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INSIGHT BEHAVIORAL HEALTH CENTERS ANNOUNCES NAME CHANGE TO PATHLIGHT MOOD & ANXIETY CENTER, RENEWS COMMITMENT TO PROVIDING EXPERT, SPECIALIZED TREATMENT OF MOOD, ANXIETY AND TRAUMA-RELATED DISORDERS

Denver, Sept. 22, 2020 (GLOBE NEWSWIRE) — Across the United States, communities are experiencing an undeniable need for more comprehensive, specialized mental health services. Americans struggling with mood, anxiety and trauma-related disorders need intensive, personalized treatment to build their resilience and learn practical tools that empower them to thrive long term. To be sure their name better describes the company’s promise to answer that need, Insight Behavioral Health is now Pathlight Mood Anxiety Center. Under the leadership and guidance of nationally recognized experts in behavioral health, Pathlight illuminates each patient’s unique journey to lasting wellness by providing evidenced-based and state-of-the-science treatment; intensive family programs, including support, education and family therapy; and the ability to meet the needs of patients with complex medical and psychiatric conditions.

With treatment center locations in six states across the country and virtual telebehavioral health options for nationwide access, Pathlight offers comprehensive treatment for anxiety disorders such as generalized anxiety disorder and obsessive compulsive disorder; mood disorders such as major depressive disorder; and trauma-related conditions including post-traumatic stress disorder. Pathlight bridges the gap between acute psychiatric treatment and weekly outpatient therapy by offering higher levels of care: Residential, Partial Hospitalization (PHP) and Intensive Outpatient (IOP) treatment. An all too common scenario for patients suffering from mental illness is having an emergency psychiatric event that brings them to the ER, followed by a short stay in an inpatient psychiatric stabilization setting, then being discharged back to outpatient therapy visits only to repeat the cycle again in the future. Pathlight interrupts that cycle of crisis care by providing evidence-based, individualized treatment that supports the patient and their family in building the skills and tools they need to make lasting change for the better.

“At Pathlight, we often work with patients who weren’t able to get the help and support they needed elsewhere,” said Anne Marie O’Melia, MD, MS, FAAP, Chief Medical and Clinical Officer at Pathlight. “We embrace innovative, evidence-based treatment modalities that aim to educate and empower patients as well as their support systems to set them up for lasting recovery. As September is National Suicide Prevention Month, it’s important to spread the message that no one should have to go it alone when it comes to their mental health. Our individualized programs help create the best outcomes when both patients and their closest supporters have tools and strategies for a path forward.”

Insight was founded in Chicago in 2006 by Susan McClanahan, PhD. After partnering with Eating Recovery Center in 2011, it expanded to treat patients in Texas, Colorado, Ohio, Maryland and Washington state. Now as Pathlight, the centers continue to be led by national thought leaders in behavioral health. Under the leadership of Dr. O’Melia, these experts include Charles Brady, PhD, who specializes in the treatment of anxiety disorders and obsessive-compulsive disorder in particular; Ellen Astrachan-Fletcher, PhD, a senior clinician and national thought leader in Radically Open Dialectic Behavior Therapy; and Elizabeth Easton, PsyD, an expert in Emotion-Focused Family Therapy.

Residential care offers 24-hour support seven days a week. The PHP level of care offers comprehensive services eight hours per day during the week and six hours per day on weekends. The IOP level of care includes three hours of programming per day, three to six days a week depending on the patient’s needs. Conveniently, all IOP patients are currently receiving their care virtually due to the pandemic.

“Delivery of therapy, education and skill development is far more efficient in higher levels of care,” said Charles Brady, PhD. “The same behavior change achieved in just eight weeks of intensive, multidisciplinary treatment might take many months or years to deliver across weekly outpatient appointments. Given the mental health challenges facing all of us today – specifically a startling increase in suicide planning, attempts and deaths – families can’t afford to wait and hope for the best.”

A survey conducted by the Centers for Disease Control and Prevention in August found that more than four in 10 Americans are struggling with mental health issues resulting from the COVID-19 pandemic. About a third of respondents said they were experiencing anxiety or depression symptoms, and 11 percent said they had seriously considered suicide in the prior 30 days.

“I have found this program essential to meet the needs of our patients in the community dealing with mental health issues,” said Jacqueline Rhew, LCPC, Co-Founder, Center for Emotional Wellness of the Northwest Suburbs outside of Chicago. “I can say with confidence that Pathlight is a leader in the behavioral health field, not only in our community but nationwide. Our patients who have received treatment in their programs have thrived as a result. They have gained skills to manage their symptoms and return to a healthy level of functioning.”

About Pathlight Mood Anxiety Center 

Pathlight Mood Anxiety Center (Pathlight) is part of a leading national mental health care system dedicated to the treatment of primary mood, anxiety and trauma-related disorders. Pathlight specializes in treatment for mood and anxiety disorders such as generalized anxiety disorder, obsessive compulsive disorder, panic disorder, depression and mania, trauma-related disorders including post-traumatic stress disorder, as well as co-occurring substance use disorder. Pathlight provides evidence-based, innovative treatment programs tailored to patients of all ages, gender expressions and ethnicities. Working with patients and their families, Pathlight’s multi-disciplinary treatment programs are designed to help illuminate their unique paths forward and provide a foundation for resilience and long-lasting mental wellness. Pathlight offers Residential, Partial Hospitalization (PHP) and Intensive Outpatient (IOP) levels of care in centers across the country as well as Virtual PHP and IOP (video) telebehavioral health services. For more information, please visit pathlightbh.com

 

Meg Mulcahy
Pathlight Mood  Anxiety Center
3037318913
megan.mulcahy@ERCPathlight.com

OCD: Dealing with compulsions during the coronavirus pandemic

About one in 50 people suffer from obsessive-compulsive disorder, or OCD, repeatedly washing their hands or worrying that they’ve touched something or someone they shouldn’t have. It’s behavior that may be exacerbated by the coronavirus pandemic. Now, clinical trials are looking at new treatments and therapies to bring these deep-seated compulsions under control.

Obsessively checking things, hoarding items, extreme fear of germs … symptoms of OCD. OCD sufferers want to stop, but find it difficult, if not impossible to do so.

“For many folks, that level of distress is so intense that it motivates them to engage in these onerous behaviors, whether it be more ritualistic or avoidance to prevent that feared outcome from taking place. The problem with any sort of ritual, is that it’s temporary. It just doesn’t tend to stick for a while,” explained Eric Storch, PhD of the Baylor College of Medicine

OCD therapies currently under study or clinical trials include deep brain stimulation to implant electrodes, anti-depressants known as serotonin reuptake inhibitors, and glutamate in the brain, which is a neurotransmitter that sends signals to other cells.

“The best treatment for anxiety disorders are therapies like cognitive behavioral therapy or desensitization therapy,” added psychiatrist Harry A. Croft, MD.

And, although COVID-19 has impacted some individuals with OCD, mental health experts say it’s useful for others to understand what it’s like to live under that cloak of anxiety … not just during a pandemic, but all of the time.

The Centers for Disease Control has recommended that healthcare providers continue to serve patients with OCD during the pandemic by implementing telehealth appointments and services where possible. More COVID-19 resources are available on the website for the International OCD foundation here.

How to determine if you have OCD: symptoms, risk factors, and a quiz – Insider

  • You may have OCD if you have symptoms like intense, repetitive obsessions that compel you to act irrationally. 
  • Some of the risk factors for OCD include having another mental health condition, a family history of OCD, and trauma or stressful life events.
  • You can treat OCD with therapy and medication.
  • This article was medically reviewed by Mayra Mendez, Ph.D., LMFT, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California.
  • Visit Insider’s Health Reference library for more advice.

Obsessive-Compulsive Disorder (OCD) is a mental health disorder that affects about two to three million adults in the US. It can range from moderate to debilitating, and it has the potential to seriously affect the quality of one’s life. 

“Full-blown OCD is characterized by causing significant distress, is time-consuming and interferes significantly with one’s life — family, social, work, health, or recreational activities,” says Lawrence Needleman, PhD, a psychologist in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center.

If you’re wondering if you are exhibiting signs of OCD, here are the common symptoms and how to go about getting a diagnosis.

Symptoms of OCD

The main symptoms of OCD are having intense, repetitive obsessions that compel you to act irrationally. According to the National Institute of Mental Health, many people with OCD spend over an hour every day thinking about their obsessions and carrying out compulsions. 

Additionally, people with OCD don’t usually find their compulsions enjoyable. Rather, it provides temporary relief from the anxiety that comes with their obsessions. 

There are many different expressions of OCD symptoms and traits. Some themes include:

Contamination and cleaning

People with this type of OCD are very fearful of getting sick or contaminated with germs. They might also be afraid of infecting others around them. Oftentimes, these people are compelled to excessively wash their hands and avoid others for fear of contracting infection.

Forbidden thoughts

 There are several different “forbidden” thought obsessions including perverse sexual thoughts, violent thoughts, or religious thoughts. People with these types of obsessions try very hard to suppress these thoughts, even to the point of avoiding people or places that they fear may trigger these thoughts. . 

Symmetry

Some people have an obsession with making sure things are perfectly symmetric. They may spend a lot of time counting objects or arranging and rearranging things until they are “perfect” in their eyes.

Harm-focused

 Those with harm-focused OCD have intrusive thoughts about harming themselves or others, and they deeply fear that they will lose control and act on the thoughts. They will likely avoid scenarios where they could potentially hurt themselves or others.

Hoarding

Hoarders feel strong emotional attachments to inanimate objects and have trouble throwing out possessions, even junk mail and old containers. They may fear that throwing the items out could result in something bad happening, so they hold onto seemingly worthless possessions. 

Checking

Some people with OCD may feel the need to check something over and over again. Door checking is a common example here. “When ‘OCD checkers’ lock a door, they can see the key turn, hear it lock, and see the deadbolt but not trust their senses or their memory. Because they don’t trust their senses, they tend to re-check according to rules, such as, check it 7 times, saying to themselves ‘It’s locked,’ and then if it feels right, you can stop checking,” says Needleman.

How is OCD diagnosed?

OCD is typically diagnosed by a mental health professional like a psychologist or psychiatrist based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

A clinician will likely ask you a series of questions that will compare your symptoms to symptoms of other similar disorders.  For example, some OCD symptoms — like paranoia and panic — may manifest similarly to symptoms of other anxiety disorders, depression, or schizophrenia. So, it’s important that you receive the correct diagnosis for the proper treatment.

A doctor will also look at how OCD-like behaviors disrupt your life. For example, someone may have an obsessive fear of germs that may cause them to clean everything in sight, so much so that they may clean  until they bleed. It’s these extreme, dramatic disruptions or, even, injuries that make the difference between a “neat freak” and someone with clinical OCD. 

Here is a quiz, based on the Yale-Brown Obsessive Scale to see if you have behaviors consistent with OCD, although only a doctor can give you a diagnosis:

 

Editor’s note: The results of this quiz should not be read as a diagnosis. To truly diagnose OCD, a clinician must also determine whether your symptoms are the result of another mental or physical condition

Risk Factors for OCD

Though it’s possible to develop OCD without any of the following risk factors, there are certain traits that may increase the chance that you have the condition. These risk factors are:

  • Family history of OCD: If your parents or other family members have OCD, you are at higher risk to develop OCD yourself. 
  • Trauma or stressful life events: OCD may be more likely to develop if you have been through trauma that raises overall stress levels and triggers intrusive thoughts. 
  • Age: OCD is most likely to show up in someone between ages eight through twelve or late teen years/early adulthood. However, the condition is diagnosable any time from preschool to adulthood.  

Treatment of OCD

Treatment for OCD is typically twofold, including both medication and therapy. Specifically, a type of therapy called Exposure and Response Prevention (ERP), has been shown to be effective.

How Exposure and Response Prevention therapy helps OCD

During ERP, people are confronted with their OCD triggers, but instead of alleviating the trigger with their usual compulsive behavior, they learn to overcome the trigger through other means.

One example Needleman gives is a scenario where somebody is afraid that if they don’t check their stove, the house will burn down. In their ERP therapy, they will practice leaving the house without checking the stove, doing this on different days and with different variations. Eventually, with practice, they learn that the risk is low and that the house will not burn down even if they don’t do their stove-checking rituals.

“ERP sounds simpler than it is because people with OCD often engage in a large number of subtle external and internal compulsions and avoidances that interfere with changing their beliefs that need to be detected and blocked,” says Needleman. 

OCD medications

Medications are often used in combination with therapy. Meds can take the edge off the anxiety somebody with OCD may feel, making it easier for someone to face their triggers during ERP therapy. 

Medication-wise, the first line of treatment for OCD is a drug class called selective serotonin uptake inhibitors (SSRIs), says Needleman. Commonly prescribed SSRIs for OCD are:

  • Zoloft: For ages 6 and up
  • Prozac: For ages 7 and up
  • Luvox: For ages 8 and up
  • Paxil: For adults only 

Additionally, Needleman says that an atypical antipsychotic medication can be added to be taken with the SSRIs if the  SSRI alone isn’t fully effective. 

If patients do not respond to SSRI antidepressants, another option is Anafranil, which is a tricyclic antidepressant (TCA). This is a different class of antidepressants that works by a different mechanism than SSRIs. TCAs are typically only prescribed for OCD after SSRIs have proven not to work for the patient. 

The Bottom Line

OCD is a mental health disorder that can be debilitating and disrupt quality of life. But with treatment, it can be managed. 

If you believe you may have OCD, make an appointment with a mental health professional so you can get a diagnosis and get on track to feeling better.  

Related articles from Health Reference:

How to determine if you have OCD: symptoms, risk factors, and a quiz

Justin Pumfrey/Getty ImagesSome people with OCD have an obsession with cleanliness.

  • You may have OCD if you have symptoms like intense, repetitive obsessions that compel you to act irrationally.
  • Some of the risk factors for OCD include having another mental health condition, a family history of OCD, and trauma or stressful life events.
  • You can treat OCD with therapy and medication.
  • This article was medically reviewed by Mayra Mendez, Ph.D., LMFT, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Centre in Santa Monica, California.
  • Visit Insider’s Health Reference library for more advice.

Obsessive-Compulsive Disorder (OCD) is a mental health disorder that affects about two to three million adults in the US. It can range from moderate to debilitating, and it has the potential to seriously affect the quality of one’s life.

“Full-blown OCD is characterised by causing significant distress, is time-consuming and interferes significantly with one’s life — family, social, work, health, or recreational activities,” says Lawrence Needleman, PhD, a psychologist in the Department of Psychiatry and Behavioural Health at The Ohio State University Wexner Medical Centre.

If you’re wondering if you are exhibiting signs of OCD, here are the common symptoms and how to go about getting a diagnosis.

Symptoms of OCD

The main symptoms of OCD are having intense, repetitive obsessions that compel you to act irrationally. According to the National Institute of Mental Health, many people with OCD spend over an hour every day thinking about their obsessions and carrying out compulsions.

Additionally, people with OCD don’t usually find their compulsions enjoyable. Rather, it provides temporary relief from the anxiety that comes with their obsessions.

There are many different expressions of OCD symptoms and traits. Some themes include:

Contamination and cleaning

People with this type of OCD are very fearful of getting sick or contaminated with germs. They might also be afraid of infecting others around them. Oftentimes, these people are compelled to excessively wash their hands and avoid others for fear of contracting infection.

Forbidden thoughts

There are several different “forbidden” thought obsessions including perverse sexual thoughts, violent thoughts, or religious thoughts. People with these types of obsessions try very hard to suppress these thoughts, even to the point of avoiding people or places that they fear may trigger these thoughts. .

Symmetry

Some people have an obsession with making sure things are perfectly symmetric. They may spend a lot of time counting objects or arranging and rearranging things until they are “perfect” in their eyes.

Harm-focused

Those with harm-focused OCD have intrusive thoughts about harming themselves or others, and they deeply fear that they will lose control and act on the thoughts. They will likely avoid scenarios where they could potentially hurt themselves or others.

Hoarding

Hoarders feel strong emotional attachments to inanimate objects and have trouble throwing out possessions, even junk mail and old containers. They may fear that throwing the items out could result in something bad happening, so they hold onto seemingly worthless possessions.

Checking

Some people with OCD may feel the need to check something over and over again. Door checking is a common example here. “When ‘OCD checkers’ lock a door, they can see the key turn, hear it lock, and see the deadbolt but not trust their senses or their memory. Because they don’t trust their senses, they tend to re-check according to rules, such as, check it 7 times, saying to themselves ‘It’s locked,’ and then if it feels right, you can stop checking,” says Needleman.

How is OCD diagnosed?

OCD is typically diagnosed by a mental health professional like a psychologist or psychiatrist based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A clinician will likely ask you a series of questions that will compare your symptoms to symptoms of other similar disorders. For example, some OCD symptoms — like paranoia and panic — may manifest similarly to symptoms of other anxiety disorders, depression, or schizophrenia. So, it’s important that you receive the correct diagnosis for the proper treatment.

A doctor will also look at how OCD-like behaviours disrupt your life. For example, someone may have an obsessive fear of germs that may cause them to clean everything in sight, so much so that they may clean until they bleed. It’s these extreme, dramatic disruptions or, even, injuries that make the difference between a “neat freak” and someone with clinical OCD.

Here is a quiz, based on the Yale-Brown Obsessive Scale to see if you have behaviours consistent with OCD, although only a doctor can give you a diagnosis:

Editor’s note: The results of this quiz should not be read as a diagnosis. To truly diagnose OCD, a clinician must also determine whether your symptoms are the result of another mental or physical condition

Risk Factors for OCD

Though it’s possible to develop OCD without any of the following risk factors, there are certain traits that may increase the chance that you have the condition. These risk factors are:

  • Family history of OCD: If your parents or other family members have OCD, you are at higher risk to develop OCD yourself.
  • Trauma or stressful life events: OCD may be more likely to develop if you have been through trauma that raises overall stress levels and triggers intrusive thoughts.
  • Age: OCD is most likely to show up in someone between ages eight through twelve or late teen years/early adulthood. However, the condition is diagnosable any time from preschool to adulthood.

Treatment of OCD

Treatment for OCD is typically twofold, including both medication and therapy. Specifically, a type of therapy called Exposure and Response Prevention (ERP), has been shown to be effective.

How Exposure and Response Prevention therapy helps OCD

During ERP, people are confronted with their OCD triggers, but instead of alleviating the trigger with their usual compulsive behaviour, they learn to overcome the trigger through other means.

One example Needleman gives is a scenario where somebody is afraid that if they don’t check their stove, the house will burn down. In their ERP therapy, they will practice leaving the house without checking the stove, doing this on different days and with different variations. Eventually, with practice, they learn that the risk is low and that the house will not burn down even if they don’t do their stove-checking rituals.

“ERP sounds simpler than it is because people with OCD often engage in a large number of subtle external and internal compulsions and avoidances that interfere with changing their beliefs that need to be detected and blocked,” says Needleman.

OCD medications

Medications are often used in combination with therapy. Meds can take the edge off the anxiety somebody with OCD may feel, making it easier for someone to face their triggers during ERP therapy.

Medication-wise, the first line of treatment for OCD is a drug class called selective serotonin uptake inhibitors (SSRIs), says Needleman. Commonly prescribed SSRIs for OCD are:

  • Zoloft: For ages 6 and up
  • Prozac: For ages 7 and up
  • Luvox: For ages 8 and up
  • Paxil: For adults only

Additionally, Needleman says that an atypical antipsychotic medication can be added to be taken with the SSRIs if the SSRI alone isn’t fully effective.

If patients do not respond to SSRI antidepressants, another option is Anafranil, which is a tricyclic antidepressant (TCA). This is a different class of antidepressants that works by a different mechanism than SSRIs. TCAs are typically only prescribed for OCD after SSRIs have proven not to work for the patient.

The Bottom Line

OCD is a mental health disorder that can be debilitating and disrupt quality of life. But with treatment, it can be managed.

If you believe you may have OCD, make an appointment with a mental health professional so you can get a diagnosis and get on track to feeling better.

Related articles from Health Reference:

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My OCD Makes Me Anxious About Being Dirty. Here’s How I Have Sex

Quinn: Yeah, things got really heavy for a few months. We’d have to work really hard for just, like, the basics. If we were kissing or caressing and I touched the outside of her underwear, she’d be like, “Go wash your hands.” Or she’d say, “OK, just don’t touch my hair now,” because she didn’t want to wash her hair again. If I did accidentally touch her hair, there’d be this huge sigh, and the mood would be dead. I got so worried about touching her in the wrong place or, if we were taking off our clothes, about if I folded our underwear the right way and put them in the right place. If we ended up fighting about where I put our clothes, I wouldn’t be able to get it up anymore. Sometimes, she’d feel let down. There were 100 little paper cuts to our intimacy.

How to tell the difference between anxiety and OCD

From Red Online

There’s more and more information out there about mental health conditions, but until you receive an official diagnosis, it can all feel quite confusing. With mental health conditions widely reported to have increased during lockdown – to the extent that a recent survey revealed 80% of British people feel working from home has had a negative impact on their mental health – it’s important to know exactly what you’re dealing with, and see your doctor if you need support.

Seeing an expert is all the more imperative because some conditions – like obsessive compulsive disorder (OCD) and generalised anxiety , disorder (GAD) – can feel similar in some ways, and might be mistaken for one another.

OCD is perhaps most known for causing physical compulsions. But sufferers of the mental disorder can also experience intrusive thoughts, which can be hard to banish. Similarly, when anxiety takes an intense hold, it’s tricky to rid the thoughts from your mind. That’s where the overlap can come, causing a misunderstanding about what’s really going on.

If you suspect you have either generalised anxiety disorder or OCD, but you’re not sure which, there are some key differences you need to know about. So we asked Fionuala Bonnar RMN, CPN, BSci, director at Mental Health First Aid England, to explain them. Read her answers and advice below.

What is anxiety?

Anxiety itself is a normal response designed to keep us safe by alerting us to possible dangerous situations and motivates us to solve everyday problems. When we feel anxious, we might notice physical responses (rapid heartbeat, sweating, dry mouth, aches and pains), psychological responses (disturbed sleep, mind racing or going blank, poor memory) and behavioural ones too (avoidance of situations or places, or behaviours such as going back to check you have locked the car/door etc).

“Everyone experiences anxiety at some time. Occasionally feeling anxious, particularly about events or situations that are challenging or threatening, is normal and very common,” says Fionuala. “However, if your feelings of anxiety regularly cause significant distress or they start to impact on your ability to carry out normal activities like meeting friends and family or working, it may be a sign of an anxiety disorder.”

“There are several different types of anxiety disorders, of which generalised anxiety disorder (GAD) and OCD are two. Some others are panic disorder, PTSD, and some phobias,” Fionuala advises. There you have it: generalised anxiety disorder and OCD are two different types of anxiety disorder, so it’s no wonder they can feel similar.

Photo credit: Ana DavilaPhoto credit: Ana Davila

What is OCD?

OCD is characterised by the presence of either obsessions or compulsions, but commonly both. These obsessional (or intrusive) thoughts and compulsive behaviours accompany the feelings of anxiety.

“Obsessional thoughts are recurrent thoughts, impulses or images that the person cannot dispel. These thoughts are unwanted and cause marked anxiety in the person,” explains Fionuala. “Compulsive behaviours are repetitive behaviours or mental activity. For instance, a common popular concern for those with OCD includes chronic hand-washing. Some people may feel they must wash their hands a certain number of times in order to prevent something from happening. Mental activity can include counting, silently or repeating certain words or phrases internally.”

A person with OCD feels driven to behave in this way in order to reduce anxiety about obsessional thoughts.

Although globally OCD is considered a form of anxiety disorder, the USA is no longer classifying OCD as an anxiety disorder. It now has its own category, called ‘obsessive-compulsive and related disorders’.

What’s the difference between generalised anxiety disorder and OCD?

One key difference lies in the worries themselves. “Those experiencing anxiety without the symptoms of OCD usually worry about things which are strongly based in real-life concerns,” says Fionuala. “While the worries may be extreme, the topics a person with generalised anxiety festers over, are appropriate. These topics concern issues such as: health, personal relationships, finances, and work.”

Those with OCD, however, find their compulsions start as a way of trying to reduce anxiety caused by their obsessive thoughts, but their behaviour is either excessive or not actually connected to the initial thought. “Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it ‘just in case’. Unlike people with OCD, people with anxious thoughts do not typically engage in ritualistic behaviour to deal with their fears,” Fionuala explains.

Photo credit: Rochelle Brock / Refinery29 for Getty Images - Getty ImagesPhoto credit: Rochelle Brock / Refinery29 for Getty Images - Getty Images

What symptoms overlap between the both generalised anxiety disorder and OCD?

Anxiety itself overlaps, being experienced in both conditions. But the difference, Fionuala says, is that “in OCD it is a contributor to the condition, and in generalised anxiety disorder, it is the impact.”

“In most cases, individuals with OCD feel driven to engage in compulsive behaviour and would rather not have to do time consuming and torturous acts. This compulsive behaviour is done with the intention of trying to escape or reduce anxiety or the presence of obsessions.” For this reason, asking a person with OCD to stop can be unhelpful.

Subscribe to Red now to get the magazine delivered to your door. Red’s latest issue is out now and available for purchase online and via Readly or Apple News+.

Like this article? Sign up to our newsletter to get more articles like this delivered straight to your inbox.

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OCD and anxiety: How to tell them apart

There’s more and more information out there about mental health conditions, but until you receive an official diagnosis, it can all feel quite confusing. With mental health conditions widely reported to have increased during lockdown – to the extent that a recent survey revealed 80% of British people feel working from home has had a negative impact on their mental health – it’s important to know exactly what you’re dealing with, and see your doctor if you need support.

Seeing an expert is all the more imperative because some conditions – like obsessive compulsive disorder (OCD) and generalised anxiety , disorder (GAD) – can feel similar in some ways, and might be mistaken for one another.

OCD is perhaps most known for causing physical compulsions. But sufferers of the mental disorder can also experience intrusive thoughts, which can be hard to banish. Similarly, when anxiety takes an intense hold, it’s tricky to rid the thoughts from your mind. That’s where the overlap can come, causing a misunderstanding about what’s really going on.

If you suspect you have either generalised anxiety disorder or OCD, but you’re not sure which, there are some key differences you need to know about. So we asked Fionuala Bonnar RMN, CPN, BSci, director at Mental Health First Aid England, to explain them. Read her answers and advice below.

What is anxiety?

Anxiety itself is a normal response designed to keep us safe by alerting us to possible dangerous situations and motivates us to solve everyday problems. When we feel anxious, we might notice physical responses (rapid heartbeat, sweating, dry mouth, aches and pains), psychological responses (disturbed sleep, mind racing or going blank, poor memory) and behavioural ones too (avoidance of situations or places, or behaviours such as going back to check you have locked the car/door etc).

“Everyone experiences anxiety at some time. Occasionally feeling anxious, particularly about events or situations that are challenging or threatening, is normal and very common,” says Fionuala. “However, if your feelings of anxiety regularly cause significant distress or they start to impact on your ability to carry out normal activities like meeting friends and family or working, it may be a sign of an anxiety disorder.”

“There are several different types of anxiety disorders, of which generalised anxiety disorder (GAD) and OCD are two. Some others are panic disorder, PTSD, and some phobias,” Fionuala advises. There you have it: generalised anxiety disorder and OCD are two different types of anxiety disorder, so it’s no wonder they can feel similar.

ocd coronavirus

What is OCD?

OCD is characterised by the presence of either obsessions or compulsions, but commonly both. These obsessional (or intrusive) thoughts and compulsive behaviours accompany the feelings of anxiety.

“Obsessional thoughts are recurrent thoughts, impulses or images that the person cannot dispel. These thoughts are unwanted and cause marked anxiety in the person,” explains Fionuala. “Compulsive behaviours are repetitive behaviours or mental activity. For instance, a common popular concern for those with OCD includes chronic hand-washing. Some people may feel they must wash their hands a certain number of times in order to prevent something from happening. Mental activity can include counting, silently or repeating certain words or phrases internally.”

A person with OCD feels driven to behave in this way in order to reduce anxiety about obsessional thoughts.

Although globally OCD is considered a form of anxiety disorder, the USA is no longer classifying OCD as an anxiety disorder. It now has its own category, called ‘obsessive-compulsive and related disorders’.

What’s the difference between generalised anxiety disorder and OCD?

One key difference lies in the worries themselves. “Those experiencing anxiety without the symptoms of OCD usually worry about things which are strongly based in real-life concerns,” says Fionuala. “While the worries may be extreme, the topics a person with generalised anxiety festers over, are appropriate. These topics concern issues such as: health, personal relationships, finances, and work.”

Those with OCD, however, find their compulsions start as a way of trying to reduce anxiety caused by their obsessive thoughts, but their behaviour is either excessive or not actually connected to the initial thought. “Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it ‘just in case’. Unlike people with OCD, people with anxious thoughts do not typically engage in ritualistic behaviour to deal with their fears,” Fionuala explains.

the back of a woman's head as she looks to the side

What symptoms overlap between the both generalised anxiety disorder and OCD?

Anxiety itself overlaps, being experienced in both conditions. But the difference, Fionuala says, is that “in OCD it is a contributor to the condition, and in generalised anxiety disorder, it is the impact.”

“In most cases, individuals with OCD feel driven to engage in compulsive behaviour and would rather not have to do time consuming and torturous acts. This compulsive behaviour is done with the intention of trying to escape or reduce anxiety or the presence of obsessions.” For this reason, asking a person with OCD to stop can be unhelpful.

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Symptoms and causes of anxiety and its diagnosis and management

All nurses will meet people who experience anxiety, and an awareness of the underlying causes, simple interventions and when to refer to specialist services can help patients to manage their symptoms. This article comes with a self-assessment enabling you to test your knowledge after reading it

Abstract

Of all psychiatric illnesses, anxiety disorders are the most prevalent and generalised anxiety disorder is the most common of all the anxiety disorders. Causes of anxiety can include stress and trauma, environmental factors and genetics. Symptoms of anxiety are both psychological and physical in their presentation, and can cause affected individuals and their families or carers significant distress. Treatment can include self-help, lifestyle adjustments, pharmacological therapy and psychological approaches. Nurses across all fields of practice work with patients who experience anxiety; an awareness of simple interventions and psychoeducation can help these patients.

Citation: Milne R, Munro M (2020) Symptoms and causes of anxiety, and its diagnosis and management. Nursing Times [online]; 116: 10, 18-22.

Authors: Rosa Milne is community mental health nurse, Royal Cornhill Hospital Aberdeen; Mary Munro is lecturer, mental health nursing, Robert Gordon University Aberdeen, and community mental health nurse (substance misuse), Royal Cornhill Hospital Aberdeen.

Introduction

Anxiety is one of the most common mental health conditions in the UK and is estimated to affect 8.2 million people at any one time (Fineberg et al, 2013). Anxiety disorders are associated with a substantial degree of impairment to an individual’s mental and physical health, high use of healthcare services and, due to their effect on work attendance rates, significant economic burden for wider society  (Fineberg et al, 2013).

Anxiety can occur when we are worried, uneasy or fearful about events that are about to happen or may happen in the future (Mind, 2017). Although anxiety about perceived threats is a natural human response that most people experience, if such thoughts start to have a negative impact on an individual’s daily life, they may be a sign of an anxiety disorder.

Anxiety disorders can affect a person’s quality of life significantly and are associated with:

  • Impaired social and occupational functioning;
  • Comorbidity with other disorders;
  • An increased risk of suicide (Hoge et al, 2012).

Types of anxiety

There is a number of different anxiety disorders, but they can be difficult to diagnose and, in some cases, difficult to distinguish from other mental health conditions, including depression (Baxter et al, 2014). Some of the most common disorders are outlined in Table 1.

The most common disorder to present in primary care is generalised anxiety disorder (GAD) (Alladin, 2015); this is characterised by chronic anxiety, worry and tension experienced without a direct environmental stimulus, such as an experience that induces fear (Rhoads and Murphy, 2015). GAD can carry with it a significant degree of comorbidity and impairment to daily functioning, and patients may experience distress and disability (Crask and Stein, 2016). Furthermore, the course of GAD can be complicated, often featuring highs and lows and without full remission from all symptoms (Zimmerman et al, 2012). This article discusses anxiety and, specifically, GAD.

Epidemiology

Up to a third of the population is affected by an anxiety disorder during their lifetime (Bandelow and Michaelis, 2015). Symptoms tend to emerge in childhood, adolescence or early adulthood (median age for onset is 11 years) but their occurrence peaks in midlife (Bandelow and Michaelis, 2015). While anxiety disorders are common across all population groups, they are twice as common in women as in men (Remes et al, 2016). Reasons for this have been attributed to women being exposed to more stressful and traumatic life experiences (Maeng and Milad, 2015) such as pregnancy (Remes et al, 2016), and higher rates than men of domestic and sexual abuse (Walby and Towers, 2017).

Causes

Although early exposure to stress and the experience of trauma are important risk factors for anxiety disorders, evidence also highlights biological causes, such as issues with the regulation of neurotransmitters and heritable genetic causes (Smoller, 2016). The ability to relate to a person who experiences anxiety is an important part of a therapeutic relationship and, as such, it is crucial to acknowledge that anxiety is not ‘just’ a mental state but also has physiological causes and responses, which can be frightening.

A recent review identified that there is a genetic heritability of around 30% for GAD and that the same predisposing genes are present across sexes (Gottschalk and Domschke, 2017). Pro-inflammatory markers have also been shown to directly modulate affective behaviour and heightened concentrations of inflammatory signals have been described in GAD, post-traumatic stress disorder (PTSD), panic disorder and phobias (Michopoulos et al, 2017).

Stress – and particularly continued exposure to stress – has been linked to anxiety, as well as having a negative impact on the body’s immune, cardiovascular, neuroendocrine and central nervous systems (Khan and Khan, 2017). Occupational stress – associated with insecurity or stress related to required tasks or workload – has been identified as a leading cause of anxiety among working populations and, as well as causing distress for the individuals affected, has a negative effect on productivity  (Fan et al, 2015).

Physical health problems can also cause or perpetuate anxiety disorders. In patients with a malignant disease, for example, a response of anxiety is understandable; however, in some patients, anxiety may increase to a level that is disproportionately high and that, if it does not improve, can lead to functional impairments (Eisner et al, 2010).

Anxiety disorders that are comorbid with a physical illness can lead to a higher symptom burden and poorer health outcomes, so the detection and testing for pathological anxiety (anxiety that interferes with the person’s functioning) in medical settings is essential to meet patients’ holistic needs (Eisner et al, 2010). Anxiety has also been shown to triple the risk of people with prediabetes developing type 2 diabetes, after taking account of sociodemographic, metabolic risk factors and lifestyle choices (Jiang et al, 2020).

Nurses in all fields should be aware of the signs and symptoms of anxiety, and work with the patient to identify appropriate interventions to ease distress.

Signs and symptoms

It is suggested that the symptoms associated with anxiety disorders can be just as disabling as schizophrenia, depression and bipolar disorder (Bystritsky et al, 2013). The Global Burden of Disease Collaborative Network lists anxiety disorders as the ninth-leading health issue contributing to years lived with disability.

The World Health Organization’s International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) states that GAD is typified by fears based on dangers – such as a loved one being in an accident – the likelihood of which is exaggerated and the effects of which are viewed as devastating or catastrophic (WHO, 2019). Worries such as these can swiftly spread to different areas of patients’ everyday lives, including health, familial relationships, employment and/or their socioeconomic situation. Common symptom of GAD are listed in Box 1.

Diagnosing anxiety

Before a diagnosis of anxiety can be made, a physical examination should take place to rule out any physical conditions that may be causing symptoms, including overactive thyroid gland (hyperthyroidism) and anaemia (iron or vitamin B12 deficiency). Physical observations, such as vital signs, should also be completed. When an assessment of anxiety disorder is conducted, the practitioner must try to understand:

  • The nature and severity of the presenting problem;
  • Any functional impairment (National Institute for Health and Care Excellence, 2011a).

Furthermore, it is important that a full holistic assessment takes place to identify the development, course and severity of the disorder, including discussing social, financial, environmental, emotional and physical effects on the person’s life. Box 2 lists some questions health professionals may ask an individual to determine the severity of their anxiety.

There are two main classification systems used in mental health settings to inform the diagnosis of anxiety:

  • ICD-10;
  • Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatric Association in 2013.

These manuals describe anxiety as varying in degrees of severity by the number of symptoms, along with their duration and frequency. For a diagnosis of anxiety, there is no set number of symptoms that individuals must present with; instead, diagnosis should focus on their frequency, intensity and how thoughts interfere with the individual’s day-to-day life.

In general and primary care settings, the GAD two-item questionnaire (GAD-2, shown in Fig 1) is often used to determine anxiety symptoms and their severity. There is reasonable evidence that this scale can be used as a case identification tool (NICE, 2011b).

Treatments

Anxiety disorders can affect individuals at different points across their lifespan and can last from a short period of weeks to several months or years. Treatment decisions are based on how significantly the anxiety is affecting an individual’s ability to function in daily life; it may take a process of trial and error to discover which treatments will work best for the specific person involved.

Treatments and support vary from person to person but, generally, fall into two categories:

  • Psychological;
  • Pharmacological.

These approaches can be used singly or in combination. Most people experiencing symptoms of anxiety are offered the least-invasive interventions (self-help) in the first instance; however, depending on the severity of their symptoms, they may require one-to-one therapy and/or pharmacological management.

Stepped-care approach

A stepped-care approach is used to organise the provision of services and help people with common mental health disorders, including those with an anxiety disorder. Table 2 outlines the recommended stepped-care approach and interventions for specific anxiety disorders.

Self-help and psychological treatments

In general, if an individual has been diagnosed with GAD, self-help psychological treatments are prescribed before medication (NICE, 2017). This may involve working through a cognitive behavioural therapy (CBT) workbook, computer course or making use of cost-free mobile applications such as Catch-it, SAM (Self-help for Anxiety Management) or, for younger people specifically, Mindshift.

The use of certain mental health apps has proved to be effective at improving symptoms of depression and anxiety (Kwansy et al, 2019). These apps can be used by individuals in their own time, and alongside psychological therapies, to help them identify triggers and develop ways of overcoming those situations that may cause anxiety.

Cognitive behavioural therapy

One of the most effective treatments for anxiety is CBT, which:

  • Helps an individual to question negative or anxious thoughts;
  • Usually involves meeting with a specially trained and accredited therapist for one-hour sessions over a period of time – usually 12-15 sessions for adults (NICE, 2017).

Studies of different treatments for GAD have found that the benefits of CBT may last longer than those of medication; however, there is no single treatment that works for everyone and some patients may benefit from prescribed medication alongside a psychological intervention (Bandelow et al, 2017).

Graded exposure therapy

Graded exposure therapy – which is used to treat any anxiety disorder in which avoidance of a feared stimulant is present – aims to reduce an individual’s fearful reaction to the stimulus (Ponniah et al, 2013). Most exposure therapists use a graded approach in which mildly feared stimuli are targeted first, followed by those that are more strongly feared. Exposure therapy has been found to increase cognitive outcomes for some people who experience anxiety disorders, such as obsessive compulsive disorder (OCD), GAD and PTSD (McGuire et al, 2014). This highlights the need to work collaboratively with the patient, as everybody’s experience of anxiety and response to treatment will be different.

Other forms of support

Other forms of support for people experiencing anxiety are often available in local communities and the third sector. Peer-support groups, social groups, exercise and changes to diet all have a positive impact on symptoms (Curtis et al, 2009). Furthermore, forming an effective therapeutic relationship with supporting health professionals has been shown to improve clinical outcomes in patients with anxiety (Bandelow et al, 2017).

Lifestyle changes

It has been suggested that people experiencing anxiety should:

The nurse’s role includes providing advice on health promotion such as healthy eating, good sleep hygiene, relaxation, and incorporating exercise and movement into daily life – all of which can benefit patients who are experiencing symptoms of anxiety.

Pharmacological treatments

Generally, practitioners following NICE’s (2011b) stepped-care approach will advise individuals to try self-help or a psychological treatment before prescribing medication for them. When an individual is prescribed medication for symptoms of anxiety, medications that will treat the physical, as well as psychological, symptoms of anxiety should be taken into account; for example, it is relatively common for beta-blockers to be prescribed for physical symptoms such as a racing heart. Before prescribing a pharmacological treatment, health professionals should discuss with patients:

  • The different types of medication;
  • Length of treatment;
  • Any side-effects or possible interactions with other medication.

Selective serotonin reuptake inhibitors are commonly prescribed to treat GAD; these work by increasing the level of serotonin in the brain. Benzodiazepines, which have a sedative effect, may sometimes be used as a short-term treatment during a particularly severe period of anxiety (NICE, 2011a). Several herbal remedies are often suggested for treating social anxiety, such as St John’s Wort, but studies have found efficacy to be mixed and more research is needed to fully understand the risks and benefits (Kobak et al, 2005).

Some people may not want to use medication for anxiety and, where appropriate, this choice should be respected and alternative coping strategies offered.

Conclusion

It is essential that nurses working in both primary and secondary care, regardless of their specialism, have a good knowledge and understanding of anxiety, its possible causes, signs and symptoms, treatments and support. A better understanding of the needs and experiences of those with anxiety will facilitate a person-centred approach and providing meaningful recovery-focused care. Box 3 provides a list of helpful, psychoeducation and relaxation resources, which are free of charge and can be used with patients who are experiencing symptoms of anxiety.

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Wrong to say Sushant was treated for depression going by medicines: Doctors

By Anand Singh and Quaid Najmi

Mumbai/New Delhi, Sep 7 (IANS): Bollywood actor Sushant Singh Rajput had been taking medicines for panic disorder and seizures since October 2019, though several senior doctors maintain that it will be “wrong” to say that these medicines were being prescribed for “depression” without knowing the case history of the patient and the probable disorders the late actor was facing.

The experts’ view came amid Rhea Chakraborty filing a complaint with the Mumbai Police against her late boyfriend Sushant’s sister Priyanka Singh and Dr Tarun Kumar of Ram Manohar Lohia hospital in Delhi and others for offences of forgery, NDPS Act and Tele Medicine Practice Guidelines 2020 for having sent a “bogus” medical prescription depicting Sushant as an OPD person when he was in Mumbai on June 8.

The remarks also follow several claims being made that Sushant was being treated for depression.

According to sources, Sushant – who was found dead on June 14 this year – was taking medicines like Lonazep 0.25 mg and 0.5 mg, Daxid 50 mg.

Sources said that Sushant bought these medicines on October 31 last year on the prescriptions given by a senior Mumbai doctor.

Similarly on January 10 this year, Sushant had bought medicines like Flunil 20 mg capsule, Ativan 1 mg tablet, Qutipin tablet, Melatonin 3 mg softgel, Modalert 100 tablet, Etilaam 0.5 tablet.

The second lot of medicines were bought on the purported recommendations of another senior doctor, who treated the late actor.

According to senior doctors, Lonazep 0.25 mg Tablet MD is a prescription medicine used to treat epilepsy (seizures), panic and anxiety disorder, while Daxid is used to treat obsessive compulsive disorder, and panic disorder.

Doctors say that Flunil is an anti-depressant which is used in the treatment of disorders like depression and obsessive compulsive disorder.

The doctors also maintained that Ativan 1 mg tablet is used for anxiety disorders, while Qutipin 50 Tablet is a prescription medicine used in the treatment of schizophrenia and is a short-term treatment of jet-lag in adults.

Doctors also explained that Etilaam 0.5 mg tablet is considered an effective anti-anxiety medicine.

Meanwhile, two senior doctors contended that if these medicines were being administered to any patient, it does not imply that he or she was in “depression”.

“The usage of the medicines is prescribed by the doctors after viewing the condition of the patient. It will be completely unacceptable to say that these medicines were administered for depression,” a well-known psychiatrist in Delhi told IANS.

“While treating a patient, we need to look at the behaviour and many other aspects. Medicines are prescribed to correct the cycle where we view or find any disorder,” pointed out the doctor, requesting anonymity.

The doctor also pointed out that Lonazep is an anti-anxiety tablet and it is a commonly used tablet while Daxid is used for depression treatment. Quitipin is used for thoughts, sleeps and number of other treatments.

Similarly, Melatonin is used to improve the sleep cycle and Modalert is recommended for those who feel sleepy in the morning. Etilaam is from the same family of Lonazep, the doctor said.

Another senior doctor also said that looking at the names of the medicines it cannot be concluded that these were being used specifically for depression.

He said these medicines can also be used for anxiety and sleep disorders.

“It is not so. All these medicines are meant for many other conditions. It is not a right way to look at it. Till the time details of the patient are shared one cannot determine or come to a conclusion that it was being used for treating depression,” the noted doctor said.

The CBI, Enforcement Directorate and the Narcotics Control Bureau (NCB) are investigating the cause of the death of Sushant.

The CBI has questioned several people including Sushant’s girlfriend Rhea Chakraborty, her father Indrajit, her brother Showik, Sushant’s ex-manager Shruti Modi, flatmate Siddharth Pithani, Sushant’s personal staff Neeraj Singh, Keshav Bachne, Dipesh Sawant and many others.

The ED has also recorded the statements of several people in the last one month.

Meanwhile, the NCB, which registered a case of drug abuse on the request from ED, arrested Showik and Pithani on Friday, while Sawant and others were nabbed in the last one week.

The NCB is also recording the statement of Rhea at its office in Mumbai for the second time on Monday. She was quizzed for over six hours on Sunday by the drug enforcement agency.

For Kids With O.C.D., Coronavirus Precautions Can Go Too Far

“What I tell parents is trust your radar,” he said. “If your child seems off emotionally, or raw or fragile in a way you wouldn’t expect, or significantly different than peers or siblings, then you won’t regret bringing a professional into the situation.”

The most effective approach for those with mild to moderate O.C.D. is cognitive behavioral therapy with exposure response prevention, which involves gradually introducing a person to the thing that scares them without giving in to rituals, Dr. Storch said. And the good news, he said, is that this treatment is effective at reducing symptoms more than 75 percent of the time. In more extreme cases, these therapies can be paired with medication.

Lara Koelliker, who is 18 and has been treated for O.C.D. since age 8, said she had severe symptoms for three years before finding a therapist who specialized in exposure therapy. The treatment helped her manage her symptoms by giving her coping mechanisms, she said.

“I’ve learned how to sit with my uncomfortable feelings, and I don’t give in to my compulsions,” she said. “Now the part of me that has been equipped with all these strategies jumps in.”

Many therapists are using video calls to treat patients now. And being inside a patient’s house, virtually speaking, can be useful for exposure treatment, as home is often “where O.C.D. lives,” Dr. Freeman said. Some kids, for example, have fears involving contamination from pets, family members, or parts of their house.

“On Zoom, I can say, ‘Can you show me that room? Can you show me that couch? Do you think you can sit on that couch? Can we do it together?’”

Beyond therapy, parents’ top priority needs to be listening to their kids, Dr. Freeman said.

“Validate, validate, validate what the kids are feeling,” she said. “And be willing to have difficult conversations that stir up anxious distress in all of us. It’s really important not to tell a child they shouldn’t be sad, anxious or upset. That invalidates the emotions they’re feeling.”

‘My relationship OCD made me question if my husband loved me’


How to be a better listener
Kirstin, who is not pictured in this piece to protect her privacy, struggled with OCD since the age of seven (Picture: Ella Byworth for Metro.co.uk)

Kirstin, 33, has obsessive compulsive disorder.

Having suffered since the age of seven, her OCD started with intrusive thoughts about physical harm. It then turned into religious-based obsessions. After getting engaged to her long-term partner, Kirstin’s OCD began to attack her relationship.

OCD is an anxiety disorder that centres around obsessions and compulsions. Obsessions are unwelcome thoughts, images, worries or doubt that repeatedly appear in your mind. Compulsions are the repetitive action you do to reduce the anxiety these obsessions cause. Compulsions can be both mental and physical – like repeatedly checking a door is locked or going over thoughts in your head to check your bodily reactions to them.

For Kirstin, her obsessions now centre around her relationship with her husband, while her compulsions make her constantly seek reassurance.

Her experience with OCD has been ‘brutal’.

She tells Metro.co.uk: ‘I grew up thinking I was evil and that the devil was inside me and controlling me. I never told anyone because obviously, it sounds insane.

‘I truly thought that I had the capability to make someone live or die. Terrifying. I spent a lot of time doing repetitive compulsions, but only ever did them in private. No one ever saw.’

Kirstin started experiencing relationship-themed OCD, which is often referred to as ROCD, about a year into her relationship with her husband. The pair have been together since 2008.


Midsection Of Newlywed Couple Holding Hands
Kirstin began experiencing relationship-focused OCD, sometimes referred to as OCD, when she formed a relationship with her now-husband (Picture: Getty Images/EyeEm)

She explains: ‘I found myself comparing my relationship to others, a lot, and constantly questioning him why he wasn’t doing what X was doing.

‘If someone got engaged, or pregnant, or moved in together, I totally flipped out. I would feel extreme jealousy but then extreme anxiety over whether or not my husband was able to “love me” as much as so-and-so’s partner loved them.’

Kirstin would obsess over whether her partner really loved her – but also over whether he was a ‘good enough person’, or whether she loved him enough.

‘Everyone always seems so sure,’ she says, describing one of her frequent obsessive thoughts. ‘I’m not sure… How do I get sure? Is he “the one”? If he was “the one”, why did he do X? Does he love me enough to marry me? Does he love me enough to have kids with me?’

Kirstin says her obsessions over her relationship really escalated when her husband proposed in June 2016.

She recalls: ‘For the first five or so years, they were fleeting thoughts. But the second my husband proposed, I had a full-blown panic attack.

‘I didn’t know if I should say yes, and completely broke down. We were on a beautiful vacation in Greece and all I could think about was “how do I know?”.

‘When I got back stateside I started comparing my engagement ring to everyone that I saw on the street. “Mine is bigger – he must love me!”, “Mine is smaller – he must not love me.” Back and forth and back and forth. It was nearly constant.

‘The majority of my compulsions were mental. Reviewing, comparing and ruminating. But I also would ask for reassurance… “Are you sure you love me? Do you love my family? Do you love my friends?”’

Despite the frequent reassurance from her husband, Kirstin has never been able to say she’s ‘happy’, without ‘feeling totally anxious or trapped’.

It’s the uncertainty that ‘kills’ her.


A woman wears her engagement ring
She began to question everything from the size of her engagement ring to whether her husband really loved her (Picture: Getty Images)

‘I know that I’ll never “know”,’ she says.

‘But the fact that I can’t have certainty in this kills me. I am constantly wondering if I would be better off or happier with someone else.’

Kirstin and her husband got married in 2017. She says that surprisingly, her wedding day was the only day where she felt free from her OCD.

‘I had no doubts and felt so happy’, she tells us.

‘I was over the moon in love and couldn’t wait to marry my best friend. I had doubts up to the wedding and doubts afterwards, but that day was amazing and so assuring.

‘That is a big thing that keeps me in the relationship now – I remember that feeling and how amazing it was to be free of the doubts.

‘It’s one of the only reasons I know my husband and I are a good match.’

In the summer of 2019, Kirstin’s OCD escalated to the point that she sat her husband down and told him she was moving out, despite there not actually being any issues between them.

‘He broke down and begged me to stay’, she recalls. ‘[He said] he would do anything to make me happy and that I was the most important thing to him.

‘That he would literally flip his life upside down to be with me. I felt guilty and confused so I changed my mind. It was not an easy few months after you tell your husband you’re leaving.’

Kirstin finally opened up to her husband about what she was going through in November 2019. Her mental illness became so intense that everything was a trigger; friends’ celebrations, TV shows, movies and even music.

She says: ‘Any time anyone would bring up a happy relationship I immediately would feel this wave of heat and anxiety come over me. It got to the point where I was isolating myself and was dissociating.


Illustration of woman and man sharing a cuppa and a hug
Kirstin’s obsessions made her seek out constant reassurance (Picture: Ella Byworth for Metro.co.uk)

‘All I could think about was my relationship. After a fair amount of research I had an ah-ha moment where I was like… “Holy s**t, my OCD morphed again”.

‘I knew that I needed some real help and for the first time got treatment. Unfortunately at that point I had had OCD for 25 or so years, and needed to go into a residential facility.

‘It was there that I finally worked with my therapist to tell my husband. And I told him everything.’

Kirstin’s husband was completely understanding – and said hearing everything that was going on helped him to understand her better.

Kirstin is currently in therapy three times a week and sees a psychiatrist twice a month.

She tells us: ‘It has greatly affected my relationship, but in ways I never would have guessed.

‘Of course it’s made things extremely painful, stressful, confusing… but by being totally open and honest with my husband we have had incredibly frank conversations about life, love, and the future that we would have never been able to have in the past.

‘We are now 100% transparent with each other and that actually has helped.


Rearview shot of an affectionate  young couple admiring a city view at dawn
Kirstin isn’t ‘cured’ but telling her husband the truth of what was going on and getting therapy has been life-changing (Picture: Getty Images)

‘That being said, I still have these crazy doubts and I’d say once a month or so I have a period of a few days where I feel like I’m not sure I want to be with him.

‘It’s like anxiety takes over and I feel trapped in my house… Like I have to leave, I have to pack my bags, I can’t stay here another second. It’s extremely overwhelming for my sanity and I sometimes feel like I’m going crazy in a prison of my own mind.’

Since receiving help, when she’s doing ‘well’, Kirstin says she can allow her thoughts to creep in and simply forget them and move along. But sometimes her days are harder, and the doubts and fears become ‘absolutely constant and distracting’.

She adds that she ‘honestly doesn’t know’ how she’s found the strength to continue in her marriage.

‘There have been times that I feel as though the pain of leaving has to be less than the pain of staying’, she said.

‘But still, I’ve never left. Something keeps me here. He is my absolute best friend and truly feels like a lifelong partner. But it’s a battle.

‘I thought I was going to get married, buy a house, have kids. Instead I got married, bought a house, had a complete mental breakdown, and haven’t really recovered.

‘I have somewhat, but I feel like everything is super tentative. I question whether or not I’ll ever be healthy enough to have a kid, or if I’ll ever stop feeling these doubts about my husband. It sucks and makes me very, very sad that OCD has caused all of this. It’s so unfair.

‘You’d think after thinking these thoughts 1.5 billion times a day my brain would get tired of them. But nope. They just keep on coming.’

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