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admin | reflection of the past meaning | 10.04.2015
Obsessive Compulsive Disorder, OCD, is a clinically recognised disorder which affects around 1-2% of the population.
Psychologists believe the condition may run in families or that people with OCD have an imbalance of serotonin in the brain.
Now new research is being done at Goldsmiths, University of London that could, in the future, help with treatment. In the meantime, for those with Obsessive Compulsive Disorder, its impact can be devastating as Imogen and Maria explain…. Professor Bhattacharya:  Obsessive Compulsive Disorder is a psychiatric disorder which affects 1-2% of the population. There are also different medications that can help reduce anxiety – usually combined with therapy (not used on their own).
JB: Once we have a good understanding of how this is represented in the brain, and if we can target, with non invasive intervention, the brain regions that are possibly mediating this thought action fusion bias, that could help us mitigate the inflated response or coupling between thought and action. In order to meet DSM-4 criteria for OCD, the individual must have either obsessions or compulsions.
The thoughts, impulses, or images are not simply excessive worries about real-life problems. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour per day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. When a clinician is evaluating a child or adolescent for possible OCD, it is important to do a thorough work up.
Most individuals with OCD, even young ones, are at least intermittently aware that their symptoms do not make logical sense. It is possible that these psychodynamic formulations are more relevant to individuals with obsessive or compulsive personality traits rather than to individuals with true OCD. Tourette’s Disorder is more likely to be present in boys and in children who develop OCD at a younger age. Once a child has been diagnosed with OCD, we need to decide which treatment or treatments to use first. It would be difficult to discuss this topic without giving a great deal of credit to John March MD and his collaborators.
Near the beginning of this type of therapy, the child and family are educated about the biological basis of OCD. When the child and family realize the biological basis of the disorder, they find it easier to externalize the symptoms.
As the therapy progresses, the child should begin to expose himself to the anxiety-provoking object or situation and then try to avoid performing the usual compulsion. The child may benefit from learning relaxation techniques and learning mental self-monitoring. When the symptoms are eliminated or at least reduced to a tolerable level, the therapist should talk to the child and parents about the future.
Fluoxetine, (Prozac) approved for adults, approved for treatment of deprssion in children aged 8 and up.
Venlafaxine (Effexor and Effexor XR) not recommended for children-advisory sent out by Wyeth August 2003. The main medications used for OCD are Clomipramine (brand name Anafranil) and the Selective Serotonin Reuptake Inhibitors. Children and families should be aware that OCD can be chronic and that symptoms may return months or years later. OCD in Children and Adolescents: A Cognitive-Behavioral Manual by John March and Karen Mulle1998, The Guilford Press. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Washington, D.C. We are located in Northern Baltimore County and serve the Baltimore County, Carroll County and Harford County areas in Maryland. Our services include psychotherapy, psychiatric evaluations, medication management, and family therapy. You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. When you live your life in a cautionary crouch, the greatest relief of all may come from simply standing up. The defining features of Obsessive Compulsive Disorder (OCD) are the presence of obsessions and compulsions. A classic example of OCD might be an obsession that after having touched a doorknob one’s hands are covered in germs and unless the germs are washed off quickly sickness (and even death) are sure to follow.
Even today, over 30 years after the above survey, there seems to be little awareness about OCD.
Only an evaluation by a qualified mental health professional can properly answer that question, but by answering the following questions you can get some idea of where you stand.
Are you frequently troubled by repetitive thoughts that are unwanted, intrusive, and that cause you to feel anxious? Is your living space filled or cluttered with excessive amounts of possessions or useless items that you are unable to throw away?
Are you frequently troubled by thoughts of acting inappropriately toward others in violent or sexual ways?
Do you frequently feel the urge to check things over and over, for fear of having done something careless that could harm either yourself or others? Do you constantly question others or seek reassurance that you have not behaved badly in some way? Do you constantly question others or seek reassurance that some bad event will or will not happen to yourself or others? Do you feel that at times, you must perform special repetitive behaviors or think in special ways in order to prevent bad things from happening to yourself or others, or to cancel out bad luck?
Are you frequently bothered by blasphemous or irreligious thoughts, or are you constantly concerned that you are not observing the beliefs or laws of your religion perfectly enough? Do you spend excessive amounts of time trying to order or arrange things in your environment, in order to make them perfect or symmetrical in some way?
Do you feel overly responsible for the well being and safety of others (even strangers), to the point of constantly checking on them and worrying about them? Are you constantly troubled by serious doubts, and do you have great difficulty in making decisions. Are you overly concerned with lucky or unlucky numbers, or do you have to perform particular actions a special number of times to prevent bad things from happening?
There are two treatments for OCD that have proven to be effective: Behavior therapy and medications. Depending upon how severe the OCD is, you could consider trying to do Behavior Therapy on your own. The Anxiety and Panic Treatment Center will also soon be starting a one week intensive treatment program for adolescents with OCD. The following books are our top recommendations for those who suffer from anxiety disorders or for family and friends of those suffering from anxiety disorders.
Based on cognitive-behavioral therapy, the most effective treatment for OCD which is also used by the Anxiety and Panic Treatment Center, the workbook’s carefully sequenced exercises are illustrated with detailed examples. The goal of this book is to help people understand the impact of their control efforts on their obsessional thoughts. 1The Anxiety and Panic Treatment Center receives a small portion of the purchase price of books ordered through Amazon which helps support this web site.
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If we can model the activities of the precuneus , we could perhaps have an impact on the anxiety causing this thought action fusion. The clinician should meet with the child and ask specific questions about obsessions and compulsions.
However, young children are less capable of abstract thought, so their degree of insight may not be as good.
The roots of the illness lay in a disturbance in the sexual life or development of the child.
An adult generally is at least intermittently aware that the obsessions or compulsions are unrealistic. There are other psychodynamic, play therapy and family therapy approaches to the treatment of OCD. They have developed, tested, and disseminated specific information that includes a detailed protocol for treatment of childhood OCD. Even young children can gain some understanding of this concept if it is presented in an age-appropriate manner. Other specific techniques may help individual children tolerate the anxiety engendered by the exposure and response prevention. In the past few years there have been more studies testing these medications specifically on children. There are several other medications that may be added if those medications produce only a partial response. They include Fluoxetine (brand name Prozac) Fluvoxamine (brand name Luvox) Paroxetine (brand name Paxil) and Sertraline (brand name Zoloft). It can occur through reading age-appropriate books, attending support groups or having group therapy with peers. This book is fairly technical and is aimed at psychiatrists and other mental health professionals. Obsessions are unwanted, unwelcome ideas, images, thoughts or impulses that repeatedly enter your mind against your will. Usual estimates for the prevalence of OCD in the general population were in the range of .05%, which would mean that between 125,000 and 150,000 people in the United States would have OCD. There is general consensus that it is a neurobiological disorder, which in plain English means that OCD is caused by a glitch in how your brain works. The backbone of behavior therapy for OCD is Exposure and Response or Ritual Prevention (or ERP). There are a number of excellent self-help books available and some of the ones I recommend are listed on my recommended books page.
Even in the Portland area there are surprisingly few options available for Cognitive Behavioral treatment for adolescents with OCD, and virtually no treatment options for adolescents in the rest of the state.
It works to help them recognize that thoughts, in themselves, are not threatening, dangerous, or harmful. And for more beauty tips on how to properly apply OCC Lip Tars (a little goes a long way), check out the super-helpful video below! All rights reserved.Your Privacy RightsThe material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Fashion Times. People with OCD experience intensely negative, repetitive and intrusive thoughts, combined with a chronic feeling of doubt or danger (obsessions).
When we discuss cause, it is important to make it clear that we are looking at Obsessive Compulsive Disorder, not an obsessive, perfectionistic personality style. Freud did recognize that one’s heredity and innate constitution contributed to the development of the disorder. Children and adolescents with OCD are more likely to have Attention Deficit Disorder, learning disorders oppositional behavior, separation anxiety disorder and other anxiety disorders. Others experience progressive worsening of their OCD until they are housebound and spend much of their days involved in obsessions and rituals. For young children, I often draw an outline of the brain and let them color round and round to signify the repetitive thoughts and actions. It may have to be done gradually because it can cause the child to experience significant anxiety.
In general, children who need medication respond to the same medications used for adults with OCD. All seem to be effective at reducing the symptoms of OCD, but different ones may be best for individual patients. If symptoms reoccur, they may return to therapy for a shortened version of their previous treatment. I can take the next thing that comes along." You must do the thing you think you cannot do. Unfortunately, with OCD one can never be certain that all the germs were properly washed off and so the washing is repeated and repeated often many times over in an often futile attempt to be certain that the germs have been washed away.
In 1983 the National Institutes of Health conducted a national survey to ascertain the frequency of occurrence of various mental health disorders, including OCD. Despite this, however, there some categories of obsessions and compulsions that are frequently seen. It is as if a circuit refuses to close and the person with OCD cannot break out of an endless loop. If you decide to seek Behavior Therapy it will be important to find someone who is trained to do ERP.
Research outcome studies have shown that two-thirds of people benefit considerably from ERP alone without medication.
To address this need we have developed a one week intensive treatment option based on a program developed by Stephen Whiteside, PhD, of the Mayo Clinic. Rather, it is the compulsive strategies they develop for coping that make the thoughts seem so harmful. Community surveys of adolescents have suggested that at any given time, 1% to over 3% are experiencing symptoms of OCD.
An obsessive-compulsive personality disorder is different from true Obsessive-Compulsive Disorder. In Freud’s theory of infantile sexuality, the child goes through the stages of oral, anal and oedipal sexual interest. As research continues, the understanding of the neurological and related biochemical mechanisms will improve. Some of the anxiety disorders have similarities to OCD and are called obsessive-compulsive spectrum disorders. However some children, particularly young ones, may not have the cognitive capacity to understand the nature of the obsessions or compulsions. There circumstances in which it is appropriate to start medication and psychotherapy simultaneously or even to start with medication alone. Often one may help them conceptualize the OCD or OCD symptoms as an unpleasant or silly creature. The child himself should have an important role in determining how quickly he wants to move through these steps. Several of these medications are available in liquid form, but you may have to special-order them. A good understanding of the disorder can help the child and family feel a greater sense of mastery and control. However, I have found it useful for adolescents and for relatives of the child or adolescent with OCD.
Compulsions are behaviors or thoughts that you feel driven to do or think even though you may recognize that they make no sense. Other times the compulsion does not appear to be so logically related to the obsession, but the person with OCD performs the compulsion anyway because it somehow reduces their distress (If I tap my foot a certain way as I get out of bed in the morning, my parents will not die today).
Researchers went from door to door in five different areas of the country and interviewed 18,500 people.
The most common obsessions involve contamination, safety concerns, pathological doubt, aggressive and sexual thoughts, somatic concerns and the need for symmetry and precision. For example, to follow up on the example used above of the hand washer, the person would touch a door knob and then not wash their hands. The program consists of ten treatment session delivered twice per day over a five day period and has been shown to produce significant improvement in adolescents with OCD. The book offers safe and effective exposure exercises readers can use to limit the effect obsessive thoughts have on their lives.


Most people with OCD have to keep washing their hands or performing tasks all the time, whereas I don’t do that. Thought action fusion is quite common in OCD, and you can also find it in patients suffering from anxiety disorders. If there are obsessions or rituals that occur only at school, it is important to know about them, so that they can be addressed too.
If the child does not successfully progress through each phase, he may develop later difficulties.
PET Scans (a kind of brain scan that shows levels of brain activity in specific areas.) have shown abnormalities in the sub-orbital cortex (the underside of the front part of the brain) and the basal ganglia.
These include tricotillomania, (compulsive hair pulling and twirling, ) body dysmorphic disorder (the obsession that part of one’s body is unattractive or misshapen) and habit disorders such as nail biting and scab picking.
If a child spends a great deal of time obsessing or engaging in mental rituals, he or she may have trouble focusing on the school lessons. Oppositional children or adolescents may not want to admit that there is something awry with their behavior. I have used the pictures in the introduction section of the book, Brain Lock by Jeffrey Schwartz, MD. The parents can help with this too by reducing and then eliminating reassurances when a child asks obsessive questions.
However, a physician may, after discussion with the family, elect to use a medication that technically is only approved for adults.
Education and the support of others can help the individual keep the disorder in perspective. The book also discusses in more depth special considerations in treating OCD as it occurs in children. To fully qualify for the diagnosis of OCD, the obsessions and compulsions must cause marked distress and take up an hour or more per day or significantly interfere with the person’s normal routine, occupational or academic functioning, or usual social activities or relationships. We used to think OCD was related to unresolved inner conflicts or from poor parenting, but these theories have not received much research support. Recall that the obsession is that their hands are now covered in germs and they or a loved one are surely going to die.
Be aware that there somewhat of a national shortage of properly trained therapists who treat OCD (especially OCD in children) and so you may have difficulty finding someone. Since the program requires clients to be available for five days in a row, out of town clients will need to find accommodations in the Portland area and we will be happy to assist with that process. In addition to self-care strategies, the book includes information about choosing and making the most of professional care. Between 30% and 50 % of adults with OCD reported that their symptoms started during or before mid-adolescence. The parents and usually the child may also fill out checklists such as the YBOCS (Yale-Brown Obsessive Compulsive Scale) These help to determine the baseline number and severity of the symptoms. During early childhood, sometimes during or just before the oedipal phase, there might be a conflict between the ego (the mediating and observing entity) and the id (the source of sexual and destructive energy).
Finally, recent research has suggested that some cases of OCD may be related to the bacteria, B-hemolytic streptococcus. The exact relationship between these two spectrum disorders and true OCD is not yet entirely clear. Individuals who need to repeatedly erase and rewrite assignments may need to spend hours of time of homework and lose time for friends and family.
In that case, a therapeutic alliance with a clinician may enable him or her to discuss his or her real feelings about the symptoms. If a child or adolescent is extremely resistant to the idea of psychotherapy, one might consider starting with medication alone. These pictures vividly show the differences in brain activity between affected and unaffected individuals. In the illustrated children’s book, Blink, Blink, Clop, Clop, Why Do We Do Things We Can’t Stop? At the same time, they should be supportive and avoid blaming the child if he is unable to avoid performing some of the compulsions. Common side effects of these medications include headache, GI complaints, tremor, agitation, drowsiness and insomnia. Since OCD can be associated with other disorders, the clinician should look other childhood psychiatric disorders.
When patients were successfully treated, whether with psychotherapy or medication, the brain scan studies resembled those individuals without OCD. He then suggests a four-step self-help approach to help the individual deal with the symptoms of OCD.
Depression is often secondary to the OCD and usually clears up once the OCD is under control. In the past the sufferer has used washing their hands to relieve the anxiety, but now they have entered treatment and are not going to wash their hands. In many ways the symptoms and treatments of OCD in both children and adults follow the same general principles.
Serotonin seems to be involved in mediating the interaction between these two parts of the brain. For the large number of individuals who manage to hide their symptoms, the cost may simply be years of anxiety and low self-esteem.
The child’s cognitive development necessitates some changes in the psychotherapeutic approach. For those who do not want to read the entire book, he provides a summary of the basics of the four steps near the end of the book.
We now know that OCD is actually one of the more common mental health disorders, in fact it is the fourth most common disorder behind phobias, substance abuse and depression.
Sometimes, however, the depression is severe enough to interfere with the treatment process for the OCD or it persists beyond the resolution of the OCD and requires treatment above and beyond that provided for the OCD. What they discover is that if they can wait long enough, the anxiety does eventually go away and no one gets sick and dies. Part of the unstable compromise might be regression to the earlier anal level of development. If medications are used, the physician must consider the child’s smaller size and different metabolism. If a child taking an SSRI, it is a good idea to consult one’s physician or pharmacist before taking other prescription or even non-prescription medications. While there has been some disagreement about the actual prevalence of OCD, there is general agreement that it is about 1% to 2%.
Because of this, we modify techniques based on the particular stage of childhood or adolescence.
I prefer to use it with patients as an adjunct to therapy and as a reminder between sessions.
If you jump into a swimming pool of cold water, the water would feel very cold at first, but if you stayed in the water you would gradually get used to it and eventually the water would not feel so cold.
Other obsessive symptoms such as checking might be seen as a way of dealing with the unwanted intrusion of hostile oedipal wishes.
However, if the OCD starts suddenly, around the same time as an upper respiratory illness, one might consider a throat swab to check for the presence of B-hemolytic streptococcus infection. Touching the doorknob and not washing you hands is equivalent to jumping into the cold water and staying there. If the bacteria are present, further tests, treatment with an antibiotic and a referral to a specialized center might be considered. The symptoms may start to express themselves years later when something happens to weaken the ego and its shakier defenses.
While the general principles of ERP are somewhat easy to explain, it is often very difficult to do the exposures. Again, if you look at it from the perspective of the person with OCD and they truly believe they or a loved one are going to die if they don’t wash their hands, not washing their hands would be extremely difficult.



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