Obsessive Compulsive Disorder

Obsessive Compulsive Disorder, more commonly known as OCD, is a term often thrown around and jokingly applied to friends or family members who tend to be a little too precise or particular about certain things. Some people even equate peculiar behaviour with such a diagnosis. But what exactly is OCD and how does it differ from the little quirks we all display from time to time?Affecting about 2% to 3% of the population, OCD is an anxiety disorder that usually lasts for years, during which time patients’ symptoms may vary in severity and focus. People living with OCD experience obsessions and compulsions. “Obsessions are intrusive thoughts, images or impulses that are involuntary and produce anxiety,” explains Johannesburg clinical psychologist and OCD expert, Kevin Bolon. He defines compulsions as voluntary behaviours aimed at reducing the anxiety experienced – these may be observable or unobservable. For example, a person with obsessions about contamination may wash their hands repetitively; someone with obsessions about possible harm may check repeatedly. While washing and checking are easily recognised, many people have more abstract symptoms such as having to pray over and over to get rid of blasphemous thoughts or having to hoard excessively. In addition to obsessions and compulsions, people with OCD may show avoidance behaviours, for instance the person with contamination concerns may simply stay indoors, avoiding contact with the outside world at all costs. Others may take an extraordinarily long time to complete routine daily activities – this is a form of OCD known as obsessional slowness.Bolon says: “When differentiating OCD from individual eccentricities, it’s important to consider two aspects – time and impairment.” If a person spends over one hour per day performing rituals that reduce the anxiety caused by their obsessions and if these rituals result in significantly impaired functioning in their work/social life, etc. then it’s possible they may have OCD.Stephen* is 28 years old and has been living with this condition for years: “It feels like obsessions are big knots in your stomach that can only be released by a compulsion. The problems is, the more you give in to the rituals, the worse the obsessions get.”Most people with OCD have good insight into their symptoms; they know their concerns are excessive, even though they cannot help following through on compulsions to set their minds at ease. “I feel like a freak, so alone… and I know what I’m doing is weird, but I just can’t stop because of the doubt,” says Stephen.The distress and functional impairment people with OCD experience also increase the risk of depression.

Commonly beginning in childhood or adolescence, OCD affects both men and women of all ethnic groups. For women, another common age of onset is at the time of pregnancy or childbirth; hormonal interactions with brain chemicals are likely to play an important role in such cases. Certain genes appear to also contribute to OCD, while there’s increasing evidence that the cause of OCD lies in problems with the circuitry, structure and neurochemistry of the brain.

The optimum treatment of OCD is a combination of medication and Cognitive Behavioural Therapy (CBT). Drake says: “OCD was considered a chronically debilitating and treatment-resistant condition prior to the development of exposure and ritual prevention. This was a groundbreaking discovery that has since been developed and refined into what is commonly referred to as prolonged exposure and response prevention, as we know it today.”

To learn more about OCD or any other mental illness, contact SADAG between 8am and 8pm 7 days a week toll free on            0800 21 22 23      .

 OBSESSION SYMPTOMS
  • Doubts about turning off electrical appliances or locking up
  • Thoughts of having hurt someone in an accident
  • Fear of contamination through direct contact, like a handshake
  • Skin problems due to excessive hand washing
  • Extreme stress when objects are not orderly or symmetrical
  • Repetitive disturbing images of a sexual or violent nature

COMPULSION SYMPTOMS

  • Frequent hand washing/hygiene rituals
  • Excessive cleaning
  • Repetitive checking of doors, stoves, switches, etc.
  • Counting in patterns, tapping or repeating words/phrases
  • Arranging objects in a certain order
  • Regularly checking in with loved ones to make sure they’re safe
 * Name has been changed.
THE SOUTH AFRICAN DEPRESSION AND ANXIETY GROUP
Tel:             011 262 6396

(a direct transcript from SADAG)


Challenges Faced by the Transgender Community

The term “transgender” applies to individuals whose gender identity differs from the physical sexual characteristics with which they were born.  This particular term only came about in the 20th century.

The dissatisfaction experienced with the biological sex that one is born with is referred to as gender dysphoria. It has a great impact on the emotional and psychological development of the individual and frequently leads to anxiety and depression. Gender dysphoria is normally evident from a young age and leads to many challenges for the growing child who finds it increasingly difficult to conform to societal standards. Socially, there are expectations regarding how female and male children should behave, for example, boys shouldn’t wear dresses or play with dolls. Children experiencing gender dysphoria learn from a young age that there is a part of themselves that must be hidden. In addition, puberty is often a very stressful period as it brings unwanted, gender specific changes to their bodies.

As they get older, transgender individuals are faced with many decisions that have to be made. Some will choose to keep their inner feelings hidden for fear of rejection and isolation. This has a huge impact on their emotional development. Others will decide to transition which is a life changing decision and is accompanied with many fears, such as fears of being rejected by family, friends and colleagues, of changing legal documents, of finding a partner, of enduring surgery and hormones and its impact on relationships. As so much of the territory they are entering is unknown, this decision can be extremely stressful.

Despite South Africa having one of the most progressive constitutions in the world, the transgender community still faces many challenges. They are subjected to discrimination, stigma and prejudices and gender-based violence is prevalent throughout South Africa. Many of these crimes go unreported due to victims experiencing secondary trauma when reporting incidents at police stations.

Many cultures do not accept the transgender community resulting in them being ostracised by family and friends. Very often they are forced to choose between their culture and their gender identity.

In certain African countries, transgender individuals are openly condemned. In Uganda a bill was passed in 2013 stating that homosexual acts were to be punishable by life imprisonment.

Stigma and discrimination is also evident in our healthcare services, our educational institutions and in the employment sector. The constant threat of persecution and discrimination is a heavy burden to bear and has a direct impact on the person’s emotional, social and physical wellness.

Accessing public healthcare services is extremely difficult. There are only two centres that offer specific services for the transgender community. The one centre is in Cape Town and the other is in Pretoria. As gender reassignment surgery is not viewed as urgent, very little time is allocated to it, resulting in a waiting list of 26 years. This prevents many transgender individuals from receiving medical services.

Although there is support available for the transgender community, more education needs to be undertaken in order to eliminate discrimination and stigma. Living authentically according to one’s gender identity is extremely empowering and liberating and creates emotional wellness.

 

Published in Diverstiy Magazine – August 2015

 

 


Coming Out

According to the Cambridge Dictionary of American Idioms, coming out refers to “be willing to talk in public about something that was kept secret” or to “announce that you are attracted to the same sex”. It is used commonly amongst the gay community to refer to the disclosure of sexual identity or gender orientation.

Faced with the decision of “coming out” can be a very daunting experience. For many people the decision is an extremely difficult one accompanied by many internal conflicts. On the one hand, letting go of secrecy and pretending in order to live an open and authentic life is very appealing. On the other, fears of rejection, isolation and discrimination are overwhelming. This decision is a personal one and the outcome needs to be weighed up carefully. Each person is unique and what is best for one might not be the best for another. Often, hiding your true self away behind a mask of heterosexuality seems to be much easier, but not being true to yourself does damage psychologically, emotionally and behaviourally.

Rather than an isolated event, coming out is a process which begins with acknowledging and accepting your sexual orientation to yourself. The feelings accompanying this phase range from denial, disbelief and anger to relief, acceptance and excitement. Once you have accepted yourself and are confident with your sexuality, you are ready to share your identity with others.

Starting off by confiding in a person whom you trust and who you know will not judge you, is very important. This person needs to be chosen carefully – it could be a counsellor, a friend, a family member or a valued colleague. The confidence you gain and the support you receive from this initial sharing will help you through the process of coming out. It is not necessary to tell everyone in your life at the same time but rather in stages guided by how you feel and what you are most comfortable with. Often coming out to one’s parents is the most difficult. Be mindful of the timing, the venue as well as the method of your disclosure and allow them time and space to absorb this new knowledge.

It is important to be prepared for the various reactions of the people with whom you share your sexual orientation. People may show shock, disbelief and have many questions to ask. Treat their concerns seriously and answer as honestly and openly as possible.

Coming out is a difficult and very brave decision to make. However,making this choice can lead to a far happier and more meaningful life.

 

Published in Diversity Magazine – October 2014


Children’s Mental Health

July is Mental Illness Awareness month – a time to reflect on mental health and give thought to how we can go about attaining it.

The World Health Organisation defines health as  “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition focuses on the positive aspects of mental health. Our mental health is part of our overall health and enables us to cope effectively with our daily life, be productive and reach our full potential. It is, therefore, well worth looking after.

Everyone is susceptible to mental health problems, irrespective of age, gender, culture or socio-economic group. Feelings such as fear, anxiety, irritability and sadness are common and are generally of short duration. However, if they last longer and begin disrupting our daily functioning, they could be signs of something more serious. Biological factors, our current environment and negative life experiences all contribute to our mental health difficulties.

Twenty-five % of children suffer with mental health complications. Parents play an important role in promoting their young ones’ mental health. There are several ways in which this can be done:

  1. Provide unconditional love: It is important that children are loved unconditionally. They need to know that whatever mistakes they make, whatever grades they achieve, however “naughty” they are, they will still be accepted wholeheartedly.
  2. Discipline consistently and lovingly: Teach your children the difference between acceptable and unacceptable behaviour and be the perfect role model. The consequences for incorrect behaviour should be fair and consistent. Set reasonable limits and allow your child to make age appropriate choices.
  3. Boost self-esteem: Children rely on adults to assist in developing positive self-esteem and confidence. A child that is always experiencing disapproval grows up believing they are unworthy. A child’s behavior needs to be separated from them as a person – bad behavior does not mean a bad person. Be on the look out for positive behaviours and praise them rather than only reprimanding unsuitable behaviours. For every negative comment there should be 5 positive ones.
  4. Provide time for play: Children learn through play which contributes to  both their physical and mental health. Setting aside time regularly to play with your child one-on-one, is a great bonding opportunity which increases their sense of worth and self-esteem.

Sibling Rivalry

Sibling rivalry refers to the competition, jealousy and fighting that occurs in many instances between brothers and sisters. It generally begins with the introduction of the new sibling and can carry on throughout childhood right into adulthood. Children have a strong need to grow up feeling safe and secure in their parent’s love and sometimes feel threatened when a baby arrives in their family. It is often hard for a child, especially the first-born, to accept and love their new sibling. Parents have to devote a lot of time to the needs of the new baby resulting in the first child feeling left out and competing for attention. They are also forced to share things such as toys, sweets, personal space and clothing, that they have never had to share before. As they grow older, feelings of being treated unfairly when one child receives something the other may not have – a later bedtime, a new toy – lead to jealousy and resentment. Unlike friends, siblings cannot be chosen and often personality differences can result in them simply not liking each other.

Although sibling rivalry is common it can be extremely frustrating and upsetting for parents. It is difficult to know how to deal with the fighting, as stepping in to resolve the issue often creates the impression that one child is being favoured. This exacerbates the problem and can cause resentment for one child whilst encouraging the other child to rely on its parent’s help to rescue him. It is important to try not to take sides, to remain uninvolved and to give them the opportunity to try and resolve their own differences.

Although it is best to let children sort out their own conflict, it is often difficult for them, as they don’t have the necessary emotional maturity and conflict resolution skills. If the situation is getting out of hand or either child is being emotionally or physically bullied, parents need to intervene and mediate. Working with both children and guiding them to deal with disputes in a healthy manner teaches skills that will benefit them for the rest of their lives.

When children argue, parents should not get drawn into the emotions. Children must be encouraged to calm down by finding their own safe space. This must not be seen as a punishment but rather as a cooling down period. Once they are calmer they can be helped to find a win-win solution – they can perhaps take turns with the wanted toy, find a game they can play together or share the last piece of cake. This is a perfect opportunity to teach negotiation and compromise.

In order to curtail rivalry amongst siblings, the following points should be considered:

  • Show each child that they are loved unconditionally. Never, ever take sides or compare your children – each child is unique and has its own strengths
  • Don’t dismiss angry, resentful feelings. Validate them and teach your children how to deal with them in a positive manner
  • Structure family time when everyone has fun and no-one has to compete for attention. Also spend one-on-one time with each child to enable them to enjoy your undivided attention
  • Be the best role model – children will deal with conflict in the same way they observe their parents dealing with it
  • Children have a right to their own possessions – they should not be forced to share everything
  • Allow children their own space for play and for friends. Encourage separate play dates
  • Teach children from a young age that everything cannot be equal. Different children have different needs and should be treated as individuals
  • Establish rules for acceptable behavior. Name calling, hitting or damaging property should never be tolerated
  • Draw up schedules to eliminate disputes, e.g. TV programs, whose turn it is to sit in the front of the car
  • Teach your children how to deal with teasing
     Published in Get It Magazine (Ballito.Umhlanga) – March 2015

 


Children’s Comments

Being allowed to enter into a child’s world in play therapy sessions has been, and remains, a great privilege. I learn so much from each and every little person.

 

” You go for counselling when you feel angry and sad and the counsellor cheers you up”  - Aron (8 Years old)

“Don’t wish your life away – it’s hard being an adult” – Luca (8 years old)

“Things just change when you’re an adult – it’s just the way it is. It’s tough luck” – Gabriel (9 years old)

” I don’t understand adults – they make the rules and then they break them” – Gabriel (9 years old)

” I don’t understand what ‘back chatting’ is. I listen to what the teacher says to me, I think about it and then give her my opinion….” – Gabriel (9 years)


How to Love Yourself

February – the month of love!

A time for celebrating romance with roses and champagne… or is it? The reality is that, for many of us, it is a time of feeling unloved and rejected – longing for that perfect relationship and that perfect romantic partner so that we can feel cherished and secure.We search for love “out there” – our “other half” to  make us feel whole – often going through one relationship after another or staying in a dysfunctional one rather than the fearful aspect of facing life on our own. We search outside of ourselves to fill the emptiness inside -  seldom looking within for support and happiness.

Our relationship with ourself and self love is the core of living a fullfilling and joyful life and is often the most neglected. We work on relationships with partners, family and friends but seldom with ourselves. We learn at an early age to don masks to hide the parts of ourselves which we have learned not to like and which we fear will prevent us from being accepted.We measure our sense of self worth by our perceived perceptions of how others see us. We are setting ourselves up for failure if we allow the rest of the world to determine how we see ourselves.

Learning to love ourselves empowers us to create the life we want and to experience joy and peace. Every relationship in our life will reflect this loving relationship. Once we learn to love ourselves we are capable of being loved and of loving others.

How do we begin to create this self love?

  1. Get to know yourself better : embark on a journey of personal growth to get to know yourself and to discover your authentic inner being. This can be a very challenging but extremely rewarding task. Re–visit your past to establish the origins of your negative self talk and find ways to disarm your  inner critic.
  2. Self nurture : discover what makes you truly happy – it could be listening to your favourite music, reading, a bubble bath… Treat yourself by indulging in a little of this each day.
  3. Journal : buy a journal, decorate it and commit yourself to writing a couple of pages in it every morning. Let it be an uncensored account of your thoughts and feelings.
  4. Take yourself on a date : delight yourself by doing something just for you – something self indulgent and extravagant. Rediscover what you love doing.
  5. Forgive yourself : mistakes happen – forgive yourself and move on.
  6. Be kind to yourself : become your own best friend and treat yourself as such. Develop compassion and understanding.
  7. Remove your masks : accept yourself for who you are. Celebrate your uniqueness and live for yourself without fear of what others may think.
  8. Avoid the inner critic : pause regularly and observe the voice in your head – your inner critic. Question it and most of the time you will find that it does not tell the truth. Learn to speak kindly to yourself.

Make this your year of self discovery – find your authentic self, remove your masks and learn to accept and love yourself for who you are. Your relationship with yourself is the most important relationship you’ll ever have.

 

“You can search throughout the entire universe for someone who is more deserving of your love and affection than you are yourself, and that person is not to be found anywhere. You yourself, as much as anybody in the entire universe deserve your love and affection.”  

– Buddha

 


Eating Disorders

Today’s teenagers and young adults have grown up in a world bombarded with social media reinforcing youth, beauty and ‘physical perfection’. Pop-stars, celebrities and athletes all model cultural standards of bodily aesthetics, and youngsters are taught to believe that you can only find love, friendship, wealth and fame through the attainment of  an extremely lean, medically unhealthy body weight. This has a particularly negative impact during the teenage years, which are usually quite emotionally turbulent, with many body image issues arising.
Clinical psychologist and head of psychological services at Tara Hospital’s Eating Disorders Unit, Jasmine Kooverjee says: “Eating disorders typically develop in adolescence to early adulthood.” Females are more likely than males to develop an eating disorder. However, international professionals have started to see a growing trend among men, specifically those in their teens and 20s.

The main types of eating disorders are anorexia nervosa, where people see themselves as overweight, even though they are dangerously thin, and they use extreme measures to control their weight; and bulimia nervosa, characterised by binge-eating episodes followed by compensatory behaviour like vomiting, fasting or excessive exercise. Binge-eating is also highlighted and involves frequent episodes of out-of-control eating not followed by behaviours aimed at purging the body of excess calories.

Shannon became bulimic at the age of 16: “Some people try to buy happiness… I tried to eat it – repeatedly and in copious amounts. Then, I’d vomit it out, trying to rid myself of the profound pain this addictive cycle never managed tor relieve. Food had become my ‘drug of choice’ – bulimia allowed me to temporarily escape from my feelings of hurt, rejection and devastation.”

Eating disorders are not due to a failure of will or behaviour – they are real, treatable medical illnesses. Kooverjee says: “At Tara we have an inpatient programme that uses the Cognitive Behavioural Therapy (CBT) approach, which focuses on the factors that maintain an eating disorder rather than on its causes. Research suggests this is an extremely effective form of treatment for eating disorders. Additional treatments include group therapy, psychodynamic therapy and medication.”

People with eating disorders often do not recognise or admit that they’re ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person receives care and rehabilitation.

Signs of an Eating Disorder

  • Constant dieting or fasting
  • Skipping meals
  • Making excuses for not eating
  • Frequently looking in the mirror at ‘flaws’
  • Wearing baggy clothing
  • Eating in secret/Not eating in public
  • Going to the toilet during meals
  • Having an intense fear of gaining weight
  • Exercising excessively
  • Having a distorted, negative body image
  • Withdrawing from social activities
  • Feeling disgusted over the amount of food eaten
  • Inducing vomiting

( A direct transcript from “Facebook Fridays” )


Tai Chi Improves Symptoms of Parkinson’s Disease

Study: Tai Chi Leads to Smoother, Steadier Movements, Longer Strides, and Fewer Falls Compared to Other Types of Exercise

 

By Brenda Goodman, MA
WebMD Health News

Reviewed by Laura J. Martin, MD

 

Feb. 8, 2012 – Tai chi, a type of exercise that guides the body through gentle, flowing poses, may help some of the worst physical problems of Parkinson’s disease, a new study shows.

If further studies confirm the findings, experts say it appears that tai chi might be an effective therapy for improving a person’s ability to walk, move steadily, and balance. Tai chi may also reduce the chances of a fall.

“The results from this study are quite impressive,” says Ray Dorsey, MD, MBA, a neurologist and associate professor at Johns Hopkins School of Medicine in Baltimore.

“It’s always difficult to compare results across studies, but the magnitude of the impact that they had is larger, in some cases, than what is seen with medications in Parkinson’s,” says Dorsey, who also directs the Movement Disorders Center and Neurology Telemedicine at Johns Hopkins. He was not involved in the research.

Parkinson’s disease involves the slow destruction of brain cells that make a chemical called dopamine. Nerve cells depend on dopamine to send messages that guide muscle movement. As the cells die, movements may become shaky, stiff, and unbalanced. Walking may be harder. It may also be tougher to start a movement or keep going.

Medications may help control some things, like tremors, but many drugs are not as good at helping the so-called axial symptoms of Parkinson’s disease, which include problems with balance and walking.

Tai Chi Comes Out Tops

For the study, doctors assigned 195 people with mild-to-moderate Parkinson’s disease to one of three groups: The first took tai chi classes, the second exercised with weights, and the third was assigned to a program of seated stretching. All the groups met for 60-minute sessions twice each week.

After six months, people who had been taking tai chi were able to lean farther forward or backward without stumbling or falling compared to those who had been doing resistance training or stretching. They were also better able to smoothly direct their movements. And they were able to take longer strides than people in the other two groups.

Like resistance training, tai chi helped people walk more swiftly, get up from a chair more quickly, and increased leg strength.

Perhaps the most impressive benefit of tai chi, however, was related to falls. Falls are common in people with Parkinson’s, and they can cause serious injuries, including fractures and concussions. Studies show falls are the main cause of hospitalizations in Parkinson’s patients. People in the tai chi group reported half the number of falls compared to those who were taking resistance training and two-thirds fewer falls than people who were doing light stretching exercises.

The research is published in the New England Journal of Medicine.

Mind-Body Benefit?

“This is a very encouraging study,” says Chenchen Wang, MD, Msc, a rheumatologist and associate professor at Tufts University School of Medicine in Boston.

Wang has studied the benefits of tai chi for osteoarthritis and fibromyalgia, but she was not involved in the current research.

“Most of our previous studies have measured paindepression, and anxiety, which are subjective measures. These results are very impressive because they used objective measurements,” Wang tells WebMD.

It’s not clear exactly why tai chi may offer an edge over more conventional kinds of exercise like resistance training, but researchers say they believe it probably has something to do with the mind-body connection that’s encouraged throughout the poses.

“It’s intentional movement. So every step you take, you are aware of it. We put quite a bit of emphasis on the self-awareness of the movement,” says Fuzhong Li, PhD, senior scientist at the Oregon Research Institute, a nonprofit center for the study of human behavior in Eugene, Ore.

Additionally, Li says, tai chi has some practical advantages over other kinds of exercise.

“You don’t need any equipment. You can practice anywhere, anytime. It’s low cost. It can easily be incorporated into the rehab setting, as well,” Li says.