Itchy OCD

My obsessive, intrusive thoughts are a lot like an itchy bug bite. When bitten by a mosquito, I know it’s best not to scratch. But it itches so much that sometimes, I can’t help but give in. As I get older and more mature, I realize more the reality that scratching does no good, and in fact makes the situation worse; each time I get better at avoiding it, though sometimes I take a few steps back. It might take all of my effort and chip away at my sanity to avoid scratching that itch. But when I can avoid scratching it, and I let the itch be, at a certain point a threshold is reached where the itching stops. The wound will heal with no scar.

You can’t get rid of an itchy bug bite — you just have to wait while it runs its course of healing. You also can’t get rid of an intrusive thought caused by OCD — all you can do is accept the thought and let it run its course. Just like you don’t really need to scratch that bug bite, your body in both situations is giving you a false alarm. The sooner you realize that and treat it like what it is, the sooner you can get better.

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Lazy Brain

Sometimes I think because I’ve developed the habit of repeatedly checking over the years, my memory has started to depend on it and not work as well. Maybe it’s just an illusion, but does anyone else feel this way? It’s like my memory has become lazy because it knows I will keep checking over and over anyway. I find I have to concentrate and check things really mindfully, otherwise I know I’ll want to keep checking it. Not only that, but a part of me actually becomes unsure whether I really checked before. Like, I have to kind of say to myself in a loud (mental) voice: “I AM CHECKING THIS RIGHT NOW SO THAT I WON’T NEED TO CHECK IT AGAIN IN FIVE MINUTES. WHEN I WANT TO CHECK THIS AGAIN IN FIVE MINUTES, I WILL REMEMBER THAT I CHECKED IT JUST NOW.”

The other day I opened a closet door, looking for something, didn’t find what I was looking for and closed it; and I kept opening it again and again, to check. Every time I closed the door I got a feeling: “Wait. Maybe I wasn’t thorough enough. I need to make sure.” And it was clearly an OCD feeling, but yet I also feel that when I check things I can get into a habit of doing them carelessly, because I’m so used to repeating it over and over.

Busy

I’m so, so busy. I have more responsibilities that I can juggle at once right now, and I keep dropping one or two and having to pick them back up.

But I’m also more happy.

I’m the kind of person who needs to stay busy, because if I have too much free time I think myself into a depression. OCD is a disorder of over-thinking, so that’s exactly what I don’t need time to do.

Now all I need to do is learn to adapt to the higher stress level of being super-busy. It leaves me with little time for my obsessions to creep in, but it is hectic and chaotic. If I can just stay calm it will be smooth sailing.

The OCD Workbook

I can’t really review it until I’m done with it, so this is more like a partial review. Yesterday was my birthday, and one of my presents was the Third Edition of The OCD Workbook by Bruce M. Hyman and Cherry Pedrick. I picked it up to just skim through for ideas and tips, not really planning on actually buying it, but my husband ended up getting it for me. And now that I have it at home, I realize it’s probably a good thing because sometimes I over-estimate my strength in cognitive-behavioral therapy. It’s easy to get going and think “I’ve got this down now,” meanwhile problems start creeping in.

The book has a great general overview of OCD and related disorders, making it an excellent choice for family members to read and get a good grasp of what their loved ones with OCD might be going through. And it’s so important for loved ones to understand. It’s easy to be well-meaning and give bad advice because you’re thinking of what would work for you, not the person with OCD; sometimes I do the opposite, and offer advice that would be good for me and my OCD but horrible for a “normal” person.

I like that acknowledgement of “primarily obsessional” OCD is included. “Pure-O” may not truly be a thing, but “Primarily-O” should totally be.

And yeah, it is a workbook, so there are sections you fill in, like checking off your own symptoms and writing in personal history. There are also neat little inspirational quotes at the beginning of each chapter. I tend to be cynical, so I don’t like overly-phony-positive motivational quotes — but these are pretty reasonable.

It also looks like there’s a pretty thorough section about tips for taking medicine along with CBT, but I can’t say for sure if it’s good since I’ve never been on psychiatric medicine. Maybe someone else would be better qualified to review that part.

I really like the list of key cognitive errors of people with OCD. Recently there was a link going around on the internet about 50 common cognitive distortions which I also really liked, and that one is even more thorough and thought-provoking. But this one is good because it’s specific for people with OCD. There aren’t 50 here, so a lot of yours (or mine) might still be missing. I think my worst ones are: pessimistic bias; what-if thinking; intolerance of uncertainty; and over-estimating risk, harm, and danger. Intolerance of uncertainty seems to be what’s ultimately at the root of all OCD, though.

I’ve also realized how selfish my OCD fears are! It’s always about me. Maybe I’m going to get hurt, sick, contaminated, or maybe something bad is going to happen to me. I’m not one of those with OCD who worries constantly about the possibility of harming others. Then again, that could also be because somewhere deep inside me, there’s always at least a tiny awareness of the fear not being “real.” So maybe I only worry about myself because I subconsciously know the fear isn’t “real.” As a child I was deathly afraid of battery acid, but it was OK to get others to touch it for me, because on some level I probably knew it wouldn’t actually kill them — I just didn’t know how to get rid of that all-pervading anxiety. Now I realize I don’t have to — I just have to learn to acknowledge and live with the anxiety.

I’ll continue reviewing The OCD Workbook as I go through it. So far I like it, and it’s good to do first thing in the morning, and just before bed — when my obsessions seem most ready to pounce.

Game Plan

Here’s another great article by Dr. Steven Phillipson, entitled “Strategies for Managing OCD’s Anxious Moments (Dance with the Devil)”. It’s the same old “OCD-as-the-Devil” analogy which actually works quite well.

It actually says “By L. Potter and the Friday Night Group — Adapted from Speak of the Devil by Dr. Steven Phillipson” so, um, I’m not sure how to correctly attribute an author here. But there’s the information; you figure it out.

The piece first goes into OCD’s “game plan,” then suggests what ours should be in dealing with it. One thing that particularly resonated me was that OCD tends “To exploit moments of weakness that come at the worst possible times in your life, i.e., when you perceive that it will be disastrous to become anxious.” That’s definitely true for me! Just like when I’m eating or expected to give a speech or sometimes even finish a sentence my breathing tic will creep in, at the worst possible times my OCD fears pop up, too. It’s not coincidental — those are moments I am more vulnerable to all my fears, especially my worst ones. Most of the time it simply means I have to watch out at the end of the day when I’m tired, because my OCD is bound to cause me to start worrying about something then. Which is funny, because normal people are like “I’m too tired to worry about little things right now” whereas my brain is like “I’m tired — that means I might’ve missed something important that I should be worried about!” But it also means I have to be wary of important times in my life — the loss of a loved one, happy occasions such as weddings, or anything terribly affecting whether negative or positive. It’s these times that I feel the need most to protect myself, and my OCD is trying to do that, but doesn’t realize it’s doing a horrible job. That’s why it ends up being called “Devil” in articles like this — it’s not a bad guy or an enemy, really, it’s just our brain, and our brain wants to protect us, but sometimes its logic is all wrong.

Also from the article: “Consider not rationalizing with the devil: do not attempt to treat the OCD by logically disputing the irrational nature of the spikes.” This is important because when you engage the OCD thought directly, you won’t win. This is probably why I have a knee-jerk reaction when people tell me “Don’t worry” which actually makes me worry even more. The thing you want to do when dealing with someone with OCD is not to tell them not to worry, but instead encourage them to objectively examine their thoughts and fears. A great way to do this is by asking questions instead of making assumptions or giving advice. Instead of saying “That’s a silly thing to worry about” or “You can’t change that” ask questions like, “What are you feeling right now? Why does this make you so upset? Is there anything you can do to affect this situation?” Or, try taking the fears at face value and see what happens. “OK, maybe all those dishes really are still dirty. But — are you sure the napkins are really clean too? What about the table? What about the cleaner you used on the table — how do you know that’s not poison?” If you can eventually get the person to realize there is some degree of uncertainty in all aspects of life, they will either A) Become motivated to accept uncertainty and begin doing so or B) Break down, shut themselves in and do as little as possible. Now of course B is a bad thing, but sometimes things have to get worse before they get better and you can’t overcome OCD without learning to accept uncertainty. That’s why reassurance doesn’t help. Don’t tell me “Everything’s OK” because I know it’s not. Not only that, but I know you don’t know, and no one really knows. The only correct answer is “Things are probably OK and for now we just have to assume that and accept that we can’t be prepared for everything that happens in life.”

If reassurance works, it’s temporary. And you’ll most likely find the time-frame that it works becomes shorter, and shorter, and shorter.

One last quote from the page: “This management is not a cure: if you choose to take the leap, this will require consistent effort for as long as the devil decides to deal it out.”

Medication

I’m curious what my readers think about medication. Do you believe that medicine is usually necessary to treat OCD? I ask because ever since finding out I have OCD, I think my obsessional fears have a lot less power over me — like just knowing where they come from has helped me become free from them — without medicine. That’s not all of it, of course, and I certainly still struggle with obsessional fears every day. However, they don’t control my life like they used to — the only problem is when a new one appears, I sometimes have trouble identifying whether it is a legitimate concern, or an obsessive-compulsive problem. People with OCD get accused of being upset over “little things” but they never feel little to us at the time! If they did, we wouldn’t be upset. If I had seen a therapist as a child, it’s possible medicine also might’ve been more necessary then, and would’ve helped me deal with my hand-washing problem before it damaged my skin too badly. As children we don’t know ourselves as well and our reasoning abilities are still developing to a great degree. But it’s hard to say in retrospect. I think most of the work really is cognitive-behavioral therapy, and I feel like relying on medicine too much is like continuing to use a crutch once your leg has healed — maybe for both children, and adults.

For Tourette’s (and other disorders) it’s different; there is no amount of cognitive therapy I can imagine taking my breathing tic away, so on days that it is really bad, I do wonder if I would be better off taking medicine. But I can’t only take it on bad days; I would have to take it every day, and that’s what worries me. Most days, it doesn’t interfere with my life that much. But I don’t envy people who have tics which do severely interfere with their lives on a regular basis, because I can very easily imagine what that is like, and I would not make the same “crutch” comparison because Tourette’s and OCD are very different in that way. OCD is a mental disorder, so to some extent many people can think their way out of it — but Tourette’s is about physical urges, and you can’t really think your way out of that. Imagine trying to think your way out of blinking or breathing when you felt like you needed to! It would be hard, and sometimes you blink or breathe without thinking. That’s the interesting thing about tic disorders — they’re a manifestation of a very normal body process that probably had a great evolutionary purpose. It’s pretty darn convenient that most of the time, we breathe without thinking about it. It’s just that people with tics do OTHER things without thinking about it, too.