Thursday, June 21, 2012

Treatment of Obsessive-Compulsive Disorder (OCD)

Written by Angela Lacalamita, MA, LCPC

What is Obsessive-Compulsive Disorder (OCD)? OCD is an anxiety disorder that results in obsessive thoughts and/or compulsive behaviors. Obsessions are defined as recurrent, uncontrollable, intrusive thoughts or mental pictures that produce anxiety, fear or worry. Compulsions are repeated actions aimed to reduce the anxiety, fear or worry. People that suffer from OCD will try to control their obsessive thoughts by checking things over repeatedly or perform rituals. Some common obsessions may include: fear of getting a disease/ contamination or unreasonable fear or worry that if things are not perfect, something terrible will occur. Common compulsions may include repeated hand washing or showering, repeatedly checking the stove, door locks, electrical outlets, the need to perform a task a certain number of times or saving things/ hoarding items that may not have value.

OCD can progress to a point where it can significantly interfere with one’s ability to function productively in social, family, work and academic settings.  Dependent on the severity of the symptoms, it could potentially result in one becoming homebound.

What causes OCD? Researchers have not confirmed the exact cause of OCD. However, biological and environmental factors play a significant role. Biological factors point to the neurotransmitters serotonin and dopamine. Experts believe that there are insufficient levels of the neurotransmitter serotonin and over activity of dopamine. More recent studies that have used brain imaging have discovered over activity in certain parts of the brain. Another contributing factor is having a genetic predisposition to OCD due to a family member having OCD or another anxiety disorder. Environmental factors such as stress and/or life transitions can potentially trigger OCD in those who may be psychologically prone.

What are the treatment approaches for OCD?  The American Psychological Association recommends that that use of SSRI medication (selective serotonin reuptake inhibitors) and/ or cognitive behavioral therapy be used in treating OCD. Experts maintain that the use of SSRI’s is an effective approach in manipulating the serotonin level in the body, thus allowing it to be available for other nerve cells. Another approach to treating OCD is through the use of the different treatment approaches within Cognitive Behavioral Therapy (CBT). One effective approach in treating OCD is using Exposure and Response Prevention. This approach is aimed at reducing the intrusive thoughts, images or impulses through repeated exposure to the obsession. The exposure is used to learn more effective thinking patterns and develop adaptive coping skills to manage the anxiety. The response prevention refers to making the decision to resist the compulsion. With gradual and repeated exposure, the individual becomes less anxious resulting in reducing and refraining from engaging in compulsive behavior.

Cognitive behavioral therapy in conjunction with a SSRI medication seems to offer the best long results. Treatment results vary by individual; however most individuals can significantly reduce their symptoms and regain control of their lives. 

Thursday, June 7, 2012

Challenges of ADHD and School

Written by: Deborah Miller-Lunsford, LCSW

Many adolescents with ADHD experience significant problems managing school, both in terms of social and academic successes.  Both parents and adolescent can become frustrated and angry leading to a great deal of stress at home.  One of the first steps is to get a formal diagnosis from counseling professional.  With that in hand, the next step is to engage the teachers and school support staff in identifying your child’s needs. Together you can develop strategies for academic success.

There are two different types of attention deficit disorders.  ADHD refers to hyperactivity and impulsivity while ADD refers to those who are primarily inattentive and easily distractible.  According to the American Psychiatric Association, however, the correct diagnostic term for both types is ADHD.  Because these symptoms can be mild to severe, parents see varying levels in skill and maturity impairment.

Our school system is not ideally designed for the ADHD child (unable to provide enough individual attention) so the child often experiences a host of challenges.  Here are some of the more common school problems that your ADHD child is likely to experience.

Restlessness: 
The hyperactive child is often restless, getting up and down from his/her seat disrupting classmates and irritating the teachers.  There can be lots pencil tapping, leg and foot moving and general bouncing around in the desk.

Short Attention Span and Distractibility:
The AD/HD child often has trouble following teacher’s lectures, participating in small group projects and performing well on tests.  The child with short attention span often finds him/herself with a wandering mind. This can result in failing to complete tasks as well as irritating project partners.

Impulsiveness:
This impulsivity can be evidenced by the child blurting out answers in class or making impulsive and incorrect responses on tests and class assignments.  Speaking before thinking is often a real problem for this child.  These statements can often resemble insults but are really just the result of not thinking before speaking. Nevertheless, this can result in the child having difficulty in the social aspects of school.

Procrastination:
Most of us have put off an unpleasant task until the last minute.  With ADHD, kids often wait until the very last minute to begin an assignment and then don’t have enough time for completion.  This can be particularly true of the “long term” research assignments/projects.  These kids just don’t anticipate how much time it will take them to properly complete all the steps and get it ready to hand in on time.  They frequently turn in poor quality incomplete assignments or they don’t get the work done at all.

Trouble Shifting Attention from One Situation to Another:
The child’s ability to shift attention from one task to another is often impaired.  Transition time, when students are switching classes or topics, often results in not turning in assignments at the end of class, forgetting to pack up everything needed to complete homework assignments, etc.  Kids can “over focus” on what they are doing which makes it difficult to switch gears and move smoothly and swiftly from one task to another.

Forgetfulness:
This is a big one!  It applies to almost any activity but it is evidenced in school by forgetting to turn in assignments, permission slips, bring home books, etc.  Homework can become a challenge when the needed materials are “in my locker.”

These are just a few of the more common complaints associated with AD/HD kids and the classroom.  Fortunately there are resources available to teach kids, their parents and teachers positive coping skills.  Structure, consistency and organization are key factors.  Finding an experienced therapist who can guide you is a good place to start.  In addition, you can find several good books that are easy to read and are encouraging for everyone.  Edward M. Hallowell, M.D., John J. Ratey, M.D., and Daniel G. Amen, M.D. are just a few of the recommended authors.  They are excellent resources to assist you with your challenges. 

The most important thing you can do as a parent of an ADHD child is to love them.  I encourage you all to Stop, Breathe and Think before responding.  

Understanding Self -Injurious Behaviors

Statistics vary as to the number of individuals who engage in self-injurious behaviors. Conservative estimates are that about 1% of the general population will self-injure. What is self- injury? Self-injury is defined as deliberate self-harm to one’s body. It can include cutting, bruising, burning, excessive body piercings/tattoos and fracturing bones. Of the above mentioned, most commonly seen is cutting, particularly in youth.  Although there is research suggesting that self-injury rarely represents a suicidal gesture, self-injurious behaviors should always be taken seriously. It can be a strong predictor for future suicide or suicidal attempts (often within 1 year of the self-injurious behaviors) and also lead to accidental death. Contrary to popular belief, self-injurious behaviors are not always a means of gaining attention. Even if the goal was to obtain attention, self-injurious behaviors communicate distress and a need for help. Primarily self-injury serves the purpose of expressing and managing painful thoughts and emotions such as anger, sadness or anxiety. Self-injurious behaviors can also be a means of distraction or a means to gain a sense of control due to feeling powerless in other areas in life. Several effective treatments are available to assist those who self-injure. Treatment strategies may include:


  • Counseling using Dialectical Behavior Therapy (DBT): DBT is a form of treatment that assists people in identifying, labeling and expressing emotions. One of the many goals is to learn ways to better tolerate distress and acquire new coping skills through techniques such as mindfulness. One of the several goals in DBT is to be able to identify and reduce stress and tension before incidents of self-injury.
  • Group therapy will allow for a healthy expression of emotions and allow people to share their experiences and decrease any shame that may be associated with self-injurious behaviors. 
  •  Family therapy addresses any history or family dynamics that may be related to the self-injurious behaviors. Family members will learn to communicate more directly and openly with each other.
  • Medications: Antidepressants or anti-anxiety medication may be used to reduce the initial impulsive response to stress.

If you know someone struggling with self-injurious behaviors, be supportive, encourage them to talk about their feelings and don’t expect them to simply stop self-injuring. A variety of alternative coping strategies will be necessary before one will be able to stop using self-injury as a coping method. Try not to judge or criticize for this may increase the risk of self-harming behavior. Encourage them to talk to a mental health professional so that the underlying causes of the self-injurious behaviors can be explored and healthier coping strategies are developed.