OCD and Transitions

by sira anamwong freedigitalphotos.net

As we enter this season of college and high school graduations, I’d like to share a post I wrote in May 2012, shortly after my son Dan graduated college…

A few days ago my son Dan graduated college. My last post touched upon what this milestone means to me, and this past weekend we had a wonderful celebration with lots of relatives and friends. A well-deserved gathering to honor the graduate.

The days, weeks, and months ahead will be a time of transition for Dan. I am keenly aware that the upcoming changes, by their very nature, will be stressful. He won’t be in school anymore, or living with his three best friends. His girlfriend won’t be nearby. In fact, none of his friends will be around when he comes back home. He’ll have lots of decisions to make – decisions he has never had to make before. What types of jobs will he apply for? How will he approach his job hunt? Where will he live? What are his short-term goals? His long-term goals? Dan, like other graduates, will basically be building a new life for himself, and though that can be stressful and anxiety provoking for anyone, it is often even more so for those struggling with obsessive-compulsive disorder, the “doubting disease.” So much uncertainty!

But there are ways to make this transition easier. I think one of the most important things to do is to prioritize all of these decisions, and just take one thing at a time. Focus on what is most important, and deal with that first.

Also, making major life decisions can be difficult for those with OCD and I think it’s important for those with the disorder to make sure their decisions are based on what they really want, not on what their OCD is dictating or what they feel is the “right” thing to do. Of course, depending on the severity of the OCD, this might be easier said than done, and that’s why having a support system in place is crucial. Therapists, family, and friends should all be aware of the changes going on and be there when needed.

Eating well, exercising, and taking care of ourselves in general are always important, and even more so during times of stress and change. Yet so many of us don’t make this a priority. Carving out some time for enjoyment, even if it’s something as simple as socializing with friends for a short time, can have a positive impact.

Dan’s OCD first became severe when he was a freshman in college. This was also a time of major transition for him. Will it happen again during this time of change?  The answer, of course, is “I don’t know.” I do know he now has the insight, skills and tools to fight his OCD – all things he didn’t have back then. Still, the future is uncertain. I, and hopefully Dan, will choose to embrace this uncertainty instead of worrying about it, and live each day to the fullest, as he moves on to this exciting new chapter in his life.

Congratulations to all the graduates out there and I wish you all the very best!

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Mental Health Awareness Channel on Vimeo

by cooldesign freedigitalphotos.net

In honor of Mental Health Awareness Month, Vimeo has posted 24 short films related to various areas of mental health.

Check them out!

You can find the videos here:

https://vimeo.com/channels/mentalhealthawareness

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A Mother’s Day Post

On Mother’s Day I often share this post that I wrote in 2011….

If you ask mothers what they want for their children, most would say, “I just want them to be healthy and happy.”  Truly, isn’t that what we all want?

So we do everything in our power to make this wish come true. We love, we nurture, we make sacrifices, and we go to the ends of the earth to try to achieve this goal for our children: to be healthy and happy.

But sometimes we come up short. Because as much as we like to think otherwise, so much of life is out of our control. Sometimes our children aren’t happy, and sometimes they are not healthy. And sometimes, as hard as we might try, there is nothing we can do to make things better for them. Whatever type of illness they are suffering from, all we want is for them to be okay.

We are in our own little club, we mothers. I don’t know about you, but anytime I hear a story of sorrow on the news, or read of tragedy in the newspaper, I rarely think of the victim. Instead my first thought is always, “That poor mother.”  Because there is no stronger emotion than the love of a mother for her child, we feel deeply when other mothers are suffering.

And so on this Mother’s Day my wish is for all mothers out there to have happy and healthy children. And if that’s not where you’re at right now, I wish you the strength and courage to carry on toward that goal.

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Mental Health Awareness Month – May 2017

by stuart miles freedigitalphotos.net

Though it’s not specific to OCD, I’d like to share this recent article I wrote….

May is Mental Health Awareness Month. In researching this yearly event I was surprised to learn that it started back in the 1940’s as a weekly observance and eventually expanded to include the entire month of May. In 2013, then President Barack Obama signed a proclamation stating his commitment to mental health and confirming May as National Mental Health Awareness Month.

Each year there is a different theme. Some past themes include What Mental Illness Feels Like, and Pathways to Wellness. This year’s theme is Risky Business. Mental Health America, the organization that started Mental Health Awareness Month, explains:

We believe it’s important to educate people about habits and behaviors that increase the risk of developing or exacerbating mental illnesses, or could be signs of mental health problems themselves. These include risk factors such as risky sex, prescription drug misuse, internet addiction, excessive spending, marijuana use, and troublesome exercise patterns.

Mental Health America, and other organizations such as the National Alliance on Mental Illness (NAMI), have created tools and organized resources to assist individuals, organizations and communities in raising awareness of the types of issues the above risky behaviors present, especially for young people. What a wonderful source of information!

Yet, even with all the awareness and advocacy surrounding mental health these days, there are still those who deal with brain disorders but are afraid to ask for help. Indeed, there are those who don’t even realize they are dealing with mental illness, and still others who reach out for help to no avail. I regularly hear stories of those being misdiagnosed, those who can’t afford proper treatment, and those who are told to just “suck it up” and get on with their lives. We live in a world where there is still stigma attached to anything even remotely connected to our mental health. Anyone who has first-hand experience with mental health issues or loves someone who does knows we have a long way to go.

And while I totally support Mental Health Awareness Month, I also believe we can each do our part every day of the year to bring about positive changes.

How? By talking. I’m not referring to public events, symposiums, or other organized activities, though they can certainly be helpful. I mean talking to each other – our families, loved ones, friends – anyone we feel comfortable with. Let’s work toward being as open about our mental health as we might be telling someone we have a physical illness. And let’s not forget talking’s underrated counterpart – listening. Everyone needs and wants to be heard and if we make it a point to listen – really listen – to one another, there’s a good chance we can positively impact all of our lives.

One of the main things I’ve learned as an advocate for OCD awareness is that once you open up to others, they will often open up to you. How many of us have felt so alone at times, thinking that nobody could possibly understand how we are feeling? The truth is there are people out there who have gone through or are going through something similar. But we will never connect with one another unless we talk. We need to share, we need to be heard, and we need to allow ourselves to be vulnerable. How else will we find each other?

Mental Health Awareness in May began over seventy-five years ago. That’s a long time. And while we have made huge strides in some respects, there are still many people who are suffering alone and in silence. Let’s all do what we can to change that. Let’s start talking.

 

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OCD and Rage

by stuart miles freedigitalphotos.net

When my son Dan’s obsessive-compulsive disorder was severe, he was so imprisoned by the disorder he could barely function. Not surprisingly, he was also depressed. Typically a mild-mannered young man, he would occasionally snap at me if I annoyed him or refused to enable him. These episodes were infrequent, and throughout his illness, Dan remained remarkably even-keeled.

This is not always the case.

A good number of people with OCD experience intense bouts of anger, or rage. While there aren’t a lot of statistics available, this study concludes that fifty percent of patients with OCD experience “anger attacks.” Not only can this be upsetting for the person experiencing rage, it can also be frightening for loved ones witnessing this potentially violent behavior. Rage in those with OCD can occur at any age, from young children to older adults.

For those who have even a basic knowledge of OCD, it’s not difficult to understand (at least to some degree) where this rage might come from. For one thing, those with untreated OCD are compelled to perform compulsions to keep their world (and possibly everyone around them) safe, and if these compulsions are interrupted or hampered in any way, it can feel equivalent to letting someone die. These feelings are real, and they can be intense enough to propel the person with OCD into panic mode – and then rage.

There are other possible causes of rage in those with OCD, including but not limited to:

So what do we do when our loved ones with OCD experience rage?

First and foremost, everyone in the home has the right to feel safe – and this is unlikely if you live with someone who regularly flies into a rage. The person with OCD should be working with a therapist who uses ERP therapy to treat obsessive-compulsive disorder and can also help your loved one better manage his or her emotions. In most cases once the OCD is under control, the rage will disappear. If the person with OCD is an adult who is refusing to get help, you might want to consider creating a contract.

A rage can involve screaming, hitting, biting, throwing things, and attacking oneself or others. If it ever escalates to the point where you fear for your safety or the safety of your loved ones, you should reach out immediately for help. You can call 911 and make it clear you are dealing with a medical emergency, so that the person with OCD is brought to a hospital, and not to the police station. This is something that nobody ever wants to do, but unfortunately is sometimes necessary.

Once again we see the irony of OCD. Those with obsessive-compulsive disorder strive to bring order, certainty, and safety to their world, yet the more they become a slave to OCD, the more the opposite happens. A good therapist can help those with OCD see the truth and encourage them to fight this tormenting illness with all their might.

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Brain-Circuit-Based Therapies for OCD

I say it over and over again on my blog. The evidence-based psychological treatment for obsessive-compulsive disorder is a type of Cognitive Behavioral Therapy known as exposure and response prevention (ERP). Medication is helpful for some individuals as well. With proper treatment, most people with OCD will improve.

But what if you don’t? What if, after attempting these traditional therapies, there is no improvement and you are still suffering with severe OCD? While I’ve written before about some people with OCD erroneously being labeled treatment-resistant, there are indeed a small number of people who receive no benefit from ERP therapy and/or medication.

Is there any hope for those who are truly treatment-resistant? Absolutely. There have actually been some alternative treatments around for a while. I’ve written about Deep brain stimulation, focused ultrasound, and neurofeedback which have all shown promising results for those with treatment-resistant OCD.

But there’s more. The research continues and in the Winter 2016 OCD Newsletter published by the International OCD Foundation, there is an excellent article about brain-circuit-based therapies for OCD. I’ll give a synopsis but I highly recommend reading the article for detailed information.

So what are brain-circuit-based therapies? The article explains:

Your brain is made up of cells called “neurons” which
communicate with each other. When several neurons work
together, they are referred to as a circuit or network.
If you’ve ever taken apart a computer or other electronic device,
you’ve likely seen a green plastic board covered in gold circuits.
Much in the way electricity travels through this circuit board to
convey information from one part of the computer to another,
your brain uses neural networks to convey information from one
part of the brain to the other.
 
So, instead of targeting neurotransmitters (the chemicals used to
communicate between individual neurons) using medications,
researchers are now looking at how neural networks function
to communicate from the parts of the brain that regulate, say,
emotions to the part of the brain that regulates movement. It
is our hope that new treatment methods that focus on neural
networks may offer help to those individuals who have not had
success with other treatment methods.

 

Non-invasive treatment options do not involve surgery and have minimal side effects. Those discussed in the article include:

  • Transcranial Magnetic Stimulation (TMS)
  • Transcranial Direct Current Stimulation (tDCS)

Invasive procedures involve neurosurgery which involve a small risk of infection or seizures. Those discussed include:

  • Anterior Cingulotomy
  • Anterior Capsulotomy
  • Deep Brain Stimulation

Again, I highly recommend reading the article for details about each procedure as well as the success rates. What I find most interesting about most of these techniques is that those who were previously considered treatment resistant were often able to benefit from ERP therapy and/or medication after undergoing one of the procedures. How great is that – they were no longer treatment resistant!

Brain-Circuit-Based Therapies seem to hold a lot of promise as researchers continue to try to unlock the mysteries of OCD. But for most people, good ‘ol fashioned ERP therapy, a lot of hard work and commitment, and medication if necessary will be enough to triumph over OCD.

 

 

 

 

 

 

 

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OCD and SSRI-Induced Apathy

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I tend not to write too much about obsessive-compulsive disorder and medication. While I’ve shared some of my son’s experiences in the hopes of helping others, I am not a doctor. I realize that the decision to take medication for OCD is a very individual choice and I know that for some people, medication can be quite helpful. For others it is not.

I do, however, believe in being as informed as possible, which is why I think it is important to mention this article titled SSRI-Induced Indifference. The article isn’t new; in fact it was written in  2010.

In a nutshell, SSRI-Induced Indifference encompasses two categories: emotional and behavioral. The emotional aspect is what comes to my mind when thinking of typical side-effects of SSRI’s. Indeed, emotional blunting is not an uncommon complaint in those taking SSRI’s, and Dan experienced this side effect. People describe emotional blunting in many ways, but basically it is a lack of emotion – no highs, and no lows. You know you’re supposed to feel a certain way, but the emotions are just not there.

What I didn’t realize until I read the article is that Dan also experienced the behavioral aspect of SSRI-Induced Indifference known as SSRI-Induced Apathy, and this typically manifests through low motivation, or apathy. The article makes it clear that this apathy must not be attributed to a “reduced level of consciousness, cognitive impairment (e.g., dementia), or emotional distress (i.e., depression).”

What an eye opener! If you’ve read my book, you might remember that at one point in Dan’s recovery, he was doing the bare minimum needed to get from one day to the next. He wasn’t motivated in any aspect of his life, yet he didn’t really seem depressed. Once his medications were reduced and then eventually stopped, he easily became re-engaged in his life. I don’t know for sure, but my guess is that symptoms such as Dan’s might easily be misdiagnosed as depression.

So it’s something to be aware of. If you experience emotional blunting and/or apathy while taking an SSRI, I’d suggest discussing it with your doctor. The good news is that all symptoms of SSRI-Induced Indifference seem to disappear once the medication is stopped. As always, decisions regarding which, if any, medications to take need to be made alongside your health-care provider by carefully weighing the benefits of the drugs versus their risks.

 

 

 

 

 

 

 

 



 

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