Saturday, September 25, 2010

Anxiety in Disguise

Inside the black box 81/365

Fellow OCD Sufferer, from OCD Reflections, had a comment on my recent post about the History of Exposure Therapy that has me thinking. She talks about the possibility of habituation to anxiety when it seems "more like a biological reaction - when I can feel my heart beat faster, butterflies in my stomach. . .my OCD fears don't bring about that sort of visceral 'anxiety'." Instead it is rumination, in her head.

I've noticed this in my own OCD experience, that in a lot of my wanting to be "complete" or have something feel "right" doesn't register on my radar as "anxiety." Sometimes I feel like all the stuff going on in my head is sealed in a black box, and I can't get a good look. I know I do feel uncomfortable and uneasy if I contemplate moving on from a task if I don't feel finished(and yet, I rarely feel finished, so I'm waiting for something illusory), and this results in a dialog with myself about why I'm not moving on, when I don't feel severely anxious in a stereotypical way, and then my mood deteriorates as I get more self-critical.

A question that helps me identify what is going on in the black box:

What is my feared consequence if I don't do something the "right" way?
My therapist emphasizes that if someone had my fears of what would happen, they wouldn't want to do things either. I fear if I make a mistake, I will be a failure, worthless, and my defectiveness will haunt me forever. So yeah, that might make avoiding doing anything somewhat appealing!

He was telling me about some recent research showing some people are exquisitely sensitive to anxiety, and will search for ways to avoid feeling it. The vague tightness in my chest, the heat in my face, the heaviness in my muscles, the diffuse sense of being off kilter--not exactly a panic attack, not classically "anxious" with a capital A--but I quickly go into avoidance when I feel this way--avoid doing anything that makes me feel this way, like living my life, with the possibility of making mistakes, leaving things out, being incomplete.

Things like taking a shower even if I feel a resistance, a nagging fear that it's the wrong task at that moment, or leaving the house early enough to meet a friend, rather than getting on the computer and reading every single email message in my inbox before I leave. All the unfinished tasks call to me as I get ready to leave--the dining room table is "clear me, clear me!" and the sweater on the chair says "take me upstairs" and the email that I've ignored for a week suddenly clamor to be read. As Fellow Sufferer continues:
I know that exposure should also work for this type of "anxiety," but sometimes it's hard to conceptualize how changing my behavior will change my opinion about the way something "has to" be done.
I've been here! Many times. For me, it is sometimes a stalling tactic on the part of my OCD--"get it all worked out before you even start"--"know everything in advance, before you begin." When my OCD says, "Do it this way. Do it perfectly. Or don't do it at all" I divert into distraction so quickly I often don't notice I've done it, and go into avoidance mode, which ultimately comes back to haunt me when I snap out if it hours later, and I haven't done the things I really value in my life, like make art, or be with friends, or write this blog. My "regular" anxiety is probably a fraction of the intensity of all the anxiety I fear is waiting for me if I stop ruminating or compulsing or distracting myself.

My therapist says the ultimate goal is to do things in the wrong way, at the wrong time, that this is when I can make a break for freedom. The times I do something instead of avoiding, and see that I survive, even if it sucks at that moment, I am reaching into the black box and adding the possibility of light. The human desire to avoid feeling worthless or inadequate is powerful--and since so much of our selves are molded when we are young, and still thinking concretely it gets all tangled up in our nervous system--and by the time we can get some distance, we don't always realize that the concrete thinking isn't serving us well. Fleeing pain when you are 5, and have no income, no independence, no real options--that makes sense. Now I'm almost 45, and attempting to do things perfectly in hopes I will loved and valued creates even more pain.


  1. Beautiful post, as usual! I feel honored to have my comment mentioned in your writing.

    I read your entry earlier in the day and it had ME thinking, too. I run into so many little OCD road blocks all the time, and I give in, despite the fact that it doesn't seem like there is any "anxiety." Instead of anxiety, it is more like irritation at myself, at my failure to do things "right," while still challenging my OCD. I realized that part of what I fear is that endless rumination I mentioned - searching, trying to find some way to make the slightest oversight or doubt "okay." Facing my fears isn't like enduring a spike of terror that gradually fades once I after its initial peak. Rather it is sort of a hum in the background that follows me everywhere, a hum that keeps trying to make its way to the surface to be sorted out. If I can hold out long enough, it will eventually fade as another concern takes its place. But in the meantime I have to keep resisting the urge to "fix" things either mentally or physically, until that particular obsession fades. Basically, the exposure and the resulting discomfort are just the first part of the battle, and the response prevention is where the real work comes in. It is so tempting to just give in, so that I can free my mind and continue on with my day without that buzz in the background, that "off" feeling, and the "need" to analyze how my "mistake" might be affecting everything I do after that as I do it. It seems like it would be one thing if the anxiety took hold of me physically and I just had to wait that out, with my mind free to do as it pleases in the meantime, but instead it's there constantly nagging waiting for me finally give in. Physically I'm fine but my mind is constantly at work either trying to solve the OCD "problem" or trying to resist doing just that.

  2. Has anyone ever experienced "anxiety" as more irritation or a feeling that something just isn't right? I completely relate to the feeling of anxiety not always being visceral, however sometimes I find myself reacting less with an anxious feeling or more as an irritated feeling. Perhaps this is the irritation of wanting things to be a certain way in order to be "safe", and not being able to control it. I don't know.

  3. Fellow Sufferer--I know that feeling of the mind nagging and nagging. I think because we are conscious beings, with language, the mind stuff is part of anxiety, not just the physical stuff.

    Anon--Yeah, I've had a feeling of unease that something isn't "just right" or "perfect"--and it's not the stereotype of anxiety as a purely physical thing. It's uncomfortable, and it is a "felt sense" but it's not sweaty palms etc.