It’s My Sibling Who Has OCD. So, Why am I Having a Tough Time?

This post originally appeared on the website for the Anxiety and Depression Association of America (ADAA). Read the original post here: https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/its-my-sibling-who-has-ocd

brothers

Katrina was excited. She, her sister, Maia, and their mother were on the way to the park to play handball. Suddenly, Maia screamed and collapsed on the ground, wailing. “A fly landed on me! A fly landed on me!” Her mother tried to calm Maia down, but with no success. “I’m sorry.” Katrina’s mom said, “We have to go home.” Katrina was crushed; her sister’s fears had ruined yet another family outing.

Sam was playing video games with his friend, Kai, and his brother, Marc. At an important point in a big battle against their opponents, Marc seemed to stop playing. Sam looked over to see Marc tapping the controller in an awkward rhythm. Kai, frustrated, turned to Sam and demanded, “Why’s your brother so weird?”

Sara was settling into language arts after recess had ended when a yard supervisor entered her classroom. After talking with the supervisor, Sara’s teacher came over to where she was working. “Sara, your sister is upset and you seem to know how to calm her down. Can you go with Mrs. X to help her?” Not again, thought Sara. I just want to do my work.

When one child in a family has Obsessive-Compulsive Disorder (OCD), they are not the only one impacted. OCD affects the entire family – it demands others accommodate, and family members can be distressed by watching the other suffer. Siblings without OCD can feel the effects of the disorder in many ways. After all, they are frequently witness to meltdowns, have plans derailed by unexpected challenges raised by the disorder, may be the target of their sibling’s OCD, face or fear judgement from friends, and can even be asked by well-meaning people to take responsibility when their sibling is struggling.  Yet, sometimes siblings’ reactions and challenges are overlooked when a family is dealing with the disorder. A bit of awareness, education, and support can go a long way to helping siblings cope better when they have a brother or sister with OCD.

A first step is acknowledging that siblings may be impacted and experiencing a number of feelings and reactions. They may feel confused by their sibling’s behavior, by the disorder itself, or by how others are acting toward their sibling. Anger is another common emotion for siblings who may experience OCD as taking away from family time, individual activities, and even attention from parents. Fear can also be a factor for siblings. Their brother’s or sister’s reactions can seem frightening and, if the OCD is directed at them (e.g., sibling is seen as “contaminated”), they may fear they’ve done something to cause it. Some siblings may feel responsible for taking care of their sibling with OCD – especially if they are frequently asked for help in managing their sibling’s outbursts. Sadness, loneliness – actually any emotion is normal.

Siblings can cope with their brother’s or sister’s OCD diagnosis better if they understand what is going on, feel they have support, and know how they can help. Start a conversation where the sibling can feel safe to share and allowed to feel whatever emotions they are experiencing. Also important is explaining OCD to the sibling, as well as what is going on in treatment to help it, at a level that is age-appropriate. OCD is less frightening when you understand it. If the sibling with OCD is comfortable, it may be helpful for them to share their specific OCD with their sibling. Siblings can meet their brother’s/sister’s OCD therapist and learn about the disorder and how to help. They can learn to assist with exposures and how not to accommodate OCD (some siblings may not want to do this, and that is okay).

Some siblings may do well to have therapy of their own, where they can feel safe to talk about what they are going through and learn more ways to help themselves. Healthier families conquer OCD more successfully. Helping siblings cope with the disorder can bring big strides toward weakening the disorder’s impact on everyone.

Postpartum OCD: One Therapist’s Reflections

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

One of my colleagues, a well-known expert in OCD, recently made a brave public announcement.  Before I share it, I want to explain one aspect that makes her so effective as an OCD therapist.  She herself suffered with debilitating OCD for many years and overcame it to live a full, productive life – and to help countless others do the same.  Open about her past, she is a role model to her both her patients and her colleagues. However, the joyous occasion of childbirth one year ago brought with it the surprising and unexpected return of her OCD. In this beautiful and personal article, Dr. Jenny C. Yip (PsyD, ABPP) describes her own experience with postpartum OCD and the work it took to triumph over it once again.

About Postpartum OCD

Pregnancy and childbirth can be times when Obsessive-Compulsive Disorder first occurs or reappears. OCD researcher and expert, Jonathan Abramowitz, Ph.D., ABPP, notes thatamong female OCD patients who have given birth, pregnancy and childbirth are the most commonly cited “triggers” of OCD onset.” In addition, “a greater than expected percentage of women with OCD attribute the onset or worsening of their symptoms to pregnancy or the postpartum.”

Women with postpartum OCD may have intrusive thoughts (obsessions) that the child may die or that harm might come to him/her, she may fear harming the baby in some way, or she may fear that she doesn’t love the child enough. Rituals a postpartum woman with OCD might have include checking on the baby to be sure it is still alive, avoiding contact with the baby to avoid harming it, taking extra steps in caring for the child to “prove” she loves it enough, or praying or doing superstitious behaviors to avoid harm befalling the infant. While there are both biological and psychological theories about the causes of postpartum OCD, there currently is not a definitive explanation for it.

While we may not completely understand what causes postpartum OCD, we do know that the same treatments used for OCD that is not related to childbirth can be very effective. Those treatments may include Cognitive Behavior Therapy (CBT) with Exposure and Response Prevention (ERP) and medication. In CBT, a therapist works with the patient to identify the specific thoughts, images, or urges the patient is experiencing, as well as the behaviors (compulsions) the patient engages in to decrease their anxiety and discomfort. Then, the therapist works with the patient to develop a plan to confront the distressing thoughts and to gradually eliminate the compulsive behaviors. In Dr. Yip’s article, she describes some of the steps she took to overcome her OCD.

If you, or someone you know, is struggling with postpartum OCD, there is help. A therapist trained in CBT and ERP may be a good place to begin. There are also excellent resources and information available through organizations, such as the International OCD Foundation and the Anxiety and Depression Association of America.

Anxiety and Depression Association of America: https://adaa.org/

International OCD Foundation: https://iocdf.org/

 

New Support Group Beginning

Image courtesy of Becris at FreeDigitalPhotos.net

I am very excited to announce that I will be starting a new support group for adults (ages 18 and over) this month. The group will be free and will emulate the GOAL model started by Dr. Jonathan Grayson and Gayle Frankel. Potential members may begin at any time.

Why a support group? First, people with OCD often feel isolated and alone with the disorder. They often feel like they are the only person who is going through this. A support group helps sufferers to connect others who are going through similar experiences and helps create a sense of community. In addition, a group can encourage those with OCD to take on challenges they might have been struggling to take on otherwise, and it can help hold individuals accountable to accomplishing a goal.

This group is for those who are all along the OCD recovery spectrum. For those who are in the midst of ERP (exposure and response prevention) treatment, it can help reinforce concepts they are learning to use. For those who have completed treatment or are in maintenance, it can assist them in continuing to do the work of staying healthy. Finally, for those concerned about starting ERP treatment, it can help give them an introduction to what treatment might be like.

For more information about the free adult OCD GOAL Support Group, please visit the Support Group page of my website.

Santa Clarita Grieves (Route 91) Event

I recently had the opportunity to speak and meet with community members at the Child & Family Center in the wake of the Las Vegas shooting. Santa Clarita residents were affected in many ways and the event was held to assist those affected, directly and indirectly, by the shooting. I was also interviewed by our local radio station, KHTS (see video). It was an honor to participate.

OCD Southern California Conference March 25th!

The 2nd annual OCD Southern California  conference is in Irvine on Saturday, March 25th.  It’s a wonderful opportunity to meet leading clinicians and researchers, get great information, and have the opportunity to interact with others who deal with Obsessive-Compulsive Disorder.

This year’s keynote speakers are Jonathan Grayson, Ph.D., of the Grayson L.A. Treatment Center for Anxiety & OCD, and Ethan Smith, National Spokesperson for the International OCD Foundation.  For more information and to register, go to:

https://www.eventbrite.com/e/ocd-southern-california-conference-tickets-32242924455

 

Get Comfortable Being Uncomfortable: Achieving Your Goal

Image courtesy of duron123 at FreeDigitalPhotos.net
Image courtesy of duron123 at FreeDigitalPhotos.net

The music is pumping, the class is full, and the energy is palpable in the room. Fitness trainer and indoor cycling instructor Wendell Mitchell moves through the rows of students.

“Get comfortable being uncomfortable!” he calls over the music, and the students respond, each giving a little more than they thought they could a moment ago.

The anxiety therapist in me delights in what is happening here. He directs students to do what’s difficult – what’s outside their comfort zone – and they do it. Each knows on some level that the only way to get to where they want to be (weight loss, endurance, energized, etc.) means having to push themselves through some level of discomfort.  They know that it won’t be given; it has to be earned.  “No pain, no gain” is the familiar gym mantra.

“This is just like anxiety treatment,” I think to myself.

In anxiety treatment, the therapist instructs and encourages the patient to act outside of

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

their comfort zone, to do something different than they might already be choosing to do. By taking these steps forward, anxiety is something that one can learn to manage and to thrive with. Yet many people fear what treatment for anxiety will be like. Just the mention of standing up to your fears is enough to keep many away from the treatment that could open the door to a much better life.

What Does He Know?

I’m intrigued by how Wendell is able to get so much out of his students, and I wonder what it is that he knows that benefits his fitness students, and applies so well to anxiety sufferers. I sit down with him to talk one sunny day. It’s clear from the start that, in the nearly twenty years he has been in the fitness industry, he has developed a passion for changing lives.  I wonder with him how he is able to inspire motivation in his students – and what nuggets I might take from this into my treatment of anxiety sufferers.

He is quick to point out that the motivation must come from each individual themselves, and not from any goal he might have for them.

“They need to find what their motivation is for being here,” he says, noting that he encourages students to think about why they are in class.

I quickly draw a parallel to anxiety treatment. A person seeking treatment must know their “Why?” Why are they in treatment? It is the job of therapist to instruct the patient in successful techniques and to nurture that inner motivation – that “Why?” – and keep it in sight throughout treatment. Without a “why,” there is no compelling reason to get better. In fitness, the motivation might be to live a healthier life.  With anxiety, the motivation might be to be able to do things a person has been wanting to do, but has felt too afraid to try.

“It’s Empowerment”

Wendell also explains to me that something happens when a person decides to push themselves, even just a little. There’s a recognition that they did something that they previously thought they could not – and that tends to trigger even more motivation.

“It’s empowerment,” he says. “Most people walk away feeling unstoppable.”

Again, I draw a parallel to anxiety treatment. When a patient does something that they previously thought they couldn’t, there is an incredible feeling of empowerment. And this empowerment tends to help propel a person forward. The  memory of that success can be a great motivator.

Baby Steps

With anxiety treatment, just as with fitness training, finding your “baby steps” is key. Rarely does a fitness student or anxiety patient start with the most difficult task.  If you’ve never taken a 45 minute indoor cycling class before, you probably wouldn’t expect to be a top performer in class on your first day. And if you’ve never stood up to a particular fear before, you most likely wouldn’t expect to stand up to the scariest thing right off the bat.

“You need to figure out where their baby steps are,” says Wendell, when discussing taking the trip up the fitness ladder. Then you can “celebrate the little small victories.”

When it comes to anxiety treatment, the same is true. A person chooses the steps that feel manageable to them as they work their way toward conquering a fear. Each step is a cause for celebration.

Be Willing

Most people begin a fitness routine knowing it will be tough work. As Wendell likes to say, “this is a workout, not a cookout, folks.” Any patient I ask about getting fit or getting good at something that involves fitness (from cycling to hiking) can tell me that it is more than just showing up and going through the motions. It takes hard work, and if one does the work, they will see improvement, and what seemed difficult at first gets easier. The same is true for anxiety treatment. It takes hard work facing your fears, learning new ways of coping, and pushing through challenging exposures. Yet the payoff is seeing what seemed insurmountable before become more manageable – maybe even easy. And just like in fitness, you get to do it at your own pace. Pushing yourself harder means more progress; going a little slower means more measured progress.

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

The key is “being willing,” says Wendell when he talks of progress in fitness. A person has to be willing to push themselves toward a goal. If they do, they may find themselves somewhere unexpected.

“I didn’t think I could do it, but here I am. I’m not gonna like it, but I’m gonna do it again.”

With anxiety as it is with fitness, if you push yourself, practice, and repeat – willingly – you may find yourself soaring to places you never imagined. Get comfortable being uncomfortable.

 

OCD Awareness Week 2015 – Does Treatment Help?

This week is OCD Awareness Week (#OCDWeek )  Many people with and without OCD wonder whether OCD is treatable  The answer is that there are very effective treatments available for OCD. Children, teens, and adults alike may feel hesitant to begin treatment for their OCD.  I often think that there is no better way to face one’s own challenges than to hear about how someone else faced theirs.  With that, I must share a blog post I read this morning.

This post is by 16-year-old Ellen, a teen who has worked hard, not only to challenge her own OCD, but to raise awareness around the globe.  She is an inspiration.

https://ellensocdblog.wordpress.com/2015/10/12/dear-14-year-old-self-ocdweek/

The 21st Annual OCD Conference is Almost Here!

Image Courtesy Pixomar at freedigitalphotos.net
Image Courtesy Pixomar at freedigitalphotos.net

The 21st annual OCD Conference, presented by the International OCD Foundation, begins this Friday in Los Angeles. This extremely valuable conference is an excellent resource for individuals with OCD, their family, friends, therapists, researchers, and anyone who has any interest in OCD at all. What makes this conference so special is that professionals, people with OCD, and others from the general public all intermingle and share information and perspectives. A person who has experienced OCD has as much to offer as a professional who is doing research and treatment. People who attend the conference generally take note of the inviting atmosphere and the ease of interacting with individuals from all different backgrounds.

This year, I will have the honor of participating in two presentations at the conference, and co-leading a support group.  If you are in, or near, the Los Angeles area, this is one conference worth checking into. For more information. look at the IOCDF’s conference website: http://www.ocd2014.org/

Parents as Part of the Treatment Team

Image courtesy David Castillo Dominici @freedigitalphotos.net
Image courtesy David Castillo Dominici @freedigitalphotos.net

I am preparing to head to the annual conference of the Anxiety and Depression Association of America (ADAA).  I look forward to conferences like this one because they provide inspiration for the work I do and the opportunity to interact with the latest information and the great minds that are working on treatments for anxiety and depression.  This year, I am fortunate to be able to present at the conference on a topic that is of great interest to me, since I work with a good number of children and teens:  Engaging Parents in Children’s Anxiety Treatment.  Because I think this is such an important subject, I’d like to share some of what I will share with the professionals at the conference here.

Through my practice, I’ve come to believe that parents are a very important ingredient when it comes to treating children who are struggling with anxiety disorders.  Why?  Well, first, it is generally parents who spend the greatest amount of time with their children and who are the “experts” on the child.  As a clinician, I know that I have a great resource to tap into in the form of the parent.  Who better to help me understand how this person spends their time, how they react to things,  what they are sensitive to, etc.?  Certainly I can often obtain a good deal of information from talking to the child or teen him or herself, but the outside perspective a parent provides is beyond valuable.

Next, working with anxiety requires a good deal of understanding on the part of the person with anxiety and their immediate support system.  A big part of overcoming anxiety disorders is education.  I spend a lot of time helping the people I work with to really understand how anxiety works and how to challenge it.  The better educated someone is, the better they are able to make good choices for dealing with their anxiety.  If a child or teen goes home to a parent who is well-educated in the ways of anxiety, that child stands a much better chance of finding success and support in defeating their anxiety.

Third, dealing with anxiety requires a lot of active work outside of session.  Learning to defeat an anxiety disorder means a child or teen has to go home and practice, practice, practice.  For that practice to be effective it has to be done regularly, with a good understanding of the purpose, and with a sound rationale.  If I send a young person home to do practice that makes sense to no one but him or her, then the task is much more difficult.  Without that support, a the chances the practice will happen decrease greatly, and treatment is going to progress much more slowly.  If a parent who understands the work to be done is there to provide support and direction, then the work is much more likely to be done, and treatment is much more likely to move along.

Finally, once treatment ends, if a parent has participated in treatment, the child or teen is not alone in his or her knowledge and understanding of anxiety and its ways.  Anxiety is a natural part of life and when it pops up a good plan is necessary to deal with any of the more difficult challenges it may present.  When a parent has participated in treatment with a child, that child has an ally in identifying anxiety when it tries to disguise itself in the future.  The parent might even recognize the signs and tricks of anxiety before the child or teen does.  Parent and child can form a team to use the tools learned in treatment and put anxiety back in its place.  They may even potentially prevent the need to return for treatment.

These are some of the reasons that I believe parents are an important part of the treatment team.  Because of this, I try to let both parent and child know how important a player each is in the treatment process.  In a future post, I will talk about some of the challenges parents face when they have a child who struggles with anxiety.

About Obsessive-Compulsive Disorder (OCD)

Image courtesy of Stuart Miles at FreeDigitalPhotos.net
Image courtesy of Stuart Miles at FreeDigitalPhotos.net

This week (October 14-20, 2013) is International OCD Awareness Week.  Since promoting OCD awareness is a particular passion of mine, of course I’d like to seize on the opportunity to do a little educating.  Just what is OCD?  How does it present?  Is it treatable?

Let’s start with a little background about how many people have OCD.  It is generally thought that 1 in 100 adults has OCD and 1 in 200 children.  That’s 4-5 children in the average elementary school, and about 20 in a medium-sized high school.  Sadly, though, OCD is often under-recognized.   The International OCD Foundation notes that it often takes between 14 and 17 years from the first onset of symptoms until a person gets access to effective treatment.  Awareness of what OCD is can help to change that.

Simply put, OCD involves obsessions and compulsions.  Obsessions are intrusive, recurring thoughts that are unwanted by the individual.  They are associated with uncomfortable feelings and they interfere with important, valued activities.  Compulsions are behaviors or mental actions a person engages in to try to feel better or to make the obsessions go away.  Avoidance of things or situations that trigger obsessions can also be a compulsion.  Compulsions only provide temporary relief.  Common obsessions include fear of being contaminated, fear of causing harm to others, fear of losing control and fear of committing a moral offense.  Common compulsions include excessive washing and cleaning, constant checking that nothing was done to harm others or that no mistake was made, mentally reviewing events, repeating movements or activities until they are “just right,” seeking reassurance and confessing.

OCD can be extremely agonizing for those suffering from it – and for those who care about them.  It can result in lost productivity, lost opportunities and general misery.  There are, however, effective treatments that exist.  According to the International OCD Foundation, the key elements of treatment for most people with OCD are “one or more of the following:  a properly trained therapist, Cognitive Behavior Therapy and medicine.”  The Cognitive Behavior Therapy that has demonstrated the most effectiveness for OCD is called Exposure and Response Prevention.  It basically involves confronting the thoughts, situations, etc. that make the person anxious and then making a choice not to engage in compulsions.  While this may sound a little unnerving, the end effect is that the person learns to tolerate uncomfortable feelings and learns that they naturally lessen on their own.

There is no need for people to suffer with OCD symptoms in silence.  Education and treatment can provide the way to a more fulfilling and more productive life.  For more information about OCD, its symptoms and its treatment, visit the website for the International OCD Foundation or for the Anxiety and Depression Association of America.