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Recognizing Different Presentations of Obsessive-Compulsive Disorder (OCD)

By Brittany Keim, MS, Therapist, The Center for Neuropsychology and Counseling

Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions are recurrent and persistent thoughts or images; whereas, compulsions are behavioral or mental actions that are performed to reduce the distress or discomfort that an individual experiences. In simpler terms, an obsession is something that you cannot stop thinking about regardless of how hard you try to stop and a compulsion is a behavior that gives you short-term relief from your obsession. For instance, an individual may experience obsessions about their safety when they leave the house. In an effort to decrease their feelings or distress, that individual may stay home and this action will act as a compulsion because it is directly related to a decrease in anxiety or discomfort.

When thinking about OCD, it is important to remember that obsessions and compulsions have to result in significant distress and impairment. This means that obsessions and/or compulsions are time consuming and take away from your ability to participate in everyday activities. Significant distress and impairment may look like being late to school, skipping work, not being able to participate in activities that you once found enjoyable, etc.

Obsessive compulsive disorder is often thought of as excessive hand washing and a fear of contamination or germs, but OCD has many other presentations that can be overlooked. Knowledge of these other presentations is helpful in obtaining a correct diagnosis and receiving effective treatment. Below, I will detail common OCD subtypes, but please note that this is not an exhaustive list of presentations.

Harm OCD – involves intrusive thoughts of harming others or committing a violent act. People fear they could lose control at any moment and engage in violent behaviors. Due to this fear, individuals with this subtype of OCD may engage in significant avoidance. They may avoid interacting with others or completing everyday tasks that pose a risk (e.g., chopping vegetables).

Postpartum OCD – characterized by unwanted thoughts of harming a newborn. Individuals who experience this presentation will often avoid interacting with their baby or they will refrain from engaging in actions that are essential in taking care of a newborn (e.g., changing a diaper).

“Just Right” OCD – obsessions are thoughts and/or feelings that something is not quite right or that something is incomplete. Those who struggle with this subtype of OCD, will often wait to complete a task until it feels “right” or they will excessively engage in a behavior until it feels “right.”

Scrupulosity OCD – strict adherence to religious principles or moral ideals. Individuals will hold themselves to high moral/religious standards and feel extreme guilt or anxiety when they fall short. Some examples of compulsions are: excessively reading scripture or not allowing oneself to enjoy interests in fear that this could be considered sinful.

Relationship OCD – described as repetitive thoughts that center on doubts or fears about the relationship. The person may experience uncertainty and obsess about whether their partner really loves them or whether the relationship will last. A common compulsion related to this subtype is seeking reassurance.

Pedophilia OCD – this subtype of OCD occurs in individuals who have no desire to harm children, but are plagued with worry that they may do so. Individuals may become concerned with their thoughts towards children and/or they may fear that they may interact with a child in a way that is deemed inappropriate.

If you are currently experiencing symptoms of OCD and relate to any of the above presentations, you are not alone. Exposure with response prevention (ERP) is an evidence-based approach to treatment that has been proven to be very effective in treating OCD. Through ERP, an individual will learn to navigate their obsessions and decrease unwanted compulsions that interfere with their everyday functioning. Reach out to The Center today to learn more about receiving treatment for OCD.

5 Ways to Accept and Overcome Your Anxiety

By Dr. Lorna Jansen

Most of us have felt anxious at one point or another. Maybe it was a school or work evaluation or a difficult relationship or fears about the state of the world that recently caused an increase in anxiety for you or a loved one. Regardless of the origin, it is important to understand how to recognize and respond appropriately to anxiety when it comes up. I attended a seminar by Lynn Lyons, LCSW, on the topic of Helping Anxious Families. What follows is a combination of information from her presentation and my own clinical experiences. 

  1. The first step is to be aware and acknowledge the anxiety you or your family member is feeling. 
    • This can manifest as physical symptoms, such as shortness of breath, shaky hands, an upset stomach or headache, and/or feeling like your heart is racing. 
    • Take notice if you are having trouble sleeping or concentrating. 
  1. The second step is to understand that we often can’t change the fact that anxiety will show up, but we can change how we respond when we feel anxious. In fact, it is more important that we should welcome anxiety and get used to the thing that is making us anxious. We can even be curious about our feelings of discomfort and realize that if we aren’t always feeling at ease, that means we’re headed in the right direction.
  2. The next step is to look at how the anxiety is being reinforced in your own life or within the family. Often, a person who is anxious will require that certain things are done to help them reduce their anxiety. For example, a child who is worried about interacting with peers on the playground may avoid going out for recess. In the absence of any safety issues, it would be best if a teacher or guidance counselor helped that child get used to playing on the playground instead of allowing them to skip out on the experience all together.
  3. Anxiety runs in families and it affects the people with whom you live. If you tend to be a person who is often worried, you have probably affected the anxiety level of those around you. If you are a parent, it is suggested that you
    • Talk less about your anxieties and fears about the world to your child, and do not repeat others’ fears to yourself or to them
    • Seek to find ways that you can encounter your fears while also supporting yourself appropriately
    • Control your response to others’ fears – try to remain calm instead of expressing excess emotions
    • Reduce your expectations that accommodations should be made in response to your fears or to someone else’s worries 
  4. Anxiety wants us to feel calm, comfortable, and certain. Instead, we can
    • Expect that worries and fears will come up.
    • Talk to your worry. You can even name your anxious voice and acknowledge it when it shows up: “Hi, George. There you are again. I hear that you’re anxious about getting in the car today.”
    • Aim to be unsure and uncomfortable on purpose at times.
    • Keep breathing. The 4-7-8 breathing technique involves breathing in for four counts, holding for seven counts, and breathing out for eight. When you notice you are breathing rapidly, try to slow it down using this method (or box or belly breathing, if preferred). Rapid breathing sends the message to your brain that you are anxious, relaxed breathing lets your body know you are OK.
    • Keep your goals in mind and remember the success you have had in the past when you have encountered other feared environments.
    • Continue showing up and remember that worry doesn’t have to get in the way of you achieving your goals, whether that be dealing with a difficult boss or taking a test at school.

In conclusion, if you or someone you know is living with anxiety, it can be draining and difficult to know how to combat it. Remember that anxiety will show up – expect it, but do not give it a foothold or give in to its demands for security.  Also, consider how you are separate from your anxiety and realize that it is not you, but a separate thing outside of you that is calling for this flight or fight responses to situations that are not actually dangerous. You can do this!

Quick Tips for Regulating Your Emotions

By: Brittany Keim, Therapist at The Center

Oftentimes, before we even know what emotion we are feeling, we experience physical symptoms that tell us that something is “off”. These symptoms can include: an accelerated heart rate, a pit in our stomach, or an all-encompassing feeling of heaviness. We ponder, “Why am I feeling this way?” This can be a tricky question to answer, which is why it is important to employ specific skills to assist us in identifying and understanding our big emotions.

Simply put, emotion regulation skills help us to manage and respond to an emotional experience in a productive way. When we know what we feel and why we feel that way, we are in a much better place to navigate a challenging situation and prepare for what is next to come.

Here are some tips to help you better understand and regulate your emotions:

Recognize your early warning signs 

As mentioned above, our emotions are usually accompanied by a physical reaction. It is helpful to catch these feelings in our body early on and before they overwhelm us. Take a moment now and ask yourself, “Where do I tend to feel my emotions?” Does your face become flushed? Does your stomach start to hurt? Does your chest get tight? These physical sensations can be thought of as hints that tell us that we are experiencing an emotion. The sooner we recognize these early warning signs, the sooner we can understand, regulate, and resolve our emotion. With practice, you may even be able to prevent big emotional reactions from happening in the first place!

Slow down and try to avoid jumping to conclusions

When we are experiencing a big emotion, it can feel impossible to think clearly. Take a few deep breaths and think of something else you can put your attention on for a brief moment. In order to properly work through an emotional experience, you have to calm yourself down so that you have the mental clarity to do some critical thinking.

Consider which emotion(s) you may be experiencing and then label your emotion(s)

It is important to identify what emotion or emotions you are feeling. Once you put a name to what you are feeling, you have valuable information. If you know what emotion you’re feeling, you’re one step closer to understanding what triggered you and why you are feeling that way.

Observe, observe, observe! Be a detective! 

Observe what is happening around you and consider what happened right before you started feeling that given emotion. Usually, the thing or event that occurred right before your emotional experience is what triggered you in the first place. Pay close attention to thoughts that you may be experiencing as this will also give you insight into why you are feeling some type of way.

Ask yourself, “What do I want to get out of this situation?”

You’ve upgraded to problem solver! Now that you know what you’re feeling and why you are feeling that way, consider what actions will help you get what you want. Think through possible solutions and choose the option that you feel will benefit you the most. For instance, if you are feeling sad because you just found out that you didn’t perform well on a test, you likely want to improve your grade. You should accept your feelings of sadness, but it probably won’t help if you sit in your sadness for a long period of time or come to the conclusion that you’re done trying in school. Instead, start thinking of helpful solutions. You may conclude that it is best to ask a teacher for help or study more next time.

Keep these steps in mind next time you encounter a similar situation 

You’ve proven that you can work through a challenging emotional experience. Use this thinking process to help you in future situations. You will likely find that recognizing your triggers can help you the next time you encounter them.

Tips on Handling Back to School Anxiety

By: Brittany Keim, MS.

Summer break is necessary for many reasons, but going back school after weeks of time off can be difficult.Educators, parents, and students alike can feel the pressure of what it means to start a new school year. There are countless questions and unknowns when August comes around the corner. Students begin to have questions such as, “Who will my teacher be?” and “Who will I sit next to at lunch?” These questions are normal, but they begin to consume our minds and unfortunately, take our attention away from the remaining weeks of summer. This time of year is undoubtedly challenging for any student, but it can be equally as hard for parents to support their children who experience back to school anxiety.

Here are some tips to keep in mind during this back-to-school season:

  • Assure your child that is okay to not have all the answers right away

Sadly, we can never have all the answers to our questions. It is important to normalize your child’s back to school anxiety by letting your child know that they are not alone and by telling your child that is it okay to feel this way. The nervous butterflies that they are experiencing in their stomach are normal! Remind your child that some uncertainty is good. Uncertainty can often lead to some of the best surprises.

  • Take off some of the pressure your child may be experiencing

Getting back into the rhythm of things can be hard. After all, a summer off from schoolwork can make us rusty when it comes to taking that first test or handing in that first book report. Children often have high expectations for themselves. I mean, who wouldn’t want straight A’s? However, it is difficult to be our very best self at the beginning of the year. Help your child manage their expectations and remind them that good things take time. In the beginning of the year, just getting through the day or the week should be good enough.

  • Help your child establish a routine in the days leading up to school

The new school year can feel far out of your child’s control. Help your child achieve a sense of control by assisting them in creating a back-to-school routine. It will be useful to start thinking about an appropriate bedtime and how long it will take your child to get ready in the morning. Summertime gives us the luxury of going to bed later and sleeping in, but it is extremely

important for your child to get about 8-10 hours of sleep each night so that they are refreshed and prepared to learn this year’s class materials. It can be helpful to practice your child’s new routine a couple of times so that they can go into that first day of school feeling like a pro!

  • Identify a few safe people at school that they can go to for help

There are many school staff members that can be of assistance and there should be no shame in asking for help. Asking for help assists us in learning! It can be beneficial to ask your child to identify 1-2 people that they can go to if they need support at school. The school nurse or guidance counselor are great options and can be excellent resources at the beginning of the year.

  • Take advantage of special events that your child’s school may offer

Your child’s school knows that this can be a hard time of the year. Knowing this, schools often offer a “Get to Know Your Teacher” event before school starts. Even though you and your child may not want to be reminded of school, it is important to go to events like these so that your child can have exposure to their new teacher, classroom, building, etc. If your child’s school does not offer an event like this, there is no harm in asking the main office or your child’s teacher if you and your child can visit the school before their first day. Teachers and school staff want to make sure your child is comfortable too!

  • Make this time of year fun

The start of a school year can be viewed as a time of excitement as well. There are countless possibilities at the beginning of a school year. A new year can be indicative of new friendships, knowledge, interests, and hobbies. Also, who doesn’t love to pick out their new backpack, colored pencils, and pens? Use back to school shopping as a way to make your child excited to start this new journey.

  • Lean on other parents, friends, and professionals for support

You are not alone in worrying about your child. It is normal to want to do everything in your power to make them feel excited, confident, and prepared for that first day of school. Take advantage of your support system during this time. If your child is struggling with anxiety about returning to school or if they are experiencing anxiety about anything else, please reach out to a therapist like myself at The Center. I’d be happy to support you and be part of your team!

Bring Joy and Peace to Your Holidays This Year

by Dr. Lorna Jansen, Psychologist at The Center

The holidays can be a wonderful time of gatherings accompanied by laughter and sweet time with loved ones. They can also bring additional commitments to already busy schedules and increased financial demands. Being in close proximity with family and co-workers at holiday events can lead to difficult conversations and stir up a variety of emotions. Ironically, some of us feel most isolated at this time of year, whether by the crush of crowds or the increased pressure we feel to be happy. Others are mourning the loss of people we care about. Below you’ll find some tips to help you navigate this holiday season:

1. Take care of yourself

  • Drink plenty of water and eat a healthy diet, focusing on fruits, vegetables and quality proteins
  • Go for a walk outside or take a class at your local gym
  • Engage in your favorite activities often, with a goal of doing one positive thing for yourself each day
  • Do your best to turn off all screens an hour before bedtime and make time for adequate sleep
  • Use a meditation app like Calm or Insight Timer to help you process what you are feeling, or an app like Gratitude to help you focus on your blessings

2. Set reasonable expectations for yourself and for others

  • Consider your values and how that can direct where you spend your energy this year
  • Call a family meeting and discuss what is important to each member this holiday season
  • Map out what different weeks or holiday travels will look like for the children in your life so that they know what to expect
  • Plan to be flexible – with expectations, with normal routines, with emotions that may arise in the hustle and bustle
  • If finances are tight and you cannot afford to buy gifts for all of your family members and friends, suggest a planned or white elephant gift exchange

3. Ask for help

  • If you need help buying gifts, decorating, baking cookies, or hosting a party, ask for help from friends and family
  • Enlist the help of online retailers to ship and wrap your gifts, and order prepared meals from your local grocery store
  • If you are part of a faith community, ask for prayer and practical help where it is available.
  • If you are struggling with feelings of depression or anxiety and are having a difficult time functioning, rally your support structure and consider seeking out a professional

The message at the holidays is that “it’s the most wonderful time of the year.” To many people, perhaps more than will readily admit it, that is just not the case. As such, the best thing you can do is to take care of yourself and your family, while practicing compassion for yourself and others. Follow these steps and if you need more help, please reach out to us or a therapist in your area.

Dr. Lorna Jansen works with individuals of all ages who are dealing with anxiety, depression, ADHD and life transitions. She is a Psychologist at the Center for Neuropsychology and Counseling in Warrington.

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