OCD and Selfishness

 

by stuart mies free digitalphotos.net

This post first appeared in 2013……

Soon after my son Dan was diagnosed with obsessive-compulsive disorder, he and I were out with some friends and decided to get a bite to eat. We were all casually chatting about various restaurant choices when Dan suddenly insisted we go to one particular place. He was adamant; we needed to eat there. So off we went. If I remember correctly some glances were exchanged (“What’s up with him?”) but nobody complained and we all went along.

I knew very little about OCD at the time, but what I did know was that this seemingly selfish behavior was totally out of character for my son. In fact, it was the exact opposite of the “real Dan” who’d always been so easy-going and eager to please others. I’ve written before about the convoluted way in which OCD operates and how it usually makes sense for those with OCD to do just the opposite of what their disorder demands. I think it’s also true that  those without the disorder often get the wrong impression, indeed the opposite impression, of the true nature of those suffering from OCD.

At the time, our friends didn’t know that Dan had OCD, but I’m not convinced that would have mattered. They likely thought Dan was selfish because he demanded we eat where he wanted to eat, with no regard for anyone else’s preference. The truth was Dan’s OCD made him believe we all had to go to that particular restaurant or something bad would happen. He wasn’t being selfish; he thought he was protecting those he cared about. Compulsions involving doing certain things at specific times or in a particular way, or being inflexible in various ways, all can be misconstrued as acts of selfishness. I’m sure everyone who has OCD as well as their loved ones could easily come up with their own examples.

But really, it’s all a big misunderstanding. Most people without OCD do not understand that those with the disorder feel they do not have a choice. They don’t choose, or even want, to act this way; they have to. It’s not about what they want; it’s about what their OCD demands. They are held captive by obsessive-compulsive disorder.

If I had understood what was happening when Dan insisted on going to that restaurant, I could have not enabled him, which we know only makes OCD stronger. Those with and without OCD need to be educated and those who are suffering need to get the appropriate treatment. Once they choose to fight it will be clear to others, as well as to themselves, who they really are.

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ERP Therapy: Better to be Proactive or Reactive?

by stuart miles freedigitalphotos.net

This post first appeared on my blog in March 2011. I revised it slightly and think it is worth sharing again…..

I recently read this blog post which brings up a discussion that occurred at an OCD support group. I think almost everyone with OCD who has used exposure and response prevention (ERP) therapy would agree it can be very effective. One of the problems with it, however, is that by its very nature it is anxiety provoking. Who wants to willingly subject themselves to sometimes seemingly intolerable levels of anxiety and discomfort?

So the question is: Do you seek out these anxiety provoking experiences, even going so far as to create them yourself, or do you just wait for them to come to you? You know they will, sooner or later.

When my son Dan began dealing with his severe OCD he would often say to me, “Make me do this,” or “Make me go here,” or “Don’t let me do this or that.” I don’t think either of us realized it at the time (I know I certainly didn’t) but he was instinctively engaging in ERP therapy. At that point, he had not had any proper treatment for his OCD. Still, even in his debilitated state, he somehow knew that exposing himself to what he feared most was his ticket out of the torturous cycle of OCD.

To those of us without obsessive-compulsive disorder it might seem like a no-brainer. If this is the therapy that works, of course you should continue to practice it as much as possible. Sure, easy for us to say. But if you have OCD, and your brain has been relatively quiet for a while, why would you want to shake things up? Why not enjoy the peace when you have it and deal with whatever you need to deal with when it comes along?

There is no right or wrong answer here. Or is there? OCD is tricky and often rears its ugly head when you least expect it to. The more you choose to embrace ERP therapy, the better your chances are of beating OCD at its own game. So should you try to enjoy the calm before the storm, or should you create your own storms regularly in hopes of completely changing the weather pattern?

I’d choose the latter.

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OCD, Learning, and Memory Problems

I’ve written posts and articles about my son Dan’s struggle with OCD in college, and our family’s experience is also fully chronicled in my book Overcoming OCD: A Journey to Recovery. The most frustrating aspects of this portion of Dan’s journey were not only the widespread lack of understanding of obsessive-compulsive disorder, but also dealing with an academic support staff who had no idea how to help him.

To be fair, it really wasn’t their fault. They were willing to help; they just didn’t know how. Aside from offering extra time on tests (which is often not even a good idea for those with OCD) they were at a loss. And so were we. Once we realized that Dan was struggling with time management, the balance of details within the big picture, and over-thinking, we asked that these issues be addressed mainly through the open-mindedness and flexibility of his professors.

But now there is something more concrete those with OCD can offer the academic support staff at schools and colleges. A January 2018 study published in the journal Psychological Medicine involved questioning 36 adolescents with obsessive-compulsive disorder and 36 healthy adolescent controls. Participants were asked to complete two memory tasks designed to measure learning and cognitive flexibility. Adolescents with OCD struggled with cognitive inflexibility and showed significant impairments in both learning and memory. The study is summarized nicely here if you’d like to learn more about it.

I believe the implications of this study are huge. For one, unaddressed learning and memory issues in an academic environment are sure to stress already anxious children or adolescents. Their confidence and self-esteem are also likely to be affected. Not surprisingly, all of these issues can exacerbate OCD and quickly lead to a downhill spiral in both academic performance and overall well-being. The results of this study have already been shared with the appropriate professionals who have subsequently helped students with OCD achieve a level playing field and realize their potential. What a relief this must be for students and their families who have struggled for so long, yet haven’t quite been able to put into words what they are actually struggling with.

Another important implication of this study is that it educates and enlightens those who still have little to no understanding of obsessive-compulsive disorder. There are academic support staff out there who believe those with OCD just need to be able to leave the room if they “have” to wash their hands – that is the extent of their comprehension of the disorder. But problems with memory, learning, cognitive inflexibility? Who knew? This study provides concrete evidence that those with OCD can use to advocate for themselves.

We are making progress. Slowly but surely, researchers are working hard to chisel away at the mysteries of obsessive-compulsive disorder, helping those with OCD along the way and giving them hope.

 

 

 

 

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How Effective is CBT for Children with OCD?

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There is no question that having a child with obsessive-compulsive disorder affects the whole family. I’ve written before about how pediatric OCD results in disrupted routines, stressful social interactions for children, and poor job performance for parents. Elevated stress and anxiety levels, as well as feelings of frustration, anger, and sadness become the norm in a household dictated by OCD.

I’ve also written about how important it is to get the right help as soon as possible. Even if parents or other caregivers think things are “not that bad,” the situation is likely worse than they imagine. Because children (and adults) with OCD can be adept at hiding their symptoms, they are often the only ones who know the real extent of their disorder – parents don’t often recognize the extent of their children’s suffering. And on the off chance that the OCD really isn’t “that bad,” it’s still always better to seek treatment sooner rather than later.

In an interesting review published in Psychiatry Research, predictions related to the effectiveness of Cognitive Behavioral Therapy (CBT) in children and adolescents (all under the age of 18) with OCD were made:

In predictor analyses, worse response to CBT was associated with older age, higher OCD symptom severity, higher level of OCD-related impairment, worse depressive symptoms, the presence of any comorbid mental disorder, and higher family accommodation of OCD symptoms. Medication at baseline was not a predictor of CBT effectiveness.

No surprises there. This analysis confirms the importance of getting help for OCD as soon as possible, before OCD has become firmly entrenched.

There is also some discussion in the report about CBT for children and adolescents with OCD who have comorbid tic disorders. Honestly, I found the wording and conclusion confusing, but it did bring to mind my son Dan’s experience with facial contortions, twitching, and tics. It is known that tics and Tourette syndrome are not uncommon in those with OCD. Statistics vary, but approximately 50% of children with OCD have, or have had, tics and 15% of them have been diagnosed with Tourette syndrome. In Dan’s case, it’s possible some of the medications he was taking contributed to his tics. Thankfully, once he was taken off the meds and was working hard on his exposure and response prevention (ERP) therapy, all his tics, twitches and facial contortions disappeared. It’s interesting to note that his comorbid diagnoses of depression and GAD (Generalized Anxiety Disorder) also fell by the wayside.

The bottom line is CBT in the form of exposure and response prevention (ERP) therapy works for children and adolescents. The sooner help is sought, the better the results will likely be. Once OCD is under control, an added bonus might be the disappearance of comorbid conditions such as depression, GAD, and even tic disorders.

There are no good reasons to delay treatment of obsessive-compulsive disorder for our children. If your child or adolescent is struggling with OCD, please do the right thing. Get help for them now.

 

 

 

 

 

 

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OCD News

by stuart miles freedigitalphotos.net

I’ve recently become aware of some exciting programs, studies, and projects going on aimed at helping those with obsessive-compulsive disorder, so I thought I’d highlight three of them for you:

Ryan Bernstein, a high school junior from Portland, Oregon, has undertaken an amazing project to raise money for the International OCD Foundation (IOCDF). He is writing a book titled: OCD to Me: an anthology of anxieties and is seeking contributions for his book. You can read more about Ryan’s personal story, as well as complete his short survey (four questions) here.

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Boston University runs a wonderful program for college-aged students. From the article:

For the past three years, Boston University has offered one of the few programs in the nation dedicated to teaching students who have had to leave college the coping skills that will give them a shot at getting back into school or work while managing severe anxiety, depression, and other serious mental health conditions.

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An exciting five-year study involving home-based ERP therapy for children is in the works, and you can read about it here. From the article:

The Pediatric Anxiety Research Center (PARC) at the Bradley/Hasbro Children’s Research Center, has received a $3.4 million funding award from The Patient-Centered Outcomes Research Institute (PCORI) to compare patient-centered (primarily in the home/community) to provider-centered (primarily in the office) outpatient treatment for kids with anxiety and obsessive compulsive disorder (OCD). The aim of the study is to devise an alternative outpatient treatment model featuring a bachelor’s level clinician, or mobile exposure coach, working in conjunction with PhDs to conduct in-home therapy visits.

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I’ve highlighted the above project, program, and study because they are all exciting, innovative ways to help those with OCD. I hope you’ll take the time to read more about them.  Who knows? They just might be exactly what you or someone you care about is looking for!

 

 

 

 

 

 

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OCD and Physical Sensations

 

by viacheslav Blizniuk freedigitalphotos.net

I have previously written about OCD and mental imagery, where I discussed how those with OCD (and those of us without) sometimes see, hear, or feel things without the presence of corresponding external stimuli. In particular, those with OCD often find their intrusive thoughts are accompanied by sensory experiences that attach some type of physical sensation to the distorted thinking of OCD.

A recent study published on November 20, 2017 in the journal Clinical Psychology and Psychotherapy delves into the link between the strength of compulsions associated with OCD and the physical sensations that come with them. For example, the study authors noted that participants who struggle with contamination obsessions might feel “uncomfortable sensations in the skin, muscles or others body parts, like an itch or a burning sensation that drives the patient to do the compulsion until feeling…relief.”

For purposes of this study, researchers asked people with OCD to answer questionnaires designed to measure the strength of these sensory obsessions. The results indicated that people who had more difficulty controlling their compulsions also tended to have stronger sensory elements related to their obsessions, compared with those who had less difficulty controlling compulsions. This seemed especially true for those whose obsessions focused on cleanliness and personal contamination. How interesting! This study suggests that the intensity of these sensations might play a significant role in how those with OCD manage their symptoms.

Other interesting findings from the study include the fact that the strong sensory components to obsessions appeared more often in people with all-around vivid imaginations, and that a large group of those with OCD experienced their intrusive thoughts as auditory – whispered, spoken or shouted voices.

Below are the key findings of the study, as summarized by the authors:

  • Obsessive thoughts are often accompanied by perceptual experiences such as feeling dirt on one’s skin or seeing blood before one’s inner eye.
  • Sensory experiences have been associated with decreased insight in obsessive–compulsive disorder.
  • We found that 75% of obsessive–compulsive disorder patients have such sensory experiences.
  • The severity of perceptual obsessions predicted low control over compulsions.
  • Clinicians should not confuse sensory experiences with hallucinations and psychosis, respectively.

I especially appreciate this last bullet point as I’ve written about OCD and psychosis and the confusion it might cause, not only for those with the disorder but for clinicians as well.

What I find most exciting about this study is its potential to be helpful in the treatment of obsessive-compulsive disorder. If strong sensations make OCD symptoms more difficult to beat, perhaps we could focus on how to reduce or redirect these sensations as part of the person’s therapy.

Once again, I am incredibly thankful for all the dedicated scientists who continue to work hard to unlock the mysteries of OCD!

 

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OCD and Limerence

by tuelekza freedigitalphotos.net

Albert Wakin, a professor of psychology and expert on limerence, defines the term as a combination of obsessive-compulsive disorder and addiction – a state of “compulsory longing for another person.” Professor Wakin estimates that five percent of the population struggle with limerence.

Limerence involves intrusive thinking about another person. It is often confused with love addiction but there is a fundamental difference. In love addiction, people want to replicate the feeling of falling in love again and again, while those experiencing limerence are focused on feelings for a specific individual.

Limerence is not the same as being in love. It is smothering and unsatisfying with little to no regard for the other person’s well being. In healthy relationships, neither partner is limerent; they do not struggle with constant, unwanted thoughts about their partner. A person experiencing limerence has feelings so intense that they rule every waking moment causing everything else to be left in the background. The person also tends to focus completely on the positive attributes of the “limerent object” and avoids thinking about any negative aspects.

Professor Wakin says, “It’s an addiction for another person. And we find that the obsessive-compulsive component of it is extremely compelling. The person is preoccupied with the limerent object (the subject of their obsession) as much as 95 percent of the time.”

When I began researching OCD and limerence I was interested in learning about their connection. I imagined it might be the opposite of relationship OCD (R-OCD). But now I’m not so sure. I certainly see the obsessive component to limerence and the compulsions could involve ruminating about the limerent object, but so much of it just doesn’t seem like OCD to me.

One question that I wasn’t able to find the answer to is, “Do those with limerence realize their obsession isn’t rational?” My guess is there is no simple answer. In this day and age, when young people in particular are influenced by television shows such as The Bachelor, it’s not hard to understand why so many of us are confused about what is rational and what isn’t when it comes to feelings, relationships, and love.

To confuse matters more, there appears to be no solid evidence that people with OCD (or substance addiction) are more likely to experience limerence. Professor Wakin and his colleagues hope to conduct and compare brain-imaging research on those with limerence, OCD, and addiction, to see how they might or might not be related. This research should be helpful, but in the meantime, Cognitive Behavioral Therapy (CBT) has shown some promise for those dealing with limerence.

 

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