Ask Dr Kim | Archived live chats

[Chris_B]

Good afternoon everyone, Dr Kim is here and we're ready to start.

Welcome Kim, our first question is below:

I am a 23 year old female with contamination-focused OCD. Do you have any advice about how I could deal with anxiety over my boyfriend's health? He is the only person I kiss and share drinks with, which means that if he does get sick, I will be likely to get infected. I really love and care about him, so the anxiety is not just about fear of contracting germs and illness, but also wanting him to be healthy and well.

[Chris_B]

Our next question is about OCD:

hi Dr. Kim, lovely to have you participate with us. People who have phobia's can be treated by desensitization which will overcome their fear, but this has never been suggested to me to overcome OCD which I have had for 56 years, and secondly over the years a lot of my habits/traits have changed being replaced by another, so I wonder why this happens, and why do we have to replace it

[Dr_Kim]

It’s lovely to be here, thank you. Phobias and OCD are all part of the anxiety umbrella. OCD treatment tends to be centred around helping the person to sit with resisting the compulsions, even when the obsessive thoughts are present. Sitting with what we might term “the NQRs (not quite rights)”, things just don’t feel right.

Your mind is telling you that unless you, eg. Wash your hands, something terrible might happen, t to resist using the “healthy” part of your brain, even if its only for a few minutes, or an hour if you c an handle it, this shows some power over the compulsion and eventually, hopefully, delivers some sense of mastery over the condition.

The thing about OCD that I have noticed is that it’s very tricky, and when you manage to master one obsession or compulsion, it’s as if it gangs up on you and decides to find something else to punish you with. So I’m not surprised that your OCD focus has changed over the years.

I feel that the focus of treatment, however, remains the same whatever the compulsion of the day is: notice the obsessive thought, and then withholding from doing the compulsion as long as you can.

[Chris_B]

Our next question is about managing alcohol use:

self medicating with alcohol is so very hard to conquer, but there can be times when we want to abstain, but as soon as something goes wrong back to the alcohol we go, because nothing else works, like going back to the hobby we ONCE loved, or going for a walk, and all we want to do is swim in alcohol, so what are your thoughts.

[Dr_Kim]

I think it is very insightful that you use the term “self-medicating”, and this puts you ahead of the game already as you can obviously see that you are using alcohol to alleviate something. I think the next steps for you are twofold: one, you may need to look at what it is you are trying to alleviate or dull out with the alcohol, and that may be best done with a trusted counsellor.

Two, you are right in saying that alcohol and the “hobby” of drinking is very hard to break, so you may need help in breaking the habit of drinking and creating better habits to cope with emotional distress, boredom, anxiety, or lack of confidence.

The breaking of the relationship with alcohol is a very difficult journey and some people find that they can do it with willpower and the support of loved ones, friends. But if you are finding that it is too overwhelming, there are many excellent supports that can help you not swim with the alcohol.

You may also need to check in with a GP to ensure firstly that your health has not been affected by the alcohol, and secondly as to whether there are medications that may help you in your journey to withdraw from it.

[Chris_B]

Our next question is about what to do when therapy isn't working:

people who don't feel as though they aren't getting any help with their psych after it's been going on for several months, just want to give up, or their family/friends say 'why do you still go because nothings happened, so it takes a lot of encouragement to keep them going.

[Dr_Kim]

If you’re sceptical about the value of your therapy, then I think it is worthwhile having an honest and open review with your therapist about the goals of your therapy, and how you both feel you are going, and whether you both feel that you are progressing in a way that is expected, and that you can understand.

It may be that the journey to getting better is slow, and your expectations are too high, or it may be that this is the wrong sort of therapy for you. Most therapists would welcome an open, constructive discussion that allows you to work collaboratively to maximise the therapeutic outcome.

If both of you feel the type of therapy is not the best for you, then there is certainly no harm to exploring other types of therapy, or other therapists to see whether they are a better fit for you.

[Chris_B]

Our next question is about the relationship between anxiety and depression:

what do you think about anxiety being the same as being depressed so they both come under the same heading, to me being depressed also involves being anxious and vice-versa so when people post in a comment about being anxious do they also mean they are depressed, as there are different levels of depression from mild to extreme, where mild we don't seem to show it whereas extreme is where you climb back into the black hole and just want to be by yourself.

[Dr_Kim]

I agree that anxiety and depression do tend to follow one another at some point if they are around for long enough, so that people who have had bad anxiety for a long time can get pretty depressed about it, and people who have had bad depression for a long time can be pretty anxious about the path to getting better.

Also, there are degrees of the illness from mild to moderate with varying symptoms. Even in one person, they can vary in their illness from mild to moderate to severe and back again over time, depending on how active the illness is at any one point. It can be a rollercoaster ride, sometimes it’s very active and strong and other times quite under control and mild.

In some ways it doesn’t really matter in therapy whether the label is anxiety or depression. Many of the medications are the same, and a lot of the cognitive work you do is similar as well, for example being able to recognise which of the thoughts you’re having are coming from the healthy part of your brain, and which are coming from the anxious/depressed part; and then learning how to challenge, accept or distract yourself from the unhealthy thought. Both require lifestyle interventions, such as healthy eating, exercise, good sleep and mindfulness.

People want validation for their symptoms, they want to know that their symptoms can be explained. For people with anxiety, they want to know the racing heart and the tightness in the chest is understandable, for people with depression the lack of motivation, or feeling like there’s no sense of pleasure of purpose, can be explained. So the different diagnoses are helpful in that they allow people to make sense of their symptoms and feel that the symptoms are understandable in the context of their illness.

[Chris_B]

Our next question is about concern for an unwell family member:

I have a family member in his late 50s with a diagnosis of paranoid schizophrenia. He was on medication for his condition for many years, but 12 months ago he suddenly took himself off the medicine and now believes that the diagnosis was false. He is clearly displaying hallucinations and paranoid delusions but we cannot convince him to get the help he needs. He gets very defensive and my family are concerned that forcing him into care would alienate him further. What would you recommend we do?

[Dr_Kim]

There’s always a fine balance between the right of the individual, and the community’s and family’s responsibility to take care of an individual who is unable (for whatever reason) to make decisions in their own best interest.

Your family member, under the influence of an illness like schizophrenia, may be unable while unmedicated and unwell, to make decisions for himself that are really in his best interests and are healthy and safe for him.
Although it may feel that you are not attending to his right to make his own decisions, this is one of these regrettable situations where family and medical communities have to step in and take some responsibility as your family member seems to be clearly deteriorating as he has both hallucinations and paranoid delusions which can be quite serious if ignored.

I think the next step would be to get a trusted GP or community mental health team (CATT team) involved to help the family member back to the path of medication and good health. In my experience, once people are restored to their previous good health, they are able to thank and understand the people around them who made the hard decisions.

My feeling is that your family member will not remain angry with you for a long time, and will understand that you made the hard decisions from a place of care and love.