Entries in Obsessive Compulsive Disorder (5)


Super Bowl Superstitions or Obsessive Compulsive Disorder?

Wendy Hope/Stockbyte/Thinkstock(NEW YORK) -- As football fans don their unwashed jerseys, sit in their favorite couch seats or line up their remote controls like Robert De Niro's character in Silver Linings Playbook, many might wonder whether their Super Bowl superstitions might be crossing over into something more serious -- such as obsessive compulsive disorder.

People with obsessive compulsive disorder, or OCD, often associate certain colors and numbers with bad luck, just like people who don't have OCD, but there are a few critical differences: When OCD patients see these colors or numbers -- or have other intrusive thoughts -- they feel they must perform rituals to avoid catastrophic outcomes, said Jeff Szymansky, the executive director of the International OCD Foundation.

"OCD gets in your head and says, 'Look, this is going to happen if you don't act,'" said Shannon Shy, who lived with severe OCD for years until he found a way to manage it.  "It's as real to you as the sun rising."

Shy, who is on the International OCD Foundation's board, remembers how he would have to drive past the same log in the road 20 or 30 times to be sure it wasn't a dead body.  That was at the height of his disorder, when he hid the problem from the world and contemplated suicide.

"You decide, 'How do I want to spend my day?' but someone with OCD and superstitions doesn't do that," Szymansky said.  "It's distressing.  It's a have to, not an I prefer to."

People with OCD -- more than two million adults nationwide -- experience intrusive thoughts -- obsessions -- which can include fear of harm, contamination or losing control.  To get rid of these thoughts, they perform rituals -- compulsions -- such as checking their stoves or washing their hands.  Even praying can be a compulsion.

In Silver Linings Playbook, the filmmakers showed De Niro's character positioning remote controls just so and asking his son Pat (played by Bradley Cooper) to sit in a specific spot on the couch during Eagles games for good luck.  Neither of these behaviors necessarily signaled OCD, Szymansky said.  But the anxiety De Niro's character displayed when he argued with his son for not sitting in the seat sounded to Szymansky like OCD.

OCD differs from putting on socks in a particular order to win a game, said Dr. Todd Peters, a psychiatrist at Vanderbilt Psychiatric Hospital in Tennessee

"That's not really going to get in the way of life," Peters said, adding that, in contrast, the person who anxiously has to repeat everything he did the day his team won probably has a problem.  "Because life is ever-changing, they can't expect other people to buy into their ritual or compulsion. ... People get so stuck in their minds that they can't get off that topic."

Peters said people with OCD get "stuck" trying to rid themselves of anxious feelings through certain behaviors.  Some of the behaviors are fairly logical, such as compulsive hand-washing to avoid germ contamination, but others are bizarre, such as needing to see a certain animal run to the right to keep a family member from dying.  He's seen patients exhibit both.

Peters said it's important that people with OCD know that a combination of drugs and exposure therapy can help them manage their symptoms.  About a third of the people who have OCD find a resolution, another third will have episodes that come and go, and a final third will struggle with moderate to severe symptoms throughout their lives.

Copyright 2013 ABC News Radio


Pathological Grooming Now Categorized as a Form of OCD

Courtesy Nicole Santamorena(NEW YORK) -- When Nicole Santamorena was a baby she pulled her hair for comfort when she was distressed or sick.  But that coping mechanism eventually escalated into pathological grooming behavior so serious that she was bald by middle school.

"I had to wear a hair piece and a bandana," said Nicole.

Today, the 17-year-old from Putnam, N.Y., still fights the urge to pull out hair, but therapy, a good support group and even Internet friends with the same compulsive behavior have all helped.

Medical experts are baffled by these behaviors.  But now they are giving more scrutiny to pathological groomers, those with dermatillomania [picking scabs], trichotillomania [pulling hair] or even simply nail biting.

"The problem is we don't have data -- it's not something we collect because we always thought of these behaviors as benign," said Dr. Nilay Shah, a neurologist and medical director of the Integrated Medicine of Mount Kisco, N.Y.

"It's common enough to see 20 or 30 percent of all kids at some point along a spectrum that we call pathological, but other than that it's a wild guess."

Soon, all of these repetitive habits will be included in the American Psychiatric Association's DSM-V or the latest Diagnostic and Statistical Manual of Mental Disorders under the broader category of obsessive compulsive disorder (OCD).

"That's a great thing," said Shah, who treats Nicole for other health issues.

"The beauty is that a categorization in the DSM-V gives it a whole new light," he said.  "And the research institutions can have a unified definition and approach that will lead to drug company and NIH funding."

Doctors know that OCD is a spectrum of disorders.  Compulsive hand washers and germaphobes exhibit repetitive behaviors as a kind of magical thinking to ward off something bad happening.

Pathological groomers like Nicole, on the other hand, derive stress relief and pleasure from their tics.

"There is a sensation I get before I pull," Nicole said.  "It's like a pulsating scalp and if I don't pull, it doesn't go away.  It's kind of a compulsion."

Studies suggest that the behavior is also genetic.  Nicole's mother picks her skin scabs and her father bites the hair from his knuckles.

"When you look at the brain wave activity, it does correspond with obsessive compulsive disorder," said Shah.  "We know consciously that it's not right or logical or reasonable, yet cannot help doing it.  And for a brief moment it feels better -- there's a release."

Researchers speculate that on a microscopic level, the signals or neurotransmitters in the brain are involved and often use antidepressant medications to help treat these behaviors.

Copyright 2012 ABC News Radio


Mom's Life Hurt by Obsessive Fear of Sweaters, Germs, Hotels

Stacey Horton/Pocket Therapist LLC(FALMOUTH, Mass.) -- Stacey Horton's obsessive compulsive disorder first emerged during a stressful period in her junior year of college about 25 years ago. She found a dead bug and couldn't throw it away. "I had to know its destiny," she said.

Horton began to collect strange items in a bag in her dorm room, and soon other compulsions kicked in.

"I had to memorize dollar bill serial numbers before I gave them away -- and license plate numbers," said Horton, 47, from South Yarmouth, Mass. Horton had come from a family of 10, and she feared that if she didn't count to 10 on her fingers, "someone in the family would get hurt."

"It was a weird form of control," she said.

OCD is a disorder of the brain and behavior, affecting about 4 million Americans, according to the OCD Foundation.

Horton, who has been in and out of therapy for the disorder, hopes to get some relief from a new mobile therapy application -- Live OCD Free.

The app guides obsessive-compulsives through exposure and response therapy, the most widely accepted treatment for OCD. Patients create their own treatment plans that map out challenges and exercises, known as "exposures."

Live OCD Free, which costs $79.99 and is available on iTunes, was created by Kristen Mulcahy, director of the Cognitive Behavioral Institute in Falmouth, Mass. It comes with a 30-page user guide and works in tandem with a therapist.

Mulcahy said she had developed the app in collaboration with leading professionals and had done rigorous pilot testing to support its effectiveness.

"I love that she is collecting data," said Jeff Szymanski, executive director of the OCD Foundation, which is the nation's biggest resource for those with the disorder.

The foundation has shown an interest in Internet-based therapies for patients. Its annual convention in July will include workshops on two such programs -- BT Steps and OCD Challenge.

"These tech-based programs are good if you don't have access to a provider," he said. "We don't recommend them in lieu of therapy, but a lot of people don't have a therapist."

The number of therapists trained in behavioral therapy for OCD is "very, very low," he said.

Horton's obsessions center on contamination, and she especially fears touching sweaters or bed sheets, where germs or insects might lurk.

Using the new app, she can set up her own rewards, such as a day of shopping, "or getting my nails or hair done," said Horton. "For me, it's just knowing that the app is there. It sounds cliched, but it's like a therapist in your pocket. It's portable, and so accessible."

Washing hands or using hand sanitizer after touching something dirty "works really well in the short term," Mulcahy said. "But in the long term, the compulsion becomes more consuming and it takes more time and energy."

The app allows patients to monitor their anxiety levels. Once they go down, they can challenge themselves to new tasks.

Exposure therapy works through "habituation," said Mulcahy. Patients learn they are "not going to be anxious forever -- it always comes down."

The app also provides a progress report, which can be shared with the therapist. "That's motivating to see," said Mulcahy. "It holds them accountable and increases their consistency."

"The app allows a set practice time and a calendar to remind them to practice daily," said Mulcahy. "They set a timer -- not to give in to the compulsion."

As for Horton, she said her fantasy goal is to live a life without OCD, which she said has disrupted her life and caused her untold anxiety. Horton is a teacher but said she could barely face working because of her fear of contracting head lice from her students.

"The whole thing is driving me nuts," she said. "It's tough on my profession. The universe is always giving me things to challenge me."

Working with Horton and the app, Mulcahy set up a hierarchy of Horton's fears, so she can practice facing them. The app challenges Horton to first expose herself to the least fearful activity, such as touching dirty bedsheets, working toward eventually staying at a hotel.  Using a public restroom, curtailing her hand washing, not washing sheets and wearing sweaters are all on Horton's task list. But the longer a patient has had OCD, the more "difficult and challenging it is to break," said Mulcahy.

"A thought causes a lot of distress, and you can't get rid of it," said Mulcahy. "Then the compulsion is anything that you do to get rid of...and diminish the anxiety. It could be physical or mental."

"Sometimes I feel sorry for myself and think, why do I have it," Horton said. "But maybe it makes me more empathetic toward others.

"It's absolute hell on earth," she said. "My dream is to be at peace and not having to be so vigilant every minute, awaiting the next germ or bug I might come upon. I'd like to relax and get into life and enjoy my children."

Copyright 2012 ABC News Radio


Hoarder Buries Himself in Atari Games and Bobble Heads

Courtesy of Lee Shuer(EASTHAMPTON, Mass.) -- Lee Shuer's hoarding began a decade ago as he began collecting Atari video games, then progressed to vintage art work and musical instruments.

But soon, his apartment was overflowing with bobble heads, collectibles and anything he could get "free or [a] good deal [on]."

"It got to the point where more is better," said Shuer, now 37, of Easthampton, Mass.  "Eventually, they spilled off the shelves, onto the floor, down the hall, into the bedroom, off the bed -- you could see the tide flow."

Shuer's acquisitions became part of his identity and self-esteem.

"If I had more fun and more toys, people might actually like me," he said.  "If I had enough things to play with, they might come hang out."

When he finally met his future wife and they had to clean out the clutter to move in to a new home, she was horrified by the volume of things and begged him to call for help.

Shuer did, and this week he is one of the key presenters at the 14th Annual Hoarding and Cluttering Conference, sponsored by the San Francisco Mental Health Association.  There, both clinicians and hoarders will attend an array of workshops on best practices and new treatments.

"I give my wife a lot of credit," he told ABC News.  "If it wasn't for her, I wouldn't be talking to you now."

After participating in a study at Smith College in 2005 with pioneering hoarding expert Randy O. Frost, Shuer joined a hoarding task force and began to help others.

"Hoarding has been around a long time, all the way back to the 14th century," said Frost, psychology professor and co-author of the 2011 book, Stuff: Compulsive Hoarding and the Meaning of Things.

Frost identified the three features of hoarding: excessive acquisition, difficulty discarding and disorganization.  He developed the "Buried in Treasures" self-help program that gave Shuer his life back.

Compulsive hoarding is strongly associated with obsessive compulsive disorder (OCD), a condition that affects about four million Americans, according to the OCD Foundation.  About 25 to 40 percent of those with OCD have hoarding symptoms.

Psychiatrists are now hopeful that hoarding will get its own category in the Diagnostic and Statistical Manual of Mental Disorders V this year, distinguishing it from obsessive-compulsive disorder.

Copyright 2012 ABC News Radio


PANDAS: Strep Throat Can Lead to OCD in Children

Courtesy of Kelly Bossman(CLAYTON, N.C.) -- Karli Bossman was a happy 5-year-old from Clayton, N.C., who loved going to kindergarten, until one day in 2008 when the easy-going child suddenly became obsessive and defiant.

She ripped off her socks and underwear because they "hurt" and insisted on wearing pajamas.  And Karli refused to get in the car because she was afraid it would run out of gas.

At first, her parents thought the little girl was being bullied, but after checking with her teachers, that was not the case.  What was so frightening was how quickly her behavior changed.

The little girl also had an irrational fear of elevators and was scared to go to bed at night for fear she would have a bad dream.

It took two years and 14 doctors to finally figure out what was wrong.  Karli, who'd had at least 19 cases of strep throat in the last three years, had developed PANDAS -- pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection.

Symptoms include obsessive compulsive disorder (OCD) -- general anxiety, emotional mood swings, rages and oppositional defiance behavior.  Some children have learning disabilities and lose fine motor skills movement.

"It's not a rare disorder, it's just rarely diagnosed," said Dr. Denis Bouboulis, an immunologist from Darien, Conn., and one of the top experts on PANDAS.  "There are a lot of children actually misdiagnosed as having a primary psychiatric symptoms, when, in fact they are autoimmune and organic."

The disorder was first described in the mid-1990s, but has only recently been recognized by the National Institute of Mental Health (NIMH).  For years, medical experts thought the link between a strep throat and OCD was only coincidental.

But in 2009, a Columbia University study confirmed that a strep infection could cause PANDA symptoms like OCD behavior and Tourette syndrome tics in mice.  According to that research, those psychiatric disorders affect 25 percent of adults and more than 3 percent of all children.

Scientists think that PANDAS and its quick onset use the same pathways as rheumatic fever, affecting the part of the brain that controls movement and behavior in a phenomenon known as molecular mimicry.

Karli's journey, which continues today as her family strives to find an effective treatment, involved many misdiagnoses, including the use of antipsychotic drugs that have side effects like tremors and weight gain.

Now, the mother of four wants to try intravenous immune globulin (IV IG) treatment that was pioneered by Bouboulis.  That helped Lauren Johnson, the Chesapeake, Va., girl who sneezed 12,000 times a day because of an OCD tic.

Copyright 2011 ABC News Radio

ABC News Radio