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.