Lena Dunham and Howard Stern Talk OCD

As part of the book tour for her just released memoir, Not That Kind of Girl, Girls creator/star Lena Dunham met with Howard Stern this morning. One thing they discussed was their shared diagnosis of OCD- Obsessive-Compulsive Disorder. Hers began when she was a child. As she writes in her book:

“ I am eight and I am afraid of everything.”

“The list of things that keep me up at night includes but is not limited to: appendicitis, typhoid, leprosy, unclean meat, foods I haven’t seen emerge from their packaging, foods my mother hasn’t tasted first so that if we die we die together, homeless people, headaches, rape, kidnapping, milk, the subway, sleep.”

She admitted to Howard that “Everything about it( OCD) is uncomfortable…. You’re completely aware of how absurd you’re being in the moment. There’s none of the comforts of psychosis.”

But she also says that with treatment she is now doing well. “My OCD isn’t completely gone, but maybe it never will be. Maybe it’s part of who I am, part of what I have to manage, the challenge of my life. And for now that seems OK.”

Lena has also become an advocate for those with OCD. Here is a video from her website:

What is Obsessive-Compulsive Disorder (OCD)?

Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life.

ocd-checklist-487x250The frequent upsetting thoughts are called obsessions. To try to control them, a person will feel an overwhelming urge to repeat certain rituals or behaviors called compulsions. People with OCD can’t control these obsessions and compulsions. Most of the time, the rituals end up controlling them.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

What Causes OCD?

OCD sometimes runs in families, but no one knows for sure why some people have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

What are the Signs & Symptoms of OCD?

People with OCD generally:

  • Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
  • Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again
  • Can’t control the unwanted thoughts and behaviors
  • Don’t get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause
  • Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.

Who Is At Risk?

For many people, OCD starts during childhood or the teen years. Most people are diagnosed by about age 19. Symptoms of OCD may come and go and be better or worse at different times.

OCD affects about 2.2 million American adults. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

How is OCD Diagnosed?

The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

OCD can be accompanied by eating disorders, other anxiety disorders, or depression.

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

How is OCD Treated?

OCD is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy called exposure and response prevention is especially helpful in reducing compulsive behaviors in OCD.

Medication. Doctors also may prescribe medication to help treat OCD. The most commonly prescribed medications for OCD are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they are also particularly helpful for OCD, probably more so than anti-anxiety medications. They may take several weeks—10 to 12 weeks for some—to start working. Some of these medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

Some people with OCD do better with cognitive behavior therapy, especially exposure and response prevention. Others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches include combination and augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.

Source: NIMH

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

1 Comment

  1. Delaram Abaei

    October 2, 2014 at 7:22 pm

    Public figures and celebrities choosing to come forward can have a strong influence on mental health awareness. When they are honest and open with the public about their challenges, they can create a platform for dialogue and conversation for many. People with mental illness are greatly stigmatized and marginalized today. And more often than not, many people dealing with psychological disorders are forced into silence. Regardless of lingering stigma, celebrities can be in a position to, through speaking out about their lives and struggles, influence many opinions on such conditions.
    However, it is as equally illuminating to note that while public figures adopting the position of spokesmen for certain diseases and health conditions can have a positive impact, this is not always the case. I have had a friend dealing with bipolar disorder from a very young age and upon hearing that a well-known television personality was advocating for the disorder and speaking out about his own personal struggles with the condition, she did not seem to have a very positive take on the story. She felt that she could not relate to him and perceived his experience to be far removed from what she had been going through. As the conversation went on, she further claimed that his expressions might give some a false impression of what it feels like to live with the condition and to grapple with its effects on day-to-day life. And the fact that she could not afford to receive the therapy and rehabilitation treatments that he had undergone or have access to many other resources that multi-millionaire celebrities had access to seemed to be a major source of the disconnect. Thus, my friend felt that, even though with the best of intentions, the television-personality was providing a warped view of the realities of this disorder.
    Indisputably, it is true that by speaking out about their struggles with mental illnesses and disorders, well-known public figures can work towards raising awareness and advocating for such conditions. However, it is important to keep in mind that celebrities and their personal experiences are only a very small sample in a vast sea of experiences and stories. As such, stories such as this can be viewed and appreciated as part of the greater mission of working towards the de-stigmatization of mental illnesses and disorders and giving voice to a disenfranchised group. And we can keep in mind that people’s experiences with the same and similar conditions and ailments can be vastly different and varied.

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