Within a child’s psyche, diagnosed with OCD, the arrival of depression becomes an unwelcome squatter in an already overcrowded home. Unlike OCD, which often carries an air of urgency, depression in children can be a far quieter, insidious counterweight. In such instances, depression should not signal the cessation of OCD treatment but a strategic pivot in the approach.

During this time, it is even more important to have active channels for communication between clinicians, caregivers, and the child. While we continue the crucial work of ERP, safety from suicidality needs to be a priority. Safety plans should be drafted with the child's input, their own strategies to fight back in the darkest moments.

In the beginning of treatment (and upon the modification of critical accommodations), parents will often reach out to our center with the concern: “we are doing everything right, why are they getting worse?” While there are many reasons why, behaviorally, OCD clicks into high gear, the simplest explanation for these early days of tumult is a behavioral concept known as the 'extinction burst'. Extinction Burst is a behavioral response often misinterpreted and mishandled, yet it's pivotal in solidifying positive changes in our kids.

Modern parenting is often characterized by an unprecedented level of protection and empathetic understanding towards our children. While these attributes are widely regarded as a positive step away from antiquated, overly-authoritarian child-rearing paradigms, they may have unforeseen, detrimental consequences for a segment of the pediatric population—those grappling with Obsessive-Compulsive Disorder (OCD). Having worked with numerous families navigating the labyrinth of OCD, I have come to the conclusion that the tenets of contemporary parenting, when applied to these situations, might actually exacerbate the problem.

Emetophobia, the fear of vomiting or seeing others vomit, can have significant impacts on various aspects of a person's life. While science is still emerging, OCD and anxiety therapists have reported that significant percentages of their clients exhibit this fear. Emetophobia may lead individuals to avoid social situations or events where vomiting could potentially occur, such as parties, restaurants, or amusement parks. Fear of being around sick individuals or situations where illness is present can lead to isolation and difficulties maintaining friendships or romantic relationships.

It's important to note that school refusal is a complex issue with multiple underlying causes, and it can manifest differently from one individual to another. Some children may exhibit overt refusal to attend school, while others may experience significant distress or physical symptoms that interfere with their ability to attend regularly.

Motivational Interviewing (MI) can be a tremendously helpful technique for people experiencing OCD who may be stuck in their treatment.  MI acknowledges the ambivalence people might feel about changing their behaviors or thought patterns in OCD. It helps explore both the reasons for wanting to maintain current habits and the desire for change. This can help individuals understand their conflicting feelings and motivations.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, provides criteria and definitions for various mental health disorders, including hoarding disorder. The DSM-5, which was the latest version available as of my last knowledge update in September 2021, contains the following diagnostic criteria for hoarding disorder:

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

Parental accommodations in the context of childhood OCD refer to actions or behaviors that parents may unintentionally engage in to ease their child's distress or accommodate their OCD rituals. While accommodations are often well-intentioned, they can reinforce and perpetuate OCD symptoms. It's essential for parents to work with mental health professionals to reduce these accommodations gradually.

Panic Disorder is a type of anxiety disorder characterized by recurrent, unexpected panic attacks. A panic attack is a sudden and intense episode of fear or extreme discomfort that often comes on without warning and reaches its peak within minutes. Panic attacks can be very distressing and are often accompanied by physical symptoms such as a rapid heart rate, sweating, trembling, shortness of breath, chest pain, and a feeling of impending doom. Unfortunately, panic attack disorder tends to have a cumulative effect, where panic attacks start to be such a fear provoking event that anticipatory anxiety actual create further attacks.

Glutamate is a neurotransmitter in the brain that plays a critical role in many brain functions, including learning, memory, and mood regulation. It is the primary excitatory neurotransmitter in the central nervous system. Glutamate receptors are proteins located on the surface of nerve cells (neurons) that respond to the binding of glutamate molecules, leading to various neuronal responses. There are several types of glutamate receptors, but two of the most well-known classes are NMDA receptors and AMPA receptors.

Exposure therapy is a commonly used and effective approach for treating flying phobia (aviophobia). Exposure involves gradually and systematically confronting the feared stimulus (in this case, flying) in a controlled and therapeutic manner to reduce anxiety and fear responses. Educating the individual about the safety of air travel, teaching relaxation exercises, visiting airports without the intention of flying and even playing airplane engine sounds or videos of takeoffs/landings can all help to gradually confront a fear of flying.

Brainspotting is a therapeutic technique that was developed by David Grand in 2003. It is used to help individuals process and heal from various emotional and psychological issues, including anxiety. Brainspotting is a specialized form of trauma therapy and is often considered an adjunct to other therapeutic modalities like cognitive-behavioral therapy (CBT) or talk therapy. A trained therapist helps the client identify and focus on specific "brainspots" within their field of vision. These spots are believed to correspond to unprocessed trauma, emotional memories, or other sources of psychological distress.

Exposure and Response Prevention (ERP) is a widely used and effective therapeutic approach for treating conditions like Dermatillomania (skin picking disorder). ERP involves exposing individuals to situations or stimuli that trigger their compulsive skin picking behavior and then preventing them from engaging in the picking ritual. Here are some exposure exercises that an OCD therapist might use to help someone with skin picking:

Blood Phobias are very common, and some may say part of our evolutionary defenses. However, for those of us whose aversion to blood/injury passes from dis-ease into anxiety reaction, either with vasovagal (fainting), panic, or avoidance responses, we must seek treatment. Exposure and Response Prevention (ERP) is a commonly used therapeutic approach for treating Obsessive-Compulsive Disorder (OCD), including OCD related to a fear of blood or injury. ERP involves exposing individuals to situations or stimuli that trigger their obsessive thoughts or fears (in this case, the sight of blood) and then preventing them from engaging in compulsive behaviors or rituals.

Dialectical Behavior Therapy (DBT) is considered an effective therapeutic approach for various mental health challenges, particularly conditions involving emotional dysregulation and difficulty managing intense emotions. Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy that was originally developed to treat individuals with borderline personality disorder. However, it has since been adapted to help people with various mental health challenges, including anxiety disorders.

The choice between virtual (online) therapy and in-person therapy depends on various factors, including your personal preferences, accessibility, and specific needs. Here are some considerations to help you decide:

Providing feedback to your partner when you have Relationship Obsessive-Compulsive Disorder (ROCD) can be challenging, as ROCD involves intrusive and obsessive thoughts and doubts about your relationship. It's important to communicate your concerns and needs while taking into account the impact of ROCD on your thought patterns. Here are some tips for providing feedback to your partner in a constructive and supportive manner

ROCD can make relationship decisions more complex, but with the right support and strategies, you can make choices that are in line with your genuine desires and well-being. Seek professional help to guide you through this process, and be patient with yourself as you navigate the challenges of ROCD.

The negative reinforcement cycle of anxiety helps explain how anxiety can persist and even worsen over time. It involves a series of behaviors and responses that maintain or reinforce the experience of anxiety.

Soothing anxiety can sometimes reinforce it, not because the act of soothing itself is inherently problematic, but because of the way individuals may go about soothing their anxiety and the unintended consequences that can result. Here's how this can happen: