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OCD

Disclaimer: this page is for information purposes and gives a quick outline of OCD to encourage people to attend groups or discuss with others. It is not meant to diagnose anyone, or be definitive (such a thing doesn't exist), please see a Doctor and from our point of view talking about symptoms is more important than labels, which can nevertheless help individuals or others understand the world. 

OCD and OCD Spectrum related disorders

Obsessive Compulsive Disorder is a form of anxiety. Rather like PTSD mentioned on another page, in the DSM-5 it was given it's own section Obsessive Compulsive and related disorders [1]. Some sources regard these as completely separate but similar, others call it an OCD spectrum. These are OCD, trichotillomania, dermatillomania, body dysmorphia sometimes shorted to BDD, health anxiety and hoarding disorder. We regard OCD as having huge overlaps in symptoms with other forms of anxiety, so people may find it useful attending our groups, as many members have done. 

OCD

Obsessive Compulsive disorder is an extremely varied condition on what the subject matter is, which can vary from mild to extremely severe. In popular culture for many years there has been an awareness that OCD can be linked to hand washing and checking of devices or appliances such as doors, taps and cookers. This only really scratches the surface and the obsessions and compulsions can be about almost anything. As the public have become more aware of it, there has been slight scepticism about what OCD actually is, in actual fact although they sound very stereotypical many cases of OCD are in fact to do with cleanliness, fear of contamination, fear of damage by failure to act, slowness, fear of one's actions on others such as abusing someone and symmetry.  

There are obsessions which are very intrusive thoughts and these are linked to the compulsions to check or do something. The compulsion does not have to be a physically highly noticeable action and may be unnoticeable to some other people. The ways of classifying OCD above have existed a long time and Primarily (or actually predominantly) obsessional obssessive compulsive disorder has been a part of OCD literature for YBOCS-SC which led to a lot of discussion when DSM-5 was written. This started being called purely obsessional OCD and then Pure O started to be used widely. This is not generally used as widely as people think it is away from online communities and many regard it as unhelpful whilst the person themselves may understandly feel it is useful and prefer calling it that. There is agreement - Pure O is part of OCD, it's just it's an extremely varied condition. For a referenced article see OCD UK [2]

Everyone gets intrusive thoughts, even people without anxiety, but the difference is these are occasional and may go after some minutes or a few hours. With OCD the obsessions cannot be separated from the compulsions and the behaviour may repeat dozens or more times per day. Similarly a lot of people have small rituals but they do not cause emotional distress and can be undone quite easily. OCD symptoms  also has broad similarity to two personality disorders (and some people who have OCD have one or both of these).  

Trichotillomania

In 2019 this is usually just called Trich, but is sometimes called hair pulling disorder. In the US the topic is more discussed than here, but estimates range between 2.5 and 11 million Americans have the condition (population 330 million). The condition is more common in teenagers and in girls than boys [3]. The pulling is normally hair, but can be eyebrows and eyelashes. Due to the level of distress of hair loss the hair pulling can be in more concealed areas at the back of the head or neck, which can be problematic for a number of reasons including not feeling the act of hair pulling. Trichophagia is a less understood rare variant where the person with trich eats their own hair and can be life threatening [3]. The disorder has a huge amount of stigma but there are treatments that can work if someone is able to seek help through specialist habit reversal training [3].

Beckie J Brown is a youtuber in the trichster community who has a popular channel. A video from ten years ago explains the condition https://www.youtube.com/watch?v=CiBIXMBEqgE

Dermatillomania

This is also called skin picking disorder or more formally excoriation. This is compulsions with picking at skin that become rituals or habitual. It can also be healed areas usually on easy to access areas like legs, arms, face, neck and scalp. After picking there is a temporary sense of relief. As there is repeated picking the area can become damaged with 'lesions'. As with other OCD spectrum disorders it is recurrent and attempts to manage it have not been successful resulting in distress affecting every day life, marking out a clear difference with just an itch or repeated skin picking. It is distinguished from picking related to substance abuse and other causes [1]. 

Body Dysmorphia

This is sometimes abbreviated to BDD online. This is a condition different from eating disorders related to internal perceptions of imperfections with bodily appearance. It is contrary to myth equally prevalent in men and women. In men a subtype called muscle dysmorphia is currently getting a lot of publicity, but for men and women features relating to the face and skin are common including nose and chin. Often someone with body dysmorphia will have more than one area of the body that is distressing to them. The issue is a difficult issue to discuss due to the stigma, but some patients will seek out surgery to the body e.g. nose to change theappearance on the false belief that it is unusual. It is believed that 2% of the population has the condition, although other estimates go from 0.7% to 2.4% [3].

This is an old BBC article from 2015 about body dysmorphic disorder.

If you have iplayer and a tv licence the BBC has a documentary on body dysmorphia called Ugly Me: my life with body dysmorphia . Caution on content.

Health Anxiety

Was previously called hypochondria, but is rarely referred to now due to the huge amount of stigma around it. These can be very intrusive thoughts about getting ill, or failing to get better from a minor illness, spending large amount of time doing checking behaviours such as tapping or mentally thinking or checking bodily sensations. Someone could be in their teens, 20s or 30s and have this. The symptoms of health anxiety can often be misunderstood for a seperate physical illness which treatment is sort or even carried out unnecessarily. Even after a thorough investigation and reassurance from doctors a patient might still think something is missing. Awareness of overreading physical symptoms and seeing their doctor can put a stigma and strain on medical and family relationships. Appropriate Cognitive Behavioural Therapy is believed to be very effective for health anxiety and a large study of patients with very severe health anxiety symptoms (Tyrer et al. 2017) suggested the effects can last years after [4]

Hoarding Disorder

Is a poorly understood disorder as less research had been done on it until 2013 and was not listed separately from OCD until the DSM-5 and ICD-10 did not list it separately until a later revision. It was frequently diagnosed as OCD for the lack of differentiation [3]. It is a 'persistent difficulty' discarding items to save them or stop distress where their accumulation hinders living areas and causes the patient a lot of distress. There are different levels of insight from good, fair, poor to absent insight/delusional beliefs [1]. Treatment is via adapted exposure therapy where the patient builds up a relationship with the therapist and a series of rules are agreed to stop the accumulation of more items and slowly reducing those hoarded. Strategies include limited touching and the patient not seeing the items once discarded [3]. In the UK hoarding disorder is also treated with CBT [5].

References

[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-5 by V.A. Arlington, published by the AMA, 5th edition, 2013. 

[2] Does Pure O Exist? OCD UK https://www.ocduk.org/ocd/pure-o/

[3] Obsessive Compulsive Disorders: All you want to know about OCD for people living with OCD, carers and clinicians by Lynne Drummond, Royal Society of Psychiatrists, Cambridge University Press, 2018. ISBN 978-1-911-62375-5

[4] Tyrer et al, 2017. National Institute for Health Research, Health Technology Assessment, Volume 21, issue 50. https://doi.org/10.3310/hta21500

[5] Hoarding disorder - NHS, published by the NHS https://www.nhs.uk/conditions/hoarding-disorder/

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PTSD

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Post-traumatic stress disorder

We have had many members who have PTSD and found the groups useful. Additionally, although we aren't therapy, there is a lot of research around PTSD and the benefits of talking group therapy PTSD settings and this may somehow relate to why our members find group support useful, in general with other members who find talking and sharing experiences of anxiety generally. 

PTSD is a form of anxiety, which was moved into a section of the Diagnostic & Statistical Manual of Mental Disorders (DSM) under Trauma- and Stressor related- disorders, so it's often viewed separately today. This has benefits because awareness of it is increasing a lot. Such an example would be in December 2016 when Lady Gaga shared publically her experiences which can be seen in this BBC article - warning, may be triggering content. In the DSM-5 which is published by the American Psychiatric Association, the diagnostic criteria for PTSD is one of the longest in the DSM having sections A through to H with several points for most of these sections. Additionally it can present with dissociative symptoms of depersonalization or derealisation. It is a very varied disorder in how it presents itself requiring highly qualified healthcare professionals. The purpose of this page is to provide some information for those who might come to groups and encourage to talk about their symptoms and seek help. Please seek medical opinions off a qualified therapist.  

The ICD-10 which is published by the World Health Organisation is the other main source and is in the public domain and parts about PTSD can be read here under F43.1.

Mythbusting

  • Women are twice as likely to have PTSD as men.  
  • In the UK common causes are physical assault, sexual assault, car accidents, threats of violence, witnessing violence, abuse, traumatic health problems, traumatic childbirth experiences and various other traumatic events too long to list.
  • Whilst many people experience trauma, most of them don't get PTSD.
  • Whilst many people's experiences of trauma may subside, it isn't a matter of it 'going away' as many people think with PTSD.
  • Hyperarousal and anger do not mean the person is just 'a bit sensitive' or is just an 'angry person'. 

Physiology

Due to neuroplasticity in the brain which is shaped by experiences, the architecture in the brain is different for someone with PTSD. This also means that with a huge amount of work through specialised therapy as your experiences change (or processesing of previous memories change) the brain can in theory be 'rewired' and PTSD symptoms subside. It is not known how long this takes for PTSD or anxiety. 

In the limbic system, which is associated with emotional regulation and how these relate to behaviours, two areas have been linked with PTSD. The hippocampus which processes memory, among other things, has been found to be smaller in PTSD patients. In some studies an enlarged amygdala (associated with the fear response) is seen and in some a shrunk amygdala. With a smaller amygdala (especially right sphere) and hippocampus, it is thought memory processing or flashbacks become difficult to process. In an enlarged amygdala it would be hypothesised to mean an oversensitive response to fear. 

Although PTSD still has a lot of research to be done, it's believed to be intimately tied to the HPA axis and stress responses. Cortisol levels in PTSD patients are believed to be low and noradrenaline and dopamine levels to be high. 

CBT

Contrary to some misconceptions on-line , CBT which is trauma-focussed and tailored to the patient is commonly used to treat PTSD and can be effective. This IS NOT the same thing at all as generic low intensity CBT treatments aimed often at 'mild to moderate' anxiety/depression that run for shorter periods of time. Trauma-focussed therapy should typically run 8-12 sessions with more for multiple traumas and booster sessions if necessary around significant dates [1]. Narrative exposure therapy and prolongued exposure therapy are included within this. If residual symptoms remain after trauma-focussed treatment more specific CBT for PTSD on symptoms such as sleep or anger may be offered [1].

EMDR

Eye movement desensitisation and reprocessing is a treatment licenced to treat PTSD on the NHS which there is evidence it can be effective. Contrary to some sources on-line it is not the 'only' or 'best' treatment for PTSD.

The NHS website describes it briefly 

"It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone. It's not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience."

The National Institute of Clinical Excellence guidance says EMDR should be 8 to 12 sessions, but more if they have experienced multiple traumas and include self-calming techniques for managing flashbacks [1].

For more information on PTSD please see the NHS website https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/

Refences

[1] Post-traumatic stress disorder, NICE guideline[NG116] Published date: December 2018 https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adults

 

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Coming to your first group session

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Coming to your first meeting?

"It's normal to be nervous, I mean, very nervous. I mean you have anxiety after all, although not many people understand that, but you know how that is. I was nervous when I came to my first session. I liked that it wasn't a bookable appointment, so I didn't have the pressure of having to turn up, but thought even though you push yourself that can mean it's easy to have second thoughts. Having to get into town, No Panic's right in the middle of town, the very middle of town in a quiet street by the cathedral, but I can see now that actually it's a good idea having it here as it means it's equal access with all the buses nearby, the tram stop and if you come in the evening there's a lot of on street parking nearby for £2. Useful for those dark nights. So let's go inside."

St James' Street - this is pretty quiety.

Outside Quaker Meeting House - there are sheffield bicycle lock stands and a glass door. 

Reception, there's a board on the left saying which groups are in which rooms and a desk behind a glass window. The staff are really helpful if you're unsure and don't mind being asked.

Board - it says room 1,2,3,4 and main meeting room. If it says room 2 then we are upstairs, room 4, downstairs. 

Inside, there's a staircase going down to your right and one going upwards. If it's Thu we're likely in room 2 upstairs. Weds - room 4, downstairs.

Room 2 is upstairs, go up two short flights of stairs and through a door 

Does No Panic Sheffield know what it's doing?

9.5 years of running sessions. Around 650 sessions. Listening to people by 100 different facilitators spread over a decade all with their own personal, work and life experience as well as listening to others. More than 2500 different people helped.  

 

 

 

 

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About No Panic Sheffield

We believe that anxiety and depression are debilitating, life-changing mental health conditions.  We also believe that everyone should have quick access to help without waiting weeks, or having to make an appointment.

We provide self-help groups every Wednesday evening and Thursday morning in the city centre.  If you are wanting to attend a group yourself or refer someone else we have some experience of sharing experiences and helping people manage better with the following:-

  • general anxiety disorder
  • Post-traumatic stress disorder
  • social anxiety
  • phobias
  • Obsessive Compulsive Disorder (OCD)
  • other OCD spectrum conditions such as hoarding, trich and health anxiety
  • panic disorder
  • low mood
  • sleeping problems
  • anger
  • perinatal anxiety/postnatal depression
  • depression
  • bipolar disorder
  • later stages of recovery from addictions and how that relates to anxiety
  • personality disorders

Many of these conditions are specialist areas and so our members receive help from specialist funded services outside NPS such as community mental health, IAPT and many 3rd parties whilst feeling able to attend groups as well alongside. 

 

TRUSTEES 

 Paul  Rob
 Paul  – Chair - Paul was a member, facilitator, Group Coordinator, trustee for recruitment and training and now Chair.  See our volunteers page for more information about Paul.  Rob  – Treasurer - Rob is a qualified Chartered Accountant and works as a management consultant.  Rob ensures all our financial records, Charity Commission returns, Insurance and other statutory and governance items are up to date.  He ensures we are financially sound and operating responsibly.  Interesting fact - Rob runs marathons and often does this to raise funds for No Panic Sheffield
 Brendan  Lorien E
 Brendan - Mentor/Trainer - Brendan is a qualified psychologist, although not now working in the profession.  He was one of the first group facilitators for No Panic Sheffield and provides invaluable advice and mentoring for our facilitators.  He occasionally facilitates groups.  Interesting fact - Brendan runs a company that provides students with rented accommodation.  Lorien was facilitator from 2013-2018 and is now a mentor and trustee. She is involved in the teams dealing with recruitment and mentoring as a trustee. See our volunteers page for more about Lorien.

 

 Charlie (No Picture)  Mel
Charlie (no picture) is a trustee. She was a volunteer facilitator between December 2016 and August 2018 and is a mentor and trustee for evaluation. Mel is a trustee for 2019/2020, read more about her on our volunteers page.
Sarah haleemathumb
Sarah is a trustee and facilitator. Find more info about Sarah on our volunteers page. Haleema is a trustee and facilitator. Find more on our volunteers page.
   
Kate (no picture) is a trustee.  

We are affiliated to No Panic UK a national charity which provides a confidential helpline – for details visit https://www.nopanic.org.uk/the-no-panic-helpline/

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