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Go Away Mr Worry – A Step Towards Managing Childhood Anxiety
Tag: OCD
OCD – Tips for family members and friends Part 6/6
- Learn as much as you can about OCD
- Take care of yourself and seek professional help if you need it
- Try not to participate in their rituals – this only reinforces and entrenches OCD symptoms
- Try not to let OCD take over the family or relationship
- Criticism and negative comments can make OCD worse – try to create a calm and supportive environment
- Acknowledge improvements however small
- A non-judgemental attitude is helpful
- Try viewing OCD as separate from the person not like a character flaw
- Remember that it is normal to feel frustrated, angry or resentful when OCD interferes with your life
- Encourage the person to talk about their OCD so you know how it affects them and how you can help
- Encourage your loved one to get professional help
OCD – Tips to help with OCD Part 5/6
- Postpone OCD rituals whenever you can – this will assist you in learning to sit with the anxiety
- Remember that unpleasant feelings always reduce when given enough time
- When you notice an obsessive thought arising, refocus your attention to something else
- Write down obsessive thoughts or worries
- Anticipate OCD urges– know your triggers and help yourself resist the compulsion by creating mental pictures or notes that remind you the compulsion is unnecessary (for example when you lock the door, make a mental picture of the locked door and say to yourself “the door is now locked”)
- Try slowly cutting back on compulsive behaviour. If you check 10 times that the door is locked, try checking 8 times and then 6 etc.
- Reduce your vulnerability to OCD by eating a healthy diet, getting regular exercise and enough sleep
- Try not to isolate yourself
- Make friends with your OCD – get to know your triggers, the more you can anticipate and identify OCD thoughts the more power you will have to manage your OCD
- Practise relaxation techniques
- Limit intake of alcohol and nicotine
- Manage the stress in your life – OCD symptoms tend to get worse when you are under stress
OCD – How medical treatment or counselling/psychotherapy can help – Part 4/6
Severe OCD is a difficult condition to treat. It is common for suffers of OCD to hide their symptoms and treat it like a secret problem. Nonetheless it is important to seek treatment from medical and psychological professionals. With perseverance most patients can expect some reduction in symptoms. However, it is common for some level of symptoms to persist despite treatment and relapse of symptoms in stressful times can be problematic.
OCD can often be successfully treated with a combination of medical and psychological interventions. People with OCD may be prescribed antidepressants know as serotonin reuptake inhibitors (such as Prozac or Zoloft) or tricyclic antidepressants (such as Anafranil). Improvements usually take up to 6 weeks and it is recommended that medication should be continued for a minimum or 6 months and sometimes for 1-2 years. If you are considering medication for OCD you should discuss this with a medical professional such as a general practitioner (GP) or psychiatrist.
Various psychological treatments may be helpful for reducing symptoms of OCD. Intervening at any point in the OCD cycle can improve functioning. Psychological treatment may address any of following;
- Relaxation techniques
- Clarifying and addressing underlying relationship problems
- Thought-stopping techniques
- Psychoeducation
- Recognising and correcting unhelpful thinking patterns
- Developing alternative coping strategies
- Behavioural experiments (designed to encourage helpful thinking patterns)
- Exposure to anxiety provoking experiences with the aim of reducing anxiety
- Problem-solving
- Recognising and relabeling obsessive thoughts
- Correcting unhelpful beliefs that underlie OCD symptoms
- Breaking negative reinforcement cycles of OCD
- Reducing stress
- Developing alternative anxiety management strategies
- Developing emotion regulation skills
- Identifying and addressing factors that trigger or exacerbate OCD symptoms
- Developing realistic ways of viewing reality
- Addressing feelings of ambivalence towards the self and building a more integrated and differentiated view of the self and others
OCD – Factors that contribute to the development of OCD Part 3/6
Factors that contribute to the development of OCD
OCD is a complex neurobiological disorder. There are various factors thought to influence the development of OCD. It is most likely an interaction between biological, psychological and social factors. Some of the factors thought to contribute to the development of OCD are:
- A genetic predisposition
- Ineffective functioning in the frontal cortex area of the brain
- Serotonin imbalances
- Intrapsychic conflict – conflict occurring within the mind
- Ambivalent sense of self – difficulty managing contradictory aspects of the self
- Personality characteristics – see next section
- Cognitive distortions/information processing errors – such as black and white thinking, perceiving things as more negative or less positive than they are, only paying attention to information that confirms a negative view, making guesses about the future and negative events, believing you know other people’s intentions
- Traumatic events in early childhood
- Stressful life events – such as the death of someone close, divorce, moving house, pregnancy etc.
Personality characteristics and thinking patterns commonly seen in people with OCD include;
- Perfectionism/criticalness – belief towards themselves and other that mistakes are unacceptable and perfection is desirable
- Excessive conscientiousness
- Strong need for control and autonomy
- Overemphasis of intellectual processes – thinking that the presence of a thought increases the likelihood that an event will happen
- Rigidity
- Inflated sense of responsibility and guilt – a belief that a person has the ability to cause or prevent negative outcomes
- Intolerance of uncertainty – believing that it is possible and necessary to be certain that undesired events do not happen
- Overestimation of danger – thinking danger is more likely to happen than it is
OCD – OCD in Children and Adolescents Part 2/6
OCD in children and adolescents
The prevalence of OCD in children and adolescents is 1-3% of the population, similar to the number of adults who suffer from this debilitating condition. However many more have obsessive compulsive tendencies that are not clinically diagnosable but are noticeable nonetheless. OCD in children is often not identified and treated in a timely manner. This is often due to symptoms being mistaken for other behavioural problems, such as not handing in homework or taking too long completing work because it needs to be perfect, resistance to completing chores due to fear of contamination or refusing to go to sleep because rituals haven’t been completed. Furthermore children are often reluctant to discuss their fears openly and tend not to have insight into the irrational and excessive nature of their thoughts and behaviour.
Sherry-Lee Smith Perth Psychologist Website
OCD – What is Obsessive Compulsive Disorder? Part 1/6
Obsessive compulsive disorder is a mental health issue which is distressing to sufferers and impairs their ability to function in daily life. OCD is characterised by persistent thoughts, ideas, images, doubts or impulses (obsessions) that are experienced as disturbing, along with repetitive behaviour or mental rituals (compulsions) aimed at reducing anxiety.
Obsessions stimulate anxiety and are intrusive, unwanted and distressing. They are often experienced as irrational to the person experiencing them.
Common obsessions include;
- Fear of contamination (by dirt, germs, bodily waste, chemicals or other substances)
- Fear of illness, harm or death (to the self or significant others)
- Aggressive obsessions (fear of hurting the self or others, violence, fear of being responsible for something terrible happening)
- Sexual obsessions (“forbidden” sexual thoughts, such as incest or involving children, homosexuality or aggressive sexual behaviour)
- Religious or moral obsessions (worry about thinking or saying something blasphemous, being consumed with always doing the right thing)
- Number obsessions (safe numbers, bad numbers etc.)
- Symmetry or exactness obsessions (alignment, perfection etc.)
Compulsions are repetitive behaviour or mental rituals that an individual feels compelled to perform in response to experiencing an obsession. The purpose of the compulsions is to alleviate or reduce the anxiety and distress created by the preceding obsession. The more successful the compulsion is at reducing the anxiety the more powerful and difficult to resist it becomes.
Common compulsions include;
- Checking (things are locked, turned off, that somebody isn’t hurt or sick, something bad hasn’t happened, that a mistake hasn’t been made)
- Repeating (rereading or rewriting, repeating activities)
- Counting (counting and recounting)
- Symmetry, ordering or arranging (straightening or arranging items)
- Washing or cleaning
- Touching
- Excessive prayer
- Avoidance of objects, substances or situations
- Repetitive reassurance seeking
Obsessive-compulsive related disorders include body dysmorphic disorder (body image related obsessions and compulsions), hoarding disorder, trichotillomania (hair pulling disorder), excoriation (skin picking) disorder, and body-focused repetitive behaviour disorder (including nail biting, lip biting and cheek chewing).
OCD is a common mental health issue that impairs the functioning of a large number of people. The life time prevalence for OCD is estimated to be 2-3% of the population. However, some researchers argue this is an underestimate and that many cases of OCD go undiagnosed and untreated. People who suffer from OCD tend to experience impairment in several areas of life including occupational performance, academic achievement, and social functioning. The severity of OCD symptoms tends to wax and wane over time relative to the amount of stress a person experiences, even when the person has engaged in treatment. It can be a chronic and debilitating condition if not treated. Sometimes OCD symptoms can also change over time. For example the subject of obsessions may differ or the compulsions used to reduce anxiety may change.
Most people who suffer from OCD recognise that their fears and rituals are irrational and excessive. Because they have this level of insight they are more often than not distressed by their own thoughts and behaviour. Nonetheless, they feel almost powerless to stop them.
The onset of OCD is usually gradual and tends to manifest during adolescence or early adulthood. However, childhood onset or later life onset is not uncommon. Stressful life experiences such as family illness, death of a significant other, marital problems, divorce, sexual difficulties, or pregnancy often precipitate the onset of OCD.
Body Image and Body Dysmorphic Disorder
Registered Psychologist
Perth, Western Australia
Body Image
Body image can be defined as the thoughts and feelings a person has as a result of the perception they hold of their physical self. When you have a healthy body image you value who you are as a person and are comfortable and happy with the way you look. If your self-worth is determined by the way you look you may have an unhealthy body image. If you think your body is unattractive or not good enough and you are fixated on trying to change or hide it you probably have a negative body image.
The social environment in which you live can have a significant influence on the development of a negative or unhealthy body image. The people you surround yourself with and the media you are exposed to impact on how you think and feel about your appearance. You have a higher risk of developing a negative body image when you live in an ‘appearance orientated environment’. This means that if you spend most of your time in the company of people who focus on appearance you are more likely to think negatively about the way you look. Receiving negative feedback from those around you about your appearance also puts you at an increased risk of developing an unhealthy body image. Furthermore, exposure to unrealistic and unattainable body images through the media creates the erroneous perception that you will only find love, happiness and success by living up to the ideal body image.
Body image concerns can create a great deal of distress for many people. When these concerns impair a person’s ability to function in everyday life there is a possibility that they have developed a psychological disorder such as an eating disorder or body dysmorphic disorder.
Body Dysmorphic Disorder or Body Dysmorphia
Body Dysmorphic Disorder (BDD) is relatively common, yet often under-recognised or misdiagnosed. People who suffer from body dysmorphia judge their sense of self primarily by their appearance. They often experience shame and embarrassment around the way they look. These individuals may experience low self-esteem and feelings of being unlovable or unworthy as well as a sensitivity to rejection. Feelings of defectiveness related to their appearance are also common.
Individuals with body dysmorphia have a preoccupation with a perceived defect in their appearance. This obsession commonly focuses on one or multiple body parts that the person finds ugly or ‘not right’ in some way. Often these worries centre on facial features, skin or hair, however any body part can be the focus, as well as overall appearance or build. Over time this preoccupation can change from one body part to another. Sometimes a person with body dysmorphia has a general perception of themselves as unattractive or ugly. A person with body dysmorphia will find these obsessions distressing and the thoughts are likely to impair their daily functioning.
BDD is an obsessive-compulsive related disorder. When a person with body dysmorphia experiences these preoccupations they will engage in compulsive behaviour aimed at reducing their anxiety over their physical appearance. This behaviour is directed at disguising, improving and examining the defect and may include;
- Comparing their appearance to others
- Mirror checking
- Excessive grooming (hair cutting, make-up application, shaving, hair styling etc.)
- Seeking reassurance from others about their appearance or attempting to convince others of the defects ugliness
- Skin picking
- Dieting
- Excessive exercising
- Steroid use
- Camouflaging (with a hat, clothes, make-up, sunglasses etc.)
- Pursuing dermatological treatment or cosmetic surgery
The compulsive behaviour seen in people with body dysmorphia is time-consuming, distressing and difficult to control. Unfortunately the behaviour that is aimed at reducing anxiety inevitably increases anxiety in the long term (even if the anxiety is temporarily reduced).
Age of onset
Body Dysmorphic Disorder usually starts in adolescence, although it can begin as early as childhood. Adolescence is a time when many young people have appearance concerns. However when body dysmorphic symptoms are seen in these age groups it should not automatically be dismissed as a normal adolescent concern. Due to the embarrassment and shame experienced by sufferers, BDD often remains undiagnosed until 10-15 years after onset.
Factors that contribute to the development of body dysmorphia
There are various theories regarding what causes BDD. Some theories focus on individual or social factors, while others focus on biological causes. Factors that contribute the development of body dysmorphic may include;
- A genetic predisposition or vulnerability in neurobiological functioning
- Individual and personality factors – such as shyness, a tendency to be self-critical, insecurity, perfectionism or an anxious temperament
- Negative early life experiences or childhood adversity – for example teasing or bullying (either about appearance or competence), poor peer relationships, social isolation, lack of support in the family or childhood abuse
- Traumatic experiences – such as physical or sexual assault
How medical treatment or counselling/psychotherapy can help
BDD can be more persistent and therefore more difficult to treat than other psychological disorders. However, those who engage in treatment fare better than those who don’t. When patients are persistent with treatment symptoms can improve.
The use of a group of anti-depressants called serotonin re-uptake inhibitors (SRIs) appear to be helpful in treating body dysmorphia. However, higher doses usually need to be used than those found to be effective with depression. Often patients don’t see improvements for at least 8-16 weeks, which is much longer than responses for depression. Generally it is recommended that patients stay on medication for a minimum of 1 year.
Psychological treatment can also help people with body dysmorphia in the following ways;
- Developing an understanding of how and why body dysmorphia occurs
- Developing an understanding of the factors that maintain body dysmorphia
- Identifying and challenging unhelpful thinking
- Addressing past trauma/s
- Addressing compulsive behaviours through behavioural exercises
- Improving social skills
- Identifying and addressing the impact of body dysmorphia
- Developing an alternative view of the self
- Addressing socio-cultural factors of body dysmorphia
- Treating co-occurring mental health issues
Tips to help with body image issues or body dysmorphia
- Set health related goals rather than goals focused on appearance
- Avoid negative self-talk
- Avoid comparing yourself to others, especially celebrities and other people in the media
- Focus on your positive qualities and skills
- Limit your exposure to relationships and media that focus on appearance (studies show people tend to feel worse about their appearance after reading magazines that focus on appearance)
- Spend time with people who have a healthy relationship with their body
- Focus on improving yourself in ways that don’t involve appearance
- Question your media defined ideas of beauty and try to focus on the beauty you see in people you admire
- Remember there is no right or wrong in regards to your appearance
- Give yourself a break from the mirror
- Define yourself in ways other than your appearance
If you are experiencing any difficulties with body image issues and would like help please contact Sherry-Lee Smith on 042 135 1020 or via email on the contact page.
Sherry-Lee Smith
Registered Psychologist
Mt Lawley Counselling Centre
13 Alvan St
Mt Lawley,
Perth, Western Australia 6050
Eating Disorders
Registered Psychologist, Perth, Western Australia
What are eating disorders and disordered eating?
Eating disorders and disordered eating involve problems around eating behaviour, attitudes and beliefs about body shape and weight, and unhealthy weight management. There are many symptoms that are common to eating disorders which include;
- Dieting
- Food avoidance
- Binge eating
- Excessive exercise
- Eating rituals (i.e. cutting food into very small pieces, only eating at certain times of the day, weighing food)
- Skipping meals
- Fear of fatness
- Distorted body image
- Preoccupation with food
- Preoccupation with body weight
- Talking and thinking frequently about food, body image and weight
- Avoiding social situations that involve food or wanting to eat alone
- Playing with food rather than eating it
- Going to the bathroom straight after meals
- Self-acceptance and self-esteem overly based on body image and weight
- Wearing loose fitting clothing to hide weight loss
- Unbalanced eating (such as restricting major food groups i.e. carbohydrates)
- Obesity
Sometimes people with eating disorders engage in what is known as ‘compensatory behaviour’. This is behaviour that compensates for overeating and can include;
- Extreme dieting
- Fasting
- Use of laxative
- Use of diuretics
- Self-induced vomiting
- Excessive exercise
These behaviour traits become a problem for people when they begin to affect physical health, mental health, work performance, academic achievement or engagement in social activities.
Types of eating disorders
In individuals with Anorexia Nervosa you may see the following;
- Failure or refusal to maintain a normal body weight
- Intense fear of weight gain and body fat
- Distorted body image
- Self-esteem based on thinness
- Overly restricted diet or binging and purging
- Absence of menstrual cycle
In individuals with Bulimia Nervosa you may see the following;
- Binge eating and compensatory behaviour (vomiting, laxative use, excessive exercise etc.)
- Self-esteem overly based on body image
- Feelings of loss of control over eating
Individual with Binge Eating Disorder may display the following;
- Regular periods of binge eating
- Eating rapidly
- Eating when not hungry
- Eating alone
- No compensatory behaviour (vomiting, laxative use, excessive exercise etc.)
- Feelings of guilt or disgust after binging
However there are a large number of people who do not meet the strict criteria for the above eating disorders who can be considered to have Eating Disorders Not Otherwise Specified (EDNOS) if the symptoms are still having a significant impact on their quality of life. These people may display the some of the following symptoms;
- Binge eating
- Dieting and food control
- Excessive exercise and other compensatory behaviour (vomiting, laxative use)
- Fears of weight gain
- Preoccupation with food, weight and body image
- Distorted body image
- Self-acceptance and self-esteem negatively influenced by body image and weight
What causes eating disorders?
There are many factors causing of eating disorders and there is no single consensus between researchers or clinicians as to what the cause is. The development of eating disorders may involve a combination of the following factors and examples;
- Cultural – the cultural ideal to be thin
- Social – problematic family relationships or friendships
- Family of origin issues – adolescents striving for autonomy from the family by controlling their food intake
- Personality/psychological – depression, anxiety, feelings of inadequacy or loneliness, dealing with painful emotions and gaining a sense of control, perfectionistic personality traits, low self-esteem, disturbances in identity development
- Neurochemical – there is some speculation about a chemical imbalance (serotonin)
- Genetics – genetic vulnerability (eating disorders can run in families)
- Transition periods across the life span
Eating disorders across the lifespan
Although eating disorders are typically thought to occur in adolescent girls, they also occur in children and adults not excluding boys and men. Eating disorders tend to develop in adolescence or young adulthood but they may also develop in young children, middle aged people and the elderly. In midlife and beyond they tend to be underdiagnosed.
Transition periods across the lifespan may trigger the onset or relapse of eating disorders. The transition period between childhood and adolescence, as well as between adolescence and adulthood place youngsters more at risk of developing an eating disorder.
Other developmental transitions or experiences that may trigger disordered eating include;
- The death of loved one
- Divorce or widowhood
- An empty nest (children moving away from home)
- Loss of youthfulness
- Pregnancy
- Menopause and physical signs of aging
- Marital difficulties
- Medical illness
It is important for parents to know that the fear of gaining weight and distortions in body perception may not be present in children.
Health, social and psychological aspects of eating disorders
Eating disorders and disordered eating can be very detrimental to a person’s health. This is one of the reasons it is important to seek help and have a doctor involved in your treatment. Physical health consequences may include;
- Arrested growth
- Fatigue
- Constipation and diarrhoea
- Susceptibility to fractures
- Delayed menarche and puberty
- Absence of menstrual cycle
- Hypotension
- Dry skin
- Hypothermia
- Electrolyte imbalances
- Hormonal imbalances
- Decreased bone density
- Compression fractures
- Osteoporosis
- Infertility
- Kidney failure
- Liver failure
- Cardiac arrhythmias (irregular heart beat)
- Dental problems
- Reproductive system damage
Many individuals who suffer with eating disorders and disordered eating also have other psychological and social difficulties. Sometimes these other issues start before an eating disorder develops and at other times they can be the result of eating disorders or something that maintains them. Often there will be a complex relationship between these issues and the eating disorder. Some of these issues include;
- Depression
- Anxiety disorders (Obsessive Compulsive Disorder, Obsessive Compulsive Personality Disorder, Social Phobia, Social Anxiety, Agoraphobia and Generalised Anxiety Disorder)
- Childhood sexual abuse or sexual assault
- Low self-esteem
- Perfectionism
- Avoidance of emotions
- Difficulty in recognising and controlling emotions
- Substance use disorders
- Personality disorders
- Self-harming and suicidal ideation
- Interpersonal dependency
- Non-assertive and permissive interpersonal style
- Avoidance of interpersonal conflict, competition and rivalry
- Struggles to fill the ‘perfect’ role in the family of origin
How counselling/psychotherapy can help?
Many people with eating disorders or disordered eating patterns do not seek help. However it is imperative that people struggling with these issues seek treatment sooner rather than later, especially in childhood and adolescence. The longer these difficulties are present the more entrenched the thoughts and behaviour becomes, the harder it is to make changes. The most effective treatment involves the support of a psychologist/counsellor/psychotherapist, a general practitioner, a dietician and possibly a psychiatrist. Visiting any of these professionals to discuss disordered eating is a good start.
Psychological treatment may address the issue directly (through addressing the symptoms) or may target the underlying causes of the eating disorder (addressing relationship issues etc). It can help in the following ways;
- Establishing healthy patterns of eating and exercise
- Identifying the thoughts and beliefs that cause or maintain disordered eating and challenging them
- Changing behaviour that maintains the eating disorder
- Identifying and addressing interpersonal difficulties
- Learning emotion regulation skills
- Gaining insight and addressing issues around role transitions, grief and loss, unresolved relationship issues
- Improving self-esteem and self-acceptance
- Problem-solving skills
- Developing coping strategies
- Improving relationship and communication skills
- Mindfulness skills (detaching from distressing emotions)
- Managing relationships
- Building autonomy
- Education around realistic weight expectations, healthy eating patterns etc
- Identity development
- Preventing relapse
If you are experiencing any difficulties with eating disorders or disordered eating and would like help with this please contact Sherry-Lee Smith on 042 135 1020 or via email on the contact page.
Sherry-Lee Smith
Registered Psychologist
Mt Lawley Counselling Centre
13 Alvan St
Mt Lawley WA 6050