Very interesting study came out this month in the European Journal of Psychotraumatology. It studied patients who were diagnosed both with obsessive-compulsive disorder (OCD) and posttraumatic stress disorder. (PTSD) For these people, repetitive behavior patterns, rituals and compulsions may ward off anxiety and may serve as a coping mechanism to control reminders of traumatic events. So, if a person was raped at a young age, that person may have obsessions related to being dirty or unclean and may cope with those obsessions by washing his hands several times a day. Some patients suffer so severely that she may wash her hands raw enough to make them bleed. These patients are truly in a lot of distress.
This study was a case report of a 49 years old Dutch man who was raped as a child by an unknown man. The patient was treated with Paxil (an antidepressant) as well as with 9 sessions of psychotherapy, particularly eye movement desensitization and reprocenssing (EMDR), and an exposure type of therapy. It was observed that the PTSD symptoms went away before the OCD symptoms did.
This studies conclusion found that there is a connection between PTSD and OCD and by treating the PTSD first, one may be able to subsequently cure the OCD as well.
It is my belief that for many people, EMDR can be a faster route to get relief in those who have experienced trauma and also suffer from OCD symptoms.
There have been numerous articles extolling both the benefits and harmfulness of caffeine. Less often has there been research on the effects on mental health. What’s my opinion? I advise caution in its usage.
There has been insufficient studies showing any benefit of caffeine on mental health. A few studies have suggested caffeine has a positive effective on depression and ADHD. This may due to caffeine increasing alertness, attention and cognitive functioning and by possibly elevating mood. There is also preliminary evidence of caffeine benefiting some people struggling with Obsessive Compulsive Disorder which I thought was interesting because OCD is a subset of an anxiety disorder and my experience has seen caffeine making anxiety worse. Neveretheless, the research is compelling.
But do the benefits outweigh the negative side effects? We know that caffeine can increase heart palpitations and contribute to stomach problems such as Gerd. These are annoying troublesome physical side effects. What do we know about its mental health downside? We do know that caffeine is addicting and may encourage other types of addictions like cigarette smoking. We also know that caffeine in large amounts can bring out psychosis and manic behavior as well as exascerbate general anxious states, panic disorder or social anxiety disorder.
My advice is to keep caffeine to a minimum. If you struggle with Depression, OCD or ADHD, see your primary care mental health provider to investigate safer, healthier treatment for your mental health conditions. There are other things less harmful and that can do the job more effectively than caffeine.
In my practice, I’m amazed about how many people come to me and have taken some test online and have self-diagnosed themselves with ADHD or ADD and want me to give them stimulants. It happens every week. I also don’t know how many times I’ve had to tell these same people that stimulants may not be the answer to their problems and can even make their mental health symptoms worse! Let me give you a case in point of when stimulants may have done more harm than good.
Larry, (not his real name) is a 53 year old male who reports that he has taken Adderall or the equivalent for 30 years. He reports it makes him organized. It makes him be able to focus and concentrate and complete tasks. I take careful note but also observe that this same guy is very rigid, angry and irritable during our visit. He has a history of attempted suicide and has been hospitalized several times. He also tries to hide the fact that he lived in a reclusive situation away from civilization for years and has been unable to work for authority figures. He also reports he is estranged from friends and family.
Yes, it is true that stimulants help many people with focus and concentration. It is also the fact that ADHD is not the only condition that makes a person disorganized, unfocused and unable to complete tasks. For instance the guy above ended up being diagnosed with Schizophrenia. Other conditions like Bipolar Disorder, Depression, anxiety disorders and Thyroid Disorders can look like ADHD. Giving the above patient stimulants can bring out his rigidness, his anger and irritability and even psychotic symptoms. If one has tendencies toward obsessive compulsive disorder it would be especially important to avoid taking stimulants. Stimulants can make the OCD worse. A better way to go might be to effectively treat the OCD symptoms and the patient may find that their ADHD like symptoms greatly improve.
Sadly, years of stimulant misuse for the above patient made him so rigid in his expectations that he was psychologically unable to consider other possibilities for his problems. This is why it is so important that when suffering from ADHD like symptoms that a specialist who works regularly with the various mental illnesses be called upon to do the initial evaluation. It can potentially prevent years of problems and help a person become quickly more functional to reach his goals. I wish this guy could have been spared all the pain he went through! Can you imagine the implications for posterity and other family members?
Most of us probably know someone who has issues with hoarding, whether it be our great aunt who saves newspapers and cannot throw any away because she plans on one day reading them all, or a neighbor who has 25 old cars on his property that haven’t been touched in years. Hoarding can often be a debilitating condition that is hard to cure. Hoarding is defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces. Yes, you may have seen television shows that devote their entire existence to our voyeuristic tendencies of peering into the households and lifestyles of mentally ill individuals with hoarding disorder.
Up until recent years, I have largely believed that hoarding is a subtype of obsessive compulsive disorder (or OCD). That is what I was taught in graduate school, although I’ve noticed that over the years my patients haven’t necessarily met the criteria of someone who has OCD. Maybe sometimes, but not always. Alas, there is a recent study that casts further light on the difficulties of hoarding disorder.
In the December 2010 issue of the Behaviour Research and Therapy Journal appears a study that examines the core features of hoarding which include clutter, difficulty discarding and acquiring to decide whether hoarding is more like OCD or attention deficit hyperactivity disorder (ADHD). Participants underwent careful diagnostic interviewing and completed questionnaires that measured features of hoarding, OCD symtoms, negative affect (or mood) and the inattentive and hyperactive/impulsive symptoms of ADHD. What they found is that OCD symptoms did not significantly predict any of the core features of hoarding disorder. Instead what they found was the inattentive (but not hyperactive or impulsive) symptoms of ADHD significantly predicted the severity of clutter, difficulty discarding and acquiring.
I find this information very informative and is helping me reformulate my ideas and treatment plan for the problems related to hoarding disorder.