Moms with OCD

by smarnad at freedigitalphotos.net

 

In this post I’d like to focus primarily on moms who have OCD, and the difficulties they might face. I won’t be focusing on postpartum OCD, but rather on moms who have already been diagnosed with the disorder and have been living with it for a while.

Some of the most common types of obsessions in OCD involve various aspects of contamination such as fear of dirt, germs, or illness. Hmm. Dirt, germs, and illness are an inevitable part of childhood. How can a mom with OCD possibly take her four-year-old child into a public restroom?

Surprisingly, most can, and do. Over the years I have connected with moms who have OCD who do what they need to do, despite their fears. By caring for their children, they are actually engaging in the gold-standard psychological treatment for OCD – exposure and response prevention (ERP) therapy. And because ERP therapy works, these moms find that the more they bring their children into those restrooms, or allow them to play at the playground without trailing behind them with sanitizing wipes, or agree to let them spend time at a friend’s house, the less their OCD rears its ugly head. In short, they habituate, or get used to, being in these situations and accepting the uncertainty of what might happen.

In addition, caring for a child (or perhaps multiple children, and even a family pet?) is time-consuming and never-ending, so moms are often so busy that they don’t have time to worry about all the things OCD thinks they should worry about. If your baby has a dirty diaper, the dog is barking to go out, your toddler just found the finger paints, and you need to get to the grocery store, you don’t have time to fret over your fear of contamination. You just change the diaper, tend to the dog, quickly wipe your toddler’s hands, and get out the door. OCD might be protesting in the background, but you have no time for its silly demands. Again, great ERP therapy!

Of course, it doesn’t work this way for all moms, and for some, OCD is in control. Unfortunately, if obsessive-compulsive disorder remains untreated, it affects children’s well-being. Their world becomes limited, they pick up on their mom’s anxiety, and they might even mimic certain unhealthy behaviors.

Moms who are struggling with OCD need to put their children’s needs before OCD’s demands. A good therapist can help them learn how to spend quality time with their children, without ruminating over all the things that might go wrong in a given moment. Modeling healthy behavior and how to deal with life’s challenges might be the best gift we ever give to our children.

Finally, all of the above also goes for dads with OCD, especially if they’re the primary caretaker at home. Every child deserves the love, support, and caring only parents can provide. Parents not held hostage by OCD.

Overcoming Harm OCD

 

Hi Everyone,

I just finished reading Jon Hershfield’s latest book, Overcoming Harm OCD. It’s a valuable book that I’d highly recommend.

Below is my review on Amazon:

Jon Hershfield has done it again. Overcoming Harm OCD is written with the same understanding and compassionate voice of his last book, When a Family Member Has OCD. Jon really gets it – not only what Harm OCD entails and how to best treat it, but also how having this disorder makes people feel. Through the sheer act of writing this book, he lets those with Harm OCD know they are not alone. My son suffered from Harm OCD years ago – what a positive difference this book would have made in his life!

Also, Harm OCD is often misunderstood by those not familiar with it – be they therapists, teachers, other professionals, or family members. This book can educate these people, so they, in turn, can help those with this type of OCD find the right diagnosis and treatment.

I highly recommend Overcoming Harm OCD to, well, everyone, and thank you to Jon Hershfield for all he does to help those whose lives have been affected by OCD.

 

 

OCD and Autism

Doctors have recently confirmed that autism and OCD frequently occur together. Autism and OCD initially appear to have little in common, yet studies indicate that up to 84% of people with autism have some form of anxiety and as many as 17% might have OCD. Additionally, an even greater proportion of people with OCD might also have undiagnosed autism. A 2015 study in Denmark tracked the health records of almost 3.4 million people over 18 years, and researchers found that people with autism are twice as likely as those without to be diagnosed with OCD later in life. The same study found that people with OCD are four times more likely than others to later be diagnosed with autism.

It can be tough to sort it all out. OCD rituals can resemble the repetitive behaviors that are common in autism, and vice versa. Also, people with either condition may have unusual responses to sensory experiences. Some autistic people find that sensory overload can readily lead to distress and anxiety, and the social problems people with autism experience may contribute to their anxiety as well. Anxiety is a huge component of OCD also, so it gets complicated.

How do we distinguish the two, or determine if someone has both conditions? It is interesting to note that people with both OCD and autism appear to have unique experiences, distinct from those of either condition on its own. Also, a crucial distinction found in this analysis is that obsessions spark compulsions but not autism traits. Another finding is that people with OCD cannot substitute the specific rituals they need with different rituals. Says Roma Vasa, director of psychiatric services at the Kennedy Krieger Institute in Baltimore, Maryland:

 “They [those with OCD] have a need to do things a certain way, otherwise they feel very anxious and uncomfortable.”

People with autism, on the other hand, often have a repertoire of repetitive behaviors to choose from. They just need to perform rituals that are soothing, not necessarily a particular behavior.

More research is needed, not only in the area of diagnoses, but also treatment. The gold standard treatment for OCD is a Cognitive Behavioral Therapy (CBT) known as exposure and response prevention (ERP) therapy, but for those with both autism and OCD, it often does not work well. Whether this is due to auditory-processing difficulties, cognitive inflexibility, or something else, might vary from person to person. Researchers are trying to adapt CBT for people with autism, and agree that a personalized variation of the therapy can be beneficial.

We have a long way to go in figuring out just how OCD and autism are connected. Hopefully, just knowing there is a connection, however, should help clinicians when they are diagnosing and treating their patients.

 

 

 

Treating OCD is More Important than School or Outside Activities

 

stock images from freedigitalphotos.net

When obsessive-compulsive disorder makes its appearance in a family, it often brings about fear and confusion. For one thing, OCD manifests differently in everyone. Truly, there is no end to the ways it can present itself, in addition to the stereotypical hand-washing and tidying up compulsions. A few examples include eating issues, refusal to leave the house, irrational fears of certain people, places, or things, and the inability to complete previously easy homework assignments. You name it, it just might be OCD.

Which leads us to the next issue that faces parents of children with OCD – getting a proper diagnosis. Misdiagnosis is common, which of course leads to the wrong treatment. Even when OCD is properly diagnosed, the right therapy, exposure and response prevention (ERP), is often elusive. What’s a family to do?

For those lucky enough to receive a proper diagnosis and referral to good treatment, you’d think the children would be on their way to recovery. However, that is not always the case – I’m hearing from more people than ever who are in this situation. While various forms of intensive treatment (intensive outpatient, partial hospitalization programs, or residential treatment centers) are often recommended for their child, many parents are concerned that a commitment to intensive treatment will disrupt their child’s life. For example, “Kate” loves dance and she’ll miss some classes and the recital, “Jake” will miss a good chunk of fourth grade if he does a particular ERP program, and “Ashley” will miss a few social events and have to tell her friends what’s going on (or lie).

Obviously, the children discussed in the above paragraph are not totally debilitated by OCD. Not yet anyway. And it very well could be that they are balking at the idea of treatment. For children who can’t leave the house, or are not able to function to any extent in their daily lives, the decision to seek treatment is typically easier – they have already hit bottom. But many parents of children who are teetering on the edge don’t seem to want to take away the few things that still make their children happy, or “normal.”

As an advocate for OCD awareness and proper treatment for over ten years, I cannot stress the importance of getting the right help for obsessive-compulsive disorder sooner rather than later. OCD rarely gets better on its own, and once entrenched, is harder to treat. So, for all those out there who might be in this situation, please get your child the right help as soon as possible. Friends and activities will come and go. Even missing a significant amount of time in school can be made up. But a child who grows into a young adult with untreated OCD might very well be so disabled by the disorder that he or she can’t even hold down an entry-level job. Getting good treatment now will free your child from the grips of OCD and allow him or her to go on to have a wonderful life.

 

 

 

 

 

 

An Interview about OCD with Dr. Seth Gillihan

 

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!

 

 

 

OCD and Emetophobia

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.

 

 

 

 

 

 

 

Distinguishing Between GAD and OCD

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.

 

 

Helping Families Affected by OCD

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!

A New Facebook Support Group

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:

https://www.facebook.com/groups/MalevolenceOCD/

Again, best wishes for a happy and healthy new year for us all!

The Bergen Treatment – Intensive Therapy for OCD

 

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.