By Nicole Bosse, PsyD, Lindner Center of HOPE, Staff Psychologist

Kyle has been happily married to his wife Joanne for 5 years. One night while watching a movie together, he notices the thought in his mind, “Gee, that Matt Damon is a good looking guy!” He then is suddenly flooded with a wave of panic and fear that perhaps the presence of this thought means he is gay and his whole marriage is a sham.  Although this scenario is fictional, it is an all-too common manifestation of a form of obsessive compulsive disorder.  Referred to as sexual orientation- obsessive compulsive disorder (SO-OCD).  SO-OCD is characterized by recurrent distress-producing doubts about whether one is gay or straight, fears of becoming homosexual (or becoming straight if their sexual orientation is homosexual), or fears that others might perceive the individual having the undesired sexual orientation.  (Williams, 2008). A person may have only one of these concerns or some combination. SO-OCD is very different from ordinary doubts and anxieties that are experienced by individuals attempting to discern their sexual orientation. For example, an individual coming to understand that they are gay may feel anxious about coming out or about the potential changes this will bring to their lifestyle. As clinicians, it is important to thoroughly assess if their client’s intrusive thoughts are ego-dystonic. In SO-OCD, ego-dystonic intrusive thoughts are cognitions that are inconsistent with the individual’s fundamental desires, wants, and sexual history.

Individuals with SO-OCD typically experience confusion and shame, which may unfortunately deter them from seeking appropriate treatment. Another factor that might impact entering appropriate treatment is that many of the individuals who struggle with this type of OCD have very few observable compulsions, which can prevent it from being recognized and properly diagnosed. Many of the compulsions typically take the form of cognitive compulsions, specifically mental reviewing to check the presence or absence of feelings of attractiveness or arousal, reassurance seeking, self-observation to see if one “looks”, talks, walks, or gestures like someone who is gay or straight, and avoidance of situations that might trigger fears.

Treatment for SO-OCD is very similar to treatment for other categories of OCD, specifically exposure and response prevention (ERP) is the gold standard treatment. It is important to emphasize in treatment that it is impossible to control thoughts and that typically trying to control thoughts or push thoughts away significantly increases them. Next it is key to explain ERP and to help them understand the reason why they are leaning into the anxiety. It can be particularly helpful to have them identify what in their life would be different once their OCD is no longer in the picture. Once the client is on board with and understands the importance of exposures, the client and clinician work collaboratively to create a hierarchy of exposures. It is important to begin with low distress exposures at first, and then gradually work up the hierarchy once they habituate to the low level exposures.

As with any form of OCD, exposures for SO-OCD can take various forms, depending on the client’s core fear. For example, one client’s core fear may be that they need to be 100% certain that they are attracted to individuals of the gender of their preferred sexual orientation, while another client’s core fear may be that they do not want to hurt the person they are with if they one day discover they are attracted to a different gender. In short, it is very important to first identify what their core fear is before creating the exposure hierarchy. Some common exposures for clients with whom I have worked whose obsessions focus on fears of being gay include identifying attractive individuals of the same sex, watching movies involving homosexual characters, attending pride events, writing sentences stating “I am homosexual,” or writing imaginal scripts about coming out to loved ones or sitting with uncertainty that they will never know 100% if they are in the correct relationship. It is also important to emphasize the second component of exposure and response prevention, namely response or ritual prevention. For instance, it would be necessary for the patient to not give in to reassurance seeking or mentally assess arousal before, during or after exposures.

Treatment length can vary depending on severity of symptoms. It is important to work with someone who specializes in OCD. Typically, therapy occurs once per week with the idea that once exposure work is started the client will be completing exposures each day between sessions.

Charles F. Brady, PhD, ABPP, Lindner Center of HOPE, Clinical Director of Outpatient Services and Staff Psychologist, OCD/CBT Psychotherapist, Associate Professor, University of Cincinnati’s Department of Psychiatry

In today’s culture the terms “obsessive” and “compulsive” have been adopted to refer to excessively repetitive thoughts and hard to resist behaviors.  In clinical situations this overly broad definition leads to substantial confusion when discussing obsessive compulsive disorder (OCD) and substance use disorders (SUDS).  Individuals who report they are always thinking about using addictive substances and “cannot stop” acting on their urges to use, are often erroneously referred to as obsessing about using or compulsively using.  Most often, someone who is struggling with a SUD does not have OCD and vice versa. However, both research and clinical practice reveal that these two conditions co-occur frequently.  Mancebo et al, 2009 documented that in their sample of OCD treatment seeking patients, twenty- seven percent were found to have SUDS.  To address the inevitable chicken and egg question, they delved further to uncover that seventy percent of the patients with co-occurring OCD and SUDS reported that their OCD symptoms preceded the onset of their SUD by at least one year.   They also found that in their sample, the participants who reported childhood onset of OCD symptoms were at higher risk for subsequently developing a SUD.  In this article, the similarities and differences between OCD and SUDS will be explained and the pertinent issues regarding the approach to treatment when a person suffers from both OCD and a SUD will be detailed.

Psychologically, the difference between a person struggling with OCD and a person with a SUD lies in what fuels the behavioral urge.   For the person with a SUD, the behavior is positively reinforced. By this we mean that the mind anticipates pleasure from completing the action (i.e., using a substance).  For the OCD sufferer, negative reinforcement describes the mechanism of striving to reduce distress as the key for driving the behavioral urge behind the compulsion.   An additional difference is that thinking about substance use initiates a pleasure experience, whereas the intrusive thought the person with OCD experiences initiates a distress response (e.g., What if I touch a door knob and die?).  There are occasions in which the person with a SUD will express that they use their addictive substance even though they do not want to.  Typically, such an individual continues to experience pleasure and pleasurable anticipation of the use of the substance, but over time they develop an aversion to the negative consequences that use of the substance has brought into their life (e.g., loss of job, legal problems., relationship damage, shame, etc…  ).

Biologically, it appears that the orbitofrontal cortex (OFC) plays an important role for both SUDS and OCD.  The OFC is a part of the brain that helps to reign in emotional reactions.  For individuals with OCD, the OFC tends to be over activated, even in neutral situations. For individuals with SUDs, the OFC becomes over active in the presence of triggers. For instance, when a person with an alcohol addiction hears or sees a beer can being opened.  When the OFC is over activated, the individual experiences an intense drive to act and is overwhelmed by their desire to act.   This is why sufferers of both SUDS and OCD struggle to resist their urges to perform a compulsion or to engage in their addictive behavior.

For the individual with OCD and a SUD, the relationship between the two may vary.  Some individuals develop addictions as an attempt to soothe and self-medicate the distress caused by their OCD. Yet others may find that their use of addictive substances follows OCD-like rules.  For example, the person who must drink 7 ounces of alcohol per night due to the obsession that if they do not, something bad may happen to a loved one.  If the use of the substance is nested within a compulsion, exposure and response prevention (ERP)targeting the compulsion may need to be started.

At times if the addiction greatly interferes with treatment for the OCD symptoms then treatment must include aggressive treatment of the SUDS early in the treatment process. There are several ways in which substance abuse disorders, if untreated can impede effective treatment of OCD. First, many substances, including barbiturates, alcohol and benzodiazepines that are involved in SUDs are depressants.  They either cause or exacerbate depressed mood. If a person’s mood is depressed, the motivation and drive necessary to engage in ERP treatment for their OCD symptoms may be severely impacted.  Also, the essential component of successful ERP treatment involves learning. The person with OCD learns that the obsessive thoughts they experienced are not as dangerous or as intolerable as they previously believed.  This learning allows them to free themselves from compulsions and helps them resist relapse. Many individuals develop SUDS in an attempt to self-medicate and soothe the distress caused by their OCD by using drugs like alcohol, benzodiazepines (e.g., valium, Xanax, Ativan,  etc…), and marijuana. Unfortunately, these substances impede learning. The patients who are unable or unwilling to reduce or cease their abuse or dependency of these substances while they engage in ERP are going to have a more difficult time accomplishing the learning needed for recovery from their OCD symptoms.

When treating a patient with a co-occurring SUD and OCD, the clinician also must consider how willing and motivated is the person to tackle both the addictive behaviors and the OCD behaviors.  It is not uncommon for a person with a co-occurring SUD and OCD to be more hesitant and resistant to let go of their addictive behaviors as they derive some pleasure from them, yet they may be very motivated to rid themselves of their time consuming compulsions and the anxiety triggered by their obsessions.  In such instances, the clinician may need to start where the motivation allows, but continue to educate and explore with the patient about how the addiction may impede their OCD recovery and how it also may be negatively impacting their health and well-being.

In conclusion, for clinicians who treat individuals with OCD or SUDs, it is of primary importance to assess for symptoms of both disorders.  The person who presents with complaints of a SUD, may be ashamed of the absurdity of their obsessions and compulsions and may not volunteer them.  Likewise, the person with OCD may also feel hesitant to report their use of substances.  When the clinician discovers that a person may have co-occurring OCD and SUDS, the patient will benefit most from a thoughtfully and collaboratively developed treatment plan to address both conditions.


Mancebo et al.,  J Anxiety Disord. 2009 May; 23(4): 429–435

BY: Elizabeth Wassenaar, MS, MD, Lindner Center of HOPE, Staff Psychiatrist and Medical Director of Williams House


Life can be overwhelming and we all would like to take a day off every once in a while. Likely, as helping professionals, we don’t take mental health days as often as we could actually benefit from them.  This is one of the reasons why, when a child or adolescent refuses to go to school, we may be initially sympathetic.  Maybe a day or two off will help, we may think.  In too many cases, however, we see that a day or two off turns into something much more problematic as parents and professionals struggle to get a school avoider back to school.  Homework piles up, grades start to fall, and friends wonder what has happened to their classmate.  Parents try many different tactics to try to get their child back to school; bribing, negotiating, punishing, or even carrying a child through the school door.

Children want to not go to school for many reasonable causes: kids can be cruel; learning can be difficult; anxiety about performance can be overwhelming; health concerns can require special privileges that feel too identifying; and getting up early in the morning is harder for some more than others. Furthermore, mental illness can make school attendance difficult for many additional reasons.  There are good reasons to keep children home from school – physical illnesses can be contagious, some stages of mental illness are better treated with mental rest, and in some cases of bullying the safest way to deal with an unsafe situation is to remove the child.

Nevertheless, school refusal is avoidance, and anxiety loves avoidance. Nothing is more reinforcing that one cannot handle something than not doing it.  So, after one has checked on physical health and for other explanations, how can professionals support parents to keep their children in school or break the cycle of school avoidance and school refusal?

  1. Help parents identify the behaviors of avoidance and link that to anxiety.

Avoidance is a coping mechanism for dealing with anxiety, which can become maladaptive when avoidance becomes the only options. Avoidance can look a lot of different ways –tantrums, tearfulness, vague physical symptoms, negotiation (more on that later), chaos, and so on.  Parents may not be able to recognize all of the forms avoidance can take. Helping them objectify avoidance will help them strategize on how to deal with it.

  1. We have to truly believe that avoiding school will not make it better.

It can be tempting to collude with anxiety that the precipitant needs to be avoided for all the reasons laid out in this article and we need to be internally convinced that anxiety is not correctly assessing the situation. As difficult as school can be, school occupies a unique place in a child’s life.  It is the place of work, play, and love.  Learning and playing are the main jobs of childhood.  Playing looks both like playing at recess and like experimenting in relationships with both friendship and love. Identity is formed and reformed through our work, play, and love.  When a child is not in school for an extended length of time, they are abrupting their opportunity for this developmental process to proceed.

  1. Negotiation is another way of avoiding and is a dangerous game.

Many of my patients have used a variety of negotiating tactics with their parent: “Let me go in later and then I’ll go, I promise” or “Let me catch up on my work today and I’ll go in tomorrow”. Small avoidances add up to large avoidance and are not moving towards your goal.  Reverse the negotiation and set up conditions that will allow an out as long one starts the day at school.  Often, once anxiety has lost its argument that one cannot handle going to school, staying in school through the day is easier to manage.

  1. Encourage parents to work with the school

Parents and school are on the same side of this concern – both parties want the child to be successful in school. For parents, this may be the first time dealing with school refusal, but it is most certainly not the first time the school has dealt with school refusal.  Most schools have a variety of plans to help keep a child in school.  Have parents reach out to the school and let them know what is going on.

  1. Set small goals that lead to the victory

The ultimate goal of full school participation is an overwhelming prospect. Depending on how severe the school refusal is, reintroducing school can be an extended process of gradually introducing larger and larger challenges.  Perhaps, on the first day, one can only walk through the school doors.  Maybe a student will be able to be in the school building, but not in classes.  Parents can engage trusted friends to provide motivation and encouragement through social interaction and distraction while at school.

  1. School has many different forms

Many families choose alternative school arrangements including home schooling, virtual schooling, and others, for a variety of reasons and this article is not meant to convict choices that do not have a child in a classroom every day. There are many viable options for school that provide an environment that promote healthy development.  When a family is making a decision to change the way school is delivered, help them examine what factors are involved in their decision.  If they are making the decision from a place of believing that the anxiety that drives school avoidance cannot be defeated then, help them with all the ways described above.

School is a venerable and sometimes dreaded rite of passage. A great deal rides on academic and social success in school which increases anxiety and can lead to school refusal.  As a team, parents, professionals, and schools can help keep children and adolescents in school and accomplishing their goals.

On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show.  Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.

Click here to listen.

Private offices enable clinicians and patients to work together in a comfortable environment.

Charles Brady, PhD, ABPP, Director OCD and Anxiety Program at Lindner Center of HOPE discussed Diagnosis and Treatment of OCD on a recent One Hour at a Time episode.

To download and listen to the program, click here.

Obsessive Compulsive Disorder (OCD) was once thought to be an untreatable condition.  However, in the past 30 years psychiatric and psychological treatment advances now allow individuals with OCD to manage and overcome their symptoms and live fulfilling and meaningful lives.  Untreated OCD is a potentially disabling condition that strikes children and adults. Estimates of up to three percent of the population will battle OCD at some point in their lives and it affects men and women in equal numbers. It delivers a staggering toll for the individual and society, as individuals with OCD to have much higher than expected rates of under-employment and unemployment.  With treatment , a person suffering OCD can now expect to free themselves from OCD’s grip. Dr. Charles Brady, from Lindner Center of HOPE’s OCD and Anxiety treatment program will discuss the nature of OCD including how it is diagnosed and how current evidence based treatments are able to help individuals reclaim their lives.



Guest Bio:

Dr. Charles F. Brady directs the Lindner Center of HOPE’s Obsessive Compulsive Disorder and Anxiety treatment program. He leads the research and development of the Center’s psychiatric rehabilitation programming. Dr. Brady is a clinical psychologist with over 20 years experience on the staff and faculty of the University of Cincinnati’s Department of Psychiatry. In addition to providing clinical service at UC, he trained and supervised interns, doctoral students, post-doctoral fellows, psychiatric residents, psychiatric fellows, and psychiatrists. Dr. Brady earned his Doctorate of Clinical-Community Psychology from University of South Carolina and completed his post-doctoral fellowship in the Department of Psychiatry at the University of Cincinnati College of Medicine. He has completed training in the treatment of OCD and OCD spectrum disorders through the Behavior Therapy Institute. Dr. Brady is Board Certified in Clinical Psychology by the American Board of Professional Psychology.

Mason, OH, November 24, 2014 – Lindner Center of HOPE staff psychologist, Charles Brady, PhD, ABPP, is a finalist for the 18th annual Business Courier Health Care Heroes awards in the provider category. Dr. Brady is one of 19 total finalists and one of five in the provider category.

Winners will be announced at a dinner on Thursday, February 12, 2015.

Dr. Brady directs the Center’s Obsessive Compulsive Disorder and Anxiety treatment program and oversees the Supported Employment program. He leadsCharles Brady Ph.D_0027 the research and development of the Center’s psychiatric rehabilitation programming. He also currently serves as the president of the board of managers of Lindner Center Professional Associates.

Dr. Brady is a clinical psychologist with more than 20 years of experience on the staff and faculty of the University of Cincinnati’s Department of Psychiatry. In addition to providing clinical service to thousands of patients at UC, he trained and supervised numerous psychology interns, doctoral students, post-doctoral fellows, psychiatric residents, psychiatric fellows, and psychiatrists.

Approximately 2 to3 million adults and ½ million children in the United States have OCD, but more than any other psychological conditions, individuals with OCD encounter obstacles that are estimated to cause an average of 14-17 years between the onset of symptoms and accurate diagnosis and effective treatment. Common obstacles include a shortage of properly trained health professionals and inaccurate or insufficient public awareness. On many levels, Dr. Brady works to address these challenges.

Dr. Brady’s positive impact as a provider is not limited to merely the population of patients he works with directly, instead his focus has always been on devising the best and most efficient ways to reach as many individuals as possible. Having established a well-respected reputation as one of the nation’s Obsessive Compulsive Disorder experts, Dr. Brady’s unique understanding of OCD and his experience in achieving positive, measurable progress is highly sought after by patients and families across the country.

It was obvious to Dr. Brady early on that, individuals suffering with OCD were underserved. To that end, Dr. Brady made it his personal mission to address the need of those struggling with OCD, seeking specialized training on his own and rising to among the most respected OCD specialists in the country.

With a keen understanding of the rarity of his training and expertise, Dr. Brady has devoted his career to sharing his knowledge and talents with those who can take it forward and multiply the impact on the suffering caused by OCD.

Heath Care Heroes is the Business Courier’s recognition of those who have made an impact on health care in our community through their concern for patients, their research and inventions, their management skills, their innovative programs for employees and their services.

Lindner Center of HOPE provides excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, intensive outpatient program for substance abuse and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.


Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.


Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

Constant hand washing, repetitive touching of doorways, checking ten times to make sure the stove is turned off:  these are all examples of behaviors we frequently associate with obsessive compulsive disorder, or OCD.

The nature of obsessive compulsive disorder

OCD is a type of anxiety disorder, characterized by unwanted, uncontrollable thoughts as well as repetitive or ritualized behaviors.  While the thoughts and actions are irrational and unproductive, the affected individual is unable to resist the urge to express them.

An obsession is a frequent and uncontrollable impulse, thought, or mental image that an individual experiences.  They are often quite disturbing or unpleasant, as well as distracting.

A compulsion is a behavior or ritual that an individual repeatedly completes as a way of trying to make an obsessive thought go away.  Individuals with obsessive thoughts about being unclean may wash their hands until they are raw.  However, compulsive behavior not only does not reduce an obsession; these frustrating and time-consuming acts usually increase anxiety.

Treatment of obsessive compulsive disorder

OCD is a mental disorder that responds successfully to treatment.  The two most effective types of OCD treatment are cognitive-behavioral therapy and medication, often used in combination.

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves retraining one’s thought patterns so that compulsive behaviors no longer feel necessary.

Two CBT components are most effective in treatment of obsessive compulsive disorder:

  1. Exposure and response prevention, or ERP, is a treatment that involves repeated exposure to a source or common cue for an obsession, while the individual refrains from the associated compulsive behavior.  Using the previous example of compulsive hand washing, an individual might be asked to repeatedly touch a public restroom’s door handle and then be prevented from hand washing.   Gradually the individual learns that nothing catastrophic occurs when the behavior is not performed. The more an individual is exposed to an anxiety-provoking trigger without incident, the more the association weakens. ERP is a therapy based upon literally facing one’s fears.
  2. Cognitive therapy focuses on the obsessive thoughts themselves.  Individuals with OCD often think of “worse-case” scenarios or experience an exaggerated sense of personal responsibility for things they cannot really control; e.g., a plane crash. Through “cognitive restructuring,” harmful thought patterns can be challenged and healthier, alternative ways of thinking can be developed. For example, the hand-washing individual may explore the underlying belief prompting this behavior, such as “I am unclean.” Once an unrealistic belief is discovered and challenged, the need to engage in the anxiety-reducing behavior may disappear over time.

Medication has also been found to be effective in obsessive compulsive disorder treatment for many individuals.  Some psychiatric or psychotropic medications help control obsessions and compulsions.  These include antidepressants that increase serotonin levels in the brain, which may be low in individuals with OCD.  Medication, if indicated, is normally used in conjunction with psychotherapy.

Professional treatment for OCD is highly effective, with research findings of long-term recovery rates of up to 75% or more.  With proper intervention, individuals struggling with the anxiety and frustration of obsessive compulsive disorder can resume productive lives.

When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.

What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.

The SSA and Mental Illness Claims

The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.

Getting Back on their Feet

It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.

When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.


This blog is written and published by Lindner Center of HOPE.

Compulsive hoarding is by no means a new phenomenon. However, it has recently moved into the spotlight courtesy of several documentaries and television shows such as A&E’s “Hoarders” and TLC’s “Hoarding: Buried Alive.”

The exposure compulsive hoarding has gained as a result has been an eye-opener to many hoarders as well as to those around them. It has brought awareness to the fact that treatment is available to help people begin to unclutter their lives.

The Characteristics of a Hoarder

Compulsive hoarding affects roughly two million Americans, according to Psychology Today Magazine. Although it is argued in some circles that hoarding is a stand-alone disorder, it is most often placed within the category of obsessive compulsive disorders (OCD).

Generally, hoarders fear that throwing anything away will have negative repercussions on their lives. As a result, they collect and accumulate things that might have little or no real use.

Although the scene inside their dwelling might appear chaotic to others, many hoarders feel hanging onto items provides them with a certain amount of control and sense of organization. Hoarders feel a personal responsibility and connection to their possessions. If an item is lost or discarded, the fragile balance in their lives can be disrupted.

Getting Help

In treating compulsive hoarding, mental health professionals use an approach similar to that of OCD treatment. The foundation of treatment focuses on a combination of medication and psychotherapy. Specifically, behavioral therapies such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are employed.

Some of the goals within behavioral therapy include diminishing the hoarder’s urge to save, and redirecting the distorted view of the importance they place on the items in question. Therapy also helps at decreasing a hoarder’s anxiety over discarding items and improving their judgment and decision-making capabilities.

Mental health centers across the country are home to experienced professionals who have successfully treated compulsive hoarders. Though treatment can be lengthy and at times difficult, it can provide a new lease on life for those struggling with this all-consuming disorder.