Archive for April, 2009

Swine Flu: A Special Warning to those with OCD

Tuesday, April 28th, 2009

The line between the worries of people with Obsessive Compulsive Disorder (OCD) and normal concerns can be quite fuzzy. Worries about a possible pandemic from Swine flu make the line even blurrier than usual. Advice for handling the threat varies considerably. Most of this advice is no doubt wise, especially advice that comes from reputable sources such as the Center for Disease Control (CDC). Be sure to stick with reliable sources for knowing what precautions to take.

For people who have any type of significant anxiety, including OCD about contamination and germs, times like these are especially difficult. You should probably consult with a mental health professional if you are not currently in treatment and feel your distress is climbing. If you are in therapy, you may want to consider making your next appointment sooner than usual. The message is that the swine flu is scary for everyone, but if you’re already a worrier, you’re likely to need some extra help.

However, if you’re currently receiving exposure and response prevention treatment for OCD, we have an important warning. In essence, exposure and response prevention involves exposing you to fears of contaminations by touching dirt, doorknobs, escalator handrails, and other surfaces. And you are asked to refrain from the compulsion to wash your hands. Normally, there are risks from exposure and response prevention, but these are extremely small. Right now, we believe the risks have risen to the point that we issue this warning:

PLEASE AVOID EXPOSURE AND RESPONSE PREVENTION TREATMENT FOR CONTAMINATION OCD IF IT INVOLVES TOUCHING SURFACES THAT HAVE BEEN TOUCHED BY MANY PEOPLE WITHOUT BEING CLEANED AND DECONTAMINATED UNTIL THE SWINE FLU CONCERNS HAVE ABATED. MOST FOLKS WITH OCD HAVE PLENTY OF OTHER TARGETS THEY CAN WORK ON IN THE MEANTIME. YOU CAN NEVER AVOID ALL RISKS, BUT THIS ONE IS UNNECESSARY AT THIS TIME.

Current conditions may even have you wondering:

  • Should I wash my hands every ten minutes?
  • Should I wash for at least fifteen minutes each time I wash?
  • Should I use a mix of harsh bleach, alcohol, and soap each time I wash?
  • Should I wear a mask everywhere I go?
  • Should I confine myself to my house …

Is it OCD or OCPD?

Saturday, April 25th, 2009

Obsessive Compulsive Personality Disorder (OCPD) is one of the 10 specific types of personality disorder diagnosed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A personality disorder is considered to be a pattern of long standing behaviors, patterns of relating to others, and ways of perceiving and thinking about the world. These traits are usually considered to start developing in adolescence and remain stable throughout most of a person’s life. However, new research has challenged whether or not these traits remain consistent throughout an entire lifetime.

People with OCPD tend to be perfectionists who are excessively dedicated to work and productivity. They are often self-righteous and determined to be in control. They demand order, structure, and rules. They like details, procedures, and specified objectives. People with OCPD have trouble delegating tasks to others because they do not believe that anyone can accomplish the task as well as they can. They almost always live well below their means and can be viewed as miserly because of fear of future financial calamities that they envision in their minds.

They also find it hard to relax or play. Leisure activities are stifled by adherence to perfection and mastery. For example, if they decide to travel abroad, they may spend huge amounts of time studying the local culture, history, and language of their destination. Not that these aren’t wonderful things to do in planning a trip, but someone with OCPD can drain all of the joy out of a trip by making it more like work than recreation.

Others describe them as plodding, rigid, and uptight. They may become passively angry or indignant over minor mishaps. Emotional expression is muted and people with OCPD may avoid showing love or tenderness.

A recent article in the Journal of Personality Disorders (2009) by Ulrich and Coid found that the rates of OCPD traits actually increase with age. Although it is an interesting finding, there are not enough studies to guess on the reason why this occurs. Perhaps we all become more structured, rigid, and rule bound as we age.┬áBy contrast, this article and other research suggests that other personality disorders appear …


Worried About Your College Student?

Tuesday, April 21st, 2009

Mental health centers in colleges across the United States are reporting significant increases in the need for services for their students (Anxiety Association of America). College can be a time of angst and worry. Often the student is away from the support of family for the first time. Students suddenly are responsible for planning and taking charge of their studies, health, social life, and schedules. New stressors include lack of built in structure, availability of alcohol or drugs, problems with roommates, and loneliness. Although some kids seem to take these pressures in stride, others can slip into disorders that require treatment.

More than ever before, students arrive at campus with mental health needs already identified. Some have already been seeing therapists and many have been prescribed psychotropic medication to treat depression, anxiety, or various attention problems. The transition to college for these students can be even more difficult because of insufficient communication between the former mental health professionals and the college mental health center. Furthermore, because of differences in health insurance coverage or lack of resources, students may not have an adequate number of sessions or trained professionals available to them. Another obstacle for parents is that now the child is 18, many mental health centers are not accessible to parents unless there is an emergency. This can be frustrating for parents who wish to consult in order to make sure that their child is getting the best treatment.

Spring is here and many students have made it through a long winter. Most weather the process. But other students end their first year disappointed. And some even depressed. Spring sometimes brings on strong feelings and emotions. And right now, final exams loom on the horizon. If you are close (family member, friend, or parent) to a college student this might be a good time to increase contact.

  • Make a few extra phone calls and add some words of encouragement.
  • Ask about what is going on in his life. Is he getting out, seeing friends, going to classes?
  • Send a box of cookies or special hot sauce. Or send a $20 bill for a pizza (college students are almost always broke).
  • Make …

Obsessing About Compulsions

Sunday, April 19th, 2009

In our most recent blog, Laura described what the obsessional part of Obsessive Compulsive Disorder (OCD) is like. She noted that obsessions are worrisome thoughts, images, or urges that pop into peoples’ heads and trigger massive feelings of anxiety, distress, or discomfort. On the other hand, compulsions are the things people do in order to reduce those unpleasant feelings. You could say that people feel compelled to engage in their compulsions, almost as if they have no choice at all in carrying them out. Compulsions take a wide variety of forms but include:

  • Checking doors, locks, or appliances
  • Rituals such as getting dressed in a precise sequence
  • Hand washing
  • Asking parents if they still love you
  • Asking partners if you look OK
  • Arranging items, clothes, or carpet fringe in precise patterns
  • Repeating certain phrases
  • Counting ceiling tiles or stairs

Maybe you’re wondering what makes these ordinary looking behaviors compulsions. Most people do lots of these things don’t they? Yes they do. But two issues make them compulsions rather than ordinary behaviors. First, they are engaged in for the sole purpose of providing some temporary relief from one’s disturbing obsessions. Second, they are engaged in frequently, as in very frequently. It’s not uncommon for people to engage in compulsions for hours each day. Thus, they distract people from getting on with their lives.

Yet people don’t give up their compulsions easily. That’s because compulsions provide so much relief. Here are just a few of the benefits people feel for a short while after engaging in their compulsions:

  • Anxiety reduction
  • Reduced urges
  • Reassurance from others
  • Increased sense of well being
  • Lessened discomfort
  • Greater certainty

The problem is that the relief is always fleeting. After engaging in compulsions, folks feel better for minutes or sometimes even hours. But the distressing obsessions always return. And thus, the urge to engage in compulsions continues.

The good news is that OCD doesn’t have to ruin your life. Very effective treatments exist. We’ve noted Exposure and Response Prevention (ERP) before, and we will again. Over and over if we must because the message is so important. We almost feel compelled to talk about ERP a lot because it works so well. Furthermore, a disturbingly small percentage of people with OCD …


Obsessing over obsessions

Wednesday, April 15th, 2009
Obsessive Compulsive Disorder (OCD) usually involves both obsessions and compulsions. Today’s blog describes and gives examples of obsessions. The obsessions of people with OCD are frequent, distressing, and interfere with life. Obsessions are thoughts, urges, or images that arrive in your brain–unexpected and uninvited. They disturb you and grab your attention. And when they occur, people are highly motivated to rid themselves of the obsession.
  • Obsessions are often quite disconnected from what you are doing. For example, you might be balancing your checkbook and suddenly have an obsessive thought about how you may have forgotten to lock the door. You struggle to stay focused on the checkbook but have a growing, powerful urge to check the lock.
  • Obsessions are potent interrupters. They barge in and take over your mind. You might be driving your car and suddenly an urge to slam your car into the car in front of you takes over your mind. You wonder what’s wrong with your brain and worry that you might actually give in to your impulse and cause an accident. You fear you might be crazy.
  • Obsessions disturb, embarrass, anger, upset, worry, or disgust the afflicted. They are not welcome thoughts, brilliant ideas, or gentle reminders. You walk into your house of worship and unexpectedly wonder if you are sexually attracted to one of the religious statues. Your mind conjures up a vivid image of throwing your body into the arms of the stone figure. You doubt your sanity.
  • Obsessions keep on coming back. You might want to stop obsessing, but you can’t. The more you push back and try to suppress an obsession the more it seems to return.

You may find it interesting to know that some research suggests that people without OCD have various thoughts and images enter their minds that are virtually indistinguishable from those that greatly upset people who have OCD. Thus, people who don’t suffer from OCD, may occasionally have thoughts of running their cars into another car, have an inappropriate sexual thought, or experience an image of having forgotten to lock up the house.

What’s the difference? Through no fault of their own, OCD sufferers take the obsessional …


When Caring Backfires on Parents: The Reassurance Trap

Monday, April 13th, 2009

Over the years, Laura and I have worked with many kids who struggle with anxiety and/or obsessive compulsive disorder. The parents of kids with anxiety tend to be loving and concerned. These parents want to do anything they can to reduce the suffering of their kids. They ask us how they can help and what they can do. An important first step is to stop doing what seems to be a natural response to a child’s fears. Most parents resist this advice at first and have difficulty following it when they try.

So what is this advice? We tell them to go against the grain of their well intentioned parenting instincts and stop reassuring their children. We know that this recommendation sounds like utter heresy to many parents, and perhaps it does to you too. After all, kids with anxiety and/or OCD feel insecure much of the time and they feel better (at least for a little while) when parents give them reassurance. But that’s the rub. When kids feel insecure and parents provide reassurance, they inadvertently reinforce the feeling of insecurity. They also end up giving an indirect message to their kids, to wit: “You need to rely on your parents to deal with distress and you can’t handle things yourself.”

Now we don’t recommend that you stop reassuring your kids all at once with no warning–doing so would result in more distress than necessary. Rather, we suggest that you discuss this issue with your anxious child ahead of time. Review some of the reassuring seeking statements that your child typically comes to you with such as:

  • Is the house really locked up?
  • Is this food clean?
  • Are you mad at me?
  • Do you love my brother more than me?
  • Is Daddy going to lose his job?

Questions like these pull parents to provide reassurance. And please realize that if your child doesn’t ask them often or doesn’t suffer from serious anxiety, giving a little reassurance from time to time is no big deal at all. But, if the questions escalate in frequency and intensity, and if your child has a problem with anxiety or OCD, you need to have a talk. …


How Worried Are You?

Friday, April 10th, 2009

Take a moment and think about your anxiety. What right now is getting you upset? Are you worried about the coming weekend? Will you get everything done that you’ve planned? How about your job, is it secure? Lots of people are worried about money these days. Are you stressed because you haven’t followed through on your diet, your budget, or your exercise goals? Did you visit your mother last week or read to your child everyday? How worried are you?

Did this paragraph help? Sorry, didn’t mean to bring this all up again. But, there is evidence that most people actually do better when they face whatever they are anxious about head on. We frequently write about exposure and response prevention as a treatment for OCD. Exposing yourself to your anxious thoughts can also help.

If you’re like most people, you worry about things that haven’t happened yet. You won’t finish those projects; you’ll lose your job; you’ll never lose weight; save enough money; please your mother; be a good enough parent. Anxiety looks at the future and the future is unknown. The future is really unknown. We’re pretty sure that no one alive today can accurately predict the future. So anxious thoughts are like endless loops or questions without any answers.

Here are a few strategies to deal with those ruminating worries.

  • Set aside a worry time. Write it down in your schedule and spend about 15 minutes worrying a day for a few weeks. During that time, write down or say your worries out loud. Do not do this late in the evening or just before bed, but do it every day. Spend five more minutes generating any solutions or productive actions you could take. If your worries pop up at other times during the day, remind yourself that you have set aside a worry time for dealing with the concern later.
  • Make a goal of actively addressing one small aspect of your worry. Don’t try to do too much–take on something very small (for example give up one expensive cup of coffee a week, take the stairs at work, or read a short book to your kid). …

Anxious Moments with Professional Code Talkers

Monday, April 6th, 2009

Chuck and I wrote a couple of blogs about children and parents that fueled some lively and heated discussion recently. Parents become passionate when their kids have any sort of problem. Anxiety skyrockets. I know. When my twin daughters were born 13 weeks early, after the first wave of fear passed, I became the advocate mom; pushing for early intervention, getting the best educational placements, and even fighting for their legal rights. Along the way I had many sleepless nights and anxious moments. I like to take action when I get anxious. So, I found myself getting two masters degrees and a doctorate in psychology. My daughters steered me into the field of psychology by their early challenges.

Last week Chuck and I attended an evaluation for one of our grandchildren. We attended as family support, not as professionals. We watched while a very talented crew of therapists, psychologists, and a pediatrician played with (and evaluated) our 18 month old grandchild. Chuck and I sat back and listened to the conclusions after a long morning. The results were carefully articulated. Each contributor started with a positive comment, one of hope, followed by a concern. For example, “he is so motivated to walk, but he falls too much,” or “his vocabulary is normal, but he doesn’t use words to communicate.”

We understood the jargon, the nuances, and what the constellation of symptoms meant for this child. But, his parents heard something else. They heard the positive news; that he wasn’t diagnosable at this time and thus, in their view, was normal. All parents want that news. And all children are gifts whether they have challenges or not.

Yet, I wonder how many other evaluations go like that? The “professionals” talk in a code that sounds like English but communicates unintended messages. It was a strange day and one of sadness.

So, what does this discussion have to do with our blog? We are committed to speaking frankly and clearly. We want to be able to communicate without code. Please let us know if we slip up. We no doubt will.


Avoiding Avoidance

Friday, April 3rd, 2009

Real estate agents are fond of saying that their field can be distilled into three words: location, location, location. When it comes to anxiety and obsessive compulsive disorder (OCD), we turn to three words to capture much of the problem as well: avoidance, avoidance, avoidance. People with all types of anxiety disorders generally feel driven to do everything they can to stay away from events and thoughts that tend to trigger their anxiety. In doing so, they hope to keep their anxiety and distress at bay.

And this approach works. So what’s the problem? Although avoiding what disturbs you provides relief, that relief is fleeting. And that short moment of relief ends up making you feel even more desire to avoid feeling anxious the next time. An example may help.

Ralph is a twenty four year old computer technician. He’s had contamination OCD since he was a teenager. His OCD started with worries about becoming ill from touching doorknobs. So he developed strategies for avoiding such germs; he would wear gloves, spray knobs with disinfectant, or use his shirttail to open doors. Each time he used one of these avoidance techniques he experienced brief relief. But then he started to worry about contamination from faucets, toilets, and steering wheels on cars. He used similar strategies for these new worries and felt momentary relief each time he succeeded in avoiding contact with his fears. But as the years went by, his relief experiences encouraged him to look for more sources of conceivable contaminations to avoid. His life became unglued when his concerns turned to computer keyboards, mice, and touch screens. Without treatment, Ralph’s future looks worrisome as he becomes more and more avoidant.

That’s what avoidance does to you. It makes your world smaller and fosters your fears. The more you avoid, the worse things get.

That’s why successful treatment for OCD (and other anxiety disorders) rests largely on the antithesis of avoidance–exposure and response prevention (ERP). ERP gradually guides people to come into direct contact with the things that disturb them or arouse their anxiety. At first exposure escalates feelings of distress. But with continued work, that anxiety decreases. …


Anxiety & OCD Exposed



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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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