In fact, however, a real struggle with OCD is a manifestation of anxiety that creates an actual disturbance in one’s life.

Lena Dunham, creator/ writer/ producer/ star of the HBO award-winning series “Girls,” showcased the leading character, Hannah, (played by Dunham herself) in very raw and honest encounters with the illness toward the end of this past season. Hannah had dealt with OCD in high school. It resurfaced when she was faced with two significant stressors: trying to write an e-book in a short time frame, and dealing with the rocky aftermath of a breakup.

Whether the scenes illustrated episodes of relentless tics, counting, or a compulsive habit that brought her to the emergency room, “Girls” took on authentic territory that invited other OCD sufferers to feel less alone.

An article here on Psych Central characterizes obsessive-compulsive disorder as “recurrent and disturbing thoughts (called obsessions) or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions).”

Unwanted impulses and bothersome images may also invade the psyche of a person with OCD. While compulsions are usually served to neutralize the excessive thoughts or obsessions, those acts may spark further anxiety since they become very demanding to maintain.

Allison Dotson’s recent article featured on the Huffington Post discusses how the OCD storyline on the series allows other people, dealing with the disorder, to relate.

“As someone with OCD, I find it refreshing to see this often-misunderstood illness portrayed in a realistic way on an acclaimed television show,” Dotson said. She remarks how OCD may be presented as a “charming slapstick character trait,” but “Girls” definitely wasn’t gunning for easy laughs.

“In the real world, OCD symptoms can rear their persistent head just as Hannah’s did under the pressure of a book deadline,” Dotson noted. “Mine certainly did – new obsessions would pop up at bedtime and stick around for months.”

Lena Dunham talks about her own experiences with OCD to Rolling Stone in their cover story, “Lena Dunham: Girl on Top.” She was diagnosed at age 9, after displaying recurring symptoms.

“I was obsessed with the number eight. I’d count eight times … I’d look on both sides of me eight times. I’d make sure nobody was following me down the street, I touched different parts of my bed before I went to sleep, I’d imagine a murder, and I’d imagine that same murder eight times.”

While she tapered off her medication toward the end of college (which produced unpleasant side effects, including extreme exhaustion and night sweats), she still takes a small dose of an antidepressant to alleviate her anxiety.

I have nothing but respect for Dunham, who shared her private (and sometimes dark) history with OCD to the public via “Girls.” A disorder that may be portrayed in the media as humorous or lighthearted now is receiving a bit more attention and awareness. Others who are faced with OCD’s symptoms may be able to connect to Dunham’s character, identifying right alongside her.

“These episodes of ‘Girls’ appear promising,” Kent Sepkowitz wrote in his article in the Daily Beast. “They are ready to show, I hope, that real mental illness is not eradicated by a pill or a better diet, by three visits to a shrink, or by a thoughtful walk along the beach.”

Unfortunately that advice wouldn’t have been able to stop me from praying rosary after rosary when I was in fourth grade to avert going to hell, nor does it quiet the annoying noise and chatter inside my brain today in any given hour. But the fact that a great leader battled the worry war does provide me some consolation.

It doesn’t matter whether you are a chronic worrier without an official diagnosis or battling severe obsessive-compulsive disorder (OCD), a neurobehavioral disorder that involves repetitive unwanted thoughts and rituals. The steps to overcome faulty beliefs and develop healthy patterns of thinking are the same.

Worrying about facing the inferno as a 10-year-old and fretting about whether or not I’ll provide enough income to keep my kids in private school stems from the same brain abnormality that Jeffrey M. Schwartz, M.D. describes in his book, Brain Lock.

When we worry, the use of energy is consistently higher than normal in the orbital cortex, the underside of the front of the brain. It’s working overtime, heating up, which is exactly what is the PET scans show. Too many “what if’s” and your orbital cortex as shown in a PET scan will light up in beautiful neon colors, like the walls of my daughter’s bedroom. However, with repeated cognitive-behavioral exercises, you can cool it down and return your PET scan to the boring black and white.

In their book, The OCD Workbook, Bruce M. Hyman, Ph.D., and Cherry Pedrick, RN, explain the ABCDs of faulty beliefs. It’s a four-step cycle of insanity:

A = Activity Event and Intrusive Thought, Image or Urge. (What if I didn’t lock the door? What if I upset her? I know I upset her.)

B = Faulty Belief About the Intrusive Thought. (If I don’t say the rosary, I’m going to hell. If I made a mistake in my presentation, I will get fired.)

C = Emotional Consequences: Anxiety, Doubt, and Worry. (I am a horrible person for upsetting her. I keep making mistakes … I will never be able to keep a job. I hate myself.)

D = Neutralizing Ritual or Avoidance. (I need to say the rosary to insure I’m not going to hell. I should avoid my friend who I upset and my boss so that he can’t tell me I’m fired.)

Those might seem extreme for the casual worrier, but the small seed of anxiety doesn’t stay small for long in a person with an overactive orbital cortex.

Hyman and Pedrick also catalog some typical cognitive errors of worriers and persons with OCD:

• Overestimating risk, harm, and danger
• Overcontrol and perfectionism
• Catastrophizing
• Black-and-white or all-or-nothing thinking
• Persistent doubting
• Magical thinking
• Superstitious thinking
• Intolerance of uncertainty
• Over-responsibility
• Pessimistic bias
• What-if thinking
• Intolerance of anxiety
• Extraordinary cause and effect

One of the best approaches to manage a case of the worries and/or OCD is the four-step self-treatment method by Schwartz, explained in Brain Lock,

Step 1: Relabel.

In this step you squeeze a bit of distance between the thought and you. By relabeling the bugger as “MOT” (my obsessive thought) or something like that, you take back control and prevent yourself from being tricked by the message. Because I’ve always suffered from OCD, I remind myself that the illogical thought about which I’m fretting is my illness talking, that I’m not actually going insane.

Step 2: Reattribute.

Here is where you remember the PET scan that would look like your brain. By considering that colorful picture, you take the problem from your emotional center to your physiological being. This helps me immensely because I feel less attached to it and less a failure for being able to tame and keep it under control. Just like arthritis that is flaring up, I consider my poor, overworked orbital cortex, and I put some ice on it and remember to be gentle with myself.

Step 3: Refocus.

If it’s at all possible, turn your attention to some other activity that can distract you from the anxiety. Schwartz says: “By refusing to take the obsessions and compulsions at face value—by keeping in mind that they are not what they say they are, that they are false messages—you can learn to ignore or to work around them by refocusing your attention on another behavior and doing something useful and positive.”

Step 4: Revalue.

This involves calling out the unwanted thoughts and giving yourself a pep talk on why you want to do everything you can to free yourself from the prison of obsessive thinking. You are basically devaluing the worrying as soon as it tries to intrude.

The French call Obsessive-Compulsive Disorder “folie de doute,” the doubting disease. That’s what obsessions are — a doubt caught in an endless loop of thoughts.

But even those not diagnosed with OCD can struggle with obsessions. In fact, I have yet to meet a depressive who doesn’t ruminate, especially in our age of anxiety. Every day gives sensitive types like myself plenty of material to obsess about. So I’m constantly pulling out the tools that I’ve acquired over time to win against my thoughts, to develop confidence — the antidote for doubt — to take charge of my brain, and to stop obsessing. I hope they work for you too.

1. Name the beast.

My first step to tackle obsessions: I identify the thought. What is my fear? What is my doubt? I make myself describe it in one sentence, or, if I can, in a few words. For example, when I was released from the hospital’s psych ward the first time, I was paranoid that my co-workers would find out. I obsessed about it and obsessed about it and obsessed some more. Finally, I named the fear: I am afraid that if my co-workers find out that I was hospitalized with severe depression that they won’t respect me anymore, and they won’t assign me any projects. There it is. There’s the beast. Phew. I named it, and by doing so, I can rob it of some of its power over me.

2. Find the distortion

Once I have named the fear or doubt, I try to see if I can file it under any of the forms of distorted thinking that Dr. David Burns describes in his bestseller “Feeling Good,” like all-or-nothing thinking (black and white categories), jumping to conclusions, magnification (exaggeration), or discounting the positive (none of my accomplishments count). My obsession almost always involves at least three forms of distorted thoughts. So I then consider his 10 ways of untwisting distorted thinking to help me to undermine my obsession. For example, using his “cost-benefit analysis” method, I examine how my fear of my co-workers finding out abound my depression is benefiting me in some way and how it is costing me. In the end, I decided to tell them because I realized that I wanted to write about my experience, and that was worth the risk of having them reject me based on my diagnosis of manic depression.

3. Pencil it in.

Awhile back, when I was especially tormented by some obsessions, my therapist told me to schedule a time of day where I was free to ruminate. That way, she said, when you get an obsession, you can simply tell yourself, “Sorry, it’s not time for that. You’ll have to wait until 8 in the evening, when I give you, My Head, 15 minutes to obsess your heart out.” I remember recording in my journal everything I was dwelling on for 20 minutes every night: that I was a horrible mom, an inadequate writer, that no one liked me, and so on. Eric was reading a book next to me and asked me what I was writing. I handed over my journal and he shrieked: “Yikes and I was just thinking about what to have for breakfast tomorrow.”

4. Laugh at it.

Alas, that story brings me to another tool: humor. As I wrote in “9 Ways Humor Heals,” laughter can make almost any situation tolerable. And you have to admit, there is something a little funny about a broken record in your brain. If I couldn’t laugh at my depression and anxiety and severe ruminations, I would truly go insane. I mean, even more insane than I already am. And that’s way insane. I have a few people in my life who struggle with obsessions in the same way I do. Whenever it gets so darn noisy in my brain that I can’t stand it, I call up one of them and say, “They’re baaaaaack…….” And we laugh.

5. Snap out of it.

I mean literally snap out of it. That’s what I did for a few months when I couldn’t take the obsessions. I’d wear a rubber band around my wrist, and every time my thoughts would turn to an obsession, I’d snap it as a reminder to let go. By bedtime my wrists were a tad red. Another behavioral technique you could try is to write out the obsession on a piece of paper. Then crinkle it up and throw it away. That way you have literally thrown out your obsession. Or you could try visualizing a stop sign. When your thoughts go there, remember to stop! Look at the sign!

6. Pull over.

One of the most helpful visualizations for me has been to imagine that I am driving a car. Every time my thoughts revert back to an obsession, I have to pull over on the shoulder, because my car is misaligned. It’s dragging right. Once I’ve stopped, I ask myself: Do I need to change anything? Can I change anything? Can I amend this situation somehow? Do I have anything I need to do here to find peace? I spend a minute asking myself the questions. Then, if I don’t have anything to fix, it’s time for me to get my car back on the road again. This is basically a visualization of the Serenity Prayer. I am trying to decipher between what I can’t change and what I can. Once I have made the distinction, it’s time to start driving again.

7. Learn the lesson.

I often obsess about my mistakes. I know I messed up, and I’m beating myself over and over again for not doing it right the first time, especially when I have involved other people and hurt them unintentionally. If that’s the case, I will ask myself: What is the lesson here? What have I learned? Just like the first step — naming the obsession — I will describe the lesson that I have absorbed in one sentence or less. For example, I recently reprimanded David for something he didn’t do. I automatically believed a fellow mom’s appraisal of the situation. I didn’t think to ask David first. As I discovered more details, I realized that David didn’t do anything wrong. I felt horrible. I jumped to conclusions and didn’t believe the best about my son. So here’s the lesson: I won’t jump so fast the next time someone accuses my son of something; I’ll get the facts first.

8. Forgive yourself.

After you take away the lesson, you have to forgive yourself. That’s the hard part. Especially for perfectionists. And guess what? Perfectionists are natural ruminators! Julia Cameron writes in this “The Artist’s Way”:

Perfectionism is a refusal to let yourself move ahead. It is a loop — an obsessive, debilitating closed system that causes you to get stuck in the details of what you are writing or painting or making and to lose sight of the whole. Instead of creating freely and allowing errors to reveal themselves later as insights, we often get mired in getting the details right. We correct our originality into a uniformity that lacks passion and spontaneity.

Forgiving yourself means to concentrate on the insights gained from mistakes, and to let go of the rest. Um. Good luck with that.

9. Imagine the worst.

I know this seems wrong — like it would produce even more anxiety. But imagining the worst can actually relieve the fear triggering an obsession. For example, when I was hospitalized the second time for severe depression, I was petrified that I would never be able to work again, to write again, to contribute anything to society. Done. Let me get into my nightgown and bury myself somewhere. I was literally shaking with anxiety I was so scared of what my illness could do to me. I called my friend Mike and rattled off to him all my fears.

“Uh huh,” he said. “So what?”

“What do you mean, ‘So what’? My life as I know it might be over,” I explained.

“Yah, and so what,” he said. “You can’t write. No biggie. You can’t work. No biggie. You have your family who loves you and accepts you. You have Vickie and I who love you and accept you. Stay home and watch ‘Oprah’ all day. I don’t care. You’d still have people in your life who love you.”

You know what? He was right. I went there in my mind: to the worst case scenario … me on disability, hospitalized a few times a year, unable to do so much of what I did before. And there I was. Still standing. With a full life. A different life, yes, but a life. And I was okay. Really okay. I felt such freedom in that moment.

10. Put it on hold.

Sometimes I start to obsess about a situation for which I don’t have enough information. Example: Awhile back I was worried about a family member in a dangerous situation. I dwelled and dwelled on it, and didn’t know what to do. Then Eric said, “We don’t have all the information yet that we need to make a decision or pursue a plan. So it’s useless to worry.” Therefore I put my obsession “on hold,” like it was a pretty lavender dress at a boutique that I saw and wanted but didn’t have enough money to buy. So it’s there, waiting for me, when I get enough dough–or, in the case of my family member, enough data.

11. Dig for the cause.

So often the object of the obsession isn’t the real issue. That object or person or situation is masking the deeper issue we’re too afraid to face. A friend of mine obsessed and obsessed about his fence in his backyard because — unlike his wife’s illness, a problem over which he has no control — he could manage the fence. So he went out with his measuring stick day in and day out until he could finally surrender to his situation. A woman I used to work with fantasized about a colleague whom she was attracted to. It was an especially stressful time for her — she was caring for four young kids plus her mother–and daydreaming about running away with her co-worker gave her the escape she needed. Her obsessions weren’t about her co-worker, however, as much as they were about her need for some fun relief in her life.

12. Reel it in.

We all know how fast obsessions can take on a life of their own. A slight hitch in a project becomes a massive hurdle, a friendly gesture by a friend turns ugly and threatening, and a minor criticism from a colleague turns into a 150-page dissertation about your flaws, inadequacies — you know, everything that’s bad about you and why you shouldn’t get out of bed in the morning. Granted, buried within an obsession are usually pieces of truth — part of the rumination is based in reality. But other parts are way off in fantasyland — with about as much accuracy as there is in a juicy celebrity tabloid story: “Celine Dion meets ET for drinks.” That’s why you need some good friends that will help you separate fact from fiction. When I call up my friend Mike and tell him my latest obsession, he usually says something like this: “Wow. Reel it in, Therese. Reel it in…You are way out this time.” And then we laugh at how far out I got.

13. Interrupt the conversation.

Here’s where a bad habit can come in handy. Are you always interrupting people? Can’t help it? You get curious about a detail in someone’s story, and you want to hear more about that, not the end of the story? That’s how an obsession works in your brain — like a conversation over coffee: “This is why he hates me, and this, too, is why he hates me, and did I mention why he hates me? I’m sure he hates me.” Practice some of your rude manners and interrupt. You don’t even have to say, “Excuse me.” Ask a question or throw out another topic. By doing so, you catch the snowball as it’s accumulating matter, and you throw it back with momentum because, as most of us learned in physics, a body in motion stays in motion. Now the conversation goes something like: “These are the reasons he should like me, and this, too, is why he should like me, and did I mention that he probably likes me? I’m sure he likes me.”

14. Stay in the present.

I grit my teeth when people tell me this. Because I’m a ruminator and we ruminators operate in past and future. We don’t think NOW. But, this advice is SO true. When you are grounded in the moment, you’re not thinking of what bad things can happen to you in the future, or dwelling on the mistakes of your past. To get me into the present, I start with my senses. I try to hear only the noise that surrounds me — cars, birds, dogs barking, church bells — because if I give myself the assignment of listening to the actual sounds around me, I can’t obsess on a fear. Likewise, I concentrate on seeing what’s in front of me. At the very moment. Not in 2034. If I’m supposed to be playing baseball with David but my mind is on work, I try to bring it back to the baseball game, where it should be.

A quiet revolution has upended our concept of the way patterns work within our lives, societies, and organizations. And much of what we have learned has come from studying the simplest of habits — such as why people bite their nails.

In the summer of 2006, for instance, a 24-year-old graduate student named Mandy walked into the counseling center at Mississippi State University. For most of her life, Mandy had bitten her nails, gnawing them until they bled.

Lots of people bite their nails. For chronic nail biters, however, it’s a problem of a different scale.

Mandy would often bite until her nails pulled away from the skin underneath. Her fingertips were covered with tiny scabs. The end of her fingers had become blunted without nails to protect them and sometimes they tingled or itched, a sign of nerve injury.

The biting habit had damaged her social life. She was so embarrassed around her friends that she kept her hands in her pockets and, on dates, would become preoccupied with balling her fingers into fists. She had tried to stop by painting her nails with foul-tasting polishes or promising herself, starting right now, that she would muster the willpower to quit. But as soon as she began doing homework or watching television, her fingers ended up in her mouth.

The counseling center referred Mandy to a doctoral psychology student who was studying a treatment known as “habit reversal training.” The psychologist was well acquainted with what has become known as the “Golden Rule of Habit Change.” Every habit has three components: a cue (or a trigger for an automatic behavior to start), a routine (the behavior itself) and a reward (which is how our brain learns to remember this pattern for the future.)

The Habit Loop

The Golden Rule of Habit Change says that the most effective way to shift a habit is to diagnose and retain the old cue and reward, and try to change only the routine.

The psychologist knew that changing Mandy’s nail biting habit required inserting a new routine into her life. “What do you feel right before you bring your hand up to your mouth to bite your nails?” he asked her.

“There’s a little bit of tension in my fingers,” Mandy said. “It hurts a little bit here, at the edge of the nail. Sometimes I’ll run my thumb along, looking for hangnails, and when I feel something catch, I’ll bring it up to my mouth then. I’ll go finger by finger, biting all the rough edges. Once I start, it feels like I have to do all of them.”

Asking patients to describe what triggers their habitual behavior is called awareness training, and it’s the first step in habit reversal training. The tension that Mandy felt in her nails cued her nail biting habit.

“Most people’s habits have occurred for so long they don’t pay attention to what causes it anymore,” said Brad Dufrene, who treated Mandy. “I’ve had stutterers come in, and I’ll ask them which words or situations trigger their stuttering, and they won’t know because they stopped noticing so long ago.”

Next, the therapist asked Mandy to describe why she bit her nails. At first, she had trouble coming up with reasons. As they talked, though, it became clearer that she bit when she was bored. The therapist put her in some typical situations, such as watching television and doing homework, and she started nibbling. When she had worked through all of the nails, she felt a brief sense of completeness, she said. That was the habit’s reward: a physical stimulation she had come to crave.

At the end of their first session, the therapist sent Mandy home with an assignment: Carry around an index card, and each time you feel the cue — a tension in your fingertips — make a checkmark on the card.

She came back a week later with 28 checks. She was, by that point, acutely aware of the sensations that preceded her habit. She knew how many times it occurred during class or while watching television.

A Competing Response

Then the therapist taught Mandy what is known as a “competing response.” Whenever she felt that tension in her fingertips, he told her, she should immediately put her hands in her pockets or under her legs, or grip a pencil or something else that made it impossible to put her fingers in her mouth. Then Mandy was to search for something that would provide a quick physical stimulation — such as rubbing her arm or rapping her knuckles on a desk — anything that would produce a physical response. It was the Golden Rule: The cues and rewards stayed the same. Only the routine changed.

They practiced in the therapist’s office for about half and hour and Mandy was sent home with a new assignment: Continue with the index card, but make a check when you feel the tension in your fingertips and a hash mark when you successfully override the habit.

A week later, Mandy had bitten her nails only three times and had used the competing response seven times. She rewarded herself with a manicure, but kept using the note cards.

After a month, the nail biting habit was gone. The competing routines had become automatic. One habit had replaced another.

“It seems ridiculously simple, but once you’re aware of how your habit works, once you recognize the cues and rewards, you’re halfway to changing it,” Nathan Azrin, one of the developers of habit reversal training, told me. “It seems like it should be more complex. The truth is, the brain can be reprogrammed. You just have to be deliberate about it.”

Today, habit reversal therapy is used to treat verbal and physical tics, depression, smoking, gambling problems, anxiety, bedwetting, procrastination, obsessive- compulsive disorders, and other behavioral problems. And its techniques lay bare one of the fundamental principles of habits: Often, we don’t really understand the cravings driving our behaviors until we look for them. Mandy never realized that a craving for physical stimulation was causing her nail biting, but once she dissected the habit, it became easy to find a new routine that provided the same reward.

Say you want to stop snacking at work. Is the reward you’re seeking to satisfy your hunger? Or is it to interrupt boredom? If you snack for a brief release, you can easily find another routine, such as taking a quick walk, or giving yourself three minutes on the Internet, that provides the same interruption without adding to your waistline.

If you want to stop smoking, ask yourself: Do you do it because you love nicotine, or because it provides a burst of stimulation, a structure to your day, or a way to socialize? If you smoke because you need stimulation, studies indicate that some caffeine in the afternoon can increase the odds you’ll quit. More than three dozen studies of former smokers have found that identifying the cues and rewards they associate with cigarettes, and then choosing new routines that provide similar payoffs— a piece of Nicorette, a quick series of pushups, or simply taking a few minutes to stretch and relax — makes it more likely they will quit.

If you identify the cues and rewards, you can change the routine.

To learn more — including how to create willpower habits among kids, and what we’ve learned about how habits function within lives, companies and society — please read The Power of Habit: Why We Do What We Do and How to Change or visit www.thepowerofhabit.com.

Likewise, you are not the only person with an anxiety disorder.

But it can sure feel that way sometimes, eh? Especially on days when everyone else at the party is acting super sociable, but you’re slunked (is that a word?) down in a corner and too dizzy to talk to anyone.

It’s easy to feel alone on days when everyone else seems to be gathering their groceries from the store shelves just fine, but you’re still hovering in the breezeway, leaning on your cart, and trying to muster up the courage to walk inside.

And it’s easy to feel alone at work, too. Everyone else can pay attention to the corporate PowerPoint presentation in the conference room, but you’re sitting next to the closed door, thinking about how far you are from the office restroom, and flexing your leg muscles for a quick escape.

Every time we say “I am alone!” we are lying.

We are not alone in our struggles…and I made a video, just for you, to prove it:

Links:

• Panic! A Blog About Panic, Anxiety, Depression, and Related Topics
• She Gets a Little Nervous
• Prozac Withdrawal
• Panic About Anxiety
• Angst in Anxiety
• Anxiety & OCD Exposed

Nope, it’s good ‘ole antidepressants.

Treatment options for obsessive compulsive disorder (OCD) are currently dominated by antidepressants, and this trend is expected to continue for the next seven to eight years.

That is, unless drugmakers step up their future research to develop new, more effective treatments, according to a new report by business intelligence company GlobalData.

GlobalData suggests that current OCD treatments leave a lot to be desired. All current medication treatment for OCD is effective — as long as person remains on the medication. Once a person stops taking, in most cases the OCD symptoms return.

According to GlobalData:

The OCD drugs market showed low growth from 2006 to 2011, primarily due to the patent expiries of Zoloft (sertraline) and Paxil (paroxetine). GlobalData’s research also demonstrates that the developmental pipeline for OCD therapeutics is weak, with only nine molecules currently in development. Most clinical trials are small and sponsored by universities or institutes, and aim to discover a second line of therapy for OCD patients unresponsive to SSRIs. Little research seems to be taking place which could offer a revolutionary change in OCD treatment, as there are no molecules in development that offer a novel mechanism of action.

GlobalData’s analysis indicates that the presence of established treatment therapies, including generic drugs and off-label antipsychotics, may have led to the absence of research activity from pharmaceutical companies. This means that, in spite of a significant unmet need in terms of drug treatment, OCD sufferers can expect to see little change in their options in the near future.

GlobalData analysis indicates that the global OCD drug market showed a low growth rate of only about 1 percent from 2006 to 2011, accounting for a value of $317 million.

The market is expected to grow at a compound annual growth rate of nearly 5 percent, to reach $461 million by 2019.

I have said many places that growing up Catholic, for me, was both a blessing and a curse.

A blessing in that my faith became a refuge for me, a retreat (no pun intended) where my disordered thinking could latch unto practices and traditions that made me feel normal. Catholicism, with all of its rituals and faith objects, provided me a safe place to go for comfort and consolation, to hear I wasn’t alone, and that I would be taken care of. It was, and has been throughout my life, a source of hope. And any speck of hope is what keeps me alive when I am suicidal.

But my fervent faith was also a curse in that, with all of its stuff (medals, rosaries, icons, statues), it dressed and disguised my illness as piety. So instead of taking me to the school psychologist or to a mental health professional, the adults in my life considered me a very holy child, a religious prodigy with a curiously intense faith.

For anyone prone to OCD (obsessive-compulsive disorder), religion can serve as a trap within a sanctuary. For me, my scrupulosity in primary school was like a game of Pin the Tail on the Donkey: I was spun around blindfolded without a clue as to which side was the head and which the butt–which rituals made me crazy and which led to the beatific vision.

Almost every anxiety and insecurity I felt as I kid fed into one fear: I was going to hell.

Therefore I did everything in my power to prevent that. My bedtime prayers lasted longer than those recited by Benedictine monks; by the second grade, I had read the Bible start to finish (a few times by the fourth grade); I attended daily Mass, walking there on my own each day; and every Good Friday I would go down to my dad’s den in the basement and stay there for five hours as I prayed the all of the mysteries of the rosary.

I guess I just thought I was really holy until I landed in therapy my freshman year at college. There my counselor strongly encouraged me to read the book The Boy Who Couldn’t Stop Washing His Hands: The Experience and Treatment of Obsessive-Compulsive Disorder by Judith L. Rapoport, M.D. After I read through its pages I breathed out a huge sigh of relief that I might not be headed towards the burning flames of hell. Its wisdom has stuck with me even today when I get trapped in that OCD-scrupulous kind of thinking.

Like the other weekend.

My daughter received her First Reconciliation. As part of the sacrament, the parents are encouraged to go to confession. I hadn’t been in ten years, so I thought I should go to be a good role model. My religion teachers used to tell us in grade school that you go into confession as a caterpillar and emerge as a butterfly. That wasn’t an accurate description of how I felt. My poor caterpillar was limping, as I felt horribly guilty, disgusted with myself, embarrassed, and every emotion they say you get rid of when the priest absolves you and you feel God’s forgiveness.

I think confession and all the rites of the major religions can be a beautiful thing, and lead to a deeper faith and a sense of love and hope. However, for someone prone to OCD, who constantly beats herself up for every less-than-perfect thing she does, or thought she has, these rituals can become weapons used to further hack away at self-esteem.

Two anecdotes from Rapoport’s book accurately articulate the kind of mental anguish attached to scrupulosity:

Sally, a bright, blonde sixth-grader, had looked forward to her Confirmation. Getting a new dress and having her aunt so proud of her outweighed all the hard work. But a few weeks before the big day she started having crying spells, couldn’t sleep, and lost ten pounds. It all began suddenly, when Sally was doing a class punishment assignment. She thought that she wasn’t doing it properly, that she was “sinning.” I’m always doing something wrong, she felt. The feeling stayed with her. Each day her symptoms became more intense. “If I touch the table, I’m really offending God,” she whispered. She folded her arms and withdrew into deep thought. Sally was terror-struck that she might have offended God by touching her hands. Did that mean that she was striking God? She wondered, retreating further into herself.

Daniel described how hundreds of times each day he would “get a feeling” that he had “done something wrong” and that it displeased God. To avoid possible punishment for these “wrongdoings” at God’s hands, he would punish himself in some way, thus reducing his concern about some more awful punishment occurring at some later time. He would also avoid any actions or thoughts that had accompanied these feelings. This led to the development of complex rules which, in Daniel’s mind, placed prohibitions on his behavior and thinking in virtually every situation of his life.

I have to exercise precaution about going to confession — and participating in rites like it — when I’m feeling really lousy about who I am and can’t get away from the self-deprecating thoughts, just as I refused to fast during Lent when I was trying to tackle my eating disorder in college by eating three regular meals a day. Going without food for 12 hours would have caused a major hiccup in my recovery.

Thankfully there are wonderful resources available today on scrupulosity, and because of the awareness, I think that kids today are better educated on what healthy faith looks like as opposed to a form of OCD. That’s my hope, at any rate.

Image courtesy of publicdomainpictures.net.

In fact, “thrown out” was a term Amanda never heard growing up.

Like most children of hoarders, Amanda kept her mother’s disorder to herself, because she didn’t understand it and because she feared that friends would treat her differently and make fun of her behind her back. She simply made up reasons why they could never meet at her house. She suffered from the hang-up that practically all children of hoarders describe as “doorbell dread,” the panic felt when someone arrives at the door.

As an adult, Amanda eventually cleared out her mother’s house and helped her settle into a retirement community. Although the hoarding is considerably better, Amanda still feels the need to barge in once a month to make sure that boxes aren’t collecting in the hallway and the bathtub isn’t storing newspapers or clothes.

This child of a hoarder is only now coming to terms with the profound effect her mother’s disorder has had on her. Upon reading Jessie Sholl’s book, Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding, she recognized herself in so much of it, breathing a sigh of relief that at least one other person in this world understands her childhood drama and the ongoing fears she battles today.

Last month Steven Kurutz published an insightful piece in the New York Times about the baggage (no pun intended) hoarders leave their children with, and the children’s journey back to a normal relationship with “stuff.”

I found it all fascinating since I have a few friends whose parents are hoarders. Much of their childhood resembled mine, as a child of an alcoholic: the inconsistency, the shame, the confusion, and that amount of energy invested into covering up all the evidence in front of friends. However, unlike children of alcoholics, or adult children of alcoholics, children of hoarders don’t know where to turn for support. There are a number of online support groups and blogs devoted to children of hoarders. In his article, Kurutz mentions a few, such as the online forum “Children of Hoarders.” A friend of mine found a group devoted to sons of hoarders, and another to daughters. However, just in that last two years has the disorder gained the attention of journalists and media, with the two reality shows, TLC’s “Hoarding: Buried Alive” and A&E’s “Hoarders.”

Wall Street Journal columnist Melinda Beck devoted two pieces to hoarding: one on how to help hoarders themselves, and one highlighting issues that children of hoarders face. A few weeks ago I interviewed Beck and asked her to share a list of things that children of hoarders, or any relative or friend for that matter, can do to either help the hoarder or process the disorder for themselves. She responded:

There are no easy answers to this, which is why so many families of hoarders give up trying to change them. Some experts advocate “harm reduction” – just making sure the papers aren’t piled in front of the space heater and there’s a path to the door and the bathroom is useable. If you can get the hoarder to accept the need for that and throw away a few things, they may realize that it’s not so traumatizing and it might be a wedge to go further. You might try cleaning out just one room and seeing how that goes.

In some ways, being forced to move out quickly like my brother was can be a blessing. You can blame the bank or the sheriff — it’s not the sensible family against the nut case. It’s true that people often start hoarding again in a new setting, but at least it will take awhile to build up to a dangerous level again.

Working on the underlying emotional issues may be the best approach. Antidepressants might numb the pain enough to let them realize that the clutter isn’t serving the purpose they want it to. I really love the advice to create “shrines” or memory boxes if they are still grieving for lost loved ones or lost parts of themselves, with a few important things they can focus on, rather than a big disorganized pile. If you can honor the emotion they’re feeling, rather than denying it, they might be more willing to cooperate.

And if feeling abandoned or lonely or purposeless is fueling this behavior, see if you can find something else for them to do to fill up that emptiness—even if it’s volunteer job. I didn’t have the chance to try that with my brother, but if I had it to do over again, that’s what I’d try.

If I could communicate only one message to children of hoarders, it would be similar to a sentiment that consoled me as a child of an alcoholic, and that is to know that you are not alone, even though it certainly feels like it when you are overwhelmed by the dysfunction. Be sure to take care of you, because you can’t begin to take care of anyone until you meet your own needs.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.

It’s the enemy of creativity, productivity, and, well, sanity. In The Artist’s Way, author Julia Cameron writes: “Perfectionism is a refusal to let yourself move ahead. It is a loop — an obsessive, debilitating closed system that causes you to get stuck in the details of what you are writing or painting or making and to lose sight of the whole.”

But you don’t even have to be creating anything to be crippled by perfectionism. It can also frustrate your efforts as a mom, a wife, a friend, and a human being. Because no one and no thing is perfect in this blemished world of ours.

I tackle this adversary everyday. And although my inner perfectionist clearly has hold of my brain many days, I do think I am handcuffed less often by the fear of messing up than I used to be. Here are 10 techniques I use to break out of the prison of perfectionism in order to live and create as freely as I can in an imperfect world.

1. Remove yourself from the competition.

Don’t make life any more difficult than it already is. Most perfectionist’s are extremely competitive… because being perfect means being the best at, well, EVERYTHING. So choose your friends and your groups wisely. For example, some professional organizations–writing clubs, publishing groups — can be extremely supportive. But some can be horribly competitive. And as a perfectionist, you don’t need folks feeding you the very message you are trying to forget: “you are nothing without total success… and if you don’t get there, I will!” Do this: check your heart rate before one of these meetings, and just after. If it’s up ten beats or more, don’t go back!

2. Make up some rules.

Of course you can’t avoid all competitive situations. Which is why you need to make some rules. For example, I can now gauge when I’m going through a period of insecurity … when I feel like I need to be the best at something in order to feel okay about myself. During these periods, I don’t check out Beliefnet’s homepage where it lists “most popular blogs,” “most e-mailed posts,” “most popular features,” because if I don’t find my name somewhere in there, I mope around the house with that tight knot of disgust and angst in my stomach. Why torture myself? So here’s my rule: I can only visit the homepage on the days when I don’t feel like my popularity as a blogger is the definitive statement on who I am as a person. The result? I haven’t been to the homepage in months!

3. Do a reality check.

Unrealistic expectations are perfectionism’s trophy wife. Think about it. They always show up as a pair. So I try my best to distinguish realistic expectations from unrealistic ones. I list them all on a sheet of paper or (on a good day) in my head and then revise them about 2,035 times during the day. Under “unrealistic expectations” are cataloged things like this: “penning a New York Times bestseller in my half-hour of free time in the evening,” “being homeroom mom to 31 kids and chaperoning every field trip,” and “training for a triathlon with a busted hip.” Under “realistic expectations,” I index things like: “do 30 hours of good work in 30 hours of working time,” “reading to David’s class and having lunch with him once a month instead of being homeroom mom,” and “skipping the triathlon, but continuing to work out four times a week to keep the brain and body happy.” Recording the different possibilities of actions I can take to inch toward my broad goals (being a good mom, an adequate blogger, and a healthy person) can be extremely liberating.

For the last three years, perfectionism has placed me in an okay spot in a terrible economy. Had I not invested so many hours into networking and writing blogs the last five or so years — sometimes on top of full-time employment and other responsibilities — I would not have a job right now. And spending a night or two recently with friends of friends I knew back in high school made me proud of all the therapy and recovery I have done since graduating.

Had I not held myself to a high standard back then, I wouldn’t have quit drinking at the age of 18, and may still be hitting the bars at night.

Perfectionism can even be noble when we are able to turn the neurosis into acts of service, where we help others in similar pain.

However, the same energy that drives me to get up early in the morning and swim so that my brain operates with fewer hiccups than it would without the workout is also the fuel that wraps my brain cells in an OCD loop, in which I have trouble letting go of the decision I made last week, or a mistake I made six years ago, or something in the future that I’m preparing for.

I think the line that determines “bad” perfectionism from “good” perfectionism is drawn with how well you are able to function despite the loud conversation in your head. If the chatty dialogue is so obnoxious that it’s hard for me to get anything done, then I have myself a case of debilitating OCD. However, if the perfectionism and fear of failure propels me to chart a course for recovery (exercise in the morning, therapy on Thursday, a half-hour meditation every day), or if it pushes me to map out an outline for a work project so that I’m not so stressed when I sit down to tackle the thing … it becomes my ally.

In her book, Better By Mistake, author Alina Tugend offers a helpful distinction between good perfectionism and bad perfectionism:

Being a perfectionist isn’t a bad thing; in fact, it may mean you have very high standards and you often meet those standards. Those who have perfectionist tendencies without having those tendencies rule — or ruin — their lives are what psychiatrists call “adaptive” perfectionists. They find it very important to do certain things in the right way, but this need doesn’t hinder their lives and can actually help them achieve great success….

On the other hand, what psychiatrists call maladaptive perfectionists need to be the best at everything, and if they make a mistake, it’s a crisis. It’s also not just about how they perceive themselves, but about how others perceive them: they believe they will lose the respect of friends and colleagues if they fail. They have to hit all their marks all the time. Their need for perfectionism can sabotage their own success.

Clearly, my perfectionism robs me of hours, if not days, of joy. Because, instead of enjoying the moment with my kids at a lacrosse game or during our walk home for school, I’m usually obsessing about a certain blog post, or thinking about next week’s topics, or doing the math again to see if I can make the amount of money this month that I need to make. Too often, I suffer from tunnel vision, where I am blind to the blessings going on all around me. I waste the opportunities of wonder, as psychologist Mel Schwartz explains in his post called “The Problem of Perfectionism”:

In our culture we move relentlessly toward greater emphasis on achievement and goal attainment. We ask our children what their grade was, not what they learned. We tend to measure our lives in terms of success and achievement and lose perspective on what it may mean to live well. This ruptures any sense of balance in our lives. We seem to lose the capacity for wonder and awe. Could you imagine looking at a magnificent rainbow and complaining that the width of one color was imperfect because it was narrower than the other colors? Not only would that be ridiculous, we’d also be ruining the splendor of the moment. And yet that is exactly what we do when we judge ourselves for our imperfections. We forget that as humans we’re part of nature, as well. As such, we would benefit if we came into acceptance of the natural flow of life, which by the way, happens to be imperfect.

What we’re aiming for, then, is to harness our perfectionism in a way that can allow us to stay in the moment, and experience the wonder born in imperfectionism.

For his CBS segment, he interviewed Jeff Bell, KCBS radio broadcaster and author of “Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder” and “When In Doubt, Make Belief: Life Lessons from OCD.”

In his Huffington Post piece, Dr. LaPook writes:

“It’s my OCD.” I hear that on and off from friends and patients who half-jokingly use the term to describe overly careful behavior (such as double-checking to make sure the stove is off) but don’t actually have obsessive-compulsive disorder. True OCD can be a devastating disease. Patients have intrusive, uncontrollable thoughts and severe anxiety centered around the need to perform repetitive rituals. They can be physical such as hand washing or mental such as counting. The behavior significantly interferes with normal daily activities and persists despite most patients being painfully aware that the obsessions or compulsions are not reasonable.

OCD affects 2-3 percent of the world’s population. We’ve seen characters with the disorder portrayed in television (e.g., Tony Shalhoub’s Adrian Monk) and in film (e.g., Jack Nicholson’s Melvin Udall in As Good As It Gets). Yet it’s still associated with stigma, shame, and an alarming level of ignorance by many health professionals. On average, people look for help for more than nine years and visit three to four doctors before receiving the proper diagnosis.

In an excellent review article on the subject, Dr. Michael A. Jenike, offers three helpful screening questions:

• “Do you have repetitive thoughts that make you anxious and that you cannot get rid of regardless of how hard you try?”
• “Do you keep things extremely clean or wash your hands frequently?”
• “Do you check things to excess?”

He suggests that answering “yes” to any of these questions should prompt an evaluation for possible OCD. Of course, these are just screening questions and keeping a spotless kitchen doesn’t mean you have a disorder.

To read his whole piece, click here.

Well, anyway, I was reading an article in the Fall 2007 issue of The Johns Hopkins Depression & Anxiety Bulletin — an interview with Gerald Nestadt, M.D., M.P.H, Director of the Johns Hopkins Obsessive-Compulsive Disorder Clinic and Jack Samuels, Ph.D., an assistant professor with a joint appointment in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine and the Department of Mental Health at the Bloomberg School of Public Health at Johns Hopkins. Wow. That’s a lot of school.

I found out that, even though most folks lump compulsive hoarding into the same illness umbrella as obsessive-compulsive disorder, hoarders actually have different brains. The brain-imaging research shows that people with compulsive hoarding have distinct abnormalities in brain function compared to people with non-hoarding OCD and those with no psychiatric problem.

According to Dr. Samuels: “What causes those brain abnormalities (besides genetics) is still not clear, but compulsive hoarding can begin after damage from stroke, surgery, injuries, or infections. In addition, psychology and environmental factors (e.g. traumatic family experiences) appear to contribute to abnormal brain development and function.”

Samuels says that hoarding belongs to a syndrome which also includes:

• Indecisiveness
• Perfectionism
• Procrastination
• Avoidance behaviors
• Difficulty organizing tasks

And here are some interesting stats: hoarding obsessions and compulsions are present in approximately 30 percent of OCD cases. However, as a group, says Samuels, OCD-affected individuals with hoarding symptoms have a more severe illness, a greater prevalence of anxiety disorders, and a greater prevalence of personality disorders than people with OCD who don’t have hoarding symptoms. Hoarders are often less responsive to treatment than non-hoarding OCD patients.

Dr. Nestadt offers six anti-clutter strategies for compulsive hoarders:

1. Make immediate decisions about mail and newspapers. Go through mail and newspapers on the day you receive them and throw away unwanted materials immediately. Don’t leave anything to be decided on later.
2. Think twice about what you allow into your home. Wait a couple of days after seeing a new item before you buy it. And when you do purchase something new, discard another item you own to make room for it.
3. Set aside 15 minutes a day to declutter. Start small–with a table, perhaps, or a chair–rather than tackling the entire, overwhelming house at once. If you start to feel anxious, take a break and do some deep-breathing or relaxation exercises.
4. Dispose of anything you have not used in a year. That means old clothes, broken items, and craft projects you’ll never finish. Remind yourself that many items are easily replaceable if you need them later.
5. Follow the OHIO rule [which apparently doesn't work in Ohio, because I'm from there]: Only Handle It Once. If you pick something up, make a decision then and there about it, and either put it where it belongs or discard it. Don’t fall into the trap of moving things from one pile to another, again and again.
6. Ask for help if you can’t do it on your own. If you feel these strategies are impossible to carry out and you cannot cope with the problem on your own, seek out a mental health professional.

When people ruminate, they over-think or obsess about situations or life events, such as work or relationships.

Research has shown that rumination is associated with a variety of negative consequences, including depression, anxiety, post-traumatic stress disorder, binge-drinking and binge-eating.

Why does rumination lead to such harmful results?

For some people, drinking or binge-eating becomes a way to cope with life and drown out their ruminations, according to Susan Nolen-Hoeksema, Ph.D, a psychologist and professor at Yale University.

Not surprisingly, ruminating conjures up more negative thoughts. It becomes a cycle.

Nolen-Hoeksema’s research has found that “when people ruminate while they are in depressed mood, they remember more negative things that happened to them in the past, they interpret situations in their current lives more negatively, and they are more hopeless about the future.”

Rumination also becomes the fast track to feeling helpless. Specifically, it paralyzes your problem-solving skills. You become so preoccupied with the problem that you’re unable to push past the cycle of negative thoughts.

It can even turn people away. “When people ruminate for an extended time, their family members and friends become frustrated and may pull away their support,” Nolen-Hoeksema said.

Why People Ruminate

Some ruminators may simply have more stress in their lives which preoccupies them, Nolen-Hoeksema noted. For others, it may be an issue of cognition. “Some people prone to ruminate have basic problems pushing things out of consciousness once they get there,” she said.

Women seem to ruminate more than men, said Nolen-Hoeksema, who’s also author of Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life. Why? Part of the reason is that women tend to be more concerned about their relationships.

As Nolen-Hoeksema observed, “interpersonal relationships are great fuel for rumination,” and ambiguities abound in relationships. “You can never really know what people think of you or whether they will be faithful and true.”

How To Reduce Rumination

According to Nolen-Hoeksema, there are essentially two steps to stop or minimize rumination.

1. Engage in activities that foster positive thoughts. “You need to engage in activities that can fill your mind with other thoughts, preferably positive thoughts,” she said.

That could be anything from a favorite physical activity to a hobby to meditation to prayer. “The main thing is to get your mind off your ruminations for a time so they die out and don’t have a grip on your mind,” she advised.

2. Problem-solve. People who ruminate not only replay situations in their head, they also focus on abstract questions, such as, “Why do these things happen to me?” and “What’s wrong with me that I can’t cope?” Nolen-Hoeksema said.

Even if they consider solving the situation, they conclude that “there is nothing they can do about it.”

Instead, when you can think clearly, “identify at least one concrete thing you could do to overcome the problem(s) you are ruminating about.” For instance, if you’re uneasy about a situation at work, commit to calling a close friend so you can brainstorm solutions.

Positive Self-Reflection

Nolen-Hoeksema has also studied the opposite of rumination: adaptive self-reflection. When people practice adaptive self-reflection, they focus on the concrete parts of a situation and the improvements they can make.

For instance, a person may wonder, “What exactly did my boss say to me that upset me so much yesterday?” and then come up with, “I could ask my boss to talk with me about how I could get a better performance evaluation,” Nolen-Hoeksema said.

Do you tend to ruminate?
What has helped to reduce your ruminating ways?

Photo by Renato Ganoza, available under a Creative Commons attribution license.

“I’ve struggled with perfectionism all my life. Between having parents with perfectionistic tendencies and my own people-pleasing and competitive nature, it’s been a part of me for as long as I can remember,” she said.

As a wife and mom of two young kids, her perfectionism seeped into everything, no matter how big or small. She dwelled on her flaws and failures — defined essentially as “anything less than perfect.” But as any perfectionist truly knows, perfectionism is unreachable. It sabotages your self-image, squashes your satisfaction and turns life into a series of disappointments.

In the book The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are, researcher Brené Brown says that perfectionism is a shield, a self-created safety net that we think will shut out the bad stuff. (It doesn’t.)

“Perfectionism is the belief that if we live perfect, look perfect and act perfect, we can minimize or avoid the pain of blame, judgment and shame,” Brown writes.

“It was not until I was 35 years old, and my girls were seven and four, that I had an epiphany,” Jordan Kravitz said.

More specifically, she was diagnosed with cancer. At first, though, her perfectionism peaked. “In the early days of my diagnosis and treatment, I used to obsess over what I could have done differently to prevent this life-threatening disease.”

That perfectionistic thinking turned into other troubling thoughts: “My perfectionism got the best of me as I blamed myself for the disease, for putting my young children through such a horrible experience, and for being a burden to my husband.”

To everyone, Jordan Kravitz appeared strong and confident. “For others, I put on the most perfect veil of confidence and heroism I could find the strength to create.” Inside, she felt defeated. “My outlook on the rest of my life was bleak, and the self-pity I felt nearly drowned me in private.”

Eventually, as she said, “by the grace of G-d,” she started facing the reality of her situation: “My very imperfect circumstances and physical state literally stared back at me in the bathroom mirror. I now had two reconstructed, deeply scarred breasts to learn to live with, and I was bald, pale, puffy and exhausted ─ side effects from being injected with the strongest chemo the doctors thought I could handle.”

Whether she liked it or not, she had to rely on loved ones to help with everyday responsibilities, something she would’ve been too proud to do before. But her friends and family couldn’t care less about her so-called imperfections. Little by little, she started accepting herself and her situation.

“I realized that I had two choices. I could drown myself in self-pity and obsess about how imperfect things were, or I could live my life to the fullest and look at life for all that it was…imperfections and all.”

Now, Jordan Kravitz calls herself a recovering perfectionist because overcoming perfectionism is a process. And getting perfectionistic about pitching perfectionism surely defeats the purpose.

Debbie Jordan Kravitz is the author of Everything I Know about Perfectionism I Learned from My Breasts: Secrets and Solutions for Overpowering Perfectionism.