An Interview about OCD with Dr. Seth Gillihan

Overcoming OCD A Journey to Recovery

 

Dr. Seth Gillihan, coauthor of my book, Overcoming OCD: A Journey to Recovery, was recently interviewed on Talk Recovery Radio based in Vancouver.

Click here to listen to the interview. Seth’s segment runs from around 5:00 – 35:00.

Enjoy!

 

 

 

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OCD and Emetophobia

pain

by marin freedigitalphotos.net

 

The fear of vomiting, or emetophobia, affects people of all ages. It is often seen in childhood and if left untreated, can become debilitating. It is also known to develop during adulthood, perhaps after an associated experience such as a severe stomach illness or episode of vomiting. The consequences of vomit phobia can be extreme, leading to such things as school refusal, social isolation, and job loss. Emetophobia can also take away any joy in life, hindering travel and leisure activities, romantic relationships, and even pregnancy (afraid of morning sickness).

To be clear, emetophobia is not just being afraid of throwing up. Rather it is an excessive or irrational fear about the possibility of vomiting. In fact, says Dr. Steve Seay, most of the people he treats for emetophobia have symptoms of other conditions such as social anxiety, agoraphobia or obsessive-compulsive disorder (OCD).

Some examples of behavior that present with all types of emetophobia:

  • Avoidance behaviors such as not eating certain foods (severe cases could lead to anorexia), not going to specific places, or not participating in certain events you might associate with vomiting (could be something as simple as avoiding parties with food).
  • “Health-conscious” behaviors such as refusing to shake hands with others in case they are/were sick, excessive handwashing, and unreasonable amounts of time and attention paid to food selection, preparation and cleanliness.
  • “Checking” behaviors to detect early signs of illness, such as being hypervigilant with your own health (taking your temperature 5 times a day), as well as being keenly aware of the health of others (watching other people eat to make sure they are not or don’t get sick).
  • Actions done specifically to reduce the possibility of throwing up, such as the performance of rituals (If I repeat “I won’t throw up” over and over in my head, then I won’t throw up).

For those with OCD who suffer with emetophobia, symptoms are also likely to include the concern that vomiting signals something much worse than it typically is, such as indication of a deadly disease. People with obsessive-compulsive disorder also might believe that if they do vomit, they will not be able to cope with the situation. Not surprisingly, those with OCD and emetophobia demonstrate more cleaning and checking rituals than others with emetophobia. While they know intellectually these rituals make no sense, they are not able to control them.

As with all types of OCD, exposure and response prevention (ERP) therapy is needed to battle emetophobia. For example, a child who will only eat certain foods because she is afraid of vomiting might be asked to eat something different, and then feel the subsequent anxiety. Another exposure might include watching videos over and over of people vomiting, sitting with the anxiety and not engaging in avoidance. With more exposures (and no rituals) the person with OCD will get used to the idea of vomiting, lessening the hold of OCD and emetophobia. This is known as habituation.

I think it’s safe to say that nobody enjoys vomiting. But if the fear of it is overtaking your life, please seek help. With a competent therapist, emetophobia, with or without OCD, is absolutely treatable.

 

 

 

 

 

 

 

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Distinguishing Between GAD and OCD

boy with teacher

by Paul Gooddy freedigitalphotos.net

 

As many parents of children with obsessive-compulsive disorder (OCD) will tell you, getting the right diagnosis is half the battle. Getting the right treatment is the other half.

It’s true that OCD can be tough to diagnose, especially in children. Rituals are an important part of a healthy childhood, and it’s often difficult to know when they should be a cause for concern. I’ve written about this issue before.

Even if you and your healthcare providers recognize that your child is dealing with anxiety issues, it’s not always easy to differentiate between OCD and GAD (Generalized Anxiety Disorder). Both can be characterized by rumination, increased vigilance, and an intolerance of uncertainty. Experts in OCD and anxiety disorders should be able to distinguish between the two, but for others it can be quite difficult. To make matters even more confusing, the two disorders might occur together.

A study published online in October 2018 in Depression & Anxiety aims to make it easier to properly diagnose these two disorders. The study looked at participants’ abilities in certain cognitive domains to determine if this information might be helpful in diagnosing OCD and GAD.

The children involved in the study had either been diagnosed with OCD, GAD, or neither (the “typically developing controls” or TDC). None of the participants were diagnosed with both OCD and GAD. Cambridge Neuropsychological Automated Battery (CANTAB) tests were administered to compare the following cognitive performances:

  • Working memory
  • Visuospatial memory
  • Planning ability and efficiency
  • Cognitive flexibility

The results were interesting. Those with OCD required more turns overall to complete multi-step problems than the other two groups, while those with GAD were more likely to make reversal errors than those with OCD or the control group. Those with GAD also took longer to identify visual patterns.

Although those with OCD and those with GAD demonstrated significantly worse cognitive functioning compared with the control group, the children’s cognitive impairments and difficulties with specific skills depended on which disorder they’d been diagnosed with. Children with Generalized Anxiety Disorder struggled more with mental flexibility and visual processing, and those with obsessive-compulsive disorder displayed poorer planning abilities.

The results show promise but more research is needed. One of the reasons I find this study so interesting is the fact that, as many of us know, the earlier OCD is diagnosed, the sooner it can be properly treated – before it becomes deeply entrenched. The same is true for Generalized Anxiety Disorder – the sooner the better. The more we can differentiate between these two disorders, the better chance we have for accurate, timely diagnoses.

 

 

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Helping Families Affected by OCD

Family
As many of us well know, OCD is a family affair, and family members typically have a lot
to learn when dealing with their loved one’s obsessive-compulsive disorder.
This recent podcast episode and blog post by Dr. Seth Gillihan covers a wide array of
topics that family members are sure to find helpful. Seth interviews psychologist Brenda
Seiger, who specializes in evidence-based treatment of OCD. The podcast
focuses on how OCD affects families, the best way to treat OCD, and how effective
treatment also improves a person’s closest relationships.

 

I highly recommend checking these resources out!

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A New Facebook Support Group

exhausted (2)

by graur codrin freedigitalphotos.net

Happy New Year to everyone! I hope it’s a year filled with good things for you and your loved ones.
I’d like to spread the word about a new and important Facebook support group that has been created by Seth J. Gillihan, PhD, who is my coauthor of Overcoming OCD: A Journey to Recovery. Seth is also the author of two books on Cognitive Behavioral  Therapy (CBT).
Seth’s Facebook group is for those who deal with, or have loved ones who suffer with, obsessions about hurting people. Specifically, Seth has chosen to focus on what he calls “Malevolence OCD,” distinguishing it from the more general Harm OCD, which can be accidental.
This type of OCD can be horrifying for those who deal with it, and the simple fact of knowing you are not alone can bring great relief. Seth can help you understand this condition and most importantly, give you insight into managing it.  The group is closed as Seth understands that this can be a sensitive and very personal topic.
If you think you might be interested in joining this new  Facebook support group, visit:
Again, best wishes for a happy and healthy new year for us all!
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The Bergen Treatment – Intensive Therapy for OCD

 

exhausted (2)

by graur codrin freedigitalphotos.net

My son Dan suffered from obsessive-compulsive disorder so severe he could not even eat. He spent nine weeks at an intensive world-renowned residential program where he learned techniques through the use of exposure and response prevention (ERP) therapy. These skills have allowed him to live a happy and productive life.

Well, at least I thought it was an intensive program.

At Haukeland University Hospital in Bergen, Norway, there is a treatment program for OCD that is truly intensive. And short. Four full days.

There are many people who spend years of their lives suffering with OCD; it can be a cruel, insidious disorder. How much can four full days of intensive therapy help them?

Apparently, a lot.

More than 1,200 people have received the Bergen four-day treatment for OCD which is a concentrated form of exposure therapy designed by two Norwegian psychologists, Gerd Kvale and Bjarne Hansen. The results have been impressive and the program has gained international attention for its effectiveness and efficiency. In fact, the psychologists were named by Time as two of 2018’s 50 most influential people in healthcare.

Avital Falk, a clinical psychologist who directs an intensive treatment program for OCD and anxiety at Weill Cornell Medicine and New York Presbyterian says:

“It’s amazing that you can so get much done in such a small amount of time. OCD treatment regimens typically involve weekly hour-long sessions spread out across several months, but more clinicians are adopting concentrated therapy. Intensive treatment in general has been getting a lot more attention in different formats that can be anywhere from three hours a week. Ten to 12 hours a week, all the way to the Bergen method, which does everything in four days.”

In June 2012 the first group of patients were tested and the results were as expected – immense improvements in the participants’ OCD.

The Bergen method works in three stages:

On day one, therapists provide patients with information about OCD and help them prepare for the exposure tasks they will engage in over the next two days. During the exposure portion, people face their fears head-on. For example, if someone is afraid of becoming contaminated, they would choose an object or surface that might trigger their anxiety and then force themselves to touch it. Kvale explains:

We encourage patients to pay attention to the moments when they feel the urge to start taking control to reduce anxiety or discomfort. And to use these as turning points for change.”

The next two days can be best described as a single prolonged therapy session. Included with ERP therapy is the use of the LET- technique, which is a method of encouraging those with OCD to focus specifically on anxiety-eliciting moments. LET stands for LEan into The anxiety and forms the core foundation of the Bergen treatment. The format of the treatment is unique in that a group of three to six therapists work as a team with an equal number of patients. Kvale believes this setup is important because it provides tailored care for each individual while also letting patients observe others going through the same process of change.

The third day is set aside for discussion and planning how to maintain the gains made during therapy.

In August 2018, results from a long-term analysis of the treatment’s effects were published. It was reported that 56 of 77 patients remained in remission four years after treatment, and 41 of the 56 had fully recovered.  More details regarding the results can be found here.

There are already plans to bring this treatment plan to other countries, including the United States. While promising, there are lots of unanswered questions. Is this program effective for those whose compulsions are mostly mental? Can it be helpful to those who deal with recovery avoidance? The list goes on.

As treatments for OCD evolve, one thing continues to be clear. More of the right kind of therapy is always a good thing.

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OCD and Multiple Sclerosis

microscope

by cooldesign freedigitalphotos.net

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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