No Shortcuts

When Jeff Bell, spokesperson for the International OCD Foundation, spoke for our OCD Twin Cities event, one of the things he said that really stood out to me was that there are no shortcuts in treating OCD.

Woman and maze

That’s true, or at least it was in my case. I wanted easy answers: for deep theological conversations to solve my problems, or for comfort and reassurance from friends to be enough, for an hour-long conversation with a therapist each week to take away the anxiety, for an easy prescription to fix everything.

I definitely did not want the hard answer: exposure and response prevention therapy.

My psychiatrist didn’t mince words in his description: “It will be hell.”

It was one of the hardest things I’ve ever had to do in my life, but one of the most necessary and most rewarding. For me, there was no shortcut to healing, and since I was already living in OCD hell, the best way out was to keep going.

So, believe me, friends: I get it. ERP therapy is hard, so hard. You might think you won’t survive it. You might think your loved ones won’t survive your going through it. You might think it’s sinful or disgusting, and your exposures are probably going to be loathsome and repellent to you.

If you need to, go ahead and look for shortcuts. I know I had to.

But in the end, there were none for me, and I’d only wasted time looking for them.

While experiencing it, ERP was hell. But on the other side? It was my rescue.

 

Do I have OCD?

Before my diagnosis and, hence, before I’d done a lot of personal research on obsessive compulsive disorder, I thought of OCD as “that disorder where you wash your hands a lot” or “the one where people tap the doorknobs” or “when you’re a really big neat freak.”  In some ways, my diagnosis was a surprise to me because I didn’t do any of those things.  But on the other hand, just the term obsessive sounded so much like my situation that I was willing to listen.

Maybe a year or so into my original search for medication (I ended up taking a year-long hiatus from the search after Luvox stole all my energy), I suddenly started worrying (or maybe even obsessing) that what I had wasn’t really OCD.  I seem to talk to a fair amount of obsessive-compulsives who also reach this point, worrying that maybe someone has plastered a name on them that is incorrect.  The interesting thing about this is that the OC usually feels guilty about it– as if they are receiving compassion and medical advice and help from friends and family for nothing, or what they are worried is nothing.

Interestingly, such a huge worry and incredible guilt only point to OCD all the more.

The more I have learned about OCD, the easier it is for me to see it in others.  Though I am by no means a doctor, I now believe that OCD is pretty easy to diagnose.

birdcage2

 

It’s all in the name.

Obsessive-compulsive disorder.

 

1) Do you have obsessions?  Basically, do you have intrusive thoughts that you find ugly or disturbing but that you can’t seem to stop thinking about?  Common themes center around questioning your sexual orientation or if you really love your significant other, thoughts about harming yourself or others (even children), blasphemous or sinful thoughts, worries that you or people you love are going to die, sexual obsessions, intense fears about contracting a disease.  Ask yourself, do I have intrusive thoughts that cause me serious anxiety?

2) Do you have compulsions? The answer to this question might not come as easily, but what it is really asking is this: when I have those intrusive, anxiety-causing thoughts, what do I do to attempt to relieve that anxiety?  Maybe your fears about germs cause you to wash your hands, making you temporarily feel a bit of relief about that possibility.  Maybe your fear about harming a child means that you won’t allow yourself to hold your baby girl.  Maybe it even means that you avoid driving down the street where a lot of children play.  If you have blasphemous thoughts, perhaps you repeatedly ask God for forgiveness or you’ll ask other people if you think that means you are now going to hell.  Sometimes compulsions seem a little “magical” too– for example, you relieve the anxiety caused by your intrusive thought by tapping your foot a certain number of times or by avoiding stepping on cracks.  Even if it doesn’t logically make sense, it’s still something providing you some temporary relief.  Seeking reassurance is a huge compulsion for a lot of different kinds of obsessions: we glimpse relief when friends reassure us, No, you’re not gay.  No, you’re not going to get sick.  No, you would never hurt a child.  No, you’re not going to hell for that.

There is a third question to ask too, although this one may or may not be reached immediately, which is
3) Have your compulsions gotten out of control?
Most obsessive-compulsives reach a stage where the compulsions (that began as an anxiety-reliever) become too much and begin to add to the anxiety: you can’t stop washing your hands, you ask for reassurance so constantly that your friends are annoyed, you are driving a long way out of your way to avoid the street with children, you are tapping doorknobs and counting and repeating phrases in your head to the point that you’re starting to look a little silly.

Like I said, I’m no doctor, but when I talk to someone who wonders if they have OCD, these are the three simple questions I ask.  If you can answer yes to the first two, then you have OCD.  

So, what next?
1. Get an official diagnosis from someone who went to school for it. 🙂
2. Skip the talk therapy and go right for cognitive-behavioral therapy.  This is treatable.

 

 

There’s so much more to OCD than hand-washing …

washing handsIf you use Google Images and search “OCD,” what you end up with is a lot of photos of lame OCD jokes and of soapy hands.  It reminds me just how little the world really knows and understands obsessive-compulsive disorder.  Heck, before my own diagnosis, I myself pretty much thought of it as “that disease where you wash your hands a lot or have to tap the doorknob over and over.”  Insightful, Jackie.

While it’s true that contamination obsessions are a prevalent theme among OCD sufferers (I read somewhere that about 60% of OCD cases deal in this arena), that’s not the only obsessive theme.*  And even hand-washing is often misunderstood.  People just don’t understand that there are persistent, unwanted, intrusive thoughts that are driving the hand-washing or other compulsions.  Compulsions are a response to what I personally think is the darker half of the disorder: the obsessions.

* Other common obsessive-compulsive themes include a need for order or symmetry, hoarding, checking, sexual obsessions (including HOCD, in which a straight person obsesses about being gay, or a gay person obsesses about being straight), religion/morality/scrupulosity (my OCD world!), and aggressive thoughts around harming others or one’s self.  OCD is probably bigger, wider, and scarier than most people ever imagined.

 

The Problem with Seeking Reassurance

For years, one of my biggest compulsions was seeking reassurance.

Do you think I’m going to heaven?  Do you think it was wrong I did such-and-such?  Do you think I hurt so-and-so’s feelings?  Do you think yadda yadda yadda …

My obsessions were like burns, and when someone would reassure me that things were okay, it was like sticking my burned fingertip under cold running water.  The relief felt real … but it was temporary.

Ten minutes later, I’d want to ask again.

(And quite often I would … sometimes to where I would frustrate my family and friends.  They would sigh deeply and look at me with these terribly sad eyes and repeat, “Jackie, no.”)

It functioned just like all compulsions– it provided a temporary relief from my obsession, but then it gets out of control.  I didn’t realize it at the time (and neither did my friends), but all they were doing was enabling my OCD.

What would have been better (although much, much harder for both the OC and the friend) is to say, “Look, there are a lot of things we can’t know with certainty.  What you’re afraid of is POSSIBLE … but it’s not LIKELY.  Let’s look at the available evidence.”  Of course, no obsessive-compulsive wants to hear even an ounce of uncertainty … uncertainty doesn’t soothe the burn like cold water.

At least, not immediately.

But as you introduce the idea of uncertainty into your life, and you learn to embrace it, what happens is that you start to heal.  It is hard for EVERYONE, but it is BETTER.  Reassurance only leads to seeking more reassurance.  Uncertainty leads to acceptance and healing and a new life.

Now, of course this is difficult.  Who wants to say to a crying child, “Something bad MIGHT happen if you don’t organize your locker”?  Or to a terror-stricken young adult, “It’s POSSIBLE you could catch a life-threatening disease if you don’t wash your hands right now”?  Or to someone who is weak with guilt, “We can’t KNOW for SURE that God didn’t heal your mother because of something you did”?  It’s agony all around.

But it is better.  Healthier.

And then you can follow things up with, “What evidence do we have available to help us make decisions?  Other students have messy lockers, and they usually go about their day just fine.  Even if you did get sick today, it probably wouldn’t kill anyone– in fact, lots of people have been sick at your workplace in the last year and no one has died.  It’s more likely that your mom died due to her illness than to your actions that aren’t connected.”  Obviously, these are hard.  They don’t erase uncertainty.  And that is the point.

Remember, uncertainty is the key to healing!!  That is why obsessive-compulsives need to surround themselves with cheerleaders not enablers, people who are willing to do the hard business of tough love, even in the face of tears and terror.  It means anxiety in the short term– but joy in the long term!

thoughtful girl

Guest Blogger! Checking OCD: Never Quite Sure

Happy Monday, friends!  I wanted to introduce you to some other types of OCD, outside of the Pure-O that I have suffered from.  Today’s post about checking OCD comes from Tina Fariss Barbour of the Bringing Along OCD Blog.  I encourage you all to visit her blog and subscribe to her!  Thank you, Tina, for today’s insightful post!
Thanks,
Jackie

Checking OCD: Never quite sure
By Tina Fariss Barbour

I’m cooking a simple meal of pasta and sauce. I can heat the sauce in the microwave. But I need to use the electric stove to boil the pasta.

The water boils and I cook the pasta until it’s done.

Then I reach over to turn off the stove.

I carefully and slowly turn the knob towards the off label. Slowly, slowly. I’m waiting for the click that tells me I’ve reached my destination.

I hear the click and stop turning. It’s off.

Or is it?

I squint at the off label. Does the line on the knob match up with it enough? Is it supposed to be exactly in the middle of the label, or can it be off-center?

And did I really hear the click? Was it the right click? Was it something else in the kitchen that made a clicking sound?

I reach over and turn the knob so that the stove is back on. The pan with the pasta is still on the stovetop.

I turn the knob off again. But I turn it too fast, I think. The click sounded different, and I didn’t feel the slight vibration under my fingers that the click usually makes.

Even though the line on the knob looks like it’s right under the off label, the click didn’t sound right.

I turn the knob again. The stove is on. I say that out loud.

“The stove is on.”

I turn the knob carefully, concentrating. I hear the click.

It’s off. I say that out loud.

“The stove is off.”

I’ll just look at the off label one more time.

Looking straight at the label, it looks like it’s lined up with the knob. But when I look from an angle, it doesn’t appear to be right under it. Which perspective is correct?

And the knob moved a tiny bit once I took my hand off of it. Does that mean it moved back into an on position?

I turn the knob on again. On. Turn. Listen. Off. Stare. Turn. On. Turn. Listen. Off. Stare.

Two hours later, I drain the water from the pasta.

That scene depicts a ritual that I have carried out, in different places, with different foods on the stove, for different lengths of time, many times.

The scenery may have changed over time, but the underlying fear has been the same: if I don’t properly turn off the stove, it will ignite something, there will be a fire, and people will die.

That fear of harming others is the basis for my checking. It makes checking one of the most challenging of my symptoms of obsessive-compulsive disorder.

Before I was diagnosed with OCD at age 26, I didn’t know there was a name for the actions I felt compelled to perform everyday. I thought of the actions as a way to “just make sure everything’s all right.”

Besides my obsessions with stoves, I’ve checked to make sure lights are turned off, the water faucets have been turned off, there are no clothes dropped behind the dryer, the dryer filter is properly free of lint, soap is completely rinsed from dishes I’m washing, and on and on.

Checking takes up a lot of time. And when I stand and stare at a light bulb, trying to convince myself that it is dark, not lit, I can feel the anxiety invade my body: I get hyper, my legs and arms feel numb, and I want to scream and run away.

When I started taking medication for my OCD, my checking compulsions lessened quite a bit. But I still find that the compulsion to check comes around, especially when I’m particularly stressed.

Lately, I’ve been using a form of the therapy that Dr. Jeffrey Schwartz writes about in his book “Brain Lock.” My therapist has modified it a bit.

Basically, when I turn off the light, or turn off the faucet, and feel the urge to check it, I tell myself, it’s the OCD that wants me to check. My brain is different because of OCD.

Then I refocus on something else, which many times, means walking away from the light fixture, shower faucet, or whatever it is that I want to check.

My goal is to accept that I will have anxiety during these times, but I will not give in to the compulsive urge to check. Every time I resist the urge, it makes it a little easier the next time.

Checking is all about looking for certainty, certainty that nothing bad will happen because I haven’t done something dangerous like leave the stove on.

But none of us—those of us with OCD and those without—can ever truly know certainty as long as we live as humans here on earth. We must learn to accept and even embrace the uncertainty and live life anyway.