Sensorimotor OCD

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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

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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.

Can We Decide Not to Worry?

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.

OCD, DBS, and Diabetes

As 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.

 

 

 

 

OCD and Psychosis

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

When my son Dan’s obsessive-compulsive disorder became severe, he was in college, fifteen hundred miles away from home. We arranged for him to see a psychiatrist near his school, who called us (with our son’s permission) after he met with Dan. He certainly didn’t sugarcoat anything. “Your son is suffering from severe OCD, and he is borderline psychotic.”

I knew very little about OCD at that time, but I knew what psychotic meant: out of touch with reality. I was terrified. Psychosis made me think of schizophrenia, though that illness was never mentioned. In fact, after I united with Dan and we met with the psychiatrist together, there was no more reference to psychosis.

So what was going on? A post on Psychiatric Times discusses the fact that OCD with poor insight should not be mistaken for a primary psychotic disorder, and a thorough history of the patient is warranted. There is also a good deal of discussion in the article regarding medication, because antipsychotics which are often prescribed in these cases have been known to induce and/or exacerbate symptoms of OCD. In addition, research has shown that these antipsychotics often do not help those with severe OCD who are dealing with poor insight, or borderline psychosis.

The DSM-5 states that OCD may be seen with: good or fair insight, poor insight, or absent insight/delusional beliefs. While many people with OCD realize their obsessions and compulsions are irrational or illogical, this is not always the case. When Dan was first diagnosed with OCD, he did indeed have good insight. But by the time he met with this psychiatrist his OCD had gotten so bad that he was at the point of borderline psychosis. At least at that moment. It should be noted that the insight of those with OCD into their disorder can fluctuate. For example, while calmly discussing a particular obsession and compulsion, people with OCD might realize their thoughts and behaviors are unreasonable. But when they are panic-stricken and in the middle of what they perceive as danger, they might totally believe what they had previously described as nonsensical.

So did Dan have something else going on aside from OCD? Thankfully, no. Once his OCD was treated, any possible issues related to psychosis resolved. This scenario reminds me of his misdiagnosis of ADHD. The same thing happened: When his OCD was treated, his symptoms that had been attributed to ADHD also disappeared.

Certainly there are lessons to be learned from Dan’s experiences. Things are not always what they seem. And in the case of brain disorders, where we’ve categorized certain behaviors as belonging to specific illnesses, we really need to be careful not to jump to conclusions in reference to diagnoses and subsequent treatments. In the case of obsessive-compulsive disorder, maybe the best way to proceed is by treating the OCD first, and then reassessing the situation. Once OCD has been reined in, we might be surprised to find that symptoms typically associated with other disorders have fallen by the wayside as well.

 

 

 

A Review of Cognitive Behavioral Therapy Made Simple

If you’ve read my book, Overcoming OCD: A Journey to Recovery, you likely remember the clear, concise text boxes written by Seth Gillihan, PhD. At the time, one of the reasons I chose to work with Seth was because of his natural ability to convey often-complicated information in an easy-to-understand manner. He did this without “talking down” to the reader – on the contrary, I think readers felt as if they were having a conversation with a caring friend.

Well, Seth has done it again – for a third time I should say. His successful book Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks was published in October 2016 and his third book, Cognitive Behavioral Therapy Made Simple, is now available.

I’ve read the book and it is everything I expected and more. Seth clearly explains the intricacies of Cognitive Behavioral Therapy (CBT) and how we can all utilize this therapy to help ourselves, no matter what life throws at us. I love how Seth uses real-life examples throughout the book to make these concepts easily relatable. My favorite chapter is “Work Through Worry, Fear, and Anxiety,” and I also appreciate his attention to Mindfulness.

Perhaps the best window into Cognitive Behavioral Therapy Made Simple is through Seth’s own words in the book’s introduction:

Over the past two decades as a student, researcher, therapist, and supervisor, two things have stood out to me about effective treatments. Number one, they’re simple: Do enjoyable activities. Think helpful thoughts. Face your fears. Be present. Take care of yourself. None of these approaches is shocking or complicated. I’ve strived to capture that simplicity in the chapters ahead. When we’re struggling, we typically don’t have the time, desire, or energy to wade through page after page of research findings or study a treatise on the esoteric nuances in the field. We need straightforward options we can use right away.

Number two, they’re not easy. I’ve learned that despite the simplicity of these effective treatments, they still require work. It’s hard to do more of what you love when you’re depressed and unmotivated, hard to face your fears when you’re fighting back panic, hard to train an overactive mind to rest in the moment. That’s where you’ll find the power in CBT—to provide not just a goal to work toward, but manageable techniques and a systematic plan to get you there.

I highly recommend Cognitive Behavioral Therapy Made Simple to all those who are not living the lives they desire due to worry, fear, anxiety or anger. This book, and Seth, will help you move forward – step by step.

 

 

OCD and Death

As some of us know, obsessive-compulsive disorder can take on many shapes and forms, limited only by the imagination of the person with OCD. In general, OCD likes to attack whatever it is we most value: our families, relationships, morals, accomplishments, etc. In short – our lives.

So it shouldn’t come as a big surprise that some people with OCD are obsessed with death. What better way for OCD to attack what is most important to us than telling us our lives are all for naught as we’re just going to die anyway?

It is not unusual for people to think about death. Personally, the thought comes into my mind often. At times it hits me like a ton of bricks that my time here on earth is limited, and this realization brings up various philosophical questions: What’s the meaning of life? Am I living my life the way I should, or want? Will it even matter that I was here? Is there life, or anything, after death? The list goes on.

I don’t have OCD so I’m usually able to let it all go after a few minutes. I realize the questions I have, for the most part, are unanswerable. I accept the uncertainty and go on with my life. For those with obsessive-compulsive disorder, however, obsessing about death can be torturous. People with OCD can easily spend hours upon hours a day obsessing over various aspects of death and dying, asking the same existential questions mentioned above, and then some. But they don’t stop there. They want answers to these questions and might analyze and research them – again for hours and hours. They might also seek reassurance, either from themselves, clergy, or anyone who will listen. It’s not hard to see that these obsessions and compulsions can literally take up an entire day and overtake lives. It is not uncommon to experience general anxiety as well as depression when dealing with OCD related to death.

So how is this OCD treated? You guessed it – exposure and response prevention (ERP) therapy. While we can’t control our thoughts about death, we can learn how to better react to these thoughts. Exposures might include those with OCD deliberately subjecting themselves to the thoughts they fear, typically through the use of imaginal exposures, while response prevention involves not avoiding or trying to escape these fears, but rather embracing the possibility they will occur. No seeking reassurance. No analyzing, researching or questioning these thoughts – just acceptance of them. In short, ERP therapy consists of doing the opposite of what OCD demands. In time, these thoughts that previously had caused so much distress will not only lose their power, but also their hold on the person with OCD.

Time and time again, we see how OCD tries to steal what is most important to us. Ironically, those caught in the vicious cycle of obsessions and compulsions related to death and dying are robbed of living their lives to the fullest. Thankfully, there is good treatment to help those with OCD learn to live in the present moment and work toward the lives they deserve.