What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and
repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your
obsessive thoughts and compulsive behaviors are irrationalbut even so, you feel unable to resist them and break
free.

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a
particular thought or urge. For example, you may check the stove 20 times to make sure its really turned off, or wash
your hands until theyre scrubbed raw.

Understanding OCD obsessions and compulsions

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in
your mind. You dont want to have these ideas, but you cant stop them. Unfortunately, these obsessive thoughts are
often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are
performed in an attempt to make obsessions go away. For example, if youre afraid of contamination, you might
develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back
stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding
and time-consuming.

Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:

Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or
danger.

Doubters and sinners are afraid that if everything isnt perfect or done just right something terrible will
happen, or they will be punished.

Counters and arrangers are obsessed with order and symmetry. They may have superstitions about
certain numbers, colors, or arrangements.

Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things
that they dont need or use.

Signs and symptoms of obsessive-compulsive disorder (OCD)

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people
experience just one or the other.

Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

Fear of being contaminated by germs or dirt or contaminating others

Fear of causing harm to yourself or others

Intrusive sexually explicit or violent thoughts and images

 Excessive focus on religious or moral ideas

Fear of losing or not having things you might need

Order and symmetry: the idea that everything must line up just right

Superstitions; excessive attention to something considered lucky or unlucky

Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

Excessive double-checking of things, such as locks, appliances, and switches

Repeatedly checking in on loved ones to make sure theyre safe

Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety

Spending a lot of time washing or cleaning

Ordering or arranging things just so

Praying excessively or engaging in rituals triggered by religious fear

Accumulating junk such as old newspapers or empty food containers

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD)

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves two components:

1. Exposure and response prevention involves repeated exposure to the source of your obsession. Then you
are asked to refrain from the compulsive behavior youd usually perform to reduce your anxiety. For
example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public
restroom and then be prevented from washing. As you sit with the anxiety, the urge to wash your hands will
gradually begin to go away on its own. In this way, you learn that you dont need the ritual to get rid of your
anxietythat you have some control over your obsessive thoughts and compulsive behaviors.

2. Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A
big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive
thoughts, without resorting to compulsive behavior.

Battered woman syndrome

Battered woman syndrome (BWS) is a mental disorder that develops in victims of domestic violence as a result of
serious, long-term abuse. BWS is dangerous primarily because it leads to learned helplessness or psychological
paralysis where the victim becomes so depressed, defeated, and passive that she believes she is incapable of leaving
the abusive situation. Though it may seem like an irrational fear, it feels absolutely real to the victim. Feeling fearful and
weak, and sometimes even still holding onto the hope that her abuser will stop hurting her, the victim remains with her
abuser, continuing the cycle of domestic violence and strengthening her existing BWS.

Battered woman syndrome is recognized by many states as a legitimate mental disorder, and there are support systems
available to women who suffer from a situation of domestic violence and BWS. Its worth noting, also, that the laws of
many states account for violent outbursts by BWS victims. If you or someone you know is afraid of coming forward to
authorities because of an injury to the abuser, there may be ways to avoid punishment. Read ahead to learn more.
How Does BWS Develop?

Battered woman syndrome begins as an abusive cycle with three stages. First, the abuser engages in behaviors that
create relationship tension. Second, the tension explodes when the abuser commits some form of abuse: physical,
psychological, emotional, sexual, or otherwise. Third, the abuser tries to fix his wrongdoing and apologizes. This third
stage is frequently referred to as the honeymoon stage, and involves the abuser making amends for his bad behavior.
During the honeymoon stage, the abuser is forgiven, and the cycle starts all over again.

As the cycle continues, the victim starts to feel that the abuse is her own fault. When the victim takes responsibility for
her own abuse, this develops into learned helplessness. The victim feels helpless because she has convinced herself
that the abuse is her own fault, yet she cannot understand why the abuse continues if its her own fault. She becomes
convinced of her helplessness, and that the abuse cannot be escaped. Thus, battered woman syndrome develops.

Recognizing BWS

Women suffering from BWS share certain observable characteristics. Speaking with a battered woman should reveal
these characteristics and help to identify her as sufferer of BWS. The common characteristics of BWS women are as
follows: 1) She takes full responsibility over the abuse, and finds it difficult or impossible to blame the abuser himself; 2)
She fears for her safety; 3) She irrationally believes that the abuser is all-powerful and will hurt her if she contacts the
authorities and seeks help.

BWS women will frequently show signs of depression, too. They may be less enthusiastic about the activities they used
to enjoy. They may also start to abuse drugs and alcohol. Once the signs of BWS are recognized, its important to get
help.

Getting help for BWS

As with any domestic violence situation, women with battered woman syndrome should contact local law enforcement
authorities and report their abuser. The police will make an arrest and the prosecution will hopefully advance. At this
point, many battered women may try to recant their statements. They may feel sorry for their abuser or may fear
violence if the police let him go.

A large number of battered women recant, but its important to keep in mind that recanting may subject the battered
woman to criminal charges for lying to authorities. Its also worth noting that recanting does not usually affect the case. If
the abuser has been arrested and his case moved forward, recanting will do little to prevent this.

Battered women may also worry about testifying in court against their abuser. In domestic violence cases, the victim is
required to testify in court against her abuser. BWS women are often afraid of their abusers. There are support options,
however. In fact, there are people known as victims aides who will stand in court and provide support for the victim as
she testifies.

Aside from these legal options, there are also organizations that provide psychological and emotional support to
battered women. This may be necessary, as the separation process can be extremely difficult and confusing for a
battered woman.

BWS and the Law

Battered woman syndrome is now recognized in legislation by many states and is considered when defending battered
wives who kill or injure their abusive spouses. For the courts, BWS is an indication of the defendant's state of mind or
may be considered a mitigating circumstance. For example, the court may consider that a BWS woman felt that she
was justified in attacking her abuser, and that she was in reasonable fear of imminent danger due to her condition and
her experiences with the abuser.

If you or someone you know is a victim of domestic violence and possible a sufferer of BWS, please contact your local
authorities and local support organizations. There are many avenues available for these women to receive help.

The four psychological stages of battered woman syndrome

DENIAL The woman refuses to admit--even to herself--that she has been beaten or that there is a "problem" in
her marriage. She may call each incident an "accident". She offers excuses for her husband's violence and each
time firmly believes it will never happen again.

GUILT She now acknowledges there is a problem, but considers herself responsible for it. She "deserves" to be
beaten, she feels, because she has defects in her character and is not living up to her husband's expectations.

ENLIGHTENMENT the woman no longer assumes responsibility for her husband's abusive treatment,
recognizing that no one "deserves" to be beaten. She is still committed to her marriage, though, and stays with
her husband, hoping they can work things out.

RESPONSIBILITY Accepting the fact that her husband will not, or can not, stop his violent behavior, the
battered woman decides she will no longer submit to it and starts a new life.

Postpartum and peripartum depression

A new addition to the family brings with it lots of changes, and a myriad of emotions may be
experienced in the first weeks of your new infants life. While a birth is anticipated over a long period,
most believe it will be a joyful and uplifting experience, but it also can create some shifts that are not
anticipated. New parents expect to be sleep deprived and to have some challenges with
breastfeeding, schedules, and trying to figure out their baby needs, but they also expect to have a
happy blissful feeling about the birth of their new baby. However, depression is often an unanticipated
occurrence.

Although this may be the case for a majority of families, a sizeable minority of new moms have a
different response. Peripartum Depression is the term which is used to include depression in
pregnancy and postpartum (after the birth) depression. The percentage of depression is 18.4%
during pregnancy and 19.2% postpartum (Dtsch Arztebl Int. 2012 Jun;109(24):419-24.).

Many new moms may feel weird or different because of their responses or feelings about pregnancy
and/or after the birth. They may not realize how common Peripartum Depression is for parents of
newborns, and thus, feel alienated and hesitant to speak up about it. This can intensify the new
mothers depressive symptoms, negative self-talk and sense of isolation.

New dads may want to help and support , but telling her to snap out of it, its not that hard, they do
not understand why she is feeling down, and/or she should be fine are very common responses.
These responses can unintentionally further increase the new moms sense of isolation and
alienation. Then, the question becomes what can we do to support new mothers and how to identify
Peripartum Depression (PPD) early?

Symptoms & Risk Factors:

The symptoms of Peripartum Depression can include irritability, crying, feeling restless, trouble
sleeping, extreme exhaustion (can be emotional and/or physical), changes in appetite, difficulty
focusing, increased anxiety and/or worry, disconnected feeling from baby and/or fetus, and losing
interest in formerly pleasurable activities. Less frequently in postpartum psychosis, it can include fear
that the baby could be accidentally harmed and/or urges to harm the baby. If we notice irritability and
mood shifts early. then mom can get the support she needs to help circumvent the rollercoaster she
would otherwise experience.

Risk factors for Peripartum Depression include a history of anxiety and/or depression, history of
depression within the family, social isolation (ie. Minimal support network) and/or a difficult birth.
Women who have these risk factors do not always get PPD and some get it without any of these risk
factors. These symptoms are more of a guide to let us know who would more likely to be at risk. If a
woman has these factors present in her history then it is helpful for family members and the woman to
know more about the signs of Peripartum Depression, as responding promptly can help to arrest the
course of her depression.

Supporting new moms who are experiencing Peripartum Depression:

Family members can encourage new moms to make their medical providers aware of symptoms
because it is critical for them to be involved as part of the support and intervention process. Self Care
such as physical activity, communication, sunshine, rest, and getting outdoors can help with the
depressive symptoms and decrease a moms sense of isolation. It can also help to break the cycle of
negative self-talk. A local support group can be a good place for new moms to be with others having
a similar experience and be with others who understand her experience. Lastly, once a mother
understands her own experience she can help educate and recognize others who may experience
peripartum depression in her family and/or community. This can go a long way in breaking the silence
and stigma around this common phenomenon.

PERIPARTUM DEPRESSION

This is a disorder that has been in existence for longer than most people care to admit. It is only within the past
10 or so years that it has been diagnosed and received attention. It has particular relevance given the release of
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on May 18, 2013.

The release of DSM-5 should be a cause for celebration for women, as peripartum depression is officially
recognized for the first time. In addition to acknowledging the significant prevalence of depression during the
postpartum period, the criteria have been expanded to acknowledge the fact that depression can begin even four
weeks prior to birth. Hopefully, this will lead to women being more open about how they feel both during
pregnancy and after giving birth, and receiving the treatment they need and deserve.

WHAT ARE THE CHARACTERISTICS?

It is important to distinguish between the so-called baby blues and the peripartum depression. The baby blues
affects about three quarters of new mothers, and are characterized by symptoms that commonly occur during the
menstrual cycle: tearfulness, anxiety, and mood swings. Baby blues are considered a normal part of postpartum
adjustment, and the symptoms are typically mild and transient. They typically begin around the second or third
day post partum, and they usually resolve within 2 to 3 weeks. They dont generally require any intervention. With
reassurance, support, and good self-care, women get through this quite well.

Symptoms of peripartum depression typically began two weeks to approximately 6 months after childbirth.
However this is a generalization, and women have been known to experience peripartum depression up to one
year after birth. There are several risk factors associated with peripartum depression. These include:

depression or anxiety during pregnancy

personal or family history of depression or anxiety

social isolation or poor support

childcare related stressors

having a history of mood changes while taking birth control or fertility medications

In addition, there is a 50 to 80% risk of having peripartum depression if a woman has experienced a previous
episode.

WHAT IF I HAVE ANXIETY AND NOT DEPRESSION?

Anxiety occurs in approximately 15 to 20% of women with the illness and it can be paralyzing. In fact, it is now
thought that anxiety occurs in numbers even greater than 20%. The anxiety tends to stops women in their tracks.
Its not that they dont want to respond to their babies, its that they feel that cant. The anxiety impairs them in
such a dramatic way that they are unable to function.

About 10% of women with peripartum depression will experience panic-related symptoms. These can range from
waking out of sleep with their heart pounding to difficulty breathing. Furthermore, 3%-5% will experience
obsessive-compulsive symptoms that can include thoughts and/or behaviors. Behaviors can include checking
things or counting things repetitively.

WHAT IF I HAVE THOUGHTS OF MY BABY EXPERIENCING HARM?

It is also relatively common for women to have intruding images or have intruding thoughts about harm coming to
herself, or, more commonly about harm coming to the baby. Understandably, this is of great concern to these
women.

Sometimes clinicians confuse intruding thoughts and images with postpartum psychosis. However, in women
with obsessive-compulsive symptoms due to peripartum depression, they are typically very disturbed by their
thoughts. For example, they may be saying to themselves, What kind of mom could I possibly be if I have these
crazy kinds of thoughts? They typically dont want to talk about them. It can be very helpful for these women to
be told that it is very normal for women with peripartum depression to have intruding thoughts and images. This
can normalize the situation a little bit, enough to open the door so that women feel safe talking about it. Very
often women are afraid that, if they tell anyone what theyre really thinking, their children will be taken away from
them.

Two of the common intrusive thoughts or images consist of a knife slipping or dropping the baby. Such thoughts
are caused by alterations in brain chemistry and are generally very responsive to medication, butthey are not
postpartum psychosis.

HOW IS POSTPARTUM PSYCHOSIS DIFFERENT?

In postpartum psychosis, when women have these intruding thoughts and images, it is part of their new reality.
There is limited ability to recognize that there is something wrong.

Postpartum psychosis is rare and occurs in 1-2 out of every 1,000 women who give birth. Postpartum psychosis
is a life threatening emergency. It requires immediate hospitalization for stabilization and treatment. It is known
that when a woman has postpartum psychosis, the risk for suicide goes up to 5% while the risk for infanticide
goes up to 4%. For anyone who may remember the Andrea Yates case from several years ago, she was a
woman who suffered from postpartum psychosis.

WHAT IS THE CAUSE OF PERIPARTUM DEPRESSION?

We know that the attachment relationship starts while the fetus is in the uterus. Peripartum depression is caused
primarily by hormonal changes that cross the placenta. This in turn, has an impact on the developing brain of the
fetus. After birth, there is a significant drop in estrogen, which in turn can trigger changes in a womans brain that
can lead to peripartum depression.

In addition to the hormonal changes, there are several other factors that can contribute to peripartum depression.
These include:

fatigue and sleep deprivation

awareness and anxiety about the increased responsibility of having a newborn

the physical and emotional stress of birthing

the emotional letdown after giving birth

the potential disappointment due to lack of partner support.

ARE THERE ANY RISKS TO ME OR MY BABY IF I DONT GET TREATED?

Several recent studies have shown that untreated depression, both during and after birth, can have risks to both
the mother and her baby. Untreated depression during pregnancy has been associated with the following:

low weight gain in the mother

increased rates of preterm birth

low birth weight of the baby

less compliance with prenatal care

In addition, babies that are exposed to stress and/or depression before they are born have been shown to have
increased behavioral problems. They also tend to have a higher rate of childhood psychiatric symptoms and
diagnoses.

HOW IS IT DIAGNOSED?

Treatment cannot occur without peripartum depression first being diagnosed. Several state governments and
healthcare providers have increased their routine screening of women. This sometimes can occur while the
woman is still hospitalized, but most often happens during the womans first postnatal visit. It is shown that this
tends to occur more often in OB/GYN settings versus pediatrician offices. The most common instrument used is
the Edinburgh Postnatal Depression Scale (EPDS). This is a very easy to use 10 question self rated instrument.
The goal is that increased screening leads to increased diagnosis, which hopefully leads to increased treatment.

Once diagnosed, referral to a mental health professional who is skilled in the assessment and treatment of
perinatal depression has been shown to make a big difference in the outcome. It has also been shown that lack
of a clinicians knowledge about prenatal and postpartum depression and anxiety can be another big obstacle to
treatment.

HOW IS IT TREATED?
Multiple factors, including accessibility of treatment options and patient preference for specific types of treatment,
determine whether mothers with peripartum depression obtain treatment. For example, a postpartum mother may
be unwilling to take an antidepressant due to her possible concerns about risks during breast-feeding to the
newborn.

Psychotherapy is an important first line option for peripartum depression. Interpersonal psychotherapy and
cognitive behavioral therapy have been the most studied and have both been shown to be effective for the
prevention and treatment of peripartum depression. Group therapy is particularly helpful to women with
postpartum depression because there is a sense of isolation that these women experience. There is often the
notion that no one else feels like this or Am I the only one whos going through this? in these women. Group
therapy lessens that sense of being alone. There is connection with others, which alone can be healing.

Rape trauma syndrome

rape Trauma Syndrome (RTS) is the medical term given to the response that
most survivors have to rape. It is very important to note that RTS is the natural
response of a psychologically healthy person to the trauma of rape so these
symptoms do not constitute a mental disorder or illness.

The most powerful factor in determining how people respond to rape is the
nature of the traumatic event itself. Not only is there the element of surprise, the
threat of death and the threat of injury, there is also the violation of the person.
This violation is physical, emotional and moral and associated with the closest
human intimacy of sexual contact. The intention of the rapist is often to profane
this most private aspect of the person and render the victim utterly helpless.
Rape by its very nature is intentionally designed to produce psychological
trauma. It is form of organised social violence comparable only to the combat of
war. We get nowhere in our understanding of Rape Trauma Syndrome if we think
of rape as simply being unwanted sex. Where combat veterans suffer Post
Traumatic Stress Disorder, rape survivors experience similar symptoms on a
physical, behavioural and psychological level.

PHYSICAL SYMPTOMS OF RAPE TRAUMA SYNDROME

Physical symptoms are those things which manifest in or upon the survivors
body that are evident to her and under physical examination by a nurse or
doctor. Some of these are only present immediately after the rape while others
only appear at a later stage.

Immediately after a rape, survivors often experience shock. They are likely
to feel cold, faint, become mentally confused (disorientated), tremble, feel
nauseous and sometimes vomit

Pregnancy
 Gynaecological problems. Irregular, heavier and/or painful periods. Vaginal
discharges, bladder infections. Sexually transmitted diseases

Bleeding and/or infections from tears or cuts in the vagina or rectum

A soreness of the body. There may also be bruising, grazes, cuts or other
injuries

Nausea and/or vomiting

Throat irritations and/or soreness due to forced oral sex

Tension headaches

Pain in the lower back and/or in the stomach

Sleep disturbances. This may be difficulty in sleeping or feeling exhausted

and needing to sleep more than usual

Eating disturbances. This may be not eating or eating less or needing to

eat more than usual

BEHAVIOURAL SYMPTOMS OF RAPE TRAUMA SYNDROME

Behavioural symptoms are those things the survivor does, expresses or feels that
are generally visible to others. This includes observable reactions, patterns of
behaviour, lifestyle changes and changes in relationships.

Crying more than usual

Difficulty concentrating

Being restless, agitated and unable to relax or feeling listless and

unmotivated

Not wanting to socialise or see anybody or socialising more than usual, so

as to fill up every minute of the day

Not wanting to be alone

Stuttering or stammering

Avoiding anything that reminds the survivor of the rape

 Being more easily frightened or startled than usual

Being very alert and watchful

Becoming easily upset by small things

Relationship problems, with family, friends, lovers and spouses

Fear of sex, loss of interest in sex or loss of sexual pleasure

Changes in lifestyle such as moving house, changing jobs, not functioning

at work or at school or changes to appearance

Drop in school, occupational or work performance

Increased substance abuse

Increased washing or bathing

Behaving as if the rape didnt occur, trying to live life as it was before the
rape, this is called denial

Suicide attempts and other self-destructive behaviour such as substance

abuse or self- mutilation

PSYCHOLOGICAL SYMPTOMS OF RAPE TRAUMA SYNDROME

Psychological symptoms are much less visible and can in fact be completely
hidden to others so survivors need to offer this information or be carefully and
sensitively questioned in order to elicit them. They generally refer to inner
thoughts, ideas and emotions.

Increased fear and anxiety

Self-blame and guilt

Helplessness, no longer feeling in control of your life

Humiliation and shame

Lowering of self esteem

Feeling dirty or contaminated by the rape

 Anger

Feeling alone and that no one understands

Losing hope in the future

Emotional numbness

Confusion

Loss of memory

Constantly thinking about the rape

Having flashbacks to the rape, feeling like it is happening again

Nightmares

Depression

Becoming suicidal

It is important that we recognise that people respond differently to trauma. While

most survivors will experience these symptoms, some survivors may only
experience a few of these symptoms or none at all. We must be careful not to
judge whether someone has been raped by the number of symptoms that they
display.

The trauma of rape is often compounded by the myths, prejudice and stigma
associated with rape. Survivors who have internalised these myths have to fight
feelings of guilt and shame. The burden can be overwhelming especially if the
people they come into contact with reinforce those myths and prejudices. It is
never a survivors fault for being raped. No one asks to be raped or deserves to
be raped.