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

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


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.