Helping Those with Recovery Avoidance

hope 3

by stuart miles

A version of this post first appeared on my blog in April 2013….

One of the most heartbreaking aspects of obsessive-compulsive disorder is the frequent occurrence of recovery avoidance. Obsessive-compulsive disorder is a potentially devastating disorder, but it is treatable. Still, many people with OCD are so terrified of treatment, and perhaps of even getting better, that they cannot bring themselves to even attempt exposure and response prevention (ERP) therapy.

So what can we do when someone we love has OCD but is not “ready” for treatment? The above link to recovery avoidance gives suggestions which include expressing our concerns to our loved ones, not enabling them, and continuing to live our own lives in a positive manner. So many families of those with recovery avoidance follow these recommendations as best they can. Sometimes there are positive results, and other times, their loved ones with OCD continue to deteriorate before their very eyes.

It’s hard to witness, especially for parents who are used to making everything “all better.” How can we just sit around and watch someone we care so much about get sicker and sicker? And so we continue to search for therapists, continue to learn everything we can about OCD and its treatment, and continue to look into every program and facility out there. These are all positive actions but the truth is unless the person suffering from OCD is ready to accept help, our efforts are likely to fall short.

Again, how can we help those with OCD commit to treatment? We can try talking to them, and we can visit a myriad of health-care professionals who also try to get through to them. We feel desperate, and resort to begging, pleading, and even yelling at our loved ones because we don’t know what else to do. They say we don’t understand, and it’s true, we don’t. Who could understand?

Other people with OCD. People who have struggled and people who have triumphed. People who get up every day committed to fighting OCD, accepting relapses if they should occur, and just continuing on doing the very best they can, determined to not let OCD overtake their lives. I think that’s what people currently suffering with OCD need to see – that there are others who truly do understand, and more importantly, have stood up to OCD and reclaimed their lives. Support groups, blogs, and events such as The International OCD Conference (being held July 27-29 in Washington, DC) have the potential to be incredibly helpful.

Many people with OCD report that having meaning in their lives and staying true to their values are important parts of their recovery. What better way to do this than to support others with OCD in whatever way works for you. It’s likely to be a win-win situation for everyone.


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How Can I Get Rid of My Anxiety?


girl with head in hands

by ambro

As an advocate for OCD awareness, I get lots of emails from people. One of the most frequent questions I receive is some form of “How can I get rid of this terrible anxiety that is ruining my life?” While I’m not a therapist, I have learned a lot in the eleven years since my son was diagnosed with obsessive-compulsive disorder, and one thing I know for sure is that is not the question any of us should be asking.

The reason? Well, for one thing, a life without anxiety is not only an unattainable goal, but an unhealthy one. Anxiety serves a purpose for us and can be helpful. For one, our instinctive fight-or-flight response can protect us from danger (think gathering  your family quickly to escape a house fire). Also the presence of anxiety can motivate us to get things done (think feeling anxious about your grade in a course and studying extra hard for the final exam).

But what if you suffer from unrelenting, severe anxiety and are dealing with a brain disorder such as obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, or social anxiety disorder? What if you’re paralyzed with so much fear and anxiety that you can’t enjoy life, or even leave the house?

Then by all means you need help. But the question to ask isn’t “How do I get rid of my anxiety?” but rather “How do I learn to live with my anxiety?”

There’s a big difference.

I know of many people who begin therapy for OCD thinking they will get rid of their obsessions and become anxiety free. What they quickly learn, however, is that exposure and response prevention (ERP) therapy, the evidence-based cognitive therapy used to treat OCD, actually initially raises anxiety as the person with obsessive-compulsive disorder is asked not to perform any compulsions. Over time, the anxiety will become less intense and subside quicker, but there will still be times in their lives when they will become anxious. None of us, whether we have OCD or not, can control our thoughts or our anxiety, but we can learn the best ways to react to them.

If you have OCD, ERP therapy can help you reclaim your life. Some additional therapies that might also be beneficial in conjunction with ERP therapy include Acceptance and Commitment Therapy (ACT), mindfulness, and medication. You can learn to accept the uncertainty of life, as well as the anxiety that often goes along with that acceptance. Perhaps most importantly, you will be able to move on from a life dictated by fear to a life where you are free to honor your values, pursue your goals, and follow your dreams.




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OCD and Atypical Antipsychotics


This post originally appeared in October 2013. Since that time, more antipsychotics have appeared on the market and more studies have shown the harm they can cause……

Medication had a significant impact on my son Dan’s journey through severe OCD. While certain drugs appear to be helpful for some people with OCD, they only seemed to make things worse for Dan. Part of the problem stemmed from his being overmedicated, as well as the fact that he was prescribed drugs that we now know can exacerbate obsessive-compulsive disorder.

Atypical antipsychotics (also known as second generation antipsychotics) are sometimes given to people with OCD to “enhance” the effects of an SSRI. This was the explanation given to us twice, when Dan was prescribed two different antipsychotics. I’ve written previously about some of the side effects he experienced so I won’t go into that here, but suffice it to say no good (and quite a lot of bad) came out of his taking these drugs.

Seth Gillihan, PhD discusses a study conducted by researchers at Columbia University and The University of Pennsylvania. Participants already taking an SSRI to treat their OCD were separated into three groups. One group was given seventeen sessions of exposure and response prevention (ERP) therapy, one group was given an atypical antipsychotic, and the final group was given a placebo.

Dr. Gillihan said:

The results after 8 weeks were striking. Individuals in the ERP condition on average had a 52% reduction in their OCD severity scores, whereas those in the risperidone (13% reduction) and placebo (11% reduction) conditions were virtually indistinguishable.

It’s clear. Exposure and response prevention (ERP) therapy is effective. The atypical antipsychotic however, did not provide any statistically significant benefit over that of a placebo. Given this information, I would think long and hard before taking such a heavy-duty medication for the treatment of OCD. Certainly I hope doctors will think long and hard before prescribing it.

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Sensorimotor OCD

tense young man

by imagerymajestic

This post first appeared on my blog in October 2013….

There are so many different types of obsessions and compulsions when it comes to OCD. Perhaps one of the less talked about are sensorimotor, or body-focused, obsessions which involve a heightened awareness and focus on involuntary bodily activities and processes. Hyperawareness of swallowing, breathing, or blinking are common examples of  these types of obsessions. Additionally, overattention to bladder and digestive processes, indeed any unhealthy focus on a specific body part or organ, might also fall into the category of sensorimotor obsessions.

To me, these types of obsessions seem particularly brutal because they involve necessary, ongoing processes in our bodies. There truly is no escape, and this fact often plays into the obsessions of the person with OCD. The fear of never being able to stop thinking or focusing on their swallowing, or beating heart, can cause intense anxiety in those with OCD. These people might be consumed with worry about swallowing, might actually be afraid of choking, or they might just be tormented by the thought that they will never be able to stop thinking about swallowing. Not surprisingly, compulsions that help distract the person with OCD follow. Counting, for example, might briefly help someone with OCD focus away from their swallowing. Avoidance behaviors such as avoiding certain foods might also be a compulsion in this case.

But as we know, performing compulsions never helps for long, and will make the OCD stronger in the long run. Those with OCD who suffer from sensorimotor obsessions often find their lives greatly affected. They have trouble concentrating on anything other than their obsession(s), and have trouble socializing and sleeping as well.

So what is the treatment for this particularly torturous type of OCD? The same as for all types of OCD: exposure and response prevention (ERP) therapy. Those dealing with sensorimotor obsessions need to face their fears and voluntarily pay attention to whatever bodily activity they are agonizing over. They need to feel the anxiety that ensues, and it will eventually diminish. In other words, they need to do the opposite of what their OCD dictates.

Dr. Steven Seay has written a great three-part series discussing many aspects of and treatment for sensorimotor OCD. I highly recommend checking it out for more information. Sensorimotor OCD, like many other types of OCD, can be complicated, confusing, and debilitating. For those suffering from sensorimotor obsessions, it is crucial to work with a therapist who specializes in treating OCD. With the right treatment, those who suffer from this type of OCD will soon be able to breathe easy….literally.

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Real Event OCD

sad woman

by david castillo dominici

As many of us are aware, one of the cornerstones of obsessive-compulsive disorder is doubt:

“Did I hit somebody while driving?”

“Did I say or do or think the wrong thing?”

“Did I shut off the stove, turn off the lights, and/or lock the doors?

The list goes on and those with the disorder often find themselves obsessing over things that may or may not have happened.

But what if you are fixated on an event in your life that actually did occur? What if you did “something terrible” a long time ago (or last week) and now you can’t stop thinking about it? You’re trying to remember all the details, you’re analyzing every aspect of the occurrence, and you’re wondering about how awful a person you must be to have done what you did.

Then you could be dealing with real event OCD (sometimes called real life OCD).

I think it’s safe to say that most of us, whether we have OCD or not, have done things in our lives that we wish we hadn’t. It’s all part of being human. We are not perfect, and sometimes we make mistakes – in how we choose to act, in which road we decide to take, in how we treat people. Many adults cringe at the thought of some of their behaviors as children or teenagers and would now behave very differently if they could go back in time.

While people without OCD can certainly regret their actions and even be bothered throughout their lives by events they’re not proud of, it’s a whole different ball game for those with OCD. People with OCD just cannot let it go and likely feel a sense of urgency to figure it all out – quickly and thoroughly. As an example, let’s imagine someone with OCD who is a kind, caring person. She remembers that in middle school there was one girl who everyone teased, and on a few occasions she joined right in. She now thinks, “What kind of a horrible person bullies someone? Maybe I’m responsible for messing up this person’s life – scarring them forever?” She searches for this girl on Facebook so she can apologize, but can’t find her. Now of course she is thinking the worst: “Is this girl even still alive, and if not, I could be to blame……..”

See the difference? OCD is laced with cognitive distortions such as black and white thinking and catastrophizing. While whatever real life event OCD latches on to might not be the person’s proudest moment, it is highly unlikely to be nearly as bad as the person perceives. Actually the problem is not the event, or even how the person with OCD feels about what happened. The problem is their reaction to their thoughts and feelings. Instead of trying to “solve the problem,” thoughts, feelings and memories of the event should be observed, accepted, and allowed to come and go. No compulsions (which in real event OCD typically include reassurance seeking and mentally replaying the event) allowed!

There are so many variations of OCD: hit-and-run OCD, harm OCD, and real event OCD, to name a few. The good news, however, is the treatment is the same no matter what type of OCD you have. If you think you might be dealing with real event OCD, exposure and response prevention (ERP) therapy can help you turn your tormenting obsession into nothing more than an event of the past.

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Can We Decide Not to Worry?

close-up of woman

This post first appeared on my blog in September 2013……

I was an anxious child and an anxious teenager. After I graduated high school, I distinctly remember saying to myself, “Enough worrying. You’re going to college. Relax and have a good time.” And I did. I didn’t worry about my grades (a big worry in high school even though my grades were great) or my social life, or anything for that matter. I didn’t slack off; I just didn’t worry. It’s amazing, now that I think of it. How is it that I could stop worrying so easily?

My worrying and anxiety came back with a vengeance after going through a difficult time, and learning a tough lesson. Bad things, horrible things, really do happen randomly, for no obvious reasons. The world is a dangerous place where things can go wrong, and so much is out of our control. And of course at that point in m y life I didn’t just worry about myself, but also my children, my husband, my entire family and my friends. So much stuff and so many people to worry about! When there was a lull in the action, when there was nothing pressing for me to worry about, I worried that there was nothing to worry about. Seriously. I’d get an unsettled feeling and would actually search for things to agonize over. It’s what my brain had become used to – what it craved.

Blogging about OCD and learning more about anxiety and neuroplasticity have helped me through my own journey with anxiety. Over the past years I have again chosen not to worry. It hasn’t been as easy as it was when I was in college, but I’m trying, and it works, most of the time.

Now I’m not for a minute suggesting those with obsessive-compulsive disorder can just decide not to worry. I don’t have OCD, and I know the severity of the worst anxiety I’ve felt is nowhere near what those with OCD experience routinely. What I am saying is it is possible to change the way we think. If I can do it, others can too. Some people can do it on their own, and others might need help. If you have OCD, working with an OCD specialist using exposure and response prevention (ERP) therapy can help retrain your brain. It’s not easy; in fact it can be extremely difficult. But the hard work is worth it and the payoff is huge: less worry, and freedom from OCD.

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OCD, DBS, and Diabetes

brainAs many of us are aware, a good number of scientific findings, such as the discovery of penicillin, have been made by accident.

Well here’s another one to add to the list.

A May 23, 2018 article published in the journal Science Translational Medicine reports a surprising side effect of deep brain stimulation (DBS), which is sometimes used in the hardest to treat cases of OCD. It was observed that an obese man with type 2 diabetes underwent DBS for OCD, and his blood sugar levels improved to the extent that his daily insulin requirements decreased by approximately 80%.

To research further, scientists recruited 14 people who had OCD and had undergone DBS. These study participants did not have type 2 diabetes. The researchers found that the DBS therapy affected the subjects’ insulin sensitivity, and turning the brain stimulators off and on made the levels rise and fall. The metabolic function of the study participants was better when the brain stimulators were turned on, as opposed to when they were turned off.

So what is happening here? Researchers believe that a boost in the activity of dopamine (a neurotransmitter involved in DBS) not only quiets OCD but also improves the body’s ability to process sugar. It is interesting to note that when we eat a lot of sugar, our dopamine levels increase as well.

Previous studies in mice have shown that dopamine released by neurons in the same general decision-making region the researchers stimulated—called the ventral striatum—plays a key role in regulating glucose throughout the body. As part of the research discussed above, the scientists also used optogenetics to stimulate striatal neurons in mice. As the neural cells released more dopamine, the rate at which other cells absorbed glucose from the rodents’ blood picked up.

Whether these findings actually lead to using DBS as a treatment for diabetes remains to be seen. Perhaps future research might lead to even less invasive procedures that target dopamine.

While I wouldn’t say that OCD and diabetes go hand-in hand, I am personally aware of quite a few people, including children, who have both illnesses, and scientists have recognized a connection between diabetes and anxiety disorders.

Sometimes studies raise more questions instead of providing us with easy answers. More research is needed to understand the connection, if any, between OCD and diabetes, so that we can figure out the best way to help those who suffer from these often-debilitating disorders.





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