OCD A to Z: Z is for Zero

I finally made it to Z! I started this OCD A to Z series in May, 2011. In thinking of a Z word, zero came to mind. For those who have suffered with OCD anxiety, there is a longing to feel zero anxiety ever again. Zero tolerance. Zero it out. Zilch. I remember my deep disappointment when I started Exposure Therapy, when my therapist said that we can't rid ourselves of all anxiety, that humans don't get that option.

OCD anxiety can be so intense, and my belief was that I couldn't cope with any more anxiety in my life. I also had a subset of existential obsessions about why there was suffering in the world, and a fear of strong feelings, with a belief that those would kill me. OCD is sneaky in giving the illusion that it's possible to escape anxiety entirely if you just do the rituals correctly. What I have learned in therapy though is that the wish to eradicate all anxiety is far more corrosive than the actual anxiety of life. OCD is such a heavy burden to add to the stresses and griefs of being human, and it is possible to thrive and get better and deal with the dictatorship of OCD rituals, and live life, in spite of difficult and painful things that happen.

Revisiting OCD A to Z from 2011

OCD A to Z: Y is for Yet Again

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

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

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

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

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

(Edited to add: biopsy was negative.)

Revisiting OCD A to Z from 2011.

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

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

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

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

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

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

Revisiting OCD A to Z from 2011

OCD A to Z: P is For Perfectionism

Perfectionism is a big part of my OCD. One of the biggest obstacles to doing Exposure and Response Prevention Therapy(ERP), is looking for "perfect" ways to do it. I've had some readers query whether I actually have Obsessive Compulsive Personality Disorder(OCPD) rather than OCD, because of all the posts I've written about perfectionism.

My understanding, via my therapist, is that there is an element of finding perfectionism to be pleasing rather than painful in the case of OCPD. My impulse is to look this up, but I've looked it up in the past, and I know the familiar trap of wanting to get everything just right.

As a child, I decided that I could be loved by my family only if I never made a mistake again, and I strived to always to get things right on the first try, or I would procrastinate, in order to avoid failure and the feared consequence of becoming worthless and unloveable.

Avoidance became one of my major compulsions, as OCD got its claws into my fears, ever the vulture circling. The most frustrating aspect was that often I didn't even know what "perfect" was in any given situation, just that whatever I was doing was "imperfect."  It was a moving target, always changing, and if I finally felt "aha, that's it" then my mind would generate some other aspect needed to make perfect.

It's been a battle accepting that my mind will probably continue to generate thoughts of not being good enough, or done, or finished, or that I've ruined a day, or my life. But I also see that I don't have to jump when these thoughts arrive, scrambling to fix things, make things perfect.

Perfection is a corrosive illusion. The "Perfectionism is actually an advantage" truisms used to send me into compulsive searching to find out if this was really true, because I could never be wrong, always had to figure things out. But I know from experience that perfectionism is most likely to prevent me from getting things done, keeps me searching for photos on flickr past the first couple pages, or delaying writing posts until I find the "right" topic. I have met amazing readers with OCD through this blog, in all its imperfections, and offered some hope, and that is what keeps me going.

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: F is for Feared Consequences

Whatever your obsession is, there is a feared consequence that fuels the leap into compulsions. This is useful information for constructing exposures. The irony is that OCD claims to protect you from whatever consequences you fear, but can instead bring on those consequences. I notice this with reading obsessions.

I sometimes get the thought that I might not truly understand what I just read, so I go back and read it again, and again, and get stuck on one page. The rereading is the compulsion, in an attempt to prevent misunderstanding, and yet this makes it even harder for me to understand what I am reading, because I am disrupting the flow of the writing. An exposure would be to keep reading, even if I'm not sure I understand.

This also happens with conversations, and a desire to include every possible detail the other person needs to understand fully. This made my sessions with my exposure therapist a challenge at first, because my efforts to include everything made it difficult to focus on anything. I feared he wouldn't be able to help me if I wasn't absolutely thorough, but humans can't convey every possible fact in an hour, and it actually is overwhelming to be listening to this, and makes it harder for the other person to understand.

Jonathan Grayson has a section about these obsessions and tactics for doing exposures in his book Freedom From OCD.

[Revisiting OCD A to Z from 2011]

The Questioner Tendency and OCD

I just finished reading The Four Tendencies by Gretchen Rubin, and her telltale sign of being a "Questioner" is that you dispute the validity of taking the quiz to find out what your tendency is. . .Yes, that would be me. In fact, it was an exposure for me to take the quiz, and tolerate the anxiety that the framework might not be valid. To be able to still learn from Rubin's observations is part of the flexibility that has come through doing Exposure and Response Prevention Therapy.  Rubin's quest has been to find the motivations for habit change, whether you meet inner and outer expectations.

Questioners question all expectations; they’ll meet an expectation if they think it makes sense--essentially, they make all expectations into inner expectations.

The desire to research can cause decision paralysis in Questioners, and I believe that OCD can take this to an extreme in the theme of indecision and perfectionism. As I've written on this blog, indecision was a struggle because of the fear of making the wrong decision and being haunted by anxiety. My research consumed much of my time. My librarian training only added to this desire for more and more information.

Rubin notes some ways to help overcome analysis-paralysis.

• Setting an action deadline
• Following the advice of someone you respect
• Limiting information sources

These ideas echo what Leonard, my ERP therapist advised. Because he was willing to answer my questions initially about OCD treatment, and point to the research on the success of ERP, I learned to respect him, and be willing to follow his advice. He knew I was a Questioner, and in addition to providing that initial information, explained that a pattern of continual questioning becomes reassurance and makes the anxiety worse by reinforcing it.

Flipping a coin was one strategy for setting a deadline, which I practiced at the grocery store.

Leonard would ask me to imagine what someone without OCD would do in a particular situation, and take my best guess as to the action to take. Yes, it is scary, but OCD promises perfect knowledge and perfect results and never delivers. 

Others with OCD might not be Questioners, but Upholders, Obligers or Rebels, and need different strategies to motivate themselves.

For an Obliger who meets others expectations but struggles meeting their own inner expectations, treatment for OCD could be more effective with accountability: exposure homework from a therapist, or attending a support group and having an accountability partner to call when a task is done. 

For a Rebel, who has struggles meeting both outer and inner expectations, accountability can aggravate the "you can't make me" response. Appealing to values and identity can help free up the oppositional pattern, as can framing exposures as a choice, not a demand. Jeff Bell has written about how focusing on what you value can give the impetus needed to face uncertainty and move ahead in spite of anxiety.

For an Upholder, who readily meets both outer and inner expectations, reading a book like Jonathan Grayson's Freedom from OCD and following his suggestions for Exposure and Response Prevention Therapy could make more sense to them than support groups or even therapy. 

Four Tendencies Quiz

RELATED POSTS

I is for Indecision

N is for Need to Know

An Imaginal Exposure Script for Indecision OCD

Indecision at the Library

Just One More Search: Information Overload and OCD

Anxiety in Creative Business: Tara Swiger and Encouragement that You Can Move Forward

This podcast on Depression and Anxiety in Creative Business from Tara Swiger caught my attention, and I wanted to write about it. Tara also sent this introduction to a follow up webinar:

Studies show that 1 in 5 adults deal with mental health issues at least once in their life.

And yet, there's so much shame and stigma about talking about this.And still, in the last few months dozens of students and friends have told me about their depression, anxiety, or struggles with their kids health.
I understand not everyone is called to talk about their experience publicly...but when we ALL stay quiet, the stigma grows strength. So today on the podcast, I'm getting honest.
You’re not alone in this.
You are NOT alone in struggling with this. And as I share, I want you to remember – whatever you’re struggling with, not only are you not alone, but you can also move forward WITH IT. Exactly as you are. People are doing it. You don’t have to be different, better, or “more together” to make a business thrive.

I have a creative business, and when I have anxiety, sometimes I come to a halt in the belief that I can't move forward WITH IT.  But the truth is I started creating art in the depths of my anxiety, and went on to start my Etsy shop in 2007 just a few months after I began Exposure and Response Prevention Therapy for my OCD.  The Exposure for me was to create the shop without knowing if it was "perfect" or the right photos, or the right descriptions, or whether anyone would ever want to buy anything. 

Tara describes how reading about intolerance of uncertainty resonated with her when thinking about her own anxiety, and this is a key theme of mine as well.  All those What If questions, the desire to know how things will turn out before they happen.

Struggling with manually creating Wordpress website for my business was the next step to realize I was compulsively researching how to do it, when in fact, I needed something simpler, and the anxiety of letting go of the idea that I needed to know how to do things before I knew how to do them.  

A turning point was at a craft show, when a woman spent a long time checking each of my items for the most "perfect" one.  The piece that the craft show customer liked the best wasn't the most flawless in her eyes, so she told me she was choosing another one that had no visible defect.  Talking with my ERP therapist, I recognized myself in this woman.  Shopping for anything would drag on because I couldn't decide if a "flaw" would mesmerize me forever or eventually fade, and I would get angry at myself for latching onto such tiny things.  

It was huge to know I was making imperfect art, but that I wanted to do it anyway.  That I did not want to walk away from something I truly loved, because it was flawed.  I now work full time in my creative business, and yes, when anxiety flares up it is difficult, but part of the difficulty is in believing that I must entirely banish the anxiety to accomplish anything, and that it is a sign that I am a "bad person" if I feel anxious. The underlying premise of Exposure Therapy is that you can move forward through the anxiety, that it is possible, and for this encouragement, I am grateful. 

 

The Mindfulness Workbook for OCD: Just Right OCD

I was glad to see a chapter on this form of obsession of doing things "just right, " also known as symmetry OCD, organizational OCD, and perfectionism OCD.  The authors get the fact that the opposite of "just right" feeling is "feeling dead wrong," which has emotional intensity.

The one compulsion that resonated the most with me was:

• Checking to see see if things appear as you feel they should(for example, reviewing the placement of two pillows on a bed to make sure they are in the perfect position.)

When my health anxiety would be active, I would check whatever symptom I had against the opposite side of the body.  This summer I had a feeling of a something stuck in my throat, and my urge was to keep checking to see if my tonsils were parallel, and then feeling ashamed that I looked in the mirror, and berating myself for my vigilance.  

An Acceptance tool for Just Right OCD is allowing the "off" feeling to be there, noticing the body sensations, and carrying it with you "on your way to doing something greater than your compulsive fixing."  

An Assessment tool for Just Right OCD is dealing with all or nothing thinking.  When I used to sew for Home Ec class, I would become so fixated on any small asymmetry of top stitching, and therefore the whole garment was "ruined," even though other people would have a different frame of reference, and not even notice the stitches, but rather overall shape of the garment.  Ironically, I won an award for excellence in Home Economics in 9th grade, even as I was convinced any flaw meant I was incompetent.

Taking Action for Just Right OCD includes recognizing that focusing on perfection can mean a tiny trigger can feel as disturbing as something more obviously huge, so setting up a hierarchy of exposures can seem impossible.  

It's important to get in there and take any opportunity to let things feel "off" rather than trying to fix it.   Trying to decide if I had a hierarchy of exposures "just right" could take up all my time and it helped that my ERP therapist understood this and encouraged me to practice tolerating the thought that I might do my exposures wrong.  

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.

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.

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

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.

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.

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.

Back Pain and my OCD.

I put my back out this week. I struggle with the presence of physical pain and the OCD that swoops in to complicate it. The first time I hurt my back, I was all of 24, and visiting my father for vacation. He asked me to vacuum the floor, and by the next morning, I couldn't get upright without my muscles seizing up. I'd never felt anything like it, but I knew that it had to be my imperfection and general deficiency that caused it. Having compassion for myself was not something that came easily, if at all. I had recurring back pain all through my 20's and into my 30's. I did have some physical therapy finally, when I was starting grad school, and the MacKenzie back exercises helped. But I went everywhere with a back pillow, and sat near the aisle so I could go stand up during concerts or lectures. I lived in fear of situations where my back might go out and there would be no way to get relief, or that I would be humiliated by my weakness.

I planned everything around how long I had to sit. I knew where the straight hard chairs were in any place I went to frequently. Once I graduated, and started a new job, my back seized up to the point that I had my husband drop me off a few blocks early to give me a chance to get fully upright before I got to the front door. I was depressed. I was anxious. Once my health insurance started, I went to a physiatrist, and got a referral for more physical therapy. This calmed my back for awhile, but the flare ups continued for a few more years, and then slowly, as I was doing therapy for my depression with Molly, my back stabilized. It seemed like a miracle.

On occasion, my back would get stiff, but recover quickly. But this week, after many situations of uncomfortable chairs--getting my hair washed at the beauty shop(which I do about once a year), meetings, long car trips--and lots of time in the studio, my back protested. I've started my Mackenzie exercises again and that has given me some relief, but I still have 3 more craft shows to get through, and the place I feel worst is in my studio, which is frustrating me, and I feel sad that what I love to do most, make art, is where the pain is aggravated. My OCD is all over this, and the more anxious I feel, the more I do things that make my back hurt even more, rituals of sitting at the computer too long. Slowing myself down is hard. The perfectionism is always in the background shouting about my need to do everything exactly right(whatever that means, since the standard always changes). I am working on it though. And know I may need to go back to the doctor and ask about occupational therapy.

If you have chronic pain and OCD, what helps you? I'd love to hear.

OCD and Serenity

I've been thinking about the Serenity Prayer this week.

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

A lot has been going on and I am dealing with it. My skin biopsy came back benign, and I didn't have the backwash of figuring out whether I'd made a mistake in calling the dermatologist, and being "oversensitive." I took my best guess, and the moment before calling was worst, but I also was accepting that I couldn't diagnose cancer by checking my ear constantly, and that felt so much better than standing in front of the mirror, holding a handmirror and a flashlight and contorting myself to get a glimpse. My mother was back in the hospital for the second time with fluid under her lung, and although I was concerned for her, I didn't research the procedure.

The challenge I always had with the Serenity Prayer is the last line, the "wisdom to know the difference" between what I can and cannot change. In my obsessiveness, I would attempt to definitively figure this out, because I had to be right, or I was a failure as a human being. I had the illusion I actually could have a 100% success rate in predicting whether I could change something, or whether I needed to accept it. Over the last few years of ERP treatment for my OCD, I've come to see that this prayer actually ASKS for the wisdom to know the difference, and this implies that at times we will fail in distinguishing this.

There are some aspects of the 12 Steps that I really resonate with, particularly the idea of life becoming unmanageable when in the power of the disorder. Part of me really hoped that I wouldn't have to deal with uncertain symptoms, health problems, or my mother getting older, and my despair when these things happened was overwhelming. I ritualized to try and make the anxiety go away. Research heart surgery. Research skin cancer. Check my skin. Over and over. But we are embodied creatures, and our bodies are not immortal, and can be injured. The enormity of this is catastrophic when you aren't getting any help for the OCD. The compassion of my therapist, my husband, members of my support group, and blog readers helped me see how much of a burden this can be, and encouraged me to find some kindness for myself.

The Uncomfortable State of Giving myself Credit

So it's been two weeks since I wrote my last post on perfectionism which resonated with several of my readers, and I have been avoiding writing another post since then, because my perfectionism says, "Ok, that post was helpful, so the next one better be even more helpful." Perfectionism raises the bar so that satisfaction is never possible. I am also realizing more and more how uncomfortable it is to give myself credit for what I have accomplished in dealing with my OCD, and that this too is a manifestation of perfectionistic OCD. This is often accompanied by my feeling on trial by my OCD.

So what is it that I fear will happen if I acknowledge the work I'm doing?

• Even more will be expected of me
• I will fail
• This will prove that I am a worthless human
• I will discover it's not possible to be perfect, and that small steps are acceptable, and I will be faced with a flood of sadness about all the time I've lost to perfectionism
• I won't be able to survive the sadness, because it will haunt me every minute

I am learning to make room for affirming of myself, but the remnants of all the old stuff cling stubbornly. I also know that there is a deep sadness about the missing years, but that the more I flee from the grief, the more it ensnares me. I also know that I respond much better to self kindness and compassion than to self denigration. At one point this is all I had to go on, in faith, that kindness worked, and even if it seemed crazy to be kind to myself, that if I wanted to heal, I needed to take the risk and be gentle, even if it was with gritted teeth.

If you are struggling with perfectionism, please know that it is possible to learn how to exist in the world without a constant striving for the perfect, that happiness is possible. Perfectionism can feel like a sticky film that refuses to be washed off, but it is not invincible. To write something that helps others with OCD is one of the most rewarding experiences I've ever had, and although my OCD clamors that I'm not feeling the gratification "perfectly right and sustained", I can still claim the moments of clarity, of being enough, of being myself.

Wordless Wednesday: Perfectionism

Photo by Mr. Ush.

15 Minutes at a Time: The FlyLady and Exposure Therapy for OCD

In January, faced with increased difficulty finding things in my house, and general chaos, I remembered reading about the FlyLady, and went to her site. Just going there was an exposure for me, since my perfectionism starting raring up, but what I like about the FlyLady is an explicit acknowledgment of how much of the home clutter chaos stems from this very perfectionism. The fear that you have to do it "right" and all at once, and rip apart every closet and scrub every surface.

She advocates doing 15 minutes at a time, and then stopping. That's the hardest part for me. My perfectionism OCD gets entangled in this, and once I start a task, I feel anxiety at the thought of stopping before the task is done, even if there's no clear ending point, and so I keep going until I exhaust myself and it seems preferable to avoid cleaning at all. For someone with contamination OCD the feared consequence may be that nothing is clean enough after only 15 minutes.

The FlyLady is practicing a form of Exposure Therapy. She dares her readers to do housework imperfectly, incompletely, incorrectly. The irony of OCD is that it's all about the anxiety not about reality. Avoiding cleaning altogether is not more "perfect" than doing 15 minutes at a time. A refrain on the FlyLady forums is "I've got so much to clean up that 15 minutes isn't enough time." This kind of thinking is part of why I didn't start actually doing exposures right away when I finally found an Exposure Therapist.

I saw the enormity of my compulsions and anxiety, and I wanted to be better immediately because I was in pain, but also because my perfectionist OCD made it seem dangerous to have a learning curve, to proceed slowly, by trial and error, imperfectly, haltingly, erratically. I needed to do things instantly, the first time, or my feared consequence was that I was a worthless failure. Again, the reality is that avoiding learning or taking small steps serves to give a relief from the anxiety of facing the fear, and yet paradoxically, set me even further behind in getting better from my OCD.

What I have learned in therapy is that anything above zero is good. 30 seconds of resisting compulsions is good. 1 minute. 5 minutes. 15 minutes. It's all good. Exposing myself to something I fear, even if it is the least of my fears, is good. Perfectionism says that you either get better all at once, or you don't get better. This doesn't give me my life back. It keeps me trapped in my compulsions. In 15 minute increments I have cleared through the chaos of my house. The FlyLady motto is that you can do anything for 15 minutes, but for 2011 she's challenging us with a new motto: Let's Go for Seven in 2011

Seven minutes on the timer, because 15 minutes can still be too daunting. The FlyLady says that housework done incorrectly still blesses your family, and in the case of debilitating rituals, this is a powerful statement.