Obsessive compulsion (OCD) can begin with obsessive, irrational thoughts and fears. These irrational thoughts are followed by ritualistic actions, such as repetitive hand washing, door closing, or gestures. These rituals are the means to cope with the intrusive, irrational thoughts, but instead a vicious cycle is set into motion. Severe OCD can completely disrupt an individual’s life and also affect family and friends, as they watch their loved one become more and more consumed by compulsive behaviors.

The exact cause of OCD is unknown and may be different for each individual, but a deficit of the neurotransmitter serotonin has been identified as a likely culprit. Treatment for OCD involves both intensive cognitive behavioral therapy and high doses of antidepressant medications. Specifically, drugs belonging to the selective serotonin reuptake inhibitor (SSRI) class have shown success in achieving remission for individuals with OCD.

Luvox (fluvoxamine) is an SSRI but is structurally quite different from other drugs in the class such as Paxil (paroxetine) or Prozac (fluoxetine). Currently, it is the preferred treatment option for people with OCD. Interestingly, studies have shown that the action of Luvox and other antidepressants in treating OCD is completely independent of depression. In other words, a person with OCD need not be depressed to benefit from Luvox treatment.

Other studies have suggested that Luvox improves the response to behavioral therapy. This shouldn’t be surprising, as nearly all psychiatric conditions benefit from a multipronged treatment approach. Luvox is also safe and well-tolerated. Another antidepressant, Norpramin (desipramine), may actually be slightly more effective than Luvox, but it carries a greater risk of side effects.

With OCD, dosages near the high end of the safety guidelines are necessary to achieve improvement and eventual remission. Recently, a new, extended-release formulation of Luvox has been developed that may be well suited to the treatment of OCD. The dosage of the immediate-release formulation must be gradually increased, thereby delaying the positive effects. The extended-release version, on the other hand, offers a much faster onset of symptom improvement.

Concentrations of medication in blood plasma are a reliable indication of drug concentrations in the brain. Blood plasma measurements have confirmed that the Luvox extended-release formula achieves an effectiveness threshold much faster than the standard, immediate-release formulation. With its combination of fast action and safety, Luvox extended-release may soon be the first-line treatment for adults with moderate or severe OCD.

References:

1. PubMed Health. (n.d.). National Center for Biotechnology Information. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ordacgi, L., Mendlowicz, M. V., Fontenelle, L. F. (2009). Management of obsessive-compulsive disorder with fluvoxamine extended release. Neuropsychiatric Disease and Treatment, 5, 301-308.

Play therapy is widely recognized as an effective therapeutic approach for children who are unable or unwilling to communicate their psychological distress. Elementary-aged children represent an especially vulnerable segment of the population when it comes to mental health barriers. First, it is during these formative years that behavior patterns are set. Children who have psychological problems early on tend to have higher rates of substance misuse, aggression, risk-taking behavior, and academic challenges than their peers. Additionally, many young children who have attention-deficit hyperactivity disorder, obsessive compulsive disorder, posttraumatic stress, autism, or other difficulties may have significant academic challenges and can benefit greatly from effective and meaningful in-school therapy.

But believing in the viability of play therapy and delivering it are two different things. Many school counselors report significant barriers to play therapy. Christine Ebrahim of the Department of Counseling at Loyola University in New York wanted to take a closer look at the barriers that counselors faced and how they overcame them. Ebrahim enlisted 359 elementary school counselors from the American School Counselor Association and had them complete online surveys regarding barriers to play therapy. The participants reported barriers such as time, space allocation, financial resources, and administrative and parental support. However, nearly all the counselors who cited these obstacles also described how they overcame them. For instance, they used their own money for supplies when they could not get funding, moved sessions to alternative locations when space was limited, and provided education about the benefits of play therapy when administrative and parental support was lacking.

One barrier was more difficult to surmount: the limited availability of play therapy training. “In looking at the data, most counselors identified specifically a lack of training as their primary problem,” Ebrahim said. Play therapy courses are not part of the curriculum at all colleges. Therefore, counselors are forced to learn through textbooks or online, or they must pay for training out of their own pockets. These results are promising in that they suggest that counselors are willing to do whatever it takes to offer play therapy to students in need. However, Ebrahim believes the findings clearly demonstrate that elementary school counselors are in desperate need of more professional play therapy training.

Reference:
Ebrahim, C., Steen, R. L., Paradise, L. (2012). Overcoming school counselors’ barriers to play therapy. International Journal of Play Therapy. Advance online publication. doi: 10.1037/a0029791

Fear can be a strong motivator. People who are afraid of living in poverty may be motivated to pursue any career option in order to avoid financial destitution. In a similar way, individuals who are afraid that they may develop specific health-related problems may work tirelessly to maintain optimal physical condition. Fear often has been linked to motivation, both positively and negatively. Until recently, however, few studies examined how fear of failure affects activity-related performance.

Jocelyn J. Bélanger of the University of Maryland sought to determine how negative feedback on specific tasks affected motivation in individuals fearful of failure (obsessive) and those who were passionate about their activity but less worried about setbacks (harmonious). In a series of experiments, Bélanger found that individuals who are passionate about achieving their goal perform differently based on their style of commitment. In particular, those with obsessive passion responded with positive motivation to negative/failure cues while those with harmonious passion saw no change in performance. In fact, the harmonious passion participants maintained the same level of performance throughout the experiments, regardless of whether they received success or failure feedback.

“Obsessive passion, associated with defensiveness, predicts performance aimed at avoiding failure, whereas harmonious passion, associated with a secure self-concept, predicts stable performance,” Bélanger said. These findings suggest that fear works as a motivator for individuals with obsessive passion. Bélanger believes that people who feel their sense of self is threatened by failure of goal attainment may unconsciously respond to that threat by increasing their performance. However, those who have harmonious passion traits are less threatened and view the feedback, positive or negative, merely as information needed to continue the process of attaining their goals. The results of this study offer valuable information that could be used for the development of goal-attainment strategies in the professional, academic, and sports arenas, and could help clinicians better understand an individual’s reaction to goal-achievement outcomes.

Reference:
Bélanger, J. J., Lafrenière, M.-A. K., Vallerand, R. J., Kruglanski, A. W. (2012). Driven by fear: The effect of success and failure information on passionate individuals’ performance. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0029585

Romantic love can be all consuming. In the beginning stages of a relationship, one or both partners may be overwhelmed with feelings of affection for the other partner. Couples may want to spend all of their waking hours together and actually crave each other’s presence when apart. These feelings are not uncommon in many budding romances. However, when they persist and lead to unhealthy behaviors, this type of love can become destructive. Much like an addiction to drugs or alcohol, people who experience love addiction pursue their drug at the expense of their friendships, careers, family members, and even self-respect.

In a recent article, Dr. David Sack, a psychiatrist and addiction specialist, explains what love addiction is. He says that people who are in addictive relationships experience limerence, a term introduced by psychologist and author Dorothy Tennov to describe love obsession and dependence. Limerence mimics new romantic love, but unlike true love that constructively develops into reciprocal, mutual affection, limerence is usually destructive. When one partner exhibits limerent behaviors, they may begin to cross emotional and physical boundaries in order to secure the attention and affection they need. Even when the feelings are not returned, the limerent partner may continue to chase after the other partner. Sack says, “Behaviors may become dangerous, such as stalking or unwanted contact, and require outpatient or residential love addiction treatment, professional counseling, and/or 12-step work.”

Limerent relationships are not all bad. Although most end with one partner being rejected and hurt, some actually grow into healthy and mutually loving unions. Individuals who display limerent behavior in one relationship may continue to do so in future relationships, creating a pattern of destruction and disappointment. Sack suggests that individuals who believe they are involved in a limerent relationship, either by their own actions or those of their partner, work with a professional to identify the negative behaviors. Understanding the cause of the limerent patterns will help an individual become aware of why they behave the way they do and give them an opportunity to transform negative patterns into more positive and promising ones.

Source:
Sack, D. (2012, June 28). Limerence and the biochemical roots of love addiction. From the Huffington Post. Retrieved from http://www.huffingtonpost.com/david-sack-md/limerence_b_1627089.html

Related articles:
What to Look for in an Addiction Therapist, Part 1
(Don’t) Keep Coming Back

Hoarding is a form of obsessive-compulsive behavior. An individual who exhibits hoarding tendencies has a difficult time letting go of physical items and becomes inundated with possessions, often to the point of causing physical and financial harm. Previous research has identified a link between people who hoard and obesity. Now, a new study led by Kiara R. Timpano of the Department of Psychology at the University of Miami, aims to determine if the brain derived neurotrophic factor (BDNF) is responsible for that link. “Studies with gene-targeted murine models have demonstrated that Bdnf variation is linked with memory impairment, greater avoidance, greater anxiety, aggression, and obesity,” said Timpano. The variation, called the Val66Met SNP, was of particular interest to her and her team. “Considering specific psychiatric conditions, the Val66Met BDNF SNP has been associated with multiple neuropsychiatric disorders, including eating disorders,” she said.

Timpano and her team examined the BDNF gene in 301 participants who were classified with obsessive-compulsive behaviors. They used the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition (SCID-P) to identify OCD and the Yale-Brown Obsessive Compulsive Scale (YBOCS) to assess hoarding behaviors. The researchers also measured the body mass index (BMI) of each participant to determine obesity.

They found that more than half of the participants were above average weight, with 25.2% being classified as “overweight” and 27.2% as “obese.” They also discovered that the individuals with the highest BMI were also the most likely to exhibit hoarding behaviors. “Results revealed that individuals in the hoarding group were over two times more likely to be classified as obese compared with non-hoarders,” said Timpano. The team hopes this study helps advance research on this issue. They said, “This finding, in conjunction with our results, brain imaging evidence, and symptomatic and gender differences in hoarding compared with other forms of OCD, provide further credence to the growing notion of hoarding as a separable and distinct phenomenon.”

Reference:
Timpano, Kiara R., Norman B. Schmidt, Michael G. Wheaton, Jens R. Wendland, and Dennis L. Murphy. “Consideration of the BDNF Gene in Relation to Two Phenotypes: Hoarding and Obesity.” Journal of Abnormal Psychology 120.3 (2011): 700-07. Print.

A new study suggests variance in the brain activity of people suffering from body dysmorphia. According to Dr. Jamie Feusner, a UCLA assistant professor of psychiatry, people with body image issues have decreased brain activity when they view holistic images. “No study until this one has investigated the brain’s activity for visually processing objects in people with BDD,” said Feusner, director of the Obsessive-Compulsive Disorder Intensive Treatment Program at UCLA. “This is an important step to figuring out what’s going wrong in the brains of people with body dysmorphia so we can develop treatments to change their perceptions of themselves.”

Body dysmorphia is found in nearly two percent of people and more prevalent in those with obsessive-compulsive tendencies. The study, which involved 14 people with body dysmorphia and 14 control subjects, involved the use of a brain scans in order to determine the brain activity of the subjects while they viewed pictures of houses that were altered and houses that were unaltered. Those with body dysmorphia displayed significantly lower amounts of brain activity in the region of the brain that process visual details. The more severe a person’s symptoms of body dysmorphia, the less activity they displayed. (more…)

If you’ve done any channel surfing at all in the last year or so, you might have come across a couple of documentary shows (Hoarders on A&E; Hoarding, Buried Alive on TLC) featuring people who are living with massive amounts of clutter and/or trash in their homes. The piles of “stuff” often reach to the ceilings, and there is barely space to stand, much less walk across a room. The programs show professional organizers and psychotherapists working with people to clean out their homes. If you’ve seen either of these shows, then you know what I mean when I say it’s something you don’t forget easily. Although the people being featured on the shows are treated with respect and compassion, the images are shocking and disturbing. How does this happen? Why do people do this? Can they be helped?

Contrary to what you might think, people experiencing compulsive hoarding are not just being lazy or careless. They are experiencing an anxiety related condition; although, there is disagreement in the medical/psychiatric community as to whether hoarding is its own issue, or that compulsive hoarding is a subtype of obsessive compulsive disorder (OCD). Although many people experiencing OCD also exhibit hoarding behavior, not all people experiencing OCD also hoard, and many people who hoard have no other symptoms of OCD.

People who compulsively hoard do experience excessive extreme anxiety, doubting, checking, and reassurance seeking before discarding items, which does suggest a close relationship to OCD. However, recent research suggests that compulsive hoarding may also be associated with a range of other psychiatric conditions, in addition to OCD. Compulsive hoarding behavior has been reported in disorders including schizophrenia, social phobia, eating disorders, depression, and dementia. In studies of the brain, researchers compared neurochemical activity and patterns of blood flow in the brain of people who compulsively hoard and people who experience OCD who did not hoard. They found that the neurochemical activity and blood flow patterns in people who hoard were different than those in people with OCD, suggesting that compulsive hoarding is a separate symptom/condition from OCD.

Many, if not most, people have a certain amount of clutter in at least one part of their homes. Where is the line between average messiness and compulsive hoarding? Hoarding behavior includes:

• Acquiring and keeping, indefinitely, a large number of possessions which appear to be useless or of limited value
• Living in spaces so intensely cluttered as to preclude activities for which those spaces were designed
• Significant distress or impairment in functioning caused by the hoarding (e.g., health problems, inability to keep a job, difficult relationships or lack of relationships with other people)
• Reluctance or inability to return borrowed items; impulsiveness and compulsion to acquire more “things” sometimes leading to stealing or shoplifting

Why/how does a person cross the line from messiness to hoarding? There are several proposed explanations for the causes of hoarding behavior. Investigators have suggested that errant cognitive processing leads to hoarding. These include information processing deficits, meaning that people who hoard have substantial problems focusing and sustaining attention, difficulty categorizing and prioritizing their possessions, and difficulty in making decisions about their possessions.

Maladaptive beliefs about, and extreme emotional attachment to, possessions may also contribute to a person’s hoarding behavior. People who hoard have an exaggerated sense of responsibility for their possessions, and desire complete control over them. They experience intense emotional distress (anxiety, grief, or guilt) about the ideas of discarding or losing an object, leading to avoidance, and escape in the form of saving and acquiring.

There are also studies showing that difference in brain activity and /or brain injury can lead to hoarding behavior. Scientists have identified the areas of the brain involved in hoarding. One study showed reduced glucose metabolism in certain areas of the brains of compulsive hoarders. Some people with traumatic brain injury, stroke, and neurodegenerative diseases have also developed hoarding behavior.

In the past, clinicians have used the same treatment methods for compulsive hoarding that they used for OCD, with poor results. While medication, cognitive behavioral therapy for OCD, exposure and response prevention therapy have all been effective treatments for OCD, they have been shown to be of little benefit for compulsive hoarding. People with hoarding behavior have high instances of poor insight, refusal of treatment, lack of cooperation, and inability to recognize hoarding as a problem, all contributing to difficulty in effective treatment.

There is hope for people who hoard, though. In a recent study, researchers designed a new cognitive-behavioral treatment especially for treating compulsive hoarding. In this treatment, motivational interviewing (getting people excited about the seriousness of the hazards of hoarding and the benefits of clearing out their homes), skills training for organizing and problem solving, and modification of beliefs about possessions are emphasized. Also, treatment includes frequent off-site sessions in which therapists helped people to sort, discard, and learn to resist acquiring more items. People typically respond more positively when the therapists are at the home with them, assisting them with sorting and discarding.

The sight of such intense messiness and disarray is certainly disturbing to see, but knowing that hoarding is a symptom of a person who is possibly experiencing severe emotional distress, hopefully, helps to engender compassion and patience in friends and family members. Information about help for hoarding can be found online at www.ocfoundation.org/hoarding/.