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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.

Sometimes It Helps to Name It: Talking About Loss During a Pandemic

By Dr. Christina Carson-Sacco

In Pennsylvania, where I live, we are about a month into the ‘lockdown’ caused by the COVID-19 pandemic. I’ve noticed there is a shared feeling among family, friends and patients. It’s like someone draped a blanket full of heavy feelings over the world. It’s even affecting our sleep, as most are tossing and turning with vivid, scary dreams.

Because so many people are struggling, it is important to recognize the evidence that suggests giving a name to the feelings and speaking about them can be helpful. In short, I think what we are all feeling is Loss and the resulting Grief.

In this unstable and uncertain time, it is easier to identify the anxiety we are feeling. But as time has dragged on, for many this has turned into loss and grief.

  • Sadly, for some, it is tangible loss due to the death of a loved one at a time when it is impossible to gather and mourn. For others it is a loss of less tangible things like routine, freedom, and normalcy.
  • Others have felt the loss of special events like celebrating birthdays, graduations, proms and other important milestones.
  • Most people are feeling a loss of connection with others due to the need for social distancing.
  • Some have lost financial security and jobs.
  • For many, there is a loss of a sense of safety and knowing what the future holds. People everywhere are feeling the change that is happening in the world as a loss. Maybe they are grieving for what they thought the future would look like. In many ways, this pandemic reminds me of the change in our country after the tragic events of 9/11. We all are grappling with the knowledge that things will be different after the pandemic, though we don’t know exactly how.

After we name it, what can we do?

  • First, don’t compare your losses to the losses of others. All are real and important. Just because someone else’s loss seems bigger than yours, it doesn’t make your pain any less valid. Have self compassion and allow yourself the space and time to grieve for your losses. Keep in mind that there is no ‘right’ way to grieve. As long as it doesn’t harm yourself for others, however you or your loved ones are doing it, is ok.
  • Crying is a natural human way to cope with pain. Go ahead and cry; find privacy to do so if you need to. Keep in mind children may be crying more, too. Or sometimes they show their grief by throwing tantrums or being defiant.
  • Then express it. Say it out loud to those who support you. Write about it. Make art. However you prefer to do it, just get it out.
  • Taking time to meditate, while doing some deep belly breathing, can help us cope with challenging emotions. There are many great, free meditation videos online or apps for your phone. Aim to take a few quiet moments to breathe and meditate each day.
  • Try to stay present and focus on what is within your control. Sometimes our grief can take us down the path of ruminating on the ‘what ifs.’ When this happens, bring yourself back to the present moment. One way to do this is to look for 5 things in your surroundings and focus on each one for a moment. Another way is to use your 5 senses by finding one thing you see, one thing you smell, one thing you taste, one thing you feel, and one thing you hear.
  • Even in times of tragedy, there are positives, though we may have to search for them. Limit your exposure to negative media stories. Spend some time each day looking for the good around you, however small. Maybe there are wildflowers blooming along the path where you walk. Maybe there are news stories about people helping others. Maybe you find joy in the funny things your pets do or a special song. Search out at least one thing that makes you smile each day.
  • Lastly, if you are in need of support, reach out to a professional. Many psychologists are providing video or phone sessions. Some organizations are offering online support groups. See the resources below.

Dr. Christina Carson-Sacco is a clinical psychologist and a partner with The Center for Neuropsychology and Counseling, P.C. with offices in Warrington and Lafayette Hill, Pennsylvania. To learn more about her group practice visit www.TheCenterInWarrington.com

Other helpful resources:

Supporting Pregnant and Postpartum Women

by Lorna Jansen, Psy.D.

Dr. Lorna Jansen
Dr. Lorna Jansen specializes in treating children, adolescents, and families. She helps clients manage stress, deal with relationship issues, and also offers academic coaching.

In mid-December, I attended a seminar on the topic of Postpartum Depression and Related Disorders. My interest in working with women who are pregnant and new mothers stems from a long-held desire to see each child loved and cared for well. That goal has carried me through 10 years of education post high school to my current profession as a Psychologist. I love nothing more than to help a family system run more smoothly, to further a connection between a parent and child so that they can communicate more freely, to help parents see each other in the best possible light so they can work together as a team.

Having recently navigated through the pregnancy, newborn, infant phase myself, I have a new appreciation for the unique time period this is in the life of a woman. It requires a new wardrobe, new vocabulary, and an entirely new way of thinking about oneself and the world. 

The presenter at my training, Hilary Waller, MS, LPC also knows about the challenges of this phase of life. Ms. Waller spoke about her work with women at the Postpartum Stress Center in Philadelphia. That facility is one of the few of its kind and is led by Karen Kleiman, who has written about every aspect of supporting this population. During the seminar, Ms. Waller shared the knowledge and insights she’s gained from working with pregnant and postpartum moms and their families. Some of what follows was gleaned from her presentation.

The postpartum phase represents a significant shift for everyone around a new baby. First of all, this includes the mother. It is likely she will be experiencing significant hormonal changes, as well as healing from the birth. She will also have a number of emotions related to her pregnancy, labor and delivery. Often, she’ll be attempting to heal, adapt, and cope on very little sleep. She may wonder what happened to her world, or she may be contemplating how to include another little one into her existing nest. Her partner is also likely tired, worn out, and trying to meet his or her own needs with fewer resources. The baby’s extended family and friends of the parents will likely be jockeying for time to spend with him, which may or may not be given in a way that is helpful to the parents. All in all, this is a complicated time of transition.

Given the various stressors and physiological changes in play, it’s not surprising that one in seven women will suffer from a perinatal mood disorder. A perinatal mood disorder is one that occurs during pregnancy or for up to two years after delivery, clinically speaking. It includes diagnoses of depression, anxiety, OCD, panic, PTSD, bipolar, and possibly even psychosis. Due to the sleeplessness and additional stress surrounding this time, it can be difficult to understand what is normal (e.g., feeling very hormonal the first few weeks after the birth) versus what might warrant further investigation (e.g., crying most of the day and feeling hopeless months after birth). In fact, many parents experience scary thoughts, such as wondering what it would be like if they ran away and never came back, or how easy it might be to harm the child, even accidentally. Oftentimes, these thoughts do not indicate the presence of a mental disorder.

Given the vulnerable and extremely dependent nature of a newborn, it is imperative to support a mother who is struggling at this time. A therapist who is trained in this area can come alongside a woman who is pregnant or in the postpartum phase and offer her a safe place to sort through her feelings. This professional will be able to assess the mother’s overall well-being and make a plan to help her cope with the various challenges she is facing. The therapist can help the mother find practical solutions to everyday issues such as when to eat, how to get enough water to support breastfeeding, and what adequate sleep looks like with an infant. The pair can also discuss what is important to the mother as a person who has her own needs, separate from her role as a caregiver, and how she can continue to meet those.

Ideally, the mother can ask for and receive the help she needs from her support network. Her partner and other extended family members may attend therapy sessions as well, as a way of enlisting support for the mother and strengthening the relationships therein. Often, a mother with a young baby has a number of fears and concerns, many of which are normal. However, a professional can help a woman identify where her thoughts or behaviors are indicative of something more serious and ensure she gets the help she needs.

To close, the period of time when a woman is pregnant and raising a young child is unlike any other time in her life. It is sweet and important and perpetually exhausting. Regardless of whether or not the mother is having her first or sixth baby, or adopting, she is forging a new path. Never before has she been a mother to this child. And, like any transition, there is a lot to learn and she can benefit from caring and thoughtful individuals in her life.

If you or someone you love are experiencing some of the following, you may benefit from therapeutic support: feeling overwhelmed or sad most of the day, having trouble sleeping due to anxiety, experiencing panic attacks, or having the urge to self-harm. Please call our office at 215.491.1119 to make an appointment with Dr. Jansen.

Stop Tearing Down and Start Building: 5 Ways to Enrich your Relationships Today

Frustrated by the way your relationships are going? Feeling like you’re always at odds with someone at home or at work? Here are a handful of tips you can use to revitalize your relationships and improve your interactions with others.

  1. Look for the positives and focus on the other person’s strengths. For example, you might start by noticing how well your spouse manages his or her job, commitments at home, balance between free time and family time, or anything else. As you observe him or her, begin commenting about what you’ve seen like this: “You do a really good job with __________” or “I’m impressed that you were able to accomplish _________ today.” John Gottman says the magic ratio is 5 positive interactions for every 1 that is negative. In order to compensate for the inevitable bumps along the way, make a concerted effort to recognize the positive qualities of those around you each and every day.
  1. Employ active listening skills. Active listening initially includes paying attention, withholding judgment and reflecting the other person’s words by repeating them back to him or her. This is especially important—and challenging—when there is conflict. As you take the time to slow down and focus on your co-worker’s point of view, you may find yourself less focused on making your case and more willing to reach a mutually beneficial solution. If you want additional information on this topic, look here: https://www.ccl.org/multimedia/podcast/the-big-6-an-active-listening-skill-set/
  1. Take care of yourself. As you are able, focus on eating well, getting enough sleep, drinking water throughout the day, exercising, and managing your stress. This will have a positive impact on yourself and everyone around you. If you need help remembering to do these things, enlist some support partners. You might also use an app like Wunderlist to organize your goals and set reminders.
  1. Look for common interests and seek to engage in those whenever possible. When you think of your relationships, consider whether there are any favorite activities, interests, or even favorite foods that could bring you and the people you love together. For example, you might consider setting up weekly, bi-weekly or monthly dates to spend time with each of your children. Enlist their help to come up with ideas of things they’d like to do or explore with you, and work your way through the list you compose.
  1. Before you speak, consider the things you often say. If you are frequently at odds with someone in your life, think about the phrases you find yourself repeating to that person. Perhaps you need to change what you are saying so your family member can really hear the message. For example, if you find that you are constantly telling your dad that he’s embarrassing you in some way, maybe you could tell him some things you appreciate about him (see #1) and then give him a few tips about what he could say or do when he’s around your friends.

These five tips may seem simple, but will require a concerted effort on your part. If it seems overwhelming to implement all five at once, start with the one that seems the most likely to create positive change and work your way through the rest as you are able. Though you may encounter resistance at first, you will soon notice small differences in the relational atmosphere. If you or someone in your life would benefit from the help of a trained therapist as you work to improve your relationships, please call our office at 215.491.1119.

 

Dr. Lorna Jansen is a psychology resident at the Center for Neuropsychology and Counseling in Warrington, PA. She provides therapy, academic coaching and assessment for children and adolescents who struggle with academic demands, anxiety, depression, and ADHD. Additionally, Dr. Jansen works with adults who are navigating life transitions, including college, marriage, divorce, and parenting.

Increasing My Productivity, Reducing My Stress: A quick overview

By Christina Carson-Sacco, Psy.D.

I think most people would say they’d like to be more productive, but also would love to be less stressed. As we are looking at a new year, it’s a good time to think about ways we can do this.

First, I’d like you to think about the roles you play in your life. Is it as a business owner? Parent? Partner? Community activist? Friend? Now, in light of that role, answer this question, “What’s my Mission Statement?” Draft your mission statement and write it down.

  • What do I do?
  • Who do I do it for?
  • How are they better off because of me?
  • What do I want them to feel?

Why do you need a mission statement? It keeps you on track. For example, if you’re thinking of yourself in your role as an activist helping homeless families, your mission statement might be, “I will increase awareness of homelessness in our county and support organizations that are providing shelter for displaced families.” If an opportunity to assist abused animals comes up, while you think it’s a very worthy cause, it does not fit with your mission statement, so you might delegate this task to another person, but not let it dilute your resources or take up your energy. Look at the questions above when examining whether or not to do something to test whether it fits with your mission statement for a particular role. This will keep you focused and help you to say “no” to requests that might distract or detract from your goals.

Next, how do we tackle those pesky to-do lists? Having lists of your tasks is a helpful way to organize and keep track of what needs to get done. Hopefully, you’re crossing tasks off on a daily basis. What many people are challenged by are the tasks that never seem to get done. Let’s take a moment to examine those tasks, by putting them into this chart. This will help you to examine why the task is never completed.

 

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For example, a task might be “organize my financial records.” The obstacles might be “need to get files from work.” You can then choose to either get the files or maybe ask someone at work to pull them together for you. Putting tasks on this chart can help clarify the obstacles, making it easier to decide how to handle them.

Some tasks have bigger obstacles, though. Beware of the “shoulds.” Is there a task that is on your list merely because you feel you should do it? However, you don’t really want to do it; you just think you should. For example, maybe one of your never-completed tasks is “Sign up to coach my child’s soccer team.” You may not really want to do that, but you feel you should because you believe “a good parent coaches their child’s team.” Examining that belief and making a conscious decision will help you to make a choice to either do it or remove it from your list. Be careful; the “shoulds” can be draining. You don’t need to do everything you feel you should do. For example, an incomplete task could be “fix things around the house.” You may believe “it’s frivolous to pay others to do household chores” or “responsible adults take care of these things,” but you never complete these tasks. Seeing them on your list could makes you feel drained or like you’re failing. It may be beneficial to either take some of these tasks off of your list or to hire someone else to do them.

Another other reason some tasks never get done is that we have fear connected to them. Looking at your never-completed to-do items, are any of them incomplete because there is some fear holding you back? For example, one of your tasks might be “go to the gym regularly.” It’s easy to think that you’re not crossing that off your list because you don’t have enough time. However, if you pause to consider a possible fear, maybe the roadblock is really, “I’m afraid that I won’t be very strong and will embarrass myself at the gym.” Identifying and facing these fears head on can help you overcome them.

Third, being productive and reducing your stress means taking good care of yourself. Remember, while some people may boast about how much they are doing, there is no pride in being busy. Being “busy for busy’s sake” can get out of control, feel overwhelming, and at times make you feel powerless over your life. Be conscious of how you’re filling your days and when you can say “no” to tasks. Ask for help when you need it.

Self-care must be on your to-do list. If your friend said they were feeling really stressed out, what advice would you give them? Treat yourself as well as you would your best friend. Doing these things regularly will help you manage your stress:

  • Sleep 8+hours
  • Eat 3+ nutritious meals
  • Hydrate
  • Go outside a little each day
  • Unplug from technology for portions of each day by setting designated work times and space
  • Exercise or just move
  • Avoid too much caffeine, alcohol and other drugs
  • Create a good support system
  • Remember to care for yourself before caring for others; are you at the top of your priority list?

If you are struggling with any of these tasks like focusing, managing your life, overcoming fears, or any of the self-care items, a psychologist can help. While reading this may have added to your to-do list, the goal is to improve how productive you feel while keeping stress in check.

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Dr. Christina Carson-Sacco is a psychologist who has been helping children, teens, adults and families in private practice for 17 years. She specializes in anxiety, depression, parenting, school challenges, relationships, and life transitions. Learn more at www.TheCenterInWarrington.com

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