Pharmacological Treatment of OCD: DVD's Available of Dr. Steven Poskar's Presentation at OCDNJ

I subscribe to the newsletter of OCD New Jersey and recently they had a Dr. Steven Poskar of OCDNY as their guest speaker.

Dr. Allen Weg, VP of OCDNJ, sent out this note after the presentation about DVD's, and I thought I would pass it on, because it sounds like a useful resource: 

. . . if you were not at our meeting last night (and, actually, even if you were), and you are interested in the latest in medication options for OCD, you should consider ordering a DVD of Dr. Steven Poskar's presentation.  It was an incredibly thorough and exhaustive review of what is out there, including some of the newest avenues of research.  If interested, call OCDNJ President Ina Spero at 732-828-0099. 

Dr. Steven Poskar is a certified Diplomate in Psychiatry by the American Board of Psychiatry and Neurology. He specializes in psychopharmacology and cognitive behavioral therapy at the Spectrum Neuroscience and Treatment Institute in New York City.

Dr. Poskar is a co-founder and current Vice President of OCDNY, the NY affiliate of International OCD Foundation. He is a member of the International OCD Foundation’s Body Dysmorphic Disorder, Hoarding and Autism Spectrum Disorder Special Interest Group.

Dr., Poskar’s presentation is entitled, “Pharmacological Treatment of OCD: The very latest developments in exploring options.” This presentation is an exhaustive review of the many medication options now available for those struggling with OCD and those treating them, including the very latest information on approaching the psychopharmacological treatment of OCD, not only by targeting serotonin and dopamine sites, but glutamate abnormalities as well.

Living With Me and My OCD: Check out the Trailer for Claire Watkinson's Documentary

In the summer, I recorded my story about having OCD for Claire Watkinson's documentary film Living with Me and My OCD.  I'm sharing the trailer here and Claire's introduction to the project, which is set for release in 2013.  I am excited that she has taken on this project to share stories of living with OCD.

My name is Claire Watkinson, I am a freelance filmmaker and a sufferer of OCD. Living With Me And My OCD is a personal documentary about OCD that I started filming in January. The feature is set for release in 2013. It will include interviews with sufferers of OCD, diary entries from myself, the Bupa Race, OCD UK and many more exciting organisations.

I am so happy by the amount of support and comments this documentary has recieved. I am touched and means so much. Please join this campaign. I need more interviews, people and interest. Get in touch, share this page and lets get OCD more talked about!

Claire Watkinson's Twitter for Living With Me and My OCD

Buy Living with Me and My OCD Wristbands

Check out the trailer:

Fear of Being a Bad Patient: Health Anxiety and Self-Worth

Problem for me is I also have social anxiety. Dealing with doctors is just as anxiety provoking as worrying about illness. My symptoms and test results seem just worrying enough to warrant monitoring the situation but I'm constantly worried the doctor will think I'm just being a hypochondriac.

I actually looked through some books on hypocondria, but they all focused on worrying about something that has been ruled out. Which isn't the case for me. I'm working on establishing a format of when to call a doctor, which symptoms or tests should be followed up on and which need not. I'm finding this helps me to let it all go and enjoy things more, particularly when I am having low symptom period. I've got a ways to go, though. :)

I've been thinking about this comment by MinM on my post Hypochondria and Health Anxiety OCD.  The social anxiety of dealing with doctors complicates my health anxiety, as well as cultural stereotypes of women as oversensitive, and my perfectionism which demands I pre-diagnose myself and get it right before I even go to the doctor.

I spent many years at my old job listening to medical residents do their rounds, and anything to do with the mind and emotions and human complications was a struggle for them in the midst of all the technical, diagnostic work they were doing.  There was a staff psychologist who would sit in at times, and I was glad to have her there providing some perspective.  Also, some residents were much more able to deal with anxious patients than others.

OCD is still an enigma to many people, professional or not, and health fears are often labeled hypochondria, even though health anxiety OCD has a significant component of dealing with uncertainty and rituals to try and undo the fear, such as repeated calls to doctors, web searching symptoms and monitoring and checking body symptoms in a similar way to those who check locks, stove burners and light switches.

My latest challenge was a physical in October with my family doctor, who was concerned about my low iron levels and said since I was "close enough to 50" that she was going to refer me for a colonoscopy.  Getting older adds another layer to health anxiety.  I'm still a few years away from 50 and I felt a surge of panic that I was going to choose the wrong thing, do the wrong thing.

Ironically, my doctor was not "certain" about this.  She even went and talked to a colleague to see if she sounded "crazy."  Here was her thought process: My iron levels could be due to being female, but she's seen too many cases of patients in their 40's who turned out to have colon cancer, and while she doubts that there is something seriously wrong with me, she wanted to play it safe, and have me consult with a gastroenterologist.

Does this sound omnipotent or certain?  No.  Do I deal well with uncertainty?  Well. . .I hadn't seen Leonard, my exposure therapist, in 5 months, so I made an appointment to sort this out with him.  I didn't look up colonoscopies in the meantime, which is huge for me.  Leonard made me laugh by saying the sedative is fabulous with a colonoscopy. . .he'd also heard that the guidelines might be changed to start a screening colonoscopy at 40 rather than 50.  

For him, it didn't trigger a big emergency because his self-worth was not at stake, as opposed to my perfectionism, which decreed I'd better get this right or prove my defectiveness.  Leonard asked if I really believed that there is a way for someone to prove I'm defective as a person by looking at my colon.  I made the appointment with the gastroenterologist and saw him a couple weeks ago.  He basically said the same thing as my family doctor, about wanting to err on the side of caution.  I scheduled the colonoscopy for January.  

If you are a reader tempted to write me a treatise about the dangers of overtesting, and other sociological factors about suburban US medicine, please be assured I've already thought about all of this, and I've taken my best guess.  Does this scare me?  Yes, it does, because I'd prefer to make a perfect omniscient choice, but ritualizing to give myself the illusion of being able to make a perfect choice has stolen many years from me already.

Some of what I've learned over the years of dealing with my OCD with Exposure Therapy:

• It's important for me to trust and respect my doctors, and be able to honestly say when I'm struggling with the OCD.  The anxiety of figuring out how to indirectly get my questions answered was exhausting when dealing with doctors who had little patience for anxiety.

• Even people without OCD have a difficult time gauging when to go to the doctor.  There will be uncertainty.   I may be wrong.  This doesn't say anything about me as a person.

• Self-Monitoring and vigilance will not magically protect me from illness and disease, as evidenced in my experiences: Skin Cancer Anxiety: Fear, Vigilance and All or Nothing Thinking and Skin Checks and OCD: Never Enough.

Relationship OCD: Two Hard Things at Once

The post on Exposing OCD with the most comments and reader resonance is Relationship OCD and Fear of Choosing the Wrong Person or Gender.  I wrote it over 2 years ago, and it still gets comments.  There is a thread of pain throughout the comments, which I find sobering.  

I am not a professional.  I am not a therapist.  I am someone sharing my story and my experience.  If there's any lesson, it's not that my readers need to marry the one they are with, or not marry the one they are with, or find another gender, but that OCD latches onto what is important to us, such as love or connection, or a particular person, or imagined ideal person.  

Relationship struggles are hard enough without OCD, and there's nothing magical about OCD treatment that will make relationships struggle-free, but it can give you the chance to choose to live your life, and choose who you love.  

OCD is offering a false promise that you can banish all fears and doubts, all unwanted thoughts, all gnawing anxiety, if you just come up with the right ritual of analysis, research, checking, double checking, monitoring feelings or repeating certain phrases.  

When I married my husband 20 years ago, I could've made the wrong choice.  Many marriages end in divorce.  The brave part was making a choice, without having absolute omniscient knowledge of the future, which of course no human gets.   Getting married didn't make my OCD go away, but I did have the victory of choosing what I wanted(or rather, my best guess of what I wanted).    

Professional help and OCD support groups are about making an investment in your future, an investment in your life, in facing the disorder that barrages you with thoughts that go against the core of your being, and yet the more you wrestle with them, the more they cling.

Fear of Thoughts Getting Stuck: The Challenge of Reading OCD Self-Help Books

I had several responses to my review of J.J. Keeler's I Hardly Ever Wash My Hands: The Other Side of OCD, expressing fears that reading the book would give them ideas or cause anxiety.  I've been mulling this over, because it's a challenge to respond.

The simplest answer is that I don't know if J.J. Keeler's account of her OCD, and the specific things she worries about, will "stick" in your mind or create new OCD obsessions.

This is the nature of OCD that one person's trigger can seem completely harmless to someone else with a different form OCD; it's not only those without OCD who think that a particular obsession is incomprehensible.  There is a tendency to assume that other people's obsessions are easier to bear.  Conversely, if we suspect that a person's obsessions might be similar to ours, then there can be a desire to quarantine them, and not get anywhere near, as if the fears were contagious.  Or we are afraid of adding a whole new category of obsessing, and again, stay away.

This is OCD's mode of operation, to convince you that you can avoid the contagion of life, if you just screen out all things that might set you off, and enlist those around you to help in this task.   I know this from the inside.  Public health campaigns to raise awareness about various illnesses seemed designed by very cruel folks to torment me.  I was already highly aware of things that could go wrong, and I didn't want to know of any additional ways to monitor and worry about.  When I was a kid there was no internet but there were posters on the bus, public service ads on tv, special episodes of programs where someone had a disease, and magazine articles.  Women's magazines were the worst, and my mood would plummet if I was in a waiting room, reading one(which I picked up because I was anxious to be in the waiting room to begin with).

In college I was doing fairly well for awhile, avoiding obsessing about moles, until a classmate opened up his datebook, and I could see he'd written in an appointment for a mole removal.  I couldn't have predicted this.  Now, it might seem that you could at least keep yourself safe by avoiding what seems obvious, like Keeler's book or other OCD self-help books, or my blog, or the OCD Yahoo Group, or OCD support groups, but what is your definition of safe?  Avoiding all possibilities of help is not safety.  OCD would have you believe that it is possible to maintain complete quarantine, but triggers are part of life.

The irony is that when I was in an anxiety spike, I would then search out articles about whatever symptom was catching my attention, in order to reassure myself that I didn't have something serious.  There would be an initial calming effect if my symptoms didn't match, but then as I'd keep reading, I'd find something that again put doubt into my mind, or introduced an even more scary possibility.

I am not minimizing the abject fear of being seized by an OCD obsession.  I've been there.
But getting help for OCD is where the true hope of living beyond your obsessions resides.  OCD wants to maintain the status quo.  Don't get help.  Don't learn about how other people have coped.  Don't risk new pain.  

If you can't read a self-help book or OCD memoir because it's too terrifying, then this is a signal to find an exposure therapist, or a self-help group, where other people can help you.  I understand the irony in this.  I was once incredibly shy and my therapist suggested group therapy, and I was appalled.  How could I go to a group for help if I was terrified of groups??  But eventually, I realized that I didn't want to go on the way I was going:  the cost of my fear was too much, I was missing my life.

Keeler, in the preface to her book, writes of having severe fears of harming someone while at Disneyland, and self-loathing for what kind of person she must be, when a toddler ran over and hugged her leg.

It felt like she was telling me I wasn't what I feared.

I have no idea who this toddler was and I never saw her again.

But she saved part of me that day.  

Hopefully, this book can save part of someone else. 

 

 

Intrusive Thoughts and Harming Fears: A Review of I Hardly Ever Wash my Hands: The Other Side of OCD by J.J. Keeler

TLC Book Tours contacted me about reviewing J.J. Keeler's I Hardly Ever Wash My Hands: The Other Side of OCD, and I was intrigued by the title because my OCD doesn't manifest in handwashing rituals, and this is the short-cut metaphor for OCD much of the time.  After reading the book, I felt like I'd found an OCD-Soul-Sister and although I am never glad that someone else has OCD, and I am glad when they can write about it in an articulate and insightful way.  

I had to laugh when J.J. Keeler describes how her twin sister had hypochondria with fear of many diseases(a type of OCD I am very familiar with), but the author had only "had" one disease: AIDS.  In the irony of OCD, in elementary school she is triggered into worrying about AIDS when her parents mention a blood transfusion she had, but what her OCD latches onto is the risk of "dirty needles" which in her young mind means thumbtacks, staples, pine needles, with dirt on them.  Humor is a major component of Keeler's account of OCD, grabbing the edge of ridiculousness about OCD fears and pulling the whole thing apart, so that the sufferer can catch a glimpse of OCD's game of generating endless scenarios and holding life hostage.  

The second chapter, The Bomb in my Teddy Bear, is a marvel of encapsulating the experience of morphing OCD thoughts.  When she was 8 years old, neighbor gives her a teddy bear at a yard sale, and a chain of fears links itself around her.  She started getting a weird feeling about the bear, and wondered why a relative stranger would give her a teddy bear for free.  Then it came to her, "The reason was obvious.  There was a bomb in the teddy bear."  Keeler agonized over how to dispose of the bear, without harming anyone else, and then when it didn't explode, wondered if the neighbor would come back to finish the job.  Her rituals to keep the anxiety from exploding were a constant stream of "figuring out" and "analyzing" combined with tin cans at the door to let her know if there was an intruder, and plotting how she could take the bear on one of her father's fishing trips and throw the bomb overboard.

Eventually, OCD moves onto other topics in Keeler's life, but the same corrosive fear and desperate maneuvers to make the fear go away.  In addition to fears about AIDS(and calling the testing center before her test was even received, to check, check, check), she feared causing harm to others after being deluged with intrusive thoughts.  If you suffer from this very painful form of OCD, please read this book.  Keeler has known the despair that made her consider suicide, because she didn't want to harm anyone and yet these images would pop into her head, and she has survived, and now thrives.  

The most difficult part of reviewing I Hardly Ever Wash My Hands: The Other Side of OCD, is that I want to quote everything, but it would be better for my readers to go find a copy of this book and read it for themselves.  

Read J.J.Keeler's Introduction to Harming Obsessions on her blog.  

Find J.J. Keeler on Twitter

Related Post:

Fear of Thoughts Getting Stuck: The Challenge of Self Help Books for OCD

http://tlcbooktours.com/

Interview with Andrea Kayne Kaufman, Author of Oxford Messed Up: Part 2

Part 2 of my interview with Andrea Kayne Kaufman, author of Oxford Messed Up.
Check out Part 1 Here.

ExpWoman:  The image of Henry inviting Gloria into the tub 
of cold water to illustrate how over time one can habituate 
to the chill, just as exposures can habituate 
you to OCD fears, is very powerful.  

The tub is central as image in this novel--
did the image come first, 
or evolve as you explored the characters?

Andrea:  So glad you asked about the tub. I remember when we were learning about exposure response prevention, the doctors described it as stepping into cold water. If you pull your foot out right away, you will never get used to it. You will never habituate.  But if you stay, it will gradually become bearable.  I also really liked the tub/water as a metaphor for rebirth and renewal. The tub is the place of Gloria and Henry's greatest suffering as individuals and a couple. It also becomes the place of their reckoning, their paradigm shifts, and ultimately their redemption. When the novel first came to me, i saw Gloria scrubbing a claw foot tub with bare hands. I also saw them striking their deal in the tub. And i saw them making love in the tub. Although when i actually wrote that scene i realized it would be very hard to have intercourse for the first time in the tub— thus, it was next to the tub on the loo floor.

ExpWoman:   
Henry's addiction has many parallels to Gloria's OCD.  
How does the addictions recovery model resonate
with exposure therapy for you?  
Have you, or do you know people, who have experienced either of these?

Andrea:  Very true.  In addition to having experience with ocd, there is also experience in my extended family with drug addiction and recovery.  When the ocd in our family got out of hand— total conflagration as the doctors said— it required more and more compulsions, reminding me of a drug addict spiraling out of control, needing more and more drugs to get high.  I also think recovery models closely resemble the cbt paradigm.  Also, one never is totally rid of ocd, it can remerge and tempt you at different points in your life just like addiction.

ExpWoman:  
Your theme of "choosing happiness" resonated with me.  
When I  stopped writing poetry, and started making art, 
I did feel guilty at first for doing something 
that made me happy, making art that expressed joy & hope.  
Is there a particular point in your life that

you "chose happiness" and if so, can you tell us a little about it.

Andrea:  This is a really important theme for me. The courage to write the novel and put it in the world was really me choosing happiness for myself. I am one of those "people pleasers' who's renounced my own needs in favor of other people's needs.  It took me a long time to learn that happiness was something you have to affirmatively choose and not just wait for other people to give you.  Moreover, it took me a long time to learn that i was worthy of happiness and love.  I also experienced some tragic losses as a child and it took me so long to stop defining myself by the cloak of tragedy— which felt familiar and comfortable. I was worried that people might not like me as much if i came out of the closet and they knew i was happy.

ExpWoman:  
I remember being surprised when Oliver is revealed
as Gloria's OCD"voice" rather than an actual boyfriend
in the first pages of the novel, and impressed 
with how this gave a sense of how integral OCD can become
to one's person.  How did Oliver come to you as a character?  
What were the challenges in creating him?

Andrea:  As we were going through ocd in our family, it became clear that the ocd was a voice in the head demanding certain things. It was like a hostage takeover. The doctor encouraged that it be externalized and named. This helped distinguish what the ocd wanted from what the actual person wanted. As parents, it also made it much easier for us to participate in erp and cbt because we knew we were standing up to the ocd and not our child.  I also really felt like there was a dilemma about whom to listen to--  the ocd voice or us.  Thus the love triangle concept was born. Oliver was a challenging but wonderful character to write because i really do view it as a love triangle. And Oliver is so different than Henry. I have been approached by a major hollywood studio about doing a movie version and talking about how to portray Oliver in a film has been a lot more challenging but there are so many intriguing possibilities.

Interview with Andrea Kayne Kaufman, Author of Oxford Messed Up: Part 1

Andrea Kayne Kaufman, author of Oxford Messed Up, graciously agreed to answer some questions about her novel, which deals with OCD.

ExpWoman:  "What if" questions are a hallmark of OCD, 
usually with dire answers.  Your novel seems to be a 
"What if" with an optimistic answer.
How did the scenario of Henry and Gloria meeting 
come about?  As a "what if" of an extraordinary kind 
or did one of the characters come first?

Andrea: Gloria came to me when we were struggling with ocd with one of our children. There were some people close to us who doubted the efficacy of the medication and cbt/erp therapy we were going to embark on. They told us our child would be fine. Was so smart. Would go to yale and find his niche eventually.  That wasn't good enough for us as we watched needless suffering. So i think that is why i created gloria.  The "perfect" yale graduate, living a miserable existence.

After our child got better (very quickly by the way), Gloria seemed to be asking for her happy ending too.  I created Henry because our child's therapist once said that what seems like the worst thing possible may actually be the best thing possible. So that is why i gave Henry his condition, the worst germs possible.


ExpWoman:   What led you to have Henry be the agent of the 
Exposure Therapy(ERP) rather than a therapist?

Andrea: Henry or any lay person is not an ideal person to administer erp.  But given Gloria's parents undermining of her early erp and history of hospitalization, she has been closed off to full treatment for years. Henry is able to open her up to the process again. His efforts are supervised by his sister (unethically perhaps) and i tried to show in the chapter with the dog that Gloria realizes Henry needs to be replaced by a real professional.  In order for the erp to be successful, you need patient buy-in and Henry is able achieve buy-in.

ExpWoman:  Some of my readers, 
most who struggle with OCD, wondered at the
speed of Gloria's recovery from her contamination OCD 
after she begins doing exposures with Henry.  
I know that my progress for health anxiety, 
intrusive thoughts & perfectionism has taken longer.  

What led you to a more rapid progression?

Andrea: Our family experience was that once we started medication and cbt/erp rigorously and consistently, we saw dramatic reduction in compulsions within 3 1/2 months. That doesn't mean the ocd has gone away. It's a life long struggle that can be triggered with all sorts of life events, hormones, stress etc. Although, it can rear its head, it has never been as strong because we have the tools.  The novel was vetted by three experts and has been hailed by the ocd community. There may be some poetic license but i really wanted to show the true torture of ocd from the inside out and how cbt can be very effective. Some people think that it is archaic and cruel, denying someone the few things that provide comfort. But cbt is the only therapy proven to really work and if done well, it can work quickly.

ExpWoman:  Which books on OCD were most helpful to you in writing this novel?

Andrea: 

The Boy Who Couldn't Stop Washing By Judith Rapoport

Ocd In Children And Adolescents By Johns S. March And Karen Mulle

Freeing Your Child From Obsessive Compulsive Disorder By Tamar E. Chansky

What Do Do When Your Child Has Obsessive-compulsive Disorder By Aureen Pinto Wagner

Talking Back To Ocd By John S. March

ExpWoman:   Did someone in particular inspire you 

to take on the subject of  dealing with OCD?

Andrea:  As I said before, we experienced very bad ocd with one of our children whose courage and tenacity really inspired me. Also, his psychologist Amanda Holly (whose video is on my website) is my total hero. She is our "ocd whisperer" and really saved a life and our family. She is one of the experts who consulted on the book.

ExpWoman:  I grew up as the daughter of an English

professor, and then did an MFA in creative writing. 

Being in the academic world had its own set of challenges 

when suffering from OCD.  What insight would you offer to 

those readers who are currently in academia and struggling?

Andrea:  Academia can definitely be daunting for anyone and especially for those who suffer from anxiety disorders like ocd. Moreover, whether you are a student or faculty member, the work in school can be isolating which can lead to stoicism, keeping all the struggles inside until they build and build. It is so important to have good mentors and advisors that you can share with— not just academics but also social/emotional struggles. It is also important to know that transitions to college or going through tenure can trigger internal stress and anxiety disorders. It is good to be prepared and prophylactic.  Finally, the world of academia emphasizes grades, publishing, comparing, competing. This dynamic is not healthy for the person who suffers from perfectionism whether in ocd form or eating disorder or something else. It is so important to master the "good enough" standard and learn to be gentle with ourselves.

ExpWoman:  I will post Part 2 of the interview with Andrea Kayne Kaufman next week.  For Andrea's introduction to Oxford Messed Up, check out her video.

Finding Hope in the Midst of Anxiety and Obsessing: It IS Possible

Hope Mosaic by Exposure Woman

Awhile back, one of my readers asked if I would post some of my art.  This is an even bigger exposure than making a video about my OCD for my last post!  As I wrote in Your one wild and precious life, my love of art gives me strength for facing my OCD.  The joy I feel when making art is something that allowed me a glimmer of hope that my life could be my own, rather than in the thrall of OCD.

Hope means looking forward to something, and some suggest that it is related to hop, to leaping in expectation.

The first time I read an article by Jonathan Grayson about obsessing about obsessing, I felt a leap of hope that someone understood what I was experiencing, the angst that I would do something to trigger my obsessing, and trying to figure out if I really was obsessing.  Grayson believed that exposure therapy could work for obsessions of the mind.

Meeting my exposure therapist, Leonard, for the first time also made my heart leap with hope.  He was a worthy foe of my OCD.

None of these things meant I was certain I'd get better or that someone could help me or that I could do exposures and survive them.  OCD had been demanding I be certain for quite some time--certain I had OCD, certain I had the right therapist, certain I was doing my exposures correctly--and this eroded my hope in the guise of helping me.   If your OCD is anything like mine it may sound like this:

You don't have enough hope.  You'll never get better.  What are the signs of hope in your life?  Figure that out.  Do a search on the effects of hope on dealing with mental illness.   What is wrong with you? Why do you feel despair?  You'll never get better.  

Whoever you are, if you suffer with anxiety and the exhaustion of worries chasing each other, remember that there is hope.  It is possible to get better.  It is possible to claim your one wild and precious life.  You are not broken, irredeemable, beyond mending or repair or healing.  If you don't have hope, you can borrow some of mine.


H is for Hope

Living with Me and My OCD: An Interview for Claire's Documentary

ClaireJaneOCD on twitter is creating a documentary about the experience of having OCD, and invited me to contribute a video.  Claire and Jane are twins in the UK, who just completed running a marathon in order to bring awareness about OCD.  This is my first time recording myself!  And definitely an exposure to make it, but hopefully will be helpful to other people who struggle with OCD.

Review of Oxford Messed Up by Andrea Kayne Kaufman: Facing OCD

[Note: In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.]


When Grant Place Press contacted me about reviewing Oxford Messed Up by Andrea Kayne Kaufman, little did I realize the connections I would find with my own life.  The protagonist, Gloria Zimmerman, is traveling to Oxford to study feminist poets, and struggles with OCD.

I have a degree focused on feminist poets.  Reading poems written by these women, and writing my own poems gave me strength to deal with depression, OCD and other pain.   I was a very serious young woman, who didn't know she had OCD, but knew that I was often scared about symptoms in my body, and trying to be perfect.  Gloria knows she has OCD, but attempts to keep herself together with rituals, Klonopin, and Van Morrison's music.

Van Morrison's music is a source of strength to both Gloria, and her "loo-mate" Henry Young(the other protagonist who has had many traumas in his life).   As a girl, I  remember sitting on the floor going through my parents record collection, trying to understand what a Moondance was, and mesmerized by the album.

I was intrigued that one of the recommendations on the back of the book came from Susan Richman from OCD Chicago, a chapter of the International OCD Foundation.  Oxford Messed Up does indeed explore Exposure and Response Prevention Therapy(ERP), the standard for treating OCD, and is the only novel for the adult market that I've ever come across that does.

Henry is the catalyst for Gloria's ERP, and this shows the importance of rapport for willingness to do Exposures.  If I hadn't trusted my ERP therapist, I wouldn't have done any of the Exposures he suggested.  I believe that family and friends are often on the frontlines of working on Exposures with the ones they love who have OCD, and that self-help has been very important for many sufferers, especially Jonathan Grayson's book Freedom from OCD, and his model of GOAL support groups.

At the same time, though, I was ambivalent about Henry's quick study of ERP, and how unrealistic this might be.  I was able to suspend disbelief because I remembered reading somewhere that ERP, even incompletely done, can be better than years and years of talk therapy. I only wish more therapists were  quick as Henry--like the 6 or 8 of them I saw before I found Leonard, who actually specializes in OCD and was expert in Exposure Therapy, rather than asking me to simply avoid my triggers or use logic to make it all go away.  I would imagine a novelist's dilemma would be how to portray a series of ERP sessions with a therapist, in a way that would make good fiction.  

Gloria has contamination OCD, which I don't have, and which gave me a brief flash of disappointment, because this is the stereotype of people who have Obsessive Compulsive Disorder.   But she also has perfectionism, a mandate to be a "Superstar,"  which I identify with, and I liked that Kaufman showed how perfectionism can underlay everything, and that this may be slower to respond than other aspects of OCD.  If patterns have been in place for a lifetime, through family culture, personal history, combined with genetic heritage, that simply habituating to the "dirty world" isn't enough, and that compassion, love, understanding and hope are crucial to regaining a life that has been ordered by taking as few risks as possible, and trying to earn the love of others.  

I recommend Oxford Messed Up for it's improvisational dialogue both internal and external, for an inside look at the OCD thought process while facing fears, for the importance of hope, and of "fatalistic optimism"(as the characters describe the music of Van Morrison).

In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.

How do you talk to friends about how OCD affects you?

In a comment on a recent post, a reader asked the following question:

I have a question for anyone reading this ... how do you let others know about your OCD so they can cut you some slack? 

I only recently realized how much this disorder messes with my daily and weekly functioning. I thought I had adult ADD but it's anxiety, not ADD. 

I live alone and my "circle" does not have any idea how much energy it takes me, sometimes, just to get out the door. Any advice on how to help them to help me would be great.

For myself, I told very few people about my OCD.  My husband, my best friend, people in my OCD Goal Support Group and then as I started Exposure Therapy, a couple more close friends.  With my husband, it helped that he was willing to read Jonathan Grayson's book Freedom from OCD.


I'd love hear what other readers have to say about how to talk to others regarding your OCD and how it affects your functioning.  

OCD Recovery as a Continuum Rather than All or Nothing

Right now I'm reading Monica Ramirez Basco's book Never Good Enough, about dealing with perfectionism. She is a cognitive behavioral therapist(CBT), and describes common thought patterns for people who are perfectionists, including "two basket thinking," where everything either falls into good or bad, right or wrong, safe or dangerous, done or undone, all or nothing, one basket or the other. Basco offers a continuum as the alternative, rating experiences, feelings or events on a scale of 0 to 100%.

Two basket thinking causes me a lot of distress, especially in relation to my OCD treatment, where I assumed I would go from having OCD to not having OCD, jumping from one basket to the other in a single leap, and anything inbetween was failure, hopelessness and despair.

Basco argues that most victories in life are small ones and if we discount those, we are missing much of our progress in pursuit of making the big jump. Paradoxically the harder I try to skip all the middle stuff and just make OCD go away, the more likely I will get stuck in an OCD flare-up, trying to accomplish something that is impossible. When I encourage myself, I gain more energy to fight my OCD and make that journey inbetween the two baskets.

Skin Cancer Anxiety: Fear Vigilance and All or Nothing Thinking

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

Challenging OCD One Step at a Time

Sensorimotor Obsessions: Hyperawareness of Body Sensations

I have felt an affinity to the Princess who can feel the pea under all the mattresses in her bed. When I read David J. Keuler's article, When Automatic Bodily Processes Become Conscious: How to Disengage from "Sensorimotor Obsessions", I recognized myself. Here is Keuler's list of examples of Sensorimotor Obsessions:

• breathing [whether breathing is shallow or deep, or the focus is on some other sensation of breathing]
• blinking [how often one blinks or the physical requirement to blink]
• swallowing/salivation [how frequently one swallows, the amount of salivation produced, or the sensation of swallowing itself]
• movement of the mouth and/or tongue during speech
• pulse/heartbeat [awareness of pulse or heartbeat, particularly at night while trying to fall asleep]
• eye contact [unlike social anxiety-based concerns, this form involves awareness of the eye contact itself or which eye one is looking at when staring into the eyes of another person]
• visual distractions [e.g. paying attention to “floaters”, the particulate matter that is drifting within the eye that is most visible when staring at a blank wall or awareness of subtle movements of the eyes, such as saccadic eye movements]
• awareness of specific body parts [e.g. perception of the side of one’s nose while trying to read or, as in the cases of a young boy and older man, a hyper-awareness of particular body parts such as their feet or fingers respectively]

My health anxiety is linked in part to assuming what I am aware of is dangerous. Floaters in my field of vision were particularly hard to deal with because I was afraid it was serious, and then when the doctor said it wasn't, I was worried I'd be aware of the bits of gray squiggles forever, and haunted by them, and I obsessed about obsessing. Bladder sensations took up a lot of my mental space from an early age.

Keuler proposes treatment consisting of:

• Helping the sufferer understand that awareness of automatic body processes is not dangerous
• Exposure to the sensation and prevention of responses such as distraction.
• Body Scan and Mindfulness, and learning to observe sensations without judgement(Jon Kabat-Zinn has detailed instructions for doing a body scan. I did them everyday for many years, and it helped expand my focus.)

He suggests post-it notes with reminds of the sensation in strategic locations, practicing inviting the sensation in rather than fleeing from it, which ultimately leads to less sensitivity to the sensations and/or greater tolerance of them. Before you panic at the thought of purposely evoking sensations you'd rather banish forever, remember that in actuality you can't perfectly set up the world to never remind you of your breathing, your tongue or your bladder.

I know that bliss when a sensation recedes and the agony of something reminding me of it, but it's the jolt of encountering the feeling reinforces the anxiety, making me wish I could ratchet down my life even more so that I never get surprised. It was liberating to discover that I could purposely face the sensation, and not have to tiptoe around my life.

Apt cartoon by xkcd, about tongue awareness.

OCD: A Guide for the Newly Diagnosed: Review of Michael Tompkins' Book for Consumers

When New Harbinger Publications asked if I would consider reviewing Michael Tompkins book, OCD: A Guide for the Newly Diagnosed, I was heartened to know that there was a new book on this topic. The introduction is by Jeff Bell, who wrote an insightful memoir about OCD called Rewind, Replay Repeat, which I took to be a good sign.

The book fits nicely in the hand, and adds to the approachability for those who have just found out they have OCD. Actually, Tompkins starts with describing the process of getting a diagnosis, and I'm glad he addressed the difficulty of finding mental health professionals who are actually familiar with the many forms OCD can take. I would argue that the comprehensive diagnostic process described in this book really only happens with therapists who are specialists in OCD, or who have trained in Exposure Therapy, and have treated a lot of people with OCD. The therapist who diagnosed me basically said, yes, it sounds like you have OCD.

Tompkins does an overview of Exposure and Response Prevention Therapy(ERP), Cognitive Therapy, and medication as well as other treatments, as well as what questions to ask a potential therapist, and how to get the most out of sessions.

I particularly liked the chapter on developing a "Recovery Attitude" including accepting such things as uncertainty, imperfect outcomes, imperfect knowledge, learning to approach discomfort in order to get through to the other side, turning away from debate with your OCD, seeking support, not reassurance, and practicing everyday. As someone who has struggled with perfectionistic OCD, I constantly battled with the fear that I wasn't doing my treatment perfectly or that I didn't have perfect knowledge of my OCD. Tompkins points out that "good enough" treatment is indeed "good enough," and OCD is demanding perfection that doesn't exist.

The book closes with information about unhealthy coping, school and work issues, a list of treatment centers, and recommended reading. It's difficult to fit everything into an introductory book, an at times I wanted more detail, or found too much squeezed into a section, but overall this book would be an excellent addition to a public library's mental health collection, as well as college libraries and hospital consumer health libraries.

Michael Tompkins, PhD, is a licensed psychologist at the San Francisco Bay Area Center for Cognitive Therapy.

Review the Young Adult Novel about OCD, Zelah Green: One More Little Problem

Vanessa Curtis's Zelah Green: One More Little Problem, is the next in this series about a teenage girl with OCD. The review copy came in the mail in the midst of my back going out, and I spent an afternoon in bed reading, which reminded me of much of my adolescence. Curtis has a good grasp of how stress can make rituals worse, and the double-edged sword of getting immediate relief of anxiety by doing the rituals, but the ultimate pain caused when they interfere with important things like friendship, love and family. I was moved by the description of Zelah holding her father's time for the first time since she was twelve, and how his skin felt.

Zelah's therapist, Stella, is concerned that Zelah is trying to take control of all the out of control things in her life during her summer "off"(which is anything but off from her anxieties), including her father being out of work, Caro from her time at Forest Hill showing up on the doorstep, and the most stable adult in her life, Heather, being out of the the country.

"Hmm," said Stella. "The thing is, Zelah, that none of the things happening in your house should really be your responsibility at all. I am not surprised your rituals are getting worse."

But for Zelah, calling her therapist if things get overwhelming seems alien. There's something about being that age, and just assuming that of course it's your responsibility, and the OCD compounding this by offering a glimpse of control, an illusion that if you do the rituals, the anxiety and fear will go away. Fortunately, Zelah also has friends, who help her make connections to both herself and to adults who can help.

Review of the first novel in the series:

Zelah Green: Who Says I'm a Freak

Imperfection as Completion: What a Concept!

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

via Right Brain | Chris Piazza

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

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

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.