OCD and Multiple Sclerosis

microscope

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Obsessive-compulsive disorder is a complicated illness, and the cause, or causes, remain unknown. Research has shown that OCD is seen more frequently than usual in those with various physical disorders, such as muscular dystrophy. An October 2018 study published in Frontiers in Immunology highlights a connection between OCD and another disease – multiple sclerosis.

Multiple sclerosis (MS) is a debilitating autoimmune disorder, where the body’s immune system goes haywire and attacks healthy cells. It affects over two million people worldwide and has no known cure. Patients with multiple sclerosis and other autoimmune disorders are known to suffer from OCD, anxiety and depression. However, the relationship between these illnesses and the immune system has been somewhat of a mystery.

In the above-mentioned study, scientists found a direct link. They discovered that a class of cells that defends the body against invaders also triggers obsessive-compulsive behavior. In mice exhibiting symptoms of multiple sclerosis, the researchers noted that immune cells called Th17 lymphocytes induced behaviors characteristic of OCD. Th17 cells infiltrated the mice brains, and the researchers believe they likely disrupted nerve circuits involved in controlling obsessive behavior.

Specifically, the researchers found that the diseased mice (with symptoms of MS) spent 60 to 70 percent more time grooming themselves compared to healthy ones. They also buried a greater number of glass marbles and shredded more of their bedding to make nests—signs that are suggestive of OCD, which is partially defined by uncontrollable, repetitive behaviors known as compulsions.

To identify the trigger for such behavior the team focused on Th17 cells because previous studies showed they can penetrate the blood-brain barrier. They also play a key role in the progression of MS. The researchers infused diseased mice with Th17 cells and subsequently found an increase in the compulsive behaviors mentioned above. Moreover, brain tissue analysis in these mice showed that large numbers of Th17 cells were found lodged in the brainstem and cortex, which are involved in regulating grooming.

The study’s senior author, Avadhesha Surolia , said:

“For the first time, we are reporting a likely link between OCD and an important arm of cell-mediated immunity. Until now, we have looked at neuropsychiatric diseases as purely a neurological problem, ignoring rather completely the immunologic contribution.”

Interestingly, when the mice were given an antidepressant such as fluoxetine which boosts the uptake of serotonin, their obsessive grooming reduced. This suggests that Th17 cells eventually disrupt serotonin uptake, giving rise to OCD-like symptoms. Researchers believe other neurotransmitters such as glutamate might also be involved.

The team also gave the diseased mice digoxin, a molecule that inhibits Th17 development, and then found that the time spent on grooming was almost cut in half. This finding could be an important step in the development of medications that might be helpful for those with OCD and autoimmune disorders. You can read more about this interesting study here.

As is the case with research, we are often left with more questions than answers. But thanks to dedicated researchers we are moving forward and slowly peeling away some of the complicated layers of OCD.

 

 

 

 

 

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OCD and The Holidays

Image result for happy holidays sign

 

 

A version of this post first appeared November 2015…..

With the holiday season upon us, many of us are firmly entrenched in the excitement, anticipation, and busyness of this time of year. Maybe we will visit friends or relatives. Perhaps a small army of loved ones will descend upon us in our own homes, or maybe we will be part of smaller, more intimate gatherings.

Whatever our holiday plans involve, there are bound to be changes in our routines. While this can be unsettling for many people, those suffering from obsessive-compulsive disorder might have a particularly tough time, especially when dealing with vacationing and traveling. It’s not hard to see why these situations might trigger all kinds of concerns for those with OCD. No matter what type of OCD they are dealing with there’s always lots to worry about when stepping out of one’s comfort zone. Some concerns might include:

Will I be able to use the public or hotel restroom?

What if I hit someone while driving on the highway?

What if I get sick while I’m away?

Will my family be safe?

The questions are endless and will be different for each person with the disorder. As you can see, however, all these concerns revolve around one thing: the uncertainty of what will be. Those with obsessive-compulsive disorder have the need to know, for sure, that all will be okay.

Friends and family also are affected when traveling and vacationing with someone with OCD. Having to alter plans, not being able to be spontaneous, and dealing with high levels of anxiety are just some of the many examples of how OCD can impinge upon a vacation. Before actually leaving home, anticipatory anxiety with all of its “what ifs” and doubt can be particularly distressing. Interestingly, anticipatory anxiety is often worse than the actual event being agonized over. So what should those with OCD do when faced with all these holiday events fraught with doubt and uncertainty?

The answer is clear. They should push through their anxiety as much as they can and embrace the doubt and uncertainty that is holding them hostage. Yes, there is uncertainty that comes with traveling or vacationing or entertaining. Indeed, there is uncertainty in every aspect of our lives, and we all need to learn to accept, not fear, it.

I know it’s not easy. But it is possible.

If you have obsessive-compulsive disorder, I propose that you give yourself a gift this holiday season and make the commitment to stand up to your OCD. Embrace exposure and response prevention (ERP) therapy in the year to come and reclaim your life. You deserve to enjoy the holidays, and every day, with your family and friends instead of being controlled by obsessions and compulsions. It will not only be a gift to yourself, but just might be the best gift you could ever give to those who love you.

 

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Ocdtalk and Gratitude

 

heart

by sira anamwong freedigitalphotos.net

 

On December 18, 2010 I started this blog, determined to try to help others navigate the often turbulent – and terrifying – waters of obsessive-compulsive disorder. My family was just emerging from this ordeal ourselves and I felt that talking about my son’s journey through severe OCD could benefit others.

Still, I had my doubts. Who would want to hear my thoughts? I’m not a psychologist, and I don’t personally have OCD. But I took a leap of faith and decided to jump right in, propelled forward by the memories of how alone I felt when my son Dan was dealing with this horrible illness. If I had heard at least one story of hope back then, it would have made all of our suffering much more bearable. And now here I was – with a real story of hope. I had to share it.

The rest, as they say, is history.  The blog has reached more people than I ever thought possible. My book, Overcoming OCD: A Journey to Recovery was published by Rowman & Littlefield in January 2015 and the paperback version followed in November 2017. I have been fortunate to speak all over the country and have been interviewed many times as well. It has been, and continues to be, incredibly rewarding.

As worthwhile and exciting as all of these events have been, what has been most gratifying to me over the years has been the individual connections I have made. From comments on my blog to personal emails, phone calls,  and meetings, it has been a privilege to be a part of all of your journeys.

I have been posting at least weekly since that very first entry back in 2010. It is time to step back a little. Ocdtalk is still alive and well, and I will still be sharing news and thoughts about OCD with you – just not as frequently as I have been. It will be a new chapter for ocdtalk. I will continue to write about OCD and other mental health topics for Psych Central.

In this season of Thanksgiving, I want to thank each and every one of you from the bottom of my heart for all the support you have given me over the years. I am truly grateful and it is an honor to continue to be part of your lives.

 

 

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OCD and Mindfulness

mindful young woman

freedigitalphotos.net by hyena reality

A version of this post first appeared in February 2014…….

For those of you not familiar with the concept of mindfulness, it is the act of focusing on the present moment in a nonjudgmental way. Just noticing and accepting what is.

Anything strike you about this definition? To me, it seems as if mindfulness is the exact opposite of obsessive-compulsive disorder:

Focusing on the present moment? Those with OCD rarely do that. Instead they either find themselves immersed in the world of “what ifs,” worrying about everything that might go wrong, or agonizing over things they think might have already gone wrong.  Lots of thinking about the future and the past. Not so much about the present.

And in a nonjudgmental way? If you have OCD, you’re probably laughing right now, because chances are you judge yourself all of the time. Whether it’s blaming yourself for bad things that might happen in the future or that possibly happened in the past, or thinking of what you did wrong or will do wrong or should have done differently, those with OCD are continually assessing their thoughts and actions. And because they often deal with cognitive distortions, these assessments are typically incorrect. One type of cognitive distortion is thought-action fusion, where people believe that thinking bad thoughts is akin to performing the action associated with the thought, or the belief that thinking these same thoughts can somehow make them come true. For example, new moms sometimes have thoughts of hurting their babies. Most will acknowledge the thoughts as having no meaning and let them go. But moms dealing with thought-action fusion might be horrified and immediately consider themselves terrible people, unfit parents, and a danger to their children, because what kind of mother thinks that way? Judgment judgment judgment.

In spite of the fact (or maybe because of it) that it is, in many ways, the opposite of OCD, many  people with OCD who practice mindfulness find it very helpful. To be able to focus on what is really happening in any given moment, as opposed to dwelling on the past or anticipating the future, takes away the power of OCD. So while exposure and response prevention (ERP) therapy remains the front-line treatment for OCD, mindfulness is a good additional tool. It can help with ERP as well as with the anxiety and fear that come along with OCD.

While the concept of mindfulness is simple, it is not always easy to put into practice. It takes discipline, awareness, practice and perseverance, but it is so worth it. I personally have become more mindful in my own life. While I don’t have OCD, I am quite prone to “what ifs,” and when I find myself heading down that road I now easily (usually) stop myself and focus on the present moment. An act so simple, yet so powerful.

And while I welcome the calm that mindfulness brings me, I am even more thankful for an additional unexpected benefit: gratitude. Focusing on the present allows me to stop and catch my breath, and when I do that I somehow become keenly aware of all the good in my life. Not in the past, and not in the future, but right now. Because, for all of us, right now is what really matters.

 

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OCD and Lack of Family Support

arguing

FreeDigitalPhotos.net by David Castillo Dominici

A version of this post first appeared on my blog in February 2014……….

I have written about OCD and the importance of family involvement in treatment, and some of the comments I received on that post proved to be eye-openers for me.  My  assumption has always been that family members, especially parents, are totally supportive of their loved one with OCD. This theory has been backed up over and over. I get comments and emails from family and friends of those with OCD who desperately want to help them. I connect with people at OCD conferences who want to learn whatever they can about the disorder so they can encourage and advocate for their loved ones. I think of my own extended family who, when things were rough for Dan, offered to help out in any way they could.

While my experiences are real, my view is skewed. Obviously I don’t hear from parents who are not supportive of their children. Why would I? And these same people are not attending conferences or reaching out to others or advocating for their loved ones. There are many reasons why this might be, such as believing their child should just “get over it,” or not acknowledging they are dealing with an actual illness. Maybe they’re embarrassed. To me, the reasons don’t matter much. What matters is there are people with OCD out there who are not only suffering, they are suffering alone.

This is heartbreaking. Even with all of the support in the world, obsessive-compulsive disorder can be a devastating illness. But having to deal with OCD without that support? I can’t even imagine. And my guess is that many people with OCD who are unsupported are also ridiculed and totally misunderstood by those they love. Nobody deserves to be treated that way.

I am not talking about ignorance here. Ignorance is the lack of knowledge. Most of us who find ourselves catapulted into the world of OCD start off ignorant. I sure did. But we do what we’d do if our loved one had been diagnosed with any illness. We learn as much as we can about it and try to find appropriate help. I know there is stigma to deal with as well as preconceived notions and misinformation about OCD. I know families and their histories can be complicated. I get this. But it shouldn’t matter. When your child is suffering you need to put all that baggage aside, learn the truth about OCD, and take appropriate action.

For those suffering with OCD who have not gotten the support they need from their families, I hope they can find the strength to develop the support system they deserve. Good friends, clergy, social workers and teachers are some examples of people who could be helpful.

Unfortunately, I know I am likely preaching to the choir here. Those who have no interest in learning about OCD or helping their loved ones are probably not reading my blog. I hope someone can reach them.

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OCD and Physical Pain

pain

by marin freedigitalphotos.net

 

Many people believe that physical pain and mental pain can be connected. I often hear from people with severe OCD who also suffer from debilitating physical pain. It’s not unusual, once their OCD is treated, for their physical symptoms to subside or even disappear completely.

Sometimes the pain those with OCD experience is directly related to compulsions they perform. For example, some people with OCD are compelled to perform extensive rituals while showering, perhaps twisting and turning in particular ways for a specific amount of time. This might lead to chronic back or neck pain. Repetition is common with compulsions and can lead to physical pain such as arthritis or carpal tunnel syndrome. I have heard of those who deal with trichotillomania experiencing relentless pain in their arms, wrists, hands and fingers. Also, turning doorknobs and tightening water faucets are other common compulsions in OCD that can lead to injury and physical pain.

In other cases, pain appears unrelated to the disorder. Headaches, intestinal issues, and fibromyalgia are just a few examples. Are they connected to obsessive-compulsive disorder? I don’t know, but I do know that having both physical pain and OCD can get quite complicated. For example, if someone has a severe headache, he or she would (hopefully) go to their doctor. The doctor might order a test, such as an MRI, which  would probably come back normal. The person’s headache subsides, and life returns to normal.

That’s if you don’t have OCD. If you do have OCD, you might feel reassured immediately after the results of the MRI, but then the obsessive thinking might kick in:

How can I be sure the test didn’t miss something?

I tripped the other day and have been more forgetful than usual. I must have a brain tumor.

Maybe the doctors got my test results mixed up with someone else’s?

As you can imagine, this list is endless. Compulsions to temporarily quell this anxiety might include going back to the doctor, asking a loved one for reassurance, or being hyperaware of every “symptom” you feel. All of these rituals only serve to make the OCD stronger.

Nothing is simple when it comes to OCD.

In an interesting study related to OCD and pain, researchers found that study participants with obsessive-compulsive disorder were actually unusually tolerant of physical pain, regardless of the nature or severity of their symptoms. The scientists believe these findings suggest that individuals who struggle with emotional pain are able to endure physical pain to a much greater extent than others. In a nutshell, it appears the physical pain distracts from the emotional pain. This finding can perhaps give us somewhat of an understanding of the role of self-injury in OCD.

Pain and obsessive-compulsive disorder appear to be connected in different ways. As I mentioned at the beginning of the article, however, when OCD is properly treated, some symptoms of pain might diminish, or disappear completely. Another great reason to get proper treatment and fight OCD.

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ERP Therapy – A Well-Guarded Secret?

secret

by stuart miles freedigitalphotos.net

OCD Awareness Week has come and gone and there were many successful, informative events to help all those whose lives have been touched by obsessive-compulsive disorder. I think the IOCDF always does a great job with its programming.

There was also attention paid to OCD through the national media, though I’m not sure if the two shows I watched/listened to were broadcasted because of OCD Awareness Week. While I think the productions both did a good job debunking the myths of OCD and illustrating what the disorder is all about (as much as you can without actually having OCD), I believe they were sorely lacking in one extremely important area – treatment.

The first show was a podcast sponsored by American Public Media. Six people with OCD recorded their thoughts and feelings throughout the course of a day, giving the listener an idea of how OCD operates. I think it was a great idea. But I kept waiting for the host of the program – or anyone – to inform us that, if you have OCD, you do not have to be controlled by it – it is treatable. While I realize that treatment was not the focus of the podcast, I also believe that not saying anything about recovery leads people to believe “that’s the way it is,” and there is no treatment for the disorder. I wasn’t asking for a lot. One sentence saying, “OCD is very treatable” would have satisfied me. But there was nothing. NOTHING! I think one of the six people with OCD might have used the word “Prozac” once in passing but that was it.

The second event was a segment of 60 Minutes with author John Green (The Fault in Our Stars, Turtles All the Way Down). John has obsessive-compulsive disorder, which is the subject of his novel Turtles All the Way Down. What an inspiration he is to everyone (young people in particular) with OCD! When asked what he does to help himself, I believe his only answer was “exercise.” I don’t know what type of therapy, if any, Mr. Green has tried, but again, I was still hoping that at some point during the broadcast the interviewer would throw in at least one sentence: “OCD is treatable.” But sadly, again, nothing.

I believe these firsthand accounts of living with OCD are invaluable. I really do. But when you (or a loved one) are suffering from this potentially devastating disorder, the only question you’re likely asking is “How can I get better?” I believe we are doing a poor job of answering this question.

Ten years ago my son Dan suffered from severe OCD. As my book jacket says, “he went from seven therapists to ten medications to a nine-week stay at a world-renowned residential program.” I believe exposure and response prevention (ERP) therapy saved Dan’s life, but finding this treatment was difficult. I became an advocate for OCD awareness and proper treatment precisely for this reason – to let others know that ERP therapy is the evidence-based, first-line psychological treatment for OCD as recommended by the American Psychological Association, and to spread the word that OCD, no matter how severe, is treatable.

Ten years later, for reasons that I just can’t fathom, this therapy still seems to be a well-guarded secret.

 

 

 

 

 

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