Exposing OCD

Imperfection as Completion: What a Concept!

2012-02-08T16:35:00.000-08:00

Recently, I read about Marcel Duchamp's artwork at the Philadelphia Art Museum. The story goes that when he shipped it to the museum, the glass cracked in transit. When the museum told him about the damage he said, "Now it is complete." I've seen this Duchamp piece in the past, and I had assumed that the cracks were made intentionally, not because of an accident.

I started thinking about Duchamp's flexibility of mind, his willingness to accept what came his way. Most artists wouldn't have reacted like Duchamp I suspect. He was a pioneer in conceptual art, and was famous for putting a ready made urinal on display as sculpture. His art doesn't appeal to everyone, but I like this incorporation of imperfection into the whole.

I can just imagine that if I were Duchamp, and my perfectionistic OCD was in gear, I would've spent a lot of energy checking the cracks, visualizing how the piece looked before it broke and comparing it in my mind, reassuring myself that the fractures did enhance the piece, going over all the conversations with the museum curator verbatim, wondering if I really did believe the cracks completed the work, or whether I was a bad person for presenting myself as a conceptual artist when in fact I wasn't sure if it was truly conceptual. . .and on and on.

Checking perceived flaws consumed a lot of my time from my teens onward, from slightly off center buttons to one stitch bigger than the others or a tiny scratch. No matter how small the "flaw" it appeared huge in my mind, and took over my whole field of vision, and became all I saw. Exposures for this kind of perfectionism included wearing the shirt, and not checking the buttons, or listening to scripts I wrote about maybe never enjoying my item because of the scratch, that it would haunt me, and always be the first thing I saw, and then listening to it until I could tolerate it, and even accept it. Marcel Duchamp would've needed a script about whether art critics would degrade his work because the cracks were too disfiguring. . .but I don't think he had OCD, and there's even a photo of him standing proudly in front of the glass.

Wordless Wednesday: Uncertainty Principle

2012-02-01T13:54:00.000-08:00

via Right Brain | Chris Piazza

Participate in online surveys for research on OCD and family relationships via Case Western Reserve University

2012-01-30T10:18:00.000-08:00

Amy Przeworski contacted me about posting a link to her online studies. Researchers at Case Western Reserve University are conducting two online studies about the relationships of individuals with OCD or hoarding. Each study involves completing questionnaires online about relationships, emotions and OCD. You must be at least 18 to participate. Those who participate may enter into a raffle for a Target gift card. The information gathered from this study may help to improve therapies for OCD.

For more information:

Individuals with OCD and/or hoarding:

http://filer.case.edu/~axp335/ocd.htm

Relatives and significant others of those with OCD and/or hoarding:

http://filer.case.edu/~axp335/famocd.htm

This study is being conducted by Amy Przeworski, a researcher in the psychology department at Case Western Reserve University.

Two Years of Exposing OCD

2012-01-18T05:51:00.000-08:00

It's Exposing OCD's blog anniversary! I've been writing this blog for two years. I am grateful for all the readers who contribute to a rich community of comments, and for those who read these words, and go on to start their own blogs. My blog roll has gotten longer and longer, and this makes OCD less isolating and lonely.

November and December were a struggle, and I pulled inward. The darkness, the cold, my back pain and subsequently spending much of my time inside and alone, contributed to depression.
Fortunately, when I called my therapist, in the midst of this lowness, he encouraged me to realize I am a social being, even if I am introverted, that I need human contact, and I focused on getting out of the house and meeting with friends or going to networking events. I also found someone who gives lessons in the Alexander Technique, who is also an artist, like I am, and he has been helping me with my posture so that when I am in the studio I don't aggravate my back.

In the mix with all this, I did my breast self-exam and felt an unfamiliar lumpiness, and started into a cascade of "What's wrong with you? Maybe you are just hyper-sensitive to your body, and that means you are a bad person. Or maybe you have cancer, and it's all your fault. . ." and on and on. I was able to wait a week or two, and do my self-exam again, to make my best guess, since I still felt something, and make an appointment to see a doctor, not knowing for sure if it was OCD-warped perception, or something wrong.

The doctor couldn't feel anything. In the past, I would have had a panic attack about how stupid I was to go, or find another doctor to make sure. He did prescribe an ultrasound, and then my annual mammogram which came back normal. I have a follow-up appointment in February. That I can deal with potential health problems is really big, and as much as I hate the uncertainty, I know I have much more ability to cope with it. I am reading a book, Present Perfect, about perfectionism and the author says that if we are alive, we are all survivors of uncertainty. Uncertainty is all around us, but OCD hones in on certain ones, and says, "If you don't know this, you can't go on" but we go on all the time--we just don't realize it.

Wordless Wednesday: If You're Worried About Being Anxious. . .

2011-12-28T19:13:00.000-08:00

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

2011-12-17T16:30:00.000-08:00

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.

Wordless Wednesday: Worry Bird

2011-11-30T12:51:00.000-08:00

Back Pain and my OCD.

2011-11-20T10:50:00.000-08:00

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.

Wordless Wednesday: Uncertainty

2011-11-16T18:58:00.000-08:00

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

2011-11-10T18:24:00.000-08:00

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

OCD and Serenity

2011-10-24T09:28:00.000-07:00

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. When she had heart surgery 12 years ago, I spent a lot of time finding articles, and simultaneously looking up symptoms I was having, and wearing myself into anxious exhaustion.

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.

OCD A to Z: Z is for Zero

2011-10-08T10:34:00.000-07:00

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.

OCD A to Z: Y is for Yet Again

2011-09-25T08:45:00.000-07:00

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(the last time she had surgery, 12 years ago, I had a huge OCD flare), got released and then had to go back the next week for fluid under her lung. She's home now, and my stepfather says her anxiety level is very high. As a child, I wanted to protect my mother from anxiety, take care of her, and it's hard not to have flashes of that desire overwhelm me.

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!

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

2011-09-10T17:43:00.000-07:00

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.

Wordless Wednesday: OCD This Way

2011-09-07T10:28:00.000-07:00

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

2011-09-05T16:59:00.000-07:00

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 became unhinged 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.

OCD A to Z: W is for Worry

2011-08-22T16:18:00.000-07:00

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.

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

2011-08-21T14:10:00.000-07:00

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:

Overall quality
How well it ties into the theme of OCD
How well it ties into a “Dare to Believe…” theme (read more on the "Dare to Believe" campaign)

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

Free Online Treatment for OCD in Australia

2011-08-12T18:56:00.000-07:00

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

2011-08-12T18:24:00.000-07:00

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.

OCD A to Z: U is For Unique Fears

2011-07-26T06:07:00.000-07:00

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:

Read Jonathan Grayson's Freedom From OCD to get the basics of ERP
Read messages on OCD Support, and PureO, and Anxiety Zone. Scan at least a year's worth of threads, and note the recurring themes(but you do not need to replicate my compulsive reading of all the archives of OCD Support. . .)
Go to the IOCDF Conference and or/become a member of IOCDF and read the newsletter. If you are therapist check out the Behavior Therapy Training Institute. They the IOCDF also has a list of treatment providers.

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.

OCD A to Z: T is For Therapy

2011-07-13T05:07:00.000-07:00

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.

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

2011-07-03T15:26:00.000-07:00

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.

OCD A to Z: R is for Relationship OCD

2011-06-29T15:35:00.000-07:00

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.

The irony is that a couple years after I got married, my sister said she had a girlfriend. My sister, the gorgeous striking woman who had been boy crazy after my father left, who had relationships with creepy men, and had more boyfriends than I could count, came out as a lesbian. 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.

Once my sister's girlfriend saw a photo of me right after highschool, with short short hair, and she said, "Apparently, I picked the wrong sister." I laughed, but her comment went right to the conundrum of assuming that our perceptions are reality. 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. A couple years ago, my sister fell in love with a man, broke up with her girlfriend, and told me she'd thought being with a woman would solve all her relationship problems, but it didn't. She finds the transition to being engaged to a man unsettling. She has uncertainties. She defines herself as bisexual.

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.

OCD A to Z: Q is for Questions

2011-06-26T07:23:00.000-07:00

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?

OCD A to Z: P is For Perfectionism

2011-06-24T13:45:00.000-07:00

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.

OCD and the Fear of Going Back to the Way I Was, Obsessing about Obsessing

2011-06-12T12:51:00.001-07:00

I got an email from my mother this week that she needs to have heart surgery. She prefaced it by saying that she hoped I wasn't overly concerned, and that she knew I'd look it up on the internet. My mother last had heart surgery in 1999, and it triggered a barrage of health anxiety and obsessive anxiety in me. OCD crises can leave scars, and fears that they will return, and obsessing about obsessing.

Will I become unstable like I did last time she had surgery?
Will I start worrying about my own body like I did last time?
Will I be doomed to repeat the OCD?

In the past I have been very superstitious about certain times of the year, or anniversaries of events, because if something bad happened then, what if it does now? Summer vacations were the bane of my existence, because the free time exacerbated my OCD, and then I'd start to dread that it would happen again the next summer, and become a kind of self-fulfilling prophecy.

My mother has health anxiety as well. She put off the first surgery 5 years because of her fear, and only had it because she was exhausted all the time. My role in the family was to protect and take care of her, and even though I was married and had my own life, the immense feeling of responsibility was very difficult to cope with. I started worrying about a gland behind my ear, and looking through medical reference books repeatedly. A swollen gland was what triggered one of my mother's first anxiety attacks about my health when I was 8 or 9, and she bolted to the doctor with me the very next morning.

In 1999, I ended up finding a therapist through my HMO, and although he was very nice, and knew some things about anxiety, he didn't query about the symptoms of OCD, and relied on cognitive therapy(CBT) to correct my thoughts. I stopped going after 3 months. My mother came through the surgery fine, but it was another 8 years until I found a therapist trained in Exposure Therapy(ERP).

What I realized reading my mother's message this week is that if I look up her heart condition, I will make myself sick, and I don't want to go back to that. I haven't looked it up. There is no site that will address my mother's specific heart and her specific surgeon. I asked my therapist about my fears of going back to the way I was in 1999. He said that I couldn't go back, that I've worked hard at my treatment, and I've changed. Stress tends to aggravate my OCD, so it could flare up, and if I try to predict with certainty whether I will have a relapse, that will increase my chances of having a relapse. OCD is never interested in the present moment, but rather wants to know what's happening in the future, or analyzing the past--but contrary to how my anxiety feels, OCD does not have magic in it, and will not guarantee my mother's surgery will turn out ok, or that I will avoid obsessing.

How have you obsessed about obsessing?

OCD A to Z: O is For Only Obsessions

2011-06-08T18:35:00.000-07:00

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.

OCD A to Z: N is Need to Know

2011-06-04T12:31:00.000-07:00

"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.

OCD A to Z: M is For Medication

2011-05-27T18:47:00.000-07:00

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 resulting in the destruction of two swaths of skin on my butt, 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 acutely uncomfortable, my wounds sloughing and oozing, 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

OCD A to Z: L is for Lost Time

2011-05-22T14:10:00.000-07:00

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?

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

2011-05-19T16:44:00.000-07:00

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.

OCD A to Z: J is for Just Right Feeling

2011-05-16T15:03:00.001-07:00

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.

OCD A to Z: I is For Indecision

2011-05-15T14:12:00.000-07:00

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.

OCD A to Z: H is For Hope

2011-05-13T16:35:00.000-07:00

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.

OCD A to Z: G is for Guilt

2011-05-11T15:50:00.000-07:00

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.

OCD A to Z: F is for Feared Consequences

2011-05-10T15:19:00.000-07:00

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.

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

2011-05-09T12:20:00.000-07:00

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 Anxi ety

OCD A to Z: D is for Doubt

2011-05-08T09:39:00.000-07:00

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.

OCD A to Z: C is for Courage

2011-05-05T17:41:00.000-07:00

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 OCD, and when I was growing up, no one knew what OCD was or 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?

OCD A to Z: B is for Body Fears

2011-05-04T15:06:00.000-07:00

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.

OCD A to Z: A is For Assurance

2011-05-03T16:15:00.000-07:00

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.

Anger and OCD

2011-04-23T16:04:00.000-07:00

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. After my father left, my mother became emotionally unhinged, and did some things that made me very angry, but by then I knew that my mother wouldn't hear it, or understand it.

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?

Constantly Aware: OCD, the Body and Health Anxiety

2011-04-17T15:37:00.000-07:00

This drawing by fisserman that I found in flickr is very true to my experience of the confluence of body sensations and mental awareness of those sensations, and my OCD. This week I've had tension and twinges in my chest, and my mind latched onto the symptoms. I find it very frustrating how certain bits of dialogue will shoot to the surface, like my doctor asking a few weeks ago if I was having any chest pain when I went in for a blood pressure check. What frustrates me is the almost immediate compulsing about whether I answered her question wrong, or that I have made a mistake, or exactly what do the sensations feel like?

And then I feel temptation to assign meaning to the symptom and the phrases both circulating within in me--a sign? a warning? a condemnation? My feared consequences are multiple, from fear of having a heart attack or dying, to fear of being judged harshly if I turn out to have ignored serious symptoms, and finally the fear that the vigilance about how my body feels will accelerate, get worse, and I will be haunted by the obsession, and that the vigilance will make me notice the sensations more, and it will snowball.

My compulsions range from checking my body--poking at my chest, watching how I sit or stand, to mentally checking my narrative of these sensations, ie. when did they start? What do they feel like? Am I really feeling them? I have resisted the impulse to search on the web, which is one reason this hasn't turned into a full blown OCD crisis, but more of a nagging, gnawing presence. What has helped is knowing that I can't establish what will happen in the future, that it's not my responsibility to do that. If the sensations persist or get worse, I will deal with it then. Or that it's too soon to know if the obsession will haunt me, or pervade everything I do and erode my enjoyment of life. I say this with gritted teeth, but it's true.

I am continuing to do things that I had planned to do, rather than retreating to reading, or otherwise freezing my life while trying to figure out the symptoms. I see my therapist on Thursday, so yay for support! Leonard is the first to say that having body sensations adds a layer of intensity to health anxiety OCD. There's something "there" and it intrudes on consciousness. My best guess is that all the time I'm spending bent over my worktable in my art studio is contributing to tightness in my chest muscles. My OCD would really like to know absolutely for sure that it's not a heart attack, and all the old "you are worthless and despicable" stuff gets mixed in as well, like "you'd better diagnose yourself perfectly or you are unredeemable."

I am feeling better the last couple days. I can tell I'm still vigilant--questions like Will the sensations come back? Get worse? but I know this pattern. I've experienced it many times how certain feelings in my body are more likely to trigger obessions than others. When I get a headache I do not usually obsess I have a brain tumor. If you have a desire to reassure me, I can understand that, but I'd rather hear about how you cope with health anxiety, and what has helped you.

Pure O: How do I tell the difference between obsessions and compulsions?

2011-04-01T08:21:00.000-07:00

There's been discussions lately on the OCD support lists about how to tell the difference between an obsession and a compulsion, if it's all thoughts, as in "Pure O." My understanding is that the initial thought is the obsession, and the cascade of thoughts afterwards are the compulsion. For me it would be something like, "What if I said the wrong thing?" as the obsession, followed by trying to figure out if I did indeed say the wrong thing, including retracing my words, trying to account for all of them, which is the compulsion.

The irony is that the compulsion is supposed to be what reduces the anxiety produced by the obsessive thought, and yet, when I used to say "I wish I could stop obsessing about this" what I really meant was the whole flood of compulsions. I fly into compulsing so quickly that it seemed quite dubious that the initial thought was causing the anxiety--surely all the retracing, figuring out, analyzing, and research were the obsession right? How could they possibly be a way to lower my anxiety??

But what I learned during exposure therapy was that compulsions only provide short term relief, and in some cases, very very short term, and then they rebound with their own additional suffering, taking up mental space and energy, and that if I challenged myself to refrain from figuring out an obsessive thought, that my anxiety level immediately spiked, and that was a sign that the compulsion was serving its function of a short term hit of relief, even if I couldn't see it as it happened.

My husband had the flu this week, and he gave this analogy--the virus is the obsession, and the immune system response is the compulsion. When we are sick, what makes us feel lousy isn't the virus itself, but the attack of the immune system on the virus. In the case of our bodies, for the flu or other illnesses, we actually want the immune system to attack, but OCD is more like an allergy, where our immune system attacks something harmless like pollen, mistaking it for an invader. I know the things we obsess about don't seem harmless, and that they are often about things important to us, but our full blown compulsions cause us more misery in many cases than the initial obsession.

In the midst of my worst OCD flare ups, I had glimpses of how destructive the compulsions were, but I was so scared by the obsessive thought that I clung to my compulsions. I finally hit a low point with my health anxiety, that even though I was terrified of getting treatment, I knew I couldn't continue on the way I was going and have any kind of life. If you are like me, you probably also spend time trying to figure out if something is an obsession or a compulsion, and wanting to know for sure which it is. Another lovely complication of the OCD! Take your best guess.

My First Dental Filling along with Health Anxiety

2011-03-15T18:11:00.000-07:00

I had my dental check up last month, with a new dentist because my old dentist wasn't on the insurance list, and when the dentist called out the number 15 when probing, I knew that couldn't be a good sign. I am in my 40's and never had a cavity. I went home and looked up adult cavities, and stopped after about 10 minutes. In the past I would've searched repeatedly, in hopes of finding the exact answer as to why I had a cavity, and how best to have it filled, so I can tell I've come a long way.

I had it filled yesterday, and there was a whole wave of things to stir up my health anxiety. First, the dentist asks if I want a silver filling or a white filling. I had a moment of "Oh, shit. I have to make a decision. I'm not prepared for this," and I ask what the difference is. He says it's "six of one, half a dozen of the other"--no absolute winner. It's like going to class and discovering a pop quiz and you haven't read the chapter. I picked the silver filling because it was a)cheaper and b)would probably last longer(when I asked which lasted longer the dentist said, "I'm not a fortune teller, but I'd say the silver.") Uncertainty all over the place.

All sorts of tidbits of things I'd heard in the past bubbled up while waiting for the numbing to take effect(what if I'm allergic to novacaine? What if?? What if I chose the wrong thing? What about all those people who are afraid of silver fillings?) I had my knitting which helped, as did thinking of Leonard, and all I've learned from him in Exposure Therapy, and the fact that we really aren't fortune tellers. We take our best guess, and sometimes the outcome sucks.

The sound of the drill wasn't as bad as I thought it would it would be, though it smelled like burning hair. I was pretty calm until I heard the dentist opening and shutting drawers, because he couldn't find something he needed--he's filling in for the regular dentist who is ill, and never used the item he wanted. So I'm listening to him improvising with the dental assistant with whatever they have on hand. The dentist ended by telling me that if I have some sensitivity to heat or cold, it will go away with time. I wanted to say, "I have OCD. My symptoms don't f-ing go away. . ." but I didn't because I know that there is a chance it will actually go away on its own if I let the fear be there, and go on with my life, rather than researching and checking the tooth constantly with my tongue.

I'm proud of myself that I haven't looked up the potential dire consequences of silver fillings, or a lack of cavity varnish. I woke up today wanting to look it all up because I was getting the insistent, "What if you screwed up? What if the sensitivity in your tooth won't go away?" Because, yes, cold water hurts my tooth. Finally I recognized that it's only the day after the dental work. It's too soon to tell. The OCD wants an answer NOW. But if I try to accelerate the answer to tamp down my fear, I will make it worse. If I repeatedly test the tooth with cold water, it is going to bring it to my attention and not give it a chance to get better. It might not. But I am practicing tolerating that uncertainty. That doesn't mean I like it, but I have things I want to do with my life, and probing my tooth will certainly lead to being stuck in compulsions, rather than making art.

Your Thoughts and Prayers Please for Someone Who Has Helped me Heal

2011-03-11T08:52:00.000-08:00

Many of you know how much I've healed during my work with Leonard, my Exposure Therapist for my OCD struggles, and now he needs thoughts and prayers for his own healing. I went for my session yesterday, and another therapist came into the waiting room to tell me that Leonard had tried to call all his clients, but that he must not have gotten to me, and that he was in the hospital. He gave everyone a good scare, but it sounds like he's going to be ok and out of the hospital soon, but he has healing ahead of him, and I'm not sure when he'll be back to seeing clients.

I am so grateful for the compassion and skill of this therapist, and saddened that he is going through this hard time. I also feel for his other clients, especially ones who have just started, or who are in OCD crisis. The rapport between therapist and client is an amazing tool for motivation and growth and courage in facing what we fear. Leonard once told me he felt honored that his clients trusted him with their personal thoughts and fears.

Life by its nature is full of the unexpected, pain and suffering, but also contains joy, love and meaning. In the past, my OCD would go into overdrive trying to figure out the suffering, with compulsive analysis, but I am learning that some questions have no answers, and I am able to live in spite of this. I never thought I'd find someone to help me face my OCD, and it feels like a miracle that I did, and I hope for miracles in Leonard's life too.

Edited to add: I saw Leonard for therapy on Tuesday. He is doing much better, and his tests came out negative, so that was a relief! Thanks again for all the thoughts and prayers.

The Uncomfortable State of Giving myself Credit

2011-03-05T15:31:00.000-08:00

So it's been two weeks since I wrote my last post on perfectionism which resonated with several of my readers, and I have been avoiding writing another post since then, because my perfectionism says, "Ok, that post was helpful, so the next one better be even more helpful." Perfectionism raises the bar so that satisfaction is never possible. I am also realizing more and more how uncomfortable it is to give myself credit for what I have accomplished in dealing with my OCD, and that this too is a manifestation of perfectionistic OCD. This is often accompanied by my feeling on trial by my OCD.

So what is it that I fear will happen if I acknowledge the work I'm doing?

Even more will be expected of me
I will fail
This will prove that I am a worthless human
I will discover it's not possible to be perfect, and that small steps are acceptable, and I will be faced with a flood of sadness about all the time I've lost to perfectionism
I won't be able to survive the sadness, because it will haunt me every minute

I am learning to make room for affirming of myself, but the remnants of all the old stuff cling stubbornly. I also know that there is a deep sadness about the missing years, but that the more I flee from the grief, the more it ensnares me. I also know that I respond much better to self kindness and compassion than to self denigration. At one point this is all I had to go on, in faith, that kindness worked, and even if it seemed crazy to be kind to myself, that if I wanted to heal, I needed to take the risk and be gentle, even if it was with gritted teeth.

If you are struggling with perfectionism, please know that it is possible to learn how to exist in the world without a constant striving for the perfect, that happiness is possible. Perfectionism can feel like a sticky film that refuses to be washed off, but it is not invincible. To write something that helps others with OCD is one of the most rewarding experiences I've ever had, and although my OCD clamors that I'm not feeling the gratification "perfectly right and sustained", I can still claim the moments of clarity, of being enough, of being myself.

Wordless Wednesday: Over and Over

2011-03-02T10:37:00.000-08:00

Wordless Wednesday: Perfectionism

2011-02-23T12:10:00.000-08:00

Photo by Mr. Ush.

15 Minutes at a Time: The FlyLady and Exposure Therapy for OCD

2011-02-21T15:49:00.000-08:00

In January, faced with increased difficulty finding things in my house, and general chaos, I remembered reading about the FlyLady, and went to her site. Just going there was an exposure for me, since my perfectionism starting raring up, but what I like about the FlyLady is an explicit acknowledgment of how much of the home clutter chaos stems from this very perfectionism. The fear that you have to do it "right" and all at once, and rip apart every closet and scrub every surface.

She advocates doing 15 minutes at a time, and then stopping. That's the hardest part for me. My perfectionism OCD gets entangled in this, and once I start a task, I feel anxiety at the thought of stopping before the task is done, even if there's no clear ending point, and so I keep going until I exhaust myself and it seems preferable to avoid cleaning at all. For someone with contamination OCD the feared consequence may be that nothing is clean enough after only 15 minutes.

The FlyLady is practicing a form of Exposure Therapy. She dares her readers to do housework imperfectly, incompletely, incorrectly. The irony of OCD is that it's all about the anxiety not about reality. Avoiding cleaning altogether is not more "perfect" than doing 15 minutes at a time. A refrain on the FlyLady forums is "I've got so much to clean up that 15 minutes isn't enough time." This kind of thinking is part of why I didn't start actually doing exposures right away when I finally found an Exposure Therapist.

I saw the enormity of my compulsions and anxiety, and I wanted to be better immediately because I was in pain, but also because my perfectionist OCD made it seem dangerous to have a learning curve, to proceed slowly, by trial and error, imperfectly, haltingly, erratically. I needed to do things instantly, the first time, or my feared consequence was that I was a worthless failure. Again, the reality is that avoiding learning or taking small steps serves to give a relief from the anxiety of facing the fear, and yet paradoxically, set me even further behind in getting better from my OCD.

What I have learned in therapy is that anything above zero is good. 30 seconds of resisting compulsions is good. 1 minute. 5 minutes. 15 minutes. It's all good. Exposing myself to something I fear, even if it is the least of my fears, is good. Perfectionism says that you either get better all at once, or you don't get better. This doesn't give me my life back. It keeps me trapped in my compulsions. In 15 minute increments I have cleared through the chaos of my house. The FlyLady motto is that you can do anything for 15 minutes, but for 2011 she's challenging us with a new motto: Let's Go for Seven in 2011

Seven minutes on the timer, because 15 minutes can still be too daunting. The FlyLady says that housework done incorrectly still blesses your family, and in the case of debilitating rituals, this is a powerful statement.

Finding OCD Support Groups

2011-02-10T17:28:00.000-08:00

The International OCD Foundation's new list of support groups is now live! I had started a list of OCD support groups for adults in the US and Canada when the IOCDF's page was under construction. I am going to leave it up for now, but I encourage readers to go to the IOCDF's support group page. You can search by location or alphabetically.

If there isn't a group in your area, there is a link to a manual by Dr. Jonathan Grayson on how to start your own GOAL group. The support group I've attended is modeled on the GOAL group structure of having a time of sharing followed by making a concrete goal for an exposure to do before the next group meeting. It was very helpful to have accountability and support from other people who understood what it's like to have OCD.

Wordless Wednesday: Attacking Difficult Questions

2011-02-09T06:16:00.000-08:00

Video by CarbonNYC

A Shout Out to OCD Reflections: Things I Have Learned The Hard Way

2011-02-06T13:32:00.000-08:00

None of my progress in Exposure Therapy has come through being perfect. None of it was perfect. My therapist said this last week, and it has been on my mind. Perfection was not required in order to do my exposures, live my life, get better from OCD. In fact perfection is the enemy of ever getting started. Then I read Fellow OCD Sufferer's latest post, Things I Have Learned the Hard Way. I encourage you to go read it if you haven't already. She's getting at the heart of some really important stuff for those of us who suffer with perfectionism OCD. I especially resonated with this:

The thing that I kind of overlooked was that whole middle part - you know, the part where you have to do the work and you don't like it and you feel like it's "too soon" or "too much" or "not time yet." Yeah, I kind of forgot about that part. . .
Waiting for the day when I feel like being "better" to take action, waiting for a time when I'm 100% sure I want to be well and want to do exposure, isn't exactly a sure-fire strategy. In fact, in retrospect, it's almost doomed to fail. It is unlikely that there will come a day when suddenly getting "better" seems easy or completely "right." If that day does come, it probably means that I'm doing something wrong...

I overlooked the middle part too. Like Fellow OCD Sufferer, I am an "OCD Nerd" and had read a thesis' worth of information about OCD, and wanted to do my Exposure Therapy perfectly, which delayed me actually doing much in the way of exposures for my perfectionism for almost a year. In spite of muddling along, I am getting better. My therapist would say there is no other way, that perfection is never an option. This is both liberating and scary. The perfectionism chimes in with "Well, if you can get better, then you will REALLY have to be perfect." I am getting better at recognizing all the guises of my perfectionism, and how rickety the arguments are, and how stifling. I am heartened to read posts where a fellow sufferer gets to the heart of the matter, the moment where you move forward, in the midst of all the "not ready" "not yet" "not right" moments.

Wordless Wednesday: The Moment/Indecision

2011-02-03T06:01:00.001-08:00

The Purpose of Therapy for OCD vs. the Goal of Therapy for OCD

2011-02-01T17:46:00.000-08:00

I remembered something the leader of my OCD support group said, "The goal of treatment is to live with uncertainty. The purpose of treatment is to reclaim your life." Sometimes in the short term all I can see is the goal of Exposure Therapy, which is to tolerate uncertainty until the anxiety recedes, or to use the fancy word, until you "habituate" to the anxiety. And often I read comments on the OCD Support Group that reflect a fear that the goal of Exposure Therapy is to suffer, "learn to live with the anxiety" or give up the possibility of any peace.

It helped me to connect the pain of doing Exposures with the purpose of doing them. My therapist didn't ask me to do Exposures just for the sake of doing them, or because it was "correct treatment"--he asked me to do them so I could reclaim my life. The first time I met with him, he listened to my history of having OCD, and said that OCD was a disrespecter of my person. I was struck by this. Much of what is important to me was lost inside the OCD. Connecting with what I value, love, am passionate about, gives me motivation to do my Exposures. I love making art, and this often gives me the fuel to defy the OCD pull toward compulsing, and therefore losing many hours in my day to rituals.

Jeff Bell, IOCDF Spokesman, in his new book When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty, argues that human beings are motivated by what they value, by making a difference, and doing things for the greater good:

As seen through the distorted lens of unhealthy doubt, "good"
choices are those that reduce our anxiety, while "bad" choices are
those that increase our fear and introduce uncertainty.

Some of the choices that I want to make, cause me anxiety, and my OCD tendency would be to label them bad, and this crashes directly into an essential part of my soul that knows I want to make these choices, that there are things I want in this life, things I desire to accomplish and experience. With OCD it's hard to inhabit your own life. When I think about all I've lost to compulsions, I feel a deep grief, but every Exposure I do allows me to move back into my own life.

What are some good choices that you've made that *increased* your anxiety, but which you chose anyway, because they were in the service of something important to you?

Skype for OCD Study: Project SOS from Drexel University(Residents from PA, NJ, NY, ID, MD, CO, HI, IA, SD, WA, WV and WI may be eligible)

2011-01-27T16:55:00.000-08:00

I was contacted by Project SOS of Drexel University, asking if I would advertise their study comparing two different types of Cognitive Behavioral Therapy/Exposure Therapy, administered via Skype. I am glad to pass on this information, and am glad that Drexel is funding research that examines factors related to the dissemination of effective, evidence based treatments for anxiety disorders.

Residents of the following states may be eligible:

Pennsylvania, New Jersey, Maryland, Colorado, Hawaii, Iowa, South Dakota, Washington, West Virginia, Wisconsin. JUST Added: New York, Idaho

Online Treatment Program for Obsessive Compulsive Disorder

Skype for OCD Study (Project S.O.S.)

General Study Information

Drexel University Anxiety Treatment and Research Program is providing treatment free of charge to eligible participants through the University's Department of Psychology. The research study seeks to examine the effectiveness of two variations of a specific type of Cognitive Behavior Therapy (i.e., Exposure and Ritual Prevention) for people with OCD. Treatment is delivered over a period of 16-18 sessions conducted via the videoconferencing program Skype.

Determine Eligibility to Enroll in Program

Let us know that you’re interested! To determine if you are eligible, please call (215) 553-7000 or email us at drexel.sos@gmail.com and provide us with your name and telephone number. Alternately, you can complete this contact form. However you choose to contact us, a member of our clinical team will be in touch with you promptly.

Here is our Project SOS Contact Information:

Phone: (215) 553-7000

Fax: (215) 762-4834

Mailing Address:
Anxiety Treatment and Research Program
Drexel University
Mail Stop 988
245 N. 15th Street
Philadelphia, PA 19102-1192

Email Address: drexel.sos@gmail.com

You can learn more about the eligibility process here.

Wordless Wednesday: Uncertainty

2011-01-26T10:39:00.000-08:00

Hypochondria and Health Anxiety OCD

2011-01-23T13:28:00.000-08:00

About 15 years ago, I was in graduate school, and I had a sharp pain in my neck, ever so brief, and it didn't even register. Then it happened again when I was feeling more stressed, after having read about a bone marrow donor drive, and immediately assuming I needed to participate, in spite of all my anxieties about needles and surgery. This time, the pain in my neck panicked me. Was I having a stroke? What was wrong? Since the internet was still primitive, I did what I used to do, which was go to the library and look for books in the medical reference section. This time I stumbled across Susan Baur's Hypochondria: Woeful Imaginings. It was like seeing myself in the mirror, through the author's accounts of people in history who suffered from fears about their health.

It wasn't enough to make my OCD vanish, but it did give me a window of understanding about my anxieties about my body, and that other people had similar fears, even though the only other person I knew of with this kind of fear was my mother. Another book I found was about Charles Darwin and his health anxieties. He wrote often about his symptoms and fears. I was fascinated, since he is a larger than life figure in history, and yet so afraid. Recently, I read about another book, The Hypochondriacs: Nine Tormented Lives by Brian Dillon, which includes Charles Darwin, Glenn Gould, Michael Jackson and Andy Warhol.

Although the subtitles of these books are full of doom, I remember how much I suffered with my health fears before I had any ERP treatment. The difference now is that I did get Exposure and Response Prevention Therapy, and it is possible to get better, to move beyond torment and woe. Hypochondria, according to the DSM, includes a component of being convinced you have a disease, in spite of medical tests to the contrary. There are definitely similarities with health anxiety OCD, and some even argue they are really the same thing, but the part that differs for me is that I am never absolutely convinced I have a particular disease, but more that I want complete assurance that I don't have it, and my websearching and checking of my body are compulsions to reduce my anxiety. My obsessiveness also extends to getting stuck on whether I really have hypochondria instead of OCD(!), but I've learned that pursuing the fine distinctions makes me much worse. Paul Salkoviskis has done a lot of work with health anxiety, and he emphasizes that seeking reassurance for symptoms tends to make them worse.

Fear of being labeled as a time wasting hypochondriac in my doctor's office has complicated healthcare for me over the years, and caused a lot of angst. I understand doctors have a lot of pressures and time constraints, but health anxiety causes intense suffering, and can be treated, and the more general practice doctors realize this, the more possibility of alleviating the suffering.

Related Resource:
Jonathan Grayson's Freedom From OCD has a section on hypochondria/health anxiety
Script for Fighting Health Anxiety OCD
Skin Cancer Anxiety: Fear, Vigilance and All or Nothing Thinking

Wordless Wednesday: What if? Anxiety.

2011-01-19T14:44:00.000-08:00

Photo by Nedral

Finding a therapist for "Pure O" OCD: 5 Things to Watch Out For

2011-01-17T16:53:00.000-08:00

I was in psychodynamic therapy for 6 years with a therapist who said I had OCD, but who didn't have a plan to treat my OCD beyond having me avoid my triggers. Previous to that I had several other therapists who didn't really have a clue about my OCD. Here are some things to watch out for--hopefully this will help you find help more effectively and not have to go through the delay I experienced in finally getting Exposure and Response Prevention(ERP) therapy.

Affirmations. If a therapist tells you to repeat affirmations about being a good person, good father, good teacher, good Christian, good whatever, in order to counteract scary, violent, disturbing thoughts, this just feeds the fire, prompting ever more desperation in trying to prove it to yourself that you are not a monster or a danger to others. This is different from having a compassionate therapist who asserts your value as a human being and encourages you to take your life back from the OCD and any other negative deeply held beliefs about your worth, by doing exposure therapy.
Deeper Issues. If a therapist tells you there are deeper issues you need to deal with, and then somehow your OCD thoughts will resolve or disappear once you've dealt with the issues, you can be in for a long long stint of therapy. Yes, there may be deep issues in your life, but resolving them is not a treatment for OCD, since the compulsions often complicate any attempts at resolution, and even if you gain a deeper understanding of your psyche, OCD can be incredibly resistant to magically disappearing.
Thought Stopping. Snapping a rubber band everytime you have an unwanted thought, or imagining a giant stop sign will sensitize you to the thoughts even more. Mental compulsions, on the other hand, can be stopped(even if it seems impossible), which leads to the next point.
Confusing obsessive thoughts with compulsive thoughts. Pure O isn't pure. I discovered with the help of my ERP therapist, that I have mental compulsions for trying to "undo" my intrusive obsessive thoughts, like freezing(and doing nothing until I solve the issue), retracing my thoughts or actions, analyzing, figuring out, avoiding all reminders of the thought, or researching.
Disputing the thoughts ad infinitum. Cognitive Behavioral Therapy(CBT) is the larger category that ERP belongs to, but CBT applied to mental obsessions without an understanding of the nature of intrusive thoughts, perfectionism and "just right" feeling can turn dysfunctional thought analysis into compulsions. I would get sidetracked into figuring out whether I'd done a thought record thoroughly enough, and even if I disputed all the errors in my thinking, it didn't seem to stick.

Wordless Wednesday: Online Can Simplify Decision Making

2011-01-12T09:58:00.000-08:00

(Hah! Not if you have OCD. . .)

1 Year of Exposing OCD!

2011-01-11T16:15:00.000-08:00

I began this blog, Exposing OCD, a year ago. I have learned immensely from the process of writing the posts, reading and responding to comments, and in discovering other bloggers who write about the experience of having OCD. I was initially inspired to start a blog when I came across The Beat OCD Blog: Overcoming OCD One Exposure at a Time. The author was blogging anonymously and about doing exposures, and it was like a door opened to the idea that I could write about my experiences as well. I had been writing articles for an OCD newsletter, but it came out only a few times a year, and I'd noticed writing had been helpful for gaining distance from my old patterns. I'd like to give a shout out to The Beat OCD Blogger(or Ann as she now calls herself), and her incredible persistence in doing exposures and reclaiming her life from exhausting OCD rituals and avoidance of the living she really wanted to do.

I wanted to write about my experience doing Exposure and Response Prevention Therapy(ERP), and as a motivator to actually do more exposures. Ironically I started the blog while at work, where my compulsing ate up many of my days, and avoidance was mixed into my other aims. Writing the blog was a distraction, but as readers found my blog, it helped focus my attention on the nature of OCD as a disorder, especially mental obsessions, intrusive thoughts, indecision, perfectionism and health anxiety. OCD is still a mystery to many people, and the most discouraging is how many therapists also find it a mystery, and either don't realize their client has OCD, or doesn't know about ERP. I hope that in some small way I am helping to describe OCD experiences such a way that others can recognize what they may have found impossible to articulate, and to offer hope that it's possible to get better, to be an inhabitant of your own life, rather than living a life of compulsions.

Writing each post was an exposure, since my perfectionism often had resulted in avoiding writing anything unless it was "perfect," along with fears of saying the wrong thing, or choosing the wrong topic or the incorrect photo. I have been honored by people's willingness to share their own experiences with me by leaving comments on the blog, and encouraged by the number of OCD blogs I've found over the course of the past year. My blog roll has grown, and although I wouldn't wish OCD on anyone, I am thankful for companions for the journey of courage in facing OCD.

Wordless Wednesday: Too Much Information is As Bad as Not Enough

2011-01-05T19:05:00.000-08:00

Dealing with Feared Consequences When they Happen: The Impossibility of Coming Out in Advance

2010-12-31T13:02:00.000-08:00

A post by Pure O Canuck got me thinking when she about her relationship OCD(ROCD) and homosexuality OCD(HOCD),

When does this horrible urge/need to find the answer end? And why does it seem like others have found the answer and I can't? It seems like others are living happily ever after. Can I say that I feel that way about my relationship at the moment? Definitely not. (Spend too much time on that and the ROCD starts up - but that's for another post.)

This desire to live happily ever after is seductive for all humans, and when you have OCD, there can be a gnawing, erosive need to figure out if you actually are living happily, or whether you have made a huge mistake in who you choose to be with by compulsively analyzing or avoiding all triggers of the fears. I read lots of "coming out" stories in college(which is one of Pure O Canuck's exposures right now), and I longed for the click, the final puzzle piece going into place, the revelation or vision that these stories seemed to offer. But I am realizing that the OCD is latching onto the metaphor of "coming out" as a form of absolute certainty, which in actuality it is not, and OCD is very opportunistic and picks up on other images like being "in denial about being gay." As Pure O Canuck says,

I know that I am not going to get an absolute, certain answer to these questions. (I don't quite understand why - it seems like others have it. But I guess that's just a momentary feeling and it will come and go.)

It's hard to accept that other people seem to have absolute certainty, and there's a longing to have some of that elixir, but in reality, people without OCD may simply be able to move on in spite of some uncertainty, rather than seeking to eradicate every last remnant. Others were indeed in denial about being gay because of strong cultural and religious pressure and condemnation, but eventually reached a point where they came to accept who they were, in spite of trepidation or fear, and often sound at peace, but this isn't the same thing as absolute certainty. OCD never grants peace in the long term. If I feed my OCD with figuring out, analyzing and avoidance, even if one obsession recedes, another one will appear.

My therapist likes to say, "If your feared consequence happens, you'll deal with it then. You don't need to know the answers to your OCD questions right now." That's the basic uncertainty--the women in some of these coming out stories didn't know that they would suddenly fall in love with a woman--but if they didn't have OCD, they dealt with it when it happened, not in beforehand rumination.

My sister is an exposure--she had at least 10 boyfriends before I even had one--then she was with a woman for 12 years, and then last year, fell in love with a man, and left her partner and plans to get married. She said she thought being with a woman would solve all her relationship problems but it didn't. She calls herself bisexual--which seems even more uncertain if you have ocd! I did the exposure of marrying my boyfriend, my now husband, in spite of agonizing whether I was really lesbian, and might never truly be happy, and over the years have grown to love my husband more and more, but I had to deal with a burst of anxiety about whether I loved him "enough" and when our 10th anniversary came, and we planned to renew our vows, I had a panic attack about whether I really could say "until death do us part"(which totally misses the point that I already had taken that vow the first time around!!) OCD narrows our vision, and allows no possibility of grace or peace.

Sensitized for Instant Response: Ruining the Day

2010-12-25T11:34:00.000-08:00

This week I've been getting stuck in fear of ruining my day, that doing something "wrong" will contaminate the rest of the day. I'm so used to making up rules for myself as to what constitutes a good day, and the OCD has me sensitized to any thoughts of "you did that wrong" or "you should've done something else," that before I even realize it, I'm reacting to the thought, wanting to eradicate it.

When I think those kinds of thoughts, I tend to take them at face value, as if they were true and credible, and with power to change the entire quality of a day. The closest metaphor is contamination. One of my feared consequences is that if I choose an imperfect action, it will spread to the rest of the day, and can't be cleaned up. My compulsion is to undo the thoughts of having messed up by either ruminating on them, analyzing them, or going into habitual websearching as a distraction. And then, ironically, OCD causes the very thing I fear--this compulsing ripples through the day and takes up my time.

I asked my husband yesterday if he thinks this way, and he said no. He might do something that ends up being a waste of time, but then he moves on to something else. He doesn't have fears that if he somehow goes awry, it will haunt him. For me, it's very basic stuff, for which there is no handbook or optimal schedule. When to take a shower. When to eat lunch. When to take a walk. When to run errands.

I have a big fear of wasting time. If I have errands to run, I get mired in figuring out how to do enough at a time so I don't "waste time." The fact is that sometimes we waste time. It's as if the OCD decrees that I live in a universe where I don't ever make a mistake or take up time doing the activities of daily living, and the insidious part is that for a long time I truly believed that I could find certainty as to what I should be doing in any given moment.

In the past, I also feared ruining a day by having intrusive scary and anxious thoughts. I've gotten better at recognizing them as part of my OCD, and not getting into a power struggle with them, and eroding all possibility of being present in my own life, but the thoughts of doing things perfectly slip in under the radar, and I do get into a battle with them. I see more exposures in my future, choosing things to do in a day, and doing them, and facing the fear. I'm edging towards this, in spite of my aversion.

Intrusive Thoughts and the Search for the Answer: Part 2

2010-12-09T07:02:00.000-08:00

As I said in Part I, the intrusive thoughts that seemingly took me over as a girl, became a fact of my history that I spent a lot of time trying to figure out. It was a reference point, a mystery, and an indictment in my mind. How could I say I was a feminist? How could I say I cared about women? How could I be a good person? Surely these thoughts and images of violence invalidated anything I might believe about the value of women. In my 30's I started seeing a therapist for depression and anxiety, and worked up the courage to tell her about the thoughts. She did something that many therapists do: she gave her interpretation. Interpretations can yield useful insight if they're not about obsessive thoughts. She said that it sounded like I was angry at my mother.

Although it was reassuring that she didn't think I was a bad person for having the thoughts, the idea that such violence in my mind's imagery was somehow symbolizing anger at my mother scared me. What kind of daughter was I? How could I ever survive such awful anger? Interpretations add fuel to the OCD fire. Each new interpretation brings its own set of things to figure out.

It is the painful irony of OCD that intrusive thoughts often strike at the very things that are most precious to us. A truly pious person has blasphemous thoughts, a gentle soul has violent thoughts, a feminist has thoughts of violent pornography. The other brutal irony of OCD is that even when books or websites that clearly describe the experience of intrusive thoughts, and the fact that they say nothing about you as a person, the OCD latches onto this and sets off a cascade of figuring out: "Do I really enjoy these thoughts? Do I really have OCD? How can I know if the thoughts are actually intrusive?" Or if you see a therapist, you can fall into the "What if I'm not truly expressing my thoughts clearly, so the therapist can't see how truly bad and twisted I am? What if I am deluding them?"

It helped immensely when I found an exposure therapist, and he knew that this cascade would appear--he would say, "I bet you are trying to figure out if your thoughts are an exception to the rule, and the OCD is getting louder and louder as we sit here--am I right?" Making the pattern explicit helped me to know it's sneaky insidious ways, and the insatiable desire to prove once for all that I am ok, not bad, not unredeemable.

Intrusive Thoughts and the Fear of Being Unredeemable

2010-12-05T19:02:00.000-08:00

Rosalie Stanton recently found my blog and shared a post she wrote about her struggle with intrusive thoughts.

I had no idea my obsessions were perfectly in-keeping with my particular case of OCD until recently. I'm not certain if it helps others afflicted with OCD, but the knowledge that I was NORMAL probably saved my life. For as miserable as I was, thinking I was wrong and twisted and evil, finding out that my disease had a name and there was nothing I could do to prevent it, nothing I was at fault for thinking, was the biggest blessing I've ever received.

The pain of feeling wrong and twisted and evil is something I know as well. When I was 9 or 10 years old, I started having thoughts that most adults would find scary, violent, disturbing, let alone a child. It was as if they were injected into my mind, just suddenly there, in an occupation, a siege. I wondered why I couldn't make them stop. I began to enter the world of my thoughts in a set way, in a ritualistic sequence, as if I was standing in front of a mirror, looking at my face, and crossing through into a world of torture of women, an observer of it all.

How I came back out each time, I don't recall, but I remember feeling defeated when the thoughts came back again. The images spun themselves into a series of stories, expanding seemingly endless to my young mind. It was as if they wrote themselves. They were unfamiliar, alien. Even now, I can't comprehend where they came from. They so crowded my mind, that one afternoon, I asked my sister and a friend to play out part of the story where doctors kept women captive. Their look of confusion combined with a stabbing sense of shame, but also gave me a little room, to feel grounded in the actual world, not in my head.

They were completely uninterested in cooperating, and from the day onward the thoughts did not return in that form. I was amazed that I no longer was sucked into the narrative of fear and violence. The thoughts did remain as a memory, as something I wondered about, as a part of my history.

In college, I participated in a survey about women's sexual fantasies, and I was stricken with fear that my old thoughts were a fantasy, that they were something I wanted to think about, something I enjoyed. Filling out the survey filled me with dread about what my thoughts meant. Then I went to a presentation about the destructiveness of hardcore pornography, with a series of slides of some of the most violent images in magazines, and it was as if the images from my past were there right in front of me. I was in a state of anxiety and fearfulness. The slides repulsed me, and yet the old images from my mind were of the same substance. I was startled by the resemblance, and even more troubled about what this meant about me as a person.

I started to worry that somehow I had been subjected to pornographic magazines as a girl, but couldn't remember it. Or maybe I had been sexually abused. Or maybe I was just bad. That all my interest in helping women, the classes I took on women's history, my compassion for suffering, was all a lie and in fact I was twisted, that all girls were twisted in some way. I spent a lot of time in my head, trying to figure out the nature of my soul, the origin of the images, and the new set of horrors that the pornographic slides had introduced into my head, and desperately wanting to make them go away.

To be continued in another post.

Field Guide to OCD: Feeling on Trial

2010-11-30T04:00:00.000-08:00

I feel like I'm on trial by OCD. This is one of the clues to recognizing being in the OCD. The OCD thrusts the burden of proof on me. I must prove all things beyond any reasonable doubt, which of course, OCD doesn't ever recognize. When I started Exposure Therapy, my OCD had a lot of power and credibility.

Right now, I am on the computer, after being on Skype with my sister. I called at 8:00 am, the time I used to start work when I was employed, and once I got off the phone with her, I was back in my old work pattern of compulsion, which was to stay on the computer, in a kind of trance, because anything else I might do could be the "wrong" thing, and I would be in for harsh cross-examination from my OCD thinking. I'm doing my mental rituals of checking of what time it is, how many minutes have passed, diverted into the "why am I doing this? What is wrong with me?" line of questioning, followed by, "you can't undo this. you've ruined your day, you can't salvage it. you suck."

This adversarial mode melds with being taught by my family that I was never good enough, and adds more fuel to the OCD fire. And OCD talks a confident way, a dictatorial, demanding way that is intimidating, and uses a kind of brute force, saying the same thing over and over, louder and louder. What if! What if! What if!

A cross-examination complete with, "Just answer the question. Don't explain. Just answer yes or no. Strike everything else from the record." What if I am fucking up my life? What if I am making a horrible mistake? What if I really am bad? What if I don't really deserve any compassion? What if I am wasting my life and this is unforgiveable? What if I am beyond redemption?

Often my own thinking seems pallid and inconsequential, signifiying nothing, powerless. But it's my own thinking that allowed me to get into treatment, and start doing things with my life, and learn to have compassion for myself. This is the act of faith, to trust the quiet still voice, without knowing for sure if it really is my own thinking--the OCD chips away at that too, demanding I know for certain if I'm thinking for myself or if it's OCD.

This is crazymaking stuff. Depending on the context, the my current line of questioning can completely contradict another line of questioning from just a second before. From "Don't trust your thinking" to "What's wrong with you that you don't trust your own thinking?" to "Ok. But are you sure this is your own thinking and not the OCD?"

What is the fruit of your OCD? What kind of fruit does it bear? Does it bring peace or joy or meaning to your life? If I am brave and take a minute to observe, I can see the destruction it wreaks, the poisonous fruit OCD bears, the mess my life became when I was totally in grips of it. OCD certainly promises peace, and promises if I just stay at the computer and answer all the questions, that I will avoid the turmoil of getting up, and facing my day in a backlash of obsessiveness, but I know from experience, if I stay on the computer a few more hours, until my back hurts, and I've thoroughly exhausted myself and my mood has deteriorated, that any peace I get is an illusion.

OCD and Emetophobia: Fear of Throwing Up

2010-11-15T10:42:00.000-08:00

Emetophobia is part of my health anxiety history. When I was 11, I got sick to my stomach, and my mother gave me some sort of medicine from a cold spoon, and I promptly threw it up. Maybe I wouldn't have reacted as strongly, if she hadn't given me another spoon of medicine a few minutes later, and of course, back up it came. I vowed from that moment that I would never throw up again. I kept my vow for over 12 years, but this vow came with a cost, as it was intertwined with my OCD. If I felt the slightest twinge of stomach discomfort or nausea, I would keep checking the sensations, trying to figure them out, diagnose them, and this would make my stomach even more tense and uncomfortable. Then I would start drinking water, with the idea that I could dilute the toxins with fluid. I'd be up all night, drinking glasses of water and unable to sleep because of my hypervigilance.

Finally, I ate something that was truly toxic, and my body wanted it out, and I threw up at age 23. It sucked. But once it happened, it was over. The phobia is never "over"--it will expand to fit whatever room there is in your life. I feel sad when I read about people with emetophobia who restrict their lives more and more in order to avoid all possibility of getting sick, or of their kids getting sick. The difficult thing is that most people hate throwing up. It's easy for this phobia to slip under the radar, since it seems logical to avoid getting sick. But a phobia will impinge on valuable things in your life. No trips because you might catch something. No parties. No eating out. No leaving the house.

I could never have predicted what made me sick at age 23. This is the sucky thing about being human. We get sick. The world isn't a clean place. Exposure therapy for emetophobia isn't about making someone sick. This is the first thing people think of when imagining treatment. Exposure therapy is about doing those things you are avoiding because you *might* get sick, and not doing rituals like constant sanitizing and hand washing. If your first thought is, "Well, I'll never get treatment, because if I have to take the chance of throwing up, there is no way I will do that"--I encourage you to think about all you are losing to this fear. If you get sick, you will deal with it then. You are stronger than you think.

OCD Cartoon by John Spottswood Moore

2010-11-14T16:22:00.000-08:00

Dr. Michael Jenike on the Yahoo OCD-Support Group mentioned this short animated video about OCD. I resonated with the spreading nature of the character's fears. I don't have contamination OCD, but the process of OCD thoughts multiplying was very familiar.

AIYH Sample from John Spottswood Moore on Vimeo.

My Experience with Exposure Therapy for Health Anxiety, OCD and Perfectionism on Health Place Radio

2010-11-13T08:19:00.000-08:00

My radio interview about Exposure Therapy on HealthyPlace Mental Health Radio Show is up, so check it out.

Listen to the HealthyPlace Mental Health Radio Show

Your one wild and precious life: OCD and Trusting Your Heart

2010-11-01T18:50:00.000-07:00

My exposure this week has been to get into my studio first thing in the morning, rather than get on the computer. In the irony that is OCD, I love being in my studio, but the ritual of distracting myself on the internet has worn a groove in my brain, so I put off making art. I've been leaving a voicemail with my therapist once I get myself into the studio. My mornings have been a chant of "eat breakfast, go into studio, call Leonard" with varying amounts of squawking from the OCD, but I've made a lot of art, which is good, because starting next weekend I have 7 craft shows in 7 weekends!

My love of art gives me a lot of strength for fighting the OCD. When I make art, I am in the present moment, and I rely on my intuition, my eye, my hands, my heart. Yes, the OCD intrudes, with delaying my studio time, or getting stuck on what to make next, or not wanting to take a break because I might not get myself back to the studio. But the self I am when creating art, is the self that is whole, and strong, and wiser than my OCD.

It took a long time before I let myself be an artist. When you've had OCD as long as I have, it intertwined with so many aspects of my being, and with my troubled family. I assumed that if I liked doing something, that this was irrelevant. I've met others recovering from OCD with a similar sense, and who also, like me, felt lost when contemplating what they might like to do, rather than what the OCD wants. Combined with my perfectionism and wanting to do things right on the first try, and my fearful thoughts of worthlessness, it was a struggle to experiment and try things out, but I loved art, and this love gave me strength to persist in making it, even though I wasn't certain it was what I "should" be doing.

The OCD chimes in with "Are you sure you love art? Maybe you don't really. Maybe you can figure this out. Start assessing the quality of your passion. What if you really should be doing something else, like when you felt called to be a minister. Maybe God is angry with your decision to be an artist." I did two semesters of seminary in a quest to banish the persistent thought that God wanted me to be a minister, in spite of my lack of any real desire to be one. I feel closest to God when I am creating art. My leap of faith is to trust my experience. This is akin to standing too close to the edge of a steep path up a cliff, and feeling woozy, but this is my one life, and OCD is lying when it promises complete safety.

I'd love to hear your story of what you love. Take your best guess, the smallest inkling if that's all you have. Think of it as an exposure.

Here are some lines from a poem, "The Summer Day," by Mary Oliver, that speak to me, and hopefully to you:

I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?

My Health Anxiety, High Cholesterol, Decisions and Curiosity

2010-10-26T11:39:00.000-07:00

I had a doctor's appointment yesterday to check in about my blood pressure(the meds are working and my numbers are good) and my cholesterol(meh). My bad cholesterol, ldl, is at the borderline high number and I have a couple risk factors for heart disease, so my doctor suggested low dose of a statin drug.

I had a big obsessive compulsive crisis about statin drugs a year or two ago, with fear of side effects and misgivings about the number of drug company funded physicians developing guidelines for when to start statins. One thing that really sucks about health anxiety is that as I get older, things really do go wrong with my health, and navigating this is like having a map but no street signs in order to use it.

I saw Leonard, my therapist, today, and he asked what was important to me in this decision(not what the OCD decrees, ie. absolute omniscient foreknowledge). It's important to me to take care of myself. I don't want to have a heart attack. My desire to avoid making any decision is strong, but I know that this is not a way to take care of myself. There are definitely aspects of my diet that I can work on, which may help, but I'm already a vegetarian. My cholesterol was fabulous when I was vegan, but that was almost 10 years ago, and I maintained veganism through sheer OCD hyperfocus on proving I was a good person.

It still feels odd trusting my own judgment. My husband of his own volition looked at the Mayo Clinic site for me, and it doesn't sound like much has changed since my last desperate search for a definitive answer. I've been having impulses to do my own search(actually, searches. One search is never enough), but I know that leads to suffering. It comes down to a) I can't know right now if diet will be enough b)It's not possible to know in advance if I will have side effects from a statin.

My desire to step outside of history and see the future as to whether statins are indeed the best choice in lowering cholesterol and preventing heart disease, and it's a desire that can't be fulfilled. Leonard said to look at what is reality and what is fantasy. My fantasy is that I could start eating perfectly, and avoid all the turbulent anxieties about side effects and drug company dealings. Realistically, there are things I know I can do to improve my eating, but not perfection, and combining diet changes and medicine could work.

I've noticed a glimmer of curiosity about the medicine, rather than just anxiety. I've noticed I can get a lot more done when I'm curious, and willing to try things, and see how they turn out, rather than trying to predict the future. The anxiety still sucks, but the curiosity gives me hope. Leonard said if my OCD gets active during this process of dealing with my cholesterol, that we will work on it together, and that I don't have to let the OCD decide for me.

Tune into Healthy Place Mental Health Radio Show for an interview on OCD

2010-10-21T19:56:00.000-07:00

I was honored to be asked to be a guest on Healthy Place's Mental Health Radio Show, this coming Wednesday, October 27th, 2010 at 8:30 pm Eastern Standard Time, to talk about my experience with having OCD and doing Exposure Therapy. Click Here to Listen.

It's also an Exposure for me to do the show, since it involves being on the telephone for 15 minutes! But I'm excited to share what has helped me in hopes that it will help others with OCD, particularly health anxiety, perfectionism and indecision.

I didn't know about Healthy Place Radio, and was interested to read their blurb:

. . .HealthyPlace is a privately held company started by people who are committed to the idea of reducing the stigma surrounding mental health and who feel that making authoritative mental health information available to the general public is a key part of achieving that goal. We are based in San Antonio, Texas. Our revenues are generated through the sale of advertising on the HealthyPlace website. HealthyPlace is not owned or directed by companies that sell any products or medications. None of the articles are written or influenced by companies advertising on our website. All advertisements and sponsorships are clearly identified and labeled. (you can read our editorial and advertising policies)

So be sure to tune in! The show should also be archived so you can listen to it after as well.

Related Post:
My Experience with Exposure Therapy on Healthy Place Radio

Health Anxiety and Hurtling into the Future

2010-10-15T10:14:00.000-07:00

When my health anxiety starts to be active, I notice a desperate desire in myself to know the future. This isn't the far away future that I seek, but the next minute or even the next second. It's like the dog in The Grinch who Stole Christmas--he is pulling a sleigh so loaded down with stolen gifts that it flips him to the back, and he is pulled skittering down the hill. I rush to meet the future, to know it, to know what will happen next with whatever symptom I am noticing, and in the process accelerate my fear and anxiety, toppling the full weight of my OCD into the next second and minute of my life.

The dialogue goes something like this(the OCD would be in all caps, boldface, but that's too hard to read, so just try to imagine it):

Me: I feel a tightness in my stomach.
OCD: What's wrong? You need to know now.
Me: It could be appendicitis. Will it get worse?
OCD: Figure it out NOW. If you don't whether or not it's going to get worse, you will be intolerably anxious.
Me: But maybe the pain will ease up.
OCD: You can't wait to find that out. You need to act now.
Me: I know if I go on Google, I will come out of a trance an hour later, and feel even worse, but yet, I feel that sinking in my chest, my face is hot, and I'm shaky, and maybe I'll be able to diagnose myself if I go on Google.
OCD: You need to see a doctor! If you don't, this means you are negligent and a bad person.
Me: I keep checking to see if it hurts. I prod my stomach, I don't do anything else but focus on the symptom. I feel like the whole situation is contaminated with my fear. I wish I could separate the anxiety from reality.
OCD: You can do that if you just keep checking.
Me: Maybe I'd feel better if I stopped checking, and let things settle down. Why can't I stop checking? I could fix everything if I stopped.
OCD: You can't do anything right! You need to know in advance if this is serious. If you go to the ER and you are just anxious again, they will mock you, and it just proves you are defective.
Me: I have some things I need to get done, and I'm not getting anything done. A trip to the ER is going to take all day. Where is my life going? I'm a mess.
OCD: Your stomach is feeling worse. Do something NOW!
Me: Listening to you is making my stomach tighten up. If I had to guess, I'd say that's what's happening. Yes, my belly might get worse, but I'll never have a chance to find out if I don't let it alone for awhile.
OCD: You can't leave it alone, or how will you fix this?
Me: I'm going to do my errands, and if I am seized with pain, I'll deal with it then.
OCD: But you need to know what is going to happen.
Me: I can't know what's going to happen in the next moment. You are asking me for the impossible. I can guess, and I might guess wrong, but this is the human condition.

Note all the crazymaking stuff going on with the OCD! What thoughts make you jump? For me, the insistent "need to know this NOW" is most likely to accelerate my anxiety.

Related Post:
Letting the Thoughts and Feelings Be There

Aubrey Lewis on the Nature of Obsessions: Depersonalization and Warding Off

2010-10-08T16:46:00.000-07:00

In exploring the history of Exposure Therapy for OCD, I came across Aubrey Lewis, clinical director of the Maudsley Hospital in Britain. Many of subsequent developers of ERP were recruited or encouraged in their work by Lewis. In 1937 he wrote an article on the Problems of Obsessional Illness, where he describes some of the characteristics of obsessions. One definition he liked was by someone named Schneider:

. . .contents of consciousness which, when they occur, are accompanied by the experience of subjective compulsion, and which cannot be gotten rid of, though on quiet reflection they are recognized as senseless.

But Lewis notes that the recognition of the obsession as senseless is not essential, but the aspect of feeling one must resist the obsession is key--attempting to ward off painful and overwhelming obsessions, and paradoxically, ". . .the more overwhelming and painful the obsession, the more urgent and unsuccessful the devices to ward it off."

I recognize my experience in this! I also see the paradox that when I am at my most panicky, it is unlikely I'll get to the point of "quiet reflection", and even in 1937, Lewis recognized the limits of Cognitive Therapy with OCD, stating that, "Critical appraisal of the obsession, and recognition that it is absurd represents a defensive intellectual effort, intended to destroy it: it is not always present, nor is the obsessional idea necessarily absurd."

This is where Grayson's book Freedom From OCD really helped me in recognizing that some things I obsess about could actually happen, but that trying to get absolute certainty that they won't is impossible, and that I actually tolerate a lot of risk in the areas not affected by my obsessions, like when I worked in a hospital, and didn't worry about contamination.

Lewis describes the sense of having a part of one's self or mind working independently, not as an integrated part of oneself, and the desire to fight against it. Also, the acute awareness of "internal speech" and having words said outloud come back into one's head. Finally, he mentions depersonalization, where the patient,

. . .is commonly so far from feeling the master of his own thoughts that he has almost no personal or free share in them at all. . .

Lewis believes that depersonalization is a state that affects all thinking, not just parts of it, as in obsessions, but that they are similar. When I start web searching, I feel some of this exclusion from my own self. There are things I actually want to do with my life, and yet these recede in the face of an obsessional thought about needing to do things "perfectly" and subsequent compulsive trance-like searching of the internet. Lewis does not discuss treatment, and rambles a bit, but I appreciate his attention to what the experience of obsessing and compulsing is like.

What do you notice about your obsessional thoughts?

Avoidance

2010-09-28T12:03:00.001-07:00

Again, Fellow OCD Sufferer has some thoughts that have me thinking, in response to my Anxiety in Disguise post. She talked about the difficulty of response prevention, and the fear of endless rumination and unease. That is the irony of the compulsions we use in OCD to damp down the anxiety--they become odious and cause their own suffering, while stealthily encouraging us to think that we couldn't function without our rituals.

And my life history colludes with this version of reality, because from a young age I used perfectionism as a way to make things right with the world, and allow the possibility I could exist on this planet. I barely registered in my parents' world. I was the invisible girl who still felt she took up too much space. When I delay writing something, because I fear going over it in my mind repeatedly, I am fearing the triggering of this compulsion, and OCD is more than glad to praise me for this. But what is even scarier, is contemplating writing something and sending it out into the world without going over it, and living with the fear that I've done it wrong, that I am inadequate and will be haunted by this distress forever.

And yet, I still get an initial moment of hopefulness when I start my compulsive avoidance, by doing extra research for a post--"maybe this time I will find exactly the right thing." It's like a high, and full of expectation, which quickly crashes to the ground when the searching drags on, my body gets tired, and my mood falls into depression, and yet OCD still claims that it's not worth taking the chance to actually do the writing and purposely let it be imperfect.

Right now I am learning that OCD is on the side of whatever painful things I believe about myself. I do not want to collude with that perniciousness. It comes down to avoidance. OCD would have me avoid so many things, because of a fear of making mistakes, that I would end up avoiding my whole life, and I did this for many years. When I do Exposures, I have the chance to actually live my life. This isn't to say there's no pain in my life, but that there is a possibility of joy as well.

Anxiety in Disguise

2010-09-25T14:44:00.000-07:00

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

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

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

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

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

Things like taking a shower even if I feel a resistance, a nagging fear that it's the wrong task at that moment, or leaving the house early enough to meet a friend, rather than getting on the computer and reading every single email message in my inbox before I leave. All the unfinished tasks call to me as I get ready to leave--the dining room table is "clear me, clear me!" and the sweater on the chair says "take me upstairs" and the email that I've ignored for a week suddenly clamor to be read. As Fellow Sufferer continues:

I know that exposure should also work for this type of "anxiety," but sometimes it's hard to conceptualize how changing my behavior will change my opinion about the way something "has to" be done.

I've been here! Many times. For me, it is sometimes a stalling tactic on the part of my OCD--"get it all worked out before you even start"--"know everything in advance, before you begin." When my OCD says, "Do it this way. Do it perfectly. Or don't do it at all" I divert into distraction so quickly I often don't notice I've done it, and go into avoidance mode, which ultimately comes back to haunt me when I snap out if it hours later, and I haven't done the things I really value in my life, like make art, or be with friends, or write this blog. My "regular" anxiety is probably a fraction of the intensity of all the anxiety I fear is waiting for me if I stop ruminating or compulsing or distracting myself.

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

Part 3 : The History of Exposure Therapy: Hans Eysenck and Learned Behavior

2010-09-21T19:05:00.000-07:00

Hans Eysenck was yet another British psychologist who explored behavior therapy beginning in the 1950's, and who wrote a damning article in 1952 about the ineffectiveness of psychotherapy. As Freud envisioned it, a psychotherapist could take the process of psychotherapy and deduce the facts from it, rather than studying what the facts actually were. I am staggered by the traces of this that still affect the practice of therapy in the 21st century. I have vague memories of reading about behavior therapy in social studies class, and the fear that people would be reduced to laboratory rats conditioned to do tasks for food. But there is something immensely liberating in the idea that our symptoms are in part a "learned behavior" which is unadaptive, and which can be unlearned.

It's as if we are running our own little laboratory within our own mind every time we have an obsessive thought, feel intense anxiety, and then apply a compulsion that reduces the anxiety quickly, but then rebounds in the long term.

In 1960, his article, Personality and Behaviour Therapy(Proc R Soc Med. 1960 July; 53(7): 504–508), he explores the uses of BT in "neuroses," a term not as popular as it once was. He cites the study from 1920 about "little Albert," an 11 month old boy who was conditioned to fear rats because whenever he reached for the animal, the experimenter would make a loud noise. This of course is probably where my vague uneasiness comes from, since freaking out small children is not acceptable. These early studies may be the roots of the discomfort many current therapists have about Exposure and Response Therapy, but it is worth stepping back from the old history and consider the even older history of Freudian psychoanalysis which brought a whole tradition of showing patients ink blots, asking what they saw, and building elaborate theories of their personality based on a puddle of ink.

The point that really stuck with me was Eysenck's description of avoidance--if Albert could've been exposed to a white rat for a long period of time, without the loud noise, the fear could be undone, but as he ironically puts it, "Little Albert is a free agent," and is going to avoid even the chance of encountering a white rat, thereby never getting a chance to break free of the fear. If we are willing to risk feeling the initial fear liberty is possible. I know that it feels as if we face the fear every day, we do things we don't want to do, and yet the OCD persists.

This is a frustrating and painful place to be in. I make a phone call, and it actually goes ok, but by the next time I'm anxious again as if I'd never done it before. It's taken me a long time to comprehend that I've had much more practice avoiding phone calls than making them, and what we practice tends to get better. Slogging through the anxiousness of the initial surge of fear without my compulsions sucks, but persistence in practicing strengthens the possibility of getting better.

Part 2: The History of Exposure Therapy: Albert Bandura and Guided Mastery

2010-09-16T09:37:00.000-07:00

As I contemplated what to write next in the series on the History of Exposure and Response Prevention Therapy(ERP), I decided to pick the first article in the pile of ones I had found, and came up with Swimming against the mainstream: the early years from chilly tributary to transformative mainstream, by Albert Bandura, Behavior and Research Therapy, 42(2004): 613-30.

I know Bandura's name from being a teaching assistant for a Health Behavior class(an ironic position for a woman with Health Anxiety), and the professor's discussion of Bandura's concept of Self Efficacy: the belief in our own capabilities to get things done. For myself, I had little belief that I could do anything to change my compulsive behaviors or deal with the obsessive thoughts, and this is truly disheartening.

ERP is a form of Behavior Therapy(BT), and Bandura traces his involvement in the history of BT, starting in the 1950's. The dominant form of treatment for psychological problems was Psychodynamic--the descendants of Freud, the heavy dependence on the therapist interpreting what the patient says in terms of things simmering in the unconscious, and searching for underlying meaning.

To directly deal with a behavior that causes suffering was considered superficial, inadequate, but Bandura noticed how people who modified their behavior(ie. stopping drinking) in one way, had changes throughout other aspects of their lives. He published an article in 1963 on psychotherapy as a learning process, and it generated huge interest--including from Victor Meyer, featured in my last post. The response from more traditional psychotherapists was resolutely negative--BT was dangerous! It would lead to "symptom substitutions" and all that unconscious stuff stewing would burst out.

In meeting others with OCD in support groups or at the IOCDF conference, and reading the OCD-Support List, and comments from readers of this blog, I am taken aback by how, in mainstream treatment of OCD by therapists of a general psychodynamic bent, they still want to find the underlying cause of the obsessions and compulsions, to the exclusion of actually addressing the behavior itself. This can lead to OCD hell--especially for those of us with existential OCD questioning of everything we do anyway. And Cognitive Therapy can also fall into the same hell, with analyzing our thought distortions ad infinitum.

This is not to say that the content of our minds was not important: there were those who were also interested in thoughts and beliefs, within the context of BT, and argued that people are self-examiners of their own functioning, that they as self-aware beings, we can influence our own environment, hence adding the "C" to "CBT"--Cognitive Behavioral Therapy.

He worked with people who had phobias, and I recognized the core truth in what he says, "When people avoid what they dread, they lose touch with the reality of what they shun." If a person with agoraphobia can test their dread by leaving the house and surviving, then they can get better, but Bandura understood the reality that

Intractable phobics, of course, are not about to do what they dread.

Yeah. I see myself in this. Bandura endeavored to create an environment where people could move toward that experience of getting back in touch with the reality that they shun. Bandura developed a treatment he called Guided Mastery, which strikes me as having elements of ERP:

Modeling of the behavior by the therapist or other support person
Following a graduated set of subtasks from easiest to most difficult
Joint performance with the therapist of the feared task
Performing the feared activity for only a short time, and gradually extending the time
Increasingly challenging oneself in order to reclaim life

And then we come back to self-efficacy, which I learned about so many years ago.

Unless people believe they can produce desired effects by their actions they have little incentive to act or to persevere in the face of difficulties. Whatever other factors serve as motivators, they are rooted in the core belief that one has the power to effect changes by ones actions.

He argues that a good therapist arranges things for others in such a way that allows for success and "avoids placing them prematurely in situations where they are likely to fail," and emphasizes that if one can learn to see failure as informative rather than demoralizing, one can become resilient.

What can you do to encourage your own successes?

Part 1: History of Exposure Therapy for OCD: Dr. Victor Meyer and Ritual Prevention

2010-09-13T04:56:00.000-07:00

The first obstacle to writing about the history of Exposure Therapy is, of course, my rituals of researching things indefinitely in hopes of being absolutely certain I haven't missed anything, and a long pattern of information hoarding. But here I am, after realizing I need to construct this series of posts as an Exposure--ie. pick a place to start without exhaustive information or a PhD thesis.*

The history of Exposure and Response Prevention Therapy(ERP) is scattered in journal articles and introductory paragraphs in books about anxiety disorders. A site that gathers information together for a fascinating read is The History of Obsessive Compulsive Disorder, written by an anonymous historian who suffers from OCD.

A name that appears often is Victor Meyer, British psychologist, who published a key article, Modification of expectations in cases with obsessional rituals. (Behaviour and Research Therapy 1966 Nov;4(4):273-80) This article isn't available in free full text, but I found a subsequent article that caught my interest [There's a lot of OCD noise in my head right now, 'just one more search,' 'you aren't done.' Yeah, I know.] Ritual prevention in obsessional patients, by Meyer and Levy, Proceedings of the Royal Society of Medicine. 1971 Nov;64(11):1115-8.

I am sobered by the bleak picture painted in much of the early and mid 20th century writings on the treatment of severe OCD, and the 1971 article refers to repeated leucotomy(ie. a kind of lobotomy) in some cases. Levy and Meyer report on a follow-up study of patients treated by interruption of their rituals. The fear had been that if someone interrupted a ritual, the person with OCD would have overwhelming anxiety or aggressive outbursts. These therapists ventured forward, and named the treatment "apotrepic therapy" from the Greek word meaning to turn away, deter or dissuade.

The sufferers were inpatients, incapacitated by their OCD, and with whom other methods of treatment had failed. I am trying to imagine this pivotal moment, a kind of stepping into the fray to break up a fight and fearing getting punched in the process. At least the researchers knew these people had OCD and that interfering with their rituals could be difficult. A couple years ago, I met someone who as a child had aggressive outbursts when his rituals were prevented by parents or teachers, and no one knew he had OCD and he was sent away to a school for kids with severe behavior problems.

Meyer's treatment consisted of instructing nurses to continually supervise patients during waking hours and preventing them from carrying out any rituals, either through engaging in distraction, discussion, or mild physical restraint(only resorted to with the patient's agreement.) The prevention of rituals was maintained for 1-4 weeks, during which the patients were gradually exposed to situations that evoked the rituals in the first place, and then supervision was also gradually diminished.

The results showed not only that compulsive behavior decreased, but that instead of the emergence of overwhelming anxiety, there was usually a decrease in anxiety and depression. The study was preliminary, but very intriguing. Some of the factors the authors attributed to the success were:

Incorporating ritual prevention into family life, since family members often get drawn into helping complete rituals.
Modeling by the supervisor who would perform whatever action the person with OCD was avoiding, ie. if they wouldn't touch a doorknob, the nurse would repeatedly touch the knob.
"Alteration in Expectancies"--Meyer's assertion that failure to perform the ritual does not necessarily lead to the feared consequence.

The frustrating part for the authors was the stressful and time consuming nature of the treatment for all involved. For Meyer and Levy, they were trying something novel and very different from leucotomy or psychoanalysis, and they saw great potential, but also were aware of the difficulties, which eerily foreshadow some of the moments on VH1's The OCD Project. I end with a quote from the end of the article about interruption of rituals:

. . .we urge that this should only be done where the staff concerned can have the closest supervision and the fullest support. The line between firm but sympathetic control and unpleasant and inhumane bullying is a thin one indeed and all too easy to cross when one has devoted a lot of time and energy to a patient who relentlessly and monotonously pursues an unchanging course.

*This is way shorter than it would've been in the past, before I got treatment for my OCD, but man, it does still seem somewhat thesis-like. . .

Why do Exposure Therapy?

2010-09-08T12:42:00.000-07:00

So here's the thing. Exposure Therapy for OCD is asking you to do what you don't want to do. If it were in flow chart form it would be boiled down to "Don't want to do it? Do it." This can be a hard sell. I pity the poor Exposure Therapists who get to present this to someone suffering with obsessions and compulsions.

In my last post I wrote about delaying getting on the computer, and doing this as an Exposure. Why would I do this? I feel anxious when I don't turn the computer on. I have too much time to ruminate about my anxieties if I am not distracting myself. But there is part of me that has dreams, and wants to live my life, not live the life OCD chooses for me. OCD is all about getting the anxiety level down by doing a compulsion; the rest of your life be damned.

I am not talking about being abusive, or harsh or punishing. I may take infinitely small steps in my Exposures, but it's not a race, or a TV show, and doing what I don't want to do is scary and takes courage and I have people in my life who understand that and encourage me. Exposure Therapy isn't a religion that I must follow, but a treatment that many clinicians have worked on developing over the past 40 years or so, based on observing what works. They aren't just making this stuff up.

Now, there are still gaps and shortcomings in our current treatments for OCD, but I will be writing some future posts on the history of OCD treatment, highlighting the breakthroughs and evolution of Exposure and Response Prevention Therapy. 40 years ago many thought patients with OCD were hopeless, and I want to pay tribute to those who searched for an answer, who believed hope was possible.

Related:
Part 1: The History of Exposure Therapy: Dr. Victor Meyer and Ritual Prevention

Delaying Compulsive Internet Searching: Hard and Yet Rewarding

2010-09-03T19:26:00.001-07:00

Thursday I didn't get on the computer until 10:30 am. It was one of my goals from my OCD support group to pick a day this week to delay sitting down in front of the computer. It was definitely an Exposure. When I start websearching, I am in a kind of groggy trance. Searching the internet distracts me from anxiety and fear and is a compulsion. Spending 3 hours on my own time was a challenge.

In the past, I've regarded any improvement in my OCD or a "good day" as a fluke, and have a desperate sense of wanting it to last, and fearing that it won't. It's as if I see OCD as the weather, a climate that can change capriciously. But if I turn on the computer, I am stepping into the storm. It feels like I'm in a calm place at first, but it's actually the eye of the hurricane, and deceptive in its stillness. I go into a zone of deeply ingrained habit and muscle memory, into stiffness in my back, shoulders, neck and hands, and by the time I get off the computer, I am sapped of energy and my anxiety level rebounds back up, as I see how much time I lost. Then it starts all over, getting back on the computer to numb myself again.

So Thursday it was me alone in the house, wanting to flee this Exposure, wanting to turn on the computer, and at the same time marveling at how much I can get done when I don't turn the computer on. The OCD wants to seize hold of this and berate me for not doing the Exposure sooner, or more often. It's amazing how contradictory my OCD is--advocating for both complete compulsive immersion online, and for perfectly doing my Exposures. If the OCD wasn't intertwined with the whole apparatus of my anxiety, I'd call it out right away, but it has a secret weapon, my nervous system, my feelings of dread, nausea, and panic, but I'm learning to question the OCD's credibility.

The Lonely Pilgrim: The Isolation of Relationship OCD

2010-08-29T11:30:00.000-07:00

Today I found a quote from the lyrics of Bruce Springtsteen's "Brilliant Disguise"
which encapsulated the sadness of the "Lonely Pilgrim's" voice:

God have mercy on the man
Who doubts what he is sure of.

I know this song, and have the album, but I haven't listened to it in awhile, and today it struck me as an achingly accurate description of OCD, particularly what some call Relationship OCD. The character in the song wants to make a real connection with the woman he loves, and yet cannot be certain of what is in her mind, or even in his own. He doesn't trust himself.

It is part of the human condition that we can't read minds, we can't really know what someone else is thinking, and this can be very lonely, but OCD grabs hold of it and intensifies the suffering with demands of knowing for sure what the other is thinking or feeling, or wanting to be sure of loving someone.

We are feeling creatures, but OCD has no mercy and erodes essential feelings of love and trust by putting the burden on the mind to figure it all out, get reassurance, guarantees, documentation and checking to make sure the feelings are still there. A quick way to lose connection with someone you love is to get lost in an OCD loop of verification within your own mind. I did this for many years in my marriage, wanting to know what physical connection "meant" and how it was supposed to feel, and compulsively going over any touch in my mind, trying to establish if it felt good, was I sure, how did I know, was I doing it right?

And when the circumstances and history of your life seem to confirm the OCD fears, that makes it even harder.

Well I've tried so hard baby
But I just can't see
What a woman like you
Is doing with me

I grew from girl into woman into the belief that no one would ever love me because I was essentially defective, and the OCD latched onto this with a vengeance, and ever increased the rumination and fear. A whole string of compulsive questions about what was wrong with me, and why couldn't I change it, and analyzing my every thought and sensation.

My husband and I actually were in a kind of "brilliant disguise," not really telling each other what we were thinking or feeling, but my OCD couldn't protect me from that, and in fact made us even farther apart. He could be in the room, right next to me, and I was far far away in my compulsing. We both found the courage to actually know each other, with the help of a therapist, and this helped immensely when I began Exposure Therapy for my OCD, since I could talk to him about how I was struggling, and at the same know that if he needed a break, he would tell me.

I've included a video of a cover of the song, done by the band The Reason. The lyrics are included. Are there any songs that are meaningful to you in dealing with your OCD?

How do I know when I'm done? OCD and the Desire for Complete Assurance

2010-08-23T16:09:00.000-07:00

OCD affects aspects of human experience that most people don't think about, or only fleetingly. It's not that OCD is totally alien, but it is more severe than what people without OCD experience. I have OCD but don't usually check switches and such. But when leaving on vacation, a few years ago, I was halfway out of town and couldn't remember if I locked the door, and went back to check. Everyone has had a day where they aren't sure, and go back to check. Sometimes special circumstances like vacation will make you more aware of the consequences of an unlocked door.

Usually someone without the compulsion to check doesn't need to remember if they locked something or turned off a switch or a knob, because they do it, and move on without even thinking about it. It feels "done" but it's barely conscious, and they flow into the next actions of their day. OCD can disrupt every aspect of the flow of life. Someone with OCD can turn off the light switch, and stand there in the dark and still not be absolutely certain they turned it off, because they get a surge of anxiety that is gut wrenching, and a host of possible feared consequences, ie. "If I don't turn this off, a circuit could short and burn the house down. So I'd better keep checking."

The other day I watched my husband search for a muffin recipe online. He looked at a couple, one fit his ingredient list, and he hit print. He knew he was done. I could even say he "felt" done, but it's so a part of him that he doesn't really feel it as much as keep moving in the momentum of what he wants to get done. Part of my OCD is not feeling finished, not feeling I've fulfilled my goal, and I'm well into page 10 or more on Google when looking for a recipe. It's like I don't have an "off switch," and I am very likely to feel anxious if I don't feel "just right" or "done" and ironically, my OCD pretty much guarantees I won't get that feeling, no matter how much compulsive searching for the perfect thing.

Even when I find something that fits my criteria, I don't believe it, because I want to be certain that it's the right thing, and I'll feel anxious if I take the chance of printing something from page one. OCD isn't about logic. This can frustrate both the person with OCD and their friends and family. There is a tendency to assume if you explain the illogic, that this will solve the problem. "You are standing in the dark. Of course the light switch is off." "You've checked 5 review sites, and they all recommend the same product--why do you have to keep looking?"

I've always been fascinated by phenomenology--the attempt to understand what someone's experience is from the inside, the lived sensations of consciousness. OCD is that moment of wondering if you locked the door, and thinking you probably did, but having dire visions of thieves in your house while on vacation. You feel anxious. You don't want to ruin your vacation worrying about this. You drive back to check the door. But OCD will keep generating those moments of stabbing fear, even after you've checked. Did I really check? How can I be sure? There's no stopping point.

Cognitive Behavioral Therapy can get hung up at this point if the instruction is to guess the probability of something bad happening, and how much of it would be your responsibility--it could be .00001% and the OCD is still going to be clamoring about no risk being acceptable. For me Exposure Therapy has involved choosing something off the first page of Google, even if I break into a cold sweat, to help retrain my brain recognize that I'm done and can move on. I spent years waiting for fanfare and illuminated signs that a decision was right so I wouldn't have to feel anxious, but I am learning that most decisions don't get that kind of certainty, and that I can actually live well in spite of this.

Email and the OCD Fear of Saying the Wrong Thing

2010-08-20T17:54:00.000-07:00

Email was like a miracle. I went to graduate school in 1993, and one of the perks was an email address. Since making phone calls filled me with dread, email was like getting released from jail, or pardoned. I loved its asynchronous nature whereby I could send a message and the other person would read it without my having to witness it, or respond to it in real time, and vice versa, when I received an email I could spend as much time as I needed to get my response right.

Of course, my OCD loved email, because I could delay actions that caused me great anxiety, like spontaneous speaking, but slowly I began to realize that email had its own set of anxieties. Email didn't erase my compulsion to making sure I didn't say the wrong thing, and most likely strengthened my fear of making a mistake. Writing email consumed a lot of time, because the using the "Send" command began to feel full of trepidation. Once I sent my email, I couldn't take it back. Pieces of messages would pop into my head, as I retraced all the nuances. I dreaded this reconstructive process, because it aggravated all my fears of saying something wrong, every time I listened to my own message in my head.

Responding to email was exhausting. The written word has a permanent quality, an inflexibility, especially in email where there isn't tone of voice(I certainly didn't know anything about "smileys") or facial expression, and I interpreted emails as if they were a holy text. What does this mean? What should I say in response? Will this correspondent think ill of me? But I chose email to communicate 90% of the time(7% consisted of real paper mail, which in a pre-computer era, involved lots of rewriting, and discarding whole pages if I made a mistake in expression, and the other 3% was on the phone under duress).

I chose email even when I started to realize that in some cases I would save a lot of agonizing by calling the person, but even though I could see that the email would turn into a convoluted dance of "Did I say the write thing? Have they gotten it yet? Why aren't they responding? I really need to know the answer to this question. Am I going to have to call, and then they will think I'm weird for emailing and then calling?" I started fearing opening my email, because of anticipating negative responses to my messages, and the longer I left a message unopened, the worse the anxiety became, until I assumed that it must be dangerous to open my emails, or why would I be so scared?

One of the exposures I did in OCD therapy was opening messages right away, especially ones that I was afraid of. I gritted my teeth the whole time, but I'd seen how my anxiety escalated the longer I waited. I also practiced writing "inadequate" responses--short, quick, unrehearsed. Which, actually is what email is--somewhere between formal letters and phone calls. I'm never going to be a person who enjoys talking on the phone(unlike my friend J. who enjoys phone calls so much that even if calling was less efficient than looking up info on a website, would still call, just to talk to people), and like Miss Manners I do agree that the phone ringing is not a "command" to pick it up--I can decide when to take calls--but I need to keep an eye on the OCD which will find a million ways to avoid saying the "wrong thing" as if we can definitively ensure that, as much as we might want to.

Related Posts:
Telephone Phobia: Fear of Making Phone Calls
Ritualizing in my Head: Retracing
Verbatims

Unhelpful Strategies: Thought Stopping for OCD

2010-08-16T10:49:00.000-07:00

This strategy has been around a long time, and never seems to go away. The premise is that you snap a rubber band on your wrist, or imagine a giant stop sign, or shout "stop", whenever you have an intrusive thought.

I have an early memory of being 8 or 9 and trying to stop thinking. I held my breath. I stood still. But I couldn't stop. I was baffled by this phenomenon. No matter how much I tried to make my mind blank, I could hear my thoughts of "Stop thinking. Have I stopped yet? Why am I still thinking?"

Thought Stopping sounds logical on the face of it. You have an intrusive thought. It makes you anxious. You want it to go away. You stop it. Except that I couldn't stop. It wasn't that I didn't try hard enough. It was that I tried too hard. Every time I jumped in to push the thoughts out, through figuring them out, rationalizing, analyzing, confessing them, researching them, websearching and other forms of distraction, cueing my relaxation exercises, my deep breathing or reassuring myself that it would be ok, the thoughts rebounded and came back even stronger.

If Thought Stopping worked, would anyone have OCD intrusive thoughts? We could just make them vanish with the snap on the wrist. Our minds are immensely creative and generative. All sorts of thoughts pop in, and if we just let them alone, they tend to pass. But if you have OCD it's a struggle to let them pass, and the initial wrestling with them does give a hit of anxiety relief, but then it's like signaling your brain that this thought is truly dangerous, so if it comes back, try to kill it, and the cycle continues.

I reclaimed a lot of my life back by doing Exposure and Response Prevention Therapy. I recorded scripts of the thoughts, and listened to them repeatedly until my anxiety level came down on its own. I had a therapist helping me to do this.

For More Information:

Am I Still Anxious? Does this Still Bother Me?
Talking to OCD: The Hazards of Talk Therapy
Freedom from Obsessive Compulsive Disorder by Jonathan Grayson

Hayes and his Action and Commitment Therapy colleagues have been researching the phenomenon of trying to make thoughts go away, and how it doesn't work.
For a useful summary of ACT, Dr. Russell Smith has a good article:
Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here.

Going Back to My OCD Support Group

2010-08-13T18:41:00.000-07:00

I happened to cross paths with someone from the OCD Support Group I used to attend, and she invited me to come back as I told her about having difficulty with a lot of unstructured time since being jobless. I went this week, and realized I hadn't been there in almost 2 years.

I like the immense practicality of this group. After a discussion, we get into smaller groups, each with a seasoned member to lead, and each person picks a goal for the next 2 weeks until the next meeting. The group can help generate ideas for exposures, which can be hard to do by yourself if you are feeling anxious and sucked into the compulsing.

The key is to choose a goal that you are willing to do, and it's like a secret weapon against OCD. The most innocuous sounding goals often lead to important change, like a catalyst setting off your own self-confidence and self-efficacy.

The defining questions for the goal are:

What action will you do?
When will you do it?
How often will you do it?

OCD thrives on vagueness in goals, like "I'll try to obsess less." My perfectionistic OCD gets set off by the idea of small steps--the squawking voice demands "all or nothing at all" but that leads to being stuck in the OCD, because if I don't do a small step, I usually do nothing at all. My goal is to write some of the tasks I actually want to get done(as opposed to what my OCD wants, ie. reduction in anxiety at all costs)on index cards and once per day randomly pick a card and do the task. I've practiced avoidance for so long that it's quite an exposure to get something done, without ruminating on whether it's the right thing at the right time. The other goal I chose was to pick one day a week where I will delay getting on the computer until after noon, to give myself a chance to get other things done.

What small step can you choose to take this week?

Related:
Challenging OCD One Step At a Time
List of OCD Support Groups for Adults in the US

OCD Squawking

2010-08-09T05:28:00.000-07:00

There's not a lot of room between noticing something, and being alarmed by it when you have OCD. I was checking my email this morning, and noticed an achy feeling in the vicinity of my bladder, and suddenly it's red alert, squawk, squawk, squawk.

An early strategy at a young age was I would stop everything and focus on the sensation, which soon would lead to not feeling anything else but that sensation, and then despair that that's all I could feel. I have a diary from when I was 11, with Holly Hobbie on the front cover, a tiny lock and key and gold dusted page edges, and several entries are descriptions of things I've noticed in my body, and trying to reassure myself, "Not to worry."

By the time I was an adult, I was convinced that if I had any pressure or awareness of my bladder, then I couldn't focus on anything else, couldn't enjoy whatever I was doing at the time. As soon as my internal conversation plunged into "I can't enjoy this vacation, this movie, this walk, this concert. . .because this sensation in my body is intruding, and it's all I can think about," I would plummet into hopelessness.

Part of this is simply being human and having consciousness--we are aware we are going to die, we remember sad things from the past, we can ask "what if?" But OCD wants to control what we are conscious of, either by making certain thoughts go away, or insisting the future be know-able. Squawk. Squawk. What sucks is that some painful sensations and memories never go away, and OCD gets locked into combat with them, making them even worse, but lying and saying, "No, really, I can make this go away. Just stick with me. Don't give in. Don't do anything until I solve this with compulsions."

I do have a lot more freedom since I started doing exposures in therapy, and outside of therapy. For a couple years I would drive by a fabulous Mom & Pop donut shop on my way from therapy to work, right around the time I started to feel pressure in my bladder from the long drive, but I wanted those donuts, and I'd stop to get a couple. At first I'd tell myself to wait until I got to work, so I could hit the bathroom, and then enjoy the donuts perfectly, but they were so good, I'd end up eating them on the drive.

What I discovered is that although I preferred not having the bladder sensations, I could still enjoy other things(like donuts!) at the same time. This may not seem like rocket science, but when you have OCD, this was like knowing how to turn straw into gold, or water into wine.

What we practice we tend to get better at. My therapist likes to say this, and I sometimes find it irritating, but it took a year of practice to distance myself from bladder panic, which can sound daunting, but after 30+ years of being limited by my need to find a bathroom at all times, I am very grateful for my new freedom.

Related:
Do I have to go? Bladder Fears and OCD

Doing OCD Homework and Fear of Failing

2010-08-06T09:02:00.000-07:00

Wednesday in therapy, Leonard had me record a description of the moment at which I feel the compulsion to ritualize, followed by my values list. My homework is to listen to it 12 times a day. The idea is that I will start building new connections to my values, so that when my anxiety spikes, my values have more of a chance of coming to the surface. I've had 15 years of a job where if I started to feel anxious, I could distract myself on the computer, and the habit is deeply ingrained. Now I have all this time at home since I lost my job, and the old critical perfectionist voice is getting loud. "You have all this time now. Why are you wasting it being compulsive?" Which then gets the OCD ramped up, because I don't want to have the thought that I am wasting time, or doing things imperfectly, and I get back on the computer to distract myself and waste more time.

Leonard's idea makes sense to me, but it almost seems to make too much sense(if that makes any sense!!) Some convoluted OCD logic, "This could work, but what if you try it and it doesn't work? And this proves you are a worthless failure. You'd better avoid doing it." I see the irony in the fact that there were many times I wanted to quit my job, because the OCD was so tied to walking into my office, feeling immediately incompetent and scared, and seeing the computer, sitting down and then wondering where the day went. Part of me hoped that if I didn't have the job, my OCD would go away. I remember starting on an SSRI, and having a bad dream that I was starting to feel better, but this meant I would have to stay at my job forever.

I suspected that quitting my job wouldn't eradicate my OCD, and that what I really needed was treatment for the OCD, before reevaluating what to do with my life. OCD isn't very sophisticated, and spent its time screaming, "You are wasting your life at this job," which sent me into a frenzy of compulsive distraction, but OCD couldn't give me any other alternative. And of course, it was the OCD that was mostly responsible for whatever wasting of my life I was doing at work. If there had been a video camera in my office, the film would've shown a woman sitting very still, moving the mouse barely perceptibly with her left hand(because she injured her right hand, and in order to keep websearching, had to switch to her left).

Today has been a lurching through various forms of perfectionism, but I listened to my recording 3 times today so far. I will give myself credit for that.

What do you want your life to be about? Acceptance & Commitment Therapy for OCD

2010-08-03T10:49:00.000-07:00

My friend J. came over today for coffee, and I told her I was avoiding doing my therapy homework for tomorrow, writing down my values. Her eyes lit up and she said, "Oh, let's do it now, together." I think she would've made an excellent Exposure Therapist in another life! At first I was like "Crap." But enough of the healthy part of me said, ok, let's do it. J. lost her job just before I lost mine, and we are going some similar re-evaluations of our lives.

My therapist is having me work through "Get Out of Your Mind & Into Your Life: The New Acceptance and Commitment Therapy" by Steven C. Hayes, PhD. Some of the ideas of ACT are really useful for dealing with OCD, especially learning to observe your mind and let the noise be there, but doing what you really value in spite of it. At times the scientific language bogs me down, especially with an OCD desire to understand it perfectly, and I'm glad I'm working on it in the context of therapy, so I can get help with the perfectionistic tendencies.

My homework for tomorrow was to write down what I truly value in 10 different domains of my life, such as friendship, relationships, family, parenting, work, recreation, spirituality, citizenship, personal growth and learning, physical health and well being. J. set the timer for 1 minute for each category and we started writing what we want our lives to be about in each of these areas. Then Hayes asks us to re-read what we wrote, as if no one else would ever see it, and whether these are things we really value or whether they are things we think we are supposed to value. All of this is ripe for OCD over-interpretation, but framing the exercise as an exposure helped--writing things down in a minute, without knowing for sure if they really *truly* are my values, not to mention judging whether these are things I *should* value.

OCD only values reduction in anxiety--there isn't much else it cares for except certainty. When I do what my OCD demands, I get a temporary drop in anxiety, but I don't get to live much of my life. I value connections with people, and making art. I don't want my life to be about my rituals. The temptation is to fall back into my perfectionism OCD, and berate myself for ritualizing, as if somehow this will help me change. But one of my values is compassion, and persecuting myself for having OCD is not compassionate, and I am slowly learning how to have compassion for myself.

Sometimes the motivation to do exposures is hard to find because the anxiety is so gripping. My therapist is arguing that my values can help guide me, and help give me courage to face the OCD. What do you value? What motivates you to do exposures?

You can download the full 2-page version of the values chart here.

For a useful summary of ACT, Dr. Russell Harris has a good article:
Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here. I read this article several years before getting any treatment for my OCD, and it stayed with me.

Scrupulosity and the Body: Lunch with the Religious

2010-07-29T17:50:00.000-07:00

Yesterday I walked into the middle of an exposure so surreal I thought maybe my therapist orchestrated it. I was meeting a friend for lunch at a restaurant that is part of a conference center. The parking lot was packed, and as I was circling around looking for a space, I started to notice the large number of bumper stickers about respecting life, marriage and chastity(the one I am still pondering is "Chastity is for lovers.") I walked into the lobby, and my friend was sitting there in a sea of nuns in full habit and priests in clerical collars, with some lay people mixed in.

There was a long line of various religious folk at the hostess desk, but fortunately I had a reservation. We were seated next to a man in a floor length black robe and a gold cross about 8 inches long, and people kept coming up to him to reverently say hello.

I went through several years of struggling with scrupulosity centered around Catholic theology, for instance, contraception being a sin. Of course the irony is that I am not Catholic. My first boyfriend was Catholic, and later I worked at a Catholic college, and being introduced some of the central Catholic issues set off a cascade of anxiety. This is the bizarre thing about having OCD--I can latch onto a thought, and wrestle with it hoping to make it go away because it disturbs me, but which has no connection to my actual beliefs. The thoughts that I feared were "What if contraception is wrong? What if I am going to hell? What if I am supposed to be Catholic?" And this is what makes dealing with scrupulosity incredibly hard--there will be people who do believe I should convert to Catholicism, who wouldn't interpret my anxiety as OCD, and this compounds the anxiety.

So there I was yesterday, enveloped in a conference about Catholic theology of the body, and I did ok. I was uncomfortable, but I focused on my friend, who is going through a hard time right now. I didn't go home and look up the conference, or research the agenda, or the supposed immorality of contraception, or sites that say a marriage without children is a sin, or read conservative Catholic websites like I used to do. At the worst of my scrupulousness, I was subscribing to a mailing list about natural family planning, trying to figure out if there was any way I was redeemable.

Yesterday I was even able to laugh at the over-the-top exposure material. Today I am feeling tired and unsteady, but I know for me the act of faith is choosing what I believe. Yes, that is exactly what will rile some people up--and I am learning to live with that.

Resources:
Although I am not Catholic, ironically I did find Scrupulous Anonymous to have some helpful articles:
Scrupulous Anonymous: Newsletter by Liguori Publications

The Scrupe Blog is moderated by a Lutheran Minister and often has quotes from religious folk who suffered from tormenting thoughts:
The Scrupe Blog

The first book I read on scrupulosity was psychologist's William Van Ornum's A Thousand Frightening Fantasies: Understanding and Healing Scrupulosity. The author did a survey of sufferers, and I realized I wasn't alone.

I heard Ian Osborn speak at one of the IOCDF Conference's and his talk about scrupulosity was very interesting.

Just One More Search: OCD and Information Overload

2010-07-27T09:11:00.000-07:00

There's a discussion that threads through the OCD-Support group on Yahoo about providing information and changing beliefs as a way to treat OCD rather than doing exposures. When someone asks about a particular feared consequence in the OCD-Support group, there is almost always several people writing to reassure the person that what they fear won't happen, and sometimes a defensiveness about the basic human need for accurate information and compassion. What unfolds in many cases is that the person already knows the information(ie. how HIV is contracted), has had repeated tests, and asked the same questions many times.

A compulsion is usually the tip of the iceberg, with a lot of suffering underneath, and there are always people who will say, "That's not a compulsion, that's a good idea." At age 27, I once told a doctor I was anxious about skin cancer, and she said "Good, you should be." She didn't know that I was checking my moles constantly, researching skin cancer, and that none of this actually made me any better and identifying moles that might be abnormal. It's not compassion to encourage life eroding rituals.

In my experience, I could never get enough information. I've earned my living doing research, and I'm good at it. I read 12 books on OCD the first month I started treatment with Leonard, but it wasn't helping me since I was trying assuage the part of me that was afraid I didn't have the perfect treatment, and that I wouldn't get better.

Fortunately, I was able to be honest with my therapist about all the reading I was doing. He didn't fit the authoritarian stereotype of an Exposure Therapist, and he did give me some information, but it was information about the nature of the disorder, about the constant desire to have 100% certainty, and that his clients get better, but he couldn't give me an absolute guarantee, and asked me to consider taking the risk and doing the treatment, and not reading more books. He wasn't asking me to follow him unquestioned, or demanding I do what he wanted. He was appealing to the healthy observant part of myself that wanted to get better. We all have this part, no matter how buried under OCD.

A Perfect Schedule Does Not Exist

2010-07-22T08:28:00.000-07:00

Yesterday in session with Leonard, I admitted my anxiety was up about doing a schedule, and I hadn't done one that week, so he suggested we do one right there in his office. Meh. I was up against the usual suspects--fear of choosing the wrong activity, at the wrong time, in the wrong quantity, and that failure to do everything would mean I was a defective human being. That's a lot to carry into schedule making!

Leonard argued that the *perfect right way to be* is only theoretical--it's not reality. There are things I really want to get done, and they are different things than what the OCD wants. I spent last week floundering around on the computer, getting stuck in one task and feeling like I must finish it, and then suddenly the day was over. So I got my notebook out in my therapist's office, and felt a surge of anticipatory anxiety, tightness in my chest and heat in my face. Actually picking things to do was not as bad as anticipating it(and the perfectionistic voice was squawking, "Why didn't you do the schedule sooner, since obviously if you'd just started it, you would be ok?" which is direct opposition to the previous squawking about "If you start a schedule, and do it wrong, you are doomed."

My OCD mind has a very limited understanding of time, or of how things get done, or how to be pragmatic. I imagine a perfect reality that I could obtain if I just tried harder, but in fact my life is happening right here, right now. Leonard suggested this is the true perfection--staying in the moment long enough to actually do what I value doing, and that aiming for perfection is a "young" strategy, a child's way of fixing pain, "Make it go away forever by doing everything just right." I remember being almost heart broken in my 20's when I would get a task done, and then there was another one to do, and it was such a disappointment to find I wasn't completely done.

To make things even more complicated, Leonard said I might discover my schedule needs to change based on what is happening at the time! He advocated for compassion with myself--that whatever I get done is more than I would've when completely entangled with OCD, and that the OC perfection voice will be loud, and I can just let it be, and go on with my day. The existential voice of doom wants to fix all of this, research the best tasks to do, or best organizers or read more books on OCD, but this is a danger signal--repairs, fix-its, or "figuring out" often lead to more OCD. Sometimes it feels like working without a net--up on the high wire, choosing things with wild abandon, but I do know my usual way of approaching my day leads to being trapped underground with no light to see my life.

Busy Work and Incompleteness OCD

2010-07-16T04:17:00.000-07:00

Thinking about my time, it occurred to me that I do a lot of "busy work" in relation to my OCD. In fact, my compulsions are busy work incarnate. I remember being in school, and teachers giving out worksheets to keep us quiet, that didn't actually lead to learning anything, and compulsions are similar way to keep the OCD quiet, except of course it manages to come back squawking! Yesterday, I was in a store with a whole aisle of picture frames, and I felt a wave of anxiety that I needed to make sure I didn't miss one that was the right size, so I'm glued to the shelves, picking frames up and putting them down, and the frame I eventually bought doesn't fit anyway, not to mention that there was no real urgency to get a frame, except in my own OCD mind.

I came home and did some of the things I really needed to do. My husband was going to do a craft show by himself this weekend, but since I'm not going to the IOCDF Conference, I am going with him, and needed to pack up for that. I was wiped out by the time he got home from work because I crammed all the necessary tasks into 1.5 hrs, and my back ached. But I am still grateful that I have this much awareness of what is going on. 15 years ago, I volunteered to do the mailing list for a group I belonged to, and I sat at the computer trying to figure out how to merge mailing labels, and entering addresses, until my shoulder was throbbing, and completely baffled with myself. I could see that it made no sense to keep sitting there typing in names, but I had an overpowering urge to finish, and no understanding as to why.

I'd noticed this need to complete things, to hit every chapter in a book, including the pages with roman numerals(my husband tends to skip introductions, which was very alien to me), footnotes, appendices, indexes. A sense of dread would envelop me if I skipped a page, or didn't understand a particular sentence before moving on. My love of reading was more powerful, in part because reading itself was a compulsion, and also a distraction from whatever was going on in my life, that I would manage to consume large quantities of books in spite of being slowed down by the nagging anxiety that I wasn't thorough and complete.

This is part of why I procrastinate--the fear that once I start something I will feel compelled finish it, no matter how useless an activity it turns out to be, or whether it causes me bodily pain. What kind of busy work is your OCD handing out?

I am the Keeper of My Time

2010-07-14T12:14:00.000-07:00

I've had a lot of time of my own this week, because my job is gone. I've been avoiding blogging here, in part because my whole routine is a mess, but also the OCD sneaks in quickly and says, "Well, now you have time to do everything *exactly right* so don't mess it up" and then I avoid posting at all. But today I'm here, because the support I've received from this community of readers and bloggers has been wonderful, and it's important to me to continue to share my experience of dealing with OCD, and sharing what I've learned.

An expression my therapist uses floated into my mind when I sat down to write, "I am the keeper of my time." As in, there is the possibility in my human-ness to keep my own time, independently of what the OCD demands. I struggled with this concept at my job in the past, because of my fear I would do the wrong task or do things in the wrong order, and even though I worked independently, I was not the keeper of my time much of the time, but rather my OCD was. The anxiety about making a mistake would come like a wall of water knocking my chest in, and I would divert immediately into compulsive web searching to distract myself.

The irony was that I would inevitably find something on the internet that caused me additional anguish, but the initial hit of anxiety relief kept me coming back. In 2001 I started therapy with Molly, who was instrumental in helping me find compassion for myself, and starting to create my own life, but who didn't really understand the nature of my compulsive searching. I started reading sites that left me feeling even more defective and unredeemable than when I started. When I said something about it to Molly she was alarmed, and told me to "draw a boundary" and stop reading the multitude of sites that were telling me I was going to hell.

If only it were that simple. I was dealing with a mother who didn't really see me as a separate person, who had her deep wounds, and I'd be reading sites about "honoring your parents" and honing in on the ones that condemned me unconditionally for not visiting with her or talking to her when dealing with all that pain. My secret hope was that I'd find a site that said I was ok--the compulsive search for comfort. I was not the keeper of my time. My time was like a stretched out sweater that couldn't bounce back into its original shape, and one of my OCD fears was that once I started websearching I couldn't recover any of the day, that it was all ruined, and this meant just about every day was ruined.

My challenge now, while unemployed, is to claim my time. My well ingrained habit, my overlearned skill, is to start drifting on the computer, and making a schedule stirs up all the fears of choosing the wrong things to do, but there is true delight in actually doing things that are important to me, like writing this post. What ways has OCD interfered with keeping your time? How have you reclaimed bits of your life? My OCD says that it's all or nothing--either I claim it all, or none at all, but that's just another sneaky way for it to perpetuate itself!

A Wave of Sadness

2010-07-07T12:53:00.000-07:00

I found out yesterday when I went to work that it was my last day. I am being laid off and my department closed. I am still dazed. The other layoffs happened while I was on vacation. I packed up my things, which took awhile since I've been there for 12 years. My supervisor was very compassionate, and I could tell he didn't want this to happen to me.

I am feeling very sad that I didn't get to say goodbye to the people at work. It's a hard thing to comprehend. I had projects in process, and now they are abandoned. I also have a lot of apprehension about losing health insurance, income, and having too much time to focus on my body and my OCD thoughts. It helped to see my therapist today.

I cried when my husband told me that we needed to make sure we found a way for me to keep seeing my therapist, because he knows that will help me deal with the loss, and that he wants me to enjoy my life, that this is important to him. I am very grateful he is in my life.

I regretfully canceled my trip to the IOCDF Conference in order to conserve funds. I am disappointed I will not get to meet some of the wonderful readers of this blog! I hope that at some point in the future, our paths will cross.

Built on Sinking Sand: The House of OCD and Health Anxiety

2010-07-04T08:28:00.000-07:00

It was the summer of 2006 when I sank deeply into the OCD with a full scale health anxiety crisis. OCD thinking is like an elaborate structure built on sinking sand. It appears so real and solid and indisputable and all the while your life is collapsing underneath you, and the logic is built on inherently unstable ground. OCD is an entire industry of thinking with very little to do with the outside world, except for the grain of truth that it inevitably latches onto.

Even writing about this summer stirs up the OCD. Part of my compulsion to make the anxiety go away was to make detailed notes about my symptoms, in hopes that I accounted for every possible thing, so my impulse, when writing this blog post, is to include every detail. The anxiety began when I agreed to take a medication which might alleviate a symptom that I obsessed about frequently. I took the medication, and started obsessing that I was getting a bladder infection, which was another one of my health anxiety themes. After fixating on every bladder sensation, and agonizing about whether to call my doctor, I finally did and she got me in at the end of the day. It is common(though perhaps not recommended) to treat women empirically if they have bladder infection symptoms, so that's what she did--no urine test.

And that began an elaborate building of health fear, one level on top of another. Because I'd had a severe headache with one antibiotic in the past, I said I wanted a different one, and in dodging one fear I landed in another as I began to obsess about getting a yeast infection from the 2nd antibiotic, and called my doctor who prescribed meds over the phone. I was overwhelmed with a surge of anger at my doctor for not doing a urine test since I had several bladder infections that turned out not to be, and since strong feelings set off my OCD, I was on very shaky ground.

Over the next weeks the OCD was compounded and grew at an alarming rate. I went to a different gynecologist, who was near my house, who did a lab test and said I did not have a bladder infection, and gave me more meds for the supposed yeast infection. I still felt urgency in my bladder, and even more urgency in my OCD desire to know exactly what was going on in my body, and perfectionistic self-condemnation for not perfectly diagnosing myself or advocating for tests, or for calling a doctor in the first place. The OCD thoughts were all about my defectiveness, and my responsibility to make sure I didn't get a kidney infection, and the imperative that I never make a mistake, and that I would be haunted by the pain and discomfort in my body.

I was on a quest to get relief from my anxious imaginings and my fixation on painful sensations in my body. I found a new family doctor, who said if I still had bladder urgency that I probably did have an infection, and she wrote a script for antibiotics, and reluctantly did a urine test at my request, but when I panicked that I did not do the test sample correctly, she went into authoritarian mode and told me to not get myself worked up, to just calm down. Well, if I could do that, I think I would have already. . .I went and cried in my car.

So here I was trying to decide whether to take another antibiotic, without test results, and the OCD structure was growing, as I felt a surge of hyperresponsibility that if I got a kidney infection it would be all my fault, so I'd better take the antibiotic. By the end of that week, I couldn't sleep at night, and I went into the doctor on a Saturday. The doctor on call was much calmer and kinder, and she prescribed another antibiotic that would be less likely to cause insomnia, but this antibiotic wreaked havoc with my digestive system. I went back to the doctor on call who happened to have my test results, and once again it showed I didn't have a bladder infection but that I did have blood in my urine, and she wanted me to see a urologist.

By this time I was a mess. My therapist Molly was on vacation. I went to see the therapist on call, and told her how I couldn't get this right, couldn't figure out what was wrong with my body, that I needed to try harder. She sat quietly for a moment, and then said that it seemed I had been working incredibly hard to find out what was wrong, with multiple doctor visits and relentless researching on the computer. I was baffled by this. This did not make sense in my OCD world, where I was never good enough, never finished, never solved, never certain.

She wrote a few sentences on a scrap of paper, and gave it to me:

May I be filled with lovingkindness.

May I be safe from inner and outer dangers.

May I be well in body and mind.

May I be at ease and happy.

This was a glimmer from outside the windows of the house of OCD, the possibility of another way to view the world. Feeling body symptoms can be hard enough without the "inner dangers" of OCD. I was to descend further into my OCD, but I had a moment of reprieve.

*********************
Thinking about it now, this is part 7.5 of my Medication Series, since it was my first OCD crisis after ceasing to take my antidepressant.

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

Home from Vacation

2010-07-02T09:47:00.000-07:00

I'm back from my vacation to Washington DC, and I had a good time! My husband and I walked thousands of steps, and saw 14 museums. I was very grateful that I started OCD treatment before going to DC, because the sheer quantity of things to see would've been overwhelming, since part of my compulsions was making sure I didn't miss anything. My husband has trouble sitting still, and likes to roam around museums. A few years ago we realized that we have the best time if he just starts roaming, and leaves me to read all the interpretative signage, and now it's even more improved because I have much more ability to move on even if I haven't finished every single word, and looked at every single item on display!

My desparate OCD compulsion to not miss anything would've been paralyzing in DC. I still had some difficulty at times. At the Museum of the American Indian, the cafeteria was full of interesting dishes I'd never had, and suddenly a several tour groups showed up and the lines got very long. I had a "nested basket" response of "Oh no, you took too long to decide and now there are crowds. How could you do that? What is wrong with you? Oh, I shouldn't be so critical of myself. Why can't I stop doing that?" but I focused on choosing some dishes easiest to get to, in spite of a barrage of "You need to choose the right one, how do you know it's the right one?" and did enjoy most of what I got. The cold radish and melon soup was delicious, and worth the risk. The maple pinto beans were not as exciting, but I am so much better prepared to just say, "Oh, well," and let the disappointment pass.

The photo above is of Christian Burchard's Basket Series from the Renwick Museum of Contemporary Craft. I asked my husband to take a photo of it, because it is such a powerful metaphor for my OCD thinking.

Nesting Dolls: OCD All the Way Down