OCD and Vacations

family at sunset

by arztsamui, freedigitalphotos.net

 

August is a popular time for many of us to take vacations. That’s what summer is all about, right? We look forward to our vacation all year. But what if you have obsessive-compulsive disorder (OCD)? How does going on vacation, planning a vacation, or even thinking about a vacation affect you and those around you?

When my son Dan’s OCD was severe, he could barely move, let alone go on a vacation. But when his obsessive-compulsive disorder improved to a moderate level, he planned a trip to Canada with a friend for his winter break. He was excited about going, and from all accounts had a great time exploring and trying out exciting new activities such as dog sledding. He wasn’t able to leave his OCD behind completely on this trip, but still managed to enjoy himself most of the time.

I, on the other hand, was worried the whole time he was gone. I was concerned about the stress of him traveling (he flew), the change in environment and routine, the absence of therapy (and his therapist), and the inevitable trials and tribulations that come along with vacations. Also, what if he needed help while away? Would he tell us? Where would he turn? Who would he call?

Indeed, the very nature of vacations is often conducive to stress for all of us, not just those with OCD. But if you have obsessive-compulsive disorder, dealing with changes in daily routines as well as sleep routines, might be particularly difficult. Perhaps you’re staying with friends or family when you are used to being alone. Or perhaps you are alone in a hotel room, when you are usually surrounded by people at home. Your food choices might be different. And if you suffer from contamination OCD, you are faced with many challenges on vacation. Public toilets in particular seem to be a trigger for a lot of people with OCD.

Still, Dan’s vacation turned out to be more stressful for me than it was for him because he was able to do what I could not: embrace the uncertainty that comes with a vacation – that same uncertainty that comes with all of life.

Those who suffer from obsessive-compulsive disorder who are able and willing to go on vacation are indeed facing that uncertainty head-on. Will their OCD improve while they’re away? Maybe. Sometimes getting away from old, familiar triggers into a totally new environment will quiet OCD. Or will their OCD spike due to new triggers, or because of any of the other reasons mentioned above? Maybe. It’s certainly possible. Of course, there is no way of knowing until you go. In my opinion, if those with OCD aren’t allowing their disorder to prevent them from actually taking their vacation, the trip, whatever the outcome, should be considered a success.

That’s the thing. We can’t let OCD call the shots. We need to continue to live our lives as fully as possible. So whether your summer involves vacations from OCD or with OCD, I hope your experiences are positive ones that create some great memories.

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OCD and Showering

shower 

When my son Dan was in the throes of severe obsessive-compulsive disorder in 2008, he would sit in his “safe chair” for eight hours at a time. He was literally “stuck.” While I didn’t realize it at the time, getting stuck, or more accurately, becoming a slave to OCD’s demands, is part of what severe OCD is all about. Never-ending compulsions take over your life as you try to achieve certainty that all is well.

I’ve always found it particularly heartbreaking when OCD latches on to our most basic needs such as loving relationships, eating, and physically caring for ourselves. One of the more common compulsions that is often used as an “example of OCD” is hand washing, which can indeed be so severe that scarring, bleeding, or infections occur. The person with OCD cannot stop washing until their doubt and anxiety subside.

What perhaps is less known to people who are not directly affected by OCD is that showering is also a common compulsion. While those with obsessive-compulsive disorder might believe they are just trying to get clean, showering as a compulsion serves the same purpose as all compulsions – to reduce anxiety and uncertainty. Some people will insist on using scalding hot water, while others will have rituals that need to be done in a certain manner. If something is done “incorrectly,” the person with OCD feels the need to start all over again. At the very least it is tiring and draining, and in the worst-case scenarios it is completely debilitating. I personally know of a young woman who got “stuck” in the shower for ten hours and had to be physically removed. As I said – heartbreaking. A basic activity of daily living turned into a nightmare.

What leads to this nightmare? How and why do things get that bad? Well, as with all types of OCD, it starts with an obsession. In those with shower compulsions, obsessions typically include contamination fears or germ phobias, but that isn’t always the case. OCD has an impressive imagination and can latch on to anything. For example, someone with OCD might fear harm coming to someone they love if they don’t wash each body part ten times in the shower. While the person with OCD typically realizes this makes no sense, there is always that doubt, and the compulsions are then carried out. Unfortunately, that’s never the end of it. The reassurance that compulsions provide is addictive and just as with drugs, tolerance rises and more and more compulsions are needed to feel that sense of relief. Before you know it, you’re in the shower, unable to get yourself out.

But there truly is good news. Obsessive-compulsive disorder, no matter how severe, is treatable. The frontline psychological therapy for the treatment of the disorder is exposure and response prevention (ERP) therapy, and it works. Remember the young woman who was stuck in the shower for ten hours? After two months of intensive ERP therapy, she now easily takes fifteen-minute showers. She is in charge of her showers, and her life, now. Not OCD.

 

 

 

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OCD and Sunshine

sunWhen my son Dan was dealing with severe OCD, he would often be awake all night, pacing throughout the house. It was not unusual for me to get up in the morning and find him fast asleep on the living room floor, or wherever else he happened to finally collapse from exhaustion. Even when his symptoms began to improve, he still could not seem to fall asleep at a normal hour and would be awake until 4:00 am or so. Not surprisingly he’d then sleep half the day away. His sleep cycle was all out of whack.

It turns out that this abnormal sleep pattern is not unusual in those with OCD and has warranted the attention of researchers. In this July 2018 article published in the Journal of Obsessive-Compulsive and Related Disorders, scientists determined that living at higher latitudes, where there is less sunlight, appears to result in an increased prevalence of OCD.

In regards to the delayed sleep-wake pattern similar to what my son Dan experienced, Professor Meredith Coles, first author of the study, explains:

“This delayed sleep-wake pattern may reduce exposure to morning light, thereby potentially contributing to a misalignment between our internal biology and the external light-dark cycle. People who live in areas with less sunlight may have less opportunities to synchronize their circadian clock, leading to increased OCD symptoms.”

In other words, if you sleep through the morning hours of sunlight, you have less chance of “catching up” with your sun exposure if you live in areas with less sun.

Professor Coles finds the results of this project exciting as they provide a new way of thinking about OCD. She says:

Specifically, they [the results] show that living in areas with more sunlight is related to lower rates of OCD.

I find the results of this research quite interesting, though not particularly shocking. We already know that lack of exposure to sunshine can affect our mental health – those with SAD (seasonal affective disorder) can certainly attest to that.

Sometimes results of studies leave us with more questions than answers. Why do those with OCD often have abnormal sleep cycles to begin with? Is it anxiety keeping them awake, or is it something else? Professor Coles wants answers to these questions as well and says that future studies are in the works including testing a variety of treatment options that address sleep and circadian rhythm disruptions. She says:

“First, we are looking at relations between sleep timing and OCD symptoms repeatedly over time in order to begin to think about causal relationships,” said Coles. “Second, we are measuring circadian rhythms directly by measuring levels of melatonin and having people wear watches that track their activity and rest periods. Finally, we are conducting research to better understand how sleep timing and OCD are related.”

Obsessive-compulsive disorder can be such a complex disorder so it is always encouraging to hear of research being done on different aspects of it. Who knows? Maybe these studies will somehow lead to better treatment options, or even a cure, for OCD. Surely that would help us all sleep soundly!

 

 

 

 

 

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Helping Those with Recovery Avoidance

hope 3

by stuart miles freedigitalphotos.net

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 freedigitalphotos.net

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

Pills_1

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 freedigitalphotos.net

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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