Anxiety and Friends: Obsessive-Compulsive Disorder

We continue our Access Astronomy spotlight on mental health in academia (part1, part2). Today's guest post is written by an anonymous contributor and carries on the anxiety disorder theme to shine a spotlight on OCD. It includes personal anecdotes and the author would prefer to not be identified. Content warning: description of panic attack onset. When not working and writing in support of destigmatizing mental health issues and identifying how to provide support for mental wellness in academia, the author works as an astronomy postdoc.

As in previous posts, this is not intended to be medical advice. Please seek the assistance of a therapist for any diagnostic or treatment purposes. If this is an emergency, call 911 or go to your local emergency room.  In the U.S. you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or click here for a listing of international numbers.

Today, I almost had a panic attack while attending a talk. It’s the first time it’s ever happened at work, and I’m considerably shaken. The speaker was delivering a very casual overview of a project in development and spent some time sharing anecdotes regarding a recent personal health scare that interrupted this work; this particular health scare happens to be the focus of fear and preoccupation whenever I experience a panic attack because the panic attack symptoms mirror those of this medical event. As pictures of the very ill astronomer in the hospital and then their scars while recovering from major surgery appeared on the screen, my stomach dropped to the floor. I began to feel nauseated, light headed; pain began to radiate down from my left shoulder and my chest and back muscles tightened as I drew my shoulders high in some futile effort to protect myself from the incoming tide of dread and sense of impending doom. I tried desperately to talk myself down: “I’m going to be ok.. just breathe, think of something else.. going to be ok.. breathe.. no, definitely not ok. I need to get out. Now.” I left the room, found and took the xanax in my bag. I then sat and waited at my desk, head between knees, for the blessed pharmaceutical to take effect and squash the spike of panic back into the quiescent level of anxiety that I generally am able to live with, taking the other alarming symptoms with it. I’m ok now, very tired and trying not to cry at my desk, but it’s over.

While this particular episode was understandable given my primary trigger was front and center in this talk, generally, panic attacks are not at all predictable. Panic attacks live in the diverse panoply of anxiety disorders, which can include generalized anxiety and specific anxiety-driven conditions like obsessive-compulsive disorder. Many of these disorders are comorbid, meaning the likelihood of having one increases if you have another; this makes sense as their root causes lie in anxiety itself, which can manifest in many different ways.

Obsessive compulsive disorder, OCD, is an anxiety disorder that centers on discomfort with uncertainty. Since our professions involve so much uncertainty, I’m not surprised to also have this in the list of my brain’s unique specializations. OCD is a distinct condition from Obsessive Compulsive Personality Disorder, OCPD, though they share many traits; I’ll focus here on OCD as it is classified as an anxiety disorder and it is my diagnosed condition. While OCD manifests in many ways, the stereotypical picture that immediately comes to mind is of repeated hand washing. The act of hand washing is referred to as a ritual, and in OCD, rituals are patterns of behavior that sufferers establish and maintain as a means to eliminate or manage the negative thoughts and emotions surrounding sources of uncertainty. Intrusive thoughts, including things like fears that you may harm yourself or someone you love, that you’re a terrible person and going to hell, doubts about important relationships, fears of uncleanliness or impending catastrophe, spur on ritualization. Rituals tend to escalate in their frequency and complexity as eventually the calm they initially brought wears off. If the sufferer does not act to mitigate the effects the intrusive thoughts suggest, it can bring about a sense of despair, panic, despondence, fear, anxiety. A person with OCD lives in a near constant state of fight-or-flight as the amygdala is convinced something bad, as suggested by the intrusive thought, will happen if you don’t act somehow, and that action is ritualization. An OCD sufferer feels they cannot stop, and simply being told to stop doing it causes pain and further anxiety because believe me, they wish they could just stop!

Sometimes the connection between the uncertainty feared and the ritual established in response are relatively clear: my fire phobia rituals include making sure small appliances are unplugged before I leave the house and being extraordinarily cautious with household fixtures that produce fire (wood stoves, candles) or that could somehow cause a fire (clothes dryer, hair dryers, toaster, oven, anything with a pilot light). This also applies to the office- I’ve been known to walk back to the building from the parking garage to ensure I unplugged things in my office. I’ve turned around mid-commute and driven home, upwards of 5 miles, to make sure my hair dryer was unplugged (even though I know I checked before I left the house, “what if..?” haunts and compels me to check yet again even as I argue with myself that I know it's fine). For me, experiencing a house fire was the clear genesis of this particular phobia and set of preventative rituals to cope. Being robbed led to my ritual of visually checking, then touching locks and deadbolts multiple times to ensure their security. For other rituals, their origins may be unclear. Fears of harm coming to you or loved ones could be calmed by tapping door frames in a pattern, left-right-right-left-left, repeatedly, upon entry and exit. The OCD sufferer is aware it doesn’t make sense in a cause-and-effect way, but is compelled to do it: the intrusive “What if?” dominates behavior patterns. As rituals escalate, they take time to perform and increasingly interfere with basic life functions; this is the hallmark of a mental illness.

There are many facets of OCD and ritualization, but a lesser known OCD behavior that can manifest in academic contexts is a cognitive distortion called scrupulosity. Scrupulosity can often refer to moral or religious contexts, with the fear and attendant intrusive thoughts that you will be punished for sinful thoughts or behaviors or that you are an inherently "bad" person. In the academic context, I want to focus on the facet of scrupulosity that is rooted in a fear that you aren’t telling the truth in the most whole, full, complete way possible. Some may dismissively call it perfectionism, but it’s a little more complicated than that- it involves compulsion to keep working on the same problem, even beyond its resolution, just so you can be *sure* that it’s really, really, resolved. What if I forgot something? What if that fit could be better? “What if...?”

For me, OCD-driven scrupulosity manifests in a few primary ways: communications with others (e-mail and giving talks) and data analysis. E-mails take a very long time to compose as I do back research to ensure what I am saying is not redundant, unclear, a waste of the reader’s time, or betraying a fundamental lack of knowledge on my part (this is where OCD and impostor syndrome can meet and amplify). Talks also take a very long time to prepare, as I feel compelled to provide the most in-depth, well-cited picture of the subject I’m presenting. These may sound like simply best practice, and indeed collaborators tend to enjoy working with me, often praising my thoroughness. But what they don’t recognize is the disruption it represents to my daily life, the delays it causes in getting other things done, and that I’m watching others in the field pass while being able to direct their efforts in more productive ways.

In data analysis, scrupulosity leads to re-doing analyses over and over- directories filled with duplication of work: version 1, version 2, 3; versions 10, 11, 12... The cycle of doing and re-doing is generally only broken when a colleague intervenes and reassures: yes, this is fine. You did a good job, I think it’s great. The external verification and validation can end the death spiral of re-re-re-doing. In the meantime, my publication rates have suffered, and if you try to explain that it’s a real, legitimate mental illness, people think you’re joking. OCD has become so trivialized, made into a meme for people who find patterns being broken distasteful (“Oh, that floor tile is in the wrong place for that design- omg I’m so OCD because that bothers me!”) that the very real suffering of people with OCD goes ignored, turned into a joke, robbed of its legitimacy and the acknowledgment of the power it has to disrupt lives and careers. Please, don’t joke about “being so OCD;” it is painful for sufferers to hear, to see the meme lists of pictures of “N things that will trigger your OCD,” and to effectively not be able to talk about it openly because it’s assumed the sufferer is using the term in jest.

One does not need to be diagnosed with OCD for it to be recognized that they manifest OCD behaviors; these behaviors may or may not be destructive to the individual’s well being or disrupt their ability to engage with life as fully as they wish to. There are a number of avenues for treating OCD, including therapy and medication. Cognitive behavioral therapy for OCD generally focuses on a technique called Exposure and Response Prevention, which aims to eliminate the response to obsession-triggering stimuli through careful, guided exposure to those triggers. Treating scrupulosity with therapy involves cognitive restructuring: the sufferer is made aware of their obsessive thoughts, identifying the distortions that drive them, and then trying to confront the distortions with more reasonable arguments or interpretations. If you are concerned about escalation of ritualization, seeing a therapist to discuss is highly recommended. There are excellent books on OCD, but I would strongly recommend reading them under the advisement of a therapist, especially if it’s a certain book that provides worksheets to be filled out as diagnostic aides- a therapist can help immensely in going through the worksheets and helping you focus your efforts on handling the issues most immediately impacting your daily life. 

Living with Anxiety Disorders in Astronomy

Today's guest post is written by Angela Zalucha, Principal Investigator at the SETI institute (website, twitter: @plutoprincessz). When Angela isn't using general circulation models to study planetary atmospheres, she is actively working to eliminate stigma surrounding mental health discussions to make our community more inclusive.

This is the second in a series of blog posts about what one astronomer has learned while dealing with mental illness (click here for part 1). It not be a substitute for help from a professional therapist or physician. If this is an emergency, call 911 or go to your local emergency room.  In the U.S. you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or click here for a listing of international numbers.

In a few hours, I have to get on an airplane. I'm afraid to fly. Right now, I am logical. You can give me statistics about how flying is the safest way to travel, teach me the physics of lift, familiarize me with the safety protocols of the Federal Aviation Administration, or show me how a jet engine works, and I will think these things sound quite reasonable. But once I'm on the plane, I lose all rationality. Scientific reasoning in my brain shuts down. This type of anxiety is what would be classified as a “specific phobia” below.

The American Psychological Association1 defines anxiety as, “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” The National Institute of Mental Health (NIMH)2 further explains, “Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships.” Interference with daily activities, whether physiological or psychological, is a flashing sign that some form of professional help should be sought.

The NIMH states that anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults age 18 and older, or 18% of the population. There are different kinds of anxiety disorders, as well as other disorders that are closely intertwined with anxiety. People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms2 (3.1% of the U.S. population; women are twice as likely to be affected as men)3. People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom2 (2.7% of the U.S. population; women are twice as likely to be affected as men)3. People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others2 (6.8% of the U.S. population; equally common among men and women, typically beginning around age 13)3. Specific phobias (such as fear of heights) affect 8.7% of the U.S. population (women are twice as likely to be affected as men; typically begins in childhood; the median age of onset is 7)3. Other conditions such as depression, obsessive compulsive disorder (OCD), and Posttraumatic Stress Disorder (PTSD) have a significant anxiety component in their symptoms3.

Back to the airplane example: my anxiety about flying was at one time more than just a minor inconvenience where I couldn't work or sleep on a plane like some people can, thus not making the most efficient use of my time. Before my my anxiety was managed, I would be looking at weather maps days in advance and worrying about atmospheric conditions. When I got off the plane I often hadn't eaten because I was so scared, and I had to spend the rest of the day in bed because I felt sick to my stomach. This anxiety was intruding into my work and personal life, which was a signal that I needed to see a mental health professional.

Like any profession, astronomy is stressful. Exams, a PhD thesis, job applications, proposal deadlines, public speaking, travel, and socializing in the workplace and at conferences are things we must do to advance in the field. For some people, any of these things alone can cause an anxiety disorder or compound a preexisting condition. Here I'd like to point out some anxiety-causing situations that I have encountered both personally and as an anonymous third-party that are associated with the profession of being an astronomer (in no particular order).

Graduate school can be a high anxiety situation, with the large teaching and research workload, comparatively low pay and insufficient benefits, high cost of living near a university, perhaps living far from family, pressure from other scientists (“so, you're in your fifth year, shouldn't you be graduating soon?”) or family (questioning your career choice), tensions between advisor or other people, intense qualification exams, writing the thesis document (dauntingly large for some), preparing for the defense, the defense itself, and post-PhD job search stress. My psychiatrist in grad school often asked me if I felt depressed (not technically anxiety, but related) after I successfully defended my thesis, because even if writing a thesis is a high anxiety event, when such a major aspect of your life is over, feelings of emptiness can occur (e.g., postpartum depression).  I also remember many fellow graduate students being immensely emotionally burdened during the uncertainty and competitiveness of post-PhD job search.

Conferences are another high anxiety event for two reasons: those associated with research itself and those associated with social anxiety. It seems that most of us work in a frenzy to get our presentations or research done right before the conference (or at the conference itself). Few people are comfortable with public speaking, and I feel the level of preparation (e.g. formal training) varies widely due to everyone's different educational and workplace background (it may or may not get better with time). On top of the stress of traveling to a conference (which might leave us jetlagged or not on our normal eating diet and schedule), socialization is necessary to build collaborations or make yourself known to employers. For first-time conference-goers or when at a conference outside your field (or a very specific case for me, where my PhD advisor and I are not in the same research field), trying to mingle with strangers, especially a group of people who have been great friends for 20 years, is frightening. We also have a societal pressure to drink alcohol (leaving some who abstain uncomfortable), but not to drink so much so as to lose professionalism.

Preparing job applications (including undergrad research positions, graduate school, postdoc positions, and faculty positions) and writing grant proposals are very time-consuming. Depending on the institution, your current position may not pay you enough or at all to write these applications, so you are trying to them on top of your normal work. For me personally, rejection leaves me so devastated that I experience a panic attack. People experience panic attacks in different ways, but the way I experience them is I feel like the room is spinning, my life is out of control, and I have to lay down and stare at the ceiling fan. Sometimes they are a result of a specific trigger I can point to, sometimes they just seem to hit out of nowhere.  If I fall asleep, I wake up feeling calmer, but I've just wasted two or three hours that I could have been working, doing chores, or having fun.  I would say more often than not, I need a “panic-resolving nap” in the afternoon.  I usually feel groggy the rest of the day. On a non-panic attack day, my anxiety increases as a function of time of day, so that late at night I am completely wired (coffee is off limits for me at any time of day). Even if I'm sleepy, I need medication to calm me down in order to sleep.

Not everyone may feel anxious in the situations, and I have probably left some out. Like other mental illnesses, we don't talk about anxiety disorders in the open, and so people do not get the support they need. When members of the field suffer, the productivity and potential achievements of the field as a whole suffers, and we need to recognize it. Anxiety disorders are not a mere inconvenience, but detrimental to our well-being. Like many mental health conditions, they serve as a barrier to access and engagement with our science.

1. American Psychological Association, Accessed 4 October 2016, http://www.apa.org/topics/anxiety/

2. National Institute of Mental Health, Accessed 4 October 2016, https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

3. Anxiety and Depression Association of America, Accessed 4 October 2016, https://www.adaa.org/about-adaa/press-room/facts-statistics

What is Mental Illness?

Today's guest post is written by Angela Zalucha, Principal Investigator at the SETI institute (website, twitter: @plutoprincessz). When Angela isn't using general circulation models to study planetary atmospheres, she is actively working to eliminate stigma surrounding mental health discussions to make our community more inclusive.

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This series of blog posts is what one astronomer has learned while dealing with mental illness. It not be a substitute for help from a professional therapist or doctor. If this is an emergency, call 911 or go to your local emergency room.  In the U.S. you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or click here for a listing of international numbers.

Hello, my name is Angela and I suffer from mental illness. What does that mean? Am I crazy? Am I insane? A mental illness is behavior or thoughts that prevent you from living an everyday life. Mental illness affects the way a person thinks, feels, and behaves, and it can impact your ability to relate with others and function on a daily basis. By no means are those with mental illness weird or abnormal--about 1 in 5 people in the US suffer from a mental illness (here are the stats from the National Alliance of Mental Illness). And those are only the ones that are diagnosed (see World Health Organization bulletin).

A few examples of living with mental illness include: washing your hands until they turn red, not being able to get out of bed due to apathy, or being so afraid of crowds that you become petrified. I'm not writing about “I got some super-glue on my hands once and tried to wash it off and it took forever,” or “I had worked really hard last week and just felt like lounging around on a Saturday in my pajamas,” or “I was tired and didn't want to go to the party.” I'm writing about “I spend so much time washing my hands that I'm late to work every day”, or “I couldn't get out of bed for a week and haven't paid my electric bill” or “my brother is getting married, but I've been worrying for weeks because a lot of people will be there.” These events (work, paying bills, family events) are things that we, our culture, or our society have deemed are necessary parts of life that we must do often, and mental illness serves as a barrier for engagement with life in fundamental ways. One in five people you know maybe coping with these issues; maybe that one in five is the reader: you are not alone, reader.

Academia exists within larger societal structures and is often rife with the same biases. While the Americans with Disabilities Act of 1990 disallows discrimination against mentally ill workers, the biases against mental illness are deep, and the reality is still very far from the ideal. Scientists and students who disclose their illness out of necessity may find that their credibility as a researcher is undermined by their need for accommodation. Too often mentally ill scientists are simply dismissed as “crazy,” or politely told that if they cannot do the required work, they should probably rethink their field of choice. This in turn leads to an unwillingness to disclose illness, which means that many mentally ill researchers struggle on without necessary medical help or workplace accommodation.

Untreated illnesses (and even treated, since that can take time) lead to cumulative detrimental effects on our careers: opportunities that couldn't be taken advantage of, lost time, and lower productivity; it's a barrier to access and ultimately, it likely means lots of talented people are lost from the field. (Currently, there are no studies of how many scientists and any level leave because a mental health barrier). Studies indicate we have a profound mental health crisis in academia, but the topic is so taboo that most of us don't even see the tip of the iceberg, much less the actual extent of the problem. (A collection of resources related to mental illness in academia can be found here).

What should you do if you feel like you might be suffering from a mental illness or maybe just want a consultation to determine if you are? It's pretty much the same as if you had a physical injury. The two main types of professionals are therapists and psychiatrists. Therapists are college-educated professionals (often PhD or equivalent) who usually use some technique such as talking, cognitive behavioral therapy, or meditation to treat your condition. Psychiatrists are medical doctors (or nurse practitioners) who can prescribe medication.

I will be honest, going to a stranger and spilling your innermost feelings is intimidating. But it's like going on a date. If you don't click with your therapist, you can go to a different one until you find one that makes you feel comfortable. Likewise, some people are afraid that drugs will change their personality, the things they enjoy. Many other patients are deterred by the strong societal stigma against medication to treat mental illness, though that has improved somewhat with time. While all medications carry side effects, prescription medications are meant to target a specific behavior, not turn you into someone you aren't.

In more urgent situations, at least in the US, if you are seriously thinking of harming yourself or have another urgent symptom, please consider calling the National Suicide Prevention Lifeline, listed in the prelude to this point. You can also go to your local emergency room or call 911. (Depending your state of mind, it may be best to have someone else drive you). They can and will treat your emergency just as if you had broken your leg. There are triage nurses and doctors that can help you with your emergency. Each state has different laws, but in my state, Colorado, you can commit yourself to a psychiatric hold where you stay in the hospital for 72 hours. For your own safety, they take away anything you could use to hurt yourself and provide mental health care to treat the most urgent symptoms. Please be kind to yourself and get help and show compassion for others who are suffering, perhaps secretly.

As for long-term care at colleges, universities, and other institutions, mental health care varies by a large margin.  A long-term goal of the AAS WGAD is to assess availability on campuses of resources to astronomers at all career levels, and ensure it is widely known within institutions how to access these resources.

Significant contributions to this post were made by Alicia Aarnio and Jackie Monkiewicz. Future blog posts will focus on specific conditions such as depression, anxiety, insomnia, obsessive compulsive disorder, and other mental illnesses.