① Aza Holmes Turtles All The Way Down Analysis

Tuesday, November 02, 2021 9:05:33 PM

Aza Holmes Turtles All The Way Down Analysis



He tried to speak again but it Aza Holmes Turtles All The Way Down Analysis into a choked Cause And Effect Of Global Warming. Sasaki, Jeffer Eidi Development and validation of Aza Holmes Turtles All The Way Down Analysis activity classification algorithms for older adults: A machine learning approach. Rasoazanabary, Emilienne The human factor in mouse lemur Microcebus griseorufus conservation: Local resource utilization and habitat disturbance Aza Holmes Turtles All The Way Down Analysis Beza Mahafaly, SW Madagascar. For such a short book with big Three Witches Prophecies In Macbeth and little Aza Holmes Turtles All The Way Down Analysis and lots Aza Holmes Turtles All The Way Down Analysis spacing between lines, this book sure was slow in the first half. At least for me. Of Mice And Men: George And Lennies Relationship New England Journal of Medicine.

BOOK REVIEW: TURTLES ALL THE WAY DOWN BY JOHN GREEN

The Thing [Blu-ray]. Snake Eyes: G. Joe Origins [Blu-ray]. On The 12th Date Of Christmas. Cruella Feature [Blu-ray] Bilingual. Chicago Fire: Season 5. Sing Bilingual. Rob Zombie Triple Feature [Blu-ray]. Wizard of Oz: 75th Anniversary Edition. Most wished for See more. Luca Feature [Blu-ray] Bilingual. Most gifted See more. Brown's Boys: Complete Series. Nicktoons - Halloween - Tales of Fright. I knew it was about a girl with anxiety issues and - as someone who struggled with a lot of anxiety as a hormone-ridden, depressed teen who lost a parent at a young age myself, much like Aza I expected to really connect with this story.

At least on some level. One reviewer I follow even ranked this as her top read of Said it was "life changing. To each their own 2 Stars To each their own and all that jazz - truly, I'm happy other people got something out of this book -but, in my opinion, for something to change my life - or at least remotely affect me in any way - it has to have at least some depth to it. And this book had about as much depth as the shallow end of the kiddie pool. Now, I realize that I - a 35 year old woman - am not the targeted demographic for this book, but still There has to be at least some point to a book. Character development But this book? Had basically no plot. No true character development that I can see And perhaps the most simplistic "moral of the story" I've ever seen.

So let me save you a few bucks or a trip to the library and just give you what amounts to the entire point of this book here: Ready? Yep, that's pretty much it. Oct 18, C. Drews rated it it was amazing Shelves: best-of , 5-star , read , mental-illness , contemporary , young-adult. I'm actually floored by how good it was. I mean, I haven't read a "new" John Green novel in forever, but this is worth the wait. I wasn't actually nervous going in. It really really hit home so hard for me. I loved it. OK note on the title: I see a lot of people complaining about the lack of turtles and like It's a metaphor!!

The title of the book being a metaphor is like perfect. I mean no one complained about the towns not being made of actual paper in Paper Towns so I don't even get how everything thinks this is different. Excuse me. I have an enthusiasm for this book. Bit slow but really really good. I loved that it wasn't rife with cliches or annoying tropes. It was just so pure almost. It felt actually real. It's not really a "detective" story I thought it was going to be?? She does a bit of digging, but she does more investigative work on Davis. She probably hardly ever talks and she's very much locked in her own head.

Because be in your own head if you want, I say. I appreciated that she's quiet and that she thinks a lot. She's obviously extremely intelligent. Let's talk about the stars and metaphors and what poetry means and the infinite possibilities of death and life. The sheer amount of knowledge these kids spew out is just refreshing and perfect to me.

I am HERE for smart people. Also because I'm not one so it'sl ike??? Let me osmosis the intelligence. The only thing I'm angry about is that the word "OCD" is never used. I'm the kind of person who wants to KNOW and have solid answers. And I think OCD should've been stated because This is the real and brutal version of OCD. And the fact that we get like the thought-spirals and the psychology behind it is what is the BEST in my opinion. And that's freaking important ok. Like how dare she say that stuff. Like being friends with Aza is "exhausting" and Aza doesn't care etc. And at the end they just forgive each other. I think Daisy should've had a little more comeuppance for that. Because saying stuff liek that to a mentally ill person underlines the horrible ideas that: a mentally ill people are too much work, and b you're being a gift from god to befriend them.

Still mostly a good female-to-female- frienship that WASN'T built on obsessing over boys or being catty! It was like SUCH a cute romance. Like it talks psychology a lot and some of the metaphors were really intense and like wow. It was so layered. I mean. It's a John Green novel. I'm not used to this I need to sit down. It's sad and it's not sugar coated. Your mental illness isn't ALL of you, but it is some of you. And as someone who has anxiety disorders too, I really appreciated this. I appreciated the whole heckin' book. Anybody can look at you. It's quite rare to find someone who sees the same world you do. View all 33 comments. Nov 13, Emma Giordano rated it it was amazing.

If I leave this review blank for now, I may force myself to film a video review which I really want to do! Rating 3. Heck, I went into it pretty much expecting to dislike. I hated The Fault in Our Stars , with all of its extremely pretentious characters although I did cry at the end, and actually liked the movie. I then left Looking for Alaska , halfway through after a friend spoiled the ending thanks a lot, Megan!

And you know what? I liked it. I actually, genuinely liked it. This book is classic John Green. You got the two teenagers from well to do families who sit around contemplating the meaning of the universe with all the knowledge and wisdom of college philosophy professors and the vocabulary of a SAT test book. And yet, in spite of all of these things, I actually enjoyed this one. So, the story is about Aza, a girl dealing with spiraling thoughts that are entirely out of her control. She feels trapped and bullied by her mind as her anxiety takes over.

And yet, she tries her best to be a good friend and daughter and to live the life she wishes she had. I know firsthand how hard it can be to deal with invasive thoughts. I know that sometimes the mind seems like a different entity from the self and John Green wonderfully showed all the thoughts going through her head. More so, he did it in a way that properly displayed mental illness. I liked the romance also, although at points it was a little too philosophical for my taste. I liked that the world goes on and good things happen and sometimes bad things happen. I also like the way that mental illness is portrayed as affecting not just the individual but also those around them.

I loved seeing how family and friendships are tested and yet remain. Truly, I think that it was all brilliantly done and I must say, kudos to John Green because I could actually relate. So, why not a higher rating? Well, this book felt like it was trying too hard. It was too many things. It took a great story and stretched it out to the point that the plot seemed thin. It felt out of focus and it greatly diminished my liking of it. I think it could have had a greater emotional impact if it had focused on only one thing, either Aza and her troubles, or Davis and his missing father. It could either be a look into mental illness or a mystery. Or, it could be both if it were longer and found a way to combine the two.

But, alas, it did not. Overall, I really enjoyed it and totally recommend. I am actually looking forward to whatever John Green writes next. Let me know what you thought! View all 35 comments. You're the storyteller and the story told. You are somebody's something, but you are also your you. I devoured it in under a day! I couldn't leave it down even though I had studying to do. I was there, with Aza, feeling what she was feeling, understanding even though I don't suffer from it, wanting to "heal" her even though I know I couldn't. This book was so deep too deep for teenagers but that's John Green for ya and it entailed so many excellent quotes that cut deep into me. The other characters were brilliant, too even though Daisy just pissed me off at times , the Star Wars references were cute, being a SW nerd myself, I relate even though the Rey x Chewbacca parts were sort of weird and I think he did his research a lot for this book.

I'm so looking forward to the movie I heard that is coming out, a John Green book not becoming a movie would be a first I hope they do it justice. It was the first of his books I read before the movie comes out not because of the movie so I'm really curious to see what their angle will be about it. View all 11 comments. You're a you. You're a she, an it, a they. My kingdom for an I. I feel at a loss for words to describe my experience while reading this book; I've seen multiple reviews state they felt Turtles All the Way Down wasn't even on the same level as The "You're a we. I feel at a loss for words to describe my experience while reading this book; I've seen multiple reviews state they felt Turtles All the Way Down wasn't even on the same level as The Fault in Our Stars , and I have to agree.

While this wasn't a BAD story per se, it didn't feel up to the John Green standard we've come to expect. Multiple times I was stopped by randoms at the gym asking how it was, because it was on their wish list, and I could never muster anything more than "This book is fine. Fine is what it is. It is not great, but it is fine" and I felt guilty for that. For such a short book with big font and little chapters and lots of spacing between lines, this book sure was slow in the first half. I believe he was going for atmospheric, but when I think of setting the tone in a slow building way, I think of descriptive writing that can be filled with prose or not, but definitely something that draws me in and makes me feel a part of the story, and that's not what happens here.

The narrative is very jerky and disjointed, and it took awhile for my brain to become engaged enough to care what was happening. I think the premise of this book, minus the billionaire side story but I'll get to that in a minute , was excellent. I love YA books featuring mental health issues and illnesses and this was by far the strongest aspect of the plot. I didn't find Aza likable in the beginning, but I feel that was the point so that we could form a connection with her as she grows and becomes aware of herself in new ways.

Honestly, I really could have done without the awkward side story of Davis and Noah's missing father. I didn't feel it added to the story; actually, I felt it took away from some of the more important factors since it stole coverage where those pages could have been used to further the main focus. I couldn't help but wonder what felt off, and I think it came down to a rushed characterization of Davis, Aza, and their relationship. It almost felt as if chunks of the story were missing and we were just supposed to fill it in our own way. I would have liked a little more development, but that's just me.

I did feel the ending was another strong point; it was messy, uncomfortable, and slightly disturbing, but added a gleaming spark of hope and a viewpoint of recovery for those struggling with various mental health issues and disorders. Please don't toss this book aside and chose not to read it just because it didn't wow me; I think it has some very valuable insight into a very tough subject that is still taboo in There are plenty of 5 star reviews that are much better than mine and I hope you enjoy it more fully than I did.

Maybe I'm getting too old for this type of YA contemporary or maybe I'm just out of touch with how teenagers behave and converse, so I think I'll just say that it was fine, but the over hyping of this book pre-production may have done more harm than good for the die hard fans. View all 41 comments. It's quite rare to find someone who sees the same world you see. View all 7 comments. View all 16 comments. Edit: Well, I cannot stop thinking about this book, and it's been a few weeks, so that deserves me upping my rating to 5 stars. It has resonated with me more than I thought it would.

This book was stunning. Hard to read trigger warnings for OCD and anxiety , but Jesus, did it feel healing at the same time. John Green wrote the shit out of this book. The way mental health was portrayed through Aza was excruciating, har Edit: Well, I cannot stop thinking about this book, and it's been a few weeks, so that deserves me upping my rating to 5 stars. The way mental health was portrayed through Aza was excruciating, harrowing and educational to read about and it still made me feel that though the stigma might have lessened a bit, the understanding of this subject is narrow.

I felt this book to my core. I was there with Aza when she was spiralling out of control, her mind constantly pulling her in different directions, finding no centre, the constant doubt hurling you further into finding no fixed point, so that you may breathe and focus. I've so much admiration for Green for writing so openly in this book. It was so raw and bleak and the ugly side of mental health truly came to live, because that's how it is and what it can manifest into. And though, it may seem difficult to find hope, a way to see the light at the end of the tunnel that seems never-reaching, it is there. It is tangible and can be found. View all 24 comments. May 18, Bill Gates rated it really liked it. When Melinda and I did an event with John Green in New York a couple years ago, we knew we had to bring our youngest daughter, Phoebe, along.

Before we went on stage, John pulled Phoebe aside to share a secret with her: the plot of his new book. He made her promise not to share it with anyone, and she stayed true to her word for nearly two years. Her struggles are a huge part of the book, as her compulsions constantly get in the way of her social life. Some people might find those parts difficult to read, but he really gives you a sense of what it feels like to live with OCD.

Because this is a John Green novel, romance must factor into the equation. Aza begins to develop feelings for Davis, the son of missing billionaire Russell Pickett. John actually talked to Phoebe in New York about what it was like growing up with me as her dad. Something about the imagery of his books makes me get caught up in the fantasy of his stories, but Turtles All the Way Down hit closer to home for me than the rest. As someone who has struggled with OCD for years, I saw some of myself in the main character. But more than anything, this book struck close to home due to the intriguing character of Davis. Although we have very different relationships with our dads, I recognized his struggle, which also plays into my own life as I find my way in this world.

This read was captivating like none other I have read before. Paper Towns is still my favorite John Green book—but my family loved talking about Turtles at the dinner table, and I think yours will, too. View all 4 comments. And it tasted good. It's been a while since John wrote a book. During the time that passed until the release of Turtles All the Way Down I caught up with most of his other books, apart from An Abundance of Katherines. But I'm glad I did. The plot wasn't all the exciting. I saw lots of people complain about an absence of plot, but some stories are more character-driven than others, as in this case.

Apart from this, there were lots of subplots that I loved - Daisy's relationship with Mychal for once, or the disappearance of Pickett Senior. The characters were fantastic. First and foremost there is Aza, a teenage girl battling with anxiety. While she did not say much, I enjoyed her narratorial point of view. She was a fleshed out character with lots of depth, which is such an improvement to John's previous main characters that were part boring and part even more boring. Now, I don't struggle with an anxiety disorder. I can't possibly judge this novel from that perspective because I never experienced anything similar to what Aza struggles with on a daily basis.

But this book managed to make me feel what a person with an anxiety disorder might possibly have to go through - so much that I could only skim the parts where the main character's anxiety surfaces and takes over all her thoughts and actions. With Daisy, Aza's best friend, it was love at first sight. This girl is precious. I loved everything about her. I never warmed up Davis, Aza's love interest, if that is what you want to call him. I don't think that I fully got him and I'm not entirely sure why Aza was drawn to him. On one hand, their relationship lacked romance, on the other hand, I'm glad that this was not one big love story. It would not have fit into the story. Overall I simply liked this novel. Money was one of the story's central themes, and while I'm both uncomfortable with and in awe of this unfathomable wealth depicted in it, I also deeply connected with Daisy, when she talked about what being poor can be like.

Of course, wealth and poverty are extremely subjective topics and people hate to talk about money, but I think John Green managed to find a good balance. Find more of my books on Instagram View all 14 comments. I must admit that never in a million years, would have expected to find myself in a situation like this, one where I'd end up completely put off guard by a book I'd never even considered reading in the first place.

I'm not a huge John Green fan. I've read his previous works and, even if I didn't completely despise them, the whole JG phenomenon never really felt to me like a complete mind-blowing experience that I absolutely had to be part of. Then why does this book changes the entire game, you might ask? Well, first of all, there was a lot to relate to. And I'm not only talking about all those pop-culture references and the exquisitely colloquial writings. I mean, yes, they're quite necessary if you look at it from a certain angle, and they serve their filling purpose greatly, but it's something else, really. As simple as it sounds, I found myself utterly and painfully represented by the issues this book portraits, and I couldn't help but see my own fight against the same angsty and suffocating thoughts the main character, Aza, has to struggle with on a daily basis, as well.

It's really something that doesn't happen everyday. Aza is a complex and damaged character, one of those charries I usually am drawn to, only this time it was because her character sometimes appeared very adult-coded, so it was a case of mutual and shared vision of life. Through the pages, you get to see her journey, in and outside her head, and, I don't know if it's just me being me, but some of the things she does and says are things I thought I was the only one doing.

Talk about relatable MC's! I like her, so so so so much. When they start throwing tantrums, I don't blame them, because they're young and immature, just like they should be. And when they learn from their mistakes, is even better. Aza's mum is probably the purest character I've seen in years. She's adorable. I respect the shit out of that woman, I admire her for being so strong and for keeping herself together for her daughter's sake even when things are shitty. She's a good mum and a good role model. Love interests aren't usually a problem for me, except for when they become love-interests-period. This time around, it was Davis' turn and, I've got to say it, I adore the guy. Just like Aza, he's walking a wire, with one foot dangling from the edge of the darker side, constrantly fighting to live up to a family name he didn't choose himself.

And he's so Likeable, you know? At least for me. I mean, he's got this whole Gansey thing going on cute and nerdy rich boy, wears khakis and polo shirts, has a frigging diary and he loves poetry. No, let me rephrase that: he loves and writes poetry. So, reason 3 this book is the best I've read this month: the plot is so blunt and easy to follow, that it flows perfectly with whatever mood you might be in that moment. Sure, it's not the thriller of the year nor the best contemporary that deals with heavy themes, but if you put all the elements together and follow the recipe step by step, you're in for an adventure.

The quotes sprinkled all over the book, in a certified Green fashion, the very same quotes I've always found a bit pretentious in the other books, add a sense of poetry as if there was little of it already! The romance is light but at the same time very intense. It's not even that much eye-rolling, if you know what I mean. And it's not always sunshine and rainbows, that be clear. I also think Green does an amazing job at presenting you both sides of the medal, backstabbing and wishful thinking included.

I think this was the first time in ages I had to physically keep myself from reading an entire novel in one day, because I didn't want it to end too soon. I'm glad I found, in this unexpected surprise of a book, a story that made me feel a little less alone in the world. Click here to watch a video review of this book on my channel, From Beginning to Bookend. Turtles All the Way Down is quintessential John Green - exceedingly eloquent teens with advanced vocabularies ponder existential questions - but, much like its protagonist, the book suffers from a confused sense of identity, trying to be too many things at once.

It subsequently lacks focus and offers weak emotional impact. View all 21 comments. I thought I would fall in love with this book but I just didn't. I loved Aza so much and as I have mental disorders I can totally relate to her. She's a wonderful character. Davis is her boy ish friend and he's awesome too. Noah is his brother. They are totally rich and their father is missing.

So this is about finding each other and finding a missing father. A few other things thrown into the mix. I think what kept this from being a 5 star wa I thought I would fall in love with this book but I just didn't. I think what kept this from being a 5 star was Daisy. I just didn't like her at all. She was Aza's best friend. I just couldn't handle her. So, on to the next! Happy Reading! View all 58 comments. I found out that there's a Japanese word "Sayonara" which means final good-bye. It's not something that you say to someone you are sure you're gonna see again. From my understanding, it also means that if we meet again, we'll be different people, I'll be a different person. And it makes sense, it makes so much sense.

View all 6 comments. Oct 11, Nat rated it it was amazing. I say mistake because when I opened up the book weeks after having read the first two chapters, I only had this vague recollection that certainly wouldn't help to continue from where I'd started. Rereading was key. To give you a bit more background on why I was so eager: Back in , John Green was one of the first authors I'd read that introduced me to the magic of books.

I owe a lot to his writing that sucked me in so completely, only to leave me craving for more by the last page, which then led me to look up what next book would satisfy that particular hunger. And here we are today. Despite all the above, I still went into Turtles All the Way Down with little to no expectations as to what was to come. I knew that though I had history with TFIOS, when I look back on certain scenes, I can't help but feel shivers of disgust like when the "two very privileged caucasian Americans who have never known starvation, genocide, or physical abuse" kissed in the Anne Frank house, which Ariane tells like it is in this article.

So if anything, I was apprehensive as to what this newest work would contain. I feel like the only way I can accurately describe the heart of the book is by borrowing this phrase : Captures the everyday moments of teens' lives and then sets fire to those moments, heightening them until they become metaphor. Her thought process and spirals gave me a keen insight into the works of the mind and expanding my view on things.

What I wasn't expecting, however, was having my own thoughts staring back at me from the page. Like, parts of typical romantic relationships that made me anxious included 1. Most people with OCD understand that their notions do not correspond with reality; however, they feel that they must act as though their notions are correct. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, while accepting that such behavior is irrational on a more intellectual level.

There is a debate as to whether hoarding should be considered with other OCD symptoms. Some people with OCD perform compulsive rituals because they inexplicably feel that they must do so, while others act compulsively to mitigate the anxiety that stems from obsessive thoughts. The person might feel that these actions will somehow either prevent a dreaded event from occurring or will push the event from his or her thoughts. In any case, the person's reasoning is so idiosyncratic or distorted that it results in significant distress for the person or for those around him or her.

Excessive skin picking , hair pulling , nail biting and other body-focused repetitive behavior disorders are all on the obsessive—compulsive spectrum. Some common compulsions include hand washing, cleaning, checking things such as locks on doors , repeating actions such as turning on and off switches , ordering items in a certain way and requesting reassurance. People rely on compulsions as an escape from their obsessive thoughts; however, they are aware that the relief is only temporary, and that the intrusive thoughts will soon return. Some people use compulsions to avoid situations that may trigger their obsessions. Although some people perform actions repeatedly, they do not necessarily perform these actions compulsively.

For example, bedtime routines, learning a new skill and religious practices are not compulsions. Whether behaviors are compulsions or mere habit depends on the context in which the behaviors are performed. For example, arranging and ordering books for eight hours a day would be expected of one who works in a library, but would seem abnormal in other situations. In other words, habits tend to bring efficiency to one's life, while compulsions tend to disrupt it.

In addition to experiencing the anxiety and fear that typically accompany OCD, sufferers may spend hours performing such compulsions every day. In such situations, it can become difficult for the person to fulfill his or her work, family or social roles. In some cases, these behaviors can also cause adverse physical symptoms. For example, people who obsessively wash their hands with antibacterial soap and hot water can make their skin red and raw with dermatitis. People with OCD can use rationalizations to explain their behavior; however, these rationalizations do not apply to the overall behavior but to each instance individually. For example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check is much less than the time and stress associated with being robbed, and thus checking is the better option.

In practice, after that check, the person is still not sure and deems it is better to perform one more check, and this reasoning can continue for as long as necessary. In cognitive behavioral therapy , OCD patients are asked to overcome intrusive thoughts by not indulging in any compulsions. Good or fair insight is characterized by the acknowledgment that obsessive-compulsive beliefs are or may not be true. Poor insight is characterized by the belief that obsessive-compulsive beliefs are probably true. Some people with OCD exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational. After some discussion, it is possible to convince the individual that his or her fears may be unfounded.

It may be more difficult to practice ERP therapy on such people because they may be unwilling to cooperate, at least initially. There are severe cases in which the person has an unshakable belief in the context of OCD that is difficult to differentiate from psychotic disorders. Though OCD was once believed to be associated with above-average intelligence, this does not appear to necessarily be the case. Specific subtypes of symptom dimensions in OCD have been associated with specific cognitive deficits.

People with OCD may be diagnosed with other conditions as well as, or instead of, OCD, such as obsessive—compulsive personality disorder, major depressive disorder , bipolar disorder , [44] generalized anxiety disorder , anorexia nervosa , social anxiety disorder , bulimia nervosa , Tourette syndrome , transformation obsession , autism spectrum disorder , attention deficit hyperactivity disorder , dermatillomania compulsive skin picking , body dysmorphic disorder and trichotillomania hair pulling. Individuals with OCD have also been found to be affected by delayed sleep phase syndrome at a substantially higher rate than is the general public. Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder.

Some research has demonstrated a link between drug addiction and OCD. For example, there is a higher risk of drug addiction among those with any anxiety disorder possibly as a way of coping with the heightened levels of anxiety , but drug addiction among people with OCD may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson and Clark , who explained that people with OCD or any other anxiety disorder may feel depressed because of an "out of control" type of feeling.

Behaviors that present as or seem to be obsessive or compulsive can also be found in a number of other conditions, including obsessive—compulsive personality disorder OCPD , autism spectrum disorder or disorders in which perseveration is a possible feature ADHD , PTSD , bodily disorders or habit problems , [49] or subclinically. OCD frequently occurs comorbidly with both bipolar disorder and major depressive disorder.

OCD is also associated with anxiety disorders. Risk factors include a history of child abuse or other stress -inducing event. Atypical antipsychotics second-generation antipsychotics such as olanzapine Zyprexa have been proven to induce de novo OCD in patients. There appear to be some genetic components with identical twins more often affected than non-identical twins. In cases in which OCD develops during childhood, there is a much stronger familial link in the disorder than with cases in which OCD develops later in adulthood.

The relationship between OCD and COMT has been inconsistent, with one meta-analysis reporting a significant association, albeit only in men, [64] and another meta analysis reporting no association. It has been postulated by evolutionary psychologists that moderate versions of compulsive behavior may have had evolutionary advantages. Examples would be moderate constant checking of hygiene, the hearth or the environment for enemies.

Similarly, hoarding may have had evolutionary advantages. In this view, OCD may be the extreme statistical "tail" of such behaviors, possibly the result of a high number of predisposing genes. A controversial hypothesis [67] is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PANDAS. A review of studies examining anti-basal ganglia antibodies in OCD found an increased risk of having anti-basal ganglia antibodies in those with OCD versus the general population.

Functional neuroimaging during symptom provocation has observed abnormal activity in the orbitofrontal cortex , left dorsolateral prefrontal cortex , right premotor cortex , left superior temporal gyrus , globus pallidus externus , hippocampus and right uncus. Weaker foci of abnormal activity were found in the left caudate , posterior cingulate cortex and superior parietal lobule. Affective tasks were observed to relate to increased activation in the precuneus and posterior cingulate cortex PCC , while decreased activation was found in the pallidum , ventral anterior thalamus and posterior caudate.

Observed similarities include dysfunction of the anterior cingulate cortex and prefrontal cortex , as well as shared deficits in executive functions. Generally two categories of models for OCD have been postulated, the first involving deficits in executive function, and the second involving deficits in modulatory control. The first category of executive dysfunction is based on the observed structural and functional abnormalities in the dlPFC, striatum and thalamus.

One proposed model suggests that dysfunction in the OFC leads to improper valuation of behaviors and decreased behavioral control, while the observed alterations in amygdala activations leads to exaggerated fears and representations of negative stimuli. Because of the heterogeneity of OCD symptoms, studies differentiating various symptoms have been performed. Symptom-specific neuroimaging abnormalities include the hyperactivity of caudate and ACC in checking rituals, while finding increased activity of cortical and cerebellar regions in contamination-related symptoms.

Another model proposes that affective dysregulation links excessive reliance on habit-based action selection [88] with compulsions. This is supported by the observation that those with OCD demonstrate decreased activation of the ventral striatum when anticipating monetary reward, as well as increased functional connectivity between the VS and the OFC. Furthermore, those with OCD demonstrate reduced performance in Pavlovian fear-extinction tasks, hyperresponsiveness in the amygdala to fearful stimuli, and hyporesponsiveness in the amygdala when exposed to positively valanced stimuli.

Stimulation of the nucleus accumbens has also been observed to effectively alleviate both obsessions and compulsions, supporting the role of affective dysregulation in generating both. Studies of peripheral markers of serotonin, as well as challenges with proserotonergic compounds have yielded inconsistent results, including evidence pointing towards basal hyperactivity of serotonergic systems. Despite inconsistencies in the types of abnormalities found, evidence points towards dysfunction of serotonergic systems in OCD.

A complex relationship between dopamine and OCD has been observed. Although antipsychotics , which act by antagonizing dopamine receptors may improve some cases of OCD, they frequently exacerbate others. Antipsychotics, in the low doses used to treat OCD, may actually increase the release of dopamine in the prefrontal cortex , through inhibiting autoreceptors. Further complicating things is the efficacy of amphetamines , decreased dopamine transporter activity observed in OCD, [92] and low levels of D2 binding in the striatum.

Abnormalities in glutamatergic neurotransmission have implicated in OCD. Findings such as increased cerebrospinal glutamate, less consistent abnormalities observed in neuroimaging studies and the efficacy of some glutamatergic drugs such as the glutamate-inhibiting riluzole have implicated glutamate in OCD. Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. The Quick Reference to the edition of the DSM states that several features characterize clinically significant obsessions and compulsions, and that such obsessions are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and that cause marked anxiety or distress.

These thoughts, impulses or images are of a degree or type that lies outside the normal range of worries about conventional problems. Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress.

Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD such as ordering items in a pantry by height , the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions to avoid significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive.

In addition, at some point during the course of the disorder, the individual must realize that his or her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming taking up more than one hour per day or cause impairment in social, occupational or scholastic functioning. In addition to the person's estimate of the time spent each day harboring obsessive-compulsive thoughts or behaviors, concrete tools can be used to gauge the person's condition. OCD is sometimes placed in a group of disorders called the obsessive—compulsive spectrum. OCD is egodystonic , meaning that the disorder is incompatible with the sufferer's self-concept. OCPD, on the other hand, is egosyntonic —marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image , or are otherwise appropriate, correct or reasonable.

As a result, people with OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. It is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions. A form of psychotherapy called " cognitive behavioral therapy " CBT and psychotropic medications are first-line treatments for OCD.

The specific technique used in CBT is called exposure and response prevention ERP , which involves teaching the person to deliberately come into contact with the situations that trigger the obsessive thoughts and fears "exposure" without carrying out the usual compulsive acts associated with the obsession "response prevention" , thus gradually learning to tolerate the discomfort and anxiety associated with not performing the ritualistic behavior. At first, for example, someone might touch something only very mildly "contaminated" such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.

That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once exposure without going back and checking again ritual prevention. The person fairly quickly habituates to the anxiety-producing situation and discovers that his or her anxiety level drops considerably; he or she can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.

It has generally been accepted that psychotherapy in combination with psychiatric medication is more effective than either option alone. The medications most frequently used are the selective serotonin reuptake inhibitors SSRIs. SSRIs are a second-line treatment of adult obsessive compulsive disorder with mild functional impairment and as first-line treatment for those with moderate or severe impairment. In children, SSRIs can be considered as a second-line therapy in those with moderate to severe impairment, with close monitoring for psychiatric adverse effects. Quetiapine is no better than placebo with regard to primary outcomes, but small effects were found in terms of YBOCS score. The efficacy of quetiapine and olanzapine are limited by an insufficient number of studies.

None of the atypical antipsychotics appear to be useful when used alone. A guideline by the APA suggested that dextroamphetamine may be considered by itself after more well-supported treatments have been tried. Electroconvulsive therapy ECT has been found to have effectiveness in some severe and refractory cases. Surgery may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in an area of the brain the cingulate cortex. In the United States, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption requiring that the procedure be performed only in a hospital with special qualifications to do so.

Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious", establishing it as one of the leading psychosocial treatments for youth with OCD. Although the causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD, and acknowledging these stressors can play a role in treating the disorder.

OCD occurs worldwide. Quality of life is reduced across all domains in OCD. While psychological or pharmacological treatment can lead to a reduction of OCD symptoms and an increase in reported quality of life, symptoms may persist at moderate levels even following adequate treatment courses, and completely symptom-free periods are uncommon. All I require of you is that for the future you pay no attention to them whatsoever. From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual or other obsessive thoughts were possessed by the devil. The English term obsessive-compulsive arose as a translation of German Zwangsvorstellung 'obsession' used in the first conceptions of OCD by Carl Westphal.

In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious. Movies and television shows may portray idealized or incomplete representations of disorders such as OCD. Compassionate and accurate literary and on-screen depictions may help counteract the potential stigma [] associated with an OCD diagnosis, and lead to increased public awareness, understanding and sympathy for such disorders.

The naturally occurring sugar inositol has been suggested as a treatment for OCD. Much current research is devoted to the therapeutic potential of the agents that affect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole , [] memantine , gabapentin , N-acetylcysteine , topiramate and lamotrigine. From Wikipedia, the free encyclopedia. Redirected from OCD. Disorder that involves repeated thoughts obsessions that make a person feel driven to do something compulsions. It is not to be confused with Obsessive—compulsive personality disorder. For other uses, see OCD disambiguation. This article may require cleanup to meet Wikipedia's quality standards.

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