Tag Archives: anxiety

Expert Tips for Understanding OCD, and How to Treat It

By Ginny Graves 

Obsessive-compulsive disorder isn’t what most people imagine it to be. We asked experts to explain what’s really going on inside the brain—and how to find long-lasting relief

Many of us have made a casual comment about obsessive-compulsive disorder, as in “I’m so OCD about washing vegetables.” But for those who suffer from the disorder, obsessions (like a fear of germs) and compulsions (like disinfecting) can be debilitating. OCD may be especially challenging at a time like this, when public health messages intended to protect us from COVID-19 can reinforce germophobia—or amplify feelings of uncertainty, a component of the illness. “Studies are underway to determine how difficult the pandemic has been for those with OCD, but it’s safe to say that some people with the disorder are really struggling right now,” says Elna Yadin, PhD, an OCD specialist on the clinical faculty at the Perleman School of Medicine at the University of Pennsylvania.

Does that mean that if you’ve become fanatical about sanitizing you have OCD? No. “OCD is an anxiety disorder that causes intense distress,” Yadin explains. “Obsessions are intrusive, unwanted, relentless thoughts or urges that can cause fear, guilt, distress, or disgust. And in an effort to get rid of or neutralize those upsetting thoughts, a sufferer develops compulsive behaviors.”

RELATED: How to Deal With OCD—From 4 People With the Diagnosis

The disorder, which is estimated to affect one in every 100 adults in the U.S. (and equal numbers of men and women), can come on at any time, though it frequently occurs after a traumatic or stressful event and tends to hit in the preteen years or in early adulthood. A number of genes have been linked to the disorder, so you can inherit a predisposition for OCD. If a parent has it, there’s about a one in four chance her child will, too

Because doctors often don’t recognize the condition and sufferers tend to hide their symptoms, it typically takes 15 years or more for those in need to get help, which is a shame, since OCD can interfere with, or even debilitate, their ability to function. The good news: Treatment can ease the disorder’s grip and transform people’s lives.

Escaping-The-Loop-OCD-GettyImages-600127754

CREDIT: GETTY IMAGES

RELATED: Aly Raisman Revealed That She Lives With OCD in a Candid Interview

On Repeat

When you think about OCD, you might imagine someone whose hands are raw from excessive washing. But the disorder isn’t about cleanliness. It’s about unwanted thoughts. And fear of germs is just one of hundreds of disruptive thoughts that torment sufferers, says Jonathan Grayson, PhD, director of the Grayson LA Treatment Center for Anxiety & OCD in Pasadena, California. “Obsessions include everything from worry that you left the stove on to fears that you might kill someone you love. They’re limited only by people’s imaginations, and people with OCD tend to be extremely creative and intelligent,” says Grayson.

Other common obsessions include perverse sexual thoughts, fear of blurting out an obscenity, concern with offending God, and superstitions about colors or numbers. “Many of us have passing scary thoughts, but we’re able to realize they’re irrational and let them go. People with OCD get stuck in a thought loop: ‘How do I know for sure I didn’t do something terrible or dangerous, or that I won’t do it soon?’ ” Grayson says. “These thoughts produce agonizing anxiety.”

That’s where the compulsions come in. They’re intended to counteract the obsessions and calm the distress, and they range from the rational, like cleaning to get rid of microbes or checking the stove to make sure it’s off, to the magical—such as counting while performing a task to end on a “good” number; repeating routine activities, like going in and out of doors; or repetitive body movements, like tapping or blinking. It isn’t always clear why people develop their unique compulsions, or why those particular actions supply relief. 

RELATED: New Study Suggests Brain Glitch May Cause OCD

You might suspect you’re “a little OCD” if you like to have your pencils arranged just so, or you triple-check your purse for your passport before you board an international flight. But having an obsessive trait or engaging in compulsive behavior doesn’t mean you have a personality disorder. “Obsessions and compulsions in OCD cause real impairment,” explains Jeff Szymanski, PhD, executive director of the International OCD Foundation in Boston. For instance, a fear of contamination may drive someone to spend hours cleaning her office every day. “If you have OCD, you don’t like the compulsions or want to do them. You have to do them [in order to] relieve your distress,” adds Szymanski.

Elizabeth McIngvale, PhD, LCSW, director of the McLean OCD Institute in Houston, who has struggled with OCD herself, explains it this way: “You know the compulsions are irrational, and the relief you’ll get is only short-term—maybe 5 or 10 minutes, or an hour—but the urge to do them and the anxiety they’re coupled with are so intense you don’t feel like you have a choice. When that’s the only coping mechanism you have, you use it.”

Because compulsions offer temporary relief, they reinforce and strengthen OCD. As a result, when left untreated, the disorder usually gets worse. 

RELATED: 7 Things Everyone Gets Wrong About OCD, According to a Woman Who’s Had the Disorder All Her Life

The Role of Uncertainty

Just as your genes can make you vulnerable to OCD, so can your brain structure. “A complex brain circuit, which pays attention and responds to danger signals and involves high-level thinking, emotional processing, and behavior, is hyperactive in people with OCD,” says Szymanski. “They’re constantly trying to seek certainty—to be sure they washed the germs off their hands, or that their spouse is still alive.” But of course, it’s impossible to be 100 percent certain of anything. 

One thorough handwashing is enough to satisfy most of us. People with OCD are bombarded by niggling doubts. “What if all the germs aren’t gone?”

That’s not the only neurological difference found in OCD sufferers: While the fear-scanning circuit of the brain is hypervigilant, the regions that provide a sense of satisfaction after a task is finished are tamped down. As a result, people with OCD don’t experience a sense of completion when they wash their hands or check to make sure the stove is off, so they feel the need to keep repeating their compulsions again and again. “Some people take 10-hour showers, or can’t leave the house, while others appear to be high-functioning but spend hours a day battling intrusive thoughts or images,” says Szymanski.

RELATED: How Can I Tell If I Have OCD?

Facing Fears

The first step to overcoming OCD is finding a specialist who knows how to treat it. “Fifty percent of medical professionals and one-third of mental health professionals misdiagnose OCD as depression or anxiety or bipolar disorder,” says Szymanski. Most aren’t trained to treat it, either.

The most effective treatment for the disorder is exposure and response prevention therapy, or ERP; it’s a specific type of cognitive behavior therapy that requires a fair amount of effort on the part of both the therapist and the patient. You can search for therapists via the International OCD Foundation’s directory (iocdf.org), and be sure to ask prospective counselors if they have ERP training, says Grayson.

In ERP, a therapist helps you expose yourself to the situations, thoughts, or images that make you anxious—without performing your usual compulsions afterward. If you’re worried about germs, for example, the therapist might go with you to the animal shelter, where you can pet a dog and then resist the impulse to sanitize your hands. If your obsession is a fear that your spouse will die, you consciously have that thought over and over during a therapy session, but you don’t act on the urge to call and check on him or her. 

RELATED: The 2 Major Types of OCD—and How to Recognize Them

“Compulsions tell your brain that your fear is real. When you stop performing them and nothing bad happens, you begin to break the link so you can see your fears more realistically,” Szymanski explains. It’s not easy, but over time, ERP actually trains your brain to tolerate uncertainty.

The treatment is effective for about two-thirds of people. Most sufferers experience a significant reduction in their symptoms after 12 to 16 sessions. But it takes steady effort. Szymanski compares ERP to seeing a personal trainer. “If you go once a week and don’t do any exercise till the next session, you’re not going to see much improvement in your fitness,” he says. “But if you work out on your own between sessions, you’ll get stronger and lose weight fairly quickly.”

Some people also benefit from pairing ERP with selective serotonin reuptake inhibitors (SSRIs), a class of medication that is often prescribed for depression and anxiety. “The drugs seem to change the trigger point for uncertainty by making serotonin more available in the spaces in the brain where nerve impulses are transmitted,” says Grayson.

While treatment doesn’t cure OCD, it can help sufferers learn to cope with the disorder so it has less impact on their lives. “When the pandemic first began, we were concerned that people in treatment for OCD would backslide—and many of them did,” says Szymanski. “But in talking with many therapists around the world who treat the disorder, we realized that a significant percentage of patients actually handled the pandemic better than people without OCD, because they’d learned to embrace uncertainty. They had developed the skills to face the fear, and function normally.” 

This article originally appeared in the  March 2021 issue of Health Magazine. Click here to subscribe today!

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IOCDF Town Halls

I highly recommend everyone to check out all the amazing work the IOCDF has been doing with providing resources to the public. From their Town Halls to their virtual support groups. Simply search IOCDF on youtube. A very common but lesser known form of OCD is moral scrupulosity watch below to learn more about the symptoms, treatments and how to recover!

Lean Into The Fear

Intrusive thoughts feel so real and intense that it creates an automatic urge to want to get rid of them. The internal dialogue quickly turns to STOP! I can’t handle it, I hate these thoughts, what does this mean etc?! Practicing bringing the thought in and showing you aren’t afraid will make the brain move on and not get “stuck”. An example is you have a thought of something horrible instead of trying to run away from it ask for more, say I want these thoughts and the thought loses its power because you are no longer afraid of it. Aaron Harvey an OCD advocate gives a great example of this when talking about passing a ladder on the street and right away having the thought that something bad will happen now if I go near that ladder, someone will get hurt or I might push someone into it. Instead of being afraid and scared he goes directly to the ladder stands under it allows all the horrible and horrifying thoughts to enter and moves on, and the more you practice this throughout the day leaning into the thoughts and fears the more your brain realizes it can no longer trap you. This is very hard to do but even trying a little bit everyday will significantly decrease the grip OCD has.

OCD Virtual Conference!


The first event of its kind, this virtual event has programming for everyone in the OCD community: individuals with lived experience, their family members and supporters, and the professionals who treat them. Running from Friday, July 31 through Sunday, August 2nd, this virtual event will feature 70 talks, 36 discussion groups, and 160 presenters!

I encourage anyone who is suffering with OCD or has a loved one suffering with OCD to attend this years conference!

To register simply go to the link and click the register button in the top right corner!

https://event.vconferenceonline.com/microsite/html/event.aspx?id=1634

ROCD

Relationship OCD is a very common and confusing form of OCD. COVID-19 has really impacted the way we live with more people working from home and layoffs on the rise. ROCD can really take advantage of these situations being around your partner 24/7 is not easy to begin with and this is a perfect catalyst for ROCD to be triggered.

Dr. Stephen Phillipson describes ROCD as:

“It’s a subset of OCD where a person is preoccupied with establishing whether their feelings for their partner are sufficient to maintain the relationship or be in the relationship.

People with ROCD have a tsunami of emotional distress over often more meaningless aspects of their partner, in terms of whether they would be a suitable partner, and so there is a tremendous amount of endless navigation or rumination about the qualities of what they think are correct or justified to continue in the relationship with.There is just an endless preoccupation, there is an endless answer seeking, sometimes even reassurance seeking from one’s partner.

Common symptoms of ROCD involve endless answer seeking and endless rumination about their partner’s qualities, and whether their internal feelings justify being in the relationship. They become very focused on their level of arousal as a proof that the person that they are with is justified to remain with. The probably is, the more that we focus on and put pressure on ourselves to have a very passionate response, the less likely we are to have that response. So it’s common that there is a tremendous amount of sexual malfunctioning or sexual apathy, because of that inverse relationship between the pressure to be sexually aroused, and then the way the brain responds to that pressure to be sexual, it’s very paradoxical.

There can be a focus on a partner’s appearance there can be a focus on a person’s character. I’ve had patients have associations about loved one’s own dating history, in terms of how long did their partner wait before they engaged in certain sexual acts as if that would provide them with reassuring evidence, or uncomfortable evidence about their partner’s character.”

A common thought process for people with ROCD is to check if their significant other has good character or if they are attracted to them. They tend to have intrusive thoughts that try to paint a horrible picture of your partner. This can be very distressing on a relationship, your partner becomes the target of the intrusive thoughts which can lead to a lot turbulence in the relationship. ROCD in specific is very difficult to deal with as relationships by nature are difficult and complex knowing when you have legitimate concerns vrs OCD is sometime hard to navigate. I encourage anyone who is going through ROCD to speak with a trained OCD therapist to help them navigate this subset.

What is OCD?

Picture a scene from a horror film playing over and over again in your mind, but this horror film is not any horror film it is about yourself, your loved ones and innocent people. The horror film is vivid with images and words popping up. You are left feeling helpless and terrified and doubting who you are as a person. How could I think these things? Do I want this? Who am I? Will I snap?

OCD wants you to be afraid of the horror film and always be enslaved to its storyline. But just like a horror film the audience knows it is not real, without the suspenseful music, special effects and graphic images it wouldn’t impact the viewer. OCD feels real because of the graphic images, thoughts and things the person cares about. If the sufferer can be an audience member and realize it is not real, sit back be uncomfortable but know that nothing is actually happening OCD will loosen its grip.

Pin on Affirmations and Thoughts

Coronavirus & OCD

Great article by Shayla Love on how to navigate Coronavirus when you have OCD.

One of the best and most effective ways to try and stay healthy during the Covid-19 outbreaks is to wash your hands. Wash them for at least 20 seconds, and be thorough—get all the spaces between your fingers, and underneath your nails. After you touch something, wash your hands again. Then wash them again before eating or picking at your face. Also, carry around alcohol-based hand sanitizer.

Experts additionally advise that people don’t get too close to others who appear to be sick—they can spread virus particles through droplets that will get into your nose and mouth. Be wary of surfaces in common areas, and disinfect those surfaces frequently.

These are evidence-based recommendations, but for someone with Obsessive Compulsive Disorder (OCD) and contamination and health anxieties, this advice can start to veer into uncomfortably familiar territory. It sounds an awful lot like the anxious thoughts they have on a daily basis, even when there’s not a new virus spreading around the globe.

For many people with anxiety and OCD, the news and well-meaning (and accurate) CDC and WHO guidelines can trigger bouts of intense anxiety and compulsive behavior. It can spark intense worries about getting coronavirus, feeling like you already have it, obsessing about what might happen if you get it, cleaning, checking, or experiencing physical symptoms of anxiety: like dizziness, breathlessness, tingling, chest pains, and more. After all, even people without OCD or anxiety are exhibiting compulsive-like behavior: buying out stores of hand sanitizer and canned goods, overstocking on masks that don’t help much if you’re not sick yourself.

I know a bit about this firsthand. When I was a child, I obsessed over whether or not my hands were clean, washing them constantly. After I washed them, I told myself I wasn’t allowed to touch anything, lest I infect them again. I would clench my fists and avoid opening doors or touching tables. If my hands even touched the insides of my shirt, they would feel contaminated to me. As an adult, I’ve also obsessed about getting various diseases, from rare autoimmune disorders to MS to bronchitis—when these obsessions would take hold, I used to sit in doctors offices weekly to try and diagnose what I thought I had.

I’ve been in therapy for OCD for several years now, where I’ve made a lot of progress on not responding when anxious thoughts arise. (Thoughts don’t ever really go away altogether, but you can get better at reacting to them.) Even though I’ve made big strides in recovery, the coronavirus outbreak can bring on a little voice in my head that says things like: A ha! See, I was right that every surface is an infected cesspool that will kill you. And: I knew it wasn’t safe to touch anything, and also you should start showering in bleach.

These outbreaks are serious: There are more than 82,000 cases of coronavirus diagnosed worldwide so far, and almost 3,000 people have died. There are currently 135 cases of coronavirus in the U.S. in 16 states, but likely many more to come as testing for the virus becomes more widespread. But how can a person with OCD manage, when suddenly confronted with messaging coming from all directions that sounds almost exactly like intrusive OCD thoughts?

Understand the reason why it’s so triggering

Covid-19 demands us to pay attention to the concepts of cleanliness and disease. And the advice to constantly wash your hands or clean surfaces gives people more reasons to think about those behaviors, said Jon Abramowitz, a clinical psychologist at the University of North Carolina.

People with OCD are often trying to do the opposite: “T[hey] take their attention away from cleanliness and get through their day acting as if the worries in their head about germs and contamination aren’t relevant,” said Shala Nicely, a therapist specialized in treating OCD. “Then the media and authorities say, actually—this is relevant.”

The CDC can also use words like “frequently” or “often” to describe how often hands should to be washed. This can cause a lot of distress to people with OCD because they can worry about the specific meaning of those words, said Jon Hershfield, the director of The OCD and Anxiety Center of Greater Baltimore. “How do I know that I am washing my hands ‘frequently’ as opposed to every hour or after every contact with a public surface?”

All this attention to germs, hand-washing, or illness can bolster anxious thoughts on those topics, and so if you’re having more of them, that’s completely normal. The trick is to not let it trickle out into your behavior, which validates those thoughts.

Follow official guidelines, but don’t go above and beyond

Of course, there is validity in the need to wash your hands while a virus is spreading, so how to toe this line? Nicely suggests borrowing a technique used in OCD therapy called exposure and response prevention, or ERP. In ERP, a person is exposed to something they’re anxious about, and then tries to not do the response that makes the anxiety go away. For example, not washing your hands after you touch the ground before eating something.

During an outbreak, Nicely said she wouldn’t recommend people to stop washing or sanitizing things entirely, but consider the exposure in a different way. The “exposure” becomes to pick one legitimate source for prevention, like information from the CDC, and follow it—but that’s it. Don’t do anything above and beyond what they advise and don’t listen to the guidelines and rules that OCD starts to set in your brain.

“OCD thinks it’s an authoritative figure on all things having to do with safety, and then it tells you what you should do,” Nicely said. “But I think it’s important to understand that OCD is not the authority on this. It does not have the knowledge to be telling you how to wash your hands.”

To make sure you’re staying within the realm of adaptive behavior, Hershfield said it can be helpful to observe what you’re doing and whether it’s changing over time. “If on Monday I am washing for 30 seconds before eating, but on Tuesday I am washing for 60 seconds, this is something to be concerned about,” he said. Once you follow CDC recommendations, tell yourself it was enough. If thoughts like, did I do it rightare you sure we did it for long enough, or let me check what I cleaned one more time come up—acknowledge them, but then let them go.

Don’t be glued to the news

Coronavirus articles are everywhere, and yes it’s important to stay informed. But Nicely also suggests not becoming too entrenched in the media coverage, and finding what works for you in the balance of being up-to-date versus knowing too much.

People with OCD can tend to be overly informed. “We become experts at whatever subject our OCD wants us to Google,” she said.

Figure out how infrequently you can check the news and still get the information you need without making you too anxious. Maybe it’s once a day, maybe it’s once a week. It could be that the best thing for you is not checking at all, and relying on and trusting friends and family to give you updates that you need to know, like any cases in your area.

“Compulsively checking the news, ruminating over what will happen in the future, or mentally reviewing what you’ve heard about the virus all create opportunities for obsession,” Hershfield said. “Focusing on the present moment, even if that includes being anxious, and working with ‘OK, this is where things are for me right now in this moment’ is your best bet.”

Accept that there is going to be uncertainty

OCD and anxiety are rooted in an intolerance of uncertainty. Ultimately, all exposures in therapy are about teaching a person that they can handle not knowing what’s going to happen when they do something that scares them.

“You can’t see viruses, so it’s impossible to know if you’re 100 percent safe,” Abramowitz said. “People with OCD tend to assume danger unless there’s a clear guarantee of safety; and hearing about the virus every time you turn on the news makes it seem like it’s easy to get.”

That’s why you might be tempted to wash your hands again, or read another news article. Because you’re trying to be more certain that you won’t get it or give it to someone else.

“We feel like if we know something we can control it, but that’s unfortunately an illusion,” Nicely said. “Knowing the current stats about the outbreak doesn’t give a person any more control over it.”

If you can accept that there are a lot of unknowns and try to live with the discomfort, it will go a long way to managing stress during the outbreak.

Don’t be too hard on yourself

All of that is easier said than done. Nicely and Abramowitz said this is going to be an extremely difficult time for many people with anxiety and OCD, and so it’s important to be kind to yourself during this process.

“Say to yourself, I’m going to do the best I can but sometimes I’m going to mess up,” Nicely said. “I’m going to be super anxious and that’s all okay. The other problem all of us with OCD can face is we want to do it perfectly. We might think: I didn’t perfectly follow the CDC guidelines and I should beat up on myself. Instead, be really nice to yourself and say, wow, this is a really hard situation for everybody.”