According to the U.S. Department of Health and Human Services, as many as one in five Americans will experience a mental health issue at some point in their lives. Of the nearly 60 million Americans who experience mental health concerns each year, many will never seek treatment for a variety of reasons including social stigma, cultural norms, and lack of access. In fact, a recent report published in the journal Psychological Science and the Public Interest found that an estimated 40% of individuals with serious mental health concerns either never receive care or start an intervention program without completing it.

The stigma surrounding mental health issues can be a significant barrier to care. Unfortunately, many people unknowingly contribute to the stigma simply with their everyday language choices. A poor choice of words not only stigmatizes, stereotypes, and creates unrealistic assumptions about certain people, but also can trivialize serious mental health conditions and their accompanying experiences.

While society tends to tread lightly around language concerning disabilities, race, or religion, it seems that we do not apply the same sensitivity to language involving mental health. For example, while you might be a little taken aback by someone who uses the word “retarded” to refer to a poor decision, you likely wouldn’t think twice about someone calling a peculiar behavior “crazy” or saying out loud that someone’s “OCD” is the cause for an orderly office.

Help Us Erode Stigma during Mental Health Awareness Month

With May designated as Mental Health Awareness Month in the United States, we would like to encourage you to think twice about the language you use and how it may affect those one in five people who may be your neighbors, coworkers, and friends who experience mental health issues.[fat_widget_right]

Show respect and consideration for those experiencing mental health conditions by avoiding these common stigmatizing phrases we hear in our daily conversations:

‘I’m So OCD.’

All too often people say “I’m so OCD” when referring to simple habits they may have regarding organization, such as arranging books a certain way on a bookshelf or keeping one’s own environment immaculately clean. True obsessions and compulsions can be quite debilitating, involving persistent, unwanted thoughts, rituals, and behaviors, all of which are out of a person’s control.

As many as 27% of people experience some form of obsessive-compulsive behavior. By using the term to describe tidiness, we popularize the experience and make it appear less severe than it actually can be. Next time you find yourself tempted to say someone else is being OCD or claim it as an explanation for your own behavior, consider how you might more accurately share your observation or insight.

‘I Can’t Focus; It’s My ADD.’

It’s not uncommon to hear people refer to themselves as ADHD or ADD when they are inattentive or easily distracted. Today’s high-tech world seems to be characterized by ever-shrinking attention spans, and it seems that people are always fiddling with their smart phones and jumping from one topic to another. However, this is not the same thing as attention-deficit hyperactivity.

Though these types of behaviors may be related to a lack of focus, an actual diagnosis of ADHD is far more complex.

People might casually refer to distracted behavior as ADHD or even go as far as to say that they’re ADHD when channel surfing or changing the radio station before a song finishes. Though these types of behaviors may be related to a lack of focus, an actual diagnosis of ADHD is far more complex and has less to do with boredom and more to do with genetics, neurotransmitters, and electrical activity in the brain. In fact, a major distinguishing characteristic of ADHD is impulsivity, which probably isn’t present in most cases where people erroneously claim ADHD as the source of their inattention.

‘My Ex Is Such a Psycho.’

At some point, you’ve probably heard someone refer to a past lover (or friend, or roommate) as a psycho. People typically use this phrase to refer to someone engaging in erratic or irrational behavior, which in reality is far from psychotic.

Psychosis is a serious mental health condition by which a person loses contact with reality and may experience hallucinations and delusions. An estimated 3% of people experience psychosis, which makes it far less prevalent than the many people who claim to have psychotic past lovers might indicate. Try not to downplay the seriousness of this condition by using the term frivolously.

‘The Weather Is So Bipolar Today.’

Sure, it may snow in the morning, warm up for an hour, and then snow again all afternoon, but it is impossible for the weather to literally be bipolar. Likewise, it’s highly unlikely that your friend having a few ups and downs today is actually experiencing the often debilitating symptoms of bipolar. Using the term bipolar in these contexts misrepresents the experience and can minimize the condition.

A person experiencing bipolar is likely to experience serious shifts in mood that may range from dangerously euphoric to suicidal. These drastic changes can seriously hinder one’s life if left untreated. Instead of using the term bipolar, consider describing the weather as unstable or unpredictable, and referring to your friend as being in a bad mood or having a hard time.

‘This Makes Me Want to Kill Myself.’

You fail your math exam and you exclaim in frustration, “I just want to die.” Or something else mildly unfortunate happens and you casually say, “This makes me want to kill myself.”

According to the Centers for Disease Control and Prevention, suicide is the 10th leading cause of death in the United States with almost 40,000 Americans dying from suicide each year. People who commit or attempt suicide do not necessarily want to die; rather, they may want to be free of pain.

If you find yourself upset with your circumstances and wanting to express your frustrations, be mindful of your word choice in this matter. It’s very likely someone in your vicinity has been touched by suicide in some way.

‘Stop Being So Paranoid.’

Paranoia is a symptom of many mental health conditions and can be detrimental to a person’s life. True paranoia can cause people to have serious trust issues and unwarranted fear and anxiety, as well as feelings of persecution and exaggerated self-importance.

When you find a friend may be worrying too much or over-analyzing something, avoid using the term paranoid and replace it with other descriptive words such as mistrusting or fearful.

‘I’m So Addicted.’

You might find yourself saying something like, “I’m so addicted to this TV show” to mean that you really enjoy it. But most likely, you are not truly addicted to it. Addiction is a serious mental health issue that can destroy lives, both of the person addicted and that person’s loved ones.

There’s a considerable difference between appreciating or enjoying something and being addicted to it. Be mindful of this distinction when you speak.

Although more than 23 million Americans experience some form of substance abuse, up to 40 million additional Americans are indirectly affected by it. These numbers do not account for non-substance addictions such as gambling, spending, or sex addiction.

There’s a considerable difference between appreciating or enjoying something and being addicted to it. A person experiencing addiction may want to stop engaging in an addictive behavior, but may feel unable to do so regardless of its continued negative consequences. Be mindful of this distinction when you speak, so as not to disparage the serious problems addiction can cause.

‘That’s Crazy/Insane/Mad/Nuts.’

It’s becoming far too common to use the word crazy and related synonyms lightly. People may think that using these terms to describe behavior that seems odd, eccentric, or strange is harmless, but it can be damaging to the self-esteem of those experiencing real mental health conditions.

The stigma alone is enough to make people feel isolated, keep them from seeking the treatment they truly need, or cause them to completely deny their symptoms altogether. But these terms, often used in a manner that belittles those who actually experience mental health issues, reinforce the dangerous stigma of mental health issues by painting them in a derogatory way.

Words Have Power; Think Before You Speak

Avoiding stigmatizing terms and phrases that cause shame, minimize experiences, and misrepresent reality can help eliminate a major obstacle to treatment. It’s not simply about being politically correct, requiring that you tiptoe around your words; the point is to simply stop and think about what you say and be mindful of how your choice of words may affect others.

If you would like to learn more about how you can raise awareness of mental health conditions and help remove stigma, check out our blog this month or visit Mental Health America for more information and resources about Mental Health Awareness Month.

References:

1. Corrigan, Patrick. (September 4, 2014). Stigma as a Barrier to Mental Health Care. Association for Psychological Science. Retrieved from: http://www.psychologicalscience.org/index.php/news/releases/stigma-as-a-barrier-to-mental-health-carhtml
2. Mental Health America. May is Mental Health Month. Retrieved from: http://www.mentalhealthamerica.net/may
3. Mental Health America. Mental Health Information. Retrieved from: http://www.mentalhealthamerica.net/mental-health-information
4. Schumaker, Erin. (April 17, 2015). It’s Time To Stop Using These Phrases When It Comes to Mental Illness. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2015/04/17/mental-illness-vocabulary_n_7078984.html

Although I can’t know what is happening in your therapy and how this may pertain to your question, clearly this is an important issue, and I hope you will discuss it directly with your therapist. I can understand that perhaps you feel reluctant to bring it up, but the ensuing conversation might be very helpful, and it could move the work you are doing together toward a deeper understanding of your relationship with her and, most importantly, with yourself.

Any emotional reaction, especially one as pervasive as what you describe, contains clues that you want to identify and investigate. For example, at some stages of development obsession is quite natural, and your obsession might be pointing toward a difficult time in your life that needs work. Young children, for example, are obsessed with their caregivers, often their mothers. If this is the root of your issue, you might learn that there was a difficult experience in your childhood that needs to be looked at. Maybe when you were very young, a toddler or a baby, you had fears that your mother or another important person in your life might leave you, never to return—that you might be abandoned. Perhaps you did in fact lose someone you loved. Teenagers, even adults, are sometimes obsessed with someone they see as a role model. They are obsessed because that person is someone they want to be and knows things they need to learn.

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An interesting aspect of therapy is an experience called “transference.” Transference means that the feelings you have for someone important in your life are unconsciously transferred to another person—in this case the therapist. We all have feelings like that; it’s quite normal. For example, people at work often relate to the boss as if the boss was their father or mother, and they might not even know it. Or your irresponsible coworker might remind you of your younger brother or sister. It’s helpful when we become aware of such feelings and then take care to recognize and correct them rather than simply reacting. Therapy can help you do that.

Let’s talk about therapy, some of its general goals, and how they may apply to your situation.

1. Speak your mind to your therapist, without concern for feeling silly, looking stupid, being insulting, or whatever worries tend to stop you from speaking up. Honesty makes for a strong therapeutic relationship.
2. There are many different kinds of obsessions—obsession with the Internet, with sports, with movie stars, with teachers, even with one’s therapist. A therapist, after all, is someone who is trying to help. It makes sense that we become attached to kind and helpful people. Who wouldn’t? Maybe, for you, this is a rare experience of being truly understood, you can’t quite believe it’s real, and you don’t want to let it go.
3. The love and gratitude we feel when we are accepted and understood is boundless. Certainly, I feel greatly attached to my teachers, mentors, and therapists. The thought that these connections are partly real and partly transference is kind of sad. “What,” I might think, “you mean this isn’t real?”
4. It is real, the feelings are real, but they are not to be acted on—they are to be explored with words only. These feelings and the therapeutic relationship are on a different and special plane, apart from the everyday world in certain ways. That is the tragedy, glory, and power of any deep therapeutic relationship.

How lovely that you have such strong feelings about your therapist. It means that you have been reached at a deep level, which has given you and your therapist a strong energic ground from which to proceed.

I hope this has been helpful. Please let me know what you think. Take care!

Respectfully,
Lynn

Perfectionism is one of those things that carry both positive and negative qualities, making it a tricky and complicated issue to understand. If you are detail-oriented or want the best for yourself, are you perfectionist or just ambitious? I think the answer lies in (1) the way you feel about yourself and (2) whether the idea of perfection is an obsessive thought that won’t let go or, rather, a repetitive behavior done in an attempt to succeed.

Of course, some amount of ambition is a good thing, right? We all want to do our best, to look our best, and to have life go our way. In that way, striving is a positive quality. However, it becomes harmful and maladaptive when we attempt to reach an invisible goal. What is perfection, exactly? Doesn’t it depend on your definition? What might be perfection for some may not be for others.

In a quote by Anne Wilson Schaef, she writes, “Perfectionism is self-abuse of the highest order.” Self-abuse is a strong wording choice that defines the obsessive quality of the idea. Perfectionism can run rampant on your self-esteem, your confidence, and your motivation to do more. If your first thought when you start an exercise routine is that you want to look like a supermodel, you may be experiencing perfectionist thoughts. Even supermodels don’t look like supermodels in real life. If you lose weight, get fit, eat healthier, and yet don’t look like a magazine ad, have you failed? Perfection is a deep whisper in our souls that we, alone, are not enough. Its invasive quality can be quite destructive to a healthy outlook on life.

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Perfectionism is most apparent in three areas of our lives. First, we are perfectionists with our bodies and minds. Every commercial, every advertisement, every billboard reminds us that we are not “right” in some way. We’re expected to believe that we must have a toned body, the longest, sleekest hair, acne-free skin, and white teeth. Second, we are perfectionists in relationships and especially parenting. We read the books, get on the preschool mailing list before our children are out of diapers, and kill all germs immediately. This quest for perfection in parenting leads to perfection-driven children who may feel they cannot measure up. Third, we are perfectionists with our environment. We want our homes to be HGTV worthy while we bake like Martha Stewart. An entire home-design-and-improvement culture was created on the perfectionist ideal.

So, what to do when perfection is running our thoughts? Here’s how to get un-perfect and still be OK:

1. Check yourself. Are you thinking perfection all the time? What if you don’t reach perfection? Will you be happy, healthy, and alive? Will others still love you? Will you still be a good person? If you understand that thoughts can come and go, you will start to realize that perfectionist thoughts can be harmful and they can be released. Check to make sure that while your standards are being met, you are not preoccupied with perfection. Flawed people are great, too.
2. Focus out, not in. Focusing on ourselves too much can breed insecurity, which in turn breeds perfectionism. Instead of focusing inward, reach out to family, friends, and strangers to see what else the world has to offer. Take a class, help a friend, volunteer, teach, garden, or build something to give away. Perfectionism loves inwardly focused people. Open yourself up.
3. Fail. Try something new with the intention of being bad at it. Paint a picture and laugh at how ridiculous it is. Talk to a stranger with the understanding that if he or she ignores you, at least you tried! Failing is a vital step to get rid of perfectionism because you learn that failing isn’t as bad as you thought. In fact, it can be fun! If you are always trying to be perfect, it can paralyze you to never try anything. So go out there and fail!

If you believe you cannot get a grip on obsessive thoughts and behaviors, please contact a mental health specialist who can help guide you to feeling more balanced.

It usually comes at the end of a long day, when you are most in need of rest and settling into the comfort of a warm bed, eager for respite. It is the arrival of “busy brain,” or “monkey brain” as the Buddhists refer to it because of the way random thoughts swing from “vine” to “vine. It’s the surge of unwelcome ruminations that seemingly come out of nowhere and are intent upon keeping you from your precious slumber.

Unfortunately, they are often not the rehashing of the day’s pleasantries but rather a review of situations that made you frustrated, angry, or anxious and, like a juggling of spinning gyros, one thought leads seamlessly into the next, one tangent to another, without a break in between. This happens to all of us, but for people who experience obsessive thoughts, this can happen for hours on end, night or day, with no relief.

Many of us know OCD from movies such as As Good As It Gets, or from shows like Monk. We use the acronym to denote any degree of perfectionism or eccentricity. We like to say he has OCD because he needs his car meticulously clean or she’s OCD because she alphabetizes her breakfast cereal.

But not all of these behaviors equate to OCD. Sometimes they are just personality traits that don’t necessarily cause any dysfunction or distress. Clinical OCD—obsessive compulsion—on the other hand is much more apparent in terms of the individual’s (as well as his or her loved one’s) dysfunction or distress.

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One of the main symptoms is obsessive thoughts, which are more difficult to depict in the movies and television as they are representative of the internal world of the person. These are different from the rituals and compulsions that get characterized, such as when Jack Nicholson can’t step beyond the threshold of his apartment without going into a full-blown panic attack.

Obsessive thoughts are thoughts that churn in the mind in perpetual cycles over and over again. It provokes curiosity as to why people affected by OCD can’t just move on and why, after days, they still seem stuck on one particular issue. Most of us, when we think about a problem, for example, identify the issue, recognize our reactions, decide how we want to deal with it, and then it’s over; we are ready to move on to the next challenge. But those who experience obsessive thoughts find themselves in a type of analysis paralysis and, instead of putting an idea to rest, they get stuck. Psychoneurobiologists refer to this stuckness as the ring of fire, because on a PET scan of the brain, which helps to identify brain functioning and patterns, the process is illuminated by a bright red circle of activity in the form of an endless loop.

So what can people do to manage themselves out of this ring of fire when their brains are predisposed to functioning this way? What can any of us do, OCD aside, when we find ourselves in this maddening merry-go-round of the mind? Research has pointed to the practices of meditation and mindfulness as valuable tools in training the brain to shift its focus. Each time an obsessive thought arises, instead of trying to stop it with another thought or idea, the person practices present-moment awareness via a checking-in process or what I call a “sensory inventory.”

The best way to conduct this sensory inventory is to focus on one’s primary senses—auditory/hearing, somatic/touch, gustatory/taste, olfactory/smell, and vestibular/movement—because this kind of awareness grounds us in what is happening right now, the present moment. Asking questions such as the following can help direct this focus: What sounds am I hearing right now? What is the temperature or sensation on my skin—is it hot or cold, dry or moist? Are there any particular smells in the room? What is my body feeling? What am I noticing in terms of bodily sensations (e.g., a churning in the stomach or tightness in the shoulders)?

When we conduct this sensory check-in, we are essentially arriving into presence and, in doing so, shifting the mind’s focus away from the storylines orchestrated by our psyches, thereby neutralizing the obsessive thought’s pull into either the past or future, both of which present us with myriad judgments, regrets, fears, anxieties, and the perpetual “I-should-haves” or “what-ifs.”

Another benefit of the mindfulness practice is the new superhighway it creates in the brain. The brain works efficiently, and when given a choice between a clear, quick route (the road that represents our habits) and unclear, rocky terrain (that which is undeveloped and uncharted), it will choose the former. Through practice, we can clear the brush away and begin to build our own, detoured path. It may be difficult at first, but just like the toddler who pulls herself up on the coffee table and, in the next miraculous moment, takes her first steps, once the road is open, the brain is eager to redirect its traffic and we find that we can quickly shift from rumination to conscious awareness.

Twisted lips, contorted mouth; you know the look of someone who is biting the inside of their cheeks when they are stressed. Why do people do that? Most of us understand it as a bad habit similar to nail biting because on the surface, it would seem like a benign repetitive behavior. However, under further consideration, the behavior may be a byproduct of an obsessive and compulsive reaction to stress and anxiety.

The medical term for the behavior is chronic cheek bite keratosis, which is a body-focused repetitive behavior (BFRB) comparable to hair pulling, nail biting, and frequent blinking. It is categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under obsessive-compulsive and related disorders, and is complementary with anxiety-related types of problems. Body-focused repetitive behaviors, such as cheek biting, most often begin in late childhood and can last throughout adulthood.

Since we often cannot escape the stress of daily life and the resultant anxiety associated with it, behaviors such as this manifest as a subconscious solution to ease emotional overload. While not an ideal choice, it does serve a purpose to those who use it as a coping method. Other times, it is common for boredom and inactivity to trigger the behavior. Cheek biting is self-injurious yet compulsive in nature since it feels almost normal and necessary in the mind of the biter. The compulsive nature is what makes it difficult to stop.

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Since this behavior usually happens mindlessly, damage to the mouth tissue can occur. It is not uncommon for the biter to bite too deep and injure the mouth. Often, cheek biters have a favorite area to bite and repetitively break the skin in the same place inside the mouth. What’s worse is that when the cheek skin has been chewed and is raw, the skin feels broken and jagged, creating an additional compulsion to smooth out the affected area by biting again. This endless cycle can create physical complications only a dentist or oral surgeon can see.

Biting the soft skin inside the cheek over and over again can lead to oral trauma such as mouth sores and ulcers, but is reversible with avoidance of cheek biting, according to the Oral Cancer Foundation.

Whether it is an anxiety-related problem, an obsessive-compulsive issue, or just a bad habit, it is clear that the behavior is not ideal and potentially harmful. However, stopping the biting is a challenge because the biter is not immediately aware of when it is happening and why it is being used as an answer to stress and anxiety. The first line of defense is to lower the affected person’s stress level and provide alternative and healthy anxiety solutions. Stress and anxiety can be lowered multiple ways, most effectively by exercising regularly and eating healthy. After that, removing stressful situations and triggers should be evaluated. Additionally, treatment including mindfulness training and meditation is almost always useful. Learning to be aware and present in each moment allows the person to be in control of behaviors. While easier said than done, mindfulness and meditation are empirically proven to improve mental health.

Often, body-focused repetitive behaviors such as cheek biting respond well to talk therapy that includes techniques drawn from cognitive behavioral therapy and its subcategories dialectical behavior therapy, habit reversal therapy, and acceptance and commitment therapy. Although no one approach works for everyone, an eclectic sampling may work well. These therapies are based on the idea that obsessions and compulsions, like body-focused repetitive behaviors, help people experience stress, anxiety, and emotions without reacting negatively to them in the form of a behavior. The goal is to experience life without needing a compulsive outlet, like cheek biting, to handle what comes.

That girl in your head—she was your first love, perhaps? And your first heartache too? You still have feelings for her, it seems, and I think that while she may have many wonderful features, she built a life with someone else, not you. You don’t know what her life is from the inside, so it’s easy to make it seem ideal. It may or may not be.

Also, she dumped you six weeks after you joined the military. First off, she might have dumped you anyway—you first got together in high school, a time when relationships can be flimsy and fleeting. It’s part of growing up.

Why do you wake up every day with her in your head? I’m guessing it’s not her so much as it is you and her together, the way you were 40 years ago—young, hopeful, naive, the world opening before you. You shared the exciting spirit of beginnings, but I wonder how long that would have lasted even if you hadn’t joined the military.

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The world seems closed to you now. You say no one loves you or knows you deep down. Your wife had two affairs, and you have been having a kind of fantasy mind affair with that girl, the ineffable first-time perfect girl. She stands between you and your life. You are holding her in between yourself and your life. What you had together for a short time 40 years ago stands between you and your real life, and it is taking the place of your real life. It’s time for you to dump her and live now. There’s no do-over.

Your two kids, you seem to suggest, are teenagers or young adults, and only interested in your money, not in you. Perhaps that’s true, I don’t know. I’m not sure you know, either, since you live with a curtain that blocks the reality of yourself in your life in this moment.

Why do people torture themselves with visions of a perfect past, a wonderful experience, that doesn’t exist? Why do you? Are you afraid of your life now, of looking at who and where you are now? Is it painful?

Perhaps you’re unhappy because where you are now is not where you would like to be. You can’t go back 40 years, obviously, but you can look ahead to the future and see what kind of life you would like to craft for yourself, what you need to do to make it real, to build a life for yourself—no matter your age—that is rooted in the present so it can be satisfying and genuine.

How can you do that? You can look deep inside yourself. You can go to therapy, or to group therapy, and dig hard and come alive.

I wish you luck, love, and satisfaction.

All my best,
Lynn

Thank you for your honest question. If anyone were to tell you that you’re “going straight to hell” for this, believe me, you’d have plenty of company on the way down—and an especially good chunk of the male population ages 15-25. My first thought was “he’s in high school or college,” when hormones have pretty much taken over, especially for men.

But the shame you refer to indicates that this is more of a psychological than physical issue; it’s as if you’re violating some strict “rule” by pleasuring yourself, which (again) is natural. It’s sad when I hear of people who can’t enjoy this; nature clearly intended this, or we wouldn’t be so powerfully stimulated by genital contact. I wonder what “commandment” or prohibition you are “breaking” by self-stimulating? Because of the intensity of the feelings here, you might want to seek out a therapist or counselor to sort out why you feel such strong self-loathing after masturbating. I would bet, in fact, that the intensity of the self-loathing creates a need for relief—and thus the compulsion to do it a second time, which then, of course, only stokes the angry “inner critic.”

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I would wonder, if you or someone else were to bring this issue to my office, if the voice of criticism might in fact exist before the act, and thus create a need to feel good in a way that is self-activated. Whose voice is this? A critical parent or caretaker? When did it start? What is the “crime” being committed here? Are you ignoring something else you “should” be doing instead? I would also be curious about the attitudes around sex in your family of origin. Was it seen as something “dirty” or wrong? Or maybe it wasn’t even talked about, creating a kind of unspoken shame around the topic; it could also be you are inheriting shame around sex and pleasure from implicit or explicit family beliefs.

Sometimes such intensely self-hating emotions come when there has been some kind of overt or covert abuse, physical or emotional. I am not suggesting this is the case here, only that sometimes in my clinical work, I find an association of good sexual feelings with shame over an earlier boundary violation, subtle or severe. Of course, any intensive criticism you might have received, about what you are doing in private with your own body, would constitute a boundary violation of its own.

The other thing I’d want to explore is the question of whether masturbation is the only way to bring some kind of embodied, out-of-your-head relief or pleasure to yourself. Sometimes folks with obsessive minds pursue repetitive means of relieving an overburdened or tired mind. If you feel you have no choice but to masturbate, or if it drains you of necessary energy to complete the tasks of living (work, play, socializing), then you might be caught in a compulsive activity which might necessitate a therapeutic intervention. (I could be wrong, but my sense is that yours is not a compulsive or addictive issue, since those with sexual compulsions usually reflect more ambivalence or torn feelings than your letter indicates.)

The danger isn’t so much the “wrongness” of the act itself, in my view; it’s the long-term effects of shame and self-loathing over bringing pleasure to yourself, and possibly sexual activity, which might inhibit intimacy and get in the way of developing satisfying romantic relationships—either concerning sex itself or shame over your habit. (I wonder if shame might also be felt in other areas where you seek personal satisfaction, like career, creativity, etc.) Shame about sex tends to create defenses that can keep others away, with heartbreaking results, when those we care about feel pushed away.

Good for you for having the courage to write in about such a sensitive issue; it’s not only a common pleasurable activity, it’s relatively common to question whether it’s OK to do. You needn’t feel shame about the need to get some guidance on this, especially if balanced, non-shaming guidance was missing in earlier years.

Kindest regards,
Darren

I see you understand yourself very well—better than most people do, in fact, and I think your understanding comes from your intellectual abilities, which I believe are way above average. You’re quite blessed to have this capacity, but the mind alone is not capable of changing this style of processing.

You write that you are in a relationship, and I wonder how your partner is impacted by your distortions, and how you deal with that together. You say that you obsess that your partner may be cheating, though there is no evidence that this is true. If you’re feeling unwanted, you might ask for excessive reassurance, which rarely works for very long to calm anxiety and which can be annoying to others. How does your partner react to your fears? Does your partner know ways to help? If not, couples counseling might be good for both of you.

Listen to the way you talk to yourself—what you say about yourself to yourself. Perhaps you berate yourself as you lose patience with your repetitive and catastrophizing thoughts. Be kind, as kind as you probably are to others. Remember that charity begins at home, and exercise compassion. And practice ways to so soothe yourself, perhaps through restorative yoga or long walks or jogs.

Finally, your obsessions may be an indication of obsessive compulsion, which often runs in families, and treatment can help effectively manage this. One way to treat obsessive thoughts is with cognitive behavioral therapy, during which people are exposed to situations that they are afraid of until they gradually become less sensitized. Psychodynamic psychotherapy with someone who specializes in helping people reach their unconscious feelings and work them out in relationship with the therapist might be ideal, or you might want to work with an art therapist or even a psychoanalyst.

Anti-anxiety or antidepressant medications benefit some people, too, but if you and your doctor decide that this is your path, you must be carefully monitored by a psychiatrist. If you do take medication, you might consider combining this with some form of psychotherapy.

Thank you very much for consulting GoodTherapy.org; I wish you a successful journey!

Kind regards,
Lynn

Editor’s note: Tammy Nelson, PhD, is the author of The New Monogamy and Getting the Sex You Want. Her continuing education presentation for GoodTherapy.org, titled Couples in Recovery After Infidelity: Creating a New Monogamy, is scheduled for 9 a.m. PDT on September 6. The event is good for 1.5 CE credits and is available at no cost to GoodTherapy.org members. For details, or to register, please click here.

“Lovesickness” means you have fallen hard. Or perhaps you love someone you can’t have. Or, worse, you have lost someone you desperately want back.

Being lovesick hurts and feels awesome at the same time. It is a romantic stage of love, a feeling so familiar because we see it in seemingly every movie, hear it in seemingly every song, and read it in seemingly every poem. Lovesickness is common in every culture in the world. In almost every story ever told, in every Disney movie, and in every vampire novel, there is an undercurrent of love or loss of love. Our longing for love and the “sickness” that comes from falling in and out of it are what make up our idea of romance.

Longing—the desire for another—and the terrible and obsessive feelings it brings are what we learn from an early age to expect when we fall in love. Wanting or longing is our cultural imperative. I want what I cannot have, either because you are from the wrong side of the tracks, the wrong family, I am alive and you are dead, or some variation on the theme. In the end, we find each other somehow. Love always prevails, and we are happy, even for a moment. When love is lost, we cry and the world cries with us. The loss of love is a universal pain, as is the joy of finding it.

New love can feel like addiction. If you put someone in an MRI machine when they are newly infatuated and look at his or her brain scan, the same portions of the brain light up as those that are triggered when high on cocaine. When in romantic love, or the limerence phase, the brain is overloaded with dopamine and norepinephrine production, which creates symptoms similar to obsessive compulsion. They include sleeplessness, restlessness, and obsession. Impulsive behaviors such as driving by the lover’s house, or sleeping with the phone waiting for a call, seem illogical. Longing to be with that person all the time, regardless of other responsibilities, precludes all logical thoughts. People with lovesickness often experience intense sexual feelings for that person and can feel desperate to see the person and to touch him/her constantly.

We may feel intense grief, frustration, and sadness when we can’t be with the person. When we get scared and worry we are losing our love interest, we might actually become physically ill. Depression can increase, and cravings for things such as ice cream or chocolate are common due to the serotonin levels changing in the brain. When our brain chemicals are disrupted, if our love object breaks up with us or if we are separated during this falling-in-love phase, we might become more obsessive and do things we never dreamed of, including parking in their neighborhood or outside their homes. At this point, those who are more unstable might even turn dangerous, breaking into homes, stealing belongings, or checking computers and phones. Jealousy, intense suspicion, and even violence can increase in people who have these tendencies.

If the relationship continues in a normal, happy way and real love kicks in, the relationship moves into the attachment phase. Dopamine levels in the brain begin to level off. Both people start to relax as levels of oxytocin and vasopressin increase. These chemicals make us want to bond, to cuddle, and to stay home. We stop wanting to see friends or even leave the house. Sex wins out over socializing, and if we’re not careful, we might get married and begin procreating.

Being lovesick can cause great surges of creativity. Some of the greatest songs in history are written at times like these. Creative urges are strong at times of real lovesickness; poets, writers, and artists have known this for ages. Sublimation means turning intense emotions into something else. If you are lovesick, now is the time to write, sculpt, sing, or even start a new workout routine. This will help you take all of the intense energy in your heart (and brain) and channel it into something that will benefit you. Start a journal and write about your feelings. Two years from now, you might read it and think, “Ugh … what was I thinking?” Or you may find you have a wonderful new romantic novel or beautiful new love song.

Individuals with Parkinson’s disease (PD) often have personality features that mimic those found in depression, anxiety, and even obsessive compulsion (OC). Behaviors such as extreme punctuality, perfectionism, rigidity, harm avoidance, and unwillingness to seek out novel experiences are common in all of these illnesses. New research has begun to explore whether or not any of these personality types are common in people with PD and, if so, whether any of these traits act as predictors of PD, or merely comorbid symptoms. To look at the relationships between PD and personality traits further, Alessandra Nicoletti of the Department of Hygiene, Public Health, and Neuroscience at the University of Catania in Italy recently conducted a study involving 100 clients with PD and 100 without. She evaluated the personality traits of all of the participants and found that OC was present in 40% of the PD participants and 10% of the non-PD participants.

Nicoletti noted that OC personality and Parkinsonian personality both present with similar cognitive and behavioral traits. She believes that even though there is an overlap in symptoms, it has not been shown that OC personality predicts later Parkinson’s. However, some research has suggested a predictive quality in OC personality for future OC. Nicoletti believes the shared traits present in both personality types are the result of similar neurological circuitry, rather than genetic predisposition to Parkinson’s.

The second most common personality type was depressive, accounting for 14 PD participants and four control participants. This personality is characterized by avoidant behaviors and negative affect, which can also be present in individuals with PD alone. Nicoletti added, “Considering the well known high prevalence of depression among the PD patients, we are aware that in some case distinguishing between these two conditions can be difficult.” She hopes that future work will examine this personality type and others more thoroughly in order to establish whether they provide an early indication of Parkinson’s risk or they merely exist as comorbid conditions.

Reference:

1. Nicoletti, A., Luca, A., Raciti, L., Contrafatto, D., Bruno, E., et al. (2013). Obsessive compulsive personality disorder and Parkinson’s disease. PLoS ONE 8(1): e54822. doi:10.1371/journal.pone.0054822

The Diagnostic and Statistical Manual of Mental Disorders serves as the “bible” of mental health practitioners, who rely on it to match diagnostic criteria with behaviors. The American Psychiatric Association periodically examines trends in mental health conditions and recent scientific evidence to revamp the criteria. The latest edition, the DSM-5, is slated for release in May 2013, and the APA recently approved several changes.

Among the new diagnoses is excoriation, which is associated with chronic skin-picking. The issue is most common among women between the ages of 30 and 45. It’s classified as an impulse control disorder and is related to obsessive compulsion.

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What Is Excoriation?
Although excoriation disorder is the name of the new “official” diagnosis, the issue has been studied for years—sometimes called neurotic excoriation, compulsive skin-picking, dermatillomania, and psychogenic skin-picking. The issue was not included in previous editions of the DSM because it is believed to sometimes be a symptom of another issue.

Skin-picking is common among people with autism spectrum as well as obsessive compulsion. When it does not co-occur with another issue, however, it qualifies for its own diagnosis. Symptoms of the issue include compulsive skin-picking that leads to injuries or wounds as well as stress. Skin-picking is relatively common. Some people pick their skin to the point of bleeding or pain by popping pimples, picking at hangnails, or peeling scabs.

Controversy Surrounding Diagnosis
Whenever the APA adopts new diagnoses or symptoms, there is always some controversy, and excoriation is no exception. Although the diagnosis has received considerably less attention than some other changes, some mental health experts have expressed concern. Because excoriation often is a symptom of an underlying issue, a separate diagnosis might stigmatize people by giving them multiple diagnoses when only one is necessary.

Some clinicians have argued that excoriation does not meet the criteria for a mental health diagnosis and is more akin to a habit. By creating diagnostic criteria for a habit, the DSM might eventually have to include other habits. However, excoriation does sometimes occur on its own, and people with the condition can experience considerable distress, so the APA opted to include it.

How Excoriation Is Treated
When compulsive skin-picking occurs, it’s important to rule out a potential medical cause such as allergies or infection. Occasionally, skin conditions can superficially resemble symptoms of excoriation. Further, excoriation can cause dermatological problems, so patients frequently need dermatological treatment along with mental health treatment.

Antidepressants are the first line of treatment for excoriation. Opioid antagonist medications, which interfere with the body’s ability to respond to endorphins and opioids, also are sometimes effective. Because compulsive skin-picking often co-occurs with anxiety, anti-anxiety medications can be helpful.

Psychotherapy that helps people develop better approaches for dealing with anxiety, enables them to develop better impulse control, and helps patients cope with changes to appearance as a result of excoriation is also a typical part of treatment.

References:

1. American Psychological Association. APA concise dictionary of psychology. Washington, DC: American Psychological Association, 2009. Print.
2. Brauser, D. (2012, December 3). Experts react to DSM-5 Approval. Medscape Reference. Retrieved from http://www.medscape.com/viewarticle/775526
3. Colman, A. M. (2006). Oxford dictionary of psychology. New York, NY: Oxford University Press.
4. Neurotic excoriations. (2012, June 27). Medscape Reference. Retrieved from http://emedicine.medscape.com/article/1122042-overview
5. Neurotic excoriation. (n.d.). SkinPick. Retrieved from http://www.skinpick.com/neurotic-excoriation

Most people experience some form of irrational fear or anxiety, and many are concerned about germs and disease in particular. Amid a flurry of films and media reports about antibiotic-resistant infections and life-threatening flu strains, it’s easy to understand why some people actively worry about what they touch and breathe.

While concern about germs can motivate people to make health-conscious decisions such as frequently washing their hands, a serious germ phobia can drastically alter how a person functions and engages with society. Even actor and television host Howie Mandel concedes he has been unable to shake the grip of mysophobia—the technical term for fear of germs. Phobias are differentiated from general fears by degree. A person who is concerned about germs might wash his or her hands or get a flu shot, but a germ phobia can interfere with every area of life. Phobias are treatable, and people experiencing them should seek medical or psychological assistance.

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Symptoms
The primary symptom of mysophobia is an irrational fear of germs. This can manifest differently in different people. One person, for example, might be fixated on a specific germ or disease, while another person might be afraid of germs and dirt in general. Common behaviors associated with mysophobia include:

• Compulsive hand washing
• Excessive use of disinfectants and antibacterial soap
• Fear of physical contact with others
• Extreme fear of getting sick
• Reacting with extreme fear to media reports of new diseases
• Fear of certain locations, such as doctor’s offices and airplanes, where germs or sick people might be present or confined

Effects
Mysophobia doesn’t simply inspire fear and avoidance. The phobia can be all-encompassing and life-altering. While people with mysophobia often recognize that their reactions are irrational, they can’t control them. They may avoid going out in public, developing intimate relationships, or eating food they did not cook. Because mysophobia affects so much of a person’s life, it can lead to other mental health issues such as depression, social isolation, and anxiety. Complete avoidance of germs can actually contribute to the development of health problems. Overuse of antibacterial and disinfectant products has been implicated in the spread of new, resistant infections, and children who are not exposed to germs are more likely to develop allergies.

Causes
No one knows exactly why people develop phobias, but mental health experts have developed a few theories. Some believe that people are more likely to develop phobias that protect from danger. These phobias include germ phobias, fear of large animals, and fear of heights. People who develop phobias may take these natural fears too far and react with extreme anxiety, placing them in danger they are believed to be trying to avoid.

Early experiences also can make a person more likely to develop a phobia. Childhood illness, the death of a parent, or painful medical procedures can condition a person to be extremely fearful of germs and to take extreme measures to avoid them. Phobias also tend to run in families; they may be genetic or simply learned from parents.

Treatment
Phobias are highly treatable and often require only a few sessions with a qualified mental health professional. Cognitive behavioral therapy, which helps people to reframe intrusive and phobic thoughts, can be extremely beneficial. Desensitization, a process whereby a person is slowly exposed to a frightening stimulus, also is highly effective. Some doctors may prescribe anti-anxiety medications to help people with mysophobia cope with their fears during treatment or to enable them to function in public. Some clients also experience success with hypnotherapy, often in only two or three sessions.

References:

1. Audesirk, T., Audesirk, G., Byers, B. E. (2008). Biology: Life on earth with physiology. Upper Saddle River, NJ: Pearson Prentice Hall.
2. Overcoming your Fear of Germs. (n.d.). Fear of Germs. Retrieved from http://www.fearofgerms.com/
3. Kring, A. M., Johnson, S. L., Davison, G. C., Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
4. Phobias. (n.d.). U.S. National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/phobias.html