OCD A to Z: O is For Only Obsessions

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 me 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 and suddenly thought "What if this is rude?" and my urge was to try and establish if it was indeed rude, over and over. 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, 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.

[Revisiting OCD A to Z from 2011]

OCD A to Z: N is Need to Know

"Need to Know" OCD has been a giant time-suck. 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 was 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, 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 unanswered, it gets easier to let them pass.

[Revisiting OCD A to Z from 2011]

OCD A to Z: L is for Lost Time

Lost time is one of my OCD themes. I had a realization 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 and uncertainties about whether they are making good use of their time. 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 unable to survive that grief. 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. 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?

[Revisiting OCD A to Z from 2011]

OCD A to Z: J is for Just Right Feeling

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. Its 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.

[Revisiting OCD A to Z from 2011]

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

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.

[Revistiing OCD A-Z from 2011]


Related:

History of Exposure Therapy

Exposure Scripts for Pure O and Health Anxiety

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/

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.

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.

Wordless Wednesday: Over and Over

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

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

Related Post
Finding a good therapist for OCD in the US and Canada

Intrusive Thoughts and the Search for the Answer: Part 2

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

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 a friend to play out part of the story where doctors kept women captive. Her 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.

She was 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

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. I called at 8:00 am, the time I used to start work when I was employed, and once I got off the phone, 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 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.

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?

Email and the OCD Fear of Saying the Wrong Thing

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

Am I still anxious? Does this still bother me? And other querulous questions.

It's as if I am poking someone who is sleeping, and saying "Are you sleeping?" poke, poke, poke, and then they wake up. The mental ritual of checking on my anxiety level or sensations is one of the hardest to deal with. I'm sure that some of those reading this blog have had the experience of being consumed by anxiety about a particular obsession or topic and then getting up the next day and the anxiety is gone. I assumed that once anxiety set in, only sleep could fix it, and I would long for it to be the next day.

Even more frustrating is waking up calm, and then remembering my anxiety from the day before and having it all kick up again. My immediate response when remembering an old worry is "Damn, there it is again. Why can't I get it to go away?" It's like a staticky bit of plastic that you try to flick into the trash, and it just clings to your fingers. This is followed by having the urge to check if I am still anxious or if a certain symptom or thought still bothers me, and the more I check, the more entrenched it gets.

I would recognize anxieties that would probably fade the next day, like fear that I'd chosen the wrong dish off a menu, and I'd be frustrated by my inability to step away from it sooner armed with this knowledge. Knowledge alone is not a match for the anxiety created by OCD. My theory is that sleeping would give me a break from poking at the anxiety, waking it up, and increasing its noisy dominating behavior. It wasn't a magical cure.

My therapist has encouraged me to let my anxiety producing thoughts into my mental space, letting the noise happen, in fact practicing introducing the noise into my mind, which is an exposure. I usually feel snarly when he suggests this, but I also recognize that the vigilant checking to make sure the intrusive thoughts aren't there repeatedly reminds me of them. And every "Damn there it is again," highlights the thought, magnifies it, makes me exquisitely sensitive to even the threat of a particularly despised thought.

I know this sounds crazy. If you are desperate to avoid a scary thought, and you forget it for a few hours, the last thing you want to hear is the idea of purposely seeking it out, and disrupting that bit of peace. But the peace is fleeting and leads to long term anxiety--I have never been able to force a thought out and make it stay out for good. I have learned that it is possible to enjoy life even with those thoughts making noise.

Good Friday and Scrupulosity

I confirmed my faith on Palm Sunday some 30 years ago, and then had first communion on Good Friday. OCD can infiltrate every aspect of your life, and the term for religious and moral obsessions is scrupulosity. Ironically, from the outside no one would ever suspect I had such struggles and turmoil about perfectly pleasing God. I was at church constantly. During Lent I went to every Wednesday night service and every night of Holy Week Services. I wrote prayers and devotionals. I took great pains to never hurt someone's feelings. I was quiet, compliant, conscientious, studious. I didn't swear.

This made my confirmation difficult, because as I knelt down to receive the blessing from the minister, obscenity hurtled into my mind. Suddenly, I was thinking words I would never say. I desparately wanted them gone. I agonized over what this meant about me, and how to make them stay away. I had been looking forward to my first communion, and yet, the first thing I thought of was "Will the thoughts come back?" which immediately brought the obscenities to mind in the self-generating way that OCD has. I couldn't be in the room, in the sanctuary of this church, because my OCD was compelling me into the future.

Existential questions heavy laden with intense anxiety and fear that I was doing everything wrong. Did I feel the "right" way during communion? Did I enjoy writing prayers more than loving God? How can people exist without being Christian? How do they get through life? Would God really reject them? I wrote long journal entries trying to figure this all out, until the point of exhaustion. In my heart, I had a passionate longing for God, and a sense of God's presence, but my constant analysis of every thought and action obliterated the possibility of comfort and peace.

Finally, in my 30's I stopped going to church, because the waves of compulsive figuring out of sermons, and fears of being imperfect and therefore damned and being afraid that if I couldn't figure out the meaning of suffering, or whether Christianity was the only way, or whether God was good, that I would disintegrate from the anxiety of these unanswered questions. I want to honor the heart of the girl I was, who loved God, but I'm still afraid.

Unhelpful Strategies for my OCD: Reassurance Seeking

There is an interesting article on reassurance seeking by Jon Hershfield on the blog of the OCD Center of Los Angeles. OCD is about unwanted thoughts and intrusive images, and the desperate desire to make them go away. Reassurance is, as Hershfield argues, like crack cocaine. There's an immediate hit of relief when getting reassurance that the thoughts aren't dangerous, you aren't dangerous, the world is not dangerous, but it is short lived.

The brain goes "Whoah. This must be serious if I need this kind of reassurance. I need more of it. I need it now." And the OCD desire for certainty feeds the craving for reassurance. I used a lot of Self-Reassurance, which also overlaps with my Research Reassurance.

When I have body symptoms, and OCD is active, I will check to see if they have changed, or check both sides to see if they are the same, or poke and prod at something. It's taken an long time for me to realize that the reassurance makes the anxiety worse and puts me on red alert. Ultimately, I am gaining no useful information when I keep monitoring my body. The mole will probably look the same in 2 minutes, and this neither proves nor disproves its actual danger.

I have also conducted what Hershfield refers to as the "Mental Review"--on getting an intrusive thought about saying the wrong thing in conversation, I would go over it, retrace it, try to figure it out.

Finally, Research Reassurance is a bugger. By age 17 I was looking up medical symptoms in the health section of bookstores, and then in the reference section at my college library. This was before the modern internet, and when graphical browsers went mainstream in the mid 90's, my research took on warp speed. Researching provides the promise of finding an answer, but in the process turns up other scary things, and adds even more to obsess about. There is no website labeled "Exposure Woman: This is exactly what the problem is, and here is the solution."

I also researched my own life experience, by re-reading my old journals, diaries and correspondence, whether letters or email. One of my first Exposures in ERP therapy was putting my journals in a box on a high shelf, and learning to cope with the desire to figure out if I've always had OCD, or if I didn't try hard enough to get help, or learning to make decisions without all the "background information" my OCD thinks I need to make a fully informed choice.

Hershfield ends with a sentence that is a true sign of his clear understanding of OCD cravings to have certainty:

Finally, when it comes to resisting the wealth of information (and misinformation) available from the web and other sources, it’s best to turn the computer off altogether when you find yourself just wanting to know something “for sure.” In fact, there’s no time like the present…so let’s see if you can move on from this blog without knowing for sure if you fully understood it.