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. ūüôā

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.)

 

 

 

Why Meds?

A blog reader emailed me and asked, “If you are okay with sharing this, could you tell me why you chose to stay on your medication after ERP?”

My response:

For me, meds are a chemical tool to slow my serotonin reabsorption. ERP is a physical tool in that it rewires the brain and a mental tool in that it gives me a new mindset toward uncertainty. I’m grateful for ALL my tools. ūüôā

 Also in my toolbox: prayer, deep friendships in which I can be vulnerable, essential oils when needed, Ativan when needed, talk therapy for non-OCD anxiety, and self-care (i.e. naps and ice cream).


¬†What I’m trying to say is that God has given me an extensive amount of assistance. Some tools only come with privilege or money (having insurance and a paycheck to pay for meds and therapy … and ice cream, ha!); some from transparency (I have the greatest friends); all are sheer grace.


I’m at a stage of my life and faith where my hands are open to all the grace I can get.

Thoughts on ERP, Writing, & Uncertainty

Uncertainty.

For so many years, it was my enemy– or so I perceived it, especially because full-blown clinical obsessive-compulsive disorder made me fear and reject uncertainty even more than the average bear. Everything in my life was about pursuing certainty, answers, black & white.

And, of course, I was miserable.

In 2008, I went through the harrowing but ultimately beautiful process of exposure therapy, which took my OCD out at the knees, giving me the bandwidth to live with uncertainty, questions, and all the shades of gray.

It’s only recently that I’ve recognized exposure therapy as the training ground (or maybe even battle ground) that would let me later pursue my dreams of being an author.

A hard truth: writing is full of uncertainty. 

uncertainty2

Not just writingРbut publishing itself too. There is this crazy-making stretch of life in the middle of writing a book that feels both unclear and perpetual. What is this book really about? Who are these characters? Can I do this? Can I finish this? Is this story going to matter to anyone but me? Is this going to even matter to me? Will my writing group like it? Will my agent? My editor? Readers? Will I find success? Will I get another contract?

The writing life is, for many of us (and especially for younger writers), a world in grayscale: a constant state of uncertainty that we have to persist in in order to find any relief or success.

For as many days as I think I’m totally failing at life and writing, I have to remember what it would have been like to be writing and publishing before exposure therapy, back when uncertainty was¬†unbearable. I’m not even sure how it would have been possible to be doing what I’m doing now without exposure therapy laying the groundwork for me to bear the not-knowing, let alone to thrive in it.

“The world doesn’t work that way.” I hear myself and other OCD awareness advocates saying this to sufferers all the time. In context, we mean, “Life inherently is full of uncertainty. You cannot eliminate it.”

The truth of that hits me over and over again in the field of writing.

Exposure therapy was the terrible, grueling practice for the writing life. Uncertainty is rampant; I try to keep my arms open.

 

Worth Saying Again & Again

Exposure therapy is the best avenue we know of for treating obsessive-compulsive disorder.

Close up of hand drawing gears mechanism with chalk

ERP (exposure and response prevention) is what every OCD expert will suggest as the frontline treatment for sufferers.

It works.

It’s¬†hard and¬†scary, but it¬†works.

Catering to compulsions is a band-aid on cancer. It treats symptoms. It cuts leaves off a weed.

ERP is chemotherapy. It goes after OCD itself. It digs out the root.

On this blog, you’ll only hear OCD treatment recommendations for:
1. ERP
2. ERP plus praying for a miracle
3. ERP plus meds
4. ERP plus meds plus praying for a miracle.

You can learn all about ERP therapy at jackieleasommers.com/OCD.

A Reunion with My ERP Therapist

For OCD Awareness Week, OCD Twin Cities had an event– a panel of OCD experts plus one special guest: yours truly. Interestingly, one of the experts on the panel was my own ERP therapist and personal hero, Dr. Chris Donahue. I have not seen him since the last day I graced his office with my presence on the day I finished ERP therapy back in 2008, though we have communicated via email, and I have sent many, many people his way for help.

I only joined the panel for the last fifteen minutes or so. For the majority of it, I was in the audience. There was this weird dichotomy going on for me: on the one hand, I was listening to this man who saved my life, who changed everything for me, who pulled me out of darkness and into light, out of slavery and into freedom; on the other hand, his voice is the voice of my exposures (I did imaginal therapy, listening to an audio recording … and it was in his voice), which were some of the most difficult things I’ve ever, ever had to do in my life. So there was this push-pull thing going on while he spoke.

Then, later, I joined him. I was able to sit next to my hero and publicly tell an audience, “This is what this man did for me. This is what life was like before, and this is what life is like now, and they are unrecognizable.” I turned to him and said, “Thank you.” He said, “You’re welcome.” It was a simple exchange … but so layered. So many things going on in my head and heart.

In any case, I am grateful. With every year that goes by of freedom, I more and more shed my identity as someone in bondage. ERP therapy saves lives. For some of us, it changes everything. It did for me.

For lots more information about OCD and ERP, go to jackieleasommers.com/OCD.

dr donahue 2

The [Beautiful] Paradox of ERP

paradox of ERP2Exposure and response prevention therapy. ERP.

The hardest thing I have ever chosen to do in my life.

And one of the best.

But that’s not actually the paradox I’m talking about. The paradox of ERP that fascinates me most centers around uncertainty.

The whole point of ERP therapy is to teach someone to learn to live with, accept, even embrace uncertainty. ERP actually re-wires the brain to help the OCD sufferer with this. Before I went through ERP, I wanted to know everything with 100% certainty. Anything less would cause intense havoc in my mind, heart, and body. Because of this intense desire to know everything with certainty, I so often felt gobsmacked by uncertainty. I lived as if, without total certainty, I could barely know anything. Doubt pummeled me like a linebacker. My life was ravaged by uncertainty.

But once I went through ERP therapy and learned to accept uncertainty, the bizarre thing is that my confidence returned. I suddenly felt surety and certainty again–¬†after I realized I didn’t need it.

When I demanded 100% certainty, what I ended up with was often something in the 25-40% range. Or lower.

When I abandoned the need for 100% certainty, I ended up in the 90-99% range. Sometimes less, but usually way, way up there.

That’s weird math. Backward logic. A paradox.

One I love.

99% sure,
Post-ERP Jackie

P.S. If the need to know for sure is ruining your life, you need ERP. Read more about it at jackieleasommers.com/OCD.

P.P.S. I’m a follower of Jesus Christ, and I can’t help but be struck by the similarity of this to “Lose your life to gain it.”

Image credit: Nicu Buculei, modified by me

OCD Scrupulosity: Is ERP Sinful?

is ERP sinfulSometimes people with religious scrupulosity fear that ERP therapy itself is sinful. It’s true that ERP therapy will definitely ask you to do things outside of your comfort zone, things that will probably make you sick. (This is how ERP works, and it is crafted specifically around your own deepest anxieties.)

But once embarked on this ERP journey, I think it’s unwise and counterproductive to try to convince yourself (or convince others … or let others convince you …) that your therapy is not sinful. (After all, the whole point of this therapy is to embrace the¬†uncertainty!)

If you are a Christian and concerned about ERP therapy, I suggest you say a prayer like this then dive in headfirst:

Lord, I am terrified about what I am being asked to do through this therapy, and I worry that it might be sinful.  But there is at least some part of me that believes this is connected to OCD, so please cover over all I have to do with your grace. I am doing these things in the hopes of restoring my right and healthy relationship with you. Please be honored by my therapy and my choice to fight for my freedom (which you won on the cross) and my relationship with you (again, made possible by the cross). Be glorified in my therapy, and cover anything sinful with your incredible grace. Make me strong enough to complete my exposures. Provide the strength I need to press through this scary therapy, and let these hard exposures and choices (that may sometimes seem wrong to me) glorify you. Amen.

There were definitely times when I (and othersРwow, that was hard!) wondered if I was doing something wrong with my ERP exposures, but in my heart of hearts, I knew that this was my last and best chance at freedom and health and hope. I held onto that and pressed through, and I will tell you this: every. single. thing. in my life is better post-ERP, in particular, my spiritual life is now thriving and healthy. I am growing in my faith. I have the joy of salvation. I trust Christ more.
And I believe that ERP was God’s tool to bring me into this way of life.
To learn more about OCD, ERP therapy, religious scrupulosity, go to jackieleasommers.com/OCD.
Image credit: Fernando Rodriguez

Co-Morbidity

comorbidDo you know the term?

Co-morbidity is the presence of one or more other disorders co-occuring along with the primary one. For those of us with OCD, our OCD is often co-morbid with depression. The depression seems to usually be a result of the OCD (as opposed to the other way around).

On their website, the Stanford School of Medicine writes:

Patients with OCD are at high risk of having comorbid (co-existing) major depression and other anxiety disorders. In a series of 100 OCD patients who were evaluated by means of a structured psychiatric interview, the most common concurrent disorders were: major depression (31%), social phobia (11%), eating disorder (8%), simple phobia (7%), panic disorder (6%), and Tourette’s syndrome (5%).

They also say:

In Koran et al.’s 1998 Kaiser Health Plan study, 26% of patients had no comorbid psychiatric condition diagnosed during the one year study period — 37% had one and 38% had two or more comorbid conditions. These proportions did not differ substantially between men and women. The most commonly diagnosed comorbid conditions were major depression, which affected more than one-half, other anxiety disorders, affecting one-quarter, and personality disorders, diagnosed in a little more than 10%.

OCD is enough of a beast on its own, but the truth of the matter is that many who struggle with OCD are fighting other demons too.

In my experience, OCD and depression teamed up against me, though, as I wrote before, the depression was secondary to the OCD (in that it was caused by the OCD). Some days I would be full of intense, manic fear caused by OCD, and other days all my sharp edges would be dulled by depression and a feeling that nothing in the world sounded exciting or worthwhile.

I’m so grateful that¬†when ERP¬†helped me steal power away from OCD, the upshot was that depression was defeated too.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

 

Image credit: Gerald Gabernig

 

A War in the Mind

war in my mindI remember the Sunday mornings in church when my mind was a war zone.

An intrusive thought would show itself, and with my Pure-O compulsions, I’d mentally bat it down (usually with repetitive prayer). ¬†I was a ninja with my compulsion moves, but OCD was just as fast and furious. ¬†Back and forth, back and forth, like a relentless game of Whac-a-Mole.

And no one knew.

All these happy people around me, worshiping God, taking in the sermon, happy and safe in their suburban church sanctuaryРand, for me, it was a battle field.

Pure-O: so invisible, so dark, so exhausting.

I praise God that those days are a part of my past. ¬†If you want to learn how I survived (and WON) this war,¬†click here. ¬†Your mind doesn’t have to be a scary place.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

Image credit: unknown.

Choosing Treatment: a Parable

bandaidOnce there was a man named Mr. Jones.  Mr. Jones found out he had a brain tumor.

Experts told him, “Mr. Jones, you need to have surgery, followed by chemotherapy.”

But Mr. Jones said, “No thank you. ¬†Surgery is¬†hard. ¬†Chemo is¬†hard. ¬†I’d prefer to¬†just meet with someone to discuss my cancer once a week. ¬†Also, I’ll apply a fresh bandaid to my forehead every few days, for good measure.”

“That won’t help, Mr. Jones,” the experts told him. ¬†“You really do need a very specific treatment for your condition.”

But Mr. Jones was insistent: he preferred the easier “treatment.”

So he met with a therapist to discuss his cancer, and he applied and reapplied bandaids whenever he was feeling worried.

It didn’t work.

And the moral of the story is this: ERP is the best way to treat OCD.

 

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

Image credit: F2 Images