Question & Dancer: Compulsions, Doubt, & HOCD

question-and-dancerI’m an artist not an expert, one who is learning to embrace questions more than answers.

These are some questions I got last month. Ask yours here.

Donnann asked: How do i deal with intrusive thoughts in the form of questions which sometimes i feel like i need to answer? They give me anxiety not finding an answer either by googling or asking reassurance.

Hi friend, asking reassurance (of friends, strangers, Google, the internet, etc.) is, in this case, a compulsion. Compulsions will never be the solution for an OCD sufferer. In the moment, it might feel good, but it is not a lasting solution. I’ve shared a metaphor before about OCD as an arsonist, setting fires in various corners of our brains. Compulsions are short-sighted in that they try to put out individual fires. It is impossible to keep up this way because while you are putting out one fire, OCD the Arsonist is setting another three. Exposure and Response Prevention (ERP) therapy, on the other hand, goes after the arsonist itself. Compulsions are band-aids; ERP is surgery.

Aurora asked: Is it common for HOCD sufferers to begin questioning whether they really have OCD?

Incredibly common, and not just with HOCD. I think that just about every person who has OCD of any stripe has, at one point or another (or a thousand points), wondered if he or she really does have OCD. Remember, OCD is called the “doubting disease.” It lives up to its name in the fullest sense, even down to a diagnosis. I know that, even when I was diagnosed with OCD and then read a book about it in which I saw myself over and over in the examples, I still faced that question. Everyone I know who has OCD has had this same concern. You are not alone!

Susan asked: What do you do when in church and the bad thoughts come?Also how do you stop ruminating?

This is not going to be a popular answer, but here it is: you let the bad thoughts come. You let them just be thoughts and don’t assign any special value to them. You let them exist and you do not fight them. OCD feeds off resistance. When we quit resisting, it gets bored with us. You learn how to do this in a healthy way via Exposure and Response Prevention (ERP) therapy. Just twelve weeks of ERP set me free after 20 years in bondage to OCD. After I learned to stop resisting and to not give bad thoughts too much value, they quit coming as often. In the first 18 months after doing ERP, I had no obsessions or compulsions. In the years since, I do very little ruminating (maybe one or two obsessive relapses each year, no more than a couple hours each). Compared to my nearly constant ruminating for two decades, this is peace and freedom.

Briana asked: Am I ever going to find someone?

Briana, you and me both, girl. I’m window shopping on eHarmony. How about you?

Halima asked: What have I done to deserve this?

Nothing, dear one. Illness sometimes just is what it is. That said, as one of deep Christian faith, I do have lots of thoughts on this. But I don’t believe it is a punishment at all.

Halima asked: How do you manage your OCD in different times of the day when the feelings of doubt and uncertainty are the most crippling?

It has been nearly nine years since I underwent the ERP therapy that changed my life. I very rarely experience that high-intensity, crippling doubt anymore, even though I was well acquainted with it for two decades. When I do have these attacks, I go back to my ERP toolbox: I accept the thoughts, I do not assign special value to them, I refuse to succumb to compulsions, I assess what the community standard is (or ask friends if I cannot tell this myself), and then I go forward with that standard. I make this sound so easy, and I know (believe me, I know!) that this is not easy, not at the beginning. In exposure therapy, you are trained how to do this, and your brain is actually re-wired so that you are able to do this. The brain actually physically changes. That might sound scary, but for me, it has allowed me to be the very best version of myself in all ways: I am more curious, more thoughtful, more productive, more creative. ERP did not erase my questions. It gave me the tools and strength to approach them in a productive way. Before I would just chase questions around and around and around, like a dog chasing its tail.

I also think naps are awesome. 🙂

Anonymous asked: What if you do see a major loss of attraction to the gender you’ve always been attracted to but don’t see a spike in false attractions to the same sex?

This sounds like so many HOCD stories I have heard over the years. The answer is still the same: exposure therapy. I invite you to read more about this from Hannah and Mae, a couple of former HOCD sufferers who each went through ERP:

Interview with a Former HOCD Sufferer
Another Interview with a Former HOCD Sufferer
A Third Interview with a Former HOCD Sufferer
A Fourth Interview with a Former HOCD Sufferer
Q&A with Former HOCD Sufferer

HOCD Story: Meet Mae, Part One

HOCD Story: Meet Mae, Part Two

Anonymous asked: Hocd or never was? – I was diagnosed OCD about 7 years ago. Had many OCD behaviours, fear of aids, terrified I’d commit a crime and would be arrested, checking I haven’t hit someone with my car, checking food, washing my hands and lips because I felt dirty or was too close to something I deemed dirty. My biggest one is hocd. I was treated for it and had good success, thoughts were still there but I coped. But since starting uni and wanting a career as a beauty therapist it’s come back big time. I have a recurring obsession about a past friend who I still sometimes see that I’m attracted to her. It will kind of rotate friends and aquaintanxes until they’re spent and then come back to her as a ‘failsafe’ as my mum calls it. But recently, I foolishly looked for reassurance on a message board, and found a post that said after therapy for hocd you might find out your gay and apparently that’s ok. Now I’m terrified to do my ERP/CBT homework. I’m also thinking it keeps resurfacing because I’m actually attracted to women and must accept it. I sometimes don’t feel disgusted anymore and not anxious and that makes me even worse. I’m just so scared that I will turn out gay, have to leave my boyfriend give up on my future family with him. I’m so scared sometimes I feel not scared anymore. I’m so lacking sleep right now. I’ve referred myself to a therapist again, but I’m terrified he or she will reveal I’m gay. I’m so afraid, please help? I read your interview with a former hocd sufferer and pray that can be me soon.

This is a very common fear for people going through ERP/CBT– that it will actually “reveal” something about them, whether that is related to their sexual identity, their “life of crime,” their “evil nature,” etc. It’s important to remember that OCD goes after the things that are most important to us, the things we deeply value. That is what makes it so hard to do ERP. If OCD went after things we didn’t care about, it wouldn’t cause that anxiety and all the questions. Stop assigning special value to these thoughts (“it must keep resurfacing because it’s actually true”); it keeps resurfacing because you have OCD and your sexual orientation is of utmost importance to you, that’s all. I’ve talked to MANY HOCD sufferers, and I’ve never heard one of them say they wish they hadn’t done exposure therapy. I am doing my best not to offer reassurances in this response (I don’t cater to compulsions!), but it’s hard! I will just say that I don’t think you can go wrong with ERP.

Thanks for all the questions, folks! If you have questions for me about anything (but especially faith, creativity, and mental illness), add yours here.

As I said, I’m an artist not an expert. I will leave you with these, some of my favorite questions in one of my favorite poems, “Questions about Angels.” Click here to hear Billy Collins himself read it. (P.S. It starts with questions, ends with a dancer.)

 

 

 

the very worst thing

There were days when my OCD would tear my worldview out from under me.  Things that I had thought were solid things to stand on (GOD-IS-GOOD, I-AM-SAVED, IT’S-OK-TO-MEET-NEW-PEOPLE, HUMANS-ARE-REALLY-HUMANS, etc.) turned into vapor beneath me, and there I was, seeming to free-fall forever.

A real, only slightly altered conversation with a former roommate:
Fanny Fakename (frustrated): I can’t believe this!  I can’t believe this!
Jackie: What?  What happened?
Fanny (in anguish): I just found out that my tennis retreat is the same weekend as this political rally I wanted to attend!
Jackie: Oh.
Fanny: The same weekend!  This is terrible.  What am I going to do?  This is the worst thing that has EVER happened to me!
Jackie: thinking harm thoughts even though that is not her regular type of OCD 😉

One thing that OCD has engendered in me is perspective.

Right now, I am trying to lose weight, and it’s been a tough battle for me, but tonight I was praying aloud in my shower and what slipped out of my mouth was, “Thank you, God, that this is not an OCD thing.  I can handle this.  OCD was the very worst thing.”

Perspective.  Love it.

What is the very worst thing that has ever happened to you?  What it OCD-related?  Have you been envious of friends and family when their very worst thing seemed tamer than yours?

Christmas isn’t fun for everyone

My roommate is a Christmas fanatic– every year, she chooses one day after Thanksgiving where we pause everything else to put on some Christmas music, drink hot cocoa, and decorate our apartment.  Every Christmas decoration in the entire apartment belongs to her.  Well, time out, I guess we each paid half for our little four-foot tree.

Desiree has this entire Willow Tree nativity set, as seen below.

Can you picture her as a senior in high school, eagerly opening up each element of the scene?  It makes me laugh– but in a good way!  Des is the sweetest girl ever, and this is a great metaphor of each of us.  Des is “steady eddie”– not that she doesn’t have her own issues to deal with– but she is strong and caring and clean and a good cook.  And then there’s me, a tornado who is still learning how to take care of herself.

Christmas is an interesting time for me– to be honest, I am learning to enjoy it.  Growing up, it was a very difficult time of the year for me.  Picture Minnesota in the winter: it gets dark so early, there’s usually piles of snow, and the temperature is below freezing– sometimes dangerously below.  It’s like a dream location for seasonal depression.

And then, with OCD stacked on top of it, pretty much everything about Christmas was a trigger: my mind would race with thoughts of whether I believed in God, and if He was real, if He had saved me.

There is an image of me that we still have somewhere at my parents’ house– me, hovering somewhere around 17-20 years old, with this look at the camera.  I can remember exactly what I was thinking in it.  I was looking at the camera and asking my future self, Are you okay yet?  I hope you don’t feel this way still.

These days, I can answer my past self, I am better.  I am healthier.  And no, most days I do not feel that way.

Praise GOD!  Thank You, Jesus, for cognitive-behavioral therapy.

So tonight I’m thinking about different kinds of folks– I know there are some– actually, MANY– who are like Des, yearly filled with holiday cheer, basking in the glow of the Christmas lights, huddled comfortably around the tree and the nativity scene.  But there are others who spend their holidays the way I did– filled with doubt (laced with the tiniest bit of hope), depression, confusion, and sickness– and all while feeling that instead, they really ought to be happy.

If you are in the second camp, I hear you.  I’ve been there.  This prayer is for you:

Jesus, I celebrate You– I celebrate Your marvelous incarnation, the Word becoming flesh.  Tonight, Lord, I lift up to You all those who are burdened with heavy, laboring hearts this season– whether from depression, anxiety, mental illness, or internal crisis.  YOU ARE STRONG ENOUGH TO HOLD US ALL.  Just as that first Christmas was the initiation of Your inexplicably great rescue plan, I pray that this Christmas will be the start of Your new rescue mission in the lives of these sufferers.  You are Love.  You are Truth.  You are the mighty redeemer.  I entrust my heart to You and ask that You would hold those for whom I’m praying– in a way that is felt.  Amen.

“reasonable doubt”

I read an interesting article today called “Casey Anthony, Reasonable Doubt, and OCD” by Stacy Kuhl-Wochner at the OCD Center of Los Angeles — you can read the entire article here.

Just wanted to quote a little bit of it for all you blog readers to consider, especially after having an interesting phone conversation along these same lines with my college roomie Megs.

Being a therapist who specializes in treating those with OCD, I can only imagine what an especially difficult task quantifying reasonable doubt would be for many of my clients.  People with OCD and related OC Spectrum Disorders such as Body Dysmorphic Disorder (BDD), Hypochondria (Health Anxiety), and Social Anxietyare on a constant quest for answers to unanswerable questions.  They seek to quantify that which cannot be quantified, to gain certainty when it is only possible to be “pretty sure.”  These are questions that most people who do not have OCD can accept despite their inevitable doubts.  But for many people who experience OCD or a related spectrum condition, “reasonable” doubt often feels unbearable.

Doubt is such an intrinsic part of OCD that the condition has often been referred to as “the doubting disease. Some common doubts seen in OCD and related OC Spectrum Disorders include:

  • Are my hands clean enough to ensure that I won’t accidentally make someone sick through casual contact?
  • Am I straight enough to to be certain that I am not actually gay?
  • How do I know if I really love my spouse?
  • What level of pain is a enough that I should visit a doctor to see if I have a serious medical condition?
  • What is the right amount of eye contact to avoid being seen as socially inappropriate?
  • How do I know whether I am a good person or a bad person?
  • If I become angry at my child, does this mean that I do not love them enough, and that I am close to mentally snapping and harming them?

The only realistic answer to these and similar questions is to accept that nobody has 100% certainty on these issues*, and to stop the mental checking.  The goal is to make decisions based on what is “most likely”, given all the evidence.  For people with OCD, it may feel terrifying** to make that leap and take that chance because their brain is telling them that absolute certainty is required.

*JLS adds: That is why the point of cognitive-behavioral therapy is not to remove uncertainty but to make one okay with uncertainty.

**”Terrifying” doesn’t even touch it.

Thoughts?  What’s the most basic thing you know that you have doubted before?  (I have sometimes wondered if all of life that I’ve “experienced” so far is only a dream.)