment for OCD

OCD can be treated but the treatment recommended will depend on how much it’s affecting your life.

The NHS explains: “The two main treatments are psychological therapy – usually a type of therapy that helps you face your fears and obsessive thoughts without “putting them right” with compulsions, and medicine – usually a type of antidepressant medicine that can help by altering the balance of chemicals in your brain.

“A short course of therapy is usually recommended for relatively mild OCD. If you have more severe OCD, you may need a longer course of therapy and/or medicine.

“These treatments can be very effective, but it’s important to be aware that it can take several months before you notice the benefit.

“You can get treatment on the NHS through your GP or by referring yourself directly to a psychological therapies service.”

Ruminating thoughts: How to stop them

Numerous strategies can help with rumination. People with depression, anxiety, or other mental health diagnoses may find that they need to try several strategies before one works.

It can be useful to keep track of effective strategies so that when rumination feels overwhelming, it is possible to turn to a list of methods that have worked previously.

People may find the following tips helpful:

  • Avoid rumination triggers: Some people find that specific factors trigger rumination. They may wish to limit access to these triggers if it is possible to do so without undermining their quality of life. For instance, a person could try putting themselves on a media diet if the news makes them feel depressed, or they could stop reading fashion magazines if these publications make them feel unattractive.
  • Spend time in nature: A 2014 study found that people who went on a 90-minute nature walk reported fewer symptoms of rumination after their walk than those who walked through an urban area instead.
  • Exercise: Numerous studies have found that exercise can improve mental health, especially over time. However, a 2018 study reported that even a single session of exercise could reduce symptoms of rumination among inpatients with a mental health diagnosis. People may find that pairing exercise with time outside gives them the best results.
  • Distraction: Disrupt ruminating thought cycles with something distracting. Thinking about something interesting and complex may help, while fun, challenging activities, such as complex puzzles, may also offer relief.
  • Interrogation: People can try to interrogate ruminating thoughts by considering that they might not be helpful or based in reality. Perfectionists should remind themselves that perfectionism is unattainable. Those who tend to concern themselves with what other people think should consider that others are more concerned with their own perceived shortcomings and fears.
  • Increase self-esteem: Some people ruminate when they do poorly at something that is very important to them, such as a beloved sport or important academic achievement. By expanding their interests and building new sources of self-esteem, a person can make a single defeat feel less difficult.
  • Meditation: Meditation, particularly mindfulness meditation, may help a person better understand the connection between their thoughts and feelings. Over time, meditation can offer people greater control over seemingly automatic thoughts, making it easier to avoid rumination.

Read about different apps that can help treat mental health issues such as rumination.

Alternatively, therapy may help a person regain control over their thoughts, detect signs of rumination, and choose healthier thought processes.

Some forms of mental health therapy, such as rumination-focused cognitive behavioral therapy (RFCBT), specifically target rumination to help a person gain more control over their thoughts.

While traditional cognitive behavioral therapy focuses on changing the content of thoughts, RFCBT attempts to alter the thinking process instead.

Learn more about cognitive behavioral therapy here.

New home for adults with mental illness to be named after slain police officer

A housing unit for adults with mental illness set to open in Fredericton in the new year will be named after one of the police officers killed in a shooting last year.

Costello House will be run by the non-profit New Brunswick Community Residences and is named after Const. Robb Costello, one of the officers who responded to a shooting at a Brookside Drive apartment complex on Aug. 10, 2018.

He died that day along with Const. Sarah Burns and two civilians, Donnie Robichaud and Bobbie Lee Wright.

Costello’s partner, Jackie McLean, chairs the board of the non-profit and said that while Costello deserves the honour, he would probably feel self-conscious receiving it.

“I feel that while we don’t know exactly why this tragedy occurred, I feel like it’s highly likely that there is a mental health component involved.” (Maria Jose Burgos/CBC)

“He would say he didn’t deserve the attention, that, you know, name it after somebody who is more important than he is,” McLean said. 

“I don’t think that he knew how important he was to so many people and the community.”

‘A lovely environment’

Costello House will have six beds and be for people recently released from the hospital.

Stephanie Brewer, the executive director of New Brunswick Community Residences, said the home will be on the north side of the city and cater to adults with a variety of mental illnesses.

“It could be any type of mental health, mental illness or emotional difficulties that somebody might be experiencing,” said Brewer. 

“A lot of our clients may be suffering from schizophrenia, obsessive compulsive disorder, anxiety disorders, depression and the list goes on.”

McLean said the home, which will be one of four owned by the non-profit in the city, will have a “homey” vibe.

She said this is important to people entering the home from an institution like a hospital.

“The most important thing for us is that these people have a home, not an institution or not something that’s clinical and cold,” said McLean.

Stephanie Brewer is the executive director of New Brunswick Community Residences. She said the new home on the north side for adults struggling with mental illnesses will have a “homey” vibe. (Kirk Pennell/CBC)

“It’s a really lovely environment and we’re really proud of how it’s turned out.”

Brewer said the building still needs a few things to make it feel like a home, and she’s hoping for donations from the community.

“We need bedroom furnishings for six bedrooms, living-room furnishings for two living areas, kitchen equipment,” said Brewer.

Costello House said the facility will be located on the north side of the city and will cater to adults with a variety of mental illnesses. (Kirk Pennell/CBC)

“Just anything you would need in your own home basically”

Mental illness still a stigma

McLean said Costello always supported her work in the organization and was always involved with the Fredericton community at large.

“He knew the value of what New Brunswick Community Residences offer,” said McLean.

“For these individuals to have the stability of a home and those supports meant that Rob wouldn’t have to necessarily deal with them through his work professionally, because a lot of their needs were already met.”

McLean said she thinks society has a long way to go in how it treats people with mental illnesses.

She said that after her partner died, she was diagnosed with post-traumatic stress disorder and anxiety.

Costello House will have six beds for people recently released from the hospital. (Kirk Pennell/CBC)

“There is stigma attached to that,” said McLean.

“A lot of people don’t understand it and mental illness is not a choice and because it’s an invisible condition people assume that you’re OK.”

A tragedy that ‘could have been avoided’

McLean said the ultimate goal is to open another three facilities over the next decade and have them named after the other three victims of the shootings.

While she doesn’t want to make a direct connection, she believes mental health played a role in the death of her partner.

“I feel that while we don’t know exactly why this tragedy occurred, I feel like it’s highly likely that there is a mental health component involved,” said McLean.

“I like to believe that had this individual received community support for mental illness, that maybe the tragedies could have been avoided.” 

The Newest Way to Understand the Angry People in Your Life

Anyone can have trouble controlling their anger from time to time. You may be frustrated because you’ve just made a huge mistake in a big project and have to start again from scratch. Perhaps you’re stuck in a long commute and will be an hour late getting home. You might be angry at a relative who just won’t back off from demanding your time and attention. All of these are situations that can lead anyone to yell out in rage, if only at the fates.

How about people you know who chronically seem ready to explode with little or no provocation? What kinds of situations arouse them to higher and higher levels of fury, or are they always on the verge of exploding over nothing? And when they release their anger, what happens next? They’ve yelled at their partner over practically nothing, and now the partner walks out the door, annoyed and disgusted at being treated in such a rude and offensive manner. This rejection only inspires even more of their outrage.

Why might anger be such a problem for some people? According to psychologist Nienke de Bles and colleagues (2019), of Leiden University in the Netherlands, the source of both chronic anger and episodes of rage may lie in the psychological disorders of anxiety and depression. For example, the authors note that there is a surprisingly high 50% rate of irritability among people with major depressive disorder, with 26 to 49% experiencing attacks of anger. People with dysthymia, a chronic but less extreme form of depressive disorder, have a similarly high rate of anger attacks, estimated at 28 to 53%. Among people with an anxiety disorder or obsessive-compulsive disorder, there are also high rates of hostility and anger.

As impressive as these statistics are, the Dutch authors believe that the data may be flawed. Research studies establishing these percentages used measures of anger that, the research team points out, were not sufficiently validated. In some cases, the statistics were based on very short tests of anger and irritability, ranging from a single item to perhaps four drawn from another assessment not initially intended to examine anger.

Furthermore, previous studies didn’t separate what’s known as “trait” anger (the tendency to be angry all the time) from “state” anger (being enraged at the time of testing). As the authors note, “Making a distinction between patients with an angry disposition as a constant factor embedded in personality, and patients that respond angrily to an immediate situation, is of clinical importance” (p. 260).

To test the role of both forms of anger in anxiety and depressive disorders, de Bles et al. drew participants from a large-scale longitudinal study based in the Netherlands that followed people for a period of four years. The original sample consisted of nearly 2,900 adults ages 18 to 65 years of age recruited from a variety of treatment sites in the community, although there were also controls who did not have a lifetime history of psychological disorders. The data for the anger study came from nearly 2,300 who participated in the fourth wave of the follow-up.

Included in the study were not only the anger scales but also demographic measures including educational background, body mass index, smoking history, lifetime history of alcohol dependence and abuse, and use of drugs in the past month. The average age of the sample was 46 years old, with most between 33 and 59 years of age; two-thirds were female. As might be expected in a psychiatric sample, those with anxiety and depressive disorders were more likely to smoke, had higher body mass, and reported having a history of alcohol dependence and abuse.

To measure trait anger, the Dutch authors asked participants to complete a 10-item scale widely used in personality research. Half of the trait anger items assessed a general disposition for experiencing anger and eventually expressing it (temperament); the remaining five asked whether participants were more likely to express anger after some sort of provocation. Sample trait items were “I get annoyed quickly” and “I am quickly irritated.” The tendency to express anger in the form of an outburst, or the more state-like quality, was tapped by a self-report scale in which participants stated that they frequently experienced irritation, overreacted to minor annoyances, inappropriately expressed anger and rage toward others, and had at least one anger attack in the past month. To be counted as an anger attack, participants had to check off symptoms such as feeling their heart was racing or short of breath, trembling, feeling dizzy, sweating, feeling like attacking others, and throwing or destroying objects.

The researchers divided their participants into five diagnostic groups that included those with a current depressive disorder (204 participants), anxiety disorder (288), comorbid (joint) depressive and anxiety disorder (222), no psychiatric diagnosis (470), and a history of past anxiety and/or depressive disorder that was no longer active (1107). As the authors predicted, the scores on the trait anger measures were highest in the comorbid anxiety and depression group, with approximately 45% classified as above the 75th percentile of scores. The combined group also had a higher prevalence of anger attacks, at approximately 23% within the past month. The highest rates of anger attacks occurred for people with major depressive disorder and, of the anxiety disorders, social phobia, panic disorder, and especially generalized anxiety disorder.

Of all the other predictors, only past month use of a drug predicted higher rates of anger attacks. However, participants with remitted disorders also had higher trait anger scores and rates of anger attacks, so that even in recovery, anger remains a problem for individuals with a history of these psychological disorders.

An important takeaway from this study, according to the authors, is that clinicians working with people who have these disorders may easily overlook the trait of anger and anger attacks because “they are not part of core … symptoms, and insight and self-consciousness of feelings of anger may be hampered” (p. 262). Notably, people who experienced worry and symptoms of depression had higher levels of anger, suggesting a more general problem with emotion dysregulation, or the inability to maintain control over their feelings. It is also important, as the authors point out, to address anger among people with these psychological disorders as a public health precaution, given the many adverse outcomes that can be associated with an anger outburst in people whose anxiety and depression go untreated.

To sum up, the study shows the unrecognized but important role of anger in psychological disorders not usually conceived of in terms of the tendency to experience rage. Looking at the findings from another perspective, if people you know seem unusually angry and ready to explode, consider the possibility that anxiety and depression may be the source of their emotional turmoil. Helping them manage their psychological disorders may prove, in the long run, to help them be better able to manage their angry emotions.

Stray pet tree wins Erie festival – Lifestyle

The tree, sponsored by a supporter of Because You Care, placed first at the Festival of Trees at the Bayfront Convention Center.

A Christmas tree dedicated to finding homes for stray pets was the winner of the 2019 Festival of Trees at the Bayfront Convention Center.

“A ’Fur’ever Home for the Holidays” was decorated by Elizabeth Gutting and sponsored by a supporter of Because You Care. It placed first among the 72 professionally decorated trees at the event, sponsored by Saint Vincent Hospital.

A tree decorated by Saint Vincent Neonatal Intensive Care Unit nurses and sponsored by the Children’s Miracle Network placed second, followed by a tree decorated by Potratz Flower Shop and sponsored by Lilly Broadcasting.

The event is a fundraiser to help Saint Vincent form a women’s behavioral health program to treat women with mood and anxiety disorders including depression, obsessive-compulsive disorder, bipolar disorder and perinatal depression.

The Obsessive Outsider: One woman’s journey from severe Obsessive-Compulsive Disorder to a life lived abundantly

The books author, Kerry Osborn, is a mental health/OCD advocate, mental health blogger, public speaker, writer and founder of The Obsessive Outsiders digital ‘mentally misunderstood’ movement. Osborn is a long time sufferer of Obsessive-Compulsive Disorder, which set in as a young adult with no genetic history of mental illness.

Kerry Alayne Osborn lived a completely normal life until the sudden onset of Obsessive-Compulsive Disorder (OCD) at the age of seventeen. Her charmed life turned upside down as her new diagnosis of OCD set in, leaving her life spinning out of control. While trying to live a normal life, as she battled through the maze of OCD, she found her OCD mind had different plans. Unlike the common stigma of OCD, Kerry found herself with a case of OCD that is the exact opposite of the known ‘perfectionism’, and ‘cleanliness’ oriented disorder.

Several dark years later, bound in the chains of OCD, the outsider found herself on a leather couch in a manic state, sitting across from the one therapist who would go on to mentor her to live an abundant life. Once confined to the isolation of her dorm room with no friends, a loss of identity, and betrayal of her own mind, Kerry pushed through to break the foundation of her dire belief system in OCD.

Passing through the waiting rooms of many untargeted therapists, Osborn finally found Jim Sterner, LMFT and enrolled in The Gateway Institute’s Intensive Therapy Program in 2010. It was during the program Kerry initially realized the disconnection of her magical thinking OCD. Osborn has worked for years to live a normal life credited to behavioral therapy and perseverance. Jim Sterner’s reflection on his work with Kerry over the years is profound, stating, “Coming from unimaginable depths of OCD, Kerry’s entire life was completely entangled in her intrusive thoughts, and almost every hour of every day was committed to neutralizing her fears and anxiety through hundreds of compulsions. After committing herself to intensive OCD treatment, Kerry has risen to improbable heights. Not only has she learned to live free of OCD, she has written a beautiful memoir about her personal journey, and is leading a website that has reached thousands of people that are continuously learning and benefiting from her experience. Kerry is a testament that if one dedicates themselves to treatment; one can overcome this dreadful disease in an overwhelming fashion. I am immensely proud of her progress along with her commitment to disseminate her knowledge for the benefit of others suffering from OCD.”

As Kerry slowly immersed back into living life again, she noticed the lack of patient-to-patient memoirs on the market demonstrating living a successful life after the worst of OCD. She decided to create the book of hope she wished she had found during her years of suffering. Osborn credits the book to being the friend she never had for other OCD sufferers to feel less alone and see first-hand that with the proper therapy, tools and perseverance, one can absolutely live an abundant life amidst Obsessive-Compulsive Disorder, in a state of ongoing OCD Recovery.

Kerry’s infectious, unapologetic, and refreshing voice doesn’t hold back. In her book, The Obsessive Outsider, she shares her journey, giving sound advice on how to tangibly do something about OCD. Putting the good, bad and the ugly on display for the world, she chooses to be a face for the misunderstood disorder that almost cost her everything. Kerry is devoted to proving that a life in recovery from the worst of OCD is possible, given the right tools and perseverance.

The Obsessive Outsider is now available to be purchased on Amazon in both print Kindle versions internationally, Apple iBooks, Barnes Noble, Nook, Kobo, Kobo Plus, Tolino, Baker Taylor, Scribd, 24 Symbols, OverDrive, Bibliotheca, Hoopla, !ndigo, Angus Robertson. The book is also available via ISBN on IngramSpark for library and bookstore purchases.

ISBN #: 978-0-578-57708-1

I’m trying not to let my OCD control me


I have a vivid memory of lying on the cold tile floor in my dark living room one night when I was 13. I was drowning in my own thoughts. I was alone and afraid. 

There were routines I had to follow every day. I checked my window five times before I went to sleep; I tapped my leg four times before the refrigerator door closed; I couldn’t wear a shirt again if I’d worn it on a bad day.

I knew what I was doing was illogical, but I couldn’t stop. 

I thought I might have had some general anxiety, but little did I know it was so much more than that. I tried therapy in eighth grade because my thoughts became too much for me to handle on my own, but nothing seemed to be working.

My therapist at the time never diagnosed me with anything specific, but I knew what I was feeling wasn’t normal. There’s no way anyone could manage living like this for the rest of their life, I thought. 

I don’t remember the exact age I was when I first read about obsessive-compulsive disorder, but I do remember being shocked at how much I related to the symptoms. 

A lot of people believe OCD is limited to people who are germaphobes or “neat freaks.” But not all people with OCD deal with those specific issues, and not all people who have germophobia or think of themselves as “neat freaks” deal with OCD. 

Because so many people overgeneralize OCD, it was hard for me to identify with the disorder because I thought I had to be extremely organized or afraid of shaking someone’s hand. However, I eventually figured out that OCD was what I was dealing with, as well as general anxiety disorder and depression. 

At 13, that’s a lot to handle. 

I remember thinking, “It’s going to be OK, I won’t have to deal with this forever. When I’m an adult, this will be gone.” 

How wrong I was. 

I spent the next six years completely consumed by my mental disorders. I felt like I was in a prison in my own head and had no control over my own life. A common feeling among those with mental illnesses, I felt like the only person I had to blame was myself.

Fast forward to last year. I was 19 and probably at the lowest point in my life, I felt consumed and paralyzed by my thoughts. 

It felt hopeless — I couldn’t escape from my own head. I would come home after class and just lay in my dark bedroom and sleep. 

It came to a point where I knew my OCD and depression were going to completely take over if I didn’t do something about it. I began searching for a therapist and ended up with the one I have today. I remember my thoughts trying to invalidate me, telling me “you’re not that bad, you don’t have OCD.” The thoughts grew louder and louder until my therapist finally diagnosed me with OCD. 

I felt a blanket of relief fall onto me. I know that may sound strange — that I was happy when I was diagnosed — but the diagnosis meant I was finally validated, and I wasn’t crazy for thinking that I had OCD. 

Things didn’t change overnight. It took a lot of work to get to where I am now. I was prescribed medication and was constantly working in therapy to control my OCD, instead of letting it control me. 

I have good and bad days like anyone else. I know now that this is something I will have to continue battling probably for the rest of my life, and I’ve accepted that. I will battle the intrusive thoughts every day because I deserve to live my life. 

Living with OCD feels like you are stuck in a box and you aren’t allowed to move, otherwise, everything will collapse on top of you. 

What’s so ironic about it is that my OCD would tell me that if I carry out these routines and compulsions, that I will have control over everything in my life, when in reality, I had lost all control and the disorder was controlling me. 

I also know that OCD is a coping skill, and part of its purpose is to help me — but it’s a toxic relationship. 

It’s like the boyfriend who tells you he loves you, but you’ll be nothing without him. Living with that in your head every day and not being able to escape from it can be torturous. 

My toxic OCD boyfriend never left me, and I don’t think he ever will, but I’m much better at shutting the door in his face before I let him inside my house. 

Because of therapy, I have tools in my toolbox that allow me to better manage what I can control in my life. These learned skills allow me to sit with OCD and tell it to leave when it has overstayed its welcome.

Editor’s note: For mental health services on campus, visit For immediate assistance, call 480-921-1006.

Reach the reporter at and follow @itsbrennaaaa on Twitter. 

Like The State Press on Facebook and follow @statepress on Twitter.

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Lili Reinhart defends OCD comment from Tonight Show interview following critcism

18 November 2019, 16:08 | Updated: 18 November 2019, 16:27

By Katie Louise Smith

Lili made a comment about obsessive compulsive disorder while speaking to Jimmy Fallon which caught some backlash from viewers.

Riverdale and Hustlers star Lili Reinhart has always been a vocal public figure when it comes to having honest and candid discussions about body image and mental health.

Last week, it was revealed that Lili had been included on TIME’s 100 Next list, as one of the rising stars shaping their industries and the future. She also recently did a cover interview with Glamour magazine, where she opened up about how depression has affected her life.

READ MORE: Riverdale’s Lili Reinhart admits playing Betty Cooper has “damaged” her natural hair

“I’ve experienced depression and anxiety. Not constantly, but I’m still experiencing it,” she shared. “I have spells of time where I feel completely unmotivated, I don’t want to do anything and I question myself…I find that talking about it and sharing my experience with other people, and reminding myself that I’m not alone has been incredibly therapeutic.”

Discussing all her recent successes, Lili stopped by The Tonight Show with Jimmy Fallon last week (Nov 14) but her comment about OCD appears to have been taken the wrong way and now she’s taken to Twitter to defend what she said.

Lili Reinhart defends her OCD comment on Tonight Show.

Andrew Lipovsky/NBC/NBCU Photo Bank via Getty Images

Speaking about how she managed to pull off her hilarious vomit scenes in Hustlers, Lili explained that the prop department mixed up a concoction of animal crackers and Sprite to act as fake vomit.

“I thought I was gonna have a problem here because I have this really OCD thing with floaters in water and drinks. Like if my drink has a little floater in it, I’m like [heaves],” Lili explained. “So like, having basically a cup full of something that looked like floaters was my worst nightmare but it was fine.”

Following the interview, Lili’s comments were clearly met with some backlash because it prompted her to respond and clarify her comment on Twitter.

“I actually do suffer from OCD, it wasn’t just a little quip I made on a talk show,” she wrote. “I’ve had OCD since I was in elementary school. So, yes. I do have the right to talk about it. Thanks.”

OCD (which stands for Obsessive compulsive disorder) can manifest in individuals in several different ways and can be brought on by a multitude of things. It can be incredibly debilitating for those that have been diagnosed with the condition but it’s also often used as an off-hand comment by people who don’t necessarily have it.

Following Lili’s tweet, fans flocked to the replies to thank her for always speaking so openly about her experiences and mental health issues.

“All the negative comments are childish, when they have absolutely no idea or control over the situation,” one commenter wrote. “So happy you’re openly speaking out about this, because there aren’t many people who do so.”

Another said: “People never take my ocd seriously. That’s because everyone claims to have it.”

Yesterday (Nov 17), Lili also called out a photo editing app “BodyTune” on Instagram for perpetuating unrealistic body image expectations.

Taking to Instagram stories, she wrote, “This is not okay. This is why people develop eating disorders. This is why social media has become hazardous to our health. This is why people have unrealistic expectations of their bodies.”

“Looking skinnier on Instagram is not worth the detrimental psychological effects that these photoshopping apps have given our generation.”

Lili, you’re doing amazing sweetie.

CBT improves long-term outcomes for anxiety-related disorders

Cognitive behavioral therapy may improve outcomes for anxiety-related disorders compared with control conditions up to 1 year after treatment completion, according to results of a systematic review and meta-analysis published in JAMA Psychiatry. Beyond 1 year, effects vary by specific disorder, researchers noted.

“Anxiety-related disorders are characterized by a chronic course, thus sustainable treatment effects are important,” Eva A. M. van Dis, MSc, of the department of clinical psychology at Utrecht University in the Netherlands, and colleagues wrote. “The results of this meta-analysis suggest that, on average, CBT was associated with moderate symptom reductions in anxiety disorders, PTSD and [obsessive-compulsive disorder] until 12 months after treatment completion. After 12 months, these effects were still present for [generalized anxiety disorder], [social anxiety disorder] and PTSD, but not for [panic disorder with or without agoraphobia].”

According to van Dis and colleagues, meta-analytic evidence on long-term outcomes of CBT on anxiety-related disorders is sparse. In the present study, the researchers compared long-term outcomes of CBT with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy and waiting list for OCD, PTSD and anxiety disorders. They analyzed data from 69 randomized clinical trials that included 4,118 outpatients and at least 1-month follow-up effects of CBT compared with control conditions.

They found that among the included trials — most of which were “of low quality” — CBT compared with control conditions was associated with improved outcomes after treatment completion, as well as at 1 to 6 months and 6 to 12 months for the following:

  • generalized anxiety disorder (Hedges g = 0.07-0.4);
  • panic disorder (Hedges g = 0.22-0.35);
  • social anxiety disorder (Hedges g = 0.34-0.6);
  • specific phobia (Hedges g = 0.49-0.72);
  • PTSD (Hedges g = 0.59-0.72); and
  • OCD (Hedges g = 0.7-0.85).

These associations remained significant after 12-months follow-up for generalized anxiety disorder, social anxiety disorder and PTSD, but not for panic disorder. Associations could not be calculated for specific phobia and OCD, according to the researchers. Among six randomized clinical trials, relapse rates after 3 to 12 months were 0% to 14% — predominantly for panic disorder.

“More high-quality randomized clinical trials on long-term treatment effects (preferably beyond 12 months after treatment completion) and relapse are warranted to facilitate more reliable long-term effect size estimations,” the researchers wrote. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.