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Managing School Avoidance in Children With Obsessive-Compulsive Disorder

– Elizabeth Deckler, MD1,2,3, Stephanie Rohrig, PhD2,3, Anthony Puliafico, PhD1,2
– Columbia University Medical Center, NewYork-Presbyterian Hospital, Weill Cornell Medical Center

What is School Avoidance?

School avoidance refers to a young person missing school due to anxiety or another mental health concern. School avoidance is different from truant behavior, when a student misses school without a lawful or valid excuse, and school withdrawal, when a parent holds a child back from school. School avoidance can be very distressing for children and their parents. Frequent school absence puts the child at risk of falling behind both academically and socially. School avoidance is a clinical concern that pediatricians and child and adolescent providers see regularly.  

School avoidance is not a diagnosis, but rather a behavior that is often associated with mental health symptoms. It is typically seen in children with obsessive-compulsive disorder, social anxiety disorder, separation anxiety disorder, generalized anxiety disorder, and panic disorder, among other psychiatric conditions. This is expected because going to school triggers the exact discomfort children with these conditions try very hard to avoid. Children with social anxiety may fear interacting with peers and teachers. Those with separation anxiety fear leaving their parents. Children with generalized anxiety or panic disorders worry that their symptoms will flare up while at school. 

How are OCD and School Avoidance Related?

Many children struggling with obsessive-compulsive disorder experience some degree of school avoidance. Obsessive-compulsive disorder, or OCD, is a mental health condition characterized by frequent intrusive thoughts, images, or urges (obsessions) and repetitive acts or behaviors intended to ease the anxiety caused by the obsessions (compulsions). A 2025 study published in Child Psychiatry & Human Development examined the relationship between OCD and school avoidance. The study, which took place in Sweden, included 385 children with OCD. At their first visit, 22% of the 385 children were attending school only partially or not at all. The study found that after these children were treated for OCD, more than half of them were able to return to school. The high degree of school avoidance in children with OCD, as well as the improvement in school attendance with OCD treatment, highlights the relationship between the two conditions. 

What Does School Avoidance Look Like Within OCD?

School avoidance looks different in every child. Common reasons for school avoidance among children with OCD have included obsessions relating to school performance, compulsions that interfere with the child’s ability to get to school, and contamination of school bathrooms. A prolonged morning ritual, anxiety about using public transportation, and embarrassment over performing compulsions in a public setting are also commonly reported.

The following case example illustrates how school avoidance can develop in a child with OCD.

“Molly is a 15-year-old adolescent in 9th grade at her local high school. She earns good grades, participates in multiple extracurriculars, and plays soccer on her school’s team. She was diagnosed with OCD in fifth grade after her teachers noticed that she felt compelled to open and close her locker exactly four times whenever she used it. She was able to successfully treat her obsessions and compulsions with exposure and response prevention therapy (ERP). However, several years later, her OCD symptoms returned and became more severe. Homework that would usually take two hours to complete now took six. Molly spent hours proofreading her essays for errors until it felt “just right,” checking over her math homework exactly four times, and repeatedly reviewing her online homework portal to confirm that her assignments were uploaded. She knew that the double checking was excessive, but she struggled to stop. Molly also had an intense fear of germs. Using the bathroom at school became a struggle. She noticed that every time she entered the school bathroom, she needed to wash her hands for ten minutes to help her feel safe from the germs. 

After two months of struggling with these compulsions, Molly started avoiding school. At first, she missed about one day every two weeks. But after a few weeks, she was missing several days per week. To Molly, staying home felt easier than facing anxiety-provoking situations at school. Once she started falling behind in her schoolwork as a result of missing class, she found it even more difficult to return. The thought of explaining her absences to teachers and peers, as well as the incomplete assignments piling up, made Molly feel like it would be impossible to return. 

Molly’s experience is surprisingly common. The relationship between obsessive-compulsive disorder and school avoidance is seen clinically and is well established in the literature. However, practical guidance on preventing school avoidance in children with OCD, and helping children who are already avoiding school return, can be hard to find. 

What Can We Do? Recommendations for Parents:

Parents play a significant role in preventing school avoidance in their children. A major aspect of OCD treatment is parental education on limiting accommodation. Parental accommodation refers to changes in routines or behaviors made to reduce a child’s distress. Examples of this include helping the child perform compulsions, planning meals around foods that the child sees as safe, and allowing the child to stay home from school due to their anxiety. If a child with OCD starts avoiding school for any reason, parents should tell their treating clinician as soon as possible.

It may feel easier to allow children to miss school when anxious, but this is counterproductive. Parents need to set limits around missing school. We recommend that parents limit children’s access to screens while they are home from school. Parents can also set clear limits, such as not allowing preferred after-school activities on days when the child does not attend school. Children should view staying home from school as boring.

Parents should also validate their child’s anxiety. OCD is a serious mental health condition that causes significant distress. When children express their worries about school to parents, they should listen, ask follow-up questions, and relay their understanding and care for the child. However, parents should be careful not to reassure the child. Reassurance seeking is a common behavior in OCD, and children with OCD struggle with uncertainty. Seeking reassurance is a form of compulsion. For children to improve their OCD symptoms, they need to practice experiencing uncertainty without reassurance. Examples of reassurance seeking include asking a parent if they believe the school bathroom is clean, having a parent confirm that they performed their rituals correctly, and asking if they think they are going to fail an upcoming quiz.

Exposure and response prevention, a critical part of the treatment for OCD, involves exposing children to places, thoughts, or situations that trigger their obsessive fear. The child then resists the urge to perform a compulsion. This type of therapy is challenging. Over time, this exercise decreases the fear and anxiety associated with the trigger. Children can participate in exposure and response prevention at school. If the child’s obsessive fear involves school performance, attending school and completing assignments exposes them to that trigger. If germs are an obsessive fear, using the bathroom at school is a helpful exercise in ERP. We recommend parents recognize the difficulty of this type of therapy and praise the child for facing triggers at school.

What to Expect From Your Child’s Therapy

The first step in treatment is evaluating current OCD symptoms. Your clinician will do a thorough assessment of your child’s obsessions and compulsions, particularly those related to attending school. If this is the first time your child is receiving treatment for OCD, your clinician will likely recommend a combination of exposure and response prevention therapy and medication, as research has shown this to be the most effective approach. It is also common for school avoidance to emerge in children who have already been undergoing treatment for OCD. In that case, your child’s therapist will assess for changes in the condition that may warrant a different treatment plan. 

The most important part of therapy for school avoidance is school reentry. Your therapist will work with you and your child to create a plan for returning to school. School reentry plans look different for every child. They can range from going back to school full time immediately to seeing the guidance counselor one day, attending one class the next day, and slowly working up to a full school day. Some children need more support returning to school, and in these cases, your therapist may recommend utilizing a higher level of care. Higher levels of care include partial hospital programs and intensive outpatient programs. Partial hospital programs and intensive outpatient programs are forms of mental health treatment where the patient lives at home but attends a treatment program during the day. At these programs, your child will meet daily with providers such as psychiatrists, therapists, and social workers experienced in treating school avoidance.

How to Advocate for Your Child in School

Schools can be invaluable partners in treating your child’s school avoidance. Parents should request that the school designate a “go-to” person for the student to meet with if they are struggling with mental health difficulties at school. This allows the child to see school as a safe place to experience OCD symptoms. Parents should also ask the school to implement the reentry plan the child developed with the therapist. We recommend parents work closely with their child’s teachers to manage missing assignments and prevent falling behind academically. 

The post Managing School Avoidance in Children With Obsessive-Compulsive Disorder appeared first on International OCD Foundation.

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Self-medication of attention-deficit/hyperactivity disorder symptoms with psychoactive substances in adults: a scoping review of how symptom-relief motives are framed and operationalised across substances

IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) use tobacco, cannabis, alcohol, cocaine and non-prescribed stimulants far more than the general population. The self-medication hypothesis holds that people with ADHD, including those undiagnosed, use substances to relieve core symptoms rather than for recreation or shared vulnerability to addiction, and is widely invoked to reframe illicit substance use as undiagnosed ADHD. How this claim is framed and tested has not been mapped across substances.ObjectiveTo map the literature invoking self-medication of ADHD symptoms in adults, substance by substance, and to characterise how each source frames the concept relative to misuse, recreational or shared-liability accounts.Eligibility criteriaEmpirical studies, reviews, commentaries, preprints and trial-register records on self-medication of ADHD symptoms with a psychoactive substance in adults or predominantly adult samples; English; inception to 21 July 2026.Information sourcesPubMed, OpenAlex and Consensus, with ClinicalTrials.gov and a preprint search. Searches were conditioned on self-medication and motive terminology, so the corpus maps the self-medication literature and does not sample the misuse or shared-liability literature independently.Charting methodsSources were charted for substance, design, population, operationalisation of self-medication, and a framing category (self-medication-framed; mixed; misuse- or shared-liability-framed; neutral/descriptive). A descriptive map was built by substance. No critical appraisal or evidence-strength ranking was made.ResultsOf 937 records identified and 820 screened, 109 sources (1986–2026) met the criteria. Coverage was heaviest for non-prescribed stimulants (n=35), cannabis (n=29), nicotine (n=25) and alcohol (n=17); no eligible ketamine source was identified. Self-medication framing was most prevalent, and uniquely accompanied by experimental data, for nicotine; prevalent but observational for cannabis; coexisted with academic and recreational motives for stimulants; and alcohol was mostly framed as comorbidity or shared liability. Self-medication was overwhelmingly inferred from association or motive report rather than tested against symptom change.ConclusionsSelf-medication framing is substance-specific in prevalence and accompanying evidence. Because the search was conditioned on self-medication terminology, the map describes how the literature frames the claim and does not adjudicate between competing accounts. Applying self-medication as a blanket explanation for substance use in people with ADHD symptoms is not warranted by how the claim has been tested.
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Timely outpatient follow-up and readmission risk in schizophrenia

Timely outpatient follow-up after psychiatric hospitalization has been proposed as a key strategy to reduce readmission; however, evidence in patients with first-admission schizophrenia remains limited. Using the Korean National Health Insurance Claims Database, we conducted a nationwide retrospective cohort study of 1,961 patients with first-admission schizophrenia, defined as having no psychiatric service utilization during the preceding three years. We examined whether outpatient follow-up within 30 days after discharge was associated with the risk of readmission within 365 days. Adjusted Cox proportional hazards models were used to estimate hazard ratios across multiple cumulative follow-up periods (60, 90, 120, 150, 180, and 365 days), controlling for sociodemographic and clinical factors. Kaplan–Meier analysis was used to assess differences in readmission-free survival. Among the study population, 53.2% received outpatient follow-up within 30 days after discharge. When evaluated across progressively longer cumulative follow-up periods, outpatient follow-up was associated with a significantly lower risk of readmission at 60 days (aHR = 0.52, 95% CI: 0.29–0.95), 90 days (aHR = 0.55, 95% CI: 0.35–0.88), 120 days (aHR = 0.63, 95% CI: 0.43–0.94), 150 days (aHR = 0.66, 95% CI: 0.46–0.95), and 180 days (aHR = 0.70, 95% CI: 0.51–0.98), but not at 365 days (aHR = 0.79, 95% CI: 0.61–1.02). Kaplan–Meier analysis showed longer readmission-free survival in the follow-up group, although the difference was more pronounced over shorter follow-up durations. Timely outpatient follow-up was associated with reduced readmission risk over shorter cumulative follow-up periods, with attenuation of the association as the follow-up duration increased.
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Kratom and 7-OH should be regulated, experts agree. They’re split on how

Kratom leaf products, often used to ease chronic pain, anxiety, or withdrawal from opioids, have been sold in the U.S. for decades, largely skirting any regulatory restrictions despite a known risk for physical dependence. But increasingly, Americans are turning to newer, more potent products made with a semi-synthetic kratom derivative, 7-hydroxymitragynine, or 7-OH. 

Clinicians and recovery advocates warn that highly-concentrated 7-OH could be even more addictive than kratom, though research is scarce. Most people agree that some sort of guardrails need to be put into place. They disagree, however, on what those regulations should be.

Read the rest…

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Acceptability and Feasibility of a Virtual Family-Based Single-Session Intervention for Young Teens at High Risk for Substance Use Disorder: Single-Arm Pilot Trial

<strong>Background:</strong> Preventive interventions to delay substance use disorder (SUD) are ideally delivered during early adolescence, a critical period for exposure to substance use (SU) risk factors. Young teens (aged 12-14 years) engaging in occasional use of alcohol, cannabis, or tobacco use, or with a family history of SUD, are at increased risk for SUD. Although behavioral-ecological family therapy is effective for prevention, many families face access barriers. Single-session interventions (SSIs) may offer an accessible, low-intensity alternative. <strong>Objective:</strong> This open pilot trial aimed to evaluate the acceptability, feasibility, and potential usefulness of a family-based SSI targeting improvements in family practices that prevent SUD. <strong>Methods:</strong> Participants were 9 young teens engaging in occasional SU or with a family history of SUD and their parent. The SSI involved a virtual 2-hour family consultation with a trained family coach. Acceptability was measured via Program Feedback Scale, feasibility via SSI completion rate, and potential usefulness via pre-post changes in parenting self-efficacy. <strong>Results:</strong> The SSI was acceptable to parents and teens (mean Program Feedback Scale scores ≥3) and feasible (8/9, 88.89% of parent-teen dyads completed the SSI). Among the 8 completing dyads, most participants (13/16, 81.25%) selected Communication and Problem Solving as their primary target for change. Parents reported increases in parenting self-efficacy from pre- to post-SSI. <strong>Conclusions:</strong> Findings support the SSI’s acceptability and feasibility for young teens at high risk for SUD. A randomized clinical trial is needed to confirm the SSI’s acceptability, feasibility, and efficacy, as well as to address potential for delivery by a lay workforce. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT06538922; https://clinicaltrials.gov/study/NCT06538922
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Harnessing Data Warehousing for Precision in Off-Label Prescription Detection in Psychiatry (PSYHAMM): Retrospective Proof-of-Concept Evaluation Study

Background: Off-label drug prescribing is prevalent across medicine, including psychiatry, often due to unmet therapeutic needs and inadequate responses to standard treatments. The PSYHAMM (Psychotropes Hors Autorisation de Mise sur le Marché) project, funded by the French Research Agency, investigates these practices. To support this research, a clinical data warehouse (CDW) with advanced data analysis tools was developed and deployed. This system integrates both structured and unstructured data from electronic health records, facilitating comprehensive data analysis. The goal is to improve understanding, regulation, and safety of off-label drug use in psychiatry by providing insights into prescribing patterns and their impacts, ultimately contributing to better clinical guidelines and patient care. Objective: This study aimed to evaluate the precision (positive predictive value) of a CDW in identifying candidate off-label prescriptions in psychiatry among the cases automatically flagged by the system, rather than its overall accuracy, sensitivity, or specificity. Methods: The PSYHAMM data analysis involved a retrospective study of pathology-medication pairs to evaluate the precision of a computerized system among system-flagged cases. This system was compared with manual checks performed by a psychiatrist. The evaluation process included verifying if the condition identified by PSYHAMM was documented in the medical record, assessing diagnostic agreement with tolerance for schizoaffective disorders, and ensuring the identified treatment was current or prescribed in the past. Precision was measured as the number of relevant documents retrieved divided by the total number of documents proposed and was computed for the precise diagnosis, the broad diagnosis, and the identified treatment among the flagged cases. Results: The study analyzed 197 records, identifying 14 unique drug-pathology combinations. Bipolar disorder treated with sodium valproate represented the most cases (108/197, 54.8%), followed by schizophrenia treated with sodium valproate (37/197, 18.8%). The overall precision for detecting off-label situations was 51.3% (101/197). The precise diagnosis achieved a precision of 75.6% (149/197), while the broad diagnosis showed a higher precision of 84.8% (167/197). The identified treatment had a precision of 61.4% (121/197). The primary challenge was temporal discrepancies, such as distinguishing between acute and chronic conditions, which accounted for most of the 48.7% (96/197) of cases that were incorrectly classified. Conclusions: As a single-center, proof-of-concept evaluation, the PSYHAMM project demonstrates the potential of automated systems to support the identification of off-label prescriptions in psychiatry as a sensitive prescreening step requiring expert validation. The relatively high false-positive rate was driven mainly by temporal discrepancies (drugs prescribed before the index stay, discontinued during the stay, or only hypothetically mentioned) rather than by semantic errors. Future research should focus on integrating real-time data analytics and expanding to multiple institutions to improve the utility of off-label detection systems.
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Navigating BFRB Recovery: Real Strategies and How to Find Help

– By the BFRB Special Interest Group

Check out part 1: More Than a “Bad Habit”: Living With a BFRB

Introduction

Living with a body-focused repetitive behavior (BFRB) often feels like an uphill battle, but recovery is not only possible, it’s entirely within reach when you have the right tools and support. To help illuminate the path forward, members of the BFRB Special Interest Group (SIG) shared their practical wisdom on what healing truly looks like in real life. From redefining success beyond a long-pick or pull-free streak to asking the right questions when interviewing potential therapists, these insights offer compassionate strategies to help you navigate recovery and build a support system that honors your unique needs.

Real Strategies To Support BFRB Recovery

If you live with a BFRB, chances are you’ve already experimented with dozens of strategies to manage or quit the behavior. But what does BFRB recovery actually look like and how is it best supported?

First, recovery is rarely a straightforward “stop the behavior.” The consensus among SIG members is that recovery is more about acceptance, reducing (rather than eliminating) the behavior, and living one’s life alongside their BFRB. So it may be helpful to think of recovery as freedom regained, rather than a number of pull- or pick-free days.

Achieving this requires a multi-faceted approach: increasing understanding of BFRBs, building awareness, finding alternate ways to redirect the energy, and changing one’s relationship with the BFRB. Finding community through BFRB support groups or other shared interest groups can also be incredibly helpful. One SIG member described the keys to recovery as “education and understanding, confidence with tools and flexibility, self-acceptance, honesty with myself, and vulnerability with my support system.” Recovery may also include investing in therapy or coaching, skin/hair/nail care, or sensory replacements.

Ultimately, BFRB recovery is an active, ongoing process rather than a checklist to complete once. And because needs change over time, staying in recovery means regularly checking in, assessing what’s working, and adjusting your approach along the way.

How to Find Help For BFRBs

It’s an unfortunate truth that finding effective help for BFRBs can be challenging. Many therapists and healthcare professionals don’t receive adequate training on BFRBs and may have some misconceptions about them. Therefore, individuals with BFRBs who are ready to seek professional help will likely benefit from interviewing therapists or other professionals before establishing care. In many cases this can be done via a brief consultation call or email before scheduling an initial appointment, and questions to consider asking include:

How do you view (or “conceptualize”) BFRBs?

A provider who sees BFRBs as simply a “bad habit” to quit is unlikely to be helpful in the long run, so look for someone who understands that these behaviors are complex, multi-faceted, and require individualized treatment. Be cautious of any therapist who views BFRBs as self-harm (an idea that’s widely rejected by BFRB specialists), insists they’re always rooted in past trauma, suggests parents are to blame, or claims medications are required for successful treatment.

What does the progression of treatment look like?

Recovery isn’t simply about doing the behavior less. It’s also about getting curious, understanding the behavior, and changing your relationship with it. Look for someone who acknowledges that progress isn’t linear and will likely involve ups and downs. Be cautious of anyone who promises to help you stop the urges or avoid the behavior completely, as this isn’t the most common outcome, even in successful treatment.

What specific type of therapy do you use to treat BFRBs?

Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB) are currently the two most evidence-based treatments for BFRBs. Cognitive Behavioral Therapy (CBT) can help with some aspects of treatment, but usually isn’t specific enough to serve as an effective treatment on its own. Exposure and Response Prevention (ERP, notably the gold standard for OCD) may be helpful for some types of BFRBs, particularly focused rather than automatic engagement, but like CBT, shouldn’t be the only modality used. Newer “third wave” modalities that focus on increasing awareness and changing one’s relationship with the BFRB are also being explored and studied. These may include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), Compassion-Focused Therapy (CFT), and Internal Family Systems (IFS, which, while not technically a third-wave CBT modality, fits the same spirit).

How do you address when behavioral strategies don’t lead to improvement?

This is an important question, since many people with BFRBs don’t experience long-term relief from behavioral strategies alone (though some do). Make sure the provider you’re interviewing understands this and has an approach in mind.

How many people with BFRBs have you treated in the past and what were the results?

This doesn’t mean you should avoid clinicians with less experience. Even the experts had to start somewhere! But if they’ve treated fewer than 5 to 10 clients, ask whether they’re willing to learn more about BFRB treatment or have a resource for consultation with someone more experienced.

Do you know someone else with more experience treating BFRBs?

If a therapist doesn’t answer these questions in a way that makes you feel confident, there’s nothing wrong with asking for a referral. Even if they aren’t the right fit for you, they may know someone who is.

A Final Message

Above all, remember this: you do not have to navigate this path alone. The shame that thrives in secrecy softens the moment you connect with people who truly understand you, whether that’s a clinician, a support group, or a community of peers who see your value. Your experience is real, your struggles are valid, and there are people out there waiting to welcome you exactly as you are. Find your people and start creating a life so fulfilling that your BFRB is simply an interesting chapter in your incredible story.

The post Navigating BFRB Recovery: Real Strategies and How to Find Help appeared first on International OCD Foundation.

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More Than a “Bad Habit”: Living With a BFRB

– By the BFRB Special Interest Group

Introduction

Body-focused repetitive behaviors (BFRBs), including hair pulling (trichotillomania), skin picking (dermatillomania), nail biting, lip/cheek biting, and more, remain among the most misunderstood mental health experiences by both the general public and healthcare providers alike. To capture the full reality of living with these complex behaviors, members of the IOCDF’s BFRB Special Interest Group (SIG) shared their lived experiences, insights, and perspectives. We explored what BFRBs really feel like from the inside out and how our collective understanding of these behaviors is shifting away from outdated stigma and toward true nervous system awareness.

What’s it like to have a BFRB?

When the BFRB SIG was asked what it’s like to have a BFRB, the response was sobering. Some of the terms used included confusing, embarrassing, frustrating, helpless, and exhausting. They spoke of fatigue from constant internal and external assessment, and how resisting the behavior can feel like denying yourself air. Some mentioned that it felt like a separate entity, urging them toward action against their better judgment, often leaving them feeling weak, powerless, and critical of themselves for not being able to stop.

But there’s another side to BFRBs: one that acknowledges the self-soothing aspect. People also describe the behavior as enjoyable, relaxing, hypnotic, and even pleasurable. Some describe a sense of entitlement to it, feeling they “deserve” this escape after a challenging day. Others celebrate the satisfaction and relief that comes with pulling the perfect hair, popping a prime pimple, or “fixing” some other nagging problem. 

This intrinsic gratification is what sets BFRBs apart from OCD. In OCD, the compulsive behavior is unwanted and driven purely by a desire to relieve anxiety. With BFRBs, the behavior is functional; the act itself brings genuine sensory pleasure or soothing. A helpful test to demonstrate this distinction is to remove the consequences: if pulling or picking caused zero physical damage, shame, or embarrassment, most people with BFRBs wouldn’t care to stop or would actually feel free to engage in the behavior more often, because the behavior feels good in the moment. In other words: those with OCD dislike the behavior and crave the result, and those with BFRBs crave the behavior and dislike the result. 

The most profound burden, however, is the heavy shame and isolation that comes from repeatedly engaging in a behavior that you (and the people around you) don’t understand. Those with BFRBs spend a significant amount of time trying to hide or shrink so they’re not “discovered” and then judged by others. Simple activities such as getting ready in the morning, going out in wind or rain, swimming, or riding roller coasters can risk extreme embarrassment. Some with BFRBs make painstaking efforts to hide it from their spouse or partner, or avoid dating altogether.

The pain is real and the solution is not simple. The urges and behaviors are complex, deeply rooted, and highly individualized. Those with BFRBs are intelligent, creative, and deeply caring people, navigating sensitive nervous systems or unique sensory needs. They are complicated, but certainly not broken.

Understanding and Interpreting BFRBs

How should we interpret BFRBs, and why do those with BFRBs repeatedly engage in this behavior that they desperately want to stop? Our understanding of the forces driving BFRBs is continually evolving, varying widely depending on who you ask.

Many view their BFRB as a chronic behavioral or willpower problem, leaving them exhausted from constantly battling their urges. Others experience a love-hate relationship, acknowledging the physical damage and social toll while benefiting from the sensory soothing, stimulation, or satisfaction it provides, what one person called “a misled offering to solve a heightened or lowered state.”

There are others who have come to view the behavior as an internal alarm system. Rather than an enemy to fight, they interpret the urges as a message from their dysregulated nervous system alerting them to an unmet need, and the behavior as “an attempt to return the nervous system to baseline.” This interpretation allows them to relate to their behavior with less opposition, and tends to support long-term recovery. As one person put it, “Your BFRB is trying to tell you something! Are you ready to listen?”

People with BFRBs may move between these perspectives over time. Because no two profiles are identical, BFRBs require an individualized lens. Equally important is dispelling common misconceptions: BFRBs are not simply bad habits, self-harm, trauma responses, or the result of poor parenting. They are complex, deeply rooted behaviors centered on nervous system regulation and meeting unmet needs.

Conclusion

If there is one truth to hold onto, it is this: you are not broken, lazy, or lacking willpower. BFRBs are complex responses to a nervous system doing its best to regulate in a noisy world. Living with a BFRB takes an immense amount of daily resilience and recognizing that the behavior is an internal attempt to self-soothe (rather than a character flaw) opens up space for genuine grace and self-compassion. You are so much more than the urges you fight and help is available when you’re ready to take the next step in your BFRB journey.

The post More Than a “Bad Habit”: Living With a BFRB appeared first on International OCD Foundation.

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Multi-region social-emotional network underlying the effects of spine pinching therapy on empathy-like behavior in a rat model of autism spectrum disorder

BackgroundSpine pinching is a promising alternative for autism spectrum disorder (ASD), yet its effects on multi-region molecular coordination remain unclear. This study examined the effects of spine pinching on cellular Fos proto-oncoprotein (c-Fos) and Oxytocin Receptor (OXTR) expression in the prefrontal cortex, hypothalamus, and amygdala, and further analyzed expression patterns across these regions using profile analysis to explore the coordinated multi-region regulation underlying improvements in social and empathic deficits.MethodsAn ASD rat model was established by valproic acid (VPA) induction. After behavioral testing, rats were divided into the model group (MG), spine pinching group (SPG), and blank control group (BC). SPG received a 15-day intervention from postnatal day 22. Then, open field, three-chamber social, and fear empathy tests were performed; brain tissues were collected for immunohistochemistry and western blotting, and profile analysis was conducted.ResultsVPA-induced ASD rats showed developmental and ASD-like behavioral deficits. MG rats exhibited social and empathy deficits and reduced c-Fos and OXTR levels in the prefrontal cortex, hypothalamus, and amygdala versus BC. Spine pinching improved these ASD-like behavioral deficits. Immunohistochemistry revealed that c-Fos and OXTR expression increased significantly in all three brain regions after spine pinching. Western blot analysis further supported these findings, showing significant upregulation in most brain regions and consistent upward trends in the remaining regions. Profile analysis revealed parallel expression profiles across regions, suggesting coordinated multi-region regulation.ConclusionSpine pinching effectively improves core ASD-like behavioral deficits in ASD rats, potentially through coordinated regulation of the multi-regional social-emotional network.
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Beyond illness severity: transdiagnostic cognitive vulnerabilities as independent predictors of psychological distress in parents of children with rare genetic disorders

IntroductionParents of children with rare genetic disorders are at increased risk of depression, anxiety, and stress symptoms. While previous research has primarily focused on illness-related factors, less is known about the contribution of transdiagnostic cognitive vulnerabilities to parental psychological distress.AimThis study examined whether intolerance of uncertainty, distress tolerance, and tendency to worry predict parental depression, anxiety, and stress symptoms beyond the severity of the child’s health status.MethodsThe study included 184 parents (92 mother–father dyads) of children with rare genetic disorders and 94 parents of healthy children (14 mother–father dyads and 66 unpaired parents). Measures assessed child health status severity, intolerance of uncertainty, distress tolerance, tendency to worry, and symptoms of depression, anxiety, and stress.ResultsParents of children with rare genetic disorders, particularly mothers, reported higher levels of depression, anxiety, and stress symptoms compared with parents of healthy children. Greater severity of the child’s health condition was associated with higher levels of psychological distress. Lower distress tolerance and greater tendency to worry independently predicted depression, anxiety, and stress symptoms beyond the severity of the child’s health status.ConclusionTransdiagnostic cognitive vulnerabilities, particularly lower distress tolerance and greater tendency to worry, together with female gender, were independently risk factors for parental psychological distress beyond the severity of the child’s health status severity. These findings suggest that preventive interventions and counseling programs for parents of children with rare genetic disorders should address not only illness-related burden but also modifiable cognitive vulnerabilities.