OCD and Schizophrenia

by david castillo dominici freedigitalphotos.net

by david castillo dominici
freedigitalphotos.net

A recent study published this month in JAMA Psychiatry suggests that those who suffer from OCD might be at a higher risk than the general population for developing schizophrenia. I immediately thought back to a post I wrote just one year ago titled OCD and Psychosis, where I discuss the fact that symptoms of severe OCD can sometimes overlap with symptoms of a psychotic disorder.

As I read the synopsis of the study, a few things jumped out at me that I think are important to keep in mind. For one, the incidence of schizophrenia in the general population is about one percent. The new study concludes that the occurrence of schizophrenia in those previously diagnosed with OCD is two percent. So while this is a significant increase, there is still a ninety-eight percent chance that those with OCD will not develop schizophrenia. Additionally, Dr. Aaron Pinkhasov, chairman of the department of behavioral health at Winthrop University Hospital in Mineola, NY, makes this observation about the study:

Notably, the study only looks at patients who have come in contact with a psychiatric hospital. As the majority of mild and moderate OCD patients are treated by general practitioners in an outpatient setting, it makes it difficult to apply these findings to all patients suffering from OCD. Hence the risk may in fact be somewhat overestimated.”

So there might be less than a two percent chance of those with OCD developing schizophrenia.

Also, in discussing the study, Dr. Pinkhasov makes this thought-provoking comment:

“At least some of the association may have been a result of misdiagnosis in patients before they developed more specific symptoms of schizophrenia.”

Interesting. While my post, OCD and Psychosis, discusses OCD being mistaken for schizophrenia, Dr. Pinkhasov talks about schizophrenia being mistaken for OCD.

There is no question in my mind that this study should be taken seriously. Future research could lead to findings that benefit both those with OCD and schizophrenia. But I believe we need to be careful as well, because things are not always as they seem. In the case of brain disorders, where we’ve categorized certain behaviors as belonging to specific illnesses, it can be difficult to know where one disorder ends and another one starts. Research results are also not always clear-cut. In this particular study, the authors conclude, “Further research is needed to disentangle which genetic and environmental risk factors are truly common to OCD and schizophrenia.”

OCD, schizophrenia, and other brain disorders can be complicated and confusing in their origins, their diagnoses, and their treatment. As more research is conducted, my hope is that all the pieces of the “OCD puzzle” will one day fall into place. Diagnosis and treatment will be easier, and as long as I’m wishing, a cure will be found.

 

 

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OCD: Irrational Disorder affecting Rational People

by seaskylab freedigitalphotos.net

by seaskylab freedigitalphotos.net

I am continuing to share some of my older posts as I work on completing my book. I hope to be back next week with something new!

When my son Dan was first suffering from severe OCD and we had no idea where to turn, we connected with a close friend of ours who is a clinical psychologist. One of the first questions Mark asked me was, “Does Dan realize how irrational his behavior is?”  When I asked Dan if he really believed someone he loved would be harmed if he moved from his chair before midnight, or if he had something to eat, he answered, “I know it makes no sense, but I just have to act this way.” Those with OCD typically know their thoughts and behaviors are illogical; they just can’t control them.

Since becoming an advocate for OCD awareness, I’ve often been told by sufferers that this is the worst part of having OCD.  You know you are thinking and acting in an irrational manner but are unable to stop the thoughts and/or the actions. “It would be better if I didn’t realize how illogical my thoughts and behaviors are,” one sufferer said. “I’d rather be oblivious than tormented.”

So what are the ramifications of this insightfulness? For one thing, because those with OCD don’t want to be perceived as “crazy” they often go to lengths to hide their disorder, even from those closest to them. They will also avoid or, at the very least, delay treatment because they feel shame and embarrassment. How can they willingly share things that they know are “ridiculous” with a therapist?  This awareness of how their thoughts and behaviors likely appear to others, indeed how they even appear to themselves, must be torturous.

For non-sufferers, I think it’s easy to understand why someone with OCD would try to hide their disorder. After all, whether we have OCD or not, we can all relate to not wanting to embarrass ourselves. What might be harder for a non-sufferer to understand is, if sufferers know their behavior makes no sense, why don’t they just stop? This question, of course, is a lot more complicated, and is what makes OCD a disorder to begin with.

We need to continue to educate and raise awareness of OCD and what it entails. I think this is just as important for sufferers as it is for non-sufferers.  Some of the most emotional interactions I’ve had with those with OCD have been when they talk about the moment they realized they were not alone: “I never imagined that there are other people out there – lots of them – who regularly turn their cars around to make sure they haven’t hit anyone.” Such a powerful revelation, to see one’s actions as symptoms of a real illness, and not just some random illogical behavior. Certainly no reason to feel shame or embarrassment.

Rational people with an irrational disorder.

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OCD and Black and White Thinking

 

foto76 freedigitalphotos.net

foto76 freedigitalphotos.net

I am continuing to share some of my older posts as I work on completing my book. The post below originally appeared in April 2012: 

Obsessive-compulsive disorder is often accompanied by some cognitive distortions, which are basically inaccurate beliefs that usually make us feel badly about ourselves. One of the more common cognitive distortions that might occur with OCD  is known as black and white (or polarized) thinking. When my son Dan was dealing with OCD but could still drive, this type of thinking was obvious. If he went 25 mph in a 35 mph zone and the driver behind him honked his horn, Dan would be convinced he was the worst driver in the world. Not a good driver who was going too slowly, but the worst driver ever. No gray, just black and white. Sometimes a humorous comment from me would make him see how ridiculous this thinking was, but more often than not, this is what he believed.

When I think of  OCD and black and white thinking, they really do make the perfect pair. One of the driving forces behind OCD is the need to know with absolute certainty that nothing bad is going to happen. What a perfect example of black and white thinking: Either I am 100% sure that I (and/or those I care about) am completely safe, or I am definitely in great danger. No gray, nothing in between.

But as we know, that’s not how the world works. We live in a world of gray. Dan is a really good driver who goes too slowly sometimes. We try to be safe, but accidents happen. Usually these accidents are no big deal, but sometimes they are. Our world is uncertain.

Like plants in a greenhouse, OCD thrives on black and white thinking, and this cognitive distortion can even sabotage the OCD sufferer’s treatment. Exposure and response prevention (ERP) therapy, by its very nature, is slow and tedious and often fraught with setbacks. A sufferer who thinks in black and white may conclude: “I’m a complete failure at ERP Therapy because I gave in to my compulsions today. What’s the use? I’m never going to get better. I shouldn’t even bother fighting.”

I think, for Dan, just being made aware of  his tendency toward black and white thinking was extremely helpful. Cognitive Behavioral Therapy to address cognitive distortions (and to get rid of them) is necessary for the OCD sufferer’s recovery. Indeed, we all need to be able to think in shades of gray, so that we can begin to accept, and live with, uncertainty in our lives.

I’d love to hear from those who have been affected by black and white thinking. How hard was it to change your thinking? Have you changed your thinking? How has this cognitive distortion affected your OCD and treatment?

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Freedom From OCD

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

During the next few weeks, I will be busy working on my book, as its publication date of January 16, 2015 draws closer. (For more information, check out the “My Book” tab above.) I’ll be reposting some of my older, more popular posts during this time:

This post first appeared in February 2012:

When he was dealing with severe obsessive-compulsive disorder, my son Dan spent nine weeks in a residential treatment program. During this time, he kept saying he “wanted his freedom back.” I wasn’t sure if he was talking about getting out of the program, or about regaining his independence from his family.

Turns out it was neither. What Dan wanted was freedom from OCD. Since that time, I have read many blogs and spoken to lots of people with OCD, and I keep hearing those same words: “I want freedom from OCD.” More than once, in fact, I have read first person accounts of sufferers who have successfully battled OCD where they refer to the “chains of OCD being broken.” They are no longer prisoners.

But what does freedom from OCD really mean? A non-sufferer may think it simply means saying good-bye to the disorder and having it be nothing more than a bad memory. Unfortunately, this is not usually the case. While OCD is highly treatable, it rarely goes away completely. So if you always have OCD, can you ever experience freedom from it?

I would answer with a resounding Yes. Freedom from OCD does not necessarily signify the absence of OCD, but rather the lack of control that the disorder has over the sufferer’s life. While someone who is not in control of their OCD will feel compelled to perform compulsions or avoid situations to rid themselves of the anxiety that comes with their obsessions, those who have freedom from OCD will accept their obsessions as just thoughts and nothing more. They will not let their OCD dictate how they live their lives.

It is not uncommon for those with OCD to name their disorder as a way of affirming that it is separate from themselves. I talk about this more on the post entitled The Enemy. While those who do not yet have their freedom from OCD may be dealing with The Enemy, those who do have their freedom are dealing with something more akin to a little brother or sister tagging along. Sure, they can be annoying and a bit of a nuisance, but they sure as heck aren’t going to boss you around!

Gaining freedom from OCD takes a lot of hard work and may be an ongoing  process. When I write about Dan’s story these days, I often say, “Dan still has OCD, but OCD does not have Dan. There is a big difference.”

And that difference is freedom.

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Back To School With OCD

school girls

This post was originally written over a year ago for Beyond OCD. I thought it was timely to share it again on my blog:

Last year at this time I wrote a post about Taking OCD to College. It focused on establishing a good support system for OCD sufferers who are embarking on this exciting, but often anxiety-provoking journey. I discussed how important communication is with all school personnel, from the Dean of Students to teachers. The more support the better.

But what happens when the support you deserve, and are entitled to, is not afforded you? What if one of your teachers thinks OCD is no big deal, or not a real illness? How do you deal with a situation like that?

My son Dan, in his senior year of college, was discriminated against because of his OCD. I know discriminate is a strong word, but it fits. According to the Americans with Disabilities Act (ADA), college students with documented disabilities are entitled to reasonable accommodations. While offering wheelchair ramps for those who can’t walk is an obvious compliance, accommodations for other issues, such as OCD, are not as clear-cut. Unfortunately, there are still many college professionals who know little, or have misconceptions, about obsessive-compulsive disorder. Students themselves might not know what they need until after the fact. Indeed, the complexity of the disorder can make the establishment of accommodations difficult. The Academic Resource Coordinator at Dan’s school, the expert who dealt with students with disabilities, “wasn’t sure” if Dan’s issue of concentrating more on details than the big picture was related to his OCD.

The best advice I can offer if you find yourself in a similar situation is to know your rights. Read up on the ADA and stand firm. Support, as well as documentation in writing, from a therapist or psychiatrist (preferably your own), can be invaluable. While college is typically a time of reduced parental involvement, I am convinced that if my husband and I hadn’t joined in Dan’s fight, the outcome would not have been in his favor. We had to bring our son’s case all the way to the president of his college, but he ultimately got what he deserved: fair treatment.

Because Dan’s OCD wasn’t diagnosed until he was seventeen (and because we homeschooled), our family never dealt with the need for accommodations during the K-12 school years. Again it’s important to know your rights and options. Laws and plans are in place, particularly for schools that receive federal funding (this includes all public schools). Beyond OCD’s site, OCD Education Station, is an excellent resource, not only for this information, but for all concerns about dealing with OCD in school. Again, there are still many school professionals who do not understand OCD, and this is just one of the many reasons why parents need to be well prepared to advocate for their child.

Whether you’re sending your child off to kindergarten or college, this exciting time can also be stressful.  Add obsessive-compulsive disorder to the equation and chances are you’re also adding an extra layer of anxiety. That’s understandable. I do think, however, that it’s important for parents to remain positive and convey an air of confidence that everything will work out just fine. Because it probably will. But if problems do arise, we need to let our children know, no matter what their age is, that we will be there to support them, advocate for them, and love them every step of the way as they navigate their educational journey.

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OCD and Insight

by smarnad, freedigitalphotos.net

by smarnad, freedigitalphotos.net

Before my son Dan was diagnosed with obsessive-compulsive disorder, I had little to no experience dealing with people who suffered from mental illness. My preconceived belief was that those who had brain disorders didn’t really understand, or have insight into, what was “wrong” with them. They needed to see a professional who would know how to treat them with the right type of therapy and/or medication, and maybe try to help them understand their illness a little. I believed therapy was something done to people, not with them.

Why did I think this way? Where did it come from? These might be questions best answered in another post. The bottom line is I could not have been more wrong. In fact, in light of what I have learned about people with brain disorders over the last eight years or so, my assumption seems ludicrous. I’m even embarrassed to admit I had these beliefs.

The first person to dispel this myth for me was, not surprisingly, Dan. He diagnosed himself with the help of the Internet, and understood his OCD better than his pediatrician did. For the most part, he continued to have good insight throughout his battle with severe OCD. This is not unusual for those with obsessive-compulsive disorder; most sufferers, at some point, realize their obsessions and compulsions are irrational.

What about other brain disorders? Well, I have read blogs written by those with bipolar disorder, schizophrenia, depression, and generalized anxiety disorder (GAD), and am continually amazed by the insight people have into their own disorders.

Having insight can be invaluable when in treatment for OCD (and I’m guessing other brain disorders as well). I’ve written many posts (my last one included) about Dan’s journey where I’ve stated that just being made aware of his cognitive distortions, or the tricks OCD can play, was extremely helpful in his fight against OCD. And insight doesn’t always have to come “naturally.” It can be helped along by a good therapist.

The benefits of insight are not limited to OCD or other brain disorders. Really, for all of us, the more we understand whatever challenges we face, the better equipped we can become to deal with them.

Education. Understanding. Insight. These things are not only necessary for those who are suffering, but also for those of us who might be on the outside looking in. Those preconceived notions I used to have about those with mental illness? No doubt there are people out there right now who currently hold my old beliefs. We need to break down the stigma and the misconceptions surrounding brain disorders. We need to have open and honest dialogue where people feel safe and unashamed to share their struggles, and we need to treat each other with compassion and kindness. Until this is accomplished, we will not have won the battle against OCD, or any other mental illness.

 

 

 

 

 

 

 

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OCD and Guilt

by frameangel freedigitalphotos.net

by frameangel freedigitalphotos.net

If you have obsessive-compulsive disorder or are close to someone who does, then you likely understand why OCD is sometimes referred to as the “doubting disease.” Doubt is what fuels the fire for OCD, and that is why those with the disorder need to be able to embrace living with uncertainty if they are going to beat OCD.

In addition to doubt, OCD sufferers typically deal with a lot of guilt. Over what, you might ask? Well, just about everything! OCD is typically accompanied by cognitive distortions, and many of these cognitive distortions can lead to feelings of guilt. For example, my son Dan suffered from hyper-responsibility. It’s not hard to imagine how his feeling responsible for “saving the world” led to tormenting guilt when things didn’t work out as he felt they should. Some other cognitive distortions that might lend themselves to feelings of guilt include black and white thinking, personalization, and thought-action fusion. A recent study of those with OCD focused on the precuneus, a part of the brain often involved with responsibility. According to the researchers:

The level of precuneus activity was greater for individuals with greater levels of obsessive-compulsive symptoms, and the activity increased when someone experienced greater ‘thought-action fusion’ – believing a negative event would become reality.

While those of us without OCD might become frustrated at what we perceive as our loved ones overblown feelings of guilt, these emotions are very real for OCD sufferers. Telling our loved one to “stop feeling guilty,” is likely to be as successful as telling him or her to “stop obsessing.”

So what do we do?

The first step, I believe, is to find a therapist who specializes in treating OCD. In addition to using exposure and response prevention (ERP) therapy, Dan’s therapist also helped him understand the cognitive distortions he was dealing with; this awareness alone was extremely helpful. The next step was to work on ridding himself of these cognitive distortions and this greatly reduced his feelings of guilt.

Guilt is a healthy emotion for us all. A child who feels guilty for “stealing” cookies from the cookie jar, or an adult who feels guilty for purposely hurting a loved one, are both displaying appropriate guilt. But when you add OCD into the mix, “appropriate guilt” often goes haywire, and can overtake the sufferer’s life. Just one more reason to seek treatment and work toward recovery.

 

 

 

 

 

 

Posted in Mental Health, OCD | Tagged , , , , , , , , | 10 Comments