By Brian L. Odlaug, Samuel R. Chamberlain, and Jon E. Grant
Surprisingly, many of the common mental health conditions in the world also happen to be the least well known. While Obsessive Compulsive Disorder garners attention from international media, with celebrities talking openly about their experiences with the condition, Obsessive Compulsive Related Disorders are far less recognized and receive scant attention.
Obsessive Compulsive Related Disorders include body dysmorphic disorder, tic disorders (including Tourette’s Syndrome), hair pulling disorder, excoriation (skin picking) disorder, hoarding disorder, and hypochondriasis. The clinical course and severity of these disorders varies from person to person yet can often be recognized by common symptoms. One might ask, what makes these “disorders” in need of treatment rather than everyday habits? A “bad habit” becomes a diagnosable disorder when the behavior becomes hard to control, and has a negative impact on an individual’s ability to function: at home, at work, or in the community. These often impairing conditions affect millions of people around the world, but are usually hidden. What can we do to help those suffering in silence?
Promoting screening for Obsessive Compulsive and Related Disorders is of the utmost importance. Society, the media, and healthcare professionals also need to work together to increase awareness of these conditions and provide timely and adequate treatment. The majority of people with these conditions have never sought treatment, and may not even be aware that they have a medically recognized condition that is potentially treatable. Left untreated, Obsessive Compulsive and Related Disorders frequently follow a chronic course, meaning that symptoms often do not improve with time, without intervention. In fact, many people have suffered with the condition for 10, 20, even 30 or more years without clinical recognition. Few other classes of disorders — mental health or otherwise — carry the overall lack of recognition and treatment as these disorders.
Individuals living with these conditions also should be aware of valuable advocacy and support groups that exist worldwide, including the Trichotillomania Learning Center and Tourette’s Syndrome Association in the United States, and OCD Action in the United Kingdom, to name a few.
Bringing these disorders out from the shadows and into the mainstream of mental health and community consciousness can only serve to improve the quality of life for our family members, neighbors and friends.
Five things that you can do to help people who suffer from OCD:
- Clinicians should screen for Trichotillomania and Excoriation Disorder in all patients, but especially women. Most people will not acknowledge the behavior readily and may not even know that they have a diagnosable and treatable problem.
- Clinicians should be aware that although anxiety may worsen some of these behaviors, that OCD and the Related Disorders are not simply versions of anxiety and therefore must be treated differently.
- Due to the potential impairment of OCD, clinicians need to take it seriously and not view it simply as an oddity.
- Family members should be supportive of someone with OCD and not shame or embarrass the person into stopping the behavior.
- People with these conditions can help themselves and others as well. Print out articles or information on your condition and show them to family, friends, or even your doctor. They might not know a lot about these disorders either and you can help educate them.
Brian L. Odlaug is a Visiting Researcher at the University of Copenhagen, Department of Public Health. Brian has authored or co-authored over 120 peer-reviewed articles and book chapters, specializing in the areas of addiction, impulse control and obsessive compulsive disorder. Samuel R. Chamberlain is a practicing psychiatrist and Clinical Lecturer at the Department of Psychiatry, University of Cambridge. He has published more than 100 peer-reviewed articles including first-authored papers in Science, the American Journal of Psychiatry, the British Journal of Psychiatry, and others. Jon E. Grant is a Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago where he directs the Addictive, Compulsive and Impulsive Disorders Research Program. They are co-authors of Clinical Guide to Obsessive Compulsive and Related Disorders.
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Image Credit: Person washing his hands. Photo by Lars Klintwall Malmqvist. Public domain via Wikimedia Commons.
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By Daniel Freeman and Jason Freeman
Students are often told — perhaps by excited friends or nostalgic parents — that university is the best time of their life. Well, for some people these years may live up to their billing. For many others, however, things aren’t so straightforward. College can prove more of a trial than a pleasure.
In truth it’s hardly surprising that many students struggle with university life. For one thing, it’s probably the first time they’ve lived away from home. College involves all sorts of potentially daunting changes and challenges with the young person’s support network of family and friends usually many miles away.
It isn’t only university life that students may be struggling with. Many common psychological problems also tend to develop around this stage of life. Depression, phobias, social anxiety, panic disorder, insomnia, alcohol problems, eating disorders, sexual problems — all typically begin during adolescence or early adulthood.
Whether students arrive at university with these problems, or develop them while there, coping with mental health issues alone and in a strange town can be particularly difficult. It’s not made any easier by the assumption that you should be having a ball.
When we think about mental health, one issue that is often overlooked is gender. Yet who is more likely to develop almost all of the psychological problems we’ve mentioned? The answer is clear: women.
Indeed, although it’s commonly asserted that rates of psychological disorder are virtually identical for men and women, when one takes a careful look at the most reliable epidemiological data a very different picture emerges.
Contrary to received wisdom, overall rates of psychological disorder are not the same for both sexes. In fact, they are around 20-40% higher in women than in men. Depression, for example, affects approximately twice as many women as men. The same is true for anxiety disorders. Women are anywhere from three to ten times more likely to develop eating disorders such as anorexia and bulimia nervosa. There’s good evidence to suggest that women are more vulnerable to both sleep disorders (primarily insomnia) and sexual problems (such as loss of desire, arousal problems, and pain during sex — all of which are classified as psychological issues).
This doesn’t mean, of course, that mental illness is an exclusively female problem — far from it. Very large numbers of men experience depression and anxiety, for example.
Nevertheless, though men tend to be prone to so-called externalizing disorders such as alcohol and drug problems and anti-social personality disorder, while women are more susceptible to emotional problems like depression and anxiety, the figures aren’t equal. If the epidemiological data is reliable, women clearly outnumber men for psychological disorders as a whole.
How do we explain this phenomenon? Why is it that women appear to be more vulnerable to mental illness than men? Well, this is an under-researched area. In the case of certain disorders — depression, most notably — some useful work has been done on gender. For most conditions, however, we have little evidence for why men and women are affected differently.
Things are especially tricky because mental illness is seldom the result of just one factor: a complex mix of genetic, biological, psychological, and social causes is often involved. Yet patterns do emerge from the limited research that has been conducted into the links between gender and mental health. What stands out is the stress caused by life events and social roles.
It’s certainly plausible that women experience higher levels of stress because of the demands of their social role. Increasingly, women are expected to function as career woman, homemaker, and breadwinner — all while being perfectly shaped and impeccably dressed: “superwoman” indeed. Given that domestic work is undervalued, and considering that women tend to be paid less, find it harder to advance in a career, have to juggle multiple roles, and are bombarded with images of apparent female “perfection”, it would be surprising if there weren’t some emotional cost. Women are also much more likely to have experienced childhood sexual abuse, a trauma that all too often results in lasting damage.
How do these environmental factors affect the individual? At a psychological level, the evidence suggests that they can undermine women’s self-concept — that is, the way a person thinks about themselves. These are the kind of pressures that can leave women feeling as if they’ve somehow failed; as if they don’t have what it takes to be successful; as if they’ve been left behind. Body image worries may be especially damaging. Then there’s the fact that women are taught to place such importance on social relationships. Such relationships can be a fantastic source of strength, of course. But to some extent we’re relying on other people for our happiness: a risky business. If things don’t work out, our self-concept can take a knock.
Perhaps then, part of the reason why so many common psychological disorders begin in adolescence and early adulthood is because this is the time when young people start to take on the demands of their conventional adult role. If those demands are more stressful for women than men that may help explain why we see young women start to outnumber young men when it comes to psychological problems.
But we need more evidence. The best answers will come from longitudinal studies: following representative cohorts over a number of years from childhood into adulthood, and carefully measuring the interaction between biological factors, life events, and mental illness.
Such research is complex and expensive, but given the extent of the burden on society and individuals alike, understanding what causes mental illness and thus being better placed to prevent and treat it should need no justification. Yet we cannot assume, as so many have done, that gender is merely a marginal issue in mental health. In fact, it may often be a crucial element of the puzzle.
Daniel Freeman is Professor of Clinical Psychology and MRC Senior Clinical Fellow, Oxford University. Jason Freeman is a freelance writer and editor. Together they wrote The Stressed Sex: Uncovering the Truth About Men, Women, and Mental Health, Anxiety: A Very Short Introduction, and Paranoia: The 21st Century Fear.
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Image Credits: (1) Stressed student. Photo by Alexeys, iStockphoto. (2) Hard study. Photo by Oliver, iStockphoto.
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The final monumental work of the late Professor David Marsden – Marsden’s Book of Movement Disorders – is due for publication this month, almost thirty years on from when the project was initially conceived. In homage to the ‘father of movement disorders’, his friend and colleague, Ivan Donaldson, has written a personal reflection on great contribution and influence David had on the field of movement disorders.
By Ivan Donaldson
When, at the tender age of 34 years, Christopher David Marsden was appointed as inaugural Professor of Neurology at Kings College Hospital and the Institute of Psychiatry in London, the now well-established neurological subspecialty of movement disorders did not exist. I first met him two years after he took up this chair and was so seduced by his enthusiasm, depth of knowledge, and friendly manner, that I went to work with him. He had already developed two research laboratories, one devoted to investigating the physiological mechanisms underlying posture, balance, and movement in health and disease; and the other to elucidating the underlying brain biochemistry. At the same time he was running a very busy neurology clinic.
Prior to then, knowledge of the diseases, which fascinated him so much, was to a large extent descriptive. David sought to find their causes, the mechanisms by which they had their ill effects, and effective therapies for them. In addition, he strongly advocated that a number of muscular spasms, which had previously been thought to have a psychological basis, were actually organic. He recognised that several apparently unrelated conditions, such as writers’ cramp, facial grimacing, and spasmodic movements of the neck, were really different focal expressions of the same underlying disorder, namely dystonia. Subsequent scientific discoveries, including genetics, proved him to be correct. He was instrumental in persuading the UK Parkinson’s Disease Society to establish a ‘brain bank’, which has led to many important scientific studies that have greatly increased our knowledge of the condition.
The importance of movement disorders was also given a boost when in 1987 David was appointed to the prestigious chair of Clinical Neurology at the Institute of Neurology and National Hospital for Neurology and Neurosurgery at Queen’s Square, London. There he was instrumental in establishing a new research unit into human movement and balance, directly funded by the Medical Research Council, and he helped set up functional neuro-imaging. He travelled widely and became a visiting professor at over 40 institutions worldwide.
Source: Journal of Neurology, Neurosurgery & Psychiatry
In 1986 he and Stanley Fahn had established the International Movement Disorder Society and the movement disorder journal, of which they became the editors. This journal broke new ground by using video — the perfect medium in which to demonstrate disordered movement. The field of movement disorders, consisting of conditions in which disturbance of movement does not result from weakness, was born. Although there were other pioneers, the depth, breadth, and quality of David’s original contributions and his pivotal role in promot
Julio Torres, Intern
Carol S. North and Sean H. Yutzy edited the sixth edition of Goodwin and Guze’s Psychiatric Diagnosis, which provides an overview of major psychiatric disorders, covering the definition, historical background, epidemiology, clinical picture, natural 
history, complications, family studies, differential diagnosis, and clinical management of each disorder.The excerpts bellow recount the place in history of panic disorders and phobias, and hysteria —what’s fascinating about both histories is the cultural emphasis in women as bearers of these disorders. In both cases, earliest observations (even in their most primitive, often inaccurate form) dealt almost exclusively with women and were constantly paired with superstitions of the time. The trend articulates the phenomenon of sexism in early psychological research.
Panic Disorder and Phobias
My cheek is cold and white, alas!
O lift me from the grass!
I die! I faint! I fall!
…
My check is cold and white, alas!
My heart beats loud and fast.
Percy Bysshe Shelley,
The Indian Serenade
It has been suggested that Shelly was having a panic attack when he wrote these lines. If so, he probably would have called it something else. In the nineteenth century, “anxiety reactions’ referring to fainting—which was fashionable among women in the era—were called “vapors.” Modern patients with panic disorder also sometimes faint—probably from hyperventilating. In Victorian times the prototype of a refined young woman was a “sooner, pale and trembling, who responded to unpleasant or unusual situations by taking to the floor in a graceful and delirious maneuver, in no way resembling the crash of an epileptic”… A Jane Austen heroine found one social situation “too pathetic for the feelings of Sophie and myself. We fainted alternately on a sofa.” Overly tight corsets may have been responsible for some of the fainting. A nineteenth-century physician, Dr. John Brown, cured fainting by “cutting the stay laces, which ran before the knife and cracked like a bow string”…
One of the first medical terms to describe anxiety disorders was “neurasthenia,” defined by an American physician, G.M. Beard, in 1869… Neurasthenia broadly included patients with hysteria, obsessional illness, and anxiety disorders, as well as hypochondriacs and swooners… The term “anxiety neurosis” was first used by Freud in 1895. It was not until 1980 that the concept of neurosis was dropped form American Psychiatric Association general nomenclature, and the term “panic disorder” replaced the older term “anxiety neurosis” as the disorder’s official name… Panic disorder was later subdivided into two types, with and without agoraphobia…, a distinction that still holds today.
The term phobia originates from the name of a Greek god, Phobos, whose likeness was painted on masks and shields for the purposes of frightening the enemy… The word phobia first appeared in medical terminology in Rome 2,000 years ago, when hydrophobia was used to describe a symptom of rabies. Hippocrates also described cases of phobic fears.
