Anger and OCD

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.

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

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?

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.