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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!

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