OCD, Learning, and Memory Problems

I’ve written posts and articles about my son Dan’s struggle with OCD in college, and our family’s experience is also fully chronicled in my book Overcoming OCD: A Journey to Recovery. The most frustrating aspects of this portion of Dan’s journey were not only the widespread lack of understanding of obsessive-compulsive disorder, but also dealing with an academic support staff who had no idea how to help him.

To be fair, it really wasn’t their fault. They were willing to help; they just didn’t know how. Aside from offering extra time on tests (which is often not even a good idea for those with OCD) they were at a loss. And so were we. Once we realized that Dan was struggling with time management, the balance of details within the big picture, and over-thinking, we asked that these issues be addressed mainly through the open-mindedness and flexibility of his professors.

But now there is something more concrete those with OCD can offer the academic support staff at schools and colleges. A January 2018 study published in the journal Psychological Medicine involved questioning 36 adolescents with obsessive-compulsive disorder and 36 healthy adolescent controls. Participants were asked to complete two memory tasks designed to measure learning and cognitive flexibility. Adolescents with OCD struggled with cognitive inflexibility and showed significant impairments in both learning and memory. The study is summarized nicely here if you’d like to learn more about it.

I believe the implications of this study are huge. For one, unaddressed learning and memory issues in an academic environment are sure to stress already anxious children or adolescents. Their confidence and self-esteem are also likely to be affected. Not surprisingly, all of these issues can exacerbate OCD and quickly lead to a downhill spiral in both academic performance and overall well-being. The results of this study have already been shared with the appropriate professionals who have subsequently helped students with OCD achieve a level playing field and realize their potential. What a relief this must be for students and their families who have struggled for so long, yet haven’t quite been able to put into words what they are actually struggling with.

Another important implication of this study is that it educates and enlightens those who still have little to no understanding of obsessive-compulsive disorder. There are academic support staff out there who believe those with OCD just need to be able to leave the room if they “have” to wash their hands – that is the extent of their comprehension of the disorder. But problems with memory, learning, cognitive inflexibility? Who knew? This study provides concrete evidence that those with OCD can use to advocate for themselves.

We are making progress. Slowly but surely, researchers are working hard to chisel away at the mysteries of obsessive-compulsive disorder, helping those with OCD along the way and giving them hope.

 

 

 

 

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How Effective is CBT for Children with OCD?

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There is no question that having a child with obsessive-compulsive disorder affects the whole family. I’ve written before about how pediatric OCD results in disrupted routines, stressful social interactions for children, and poor job performance for parents. Elevated stress and anxiety levels, as well as feelings of frustration, anger, and sadness become the norm in a household dictated by OCD.

I’ve also written about how important it is to get the right help as soon as possible. Even if parents or other caregivers think things are “not that bad,” the situation is likely worse than they imagine. Because children (and adults) with OCD can be adept at hiding their symptoms, they are often the only ones who know the real extent of their disorder – parents don’t often recognize the extent of their children’s suffering. And on the off chance that the OCD really isn’t “that bad,” it’s still always better to seek treatment sooner rather than later.

In an interesting review published in Psychiatry Research, predictions related to the effectiveness of Cognitive Behavioral Therapy (CBT) in children and adolescents (all under the age of 18) with OCD were made:

In predictor analyses, worse response to CBT was associated with older age, higher OCD symptom severity, higher level of OCD-related impairment, worse depressive symptoms, the presence of any comorbid mental disorder, and higher family accommodation of OCD symptoms. Medication at baseline was not a predictor of CBT effectiveness.

No surprises there. This analysis confirms the importance of getting help for OCD as soon as possible, before OCD has become firmly entrenched.

There is also some discussion in the report about CBT for children and adolescents with OCD who have comorbid tic disorders. Honestly, I found the wording and conclusion confusing, but it did bring to mind my son Dan’s experience with facial contortions, twitching, and tics. It is known that tics and Tourette syndrome are not uncommon in those with OCD. Statistics vary, but approximately 50% of children with OCD have, or have had, tics and 15% of them have been diagnosed with Tourette syndrome. In Dan’s case, it’s possible some of the medications he was taking contributed to his tics. Thankfully, once he was taken off the meds and was working hard on his exposure and response prevention (ERP) therapy, all his tics, twitches and facial contortions disappeared. It’s interesting to note that his comorbid diagnoses of depression and GAD (Generalized Anxiety Disorder) also fell by the wayside.

The bottom line is CBT in the form of exposure and response prevention (ERP) therapy works for children and adolescents. The sooner help is sought, the better the results will likely be. Once OCD is under control, an added bonus might be the disappearance of comorbid conditions such as depression, GAD, and even tic disorders.

There are no good reasons to delay treatment of obsessive-compulsive disorder for our children. If your child or adolescent is struggling with OCD, please do the right thing. Get help for them now.

 

 

 

 

 

 

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OCD News

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I’ve recently become aware of some exciting programs, studies, and projects going on aimed at helping those with obsessive-compulsive disorder, so I thought I’d highlight three of them for you:

Ryan Bernstein, a high school junior from Portland, Oregon, has undertaken an amazing project to raise money for the International OCD Foundation (IOCDF). He is writing a book titled: OCD to Me: an anthology of anxieties and is seeking contributions for his book. You can read more about Ryan’s personal story, as well as complete his short survey (four questions) here.

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Boston University runs a wonderful program for college-aged students. From the article:

For the past three years, Boston University has offered one of the few programs in the nation dedicated to teaching students who have had to leave college the coping skills that will give them a shot at getting back into school or work while managing severe anxiety, depression, and other serious mental health conditions.

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An exciting five-year study involving home-based ERP therapy for children is in the works, and you can read about it here. From the article:

The Pediatric Anxiety Research Center (PARC) at the Bradley/Hasbro Children’s Research Center, has received a $3.4 million funding award from The Patient-Centered Outcomes Research Institute (PCORI) to compare patient-centered (primarily in the home/community) to provider-centered (primarily in the office) outpatient treatment for kids with anxiety and obsessive compulsive disorder (OCD). The aim of the study is to devise an alternative outpatient treatment model featuring a bachelor’s level clinician, or mobile exposure coach, working in conjunction with PhDs to conduct in-home therapy visits.

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I’ve highlighted the above project, program, and study because they are all exciting, innovative ways to help those with OCD. I hope you’ll take the time to read more about them.  Who knows? They just might be exactly what you or someone you care about is looking for!

 

 

 

 

 

 

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OCD and Physical Sensations

 

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I have previously written about OCD and mental imagery, where I discussed how those with OCD (and those of us without) sometimes see, hear, or feel things without the presence of corresponding external stimuli. In particular, those with OCD often find their intrusive thoughts are accompanied by sensory experiences that attach some type of physical sensation to the distorted thinking of OCD.

A recent study published on November 20, 2017 in the journal Clinical Psychology and Psychotherapy delves into the link between the strength of compulsions associated with OCD and the physical sensations that come with them. For example, the study authors noted that participants who struggle with contamination obsessions might feel “uncomfortable sensations in the skin, muscles or others body parts, like an itch or a burning sensation that drives the patient to do the compulsion until feeling…relief.”

For purposes of this study, researchers asked people with OCD to answer questionnaires designed to measure the strength of these sensory obsessions. The results indicated that people who had more difficulty controlling their compulsions also tended to have stronger sensory elements related to their obsessions, compared with those who had less difficulty controlling compulsions. This seemed especially true for those whose obsessions focused on cleanliness and personal contamination. How interesting! This study suggests that the intensity of these sensations might play a significant role in how those with OCD manage their symptoms.

Other interesting findings from the study include the fact that the strong sensory components to obsessions appeared more often in people with all-around vivid imaginations, and that a large group of those with OCD experienced their intrusive thoughts as auditory – whispered, spoken or shouted voices.

Below are the key findings of the study, as summarized by the authors:

  • Obsessive thoughts are often accompanied by perceptual experiences such as feeling dirt on one’s skin or seeing blood before one’s inner eye.
  • Sensory experiences have been associated with decreased insight in obsessive–compulsive disorder.
  • We found that 75% of obsessive–compulsive disorder patients have such sensory experiences.
  • The severity of perceptual obsessions predicted low control over compulsions.
  • Clinicians should not confuse sensory experiences with hallucinations and psychosis, respectively.

I especially appreciate this last bullet point as I’ve written about OCD and psychosis and the confusion it might cause, not only for those with the disorder but for clinicians as well.

What I find most exciting about this study is its potential to be helpful in the treatment of obsessive-compulsive disorder. If strong sensations make OCD symptoms more difficult to beat, perhaps we could focus on how to reduce or redirect these sensations as part of the person’s therapy.

Once again, I am incredibly thankful for all the dedicated scientists who continue to work hard to unlock the mysteries of OCD!

 

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OCD and Limerence

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Albert Wakin, a professor of psychology and expert on limerence, defines the term as a combination of obsessive-compulsive disorder and addiction – a state of “compulsory longing for another person.” Professor Wakin estimates that five percent of the population struggle with limerence.

Limerence involves intrusive thinking about another person. It is often confused with love addiction but there is a fundamental difference. In love addiction, people want to replicate the feeling of falling in love again and again, while those experiencing limerence are focused on feelings for a specific individual.

Limerence is not the same as being in love. It is smothering and unsatisfying with little to no regard for the other person’s well being. In healthy relationships, neither partner is limerent; they do not struggle with constant, unwanted thoughts about their partner. A person experiencing limerence has feelings so intense that they rule every waking moment causing everything else to be left in the background. The person also tends to focus completely on the positive attributes of the “limerent object” and avoids thinking about any negative aspects.

Professor Wakin says, “It’s an addiction for another person. And we find that the obsessive-compulsive component of it is extremely compelling. The person is preoccupied with the limerent object (the subject of their obsession) as much as 95 percent of the time.”

When I began researching OCD and limerence I was interested in learning about their connection. I imagined it might be the opposite of relationship OCD (R-OCD). But now I’m not so sure. I certainly see the obsessive component to limerence and the compulsions could involve ruminating about the limerent object, but so much of it just doesn’t seem like OCD to me.

One question that I wasn’t able to find the answer to is, “Do those with limerence realize their obsession isn’t rational?” My guess is there is no simple answer. In this day and age, when young people in particular are influenced by television shows such as The Bachelor, it’s not hard to understand why so many of us are confused about what is rational and what isn’t when it comes to feelings, relationships, and love.

To confuse matters more, there appears to be no solid evidence that people with OCD (or substance addiction) are more likely to experience limerence. Professor Wakin and his colleagues hope to conduct and compare brain-imaging research on those with limerence, OCD, and addiction, to see how they might or might not be related. This research should be helpful, but in the meantime, Cognitive Behavioral Therapy (CBT) has shown some promise for those dealing with limerence.

 

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You’ve Beaten OCD – Now What?

A version of this post first appeared on my blog in July 2016…..

For many people, the journey through obsessive-compulsive disorder and back to good health is a long one. Getting the correct diagnosis, or even just recognizing you have OCD, often takes years. Then comes the search for appropriate treatment, followed by a long-term commitment to therapy and hard work. We know recovery is possible, but it is rarely a “quick fix.”

I try to imagine what it must feel like, after being controlled by OCD for so long, to finally have your life back? Relief. Gratitude. Excitement!

Yes, but for many, also add trepidation and confusion, with a helping of uncertainty.

What do I do NOW?

Living with a good-sized case of obsessive-compulsive disorder can be a full- time job. Obsessions, compulsions, more compulsions, getting stuck, avoidance, more compulsions, planning your next move, more compulsions – it can literally take up all your time. When my son Dan’s OCD was severe, OCD was all he “did” day in and day out. It truly stole his life.

And yet, it’s not hard to understand that when you’ve performed compulsions for such a long time, they can become comfortable and familiar – not unlike a security blanket.

So when you finally get your life back, it can be disorienting and scary. You might even feel anxious about feeling well because you’re not used to feeling that way and don’t know how to handle not being a slave to OCD. What do you do with all this free time? How can you be sure to live that happy, productive life you’ve worked so hard to reclaim?

I have heard from quite a few people who have faced this issue, and it’s not unusual for OCD to try to worm its way back into their lives. All the uncertainty about what’s to come can be a ripe breeding ground for OCD. In addition, those with the disorder might start to obsess about how they think they are supposed to feel, or maybe even wonder if they ever really had OCD in the first place?

Hopefully, those who have made it this far in their battle will recognize OCD if it rears its ugly head and see it for what it is – a big bully trying to regain control. They will respond appropriately by just acknowledging the anxiety, not giving it any additional attention, and then continuing on with their lives. Of course, one of the best ways to keep OCD at bay is by continuing to use exposure and response prevention (ERP) therapy.

Back to the question of “What do I do NOW?” the answer is clear. You live your life the way YOU want to, not the way OCD wants you to. You identify your goals and work toward them within the framework of your values. What do you want out of life? While to some people the answers are obvious, others might need guidance to help figure out their fresh path. A good therapist can be invaluable.

Let’s get back to those feelings of Relief. Gratitude. Excitement! Because for all those whose lives are now unencumbered by OCD, anything is possible. Your hopes and dreams really can come true!

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The Cost of OCD – And Yes, I’m Talking about Money

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If you or a loved one has obsessive-compulsive disorder, then you know how devastating  it can be when left untreated – it takes a huge toll not only on the person with OCD, but also on all those who care about him or her. In addition to wasted time and energy, relationships have been destroyed, families have fallen apart, careers have been ruined, and people’s lives have been shattered.

When we talk about the high cost of living with obsessive-compulsive disorder, the above scenarios are usually what we are referring to.

But what about the actual cost in dollars (or pounds, or whatever currency you use)? Is it expensive to live with OCD?

It sure is. My guess is everyone with the disorder will have his or her own examples, but let’s just take a look at a few of the more common ways money can be lost to OCD:

  • If you deal with contamination OCD, this might just be the most expensive type of OCD to live with. Perhaps you go through so many cleaning products you are buying them a few times a week or even daily. And don’t forget your inflated heating and water bills from the hours and hours of showers you “have” to take, or from the excessive loads of laundry you “must” do. You might regularly throw out perfectly good clothes or other items because you feel they are contaminated. Then you “have” to go out and buy new items to replace the contaminated ones. And if you wash your hands until they are so raw they bleed, you need to buy lotion and/or first-aid supplies to prevent infection. You might even need to visit a doctor – another expense.
  • If you have “hit and run” OCD or any type of OCD related to driving, you might find yourself driving in circles for hours just to make sure you didn’t hit anyone. Maybe you take longer routes to avoid certain roads. These compulsions add extra wear and tear onto your car and are a waste of gasoline.
  • If you have OCD related to your health it can come at a substantial cost. Unnecessary visits to doctors and hospitals as well as needless tests and medications can easily cost hundreds, if not thousands, of dollars.
  • If you deal with “just right” OCD, you might often be late for work, school, or other obligations, causing you to lose your job or perhaps your college scholarship, or at the very least find yourself underemployed. Job loss, poor school and work performance, and underemployment are all common repercussions of living with untreated OCD, and the financial costs can be staggering.

As you can see, in addition to mental torment, there is a huge monetary cost to living with OCD. And the financial losses are not limited to those with the disorder. Family members and all loved ones and caregivers often suffer as well.

The solution?

Get the right help. Yes, finding a good therapist and engaging in exposure and response prevention (ERP) therapy can be tough – and expensive – but instead of wasting time, energy, and money, you will be making the smartest investment possible as you work toward a life controlled by you, not OCD. And that’s something you can’t put a price on.

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