Saturday, May 21, 2016

OCD – Obsessive Compulsive Disorder

OCD Obsessive Compulsive Disorder

What is OCD?

OCD – Obsessive compulsive disorder – is a severe type of anxiety disorder involving obsessions and compulsions that affects the day-to-day functioning of a person.

What are obsessions?

Obsessions are thoughts, images, or impulses that occur over and over again; cause severe anxiety; feel outside the person’s control and affect the day to day functioning of a person.

What obsessions are not

Most of us know what it is like to be preoccupied with a thought, idea or even a person sometimes. These are not obsessions. They often give pleasure, usually pass off soon and do not affect our daily routine or work. Certain types of personality are also linked to a fastidious concern for details and “correctness”. However, this is not associated with anxiety and hence not an obsession.

What are compulsions?

Compulsions are repetitive behaviours aimed at decreasing the anxiety associated with the obsessions.

What compulsions are not

Not all repetitive behaviours are compulsions. Bedtime rituals, religious practices, learning new skills involve repeating an activity. Behaviours also depend on the condition and situations of a person’s life. Arranging wares back on shelves are a normal part of a shop assistant’s work and are not compulsions.

Types of obsessions and compulsions in OCD

Contamination
Contamination is among the commonest of obsessions. There is a fear of dirt, germs, waste, toxins or body secretions. A person is afraid of getting an illness or spreading it. Sometimes he/she may just have feeling of “not being clean”. Touching an “unclean” object or even being near it may cause extreme anxiety. This is only eased by repeated washing and cleaning. Often the washing has to be done in a particular way or be repeated many times before he/ she feels clean again. The person also goes through great trouble to avoid or prevent contact with the contaminants. In time, they may become house-bound and force family members to also follow these cleaning rituals.
Pathological doubt
A person worries all the time that he will cause some harm to himself, his family or others due to his own carelessness. ‘Did I lock the door?’; ‘Did I switch off the lights?’; ‘Is the gas turned off?’ This constant questioning, doubt and responsibility leads to a compulsion to check and recheck. He may need to check the gas switch and the locks so many times that he gets late for work or is unable to sleep at night. Though he knows that the task is complete, his compulsive, repetitive behaviour continues.
Perfectionism and need for symmetry
A person has a need to do or arrange things “perfectly”. Items on his desk have to be placed in a certain way; or his shoes may need to be stacked in an exact order. He may need to perform certain actions or behaviours a certain number of times or in a precise order to have a sense of ‘completeness’. A child with OCD may worry that his homework is ‘not quite right’ and spend hours checking, erasing and re-doing his work because his T’s are not crossed properly. A person at work may feel that the day will go badly for him if he does not take a certain number of steps (say in multiples of seven) to his desk.
Concern about illness and disease
A person may have an irrational fear of developing a serious or incurable illness-usually HIV, heart disease or cancer. He may consult doctors and visit hospitals repeatedly. Despite normal medical reports and reassurance he will get investigations done again and again.
Distressing sexual thoughts and images
'Sinful' religious images are other common obsessions. This specially occurs near religious places or during religious rites and rituals. He may feel intense guilt and avoid such places or services in the future.

OCD Treatment

Treatment of OCD consists of cognitive behaviour therapy (CBT) and medication. OCD treatment is best done as early as possible, as chronic OCD can affect daily life, work and relationships. CBT is essential for all patients with OCD. CBT tackles the obsessive thoughts [Cognitions-C]; the compulsive behaviours [B] in a methodical way [Therapy-T]. CBT by itself can reduce symptoms and delay or prevent relapses.

OCD medication may be required when symptoms are moderate or severe. Medication for obsessive compulsive disorder is usually combined with CBT. The outcome of therapy also depends on family support; and the patient’s own insight, motivation and readiness for change.

Monday, April 18, 2016

ADHD and Me

ADHD and Me

Hi. I’m Jai. I’m 8 years old. This is my story. My doctor says I have an illness. I don’t feel sick. But I do know that grown-ups around me are annoyed with me most of the time. I’m constantly being told, “sit still’’, “stop dreaming”, “pay attention”. I can’t seem to be able to do just that.

In class, I seem to lose track of what the teacher says. I try to listen, I really do. I start doing what she says, then I notice the insect fluttering on the window pane, I see the boy in the row ahead tapping his fingers on the desk, the office boy walking down the corridor and the sound of laughter from the next classroom. I don’t realise I have left my seat till teacher tells me “Jai, return to your seat”.

My parents are frequently called to school to meet my class teacher. They are unhappy with my marks. They think I’m careless and lazy because I take all evening to do my homework. I tell my mother that I try hard. I feel sad and frustrated that she doesn’t understand or believe me. Some of the other children make fun of me specially when I can’t answer in class. Mostly, I haven’t heard the question. They don’t like to play with me as I get excited and can’t wait for my turn.

Things changed about 6 months back. My parents took me to a special doctor. The doctor seemed to understand that I was not being naughty or disobedient. He talked to me, looked at my exercise books and listened to my parents. He told my parents that I had an illness, ADHD. I needed medicines for treatment of ADHD to improve my focus and concentration. I also need structure and routine in my life. It was such a relief to know it was not my fault.

A lady at the doctor’s clinic gave me some puzzles and games to do. I liked her; she spoke slowly and clearly. She explained things one at a time and did not mind repeating herself when I did not get her the first time. She helped us draw up a time-table - we had such fun doing that because she made time for everything I want to do. Now I have a study time, a play time, TV time, all clearly written in the big chart I helped to make. It reminds me of what I have to do and gives me enough time to prepare for it. Mother says I sit quietly for longer periods. Teacher says I pay more attention and don’t disturb other kids in class. She is more patient with me too.

Understanding ADHD and Helping Me

Doctor says there are many children like me. Here’s what you can do to help me and others like me.

  • Help me focus. Make sure I’ve heard you and understood what you want me to do.
  • I sometimes don’t realise I’ve left my seat. Please remind me to stop and think.
  • I need structure and routine in my life.
  • I need to know what comes next.
  • Please give me time to adjust to any changes in my schedule.
  • Please let me learn at my own pace, I get confused and make mistakes when you ask me to hurry up.
  • Please give me instructions one step at a time. Make me repeat them.
  • Please give me short work periods and small goals to start with.
  • Please give me immediate feedback; did I do things the right way?
  • Do give me praise even if I succeed only partially. Please don’t wait till I’m perfect.
  • Don’t always find fault with me. Please praise me and reward me when I do something well.


Thank you for being patient with me.

Monday, February 1, 2016

Dealing with Grief

girl dealing with grief
Dealing with grief is a process of acceptance

Grief is the response to losing someone to death. All of us understand that death and loss of a loved one is a part of life. However, the reality of death often leads to feelings of shock, sadness and confusion. Acute grief occurs in the immediate aftermath of the loss. It is intensely painful characterised by sadness, crying, constant thoughts of the deceased, disturbed sleep, appetite and disinterest in one’s own self and others. In a majority of cases, this is followed by integrated or abiding grief in which memories of the loved one mingle with sadness and longing but it does not persistently occupy the mind or disrupt normal day-to day activities.
“Well, everyone can master a grief but he that has it.”
William Shakespeare. Much Ado About Nothing. III.ii.25

Loss through death affects each of us differently. How one feels depends on the nature and circumstances of the loss, one’s beliefs and religion, age, relationships and one’s own physical and mental health. A sudden or violent death, death of a child or loss of a long-time spouse are always more difficult to accept. If the relationship with the departed person was difficult, the grief is more complicated and may take more time to work through.

Stages of grief

5 stages of the grieving process has been described. The stages do not necessarily come in order, nor are all the stages experienced by every person. One may return or go through one or the other stage several times before acceptance of the loss.Grief is a process and not just a state. During the process of grieving and bereavement a person may experience many emotions during the course of bereavement- helplessness, anger, sadness, denial, despair and yearning are common.
Denial
The first stage is the stage of denial ('It's not true’; ‘There must be some mistake.’) This is a normal defence mechanism which helps to cushion the immediate shock.
Anger
Once the reality sinks in, the pain is often redirected and expressed as anger. ‘Why me?’; ‘Its not fair’; ‘How can this happen to me’; are the common reactions in this phase. Anger may be directed towards objects, strangers, the doctors or family members, God; or even towards the deceased person- ‘How could you leave me alone?’
Bargaining
A promise of good behaviour or an attempt to strike a bargain (‘I will always listen to you’, ‘I will never worry you again,)’ is often the reaction at this stage.
Depression
Sadness and regret are mingled and one may often say ‘There is no point in life; - I may as well die too’.
Acceptance
At this stage emotions are stable and calm.

Strategies for dealing with grief 

Though each one copes differently, the following strategies may help you cope with your feelings and come to terms with your loss.
  1. Talking about your loss: It may be difficult for you initially- but in time it helps to talk about your loss and your feelings with a trusted family member or friend or a counsellor.
  2. Accepting your feelings : The anger, guilt, helplessness you may feel are normal and part of the grieving process. There is no guilt or shame in accepting them; and it paves the way for healing.
  3. Taking care of yourself : Establishing a routine with regular meals, exercise and adequate rest is important for your physical and mental health.
  4. Reaching out to others: Working with people less fortunate, or carrying on the legacy of the deceased (teaching, helping in the community) helps to give meaning to life.

When to seek professional help

  • Though different people take different times, intense and persistent grief continuing over a period of six months may require professional help.
  • Loss due to suicide is among the most difficult to bear. In such cases, counselling during the first weeks is both advisable and beneficial.
  • Inability to cope with or resume daily life or work activities, intense sorrow or pain which does not subside with time, inability to maintain or build relationships are indications to consult a mental health specialist.
Recovery from grief is a highly individual process. Each individual works through grief on their own with time, using their own personal ways of coping. Acceptance, rationalisation, humour, distraction, prayer, avoidance of reminders are some of the many ways in which people cope. Social support and healthy habits contribute to recovery which may take a few months or even a year.