Obsessive Compulsive Disorder

Peace in Calamity

You made sure multiple times to unplug your steam iron but now you’re in your Chemistry lab, unable to focus on your lab report for the past half an hour because you can’t seem to be sure if you really did unplug it and if it would cause the entire building to burn down. You’re having thoughts about walking back to the dormitory and seeing everything aflame. Police cars, ambulance, fire trucks and people crying all over because you forgot to unplug that iron. How will you ever live past being responsible for the lives of all those unsuspecting students? Jail is waiting for you and you’ll have to give up all your dreams of getting into grad school. What would your family and friends think? How would you console the parents of these students? This is the thought process of those enduring symptoms related to the checking form of Obsessive Compulsive Disorder (OCD).

OCD is different from person to person and is considered a chronic disease. If diagnosis of this mental illness in itself wasn’t difficult enough due to the existence of the numerous variations (ruminations, contamination, checking, hoarding, etc.), finding the right treatment also becomes problematic. Presently, OCD can be treated through a combination of means, but there is not necessarily a cure. If proper treatments are employed, a chance for recovery over time is definitely possible. A lot of different medications and treatment methods have been tested and were found ineffective and the research is still ongoing. According to Stanford Medicine: Clozapine, carbamazepine, lithium, clonidine, stimulants, ECT, sleep deprivation, and bright light therapy are not effective.

So then, what actually works? Medications such as selective and non-selective Serotonin Reuptake Inhibitors (SRIs), antidepressants, neuroleptics and other psychiatric ones are now commonly being used. Clinical psychologists or psychiatrists may prescribe more than one medication to effectively control OCD symptoms. Side effects are common with any form of medications but the risk for self-harm and suicide is higher with psychiatric meds. Although it’s reported that about 50% of patients respond well with solely behavior therapy, there are still many who have to take medication in conjunction with other forms of behavior therapy as well.

Some patients have tried forms of therapy which include: support groups, cognitive behavioral therapy (CBT), aversion therapy, psychoeducation, rational emotive behavior therapy, Exposure-response prevention (ERP), psychotherapy, systematic desensitization, group psychotherapy, and etc (Mayo Clinic). Out of these, many claim that ERP has been the most effective. Exposure-response prevention is a type of Cognitive Behavior Therapy (CBT) which has the patient face his or her fear without allowing them to perform their rituals (compulsions). It is effective for many, but not for all.

The ERP exposures may be applied in two ways; in real life (in vivo) or in imagination (imaginal). To better illustrate this form of treatment, in vivo ERP for someone experiencing concerns related to contamination would consist of having the patient shake hands with someone and having them resist the compulsions related to hand washing. Imaginal ERP for the same would involve having the patient imagine scenarios where they would shake hands and resist washing their hands. These procedures are followed through a structured manual and even if they don’t necessarily decrease the resulting distress, they are said to increase the tolerance towards the patient’s fears. It is then overtime repeated until the patient’s rituals in response to the fear decreases.

Although it isn’t discussed enough, OCD is one of the most debilitating mental illnesses. For similar reasons, it is often underdiagnosed and therefore, access to specialized treatment is also very limited. Everything related to treatment becomes even more difficult when there are chances of comorbidity with OCD and other forms of mental illnesses. For example, the relationship between obsessional ruminations and depression is particularly close: a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive disorder. This makes it strenuous for those who are experiencing a variety of these symptoms. Research revolving more effective treatment is still at large and an ongoing effort. Hopefully, the search leads to giving these patients a peace of mind in their tumultuous times.


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DSM, Diagnoses, and Debate: The Many Dimensions of Mental Health

One of the biggest debates surrounding the field of psychology and its practitioners today is the debate concerning how exactly mental health diagnoses should be made. What defines a mental illness? Who determines what constitutes each specific illness and what gives them the credentials to do so?  In the early years of psychology, this very issue contributed to the struggle psychologists faced in legitimizing their field as a science.  Poor diagnostic techniques and lack of standardization of diagnoses made early psychological ventures appear more philosophically-based than factual and scientific.  Today, however, we have the Diagnostic and Statistical Manual of Mental disorders (DSM for short), first created in 1952 as a collective effort by the American Psychiatric Association to standardize psychological diagnoses and further legitimize the field of psychological study.  While the original DSM was a breakthrough in psychological study and treatment for the mentally ill, specifics on the diagnoses are still fiercely debated, and definitions are continually being revised and reworded to include and exclude certain elements of specific disorders.  These specific diagnostic criteria affect not only the psychologists doing the diagnosing — they also greatly impact the people themselves who are being diagnosed.

The debate over how exactly to diagnose patients and what constitutes each individual illness has become particularly relevant again recently, as the fifth version of the DSM was released just a few short years ago in 2013.  It was released to many mixed emotions over the changes that had been made from the previous version. Many psychologists are concerned with the fact that the DSM-V still emphasizes categorical diagnosis, maintaining the need for patients to meet specific criteria for disease diagnosis, which critics believe is outdated and less clinically relevant. Some have even begun working on an entirely new classification system that relies solely on dimensional diagnosis or diagnosing patients according to a spectrum of impairment or disability.  Proponents of this method argue that someone should not have to merely meet a certain “list” of symptoms, but that the severity of their symptoms should also be weighed heavily in their diagnosis.  

Not all of the updates should be criticized, however; the category for bipolar disorders, for example, has also been changed, expanded to include “an emphasis on changes in activity and energy — not just mood.” The phrase “mixed episode specifiers” has also been included in describing manic, hypomanic, and depressive episodes, allowing for more freedom in how patients describe the highs and lows related to their bipolar disorder.  Categories have also been added that describe episodes of short duration and anxiety-related specifications of bipolar disorder.  Thus, as it relates to bipolar disorder, the changes brought about in the DSM-V actually make diagnosis easier for patients struggling with a wide variety of symptoms, for the most part, and include categories and intricacies of the disease that may have been ignored by previous versions of the DSM.

While the clinical relevance of the DSM diagnostic criteria cannot be ignored, the changes in the definition of these diagnoses and the debate surrounding them impact more than just the list of signs and symptoms needed for a specific diagnosis. What about the patients behind the disorders?  How are these changes in diagnostic criteria affecting patients of specific diseases?  When categories are expanded or done away with, it can have a significant influence of the patients, whose diagnoses often become an integral part of their identity.  Melissa Miles McCarter, an author, academic, and publisher, reflects on her experience with bipolar and how it relates to her career and her everyday life, even becoming intertwined in the two.  She says, “Without medication, I deteriorate and become dysfunctional or am thrust into a deep depression followed by manic psychosis. However, if I had never had these challenges, even the bouts with severe mental illness, would I still be the same person — and would I want to be?” Another example of the effects diagnostic criteria can have on mental health patients is in the removal of Asperger’s Syndrome, placing patients that previously met that criteria into a new broadened category renamed “Autism Spectrum Disorder,” which sparked much debate among the Asperger’s community.  

While criteria specific to bipolar disorder and those diagnosed with this disease may have been benefitted from the DSM-V, many categories of illnesses are still under continuous debate.  Re-wording, rewriting, and recombining signs and symptoms of disorders affect not only the psychologists who must be familiar with diagnostic criteria — they also affect the patients whose identities are oftentimes tied quite closely with a disorder they have come to embrace as their “own.”  Unfortunately, no system is without its flaws, and this fact speaks to the current debates facing psychological diagnoses.  While psychologists continue to strive to make improvements to classifications of mental disorders, the interests of the ones who are actually suffering from the mental disorders must be balanced with the need for better classification systems and criteria.


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Anxiety and Anxiety Disorders Bipolar Disorder

Bipolar Vs. Anxiety: The Unlikely Relatives

Imagine being on a euphoric mental high so powerful, it makes you dangerous to yourself and others. It makes quickly spending your life savings and engaging in risky sexual behaviors seem like a natural course of action for the intense euphoria you’re experiencing.  After this “high,” your mental state quickly takes a downturn. You crash, you hit the proverbial wall. It becomes hard to function, even though everything was so effortless just days before.  As one patient, comparing her mental state during highs and lows to a sprinting race, puts it,Life, everyone and everything in life, me included, are exquisitely and fabulously beautiful. But then the sprint and marathon race inside my brain finishes. My brain becomes completely exhausted — depleted of everything it had.” By definition, you are experiencing the manic and depressive episodes shared by all sufferers of this disorder, commonly known as bipolar.  

Now, imagine you are fearfully anticipating an upcoming event. Your anticipation is so pervasive it makes it hard to think about anything else or to focus on things that need to be accomplished for school or for work. In fact, it’s even affecting you physically, in the form of muscle tension and lightheadedness. “It feels like a constant heaviness in your mind; like something isn’t quite right, although oftentimes you don’t know exactly what that something is.” You would be experiencing generalized anxiety.  

Now put the two together, the manic highs and depressive lows, the heavy thoughts and the fearful anticipation. This combination of bipolar and anxiety disorders, something psychologists refer to as comorbidity, is in fact what many bipolar patients experience regularly.  According to a study performed on bipolar patients who were part of the National Epidemiologic Survey on Alcohol and Related Conditions, an estimated 60% of people diagnosed with bipolar have also suffered from an accompanying anxiety disorder. This is in contrast to the 2.9% of the population of American adults that suffer from anxiety disorders who may or may not have an accompanying mental illness. Although anxiety may be hard to distinguish from the highly aroused mental state that comes with bipolar manic highs, Dr. Naiomi M. Simon, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, says that several key factors can help in making a diagnosis. The presence of anxious mood, general worry, panic attacks, or related anxiety symptoms, extended periods of sleeplessness when not in a manic state, and even the time frame during which anxiety symptoms develop, all aid in making a proper diagnosis for an accompanying anxiety disorder.

The fact that these two diseases are so closely tied together is problematic for several reasons. First, some studies show that individuals diagnosed with both disorders were twice as likely to be hospitalized during a depressive episode than those strictly diagnosed with bipolar. The study also correlated stronger bipolar symptoms, such as more manic and depressive episodes and a higher likelihood of suicidal behavior, with a co-occurrence of an anxiety-related diagnosis. Second, just as bipolar is tied to a higher likelihood of experiencing anxiety, the reverse is true as well; those experiencing symptoms solely related to an anxiety diagnosis are nine times more likely to develop bipolar disorder at some point in their lifetime.  Third, treatment for comorbid anxiety and bipolar may be more difficult, as some of the medications prescribed for anxiety may trigger manic episodes even when the patient is taking medicine to control the effects of their bipolar. In addition, antidepressants are sometimes addictive, which may be especially problematic for those more prone to substance abuse as a result of their bipolar.

Despite the potential complications in treatment, there is still hope for decreased symptoms for those struggling with both bipolar and anxiety. According to the Anxiety and Depression Association of America, therapy, in addition to taking prescribed medication, may play a crucial role in mitigating patients’ anxiety symptoms. Research is still being done to investigate the effectiveness of these techniques as they relate to anxiety and bipolar comorbidity.

Though bipolar and anxiety treatment together is still proving to be a challenge for healthcare providers, the combination of both disorders is certainly not uncommon or unique by any means. The comorbidity of these two disorders affects over half of the those diagnosed with bipolar, an important and startling statistic. According to this statistic, patients of both illnesses would actually be in the majority.  Dealing with this sort of mental illness is a complex battle, but with continued research and developments in this field of psychology, perhaps bipolar may one day feel a little less like an exhaustive marathon race and anxiety may feel a little less all-consuming. In the meantime, perhaps increased awareness for the complications of both these disorders can give those of us who do not have to suffer under the grip of manic and depressive episodes and generalized anxiety a better understanding of what sufferers of these disorders experience regularly, perhaps every day.


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