Saturday, December 17, 2011

OCD Workshops for Parents at the Child Mind Institute in New York City


The Child Mind Institute let me know that they are offering a series of workshops for parents of children with OCD, with the last three being in January, February and March, 2012. All of the workshops in the series are free and open to the public. Here's a description of their mission:
Our Obsessive-Compulsive Disorder Parent Support and Information Group workshop series covers a range of issues affecting children with obsessive-compulsive disorder (OCD) and their support networks, from navigating friendships and family gatherings to the ins and outs of treatment and medication. This program is an opportunity to gain invaluable skills and learn how to help your children take control of their condition and thrive. Below you'll find the dates and topics of the 2011-2012 workshops; descriptions to follow.
This series is brought to you by the Child Mind Institute's Intensive Pediatric OCD Program. All workshops are held at the Child Mind Institute headquarters located at 445 Park Avenue (with entrance on 56th Street), New York, NY 10022.
The Nuts and Bolts of Exposure Therapy
Speaker: Jerry Bubrick, PhD, Senior Director, Anxiety & Mood Disorders Center; Director, Intensive Pediatric OCD Program
Date: Tuesday, January 10, 2012
Time: 6:00PM - 7:30PM
Location: Fascitelli Board Room at the Child Mind Institute
At first glance, the treatment for a child with OCD can seem illogical and difficult—why would my child want to do exactly what she fears? In this workshop, Jerry Bubrick, PhD, Senior Director of the Anxiety & Mood Disorders Center and Director of the Child Mind Institute's Intensive Pediatric Obsessive-Compulsive Spectrum Disorders Program explains why exposure therapy is the gold standard in OCD treatment and how it works to alleviate the extreme anxiety a child experiences around his or her symptoms. He explains how to help your child face the "bully in the brain" head-on and regain control over his or her life.
Is Medication Part of the Answer? Medication Approaches to OCD
Speaker: Roy Boorady, MD, Senior Director of the Child Mind Institute's Psychopharmacology Center
Date: Tuesday, February 7, 2012
Time: 6:00PM - 7:30PM
Location: Fascitelli Board Room
When deciding how to best treat a child with OCD, it is important to be aware of all of the options. Treatment for children with OCD will often involve cognitive-behavioral therapy, medication, or a combination of the two. Roy Boorady, MD, Senior Director of the Child Mind Institute's Psychopharmacology Center and one of the nation's foremost experts in the psychopharmacological treatment of children and teens, discusses medication approaches to treating OCD. You'll gain a deeper understanding of when and how medication should be used in the treatment of OCD as well as the benefits and drawbacks of the different classes of medication available.
Real Stories: Parents Speak
Date: Tuesday, March 6, 2012
Time: 6:00 PM - 7:30 PM
Location: Fascitelli Board Room at the Child Mind Institute
Join us for a very special Q&A panel of parents who've successfully led their children through the challenges of OCD. They will share personal stories—their struggles as well as the successes—of raising a child with OCD. You'll have the opportunity to ask questions and gain insight into how you can help your child while maintaining balance in your life.

Sunday, November 20, 2011

Back Pain and my OCD.

Bent Spine

I put my back out this week. I struggle with the presence of physical pain and the OCD that swoops in to complicate it. The first time I hurt my back, I was all of 24, and visiting my father for vacation. He asked me to vacuum the floor, and by the next morning, I couldn't get upright without my muscles seizing up. I'd never felt anything like it, but I knew that it had to be my imperfection and general deficiency that caused it. Having compassion for myself was not something that came easily, if at all. I had recurring back pain all through my 20's and into my 30's. I did have some physical therapy finally, when I was starting grad school, and the MacKenzie back exercises helped. But I went everywhere with a back pillow, and sat near the aisle so I could go stand up during concerts or lectures. I lived in fear of situations where my back might go out and there would be no way to get relief, or that I would be humiliated by my weakness.

I planned everything around how long I had to sit. I knew where the straight hard chairs were in any place I went to frequently. Once I graduated, and started a new job, my back seized up to the point that I had my husband drop me off a few blocks early to give me a chance to get fully upright before I got to the front door. I was depressed. I was anxious. Once my health insurance started, I went to a physiatrist, and got a referral for more physical therapy. This calmed my back for awhile, but the flare ups continued for a few more years, and then slowly, as I was doing therapy for my depression with Molly, my back stabilized. It seemed like a miracle.

On occasion, my back would get stiff, but recover quickly. But this week, after many situations of uncomfortable chairs--getting my hair washed at the beauty shop(which I do about once a year), meetings, long car trips--and lots of time in the studio, my back protested. I've started my Mackenzie exercises again and that has given me some relief, but I still have 3 more craft shows to get through, and the place I feel worst is in my studio, which is frustrating me, and I feel sad that what I love to do most, make art, is where the pain is aggravated. My OCD is all over this, and the more anxious I feel, the more I do things that make my back hurt even more, rituals of sitting at the computer too long. Slowing myself down is hard. The perfectionism is always in the background shouting about my need to do everything exactly right(whatever that means, since the standard always changes). I am working on it though. And know I may need to go back to the doctor and ask about occupational therapy.

If you have chronic pain and OCD, what helps you? I'd love to hear.

Thursday, November 10, 2011

OCD-Stop: Free Online Treatment for OCD in Australia from Swinburne University


I received a message from a research assistant at Swinburne University of Technology in Australia about online treatment they are offering through a study by Swinburne's National eTherapy Centre. Their website mentions Exposure Therapy in conjunction with Cognitive Behavioral Therapy as effective treatment for OCD.

More about OCD STOP!

OCD STOP! online treatment is based on a face-to-face Cognitive Behaviour Therapy (CBT) already in use. Evidence shows CBT is the most effective treatment for OCD. The online program OCD STOP! is known to help reduce symptoms of OCD. This study aims to find out who can most benefit from this treatment.

OCD STOP is free, safe, completely confidential, and does not use medications.

The 12 week program provides information about OCD, and helps participants learn how to control their anxiety and better manage their OCD. During the trial participants receive assistance in the form of weekly email contact with a qualified therapist.

Participants in the trial will be randomly assigned to one of two groups, those undertaking a cognitive behavioural treatment program called Systematic Treatment of Obsessive Compulsive Phenomena or OCD-STOP, and those completing Progressive Relaxation Training. Irrespective of which program they are assigned, all individuals will be given the opportunity to take the alternative treatment at no cost.

The director is Prof. Michael Kyrios, an academic clinical psychologist.

Note: OCD Stop! online is free. There is also a group that meets onsite, with a nominal fee.



Swinburne is also offering a 12 week STOP Group for OCD, starting April 2012, at Swinburne's campus in Hawthorne VIC, Melbourne.The program cost $420 for the 12 weeks. You may be eligible to receive Medicare Rebates. Medicare rebates are only available for sessions attended. A Mental Health Care Plan and a GP referral for psychological group therapy are needed to obtain a Medicare rebate for the cost of the group. The next STOP therapy program is planned to commence in April 2012. To find out how you can register to participate in this group please contact the Clinic's Project Officer by phone (03) 9214 5528 or email psychprojects@swin.edu.au

Monday, October 24, 2011

OCD and Serenity

Serenity Prayer Stone

I've been thinking about the Serenity Prayer this week.
God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
A lot has been going on and I am dealing with it. My skin biopsy came back benign, and I didn't have the backwash of figuring out whether I'd made a mistake in calling the dermatologist, and being "oversensitive." I took my best guess, and the moment before calling was worst, but I also was accepting that I couldn't diagnose cancer by checking my ear constantly, and that felt so much better than standing in front of the mirror, holding a handmirror and a flashlight and contorting myself to get a glimpse. My mother was back in the hospital for the second time with fluid under her lung, and although I was concerned for her, I didn't research the procedure.

The challenge I always had with the Serenity Prayer is the last line, the "wisdom to know the difference" between what I can and cannot change. In my obsessiveness, I would attempt to definitively figure this out, because I had to be right, or I was a failure as a human being. I had the illusion I actually could have a 100% success rate in predicting whether I could change something, or whether I needed to accept it. Over the last few years of ERP treatment for my OCD, I've come to see that this prayer actually ASKS for the wisdom to know the difference, and this implies that at times we will fail in distinguishing this.

There are some aspects of the 12 Steps that I really resonate with, particularly the idea of life becoming unmanageable when in the power of the disorder. Part of me really hoped that I wouldn't have to deal with uncertain symptoms, health problems, or my mother getting older, and my despair when these things happened was overwhelming. I ritualized to try and make the anxiety go away. Research heart surgery. Research skin cancer. Check my skin. Over and over. But we are embodied creatures, and our bodies are not immortal, and can be injured. The enormity of this is catastrophic when you aren't getting any help for the OCD. The compassion of my therapist, my husband, members of my support group, and blog readers helped me see how much of a burden this can be, and encouraged me to find some kindness for myself.

Saturday, October 8, 2011

OCD A to Z: Z is for Zero

Vintage Teal Zero Fan


I finally made it to Z! I started this OCD A to Z series in May, 2011. In thinking of a Z word, zero came to mind. For those who have suffered with OCD anxiety, there is a longing to feel zero anxiety ever again. Zero tolerance. Zero it out. Zilch. I remember my deep disappointment when I started Exposure Therapy, when my therapist said that we can't rid ourselves of all anxiety, that humans don't get that option.

OCD anxiety can be so intense, and my belief was that I couldn't cope with any more anxiety in my life. I also had a subset of existential obsessions about why there was suffering in the world, and a fear of strong feelings, with a belief that those would kill me. OCD is sneaky in giving the illusion that it's possible to escape anxiety entirely if you just do the rituals correctly. What I have learned in therapy though is that the wish to eradicate all anxiety is far more corrosive than the actual anxiety of life. OCD is such a heavy burden to add to the stresses and griefs of being human, and it is possible to thrive and get better and deal with the dictatorship of OCD rituals, and live life, in spite of difficult and painful things that happen.

Sunday, September 25, 2011

OCD A to Z: Y is for Yet Again

anxiety
It's been a hard month, and when I thought of what to do for Y, the phrase "Yet Again" came into my head. There's a jolt of surprise every time anxiety intrudes into my life, and a heart sinking disappointment. I have been learning to expect the anxiety, with less of a "yet again" and more of a "oh, it's you again." My therapist likes to tell me that I've had years practicing the old OCD stuff, and to expect it to come back. This isn't the same as being doomed, and that's the hard thread to hold onto when I'm having a hard time. If I expect the OCD to be there, and don't give into the "Oh, no, it's back. How can this be?" compulsion of figuring out, it's less likely to get worked into a big flare up.

The last month started with my husband being away for a week, which I find stressful, and stress makes my OCD worse, and since I've been doing so much better in the past 6 months, I was taken by surprise at all the old crap. My mother had her heart surgery), got released and then had to go back the next week for fluid under her lung.

Then, last week, I absentmindedly scratched at an itch on my ear, and it started to bleed, in the area of the spot where my squamous cell skin cancer was 5 or 6 years ago. I spent some time trying to see it in the mirror, actually two mirrors, and a flashlight, because it's part of my ear that's really hard to get a look at. I did remember that this is one of my compulsions, and the more I look at it, the more anxious I get. I haven't looked anything up on the internet. After a day of free-falling anxiety, I called my dermatologist. Her first available appointment was October 24th, but then the receptionist asked what I was coming in for and she said, "Hmmm. That sounds like something to come in sooner for." In the irony of OCD, I couldn't decide if this made feel better or worse!

Part of OCD is perfectionistic, and a fear of guessing wrong, and being humiliated at the doctor's office if I went for "nothing," so that part of me was relieved. Part of my OCD is health anxiety, and that part of me was like "WTF"?? So I'm seeing the dermatologist on Wednesday. Next, I called my therapist, and made an appointment for Thursday. He told me that it's unlikely I could diagnose a cancer by touch or by getting a look at it. . .and to go on with living my life, so that I don't lose that time, and also that the thoughts and anxiety will pop into my head, and that's normal, and if I don't do my compulsions, I'm less likely to relapse with my OCD this week. I could have a recurrence of cancer, or I could have a pimple, or sharp fingernails. As much as my OCD insists I can diagnose it, I can't, especially not by repeated checking.

Then I had coffee with my best friend yesterday. She's going through the possibility of a divorce, and first week at a new job, and all the old critical voices of her abusive childhood blaring full blast. She doesn't have OCD, but she understands the nature of insistent beliefs from the past, on high volume. (And got even more insight to the irrational fears of OCD, when she was offered the new job and suddenly feared she'd fail the drug test, even though she doesn't take drugs.) So she talked about her sadness with her marriage, and I talked about all the old health anxiety and perfectionistic voices saying "what's wrong with you? why did you scratch at your ear? why do you notice the smallest thing? or maybe you should've noticed it long ago? you are a bad person, you should know what's wrong", and it was a relief that she got it.

As I approach this gauntlet of a week, I would appreciate all your thoughts and prayers!

Saturday, September 10, 2011

OCD A to Z: X is for X-ing it Out




X Out


Until the 4th grade, I went to a school that didn't have letter grades. When I got my first test paper back with 2 x's, I knew instinctively that this was bad, and I should only have check marks, only right answers. My perfectionism started early. An x meant I had done something wrong, and I could feel fear in my chest, and a flush of shame in my face. I had decided that being perfect was the key to being ok, to being loved, to being acceptable. This is a potent belief that influenced my life thoroughly, and when mixed with OCD, extremely painful.

OCD offered a supposed solution, a method for being perfect, if only I analyzed and ruminated enough about every thought I had, every action I took. There are times when I want to x out OCD, draw a big black x through it, banish it, deface it. I'm old enough to remember learning to type on an electric typewriter, and the satisfaction of pressing down the x key and obliterating a whole line of type. My perfectionism is sneaky and I find myself desiring to perfectly eradicate my OCD symptoms, and this slowed me down for a long time, since anything I did wasn't enough in my mind, and any progress I made, I dismissed as inadequate. But over time, through the love of my husband and my friends and the help of my therapist, I have learned compassion for myself, for the girl I was, the girl who could never make a mistake or else she was worthless and doomed. If you struggle with this kind of self-loathing, know that it is possible to learn kindness for your own self. A child doesn't know there is hope or that perfection is impossible, but as adults, we can step outside that suffocating room of condemnation, and move toward freedom.

Monday, September 5, 2011

Review of Zelah Green: Who Says I'm a Freak? Young Adult Fiction about OCD



When the publicist for author Vanessa Curtis contacted me about possibly reviewing the young adult novel, Zelah Green: Who Says I'm a Freak? , I was intrigued, because I was a voracious reader as a teen, but do not recall any books about characters with OCD.

Zelah is in the confluence of pain between her mother dying, her father remarrying to a woman who doesn't like her, followed by her father disappearing, and her persistent need to keep germs away, and elaborate routines of cleaning, counting and physical gestures. My OCD, although present from age 9 or 10, flared when my father left and my mother was depressed, when I was 16, so I resonated with the overlap of the traumas and the rituals and the flood of anxiety, and the fear of being a freak.

Zelah is from the UK and through various twists in the plot ends up in a group treatment home for teens, run by husband and wife behavior therapists. I don't know how representative this is of the British mental health system, but it does provide a setting for Zelah's growth as she discovers other kids who are "freaks" and finds commonality of experience, and also is guided into exposure therapy for her rituals--purposely touching faucets, and toilets and not washing and moving at an incredibly rapid pace.

My main ambivalence about the book was the tendency of the therapist to dictate what step Zelah would take next in combating her OCD, and her relative quickness in doing what was asked of her. On the other hand, I did appreciate that the therapist understood Zelah's thought process, her fear of bad things happening if she didn't do her routines exactly right, and the focus on addressing the compulsive actions directly, rather than assuming that if everything was made right in her family, then her fears would magically disappear.

I remember at age 13 or 14, noticing that all the young adult novels I read were about unpopular kids, outsiders, with lives in turmoil or chaos. I wondered about that, how the characters seemed on the margins. Of course, I was on the margins as well, and I kept reading the novels, hoping for some company, some acceptance. A book like Vanessa Curtis's could have helped me feel less alone with my anxieties, and my OCD. The closest I came to having this was when I read The Best Little Girl in the World by Steve Levenkron, about a teenage girl with anorexia.

Here is a page from my list of books. I recorded the title of each one, which was probably a compulsion.




Monday, August 22, 2011

OCD A to Z: W is for Worry



Worry is like leaving your headlights on, and draining the battery. Worry is exhausting and stalls you in the middle of nowhere. The saying that "most of the things you worry about never happen" has circulated for many years. I remember seeing it over 25 years ago when I was in high school. Worry is used as a talisman to ward off disaster. The first time I saw a psychiatrist in the early 90's for my anxiety, he diagnosed me with Generalized Anxiety Disorder(GAD), which involves worrying about several different areas of life.

You worry too much.
If only you would stop worrying. . .
There's nothing to worry about.

The word worry comes from the Old English wyrgan, which meant to strangle, and evolved to mean "to cause mental distress or trouble." For all the stranglehold worry has held in my life, I couldn't imagine being without it. I felt that it somehow protected me, and that if I stopped worrying, something bad would happen. I hated worrying, but it was a compulsion.

I also felt like I had a responsibility to worry, since if something bad would happen if I stopped, then it would be my negligence. This can conspire with the OCD, and especially with intrusive thoughts, and the fear that if you stop worrying about the meaning of the thoughts, then it says something about your moral character, and so the worry starts up all over again.

What is worry actually doing? I once read that some researchers believe it damps down strong feelings and fears, and even though noxious, serves a function to buffer the fears. But can worry actually ward off danger? Will it guarantee I'm a good person, not a danger to others or myself? If worry can motivate me to actually do something constructive, I can see a use for it, but most of my worrying led to more fear, more exhaustion, more erosion of my life.

Sunday, August 21, 2011

Call for Submissions of Creative Work for OCD Awareness Week 2011: Deadline August 31, 2011

The IOCDF is asking for submissions of art, writing, music and film for OCD Awareness Week 2011. If you have something you would like to share, the deadline is August 31st, 2011 at 12am EST.

What

The International OCD Foundation and its affiliates from across the country will come together to educate their communities and the public as a whole about obsessive compulsive disorder (OCD) and its treatments. Learn from the nation's leading experts about how they work with those who suffer daily from the debilitating disorder. Have the opportunity to hear testimonials from patients both recovering and just beginning treatment and learn about the different treatments and therapies that help people hold jobs, balance relationships with family and friends, and lead more typical and productive lives.

Why

OCD Awareness Week is presented by the International OCD Foundation as a vehicle for support, advocacy and education to help end the stigma surrounding OCD and encourage sufferers to identify the disorder and / or seek treatment. The national Foundation has enlisted the support of its Affiliates nationwide to join in this education effort.

2011 OCD Awareness Week Event - October 15

In an attempt to raise awareness of OCD and effective treatment the IOCDF will hold a national event in Boston, MA this year. This event will be video-streamed live across the country. Building on last year’s successful story telling event this year we will be broadening the event to “creative expression” of OCD. We will be looking for submissions in four different categories (for more specific information pertaining to each category please click on the desired category below):

Click here for applications in the following categories:
Casestudy/Artwork
Personal Story/Fiction/Poetry
Short Film/Video/Animation
Song/Music

All submissions will be viewed and judged according to the following criteria:

Submissions will be accepted between August 1 9am EST until August 31 at 12am EST. Up to 5 finalists from each category (determined by a panel of experts through the IOCDF. The decision of the judges will be final.) will then be posted on our website for the public to vote. In mid-September winners will be announced. Winners will have transportation and hotel accommodations paid for by the IOCDF for the October 15th event.

Click here for applications in the following categories:
Casestudy/Artwork
Personal Story/Fiction/Poetry
Short Film/Video/Animation
Song/Music

Friday, August 12, 2011

Free Online Treatment for OCD in Australia


Macquarie University's Centre for Emotional Health in Australia contacted me about passing on information about a free online course they are offering for dealing with OCD. I checked out their About Obsessive Compulsive Disorder (OCD) factsheet, and they advocate for Exposure and Response Prevention Therapy, so if you live in Australia, this could be helpful.

Here are some details:
The eCentreClinic OCD Course is a 5-lesson cognitive and behavioural treatment package that delivers remote evidence- based treatment. The treatment includes techniques that would normally be delivered in face to face treatment. The main emphasis is on exposure and response prevention however the Course also includes a strong cognitive component. The OCD Course is delivered over 8 weeks and the participant has bi-weekly telephone contact with a Clinical Psychologist who is experienced in the treatment of OCD. The Course is open to individuals with all subtypes of obsessive compulsive disorder (with the exception of primary hoarding compulsions).

The OCD Course has been tested in one open trial with 20 participants to date. This research has been accepted for publication in the Journal of Anxiety Disorders. In summary the results from this study showed a high level of acceptability for the Course with 81% of participants completing all the Lessons and 100% of respondents indicating that they would recommend the Course to friends. In terms of clinical outcomes, participants improved significantly on the Yale-Brown Obsessive Compulsive Scale and 52% of participants no longer met criteria for OCD at 3 month follow-up.

Exclusion criteria for the OCD Course include:

- Aged <18

- Primary hoarding compulsions

- Suicidal intent

- History of psychosis

- No access to the internet

- Unstable medication dosage

- Current CBT treatment for OCD

- Residing outside of Australia

For enrollment information, check out The OCD Course.


OCD A to Z: V is for Voice

Censure - Illuminated


I hear a distinct voicing of my OCD thinking, a pattern I am getting better at recognizing. I personify my OCD as a voice that at times I argue with or reason with or acknowledge and move on to something else. When I first started Exposure therapy, whenever I said that "I" wanted to check something, or look something up or find certainty about an urgent question, my therapist would say, "The OCD wants this"--he said he wasn't suggesting I actually had another person inside me, but that he believed there was more to me than compulsions, that what I wanted was something bigger than my disorder allowed.

Sometimes he would have me be the OCD voice and he'd be "me"--and it would get intense. He'd call out the OCD, with its rigidity, and it's insistence on the unobtainable in order to be happy, and the lack of sophistication in dealing with life, a "one trick pony" with nothing to offer me but an illusion. At first I hated it, because I felt attacked, felt wrong and a failure, but I started learning to trust my therapist's support of me as a person, and seeing that his loyalty was to my soul, my purpose, my being, not to a pattern of obsessive compulsive thinking. OCD can latch onto any human experience, and in this way can feel absolutely unique, and yet the overall pattern is the same, the mode of operation, the demand for certainty, the search for actions or thoughts to undo the anxiety of the obsession.

Lolly over at Lolly's Hope Blog posted Pearl Jam's I Am Mine yesterday, and it was exactly what I needed to hear at that moment.
The North is to South what the clock is to time
There's east and there's west and there's everywhere life
I know I was born and I know that I'll die
The in between is mine
I am mine
I am mine. My OCD gets in my face and says, "Ha! How do you know what's you and what's not? Are you sure you can be yourself? You need to figure this out. Now." But I can see the pattern, the opportunistic nature of the OCD wanting an answer, wanting to know for sure, wanting to perpetuate itself. If you are struggling with the erosion of your life because of OCD, remember that you are in there. You aren't broken or defective. One of my great fears was that if I started to get better from OCD I'd discover how truly bad a person I was, and then be without hope altogether, but the compassion of my therapist, my husband, other people dealing with OCD--all this helped me to see that there is hope, that I am no less than any other human being.


Tuesday, July 26, 2011

OCD A to Z: U is For Unique Fears

breathing underwater

U was a hard one at first, but I remembered how many times I've encountered concern about having unique fears on the OCD Support Yahoo group, and in my own OCD support group, and in comments and emails from readers. OCD is as diverse as the people who suffer from it, with obsessions and compulsions that can be as unique as a fingerprint, but sharing the commonality of being human, and suffering from this disorder.
  • There is a despair that you are the only person who has a unique set of symptoms, and therefore maybe it's not really OCD, but something more dire.
  • There is fear that if no one else has these symptoms, no therapist will be able to help.
  • There is a visceral panic that the very bizarreness of your thoughts is a sign about you as a person, and your worth.
These fears are compounded by the lack of therapists trained in Exposure and Response Prevention Therapy, and who have sufficient experience treating OCD. For an inexperienced therapist, OCD symptoms may sound unique, but to someone who is familiar with OCD, they can see the underlying thread, the essence of the disorder underneath the permutations. This is not the same as finding a perfect therapist, and if you are like me and have perfectionist OCD, this can make it difficult to accept that all therapists are imperfect, even good ERP ones.

OCD is strangely unknown. Yes, there are whole reality TV shows devoted to it, but when faced with a patient in their office, it is all too easy for therapists to be distracted by the individual symptoms, trying to figure them out, trace their causes. This is what works in therapy for many other problems. I believe that recognizing OCD can be learned. My therapist didn't start out as an ERP therapist, but his OCD patients weren't getting better, and he wanted to learn more, and he educated himself, and now wants to go out and spread the word to his colleagues through continuing education and conferences.

It's like when someone mentions something and then you see it everywhere, but before then, you never noticed. Here is my prescription for therapists who want to learn more:

My prescription for someone suffering from a fear of having unique, untreatable symptoms would be much the same as for therapists, along with the knowledge that this is OCD's mode of operation to latch onto whatever is important to you, whatever your unique life experiences. For me, obsessing about obsessing is a struggle, so worrying that my OCD wasn't OCD, became one of my key themes, and I had to practice doing imaginal exposures, listening to scripts about how my OCD might really be something else, or untreatable, while going ahead with my treatment.

Wednesday, July 13, 2011

OCD A to Z: T is For Therapy

Psychotherapy
The International OCD Foundation has a useful checklist of questions to ask of potential therapists for OCD, as well as a database of OCD therapists. This is where I refer people who ask about finding a good therapist for their OCD. There is evidence that Exposure and Response Prevention Therapy works for Obsessive Compulsive Disorder, and yet very few therapists who are actually trained to do it or who have even heard of it.

It's a bizarre thing that OCD symptoms in all their permutations sound incredibly familiar to me, but to therapists who are unfamiliar with OCD, they don't see the patterns, and are baffled, frustrated, or assume there are deeper issues that must be dealt with first and the symptoms will then go away. I have had several excellent therapists who cared deeply about me, and wanted only the best for me, and did indeed help me dramatically with other areas of my life, but who didn't know how to treat OCD or didn't even recognize that I had OCD.

There are some areas of the US with no trained ERP therapists, and this sucks, but I encourage you to persist in searching out help, whether by support groups, or therapists who work with Skype, or the telephone.

Tips for Interviewing Therapists: What Should I Ask?

The following checklist can help guide your search for the right therapist. The answers to most of these questions are available on the individual listings in our Treatment Provider search engine, but it never hurts to ask a therapist yourself:

"What techniques do you use to treat OCD?"

If the therapist is vague, or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP), use caution.

"Do you use Exposure and Response Prevention to treat OCD?"
Be cautious of therapists who say they use CBT, but won't be more specific.

"What is your training and background in treating OCD?"

If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also, look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF, like our Behavior Therapy Training Institute (BTTI) or Annual Conference.
"How much of your practice currently involves anxiety disorders?"

"Do you feel that you have been effective in your treatment of OCD?"

"What is your attitude towards medicine in the treatment of OCD?"

If they are negative about medicine, this is a bad sign. Medicine is an effective treatment for OCD.

"Are you willing to leave your office if needed to do behavior therapy?"

It is sometimes necessary to go out of the office to do effective ERP.
This has been adapted from: "How to Choose a Behavior Therapist" by Michael Jenike, M.D.

Sunday, July 3, 2011

OCD A to Z: S is for Scrupulosity and Obsessing about God, ethics, and sin

unforgiven

I remember reading that the word "scruple" comes from the meaning "sharp stone" and scrupulosity is like a sharp stone in your shoe, paining you with every step. Scrupulousness can be a form of OCD, with a sensitive conscience constantly jabbed by fears of committing sins, doing something wrong, making a mistake or being negligent. Scrupulosity means never feeling forgiven, redeemed or having any lasting relief from confession(if one is Catholic), or constant fear of eating something not Kosher(if one is Jewish), or fear of breaking the law, being dishonest, or unjust(whether religious or secular).

Compulsions could include repeated confession, constant checking to make sure items are Kosher, repetitive prayers, or rituals that seemingly have nothing to do with what you fear, but give you a brief relief from the fear. For me, going to church generated whirlwinds of questions, and sucked up my energy, and filled me with despair. I went to a very liberal church, and ruminated on whether I was going to hell because I believed being gay wasn't a sin, or that women could be ministers. I was afraid that my decision to go to this church was a mistake, even though in my heart, I couldn't go to any other church.

And of course, there are people who would say that really God was trying to get me to repent, that I really was making a mistake, that it wasn't OCD at all. This is where faith comes in, the faith to believe what I know in my heart, in spite of the intrusive thoughts, and the collusion of some preachers and teachers with what my OCD is saying. I also suffered from fears of being a bad person, outside of any particular theology. An excellent article is Scrupulosity: Blackmailed by OCD in the Name of God by Laurie Krauth, who describes this type of fear:
Some people—religious and not—experience scrupulosity as an irrational moral perfectionism. I’ve heard them describe the fear of getting “in trouble” for making a non-existent or unlikely error for which they would be punished. A businessman obsessed about having told a colleague that he had read a book when in fact he had skimmed one of the chapters, and agonized over how to clarify “the truth” to his colleague.
There is part of me that knows God is bigger than my OCD fears. There is part of me that knows I have intrinsic worth by virtue of being human.

Wednesday, June 29, 2011

OCD A to Z: R is for Relationship OCD

clear the air detail copy


I'd never seen the acronym ROCD before until I came upon it on a OCD self-help list called Stuck in a Doorway, about 6 or 7 years ago. It stands for Relationship OCD, and another common one was HOCD for Homosexuality OCD. I believe they are both just different ways that OCD latches onto whatever is important to us. I've dealt with both of these themes of OCD, and they were so interconnected that trying to separate them out would've been futile.

OCD wants definitive answers, and when an obsessive thought or question centers around being with the right person(ROCD) or gender(HOCD), my desire was to answer the questions so I could breathe, so I could not be vigilantly checking to make sure I was making the right decision, and not be haunted by it later.

I was shy, and didn't date in highschool. I had a friend who lived in a cooperative community and most of her mother's friends were lesbians. This friend and I loved talking about big questions, the meaning of life, the nature of history. She gave me feminist theorists to read, and I gave her books by Madeleine L'Engle and C.S. Lewis. She didn't believe in God, but I wanted to be a minister, but we still talked for the enjoyment of spirited talking. She didn't date either, and rumors abounded that she was a lesbian. We went to see Entre Nous, a French movie about a woman who leaves her husband for another woman. This haunted me, because my father had left my mother that year, when I was 16 and my sister 13. My friend said that this woman as becoming free , but I kept seeing the shot of the daughter waiting for her mother.

I moved away after I graduated, and she gave me 3 cassette tape of "Womyn's Music" to listen to, Meg Christian, Ferron, Chris Williamson, Sweet Honey in the Rock, and I loved the songs. Reading about women in history was one of the few things that kept my interest in college, and I ended up majoring in feminist theory, but slowly this evolved into a way to try and figure out if it was safe to be with a man. I had fallen in love, with a man, and my OCD was tenaciously throwing out barbed questions about the reliability and safety of men, and that perhaps I was a traitor to my gender to deal with men and their violence. I wondered if the feminist songs I loved meant I was a lesbian, or the many women friends I felt safe with or found attractive meant that as well.

In spite of all this rumination, and reading and analyzing, I agreed to marry the man I was in love with, at age 25. My OCD fears were that marriage was inherently dangerous, and I would be mocked by those who came after me for being part of that institution. It took all I had to carry through when we went to apply for a marriage license, and the form said that $25 of the fee went toward a fund for victims of domestic violence. I didn't know I had OCD, but I knew I was filled with anxiety, and I clung onto the fact that I couldn't imagine being with anyone else, and that I had to ride through the anxiety, and that without getting married, I would have no health insurance after I graduated.

I used to wonder if I was suppressing my "true" self by being with my husband, but the exposure of being married, and enjoying his company until the anxiety subsided helped my obsessing about this to recede to the background as my health anxiety and perfectionism came to the forefront and sucked up much of my energy and life.

After I had my hair cut short, I remember some people calling me a boy, but how I looked didn't determine who I was. My fears didn't determine who I was. The healthy part of me knew I loved the man who became my husband.

If you've read this far, take courage. My story doesn't have a lot of conventionally reassuring aspects. But OCD can be treated with Exposure Therapy. You can learn to listen to the voice within you that knows who you are. You can learn to deal with your evolving self. No one gets a lifetime guarantee that they've chosen the right person or right gender. Just look at the divorce rate. OCD compulsions of analyzing and checking and figuring out will corrode a relationship, causing the very thing we fear, the loss of love, the fear of haunting memories.

Sunday, June 26, 2011

OCD A to Z: Q is for Questions

Question Marks

Questions are a defining aspect of OCD for me. Something about an unanswered question creates more anxiety than many statements of scary facts. "What if that bump on my ear is skin cancer?" kept me suffering more than when the doctor told me it was skin cancer, especially since I obsessed about the bump for 5 years. But then OCD in its opportunistic way turned its attention on "How could I have obsessed about this for 5 years? Why didn't I go to the doctor? What if this means I am a negligent irresponsible person?"

As a girl it was, "What if I am drafted into the army?" or "What if I can't fall asleep because I feel like I need to go to the bathroom?" In highschool I had "What if those earrings I bought my mom for her birthday look like sperm and she hates me for that?(that particular obsession seriously sucked)" and "What is that red dot on my lip?" "In college it was, "What if I am meant to be with a woman rather than a man?" or "What if it too dangerous to be with a man, and I should break up with my boyfriend?"

As an adult it was "What if my beliefs are wrong? What if it really is a sin to be gay or have sex before marriage?" About this time, the internet was freely accessible, and I searched for answers to these questions, like turbo charged trips to the library reference section, searching without boundaries. I rarely asked my questions of other people. I focused on finding the answer myself, but whatever answer I found was not sufficient to stop the questions. Many questions in life have no answer, or inadequate answers, or painful answers. OCD gave me the illusion that I could find a good answer to every question I had if I just looked diligently enough. At one point I decided it would be easier to say God didn't exist than to keep trying to find answers to my theological questions, and my therapist said that she believed God would understand how much pain I was in that I would be pushed to this point.

What kind of effect do questions have on you?

Friday, June 24, 2011

OCD A to Z: P is For Perfectionism

perfectionism

Perfectionism is a big part of my OCD, and one of the biggest obstacles to doing Exposure and Response Prevention Therapy(ERP), because of looking for "perfect" ways to do it. I've had some readers query whether I actually have Obsessive Compulsive Personality Disorder(OCPD) rather than OCD, because of all the posts I've written about perfectionism. My understanding, via my therapist, is that there is an element of finding perfectionism to be pleasing rather than painful in the case of OCPD. My impulse is to look this up, but I've looked it up in the past, and I know the familiar trap of wanting to get everything just right.

Early on I decided that I could be loved by my family only if I never made a mistake again, and I strived to always to get things right on the first try, or I would procrastinate ever trying at all, in order to avoid failure and the feared consequence of becoming worthless and unloveable. Avoidance became one of my major compulsions, as OCD got its claws into my fears, ever the vulture circling. The most frustrating aspect was that often I didn't even know what "perfect" was in any given situation, just that whatever I was doing was "imperfect" . It was a moving target, always changing, and if I finally felt "aha, that's it" then my mind would generate some other aspect to make perfect.

It's been a battle accepting that my mind will probably continue to generate thoughts of not being good enough, or done, or finished, or that I've ruined a day, or my life. But I also see that I don't have to jump when these thoughts arrive, scrambling to fix things, make things perfect. Perfection is a corrosive illusion, and all the "Perfectionism is actually an advantage" truisms used to send me into compulsive searching to find out if this was really true, because I could never be wrong, always had to figure things out. But I know from experience that perfectionism is most likely to prevent me from getting things done, keeps me searching for photos on flickr past the first couple pages, or delaying writing posts until I find the "right" topic. I have met amazing readers with OCD through this blog, in all its imperfections, and offered some hope, and that is what keeps me going.

Wednesday, June 8, 2011

OCD A to Z: O is For Only Obsessions

ruminate

When you don't appear to have any physical rituals, it seems very logical to assume that you only have obsessions, and no compulsions. This is where the "Pure-O" label originates, in the idea of being purely obsessional. What I have discovered in treatment is that compulsions or rituals that take place in my mind are every bit as real as those that are visible to the rest of the world.

Compulsing is the glue that makes an obsessive thought stick(after the initial hit of relief). It reminds of times I have tried to fix something I perceive as a flaw, and ending up making it worse, because the thought of walking away without trying to get rid of it seems too anxiety provoking. There are some thoughts that if I imagine letting them pass, I get very anxious, because I must make sure they aren't true, or I believe they say something about me as a person.

If I get involved in the battle against them, I lose every time. Going over conversations in my mind, reconstructing what I said, analyzing, ruminating, mental acrobatics. I left a comment on a friend's facebook wall today and suddenly thought "What if this is rude?" and my urge was to try and establish if it was indeed rude, over and over, and in the past I would've gotten stuck on this and lost a chunk of my day, or tried to find a way to see if the other person thought it was rude and on and on.

Other of my rituals actually are physical, but I never thought of them that way. Looking things up on the internet is an actual activity, as is avoiding certain things(for years I didn't watch the news or listen to the radio), or long sessions of writing in my journal analyzing everything.

Once I learned to identify my compulsions, it was easier to figure out what an exposure was, and what "response prevention" means in Exposure and Response Prevention therapy. So today, I accepted that my facebook comment may have been rude, felt some anxiety, and moved on instead of analyzing every angle, and the anxiety moved on as well.

Saturday, June 4, 2011

OCD A to Z: N is Need to Know

Searching for answers.

"Need to Know" OCD has been a giant time-suck in my life. My mind generates a lot of questions, and for many years I assumed I must therefore find the answer to these questions, even if it's totally irrelevant to what's important in my life. The compulsion is the search for the answer, because of the threat of feeling gnawing anxiety at not having found the answer, and fear that it will take up all available space in my head and that I'm missing something important.

Some people might blame this on the internet and smartphones, but all I needed was my mind. I'd forget someone's name, and wrack my brain trying to remember it, or dig through all my journals to find it. I'd go to the library and look at reference books. It didn't help that for 15 years I actually was a librarian, and I was trained to find things out! I was good at my job because of my honed skills of tracking information down, but got bogged down with finding too much information at times, because of not wanting to miss anything.

Yes, many folks have difficulty with getting sidetracked on the internet looking up random stuff, even without OCD, but OCD makes it feel dire if you don't hunt for an answer or find a missing link or recover a fragment of memory. I am learning to accept that my mind will be generating questions. That's what it does. Part of what makes me a writer is that I have a lot of questions and observations about the world. But if I follow every question down the path of finding an answer there isn't time for much else. It's hard to let some things go. I had the illusion that I really could find the answer to any question I had, but some can't be answered. But it is an illusion, and if I can remember that, and practicing letting some things go unaswered, it gets easier to let them pass.

Friday, May 27, 2011

OCD A to Z: M is For Medication

seratonin and dopamine went walking


I knew I wanted to write about medication as my M word, but I was feeling anxious about it. My path to taking medication was long and convoluted. I'm up to Part 7.5 of my medication story, as you'll see from the list of posts below. In Part 7.5, I had been off my SSRI antidepressant(pitifully low dose for OCD) for several months, and increasingly trapped in my anxiety about my body.

My incessant seeking of answers about my symptoms led to more medical tests, including a biopsy and a freak accident, after which I could barely sit or walk, and all manner of bandaging as the wounds slowly healed. I've never experienced pain like that before. Getting in and out of the car was an ordeal. Yet in the middle of this crisis, I realized I needed real help, and I found a therapist on the International OCD Foundation list, who specialized in Exposure Therapy, and made an appointment, just a week after my injury. I drove 1.5 hrs through traffic, in raw pain, and limped into the therapist's office. I was trying to sit on the couch and talk about my symptoms of OCD, while feeling like a freak.

This Exposure therapist referred me to another therapist in the practice, Leonard, who helped me change my life. I had gone back on my tiny dose of the SSRI after finding out my sister-in-law had had a heart attack at age 49, and the health anxiety was more overwhelming than my fear of medication. Leonard advised me that OCD often responds to larger doses, and with my doctor's approval, I slowly ramped up my dose of the course of a couple of months to the maximum. Leonard didn't patronize me. He didn't throw meds at me. He helped me to see that in order to do my exposures, and have some breathing room from the OCD, that a high dose could aid that. I'm still on that high dose, and in the process of slowing down my ERP therapy, as I've made tremendous progress. In the past my OCD would be agitating to get me off meds right now, because of needing to know right now if there are long term effects. I still get those thoughts, but if I go off the meds, it will be on my terms not the OCD's, and for now, the benefit of reclaiming my life is enough.

Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Sunday, May 22, 2011

OCD A to Z: L is for Lost Time

Hour Glass

Lost time is one of my OCD themes. I had a realization this week that the thoughts about wasting time, doing the wrong thing with my time, or losing time, are not going to magically disappear. I've been waiting for them to go away, and leave me alone. Everyone has thoughts about whether they are making good use of their time, and uncertainties about this. Mine have been interlinked with perfectionism, and fear of making any kind of mistake, and mental rituals of analyzing the best thing to do at any given moment with my time, not to mention avoiding doing anything at all, in case I choose the wrong thing.

The fact is that I have lost a lot of time due to the OCD. I've struggled with the thought that it's intolerable to have lost time, and I will be able to survive that grief, and I've endeavored to make the thought and the grief go away by analysis, which rebounds into even more focus on what I am trying to escape. It's the classic, "Don't think of a white bear"--what's the first thing that happens? You remind yourself of what not to think of, and there you are thinking about a white bear.

I've lost time doing my rituals. I've lost time while avoiding things I fear. I'm realizing that there are phone calls that would be useful to make as I work on my art business, and I lose time because I am afraid of phone calls, of saying the wrong thing, not knowing in advance how the call will go, and I'll freeze while avoiding the call, and get nothing done at all.

What are the ways in which you've lost time due to OCD?

Thursday, May 19, 2011

OCD A to Z: K is For Kabat-Zinn and Mindfulness

Be Mindful

I had a hard time thinking of a K word, but then Jon Kabat-Zinn popped into my mind. I first came across Full Catastrophe Living about 10 years ago, and what stayed with me was the idea that mindfulness was about focusing on the breath, and if your mind wanders, that is normal, and bringing it back to the breath is all you need to do, even if it only stays a split second. I appreciated the rock-bottom simplicity of this, even in the midst of a very exhausting state of OCD mind.

A few years ago, I also read The Mindful Way Through Depression which comes with a CD of mindfulness exercises, and I listened to them daily for almost a year. For much of my life, depression was intertwined with my OCD, and there are many clinicians researching mindfulness as part of the treatment of OCD in addition to depression. The theory is that the more we fight with our obsessive thoughts, the more entrenched they become, and mindfulness can be an adjunct to Exposure Therapy, a way to practice letting thoughts be there and lessening their charge.

As my therapist has pointed out many times, when in the midst of OCD compulsions, I am not in the present moment. I am either in the past, worrying about something that happened, or in the future anticipating "what ifs." He believes the only functional moment is the present one. This is where we make our good decisions, respond to what's actually happening, are most alive. At first I doubted this, because I associated the "present moment" as the one where I was suffering, and compulsing. But slowly I have come to see that in that suffering I am digging into the past or racing into the future. This doesn't mean that the present moment is magical, always calm and peaceful, but it gives a better chance of getting better from OCD. My old rituals don't get me any closer to long term peace.

Monday, May 16, 2011

OCD A to Z: J is for Just Right Feeling

"Just Right"

One of the most difficult aspects of my OCD to see clearly is the seeking of a "just right feeling." It pervaded my life. There's a stereotype of people with OCD being driven to straighten crooked photos, but "just right" OCD can attach to things that have no discernible order. Mine most often manifests as "how I started my day doesn't feel right" and moves rising anxiety, followed by the compulsion of freezing in place, trying to undo the feeling of having ruined the day. It's very vagueness is what makes it difficult to articulate even to myself. It's like I have a faulty shut-off switch, and the urge to move on doesn't come, or I'm expecting it to be incredibly dramatic.

When I was in college I noticed how I felt compelled to finish certain things in all one sitting, or I felt anxious. I think some of my procrastination came from avoiding starting tasks that would then need to be done straight through, because the thought of taking a break filled me with apprehension. My feared consequence is that the anxiety would overwhelm me, or that I wouldn't be able to pick up where I left off if I took a break. I did have some self-awareness that it was irrational to require myself to read all the chapters in a book, if the prof had only assigned 3 of them. But I didn't know how to stop.

Sunday, May 15, 2011

OCD A to Z: I is For Indecision

Indecision Stole My Life

Indecision OCD has eaten up a lot of time in my life. I'll get the thought that I might make a mistake, or the wrong decision, and my anxiety rises, and my compulsions consist of checking items closely for flaws, reading labels repeatedly, picking up every item, making sure I look at every rack in the store, plus mental rituals of figuring out which is the best choice, and interminable research.

I am much better at making decision now, after doing exposures, and listening to exposure scripts on my ipod, and the "high tech"(as my therapist calls it) tool of flipping a coin to make certain decisions. If I am tired or vulnerable, I am more likely to start agonizing over ordinary decisions. Yesterday, I was in the consignment store looking for t-shirts, and found myself looking at all the racks twice, even though intellectually I knew that there wasn't anything. For so many years I feared "missing something valuable or important" and it's a hard habit to break.

I remind myself to make at least one decision at the grocery store by flipping a coin--this cereal or that cereal, buy this item, or leave it on the shelf. I remember the days when I'd pace the store for 1/2 hr trying to make one decision, and how if I thought of a criteria for my choice(ie. price), I'd start to debate in my mind if that was the right criteria to use. I'd break into a sweat, my face would get hot, and whatever else I needed to do in my life was put on hold. I hated myself for wasting so much time, and I'd come home exhausted and demoralized.

OCD often is about certainty. I want to know for certain I've made the right choice, in advance, before I ever choose the item, or use it, or whether I've chosen the right action for all time. We don't get that kind of omniscience. Even in the grips of indecision, I knew that sometimes I chose something, and it sucked, even after all my compulsions, but it took encouragement from my therapist and friends to take the leap, and take my best guess, or leave something to chance, or not know an encyclopedia of information for every choice I made. We trick ourselves into believing that we can predict the future with certainty, if only we tried hard enough.

Friday, May 13, 2011

OCD A to Z: H is For Hope

HOPE


If there is one idea I would like my Exposing OCD blog to convey, it is that of hope.

Hope that OCD can be treated.

Hope that you can get better.

Hope that you can have a life.

I wasn't diagnosed with OCD until I was 33, and I didn't find a therapist who used Exposure Therapy(ERP) until I was 39. I've suffered with anxiety for much of my life. I had vivid imaginings of what could go wrong from age 8 or 9. I was monitoring my body for any changes in elementary school. I was intelligent, and assumed if I couldn't fix myself with that intelligence, then there was no hope for me.

It can be hard to find a therapist who is experienced in ERP. It can be hard to find a therapist who has even heard of ERP. It can take years to discover that what you suffer with is OCD, not a "fear of commitment" or "relationship issues" or "lack of confidence." But if you are reading this blog, you are a step closer to finding a way to deal with your OCD. Check out the IOCDF, or read Jonathan Grayson's Freedom From OCD, or seek out a support group, ERP therapist, or the bloggers in my blogroll.

If you can't feel hope, then borrow some of mine to get you through the journey of finding help, of doing exposures, facing your fears, or dealing with the unknown.

Thursday, May 12, 2011

OCD A to Z: G is for Guilt



Guilt pervades the responsibility form of OCD, which I have dealt with in the past. Responsibility OCD involves a magnified sense of what you are responsible for, can prevent, or should prevent. When I was in graduate school, there was an article in the paper about a guy riding his bike around town and harassing women. I was flooded with panic that it was my responsibility to alert every woman I knew. I spent hours analyzing what I should do. Part of me knew that this was an impossible task, to warn every woman of every danger, and I felt like I was ridiculous for having this urge, and yet, the feared consequences were so scary in my mind, that I would be held responsible if any woman I knew was harassed, stalked or attacked by this man.

This guilt has a gnawing quality, an insistent agitation of the mind. I believed I was a bad person. I bargained with myself about how much action I would take, in order to relieve my anxiety and protect my friends and yet not seem crazy. OCD thinking can be incredibly inflexible and single-minded. Finally, I made copies of the article from the paper and put it in the mailboxes of several women I knew at the University. I felt a moment of relief, followed by more guilt that I couldn't know for sure they would read the article, or take it seriously and be cautious, and anxiety that I was ridiculous, and also inadequate at the same time--ridiculous for wanting to warn everyone, and inadequate for NOT warning everyone.

Somehow I worked the article into a conversation with one of my friends I'd given it to. She said that she's seen the same article already. I felt deflated and relieved all at the same time. It hadn't occurred to me that others would read the paper. There is a grain of truth in the feared consequences--someone might not read the paper and be hurt--and yet no one person can save everyone from every danger, as much as OCD might insist you can. It sucks that we can't keep the ones we love safe under every single circumstance. Yes, we may feel guilt, but that doesn't mean it is in our power to prevent every eventuality. Ironically, the people I've met in my OCD support group and readers of this blog are some of the most conscientious, kind, responsible people I've known, but OCD makes them feel they are deadly.

Tuesday, May 10, 2011

OCD A to Z: F is for Feared Consequences

seattle library shelves

Whatever your obsession is, there is a feared consequence that fuels the leap into compulsions. This is useful information for constructing exposures. The irony is that OCD claims to protect you from whatever consequences you fear, but can instead bring on those consequences. I notice this with reading obsessions.

I sometimes get the thought that I might not truly understand what I just read, so I go back and read it again, and again, and get stuck on one page. The rereading is the compulsion, in an attempt to prevent misunderstanding, and yet this makes it even harder for me to understand what I am reading, because I am disrupting the flow of the writing. An exposure would be to keep reading, even if I'm not sure I understand.

This also happens with conversations, and a desire to include every possible detail the other person needs to understand fully. This made my sessions with my exposure therapist a challenge at first, because my efforts to include everything made it difficult to focus on anything. I feared he wouldn't be able to help me if I wasn't absolutely thorough, but humans can't convey every possible fact in an hour, and it actually is overwhelming to be listening to this, and makes it harder for the other person to understand.

Jonathan Grayson has a section about these obsessions and tactics for doing exposures in his book Freedom From OCD.

Monday, May 9, 2011

OCD A to Z: E is For Exposure and Response Prevention Therapy(ERP)

Stacy Nichols - Exposure Therapy 20" x 34"

When I first realized I had OCD, about 7 or 8 years ago, I joined the International OCD Foundation and started receiving their newsletter. As much as I learned from the excellent articles, I assumed that Exposure and Response Prevention Therapy(ERP) wouldn't work for mental obsessions, things happening in my head. Thoughts seem like the substance of our minds, unmovable. Another E word that came to mind was "endless," as a way to describe the thoughts that hang on like thistles on your socks after a hike.

But ERP does work as a treatment for mental obsessions, Pure O, intrusive thoughts. I am so much better than I was before I started ERP 4 years ago. Yes, at first it seemed like trying to see through muddy water, and having an experienced Exposure therapist helped me get far enough away to see the patterns and processes of the OCD.

In a nutshell, ERP is exposing yourself to a thought you don't want to have, or situations that evoke that thought, and then preventing yourself from responding with compulsions in order to make your anxiety go away. So if I have the thought that the ache in my side is appendicitis, which strikes fear into my heart, because I need to know for sure, and right now, an exposure could be saying "Yes, I may have appendicitis. I don't know for sure," and response prevention could be staying off google, not researching the symptoms, or calling my doctor, or going to the emergency room, or poking at my side to see if it still aches. And the ultimate result will be less sensitivity to that thought, an ability to let it float in and out, and continue on with my life.

I encourage anyone who suffers from mental obsessions to seek out an ERP therapist. Check the IOCDF's list of therapists, and also their list of OCD support groups. And read Jonathan Grayson's Freedom from OCD. He published some articles in the IOCDF newsletter about obsessing about obsessing which finally led me to seek help for my OCD.


Related:

History of Exposure Therapy

Exposure Scripts for Pure O and Health Anxiety

Sunday, May 8, 2011

OCD A to Z: D is for Doubt



OCD is sometimes known as the "Doubting Disease." This has been a key element in my struggle with OCD, the gnawing nature of doubt. Fred Penzel, OCD therapist, sums it up well:

OCD can make a sufferer doubt even the most basic things about themselves, others, or the world they live in. I have seen patients doubt their sexuality, their sanity, their perceptions, whether or not they are responsible for the safety of total strangers, the likelihood that that they will become murderers, etc. I have even seen patients have doubts about whether they were actually alive or not. Doubt is one of OCD's more maddening qualities. . . It is a doubt that cannot be quenched. It is doubt raised to the highest power. . . Even when an answer is found, it may only stick for several minutes, only to slip away as if it was never there. Only when sufferers recognize the futility of trying to resolve this doubt, can they begin to make progress.
I went with my husband to Easter church service. I don't usually go to church. My OCD doubting took a heavy toll on my spirit. I am at the point where I can go every once in awhile, and not have it cascade into intense doubt. One of the scripture passages was from the Gospel of John. You may have heard the expression "doubting Thomas" about the disciple who refused to believe Jesus had risen from the dead until he saw and touched the wounds himself. John 20:24-29

Listening to this passage, I wondered if Thomas' doubt was quenched by touching the nailmarks, or if the doubt kept returning, haunting him with questions about whether he actually felt his hand go into wound, or if he did trust that experience but agonized over whether his belief actually "counted" since he had to have physical proof first.

Thursday, May 5, 2011

OCD A to Z: C is for Courage

Courage

Facing OCD takes courage. My therapist tells me that we only have one nervous system, and the danger we perceive through our obsessions feels as real as any other danger. Who would want to face their deepest fears? It's important to find people who en-courage you, cheer you on with every small step of facing your fears, who have the ability to see that what looks "silly" or "easy" or "ridiculous" to them feels terrifying to you.

This isn't the same as having people go along with our compulsions in order to keep the peace, or because they don't want to cause you pain. The true pain comes from feeding the OCD with every ritual performed, every reassuring question answered over and over. An en-courager will help you tap into the courage you didn't even know you had in order to reclaim your life by doing exposures.

Finally, there are some people who will dis-courage you, who will mock your compulsions, or mock your attempts to do exposures to what you fear, saying "no big deal" or "it's about time." Yes, it can be frustrating to those who love us and work with us when we are pouring huge amounts of energy into doing compulsions rather than fighting the compulsions. I understand this. My mother had health anxiety , and when I was growing up, no one knew how to treat it, and this caused a lot of pain in my life. It took me a long time to understand that being harsh and critical of myself depleted my courage rather than building it up. What gives you courage to face your triggers or do exposures?

Wednesday, May 4, 2011

OCD A to Z: B is for Body Fears

page 214 Nervous System

My awareness of my body as something to be feared started at age 8 or 9, and as symptoms started cascades of anxiety, I grew to believe that my body was against me, betraying me. I once made a list when I was 19 or 20 of all the different body fears I'd had experienced: swollen lymph nodes, strange moles, pounding in my stomach and on and on. I filled a long sheet of looseleaf, both sides. I would get very angry at my body, imagining it was willfully sabotaging me, generating symptoms. About 10 years ago, I had irregular bleeding, and the fury I felt at my body was intensifying, when I had a sudden thought: My body doesn't know any more than what's going on than my mind does. My body isn't plotting on how to get me anxious. OCD is generating the anxiety based on what I feel in my body, but adding a whole layer of interpretation, quick plunges into fear of serious illness, and increasing my focus on the symptoms.

Tuesday, May 3, 2011

OCD A to Z: A is For Assurance

"Be not afraid... I will be with you always"

Assurance comes from Old Latin, to secure, to make safe. I believe it's a natural human desire to assure the ones we love, to make them feel safe, and it can seem counterintuitive to put a limit on re-assuring someone who has lots of anxiety and suffers from OCD. Assurance evokes the hymn Blessed Assurance, by Fannie Crosby and Phoebe Knapp (note, if you click on the song, it starts playing)which I remember singing in Sunday School, and loving the feeling of certainty, the exuberance of knowing something for sure.
Blessed assurance, Jesus is mine!  
O what a foretaste of glory divine!
Heir of salvation, purchase of God,
born of his Spirit, washed in his blood.

Refrain: This is my story, this is my song,
praising my Savior all the day long;
this is my story, this is my song,
praising my Savior all the day long.
I used to try and figure out the difference between "assurance" and "reassurance"--was I seeking information that I really needed, or was I doing a compulsion to lower my anxiety briefly, before researching again and again. I finally accepted that I can't definitively know this, that OCD is crafty in coming up with ways to bluff and say "You really need this information. You really need to search. This is new." My longing to definitively figure everything out is part of the disorder of OCD. Yes, uncertainty is painful for human beings, even without OCD, but OCD tells the lie that you can think your way through using compulsions. Reassurance doesn't last. Reassurance is a false sense of safety and security.

Saturday, April 23, 2011

Anger and OCD

My angry tiki mug 118/365

OCD Reflections had a recent post about White Hot Anger that struck a chord with me, about how she usually keeps her frustration to herself, and if she is angry, it must be fully justifiable, and also gets angry at herself for getting angry. I was the girl who quickly learned that anger was a really bad idea in my family. When my father left he told me I had no reason to be angry, but he was the same person, just in a different context. My parents never fought. I can only remember one disagreement articulated, about whether or not a minor cut needs a bandage, or to fresh air.

This aversion to anger got entangled with my OCD, and when I felt anger, I immediately started analyzing it, trying to figure out if I was justified to feel angry, retracing the conversation, attempting to reconstruct every word. By the time I did this gauntlet of compulsing, the anger was even stronger. One of my feared consequences was that I wouldn't survive feeling angry, that it was dangerous. Another fear was that the anger would never dissipate, and I would be stuck with it forever, haunted by it. Ironically, my compulsions made this come true, by intensifying the feeling.

My ERP therapist told me anger wouldn't kill me, which of course sounded crazy and made me angry. My perfectionism latched onto being angry as "wrong" and I would berate myself for having angry feelings. My therapist told me that feelings just are, that they are just there, and not "justifiable" or "unjustifiable." We can control our actions in response to our anger, or how we view our anger, but if the feeling arises, the more we flee from it, the more it lingers, much like any of my other obsessions. Anger can be a sign that something needs to change, that we feel exploited, or taken advantage of, or hurt, and can give us the energy and motivation to make changes.

The more willing I am to just let the anger be there, as uncomfortable as it is, the less intense it gets. I also need to be willing to guess if I'm angry instead of knowing "for certain" that I am angry--I used to spend a lot of time and energy trying to establish if I was truly angry or not. Anger has set off my OCD in the past, as have just about any strong feelings, negative or positive. But anger was also one of the motivators for my seeking treatment for my OCD, anger at how OCD was eroding my left and affecting my relationships. I met someone who had severe OCD as a child, and if someone tried to interfere with her rituals, she was get extremely angry and lash out. She wasn't able to articulate her fears, or what was going on in her head, and was sent away to a residential school, and it was many years until she was diagnosed with OCD and got treatment, and an understanding that she could survive without her rituals.

How does anger interact with your OCD?