Anxiety – Avoid or Accept?

by stuart miles

by stuart miles

According to the Anxiety and Depression Association of America, 40 million adults in the United States over the age of 18 suffer from an anxiety disorder, making it the most common brain disorder in our country.

Who among us hasn’t dealt with anxiety? While experiencing anxiety certainly doesn’t mean we have an anxiety disorder, most of us know what anxiety feels like. Symptoms vary but often include sweating, racing or unwanted thoughts, palpitations, and a sense of impending doom. Some people think they’re having a heart attack or might actually believe they are dying. It’s a truly horrible sensation and many of us will do whatever we can to avoid feeling anxious.

Maybe that’s the problem.

People are not wired to be happy and carefree all of the time. If we are lucky, we feel that way some of the time, but being human means we will also experience sadness, fear, and yes, anxiety. It is important to note that while feeling anxious is unpleasant, to say the least, it is not dangerous or harmful to us. It is indeed a normal part of life. While anxiety-provoking situations have no doubt evolved over the years (perhaps we now fear a terrorist attack more than a bear attack), our body’s response has not changed.

So instead of trying to rid ourselves of anxiety, perhaps we need to just accept the fact that we will feel anxious at times. When those sensations of anxiety wash over us, we need to allow them in and not fear them or fight them. I know it’s often easier said than done, but with practice, it can be achieved.

Those with obsessive-compulsive disorder might notice a correlation between accepting anxiety and the best way to deal with obsessions. For those with OCD, obsessions are so upsetting that the person experiencing them will do anything to get rid of them. Enter compulsions, which are performed to relieve the distress caused by obsessions. But those who understand their OCD realize that trying to stop thinking about their obsessions, or warding them off with compulsions, only makes the disorder stronger in the long run.

So what is the best way to deal with OCD? Not surprisingly, the same way we should deal with anxiety. Face it head on. Proper treatment for OCD involves noticing and accepting whatever thoughts, feelings, or impulses come your way, and not engaging in compulsions. A good therapist trained in ERP therapy can help.

While we are not able to control how we feel, we can choose how we react to our feelings. Accepting them instead of avoiding them, I believe, will go a long way toward achieving good mental health.



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Is Thinking about Compulsions a Compulsion?

by FrameAngel

by FrameAngel

I corresponded with a young woman with obsessive-compulsive disorder who had participated in exposure and response prevention (ERP) therapy and made some major improvements in dealing with her OCD. However, she still struggled at times and wasn’t quite where she wanted to be – like many with OCD, she was a work in progress.

She had an upcoming vacation planned with her serious boyfriend and was determined that her OCD would not ruin this special time they had planned together. She would not avoid people, places, or things that might make her anxious, she would not apologize for no good reason, and she would not ask for reassurance of any kind from her boyfriend. In short, she was determined to not engage in any compulsions during their vacation. Things would be perfect and she’d have a great time.

My first thought was, “How impressive!” She was doing everything she could to resist her compulsions. But as we communicated more, it seemed to me that perhaps she had become obsessed with not doing her compulsions. And to quell this obsession, she would continuously monitor herself to make sure she wasn’t engaging in any compulsions. Could this check on compulsions actually be a compulsion?

If you’ve lost me, I’m sure you’re not the only one. To say OCD can be confusing is an understatement to say the least.

As it turns out, this woman’s vacation didn’t turn out too well, as she found herself unable to stop focusing on not performing compulsions. Her plan had backfired. Her anxiety skyrocketed, and was not able to enjoy her vacation. Sigh. OCD at its finest (she said sarcastically).

So, what should she have done? As someone without OCD, it’s easy for me to say, “She just should have relaxed, enjoyed the moment, and not been so hard on herself.”  But I know that’s often easier said than done. Still, accepting the fact that she is indeed human, and will slip up here and there as we all do, might have made for a better time.

I don’t believe any of us are perfect, and if we focus on perfection, we are bound to be disappointed. Doing the best we can at any given moment, being mindful and present, is all we can really ask of ourselves. And when the mistakes happen? Well, we can acknowledge and accept them, strive to do better, be kind to ourselves, and move on to the next moment. Otherwise we are just letting OCD win.








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OCD and Cognitive Behavioral Therapy for Insomnia (CBT-I)

by stuart miles

by stuart miles

Sleep is often a big issue for those with obsessive-compulsive disorder. In fact, in over five-and-a-half years of blogging, my most viewed post, by far, is OCD and Sleep.

OCD has the potential to complicate anything, and sleeping is no exception. While most of us, with and without OCD, can relate to bouts of insomnia, sometimes issues with sleep can be directly related to obsessive-compulsive disorder.

For example, someone with OCD might be terrified of sleeping because they are convinced they will die in their sleep. So they force themselves to stay awake. Or perhaps there is an obsession directly related to one’s bed or bedroom. When my son Dan’s OCD was severe and he was away at college, he was not able to touch his mattress and therefore couldn’t sleep on his bed. To this day, I don’t know where, how, or if, he slept at night.

If sleep issues are indeed directly related to OCD, then exposure and response prevention (ERP) therapy, the Cognitive Behavioral Therapy (CBT) used to treat OCD, can definitely help.

However, if someone with OCD has sleep problems that are not directly related to their disorder, then ERP is not the way to go; CBT-I is.

Cognitive Behavioral Therapy for Insomnia (CBT-I) , like other forms of CBT, addresses your thoughts and beliefs (which might be flawed), and helps you appropriately change your behavior. Some areas that CBT-I  specifically focuses on include what to do when you can’t sleep, what you do while you’re in bed, sleep restriction, and changing how you think about sleep. After learning about CBT-I many people are surprised that what they’ve done in the past to try to help themselves sleep might actually have made things worse. For example, “sleeping in” to try to catch up on sleep is not generally beneficial, but getting up at the same time every morning is.

Not surprisingly, when we sleep better, we feel better. Any of us who has experienced chronic insomnia knows how sleep deprivation can exacerbate other medical conditions we might be dealing with. OCD is no exception, and I have heard from so many people who state their OCD flares up when they are very tired.

According to Michael Perlis, Ph.D., an associate professor of psychiatry and director of the behavioral sleep medicine program at the University of Pennsylvania School of Medicine, “…treating insomnia concurrently with comorbid psychiatric disorders not only will improve sleep, but also may have a halo effect on those disorders.”

So a by-product of a good night’s sleep just might be milder OCD.

A discussion of sleep and OCD wouldn’t be complete without addressing the fact that some medications commonly used by those with OCD (such as SSRIs) might cause sleep problems. These might be remedied by simply changing the timing of when the medications are taken, or perhaps a change in medication is warranted. This issue,of course, should be discussed with your health-care providers.

For those who battle obsessive-compulsive disorder (indeed for all of us) a healthy lifestyle can result in many benefits. And an important component of a healthy lifestyle is a good night’s sleep. If you suffer from insomnia not directly related to OCD, I highly recommend looking into CBT-I.

Sweet Dreams!


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OCD and Thoughts of Suicide

by david castillo dominici

by david castillo dominici

Suicide. It’s a word that invokes paralyzing fear in those who love someone with a brain disorder. And well it should. Thoughts of suicide should always be taken seriously and help should be sought immediately.

But when you have OCD and are dealing with thoughts of suicide, it can get complicated, to say the least.

We already know that those with OCD often attach more meaning to their thoughts than those without the disorder. While most of us can acknowledge our thoughts and just let them float by, those with OCD obsess about them. Will I become contaminated? Will I hurt someone I love? Will I commit suicide?

In some cases, thoughts of committing suicide become an obsession for those with OCD. They do not want to commit suicide, just as they do not want to harm others, or offend God, or carry out any other undesirable act their OCD is focusing on.

So how do we know when to worry? When we should take thoughts of suicide seriously in those with OCD?

I can’t stress enough, even if thoughts of suicide appear to be “just OCD thoughts,” how important it is to seek professional help (preferably an OCD specialist) to evaluate the situation. Sadly, there are those with severe OCD who have indeed committed suicide, so the topic should never be taken lightly or ignored. Even if your loved one with OCD doesn’t seem “that bad off,” don’t dismiss their thoughts. Those with OCD can be masters at hiding their pain.

That being said, it is not uncommon for the idea of suicide to become an obsession for those with OCD. Remember that OCD latches on to what we care about the most, and if we value our lives and want to live, having even innocuous thoughts of suicide can be fodder for OCD. And since we can’t be 100% certain of anything (how do I know I won’t kill myself?) the vicious OCD cycle begins.

So how is this type of OCD treated? Exposure and response prevention (ERP) therapy, as we know, is the front line psychological treatment for OCD. But we are not going to expose the person with OCD to suicide! Imaginal exposures, based on imagining something as opposed to actually carrying it out, can be extremely helpful.

I don’t think a discussion about OCD and suicide can be complete without at least mentioning the possibility that medications might contribute to suicidal thoughts. In my book, I talk about how my son Dan’s suicidal thoughts were related to being improperly medicated. And a co-morbid diagnosis of depression might also be a cause for concern.

When dealing with only OCD, the content of the thoughts really doesn’t matter. But when the content of the thoughts involves suicide, where the stakes are so high, it is better to be safe than sorry, and it is important to confirm that there really is no intent involved. Once that is established, the person with OCD can move forward with ERP therapy.






Posted in Mental Health, OCD | Tagged , , , , , , | 9 Comments

Back to School with OCD

by nuttakit

by nuttakit

Another previous post about OCD and school……..

I’ve previously written about taking obsessive-compulsive disorder to college, where I focused on establishing a good support system for those with OCD who are embarking on this exciting, but often anxiety-provoking journey. I discussed how important communication is with all school personnel, from the dean of students to teachers. The more support the better.

But what happens when the support you deserve, and are entitled to, is not afforded you? What if one of your teachers thinks OCD is no big deal, or not a real illness? How do you deal with a situation like that?

My son Dan, in his senior year of college, was discriminated against because of his OCD. I know discriminate is a strong word, but it fits. According to the Americans with Disabilities Act (ADA), college students with documented disabilities are entitled to reasonable accommodations. While offering wheelchair ramps for those who can’t walk is an obvious compliance, accommodations for other issues, such as OCD, are not as clear-cut. Unfortunately, there are still many college professionals who know little, or have misconceptions, about obsessive-compulsive disorder. Students themselves might not know what they need until after the fact. Indeed, the complexity of the disorder can make the establishment of accommodations difficult. The Academic Resource Coordinator at Dan’s school, the expert who dealt with students with disabilities, “wasn’t sure” if Dan’s issue of concentrating more on details than the big picture was related to his OCD.

The best advice I can offer if you find yourself in a similar situation is to know your rights. Read up on the ADA and stand firm. Support, as well as documentation in writing, from a therapist or psychiatrist (preferably your own), can be invaluable. While college is typically a time of reduced parental involvement, I am convinced that if my husband and I hadn’t joined in Dan’s fight, the outcome would not have been in his favor. We had to bring our son’s case all the way to the president of his college, but he ultimately got what he deserved: fair treatment.

Because Dan’s OCD wasn’t diagnosed until he was seventeen (and because we homeschooled), our family never dealt with the need for accommodations during the K-12 school years. Again it’s important to know your rights and options. Laws and plans are in place, particularly for schools that receive federal funding (this includes all public schools). So many school professionals simply do not understand OCD. Until this changes, it is up to us to educate them. This is just one of the many reasons why parents need to be well prepared to advocate for their child.

Whether you’re sending your child off to kindergarten or college, this exciting time can also be stressful.  Add obsessive-compulsive disorder to the equation and chances are you’re also adding an extra layer of anxiety. That’s understandable. I do think, however, that it’s important for parents to remain positive and convey an air of confidence that everything will work out just fine. Because it probably will. But if problems do arise, we need to let our children know, no matter what their age is, that we will be there to support them, advocate for them, and love them every step of the way as they navigate their educational journey.

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Back to School with an OCD Checklist

by stuart miles

by stuart miles

As we approach “that time of year,” I thought I’d once again share this post as I think it could benefit a lot of people:

Dr. Aureen Pinto Wagner has compiled a checklist of ways obsessive-compulsive disorder might affect kids at school, or in relation to school. While the article is geared directly toward kids, and suggests that children share their checklist with their parents, I also think it can work the other way. Parents who know their children have OCD, or suspect they might, can work through the checklist with their child to help pinpoint potential problem areas in school. This information can then be shared with their child’s therapist (and teachers) who can work with the student on his or her issues.

One great thing about this list is that it’s appropriate for all ages, from kindergartners to high school students. For those young people who find it difficult to verbalize their feelings or talk about their OCD, this checklist could be a godsend. Thank you Aureen!

The start of a new school year can be stressful. Add OCD into the mix and major problems can arise. We should expect our children to get the support they deserve – in classrooms where, ideally, teachers have at least a basic understanding of OCD.

Here’s to a happy and successful school year for all students and parents!

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Therapists with Obsessive-Compulsive Disorder

by stuart miles

by stuart miles

When I first became involved in OCD advocacy about six years ago, I would occasionally come across articles or books written by therapists whose bios revealed that they had OCD themselves. I always found this information comforting, because at the time it was hard for me to believe my son would ever again be able to function in the outside world. If someone with OCD can come so far – from struggling with a devastating disorder to helping people with this same illness, then maybe there was hope for my son as well.

Lately, I seem to be coming across more and more therapists and other health-care professionals who specialize in treating obsessive-compulsive disorder and have OCD themselves. It could be that people in general are more comfortable disclosing their mental health issues, or it could be that more people who have overcome OCD are choosing  careers where they can help others do the same.

How great is that!

I have written before about how those with OCD are often hesitant to seek help as they are aware of how irrational their obsessions and compulsions are. They are embarrassed to discuss their OCD in detail. But if their therapist also has OCD, they just might be more willing. After all, who can understand what you’re going through and how you are feeling better than someone who has had similar experiences?

Perhaps the greatest benefit of having so many practicing therapists with obsessive-compulsive disorder goes back to a word in the first paragraph of this post: HOPE. Here are people who have not only overcome a potentially devastating disorder, they have no doubt worked very hard to achieve their dream of helping others. They have chosen a difficult path and have succeeded. How could there be any better role models for those who are wondering if they might ever be able to live the lives they want?

One of the main reasons I blog is to spread the word that OCD, no matter how severe, is treatable, and I often refer to my son’s story as proof. But to have that proof – that hope -sitting in the same room as you? I don’t think it can get any better than that.





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