Obsessive Compulsive Disorder

Obsessive compulsive disorder, or OCD, is characterized by disruptive obsession and compulsions. Obsessions are recurrent and persistent thoughts that are both unwanted and cause distress. The individual attempts to neutralize them by performing an action. Compulsions are repetitive behaviors or mental acts that the individual feels compelled to complete. These acts aim to reduce anxiety and distress, even though they may only be loosely related to the cause of distress or are excessive. The individual may even be aware that the thoughts and actions used to reduce them are unreasonable and unlikely, but they have no power over them. Obsessions and compulsions usually occur together, though only one may be present in some individuals. These obsessions are time consuming or cause significant distress and impairment in several areas of functioning. Obsessions can take up anywhere between 1-3 hours per day in more mild cases, and in more severe  cases consuming most of the day. Symptoms cannot be associated with substance use, medications, or be better explained by another mental illness. About 1.2% of Americans have OCD. Treatment consists of typically a combination of medication and psychotherapy, though medication will not work for all cases. Medications for OCD are most commonly antidepressants in high doses. Psychotherapy focuses on reducing anxiety surrounding obsessions and reducing compulsive behaviors. Eventually, after managing the anxiety, the individual will feel less and less anxiety around the obsessions.

 

Depending on the obsessions and compulsions, OCD can be very disruptive in a lot of different areas. But specific functioning differs between sufferers. Some have problems with relationships because they obsess over losing or hurting loved ones. Some have rituals that make completing school-related tasks difficult or time consuming, such as needing to read each page a certain number of times or anxiety surrounding a task becoming so overwhelming that the task is avoided altogether. Those without OCD have a hard time understanding that these are not made up, that someone with OCD cannot control what they obsess over or what compulsions are needed to reduce anxiety. And because these thoughts can pop up at any time, it is difficult to predict what the student will need to succeed. Many of the more common accommodations are of no use to a student with OCD. Students are encouraged to seek help in managing their symptoms, as this will aide them in the long run for reducing stress. While in college, it may be helpful to contact the disabilities office and set up specific accommodations for what the individual needs to function in college while being treated. Not all accommodations will look the same from one OCD student to the next. This illness is completely manageable, and success in a college environment is very possible.

Resources:

https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

https://iocdf.org/about-ocd/

http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/dxc-20245951

https://www.collegemagazine.com/feel-crazy-living-ocd/

https://www.hercampus.com/school/chapel-hill/her-story-coping-ocd-college

https://psychcentral.com/lib/ocd-and-college-accommodations/

http://beyondocd.org/information-for-college-students/disability-accommodations

10 Things your OCD will lead you to believe

Staff report—

While working on my obsessive compulsive disorder (OCD) in therapy for a little over a year now, one of the biggest lessons I’ve learned is that OCD loves to lie. Through these sneaky lies, OCD pretends to be a helpful friend who wants to keep us safe. But really, it only manipulates us into doing more and more rituals. When stressed and struggling with an obsession, I’ve found it’s helpful to identify when OCD is trying to tell a lie. Then, I’m more likely to resist doing a ritual or to fight through the discomfort of an exposure.

—> Here are 10 common lies OCD tries to tell…and why you shouldn’t believe them!

1. I have to do rituals to feel safe or keep others safe.

While most people with OCD know their fears are irrational, sometimes in a stressful moment those fears can feel true. At times like this, I try to remember the relief and feelings of safety you feel after doing a compulsion will only be temporary. Doing rituals never makes me feel safe in the long run. Delaying a ritual and sitting with the anxiety is actually what gives me feelings of safety and control.

2. I have to do rituals if I want to feel less anxious.

Because of its cyclical nature, one of the main pitfalls of OCD is that it can grow quickly. Doing a ritual decreases anxiety, which feels really good in the moment, but the relief is only temporary. When the obsession pops up again, we have to do the ritual more and more for our anxiety to go away. With every ritual we do, we continue to learn that ritual equals less anxiety, even though it doesn’t work very well. Exposure and response prevention therapy (ERP) reteaches our brain that if we don’t do a ritual, eventually our anxiety will come down on its own. With every exposure we do, our anxiety comes down faster.

3. This anxiety will last forever.

This lie can feel especially true during an exposure or panic attack, but it’s not only false — it’s impossible. All anxiety will come down eventually. It might soon go back up again, then down, then up, etc., but it will come down. I pinky promise.

4. Just do the ritual one more time. It’s better than trying to resist.

This is one of the lies OCD tells me most often: “One more time!” It’s the same lie music directors and dance teachers always told us in practice, and it’s never true. Giving into the ritual only makes the obsession grow more, which means you’ll have to do the ritual even more times.

5. My thoughts make me dangerous.
Something my therapist told me this week is, “We can’t choose what thoughts we have, but we can choose what we do.” What many people don’t realize is everyone has weird, intrusive thoughts. While most people shrug them off and go about their day, the difference is people with OCD tend to overreact to these thoughts. We feel responsible for our weird thoughts and feel like dangerous people. Because of this, we obsess about the thoughts and engage in rituals to reduce our anxiety, which accidentally makes the thoughts come more often. This lie is simply not true; thoughts are just thoughts.

6. I shouldn’t tell people about my thoughts.

When my OCD tells me my thoughts are dangerous, it also tells me to keep them a secret. We don’t want people to know all the weird thoughts we have. This only makes the thoughts stronger; we fall deeper into the obsession. It also makes it harder to get help. It’s like saying “Voldemort” — you can take some of the power away just by saying it out loud.

7. I should be able to control my thoughts.

Wouldn’t it be nice if we could try really hard and just stop having intrusive thoughts? Yes, that would be nice, but I’m sorry to say that’s not the reality. Go ahead and try, I’ll wait. Tired yet? As nice as it would be to have control over our thoughts, I repeat, “We cannot choose what thoughts we have, but we can choose how we react to them.” The more we react to the thought and try to stop thinking about it, the more we think about it. The less we react to a thought and treat it as just a thought, the sooner it passes.

A common way to demonstrate this phenomenon is the pink elephant experiment. Try it yourself here!

8. There is a high probability that something bad will happen.

This is a common lie all anxiety disorders try to tell, but one I’ve tried especially hard to fight back against and test out many times. What I’ve found is usually, it’s not as bad as I expect it to be, or the bad thing doesn’t even happen at all. Quite often when I do an exposure, the anticipatory anxiety is worse than the anxiety I feel when I’m actually doing the exposure. Our brains really like to keep us safe, which means our brains really like to tell us something bad will happen, even when most of the time it doesn’t happen.

9. If something bad does happen, then I won’t be able to cope.

What about when you take the risk or do an exposure, and the bad thing does happen? I also underestimate my ability to cope with something bad. We are far more capable of coping than we usually believe.

10. I need certainty.

OCD related fears come in all shapes and sizes, but one aspect that ties them all together is an intolerance of uncertainty. Whether you check a lock multiple times or reread a page over and over, the goal is to feel certain that the feared outcome won’t happen. The only way to feel free then is to embrace uncertainty. Instead of responding to a “What if?” by ritualizing and desperately trying to achieve certainty, it’s better to respond with “Maybe…” and work on accepting the uncertainty.

~Morgan

College Mental Health Crisis

STAFF REPORT—

When I look back at college, I can say with utter certainty that “these were among the best days of my life.”

I was “independent” and “free” (both words I enjoyed using) and I considered myself unfettered by parental monitoring.

I forged new relationships.

I stayed out late.

I had meaningful and existentially provocative conversations with classmates.

I fell in love.

What’s not to like?

Ironically, it turns out that these very features of college – the unfettered independence and developmental exploration that I relished – can make college great for some young people, and at the same time can make college absolutely miserable for others.

When I was in college, there wasn’t much room for the miserable part.  Universities acted like the emotional hardships of being away from home were unusual and rare and administrations largely ignored these issues.

Today, things have definitely changed.

Colleges acknowledge that students experience profound emotional struggles, but colleges have remained largely ill-equipped to help these students.

Let’s look at the good, the bad and the ugly of the college mental health universe.

The Good

There are more opportunities for developmental growth than ever before. Colleges actively recognize the immense variety of ways that young people come of age. There are academic and extra-curricular offerings for people to explore who they are and what values they hold dear. This is especially the case for special programs designed to support women and minorities, programs that we never dreamed would occur as recently as 20 years ago.

The Bad

We’re also seeing increasing drop-out rates, more powerful distractions from the online world, and greater academic and social expectations for students.  Add to this the ever-growing financial challenges for students and parents and the decreased certainty of finding a job, and we have the cliché of the “perfect storm” for the emotional stress of higher education.

The Ugly

As we said above, despite great strides, colleges remain largely ill equipped to negotiate these complex psychosocial waters.

As students in the United States head back to college for the winter term, we’d like to address some of the greatest psychological challenges facing universities and their students. This week we’re going to tackle the most disturbing and unsettling issue in college mental health – the possibility of deliberate self-harm and even suicide among university students.

We don’t want to be too alarmist.  Although suicide attempts on college campuses do appear to be increasing, it is not the case that simply being in college means that someone will more likely consider suicide.  However, because many psychiatric illnesses have their natural onset among college-aged individuals, students are at higher risks when these illnesses coincide with the college-related stressors we’ve outlined above.

Consider these statistics:

  • There are more than 1,000 suicides on college campuses each year – That’s 2-3 deaths by suicide every day
  • Suicide is the second leading cause of death among college-age students
  • More than half of college students have had suicidal thoughts, and 1 in 10 students seriously consider attempting suicide
  • Most importantly: 80-90% of college students who die by suicide were not receiving help from college counseling centers

These are of course alarming statistics. Some have even called this a crisis.  The most important question to ask, therefore, is this:

What can we do to improve the situation?

To answer this question, let’s start by looking at what we know about college suicide.

Attempts at suicide and death by suicide are most common in college students who:

  • Are depressed
  • Are either under the influence of substances, or have a substance use problem
  • Have made a previous attempt
  • Have a family history of a mood disorder such as depression or bipolar disorder
  • Are struggling with a history of trauma

We also know that students often tell others when they’re emotionally struggling, and that teachers, peers and resident assistants are more adept at recognizing emotional distress among struggling students.

Nevertheless, suicidal students often feel helpless, hopeless, and trapped. Some of these students resist seeking help because they’re ashamed.  They might fear a “black mark” on their record or being judged by others.  Even if they don’t have these concerns, they often don’t know what services are available.

Obviously, this is a complex and multi-faceted issue.  We won’t be able to rectify this trend overnight.  But there are steps we can take to ameliorate the risks.  These include:

1.  Establish new educational platforms about depression and suicide.  Key to prevention and early intervention is education about mood disorders and suicide risk.  Some educational initiatives include live and online modules that can be used in a wide range of forums on campus – from dorms to the classroom to campus-wide events. These modules are not just for students; parents and faculty benefit as well.  We also need to be more creative in our educational approaches. For example, a film series on depression and suicide followed by discussion groups could be an incredibly powerful way to educate the community.  There are a number of very informative online sites that can serve as adjuncts to these educational efforts.  Chief among these are Griffin Ambitions, the American Foundation for the Prevention of Suicide and the Jed Foundation.  Another important component includes making students aware of what they can and should do if they are worried about a friend or fellow student. In fact, everyone on campus needs to know where to go and what to do when there are safety concerns.  Each college campus should have a user-friendly website or app that features a clear description of the risk factors for suicide and self harm and explicit advice about how to approach a student about whom there are question

2.  Increase access to mental health services.  Every member of the university community as well as parents and family should know how to seek help on and off campus.  A college website can house all the needed information about these services, including information about clinicians and the nature and coverage provided by insurance.  This information should also include clear directions about how to access the best emergency departments either on campus or in local hospitals if serious concerns are warranted

3.  Support community forums.  Most students struggling with a mental illness or emotional crisis feel alone and frightened.  Study after study tells us that we feel better and safer with social supports.  Providing community forums on a regular basis, and throughout the campus, sends a key message: You are not alone, and something can be done about your suffering.

4.  Foster peer counseling.  Depressed and suicidal students are often more likely to talk with friends than parents, teachers or advisors.  We have seen this demonstrated in the success of the programs like AA for substance use disorders and in support groups for all sorts of emotional and behavioral difficulties.  Organizations such Active Minds, tailored to college students, have been highly effective in the mission of peer counseling.

5.  Decrease the stigma of mental illness.  Perhaps the greatest barrier to seeking help is the fear of being judged or ridiculed. Many individuals still do not believe that depression and mood disorders are illnesses and feel that suicide is a sign of deep personal weakness.  Colleges need to take the lead in dispelling these false beliefs. Treatments for depression are effective, and the entire college community needs to be aware of this fact.

6.  Promote means for increasing student wellbeing.  Depression is often prevented by a number of activities – regular exercise, good sleep habits, substance use awareness programs, group discussions, cognitive behavioral techniques, expressive arts, and discussion groups have all proven helpful. These activities should be encouraged and fostered on college campuses.

Because each college is unique, colleges must tailor these initiatives to their own circumstances, but the benefits of taking action cannot be underestimated.  Colleges can literally save lives. They just have to act.

This blog was originally posted on The Clay Center for Young Healthy Minds at Massachusetts General Hospital and includes a podcast reviewing the college mental health crisis.

For additional information please see:

From the Clay Center

When Kids Leave Home: Part 1

When Kids Leave Home: Part 2

Examples of college webpages:

Counseling & Psychological Services – University of Pennsylvania

Mental Health and Well-Being – Cornell University

Dear Teachers & Professors,

An open letter to those in education

Dear teacher(s)  professor(s),

TO WHOM IT MAY CONCERN:

I am a person living with mental illness. Odds are, I’m not the only person in your life who faces this — whether you know it or not. Your knowledge about mental illness may be limited to what the media says, or what society says. With the alarming amount of college students with mental illness these days, I would hope you’ve educated yourself on this topic.

I am a person living with mental illness. I’m also a good student. Yes, I may have missed class, not participated in a discussion or turned something in late, but if that’s all you see then you’re not seeing the whole picture. I’m not asking for excuses or looking for a way to get out of assignments or rules. I would love to be able to adhere to everything without a problem. But I can’t. I have a disability, and even the department that provides accommodations for disabilities doesn’t help much. Aside from the scars on my body and physical symptoms of panic attacks, my illnesses are invisible.

When I don’t come to class, you may see a student who is lazy or didn’t feel like coming. But what you don’t see is the restless night I had tossing and turning with my insomnia. You don’t see the black mass encompassing my entire being some days. You don’t see the fight in my mind between staying alive or giving up. I’m not just lazy. It’s not because I didn’t finish the homework. I wasn’t in class because I couldn’t get out of bed today. I could not face the light of day because my depression had chained me to the darkness of my room.

I had a teacher tell me once it wouldn’t be fair to the people who always made it to class if my absences didn’t affect my grade. At the time, I understood. But looking back now, I realize that makes no sense. Accommodations exist for people with disabilities for a reason. By “understanding” but still penalizing me for something caused by my mental illness, you are keeping me at a disadvantage. It’s not fair to expect I be on par with other students who don’t have the added obstacle of an illness. I promise I’m giving it my all. I’m balancing my recovery and my education at the same time, and I shouldn’t feel like I have to choose. I shouldn’t feel like I can’t do both.

I’m not asking you to never expect me in class or constantly give me extensions. I’m not saying to just let it slide. I’m asking you to be empathetic, understand that I’m a student facing an illness and help me succeed. I’m asking you to not give me a low grade solely because my mental illness prevented me from having a perfect attendance. I’m asking that you look at me as a whole person. I’m asking that you care, and if you can, that you advocate for students like me. I’m a person living with mental illness, and there are so many of us who need your understanding.

-JACOB M. GRIFFIN
BALL STATE UNIVERSITY
FOUNDER OF GRIFFIN AMBITIONS LIMITED, A HOOSIER BASED 501c/3 NON-PROFIT
FOUNDER OF ACTIVE MINDS AT BALL STATE UNIVERSITY