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What It’s Like Using the Internet When You Have OCD ’When I’m not on [Twitter]… I have literal heart palpitations’ Go to the profile of Angela Lashbrook Angela Lashbrook Mar 27 Original Photo: Oleg Magni In Microprocessing, columnist Angela Lashbrook aims to improve your relationship with technology every week. She’ll go deep on the little things that define your online life today. This week’s column contains frank discussions of mental illness and stigma against those with mental illness. If you have obsessive-compulsive disorder or another mental disorder and need support, you can contact the National Alliance on Mental Illness at 800-950-NAMI or via text at 741741. United Kingdom residents can call OCD Action at 0845 390 6232. Canadians can find contact information for local support here. Morgan was diagnosed with obsessive-compulsive disorder (OCD) 20 years ago. While a combination of medication and therapy has kept it mostly under control, she says, it still comes back occasionally in an incredibly frustrating manner. “There have been flare-ups that have slowed me down because I had to type a sentence, erase it, and type it until it was ‘safe,’” she says. What Morgan is experiencing is an emerging manifestation of OCD: When symptoms express not in the physical world (for example, when a patient repeatedly, and in a way that interferes with their life, checks their oven to ensure that it’s off), but on the internet instead. There’s no name for this phenomenon. In many ways, it’s merely another venue for OCD to articulate. But for some people with OCD, it can make the internet an incredibly stressful, unhealthy, and, in some cases, dangerous place to be. It can also make it easier to access care, as a hospital in Sweden is finding in its ongoing research on internet-based therapy for people with the disorder. The term OCD and its components, obsessive and compulsive, get thrown around a lot, and in contexts where they probably don’t belong. I’m not actually “obsessed” with the latest book I read, and I don’t have a true “compulsion” to check Twitter, even though sometimes it certainly feels that way. Similarly, people use the term OCD when, for example, they like to keep their kitchen countertops sparkling clean. For some people with OCD, it can make the internet an incredibly stressful, unhealthy, and, in some cases, dangerous place to be. Simply wanting a clean kitchen does not mean a person has OCD. What makes it OCD is when the person can’t leave the house without wiping down the countertops once, twice, three more times, because they’re afraid of what will happen if they don’t. When they can’t do a task without repeating a particular prayer or mantra. When the thought of a disorganized kitchen isn’t just annoying; it causes actual distress and extreme anxiety. And OCD extends far beyond a stereotypical concern with cleanliness. Some people with OCD experience upsetting, intrusive thoughts, such as envisioning themselves hurting a loved one. According to Sanjaya Saxena, a professor of psychiatry and director of the UC San Diego Obsessive-Compulsive Disorders Program, one of the best ways to understand OCD is that it relates to fear. Whether it’s a contamination-related fear, as in the case of needing to keep a kitchen sparkling clean, or a concern about acts of violence, accidents, or even the fear that a patient will say the wrong thing in a social situation, “these can create obsessional fears, and that can lead to compulsions,” Saxena says. Checking their social media accounts multiple times an hour doesn’t necessarily mean a person has OCD. But for Anna*, a woman with OCD who developed a compulsion related to checking her social media accounts after an embarrassing social interaction, it does. “Some people I knew made me feel weird about not knowing something, so I became obsessed with trying to know as much as I can, whether it is a political thing or about someone from high school being engaged,” Anna says. “Part of it is being afraid of looking stupid and having social anxiety as well.” Jenny*, who also has OCD, says that in high school, her fears related to leaving a hair iron or a light turned on. Now she compulsively checks her Twitter account because of an ever-lingering “what if?” “When I’m not on this site, I have, like, literal heart palpitations,” she says. “What if there’s a thread I should be commenting on? What if there’s some post I should be liking? What if, what if, what if… I hate it and wish I could quit.” Jenny says that while she still has to manage her OCD symptoms regularly, she’s glad they’re expressed in a more “socially acceptable” manner than they were in the past, when little details would prevent her from leaving the house entirely. She can leave the house now and socialize, but, Jenny says, “I just feel so incredibly weak for being… hooked on a website, you know?” Mental disorders don’t mean a person is weak, though stigma against those with mental health struggles remains steep, and the social and economic costs related to the disorder can be high. This is also true of internet-related symptoms of OCD, which can cause increased stress in work environments, such as when a person has fear related to sending emails. Saxena says he has patients who have trouble sending emails at all, concerned that they might write something offensive or use foul language, even though such modes of communication are totally out of character for that person. These “checking behaviors,” he says, “can sometimes take hours and hours and hours out of a day. Some folks say, ‘I’m getting my work done, but it takes four hours longer because I have to go back and check everything over again.’” Even more serious, according to Saxena, is what he calls avoidance, in which a person with OCD decides that because of their symptoms, they’re unable to use the internet at all. In such a situation, a person’s ability to complete their work is severely inhibited, and they may miss important messages from colleagues, friends, and family members. Perhaps more frustrating, and even frightening, is when people with OCD experience symptoms that compel them to Google dangerous search terms. One of the most common ways OCD manifests online is when people have a fear that they’re somehow violent. “I was at my grandpa’s condo, and I looked up ‘child hentai’ for no reason. I don’t know why the hell I did that, because I’m VERY against that type of stuff of any kind,” wrote a user on an online OCD forum in a thread about obsessive internet searching. The user closed out the browser before the results popped up, but they’re now plagued with fear, because “if they wanted to, THEY COULD SEE THE INTERNET SEARCH, coming from my grandpa’s router. I’m horrible. I can’t keep it out of my head, and I don’t know what to do.” Jonathan Abramowitz, a professor of psychology and neuroscience at the University of North Carolina at Chapel Hill, specializes in OCD and related disorders. He says one of the most common ways OCD manifests online is when people have a fear that they’re somehow violent, even if they’ve never been violent or actually wanted to hurt anyone. “Someone who has obsessive thoughts about violence might go on the internet to look up all about serial killers and try to compare themselves to known killers to make sure they’re not going to act on their thoughts of violence,” Abramowitz says. “Or people who are afraid, ‘What if I have a thought about molesting a child?’ and they go online and look up stuff about child molesters.” (Research shows that people with mental illness are no more violent than people without mental illness.) Internet-related symptoms can be socially and financially debilitating for some people with OCD, but there’s been very little, if any, research done on the subject. Kiara Timpano, an associate professor of psychology and director of the Program for Anxiety, Stress, and OCD at the University of Miami, says very little is known about the intersection of the two. Saxena says this is because people with OCD can develop symptoms related to pretty much anything. “It’s next to impossible to kind of look into all of” the ways OCD can manifest, he says. “The fact that it relates to the internet is not really what’s critical.” While the internet can be a problematizing factor for people with OCD, it can potentially be helpful as well. The Rücklab, at the Karolinska Institute, one of Sweden’s top medical universities, is conducting research on how online cognitive behavioral therapy (CBT) can be used to treat people with the disorder. So far, results have been promising, with multiple studies showing that “ICBT” is effective and cost efficient and could make it easier for people to access treatment who might otherwise have trouble getting to or affording therapists. Further research is needed, however, to know how ICBT compares to traditional, in-person CBT, and Abramowitz stresses that nothing really compares to one-on-one work with a therapist. The internet, as far as anyone knows, doesn’t cause anyone to have OCD. It doesn’t seem to make symptoms worse. It does, however, create new avenues for the disorder to express and new ways for people with OCD to find themselves regularly confronted with their symptoms. But as difficult as the disorder can be, with regular therapy (in particular, cognitive behavioral therapy) and, potentially, medication, OCD is manageable. As Morgan notes, the combination of medication and years of therapy have tamped down her symptoms to the point where they only occasionally resurface. And while many people, because of insurance, busy schedules, or physical proximity, lack access to the professional support they need, if the promising work at the Rücklab is any indication, many people with OCD might soon find their symptoms a little easier to handle.

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