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Red= Summary & Main Ideas
Purple= Personal Connection Quotes & Reflection
Green= Outside Connections
Blue= Class Connections

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Daniel Leigh struggles with OCD, but doesn’t know it and calls his OCD habits “Zaps.” He thinks that he is mentally off and tries to hide his symptoms and behaviors from other people so that they don’t see him as “weird.” Some of his behaviors include flipping light switches over and over and avoiding the number 4. Daniel’s best friend Max sympathizes with Daniel’s OCD, but he can’t relate or support much. Daniel also has a major crush on a girl named Raya, but feels like he should hide from her because of his differences.

Daniel is quite shy and is the backup punter on the football team even though he doesn’t like it. He considers himself to be the waterboy and spends practices meticulously organizing cups until he gets put onto the field. Daniel helps the team win when he is put on the field as a last minute kicker, but the other kids do not stop being mean to him.

Sara Malvern, another outcast at Daniel’s school, reaches out to Daniel asking for help in figuring out who killed her father. The two discover that Sara’s dad had actually suffered from a severe depressive disorder and died by suicide with an overdose of prescription pills.

After discovering the true cause of her father’s death, Sara opens up to Daniel about her experiences living with OCD and depression. As Sara and Daniel bond over their shared experiences with OCD, Daniel feels less alone with his condition and starts to feel more normal. The two become close friends and embrace their differences and grow to understand that not all mental illnesses can be obvious from the outside. In the end they are thankful because their differences from others is what brought them to each other.

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A key part of the book is Daniel feeling like he is the only person in the world that has the "Zaps" that he constantly works against. I wanted to find a celebrity that struggles with OCD as an example of someone else who would make Daniel feel less alone.

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"America's Got Talent" judge Howie Mandel has been open for many years about his struggles with anxiety and obsessive-compulsive disorder (OCD). However, in a recent interview with People magazine, the comedian discussed how painful that struggle could be: "If I'm not laughing, then I'm crying. And I still haven't been that open about how dark and ugly it really gets."

Mandel, 65, has suffered from OCD since childhood (although he wasn't officially diagnosed until he was an adult). In an interview with Everyday Health in 2010, Mandel said: "I was always incredibly obsessed with germs and cleaning and taking shower after shower after shower. Even when I was very young, I wouldn't tie my shoelaces because they had touched the ground. I had continuous repetitive thoughts that I couldn't get past. As a child, my mind was a lot busier than I was."

Although Mandel said he is "living in a nightmare," he explained that he tries to anchor himself: "I have a beautiful family and I love what I do. But at the same time, I can fall into a dark depression I can't get out of." He has been married to his wife, Terry, since 1980 and has a son and two daughters. His eldest daughter, Jackie, 36, also suffers from anxiety and OCD.

The pandemic was an especially difficult time for Mandel. He told People: "There isn't a waking moment of my life when 'we could die' doesn't come into my psyche," he said. "But the solace I would get would be the fact that everybody around me was okay. It's good to latch onto okay. But [during the pandemic] the whole world was not okay. And it was absolute hell."

Mandel said he is speaking up again at this time because "my life's mission is to remove the stigma [of mental illness]. I'm broken. But this is my reality. I know there's going to be darkness again -- and I cherish every moment of light."
OCD
OCD is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.

Approximately 2.3% of the U.S. population has OCD, which is about one in 40 adults and one in 100 children. The average age of onset is 19.5 years. About 50% of those with OCD have onset of symptoms in childhood and adolescence.

Males present earlier, but in adulthood, more females are affected. In families with a history of OCD, there's a 25% chance that another immediate family member will develop symptoms.

Half of adults with OCD (50.6%) have serious impairment, 34.8% have moderate impairment, and only 15% are mildly impaired.

The majority (90%) of adults who have OCD at some point in their lives also have at least one other mental disorder. Conditions that are often comorbid with OCD include:

Anxiety disorders, including panic disorder, phobias, and post-traumatic stress disorder (75.8%)

Mood disorders, including major depressive disorder and bipolar disorder (63.3%)

Impulse-control disorders, including attention deficit-hyperactivity disorder (55.9%)

Substance use disorders (38.6%)

Signs and Symptoms
People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

Fear of germs or contamination

Unwanted forbidden or taboo thoughts involving sex, religion, or harm

Aggressive thoughts towards others or self

Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

Excessive cleaning and/or handwashing

Ordering and arranging things in a particular, precise way

Repeatedly checking on things, such as to see if a door is locked or that the oven is off

Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive

Spends at least 1 hour a day on these thoughts or behaviors

Doesn't get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause

Experiences significant problems in their daily life due to these thoughts or behaviors

Etiology
The exact cause of OCD is still unknown, but it is believed to be multifactorial. Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen.

Imaging studies (functional MRIs, diffusion tensor imaging, and single-photon emission computerized tomography) have shown differences in the cortico-striatal-thalamo-cortical (CSTC) circuits of the brain in patients with OCD. These differences are most noticeable in the orbitofrontal cortex, the caudate, anterior cingulate cortex, and thalamus.

Environmental factors may also play a part in the development of OCD. Those implicated (but for which causal associations have not, as of yet, been established) include:

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, a group A streptococcal infection

Premenstrual and postpartum periods, which can be associated with new onset or exacerbation of OCD

Exposure to traumatic events

Neurologic lesions, such as stroke or traumatic brain injury that affect CSTC circuits

Treatment
The mainstays of OCD treatment are serotonin reuptake inhibitors (SRIs) and cognitive behavioral therapy (CBT). Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

It is important to consider any other mental disorders a patient may have when making decisions about treatment.
Medication
Two primary neurotransmitters are thought to contribute to OCD: serotonin and glutamate. The improvement of OCD symptoms with the use of serotonergic antidepressants led to the hypothesis that changes in serotonin play an important role in OCD. More recent studies support the idea that glutamate also plays a significant role.

SRIs, which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in the treatment of OCD compared with depression and may take 8 to 12 weeks to start working.

If symptoms do not improve with these types of medications, research has shown that some patients may respond well to an antipsychotic medication, such as aripiprazole or haloperidol, as an adjunct.
Psychotherapy
Psychotherapy can be an effective treatment for adults and children with OCD. Research has shown that certain types of psychotherapy, including CBT and other related therapies (e.g., habit reversal training), can be as effective as medication for many individuals. Research also has shown that a type of CBT called exposure and response prevention -- spending time in the very situation that triggers compulsions (e.g., touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g., handwashing) -- is effective in reducing compulsive behaviors in patients with OCD, even in those who did not respond well to SRIs.
Other treatment options
In 2018, the FDA approved transcranial magnetic stimulation (TMS) as an adjunct in the treatment of OCD in adults. TMS is a procedure that uses magnetic fields to stimulate nerve cells in the brain. The FDA permitted the marketing of TMS as a treatment for major depression in 2008 and expanded the use to include pain associated with certain migraine headaches in 2013.

Clinical trials of new methods for treating OCD can be found at the National Institute of Mental Health clinical trials webpage.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children's Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.
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Howie Mandel 'Living in a Nightmare' With OCD

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"America's Got Talent" judge Howie Mandel has been open for many years about his struggles with anxiety and obsessive-compulsive disorder (OCD). However, in a recent interview with People magazine, the comedian discussed how painful that struggle could be: "If I'm not laughing, then I'm crying.

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The Mayo Clinic's brief overview of OCD includes symptoms, treatment, and local facilities to get assistance.

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Overview

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior - the vicious cycle of OCD.

OCD often centers around certain themes - for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped.

If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

Fear of contamination or dirt

Doubting and having difficulty tolerating uncertainty

Needing things orderly and symmetrical

Aggressive or horrific thoughts about losing control and harming yourself or others

Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

Fear of being contaminated by touching objects others have touched

Doubts that you've locked the door or turned off the stove

Intense stress when objects aren't orderly or facing a certain way

Images of driving your car into a crowd of people

Thoughts about shouting obscenities or acting inappropriately in public

Unpleasant sexual images

Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as:

Washing and cleaning

Checking

Counting

Orderliness

Following a strict routine

Demanding reassurance

Examples of compulsion signs and symptoms include:

Hand-washing until your skin becomes raw

Checking doors repeatedly to make sure they're locked

Checking the stove repeatedly to make sure it's off

Counting in certain patterns

Silently repeating a prayer, word or phrase

Arranging your canned goods to face the same way

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist - someone who requires flawless results or performance, for example - and having OCD. OCD thoughts aren't simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional.

Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.

Genetics. OCD may have a genetic component, but specific genes have yet to be identified.

Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Risk factors

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.

Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.

Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Problems resulting from obsessive-compulsive disorder may include, among others:

Excessive time spent engaging in ritualistic behaviors

Health issues, such as contact dermatitis from frequent hand-washing

Difficulty attending work, school or social activities

Troubled relationships

Overall poor quality of life

Suicidal thoughts and behavior

Prevention

There's no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening and disrupting activities and your daily routine.

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Obsessive-compulsive disorder (OCD) - Symptoms and causes

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Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress. You may try to ignore or stop your obsessions, but that only increases your distress and anxiety.

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I was very surprised by how much I enjoyed and related to this book. Before reading it I had thought it looked interesting, but I didn’t think that I would really be able to see myself in the character’s shoes. It was surprising to see how much anxiety and OCD were intertwined with each other. I suffer from anxiety and I hadn’t realized how closely linked anxiety could be to other situations without a direct anxiety diagnosis.

Something that I strongly related to in the book was Daniel’s feeling of isolation and fear because of his conditions. Mental Health issues are something that can make people feel very alone and I know I struggled with finding people who had shared experiences with me because of how different each person’s times can be. It was nice to see a book that illustrated those struggles from both the perspectives of someone with a mental illness and the perspective of those who care for someone with a mental illness.

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“Grinning. I let myself be swept away in the celebrations.”

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“Grinning. I let myself be swept away in the celebrations.”

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Page 163

I related to this quote and situation because sometimes when I’m excited about things that celebration doesn’t feel fully real until there are other people joining in with my celebration. Getting swept up once others join in(like how Daniel felt) is something that I have experienced multiple times.

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“He had turned it on, and he had done something terrible.”

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“He had turned it on, and he had done something terrible.”

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Page 23

I related a lot to this quote because sometimes with my anxiety I tend to catastrophize. I have had moments in my life where I do something that I know makes sense, but once I do it I suddenly question everything about it.

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OCD falls under the category of Emotional Disturbance for IEPs. As we learned in Chapter 3, Emotional Disturbances make up around 6% of students in the special education system.

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“Football was really the only thing he talked about other than grades and chores.”

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“Football was really the only thing he talked about other than grades and chores.”

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Page 53

Though I do not relate to the football obsession in this quote, I do understand and can relate to Daniel’s frustration with people who only want to talk about one topic all of the time. Also, Daniel’s father’s inability to read Daniel’s expressions in this scene is something I can relate to and have noticed in others before.