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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OCD and The Holidays

Image result for happy holidays sign

 

 

A version of this post first appeared November 2015…..

With the holiday season upon us, many of us are firmly entrenched in the excitement, anticipation, and busyness of this time of year. Maybe we will visit friends or relatives. Perhaps a small army of loved ones will descend upon us in our own homes, or maybe we will be part of smaller, more intimate gatherings.

Whatever our holiday plans involve, there are bound to be changes in our routines. While this can be unsettling for many people, those suffering from obsessive-compulsive disorder might have a particularly tough time, especially when dealing with vacationing and traveling. It’s not hard to see why these situations might trigger all kinds of concerns for those with OCD. No matter what type of OCD they are dealing with there’s always lots to worry about when stepping out of one’s comfort zone. Some concerns might include:

Will I be able to use the public or hotel restroom?

What if I hit someone while driving on the highway?

What if I get sick while I’m away?

Will my family be safe?

The questions are endless and will be different for each person with the disorder. As you can see, however, all these concerns revolve around one thing: the uncertainty of what will be. Those with obsessive-compulsive disorder have the need to know, for sure, that all will be okay.

Friends and family also are affected when traveling and vacationing with someone with OCD. Having to alter plans, not being able to be spontaneous, and dealing with high levels of anxiety are just some of the many examples of how OCD can impinge upon a vacation. Before actually leaving home, anticipatory anxiety with all of its “what ifs” and doubt can be particularly distressing. Interestingly, anticipatory anxiety is often worse than the actual event being agonized over. So what should those with OCD do when faced with all these holiday events fraught with doubt and uncertainty?

The answer is clear. They should push through their anxiety as much as they can and embrace the doubt and uncertainty that is holding them hostage. Yes, there is uncertainty that comes with traveling or vacationing or entertaining. Indeed, there is uncertainty in every aspect of our lives, and we all need to learn to accept, not fear, it.

I know it’s not easy. But it is possible.

If you have obsessive-compulsive disorder, I propose that you give yourself a gift this holiday season and make the commitment to stand up to your OCD. Embrace exposure and response prevention (ERP) therapy in the year to come and reclaim your life. You deserve to enjoy the holidays, and every day, with your family and friends instead of being controlled by obsessions and compulsions. It will not only be a gift to yourself, but just might be the best gift you could ever give to those who love you.

 

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Ocdtalk and Gratitude

 

heart

by sira anamwong freedigitalphotos.net

 

On December 18, 2010 I started this blog, determined to try to help others navigate the often turbulent – and terrifying – waters of obsessive-compulsive disorder. My family was just emerging from this ordeal ourselves and I felt that talking about my son’s journey through severe OCD could benefit others.

Still, I had my doubts. Who would want to hear my thoughts? I’m not a psychologist, and I don’t personally have OCD. But I took a leap of faith and decided to jump right in, propelled forward by the memories of how alone I felt when my son Dan was dealing with this horrible illness. If I had heard at least one story of hope back then, it would have made all of our suffering much more bearable. And now here I was – with a real story of hope. I had to share it.

The rest, as they say, is history.  The blog has reached more people than I ever thought possible. My book, Overcoming OCD: A Journey to Recovery was published by Rowman & Littlefield in January 2015 and the paperback version followed in November 2017. I have been fortunate to speak all over the country and have been interviewed many times as well. It has been, and continues to be, incredibly rewarding.

As worthwhile and exciting as all of these events have been, what has been most gratifying to me over the years has been the individual connections I have made. From comments on my blog to personal emails, phone calls,  and meetings, it has been a privilege to be a part of all of your journeys.

I have been posting at least weekly since that very first entry back in 2010. It is time to step back a little. Ocdtalk is still alive and well, and I will still be sharing news and thoughts about OCD with you – just not as frequently as I have been. It will be a new chapter for ocdtalk. I will continue to write about OCD and other mental health topics for Psych Central.

In this season of Thanksgiving, I want to thank each and every one of you from the bottom of my heart for all the support you have given me over the years. I am truly grateful and it is an honor to continue to be part of your lives.

 

 

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