Writer and actress Lena Dunham confesses in a recent issue of The New Yorker that at the tender age of just 8, “I am afraid of everything.”
She isn’t kidding.
“The list of things that keep me up at night includes but is not limited to: appendicitis, typhoid, leprosy, unclean meat, foods I haven’t seen emerge from their packaging, foods my mother hasn’t tasted first so that if we die we die together, homeless people, headaches, rape, kidnapping, milk, the subway, sleep,” she writes.
The piece is an excerpt from her new book due out Sept. 30, “Not That Kind of Girl,” and it provides a glimpse at Dunham’s near life-long relationship with therapists for her obsessive compulsive disorder.
Though Dunham, now 28, and Hannah Horvath, her neurotic alter ego in HBO’s popular series “Girls,” might seem at risk of being overcome by fear, mental health experts say OCD is highly treatable — but not with talk therapy.
Having a good relationship with a therapist is important, but “that kind of therapy doesn’t do anything for OCD,” said Jeff Szymanski, executive director of the International OCD Foundation.
“When you do talk therapy, you are talking about your anxiety and what makes you anxious,” he said. “I hate spiders, but no amount of talking about spiders will change how I feel about them. How you get less fearful is you approach it.”
OCD is a brain disorder that causes severe anxiety, involving both obsessions and compulsions that disrupt daily living. Thoughts and images can get replayed in the mind, causing “intense feelings of anxiety” and the brain tells the sufferer to react, according to the foundation.
The most effective treatment for OCD is exposure and response prevention, or ERP, a form of cognitive behavior therapy, according to Syzmanski. It can also be accompanied by medication to help decrease the anxiety.
In ERP, patients confront the thoughts, images and situations that make them anxious, then they learn to choose not to exhibit the compulsive behavior that accompanies them.
About 70 percent of people who go through ERP get a reduction in their symptoms, he said. Eventually, patients become accustomed to the fears in a response called “habituation.”
“You want to give a person some new experiences with the things that make them anxious and in that experience comes a new understanding about it,” said Szymanski. “It’s not a very verbal thing.”
An estimated half million children and more than 2 million adults in the United States suffer from obsessive compulsive disorder, according to the National Institute of Mental Health.
Though it typically starts in early adolescence or young adulthood, OCD can occur at any age, preying on a child's worst fears and anxieties.
Alison Dotson, president of the support group OCD Twin Cities in Minneapolis, was diagnosed with OCD when she was 26, but she said she knew something was wrong long before then.
“I read lot of dramatic novels for girls and thought I would get a brain tumor,” said Dotson now 36. “When I read Judy Blume, I thought I would get scoliosis. I started to obsess about it and I wouldn’t tell my parents, afraid they would find out the truth - I was going to die young.”
She said that by middle school she obsessed about being gay and then developed “irrational” fears that she was living an un-Christian life.
“You can tell yourself it’s not rational and talk through it a bit, but once it’s triggered, you have to learn to cope with it,” she said.
Dotson worried that she might harm a child by accidentally touching it inappropriately and was afraid she could never have babies. “I felt sure it would happen and yet there was no basis for it,” she said. “I had babysit all through college.”
Her thoughts got so intrusive and repetitive that she slipped into depression. “I couldn’t sleep at night - I didn’t want to be alone with my thoughts,” she said.
"My OCD isn't completely gone, but maybe it never will be. Maybe it's part of who I am."
Dotson finally sought professional help and was prescribed antidepressants. “It was a huge component for my recovery — diagnosis was a relief.”
But it was exposure to her brother’s children that stopped the “terrible, ugly cycle” of her fears.
“The baby was like ERP in real life,” she said. “I wanted to be a good aunt. It was terrifying, but I faced my fears.”
Szymanski said that if OCD sufferers are “really engaged” in ERP, they can get better.
“If you have ever known someone who smoked a long time and quit, they still have a craving,” he said. “It’s kind of on the back burner and under a lot of stress it can start to creep back. … You can have bouts with it, but it’s mostly in the background.”
The most severe cases may need residential psychiatric programs for up to three months. Augmentation therapies, using dopamine-based or glutamate drugs can also be used to treat difficult OCD cases.
Other celebrities besides Lena Dunham have discussed their OCD symptoms publicly — Howard Stern and Howie Mandel — but they have not been official spokespersons for the disorder, according to Szymanski.
However, the foundation this year honored comedienne Maria Bamford with its first Illumination Award for her media efforts on behalf of those who suffer from OCD.
Bamford uses her comedy to talk about a form of the disorder called “unwanted thoughts syndrome,” and has said that as a child she feared might kill members of family or molest animals.
As for Dunham’s OCD, she says on her website that she hopes she can, among other things, send “hopeful dispatches from the frontlines of that struggle.”
And she strikes an optimistic note at the end of her New Yorker piece.
"I feel good,” she writes. “My OCD isn't completely gone, but maybe it never will be. Maybe it's part of who I am, part of what I have to manage, the challenge of my life. And for now that seems OK."