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Obsessive-compulsive disorder - Wed 25 Apr 2007

Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can't control. If you have OCD, as it's called, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.

The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life.

Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable--symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families.

Depression or other anxiety disorders may accompany OCD. And some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes.

Research by NIMH-funded scientists and other investigators has led to the development of medications and behavioral treatments that can benefit people with OCD. A combination of the two treatments is often helpful for most patients. Some individuals respond best to one therapy, some to another. Two medications that have been found effective in treating OCD are clomipramine and fluoxetine. A number of others are showing promise, however, and may soon be available.

Behavioral therapy, specifically a type called exposure and response prevention, has also proven useful for treating OCD. It involves exposing the person to whatever triggers the problem and then helping him or her forego the usual ritual--for instance, having the patient touch something dirty and then not wash his hands. This therapy is often successful in patients who complete a behavioral therapy program, though results have been less favorable in some people who have both OCD and depression.

text taken from

ANXIETY DISORDERS: DECADE OF THE BRAIN (NIMH).

Seen in "The Anxiety Panic Internet Resource"
TAPIR

See:- HERE

Seeking help - Wed 21 Feb 2007

If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.

However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are 'mad'. In fact, people with anxiety and fears hardly ever have a serious mental illness. It's much better to get help as soon as you can rather than suffer in silence.

People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a door-bell ringing or a car's horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. AIthough friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable. Anxiety & phobias in children
Most children go through times when they feel very frightened about things. It's a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.

Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.

If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask the family doctor to look into it.

Helping people with anxiety and phobias
Talking about the problem This can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.

SeIf-help groups
These are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping. These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences - women's groups, bereaved parent's groups, survivors of abuse groups.

Learning to relax
It can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see below). It's a good idea to practice this regularly, not just when we are in a crisis.

Psychotherapy
This is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.

If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse or counsellor.

Medication
Drugs can play a part in the treatment of some people with anxiety or phobias.

The most common tranquillisers are the valium-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.

Antidepressants can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of the draw-backs is that they usually take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation. Taking a certain kind of antidepressant, the MAOIs, may mean that you have to stick to a special diet. Please see our leaflet on antidepressants for more information.

Beta blockers are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety and can be taken shortly before meeting people or before speaking in public.

Advice
Advice is obtainable from:

National Phobics Society: 339 Stretford Road, Hulme, Manchester M15 4ZY, Tel: 0870 7700456

Formed by a sufferer of agoraphobia for those affected by anxiety disorders. A volunteer-led organisation, run by sufferers and ex-sufferers of anxiety disorders.

Stress Management: 'Foxhills', 30 Victoria Avenue, Shanklin, Isle of Wight PO37 6LS. Tel: 01983 868 166.

The Thanet Phobic Group: 47 Orchard Rd, Westbrook, Margate, Kent CT9 5JS. Tel: 01843 833 720.

www.destigmatize.org.uk
A new organization working with the National Phobic's Society which aims to provide information and support for sufferers of anxiety disorders mainly, but not exclusively, in the Asian population.

Books
Anxiety and Depression by Robert Priest (McDonald and Co.)

Living with Fear by Isaac Marks (McGraw Hill)

Self-Help for your Nerves by Claire Weekes (Angus and Robertson)

Tapes

Control Your Tension, Lifeskills, Bowman House, 6 Billetfield, Taunton, Somerset TA1 3NN. Tel: 01823 451 771

The Mitchell Method of Relaxation Laura Mitchell, 8 Gainsborough Gardens, London NW3 1BJ.

This page was filched from The Royal College of Psychiatrists...thanks guys. CF.

Heart attack? Or was I just panicking? - Thu 19 Jan 2006

I hadn’t planned to die on 10th August 2003. In fact I was just entering a new phase of life. Having emerged from the backside of a hostile and excruciating divorce, I was on holiday in Northern Cyprus with the new man.

I finished breakfast, had my cigarette and left the hotel restaurant to take the two minute walk back down the steep hill to our bedroom. It was a beautiful day. Hot, hot, hot even though it was only 9.30am. And then it hit me. Half way down the hill, the most excruciating pain I had ever experienced thumped me in the middle of my chest stopping me in my tracks. It sucked my breath away as it travelled down my left arm.

Oimigod, I must be having a heart attack. I was 45 years old.

By now, sweating profusely, I summoned up everything I had, forcing myself to walk slowly back to our air-conditioned room, hoping I’d arrive before I kicked the bucket. Once there, I collapsed onto the bed, still perspiring, very nauseous and groaning with pain. I could hear my man happily showering whilst singing Bob Dylan’s ‘If you gotta go, go now’ blissfully unaware that only yards away, I probably was about to go, right then.

The pain was indescribably agonising. I tried to slow down my breathing, willing it to pass and was on the verge of calling out for help when, just as suddenly as it had come on, the pain vanished, leaving me feeling fragile and exhausted. Having had a friend who’d suffered with angina that, I concluded, was what it was. Not a heart attack but a warning for me to give up smoking, lose some weight, take more exercise. I resolved not to say anything about it (why ruin the holiday after all?) and to see a doctor when I returned home.

However, once back I reasoned it was probably a one off, and I’d be fine, but how wrong I was. A couple of long months later, the same crushing chest pain, accompanied by nausea, awoke me one morning. Although lying in bed, I felt faint, was sweating and felt, with a sense of foreboding that sadly, this time, my number was definitely up. Once again, the thing built to a climax and lasted approximately ten minutes before subsiding, leaving me feeling simply dreadful and needing to go back to sleep. Yet again, I was too scared to go to the doctor so I told myself that clearly it was only angina and probably wouldn’t kill me - yet.

The next attack came on six weeks after that, the fourth one around a month later, followed by another one a week later. What the hell was happening to me?

For New Year’s Eve 2003, we decided to drive to France and treat ourselves to a banquet in a Chateau. We arrived late on December 30th, had a fabulous meal and went to sleep. The following morning, the by now familiar crushing chest pain, faint feeling and sickness again awoke me. This time, the colour apparently drained from my face and, feeling really very sick, I rushed to the bathroom only to pass out on the way. He deftly caught me just before I hit the floor whilst losing control of all my body functions. People choose to test the strength of their relationships in different ways. Mine was an involuntary display of incontinence. How sexy was that? If he could withstand that, we were surely destined for a fabulous future, n’est ce pas? Later, the hotel management kindly refunded our money for the second night and we left. Enough was enough; it was time to see a GP.

Suspecting epilepsy, the first GP organised an EEG and upon seeing the results, referred me to a neurologist. This was to be the start of my Annus-Ologist. Over the course of the next 12 to 18 months I was referred to a neurologist, a gastroenterologist, a cardiologist, an endicronologist, a gynaecologist, several therapists and a urologist – all utterly unhelpful; and Professor Jonathan Brostoff, a leading immunologist who was kind, took me seriously and tried to be helpful. I had EEG’s, ECG’s, endoscopies, colonoscopies, manomentries, ultrasound scans of my vital organs, allergy tests, hormone screening. I stopped smoking and drinking, recreational drugs were certainly now right off my menu. I started taking far more exercise, and I went through a process of food and drink elimination, testing possible triggers one by one.

I was prescribed low-level anti-depressants along with drugs to control acid production in my stomach and Nifedipine – a magic drug which alleviates angina symptoms. Still the episodes continued, increasing in number and intensity until I was having up to four a day. Alarmingly, they were now happening at any time and I remained unable to pinpoint any discernible reason or trigger. One really bad day, I had a terrible episode at home. Lena, who helps me with my cleaning, tells me that my colour drained, my lips went blue and my eyes were rolling. She dialled 999 and bless the ambulance service, they arrived in less than ten minutes, whisking me off to Hampstead’s Royal Free hospital where concerned doctors ran a battery of tests – all of which were very thorough and totally non-illuminating.

By now I was truly terrified. I was convinced that despite all the tests, they’d missed something major. Was it my heart? Maybe some previously unknown form of cancer? Something to do with my digestive or respiratory system? This was taking over my life, I was frightened to be alone lest I faint, fall and injure myself. I worried that I may die at home in bed or on the kitchen floor to be discovered by my then 14 year old. I churned things over and over in my mind; worrying, revisiting, wondering whether I was being punished for something.

During all of this, my anxious parents had mentioned my problem to their friend Geoff. He suggested that I might be having stress induced panic attacks, he recognised the symptoms. I ‘pooh-poohed’ this ridiculous, amateur diagnosis. Yes, I may have been through a brutal divorce. Yes I’d left my gorgeous home to move into far less grand accommodation and I was under other pressures but I just wasn’t the sort of person who would be prone to something as mental as a panic attack. I was the sort person friends or relatives turned to for help and support. I could take the heat.

One day, in an idle moment, I punched ‘panic attack’ into Google UK. 1,290,000 results showed up and the first one I looked at offered the following:

A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. The cause is not clear. Stressful life events such as bereavement may sometimes trigger a panic attack.

Various symptoms then occur during a panic attack. These include one or more of the following:

· Palpitations or a thumping heart.

· Sweating and trembling.

· Hot flushes or chills.

· Feeling short of breath, sometimes with choking sensations.

· Chest pains.

· Feeling sick.

· Feeling dizzy, or faint.

· Fear of dying or going crazy.

· Numbness or pins and needles.

· Feelings of unreality, or being detached from yourself.

Good god. Save for the pins and needles and the choking, I was experiencing all of those symptoms each time I had an episode.

Could it really be possible that this was all simply a physical manifestation of what was going on in my mind? I had to take a leap of faith to even start believing that the mind could be that powerful. I called the website’s helpline number and chatted for forty-five minutes to an extremely helpful and reassuring counsellor. She explained that once the body starts to react to stress in this extreme way, it gradually becomes conditioned into that reaction until any little bit of stress, even subconscious, can trigger an attack.

My next port of call was Dr Elizabeth Bradley, a second GP, who listened carefully then agreed with my diagnosis, immediately referring me to a psychiatrist initially who suggested I take heavy-weight anti-depressants in tandem with Cognitive Behavioural Therapy (CBT) and breathing lessons. Eh? I’d always thought I’d pretty well mastered the art of breathing but apparently my problem stems from hyperventilation and I’d got myself into bad breathing habits. I resisted the anti-depressant route feeling that their potential side effects (such as feeling worse before I felt better, putting on weight and losing my orgasm) would guarantee me a suicidal, let alone depressive, state. I didn’t in all honesty even feel depressed, just chronically anxious about my world, the Universe and everything. The doctor did however explain why my symptoms couldn’t possibly be heart related. He began to convince me but nagging doubts persisted.

I’m now six months down the line of CBT with chartered clinical psychologist, Judith Halperin. She’s worked with me to re-frame the attacks as “moments of anxiety” and now knowing that they will pass very soon after starting, I no longer feel that they may kill me. I now also recognise the pre-cursor signs of a “moment” and can often take averting tactics including forcing myself to relax. My new breathing technique helps me to modulate my breathing, drawing breath from the pit of my stomach rather than somewhere up in my throat. These days, so confident am I that a ‘moment’ will pass quickly that I no longer even reach for a quick fix drug.

Although I’m still having my ‘moments’ the nature and intensity of these has lessened and changed almost beyond recognition. Part of that change is down to recognising them for what they are - an extreme, physical interpretation of anxiety - and hence I’m not actually panicking during an attack about whether the symptoms are indicative of something much more sinister. I’ve also been seeing Mary Walker BA DipION BANT, a nutritionist whom I feel has helped me too. I’m still off the fags and now just have to tackle losing the weight gained due to having stopped smoking. Getting to this stage has taken two and half years of blood, sweat, tears – and lots of dosh. Now at least I’m having some days totally free of ‘moments’ and I’m quietly optimistic that these will increase.

For further information on panic attacks and stress related anxiety disorders, you could start with www.patient.co.uk

This article appeared in "The Independent" on the 17th of January 2006. It was written by one of our members. (Nicola).

If anyone else would like to share their story you can send it to me and I will place it online. CF.

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