My Health Anxiety, High Cholesterol, Decisions and Curiosity

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

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

j

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

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?