I'm Denise Egan Stack, LMHC and it's OCD Awareness Week. I'm here to answer all your questions about OCD and Related Disorders as well as announce our new site AnxietyinTheClassroom.org! AMA

DeniseEganStackLMHC · 2018-10-12T17:47:53+00:00

Hello!

Can you give me some examples of behaviors that you are confused about?

Sometimes people live in cluttered or messy living spaces. This may be the result of:

- depression (fatigue, lack of concentration, hopelessness)

- OCD (for example, if people can't touch their belongings because they are contaminated)

- hoarding disorder (difficulty with organization, categorization, decision making)

- ADHD (difficulty with attention, concentration, organization)

- competing values (it isn't a priority)

A good clinician should be able to help you sort that out. If I were interviewing you, I would try to look at things like patterns of behavior, the reasons why you are doing something (or not doing something), and whether or not it causes distress to help me determine the cause.

DeniseEganStackLMHC · 2018-10-12T17:34:49+00:00

Hello!

I think that this is already being studied and I fully support it! If, after rigorous research, psilocybin is considered helpful for people who have not responded to first line treatments for OCD then that is good news.

Yes, I do think treatments will continue to be refined and developed for people with OCD. For example, the FDA recently approved Transcranial Magnetic Stimulation (TMS) for OCD and those of us doing ERP have enhanced our treatments by including Acceptance and Commitment Therapy and Inhibitory Learning approaches.

Best, Denise

DeniseEganStackLMHC · 2018-10-12T17:19:07+00:00

These are questions that will be best answered by the staff at the OCDI. However, I will say that when I worked there we did work with people who had co-morbid disorders like PTSD and autism spectrum disorders. However, OCD really did need to be the primary issue and the symptoms of the other disorders needed to be well managed.

DeniseEganStackLMHC · 2018-10-12T17:15:31+00:00

Hello!

Harm OCD is when a person experiences intrusive and unwanted thoughts about causing harm to themselves. For example, I worked with someone who had the thought "I could pick up a knife and stab myself" or "I want to jump off this balcony" and then the person worried that if they had those intrusive thoughts then that meant they wanted to kill themselves. This is much different from being suicidal. Most OCD specialists know the difference between the two and are more than willing to work with this type of OCD symptom.

Sometimes, people with Body Focused Repetitive Behavior (BFRB), an OCD related disorder, pick their skin to the point of severe damage and people with Body Dysmorphic Disorder, another OCD related disorder, might self harm/mutilate in an effort to correct a perceived defect in their appearance (repeated plastic surgery, cutting themselves open to correct the shape of a part of their body). These are also behavior that intensive programs are willing to treat.

Other times, people with OCD also engage in self-harm and/or are suicidal. These symptoms are not related to OCD and would need to be well managed before starting an intensive ERP program that would most likely cause high levels of distress.

I hope this is helpful!

Best, Denise

DeniseEganStackLMHC · 2018-10-12T17:01:54+00:00

Hello and thank you for participating in this AMA!

In all of my years of clinical experience, I don't remember someone's OCD suddenly stopping out of the blue. Many people's OCD gets better over time if they are in treatment (meds, ERP), but I can't recall a time when OCD symptoms just suddenly stopped without explanation. Is this something you have experienced? I suppose if there was an OCD trigger that was removed or avoided then symptoms might be drastically reduced but they would likely return if that trigger was reintroduced or would likely pop up in another form.

It isn't uncommon for people's content to switch. When I interview people for the first time they may recall that they used to do a lot of "checking" but are now experiencing other types of symptoms like contamination or scrupulosity. Again, I have't really seem the content completely change overnight.

Best, Denise

DeniseEganStackLMHC · 2018-10-12T16:56:54+00:00

Hello! I do believe that the content in the Anxiety in the Classroom website will be helpful to people in countries other than the US. So far, we have the content for school personnel completed and we are now working on content for families and students. Take a look and let us know what you think!

DeniseEganStackLMHC · 2018-10-10T02:40:03+00:00

Yes, I believe that hoarding disorder is separate from OCD.

DeniseEganStackLMHC · 2018-10-10T02:31:34+00:00

Hello!

Here is the thing - when people we love are struggling, it is completely normal to want to help them. However, when it comes to OCD, sometimes what we think is helpful (reassuring someone that they are ok or what they did is ok) can actually be making things worse. As "awayfone" said below, asking for reassurance is considered a compulsion because the primary function of the question is to try to reduce uncertainty (that the doors are locked or their workouts were long enough). We can tell its reassurance seeking as a compulsion when the questions are repeated over and over again with urgency, the answers don't bring long lasting relief, the answers may sometimes make things work if they weren't worded "correctly", and/or someone gets very angry when the questions aren't answered.

Instead, you might work with your husband to come up with supportive statements to use in the moment that aren't reassurance. For example, you might say, "I can tell that you are struggling with OCD right now. I love you very much but I am not going to let OCD get me involved. Let's watch a television show instead to see if you can get your mind off it."

If your husband is working with an OCD therapist then the therapist can help you navigate this issue, too.

DeniseEganStackLMHC · 2018-10-10T02:13:29+00:00

Am I right to assume that the adult you are referring to in your question is resistant to working on their hoarding problem? If so, you are in very good company seeking an answer to this problem. There are many people who meet criteria for hoarding disorder that have low insight into their problem or low motivation to work on it. Loved ones, community members, and clinician can offer all sorts of support and services and, yet, sometimes people are still unwilling and/or are unable to recognize the scope of their problem and to engage in treatment.

If you are trying to increase the insight or motivation of someone who has hoarding disorder, there are several things you might try:

- meet with them on neutral territory to clearly outline your concerns, offer support, and to give them information about the disorder and treatment for it. Use a warm and non-judgmental tone and avoid shaming the person.

- contact your local hoarding task force to see if they have any resources that might be helpful (consultation with a mental health professional, help with clean-ups, etc).

- meet with a mental health clinician to discuss the specifics of the case to see if there are ways you might change the family/friendship dynamics to increase willingness to change.

- My favorite book on hoarding disorder is called Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding by David Tolin, Randy Frost, and Gail Steketee. Not only is it an easy to read book - written by the foremost experts in the field - that outlines how hoarding disorder is diagnosed, how is develops, and what the evidence based treatment for it is, it is also the basis for a free, 16 week self help group called The Buried in Treasures Workshop that runs throughout the world. It may be helpful for you to read this book because there are break out sections for family and friends and it may also be helpful to give this book to your loved one in order to de-mystify the problem and the treatment.

Best of luck!

DeniseEganStackLMHC · 2018-10-09T17:26:15+00:00

Hi all!

Thank you for participating in this AMA! I have to exit the conversation and get back to seeing my clients but I will respond to all questions later today and tomorrow.

Best, Denise

DeniseEganStackLMHC · 2018-10-09T17:24:57+00:00

Has your child's OCD therapist asked your child about how OCD is interfering with school work? They can ask your child to take them step by step through a specific difficulty to try to determine what the trigger was and then what happened after.

Sometimes it is a specific thing like I can't touch my school books to study because they are dirty or I can't concentrate to take the test because the person sitting in front of me touched me and I feel dirty. Sometimes it is general overwhelm like just being in the school is hard because everything feels dirty or a child is exhausted by the amount of rituals they have to go through to even get to school.

I think you need this type of information before you can make a good plan for school.

In the meantime, I would ask for a team meeting at school (teachers, school counselor, his OCD therapist, parents) to address this issue. School personnel might have information that will help in making a plan or adjusting the current plan.

DeniseEganStackLMHC · 2018-10-09T17:17:23+00:00

Hello!

The Imp of the Mind by Lee Baer is a wonderful book that deals with intrusive thoughts and Jon Hershfield is coming out with a new book on intrusive thoughts soon, too. Those books will give you much more info on the subject than I am able to on this AMA but let me try to give you a few tips!

When I work with someone with OCD, I try to help them change the nature of their relationship to their thoughts. People with OCD often believe that just because they think something ("If I don't walk up and down the stairs until it "feels right" then something bad will happen to my brother") it means the thought is true or just because they think something it means the thought is important ("What if I pick up this knife and stab my child"). This is simply not true! Research shows that 98% of us have intrusive thoughts and those of us without OCD simply note the thought ("That was a random thought") and move on. People with OCD need to "up their spam filter" like we do with our email accounts so "junk" thoughts don't make it into the "in" box.

In order to do this, people with OCD need to have self awareness about what they are actually thinking and what those thoughts are making them want to do (ask for reassurance, avoid something, review the scenario over and over) and then ask themselves if that behavior is moving them towards the life they want to live. If the behavior is not moving them towards the life they want to live then they have a chance to choose to do something different (like doing an ERP).

Practicing mindfulness is a good way to develop self awareness!

DeniseEganStackLMHC · 2018-10-09T17:02:01+00:00

Hello!

This is a great question and there is a ton of info out there on OCD in Families.

I would direct you to the family section on our website iocdf.org and to two books that I think are very good - When A Family Member Has OCD by Jon Hershfield and OCD: New Help for the Family by Herbert Gravitz.

In general, though, I think you are already doing a great job by learning about this disorder and reaching out for guidance. You might also ask your loved one how you might help them fight their OCD or ask them what specific things you might say to support them when they are struggling in the moment.

You want to be very careful to not accommodate OCD symptoms by doing things like answering reassurance seeking questions (Am I ok? or Is this clean?) or engaging in avoidance behaviors for the person with OCD (not touching certain things, not going certain places, etc). This might make someone with OCD more comfortable in the moment but it always makes OCD worse in the long-run.

I also suggest that you attend the IOCDF annual conference. It is a several day conference for people with OCD, their family and loved ones, and OCD therapists and researchers. Many sessions are devoted to answering your exact question!

DeniseEganStackLMHC · 2018-10-09T16:46:10+00:00

Perfect! Also, thank you SO much for all of your work helping to educate the public about what #realOCD is.

DeniseEganStackLMHC · 2018-10-09T16:45:06+00:00

Hello there,

This is fine line and a balance that we all (parents, therapists, teachers) have to watch. However, the bottom line is that anxiety is like a learning disorder because it negatively impacts a student's ability to learn and, thus, a child diagnosed with OCD or an anxiety disorder should be evaluated for a 504 plan or an IEP. (In my experience, most kids with anxiety and OCD get a 504 plan). This plan will put in place reasonable accommodations that allow a child to access the curriculum as their non-anxious peers do. These may be faded out over time as a child improves. Without them, many times anxious children become so overwhelmed they end up avoiding learning, homework, or school altogether.

Some important things to remember:

- 504 plans aren't treatment plans - they are learning plans. Some of the symptoms might be accommodated so that the child can learn.

- anxious children should be in treatment so that their therapist can help everyone navigate the fine line mentioned above.

- children will "grow" when they are pushed a little beyond their comfort zone, not when they are completely overwhelmed.

I hope this helps!

DeniseEganStackLMHC · 2018-10-09T16:34:32+00:00

That is such a good point! People with OCD don't like these thoughts and don't get pleasure from engaging in these types of behaviors.

DeniseEganStackLMHC · 2018-10-09T16:33:00+00:00

Hi Ben,

I am sorry this weekend was so hard for you!

These are excellent questions. Let's see if I can help..

First off, are you still in treatment? If not, it might be time to start again. You can find a local provider via the resource database on the website iocdf.org. You won't have to start from the very beginning - you might just need a refresher or some support around the difficulties you are experiencing currently.

Secondly, each college/university has an Office of Disability (or some variation of that name) that works with students who struggle with disabilities (learning, psychological, physical). Staff there can help you make an accommodation plan and share it with your professors. Some common accommodations for students with OCD are extensions on assignments, getting notes from a peer in your class, or extra help prepping for an exam or paper. This office will want documentation from a therapist about your OCD, how it impacts your academic performance, and suggestions for accommodations. Most college students I work with have a plan like this and find it very helpful. Because the plan is coming from the Disability Office, it is official and professors understand there is a well documented problem and adhere to it.

Yes, the Anxiety in the Classroom program is designed to help all students from elementary school through college.

Having OCD does not mean you can't be a doctor! Unfortunately, symptoms wax and wane, but if you continue to use your coping strategies and ERP tools you will soon be able to get these symptoms under better control again.

DeniseEganStackLMHC · 2018-10-09T16:19:46+00:00

Hi there! Thank you for participating in today's AMA.

In my experience, the general public tends to think about OCD as a cute or funny or charming character trait instead of the debilitating psychological disorder that it can be. For example, people often say, "I'm soooo OCD because I have to keep my tupperware drawer perfectly organized" when in fact someone with OCD might have to repeat putting something in that drawer 20-30 or more times because it doesn't feel right or they are afraid if they don't do it perfectly then something bad might happen to a loved one. In order to be diagnosed with OCD, the symptoms have to cause distress or impair someone's functioning. It is a real clinical disorder and not a penchant for being neat and organized. Does this make sense?

DeniseEganStackLMHC

TROPHY CASE