OCD A to Z: Z is for Zero

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.

Revisiting OCD A to Z from 2011

OCD A to Z: Y is for Yet Again

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

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

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

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

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

(Edited to add: biopsy was negative.)

Revisiting OCD A to Z from 2011.

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

Until the 4th grade, I went to a school that didn't have letter grades. When I got my first test paper back with 2 x's, I knew instinctively that this was bad, and I should only have check marks, only right answers. 

My perfectionism started early. An x meant I had done something wrong, and I could feel fear in my chest, and a flush of shame in my face. I had decided that being perfect was the key to being ok, to being loved, to being acceptable. This is a potent belief that influenced my life thoroughly, and when mixed with OCD, extremely painful.

OCD offered a supposed solution, a method for being perfect, if only I analyzed and ruminated enough about every thought I had, every action I took. There are times when I want to x out OCD, draw a big black x through it, banish it, deface it. I'm old enough to remember learning to type on an electric typewriter, and the satisfaction of pressing down the x key and obliterating a whole line of type.

My perfectionism is sneaky and I find myself desiring to perfectly eradicate my OCD symptoms, and this slowed me down for a long time, since anything I did wasn't enough in my mind, and any progress I made, I dismissed as inadequate. But over time, through the love of my husband and my friends and the help of my therapist, I have learned compassion for myself, for the girl I was, the girl who could never make a mistake or else she was worthless and doomed.

If you struggle with this kind of self-loathing, know that it is possible to learn kindness for your own self. A child doesn't know there is hope or that perfection is impossible, but as adults, we can step outside that suffocating room of condemnation, and move toward freedom.

Revisiting OCD A to Z from 2011

OCD A to Z: W is for Worry

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

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

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

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

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

Revisiting OCD A to Z from 2011

OCD A to Z: V is for Voice

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 its 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.

I came across Pearl Jam's I Am Mine, 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

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. 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

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. 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. They 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. The IOCDF also has a Guide to Low Cost Treatment Options for OCD.

Tips for Interviewing Therapists: What Should I Ask?

The following checklist from the IOCDF can help guide your search for the right therapist. The answers to most of these questions are available on the individual listings in the IOCDF 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?"

A good answer would be over 25%

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

If they are negative about medicine, this is a bad sign. Medicine can be 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.