Note: The below story is meant to be read top-to-bottom. It is not updated or chronological and first published in November 2017. For timed updates go to “My Updates”.
OCD. Obsessive Compulsive Disorder. I have it. For over 40 years, I’ve been afflicted with an underlying problem that I didn’t fully realize I had until I was recently diagnosed. And it’s all new to me. Sure, I remember the “even number counting”, the rigid routines designed to calm my anxiety as a child and young adult. I made jokes about it, after I thought I had banished some outward symptoms in my early 20’s. What I didn’t know was just how deep it runs, how debilitating it can be, and how it has had an out-sized influence on my life. You see, it’s not just those outward physical manifestations (which I still have) that you associate with quirky TV show characters, it’s also very much internalized and that was not something I was aware of until now. It makes sense of a lot of things that have gone on in my life. In the case for me, and most other sufferers, your life is peppered with pathological doubt, inflexible anxiety, rumination, confrontation avoidance, and an overpowering inability to make small and most certainly, larger decisions. Oh, and let’s throw in “intrusive thoughts/obsessions” to…obsess over. Furthermore, OCD is merely a component of overall anxiety and they are both linked.
Let’s be clear – this is not an abdication of any responsibility, it’s merely an honest acknowledgment of a chronic condition I have, it’s influence on me and in turn, my taking responsibility in getting assistance. I cannot and will not understate that on various occasions the results of having this have been very painful and, at times, depressing. That being said, for the first time in my 40+ years, I finally have a face to place onto this constant dull, obsessive and lurking anxiety-laden presence that is in me, and that face is – OCD.
So, what got me to this point? It started out when I decided to get help for Situational Depression, and it turned into quite a bit more. I had my GP and a couple of therapists (first time I’ve seen therapists, as I was trying to find one that I liked) tell me, separately, that I likely have OCD (and Anxiety/Social Anxiety). Shortly thereafter, I took an intensive test and, yup, that confirmed it. So…I guess…Yay me?
What triggered the depression in the first place? One damned rough year and a half or so. It kicked off when my dog and good buddy died, I had a series of forced moves in a very short amount of time, which included being in location-based isolation for a few months, relationship troubles with plenty of confusion and pain, a breakup, a dad with failing health due to spreading cancer to the brain (with seizures and COPD to boot) and a terrible work environment that was ignoring major contributions I made for the company. And that’s just some of what was adding to the stress and contributed to wearing me down. As with a lot of things in life, not all were out of my control as some parts were definately of my own doing.
Everyone has rough patches and I’m nothing special but give those stressors to someone who has Anxiety/OCD? It’s magnified…a lot more than the average person and that is one of the underlying issues with it – you have an amplification of emotional responses to stress and in my case many times it manifests itself with over-the-top rumination and decision-avoidance punctuated with doubt about, many times, the easiest of tiny decisions. And many times it involves compulsions that are designed to seek comfort from stressors. That being said, with all the previously mentioned things occurring in my life, if you’ve talked to me you know how bad the whole situation has/had gotten.
Funny though, almost to a “T”, this describes my life at 21 with almost all the exact same emotional pressures and more. It was, as we’ve all experienced, a series of events and losses in my life (some, a professional would consider, technically – traumatic) in a very short amount of time. What got me through, when I was young, was help from my friends (just being around them) and being able to blow off steam on the weekends. I learned a lot from that but didn’t get the full help and guidance I likely needed. I was depressed. I finally made it through, though it was a hard slog, and was always proud of the fact that I got over it without any help!…You know what?…That was a damned mistake because I didn’t “get over it”. I still suffered with something I didn’t quite realize was perpetually looming there and influencing me on a day-to-day basis for years afterwards. Had I “taken the leap” or “manned-up” and gotten the help I clearly needed (side note: my mom did ask if I wanted to see a therapist then) I would have been in much better shape between that time and now. I didn’t have the maturity, self-esteem, self-awareness, education, motivation…or whatever the hell…enough to step up and deal with my issues, and those that have been intimately close to me in the past, and recently, did suffer as a result too.
Just to let you know, I have to say, that the support of friends and family this time around has been just as important now as it was then and I truly thank all of them.
Sufferers of OCD are generally very anxious and emotional. They display many non-OCD symptoms, such as signs of depression, excessive worry, extreme tension, and the constant feeling that nothing is ever right.” – Psychguides.com
This goes back some ways but perhaps you remember seeing that day-dreaming school boy Ralph Phillips from the old WB cartoon? Yeah, that was me. I was an anxious kid with an over-active imagination and I excelled in day dreaming at elementary school. My grades were awful and parent teacher’s conferences filled me with absolute dread and anxiety. Math tests put me downstairs in the nurse’s office with a nauseous stomach many, many times. I wasn’t the best student to be sure. One thing, however, was I usually spent a couple times a year, for a few days at a time, at home sick with bad allergies and asthma but I actually loved it and if it was during the school year that made it even better. Being an introvert, I would spend the time inventing things, playing in far away imaginary lands, drawing, playing with legos for hours and hours on end, hung out with imaginary friends (one who oddly enough looked like Art Garfunkel…weird) and, naturally, watching The Price is Right. You know, stuff kids might do when staying home. But, holy shit, I was wound tight (still am).
That wonderfully creative and thoughtful mind is, aside from some of the very good stuff it provides for me personally, relationship-wise, and certainly professionally, also helps create a more fertile playground for a high level of over-thinking and over-imagining. Like a lot of kids I had my share of overactive fears and that’s where, I believe, the OCD first appears. I don’t remember exactly but…I was…maybe…7, 8…9? I do, however, remember some of the compulsive routines I did, methodically, for years to quell my fears and generalized Anxiety. Below are some examples.
Side note – I can’t speak for all kids and how they developed their symptoms, I’m not a mental health professional and needless to say OCD behaviors run far and wide from person-to-person, so I’m just going to mention my experiences and how the OCD might have presented itself in my situation. It’s not nearly as bad as many other sufferers suffer with day in and day out but I still have to deal with it’s effects.
First one that stands out is, as a kid I would perform an exacting ritual to check for spiders, compulsively, even though it made no sense, every night before bed. Here is just part of that routine – having to check the top of the door by jumping up and down on the bed 4 times, leading with the left leg and then repeat 4 times with the right, scanning the room 4 times, checking behind the headboard 4 times then alternating hands for another 4, flipping the light on 4 times also alternating between hands, etc…yeah, there’s a theme here I’ll address later. Then, I had a prayer ritual because, hell, after seeing The Exorcist, and Beyond the Door, when I was a little kid, I started to be obsessively mortified about possession (The Exorcist is laughable today but…wow…did it scare me back then). These two, among other patterns, were very specific and minutely exacting rituals I carried around for years, even after the original fears subsided. However, as a kid/teenager I still felt compelled to do them, still checking for spiders well past when they held any real concern for me or that I needed to worry about succumbing to soup spewing demonic possession. But why did I continue them? Because a compulsive ritual was established, and thus tying these 2 things into either – 1. what is clinically known as “Magical Thinking” (the spider checking merely morphed into a vague need to do it to make things “right” so nothing bad would happen) and 2. the praying, called – “Scrupulosity” (compulsive religious acts). These compulsions offer the sufferer a reprieve from whatever underlying stress they are having and the original intent might not even be relevant. But it soothes you, only briefly, because the more you indulge the compulsion the more you need to do it.
Note – I’m not saying praying is bad at all, but for me it was less about religiosity and more about an exacting ritualized pattern to calm my nerves. Big difference.
So, for me, what I experienced was a lot of generic – “do this, then good things will happen”. Like avoiding walking on sidewalk seams, or placing my footsteps inside the lines on rectangular-patterned carpet segments (these still come up, although almost subconsciously and difficult for me to notice and address). I really don’t think anything bad will truly happen but the compulsion is there that something, vague and nebulous, forces me to do it to “make things right” and I get anxious if I don’t comply. And another good example of that is having to frantically finish a task before a commercial break is over, before a plane lands, a song ends etc. etc….for…I dunno…some impending sense of good luck if I finish it, you know?
The biggest one for me then, and to an extent even today, is even numbers and symmetry. I felt/feel a need to touch, or visually inspect objects an even number of times. So, let’s say I brush my elbow on a doorknob. I’ll feel the need to touch it a second time, with the same elbow to establish an even number, and then repeat with the other elbow in the same amount of numbers. To “balance it out”, because if I don’t? Something vaguely bad will happen. At my age I obviously know it’s not really a superstition but merely a compulsion and I’m much better at outward manifestations than I used to be, however, that particular compulsion is still there. It presents itself quite a bit but more so when I’m out in public and having to talk about myself or personal stuff (I am an introvert, after all and until recently not really good at talking about what makes me tick). I’ll compile a list later and while I don’t do all of them anymore, for some, I still feel the draw and they seem to subconsciously start occurring. But the sneaky thing with OCD? If you put a stop to one compulsion, it’ll show up somewhere else…which is what has happened to me…and into my decision making process (which I’ll definitely address further down)…So, with that in mind, think of it a lot like Whack-A-Mole…it’ll pop up somewhere else…
Good interview on Fresh Air with author John Green about living with OCD and his new book “Turtles All the Way Down” about a character who also suffers from it. He is the author that wrote ‘The Fault in Our Stars”.
My condition isn’t as bad as his as with my OCD I don’t have those issues with catching germs or cleanliness…which is apparent…if you’ve seen my old place, nonetheless, he does make some very salient points about how OCD can effect you:
“Since doubt is the cornerstone of OCD, sufferers often have the need to know, for certain, that all these decisions they are making are the right ones. This is much easier said than done… Perfection eludes us; there is always doubt.”- Mentalhelp.com
“OCD sufferers might also worry how their choices will affect others, and agonize (to the point of obsession) over even the most minor decisions.”- Mentalhelp.com
“…those with OCD might make a decision they are quite sure of, only to then have OCD sabotage it. A vacation (or Relationship – my edit) … you’ve been dreaming about for years can now finally be a reality, but OCD might force you to second-guess your choice. The weight attached to all kinds of decisions can be too much to bear, at which point OCD sufferers may avoid making decisions whenever possible. Unfortunately, avoidance is never the answer, and while this tactic may temporarily quell anxiety, in the long run it will make OCD stronger.” – Mentalhelp.com
Let me emphasize, and as the reader you should know – the above quotes, for me? Are…sigh…horribly spot on. OCD can have an overpowering influence on making choices, and in my case – create obsessive thoughts on how others will perceive you and your said choices (Note: My perception issues are definitely tied into Social Anxiety and worth the click through to illustrate my comorbidity), and the avoidance of even making a decision and all the consequences that might result. This is, by far, one of the worst manifestations that I have as it has negatively affected me and those close to me. This is not an understatement.
Before I go on, let’s keep this in mind – OCD is not just about being a “clean freak” or very “organized” because that is OCPD. It can, however, vary far and wide from person to person but many times the results are disastrous.
Okay, so here is, exactly, what it’s like to be me and why, many times, I avoid making choices – I go to buy a shirt but have money for one. After trying on a couple, I need to choose. Most people will just mull it over a bit, pick one and be content. Not me, my decision-making anxiety will start up, almost uncontrollably, and the compulsion to create an endless loop of decision making and doubt kick in. “This one works better for work…but this one looks a bit nicer…I think…maybe…this one seems like it’s better made…although this one would be better for more seasons…but this one people might judge me on…maybe I should wait and put it off…I dunno…” And on and on and on…It sounds funny, but it’s a real-life occurrence and not an analogy. It sucks and infuriating to feel this way. It’s not all the time but disturbingly frequent (which is why I have my default purchases and places…to avoid choice). Just to emphasize this is not “waffling”, or just “commitment issues” because it’s far more than that. It’s an internal mechanism driving me (one I am working to resolve).
Another example – it takes me years to buy a car. I get bogged down in the minute details of comparing features between different choices and that takes a lot of time. My enjoyment of cars just feeds the OCD and my obsessive need to get lost in the weeds of minutiae and to have all the “facts” (and with OCD you can never have enough facts) before making a decision, over and over and over again…obsessively. Doesn’t matter if you have all the information you could ever need, you cannot pull the trigger, you won’t just take a chance, so you keep going over the lists, “doing the math” and caught in a never-ending thought loop. It’s tiring, and many times, fruitless. Then I’ll just ruminate over a lost buying opportunity, years after the fact.
Look, sometimes I even get anxious making plans in advance of the weekend because I can’t make a decision on what to do, I get worked up and over-think. If I choose to stay home, I regret my decision and wonder if I should’ve gone out and that I’m missing out…until it’s too late to call someone, then the decision is made for me…by not making a decision. And then I ruminate.
These anxiety-inducing, risk-averse situations are fairly common and only becomes worse when involving…relationships. It’s brutal and infused with a far greater level of emotion and anxiety and can be paralyzing. Even if I know the answer, in my heart of hearts, it doesn’t matter because of a term that ties into OCD – “pathological doubting”, which is spot on. You see, I’ve been asked, more than once through the years, to make decisions on a relationship. Finding a definite answer is tough because of overpowering anxiety and indecision. In turn, that lurking OCD pounces and asks a sufferer to do something they might be, often, unable to do (again, untreated). This is because there are physical mechanisms in the brain (addressed a few posts down) that are causing being stuck in a non-stop, inescapable flowchart loop…for me, this is frustrating and quite often…sad.
So, making heavy and important decisions crushes me with doubt and fear even if I know 100% how I feel (it’s the brain, not the heart) and that starts a feedback loop of 2nd, 3rd and 4th guessing. Ultimately, the decision is made for you, and usually, the results please no one. If you’re reading this your gut response might be that it sounds lazy, weak, shifty or that I lack caring/empathy but I can assure you, it’s not that at all. It’s full of emotion and angst because OCD is tied into Anxiety after all. It’s taxing, tiring and physically/mentally unhealthy for everyone and that knowledge hurts even more…because I know I’ve hurt others too. And, again in relationships, even being in love, I can’t help but still find things to cast “doubt” upon and that reinforces the inability to make a choice (It’s OCD with a Relationship component, and if you follow this link you can see how much it sucks). It’s profoundly hurt me, and as I’ve said, – others too. So, think about it – if there is so much drama associated with buying a fucking measly shirt, anything beyond that can be more of a struggle. No…no…affairs of the heart can’t be broken down into lists, doubts and constant second guessing now can it? Nope! But OCD will demand it of you and you will comply and you will feed it. It’s always hungry.
So, in the end, if left untreated, it’s like a shitty Santa, checking his list twice to find out whose naughty or nice but going back and checking it 3, 4, 5, 6 times…to be sure…and then nobody gets presents in the end because time has run out. Screw you, Shitty Santa.
Before I go too far, I want to move this earlier in the blog so as not to create the impression that I’m using OCD/Anxiety as some sort of an excuse.
With all of this, a reader might get tempted to say this blog is just all about – “Boo hoo! It’s not me, it’s the OCD’s fault!”. That is not the case at all, it’s just that…all of the sudden…I understand a lot more about me than I did before and how what I do affects me and others. I needed to get pushed to a point where I could just be open and honest with myself (and others), which is what this is blog is all about and why it’s public (not an easy thing to do). It’s my history, my realization, acceptance and treatment and it’s been cathartic. I’m very guarded about what makes me tick, and that makes sense, since having this isn’t something you want to crow about and most people never confide in it because they feel shame/embarrassment at the “weird” and irrational thoughts they have. Plus, to be honest I didn’t know I had it to this extent. You get sort of used to how things are and assume that’s the way they’re meant to be. Sure, I knew about the even-numbered patterns and symmetry deal but I had no clue about it’s relation to more internal things like decision-making thought processes, ruminations and doubt. And the more you indulge in your OCD, the stronger it can become. To be clear, it doesn’t define me nor does it abdicate personal responsibility and I am not a victim. I certainly am in charge of myself and my actions but OCD has still had a very powerful influence and….that…cannot be denied. However, irresponsibility is if I do nothing to rectify these things and bemoaning my lot in life.
Anyway, when OCD was first brought to my attention, from more than one medical practitioner, I immediately started researching (legit sources BTW). It was, quite literally, like tumblers of a lock falling into place. An audible “Click!” of understanding. Or, for another apt metaphor – it’s like having the pages of a book scattered about the floor. You can pick them up and read them individually, out of order, and get a sense but not the whole picture. Just snippets. But if you put them in order and read it from front to back…”Bam! It all makes sense now! Holy shit!” And because of this discovery I can, hopefully, do the things I need to do and try to mitigate it’s effects. No, it won’t go away, it will always be with me as it’s a chronic condition but there are courses of action, medicinal and therapeutic, that I can do to make it better and to get to work on it. And just knowing what the hell is going on is…well…as GI Joe is known to say –
Let’s get to the shittiest side in all of this. Among the crappy things I’ve done, to avoid making a decision, is – diverting, controlling narratives, dodging questions and even telling lies to avoid anything that involves having to make a choice. Because, making any decision of consequence, as I’ve said before, for me is – internally wrenching and overflowing with pathological doubting (furthermore fueled by diagnosed Social Anxiety and it’s effects on me about outward perception). It’s never a simple “yes” or “no” answer with me (I’m sure friends and others can attest to that) because that requires making – a choice. It’s not fun to admit even if I’ve come to terms with it. Yes, I’ve more than diverted or dodged questions and have been, very rightfully, called out on it by several people. It’s created larger problems for me and others, because I wanted to avoid “tough talk”, “take action” and I’d do anything to avoid decision-making and stress (You could ask the following – Why is he still unmarried? Why doesn’t have kids? Why does he still rent? etc.). So, I’d change subjects, act like every thing is just “fine”, crack a joke, and put off any real talk…and if lying buys me time, then…I’ve done that. Lying for me is not an ongoing constant but even if it just ends up being a few, large or small, then how does someone else determine what is and isn’t the truth, coming from me? It doesn’t matter if its done for reasons of not “hurting others feelings” because the act of lie is, in fact, hurting others.
Here’s a true situation – a friend asks “Hey, let’s do something tonight”. Rather than just say – “No” or “Yes” and leave it at that, I might instead say – “I’m not sure, I’m not feeling so well, so I don’t think I will do anything later…but I might feel better. I’ll probably let you know.” This avoids commitment and confrontation by not having to explain a definitive “no” but still keeps the option open and, presumably, makes the decision easier by not actually making one. However, it boils down to one simple fact – It’s horribly wrong. It is – a lie. Maybe if someone’s life is in jeopardy, but other than that – it’s inexcusable. Now, imagine if stakes are higher. You don’t want to confront that uncomfortable feeling of non-stop internally looping anxiety and decision-making, because you will try to find that obsessive “100% answer” (which does not exist), so you try everything in your power to “kick the can”, put it off, or compartmentalize, to avoid that horribly uncomfortable mental position (yeah, fucking selfish huh?…but it’s out of your control and you don’t even truly know it’s occurring or why you do it). But the more you avoid, the more it builds…and builds…and builds…This is what, left untreated and what my unacknowledged OCD can and will do. That rumination and doubt can ruin just about everything you hold dear, even if you feel you know the answer in your heart…it’s just that your brain won’t allow it because it’s stuck in a perpetual spin-cycle of anxiety and obsessing about uncertainty. I can…unfortunately…attest to that ugly truth.
All of these methods of avoidance, are sooo tempting because it “buys you time” and relieves you of that rocket-fueled anxiety…temporarily…that is until your ass has to cash that check. Well, now you’re right fucked, you quite possibly will ruin things, and often end up hurting others in the process. How can you regain trust? Well, you can’t and never will and that’s the price you pay, no matter if you assign it to OCD, Anxiety, or what not. It’s a simple fact…and it sucks.
This is the first thing I have approached, hence why I’m writing this blog. If you know me at all, you know I’m not an open book and if you ask me my about my feelings, what my plans/goals are or what makes me tick…I avoid…I get anxious. If you’re sitting right across from me, and I’m telling you how I’m really doing, my anxiety will spiral up, I’ll likely stumble over words and feel the need to do stress-relieving compulsions (tapping, blinking, visually tracing symmetrical patterns on the wall, even number movements, etc.). It’s tough because making decisions and sharing internal thoughts (both of paramount importance in your day-to-day relationships) can be extremely uncomfortable and, up till recently the causes were, frankly, invisible to me (see: GI Joe post).
When I constantly second guess and doubt even the smallest of things, I’ll seek to delay and find relief at any cost. In it’s way, putting off a decision is related to the whole routine of checking for spiders, worrying about goofy 70’s demon possession movies or number counting and nervous tics. It’s about seeking relief, a fear of the unknown and avoiding “taking a chance”. You see, OCD has physiological ties into decision making issues, which is where some people get things like compulsive house cleaning, lock checking or hoarding. For instance – Lock checkers aren’t 100% sure they locked the door, compulsive non-stop cleaning is someone cannot be convinced something isn’t 100% clean and Hoarders keep things because they lack an ability to decide, 100%, whether or not they should keep something. But life is full of doubt and nothing is 100% but with OCD you are obsessed with 100%, not 99% but 100%, without any anxiety-riddled doubt. So, these physical mechanisms you notice with shows, films and book characters like Monk, The Aviator, Poirot, or As Good as it Gets are true, it’s just that I (and others) internally “check” things more than physically. BTW, honestly, I used to be a bit of a hoarder. Among the things I collected were car magazines…I’ve now thrown out a ton.
On an positive note, just being open and honest with what is going on, I found it strengthens bonds with friends and family because now I don’t avoid questions that I couldn’t answer before. Example – My sister remarked, when I finally was being up front and unloaded on her, she said – “Finally, you’re showing some passion”…translation? – “You’re being honest, real and not dodgy”. It floored me. I thought she’d be pissed because I basically yelled at her which is not my default response. I didn’t just act like everything was fine, crack jokes to divert attention, or lie. (It wasn’t about her though, just about what I had been thinking about after she kept pressing me).
In some cases it’s actually more amusing than anything else – Say you had a large lunch and your gut makes noises, people always ask – “Are you hungry?” The typical answer is “Oh, yes, I’m hungry”. Now, I just acknowledge that it’s probably a brewing fart – “No, I already ate, it’s intestinal issues.” Or when my boss asks me “Did you have a fun weekend?” and I didn’t have a good weekend, rather than say “It was good” I just remark – “Nah. Personal stuff” and walk away and leave them without a “good” response. Much better than saying you had a good weekend when you might have had a lousy one. And “honestly” my boss? Screw ‘em.
I can’t be absolved of all my doings. It, sadly, is what it is. All I can do is…better. I owe that to you, my friends and family, my coworkers, people I interact with daily and even…myself. In the absolute end, and as mentioned earlier – No matter what I’ve said in this blog and whatever the reasons for my actions, I know one thing – if I’ve lost someone’s trust and hurt them, I am nothing if not truly sorry and apologize to them and to you. Simply, the buck stops here…with me.
Found this over on Reddit. Got permission to use some of this from the original poster (Thanks THWAY…) This is just the first part as they go on to describe their successful treatment but I felt this part just works nicely for description’s sake. I’ll be posting the science aspect of OCD and this is a nice lead in to that. I will also post their second half at a later time:
“And the reality is that you’ll never be sure, because OCD just latches onto the vagueness that can never be proven, and that’s what keeps the cycle going.
I’m talking mostly about rumination/pure o I guess but maybe it applies more broadly too.
The thing is every time the doubt/anxiety comes around it’s my instinctive reaction of discomfort/fear that I want to get rid off. It’s not because that the thought/anxiety is true or a real thing of concern, it’s that I’ve learned to react to it as if it’s super paramount and critical.
I just want to get rid of that uncomfortable (sometimes unbearable) anxiety so I think and I ruminate and I perform all these elaborate compulsions because I’m convinced that THIS time it’ll work. THIS time I’ll find the ultimate answer/solution and the doubt will go away forever. But there is no real solution. And anything that brings temporary relief only drives the cycle more because the brain has learned through all the attention on it that this is a critical threat that needs to be solved, and it just goes on and on and on and on.
There’s enough false hope, false threat, and most importantly vagueness (aka there will ALWAYS be something that your OCD can latch onto again – like something undefinable like good or bad or love or evil or – ), that it can go on for what feels like forever.
It’s like this bridge between the OCD and logical part of the brain that can never be crossed no matter how much you try, it’s like hitting a glass wall. The logical self from a distance KNOWS how irrational and ridiculous this all is but seems to be unable to do a thing.”
“OCD was once called ‘la folie du doute’ (‘the madness of doubt’), highlighting the central role of self-doubt in its symptomatology (Janet, 1908).” – Yes, I know it’s French.
So, what is it? There’s science behind all this and it’s not just – “Oh, hey, I can’t make a decision.” – or – “I need to touch things an even number of times” (or if you’re someone else – obsessive hand washing, hoarding, over-the-top house cleanliness and order, excessive lock checking, self harm thoughts, etc).” There is plenty of discussion on what causes something that affects 2-3% of the U.S. population (~3.3 million). What it is, when you get right down to it – It’s part of anxiety disorder and brought on by part of a broken system in the brain.
Some thoughts are that it’s causes are possibly hereditary, it might be a spontaneous mutation, perhaps some stress that caused a gene to switch on as a child, maybe an illness like streptococcal infections causing an autoimmune response that causes injury, or perhaps environmental factors. Maybe various combinations of all the above. The brain is an organ after all. That being said decades ago, there was little to know but as of late, study into OCD has increased significantly. I’m lucky, to an extent, as my OCD is less worse than a lot of other sufferers.
Anyway, I feel it best to pull quotes to help describe medical thoughts on OCD, as I’m not a medical professional, and then link to the original articles if you want to explore more. It’s a lot to read, and perhaps boring, but I’ve highlighted some text that I feel best describes things, some in layman’s terms, more scientific in others, or that just resonate the most with me:
“…OCD produces profound morbidity. Difficulties with decision-making and intolerance of uncertainty are prominent clinical features in many patients. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task… to investigate differences in valuation and value-based choice during decision making under uncertainty…Participants’ choices were used to assess individual decision-making characteristics. OCD participants did not differ from healthy controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than healthy controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). Compared to healthy controls, individuals with OCD were less consistent in their choices and less able to identify options that should be clearly preferable. These abnormalities correlated with symptom severity. These results suggest that value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty…”
“… Of note, the circuitry that is linked to valuation (Bartra et al, 2013) is abnormal in OCD (Maia et al., 2008; Menzies et al., 2008). This raises the possibility that abnormalities in valuation may contribute to decision-making difficulties observed clinically in patients…”
“Individuals with (OCD) often exhibit indecisiveness, pathological doubt, and avoidance of uncertainty (Rasmussen and Eisen, 1992; Reed, 1985; Tolin et al., 2003), even when the task at hand is unrelated to their primary symptomatology (Hamilton, 1957).”
“In OCD and compulsive individuals, some decision making acquires an abnormal emotional valence, because of abnormal activity in the OFC.” This leads to abnormal activation of the ACC and prevents an individual from making a quick or automated decision. Individual ends up in a vicious cycle where anxiety about decision making increases activation in the OFC which makes it increasingly hard to make a decision. The DLPFC is implicated in the executive function that terminates a compulsion. It is no coincidence that dysfunction of orbitofronto-striato-thalamic circuits are a cause of pathology in OCD, since these areas play a key role in decision making (Heekeren et al., 2008).”
“…brain scans of people with OCD are different than those of people without it – the prefrontal cortex of the brain is overactive in people with OCD….
…It also appears to be related to an imbalance in the levels of the neurotransmitters serotonin and dopamine, with serotonin levels being abnormally low and dopamine levels, abnormally high. Certainly, though, the OCD brain, specifically the prefrontal cortex, uses far more energy than the non-OCD brain.”
“The loop is of particular relevance to hyper- and hypo-kinetic movement disorders, such as Parkinson’s disease and Huntington’s disease, as well as to psychiatric disorders of control, such as ADHD, OCD, and Tourette syndrome.
In OCD, the loop may be dysfunctional, with an imbalance between the indirect and direct pathways resulting in unwanted thoughts, getting “stuck”.
I’ve attached 3 videos that I think give you a pretty good idea of how OCD works. I highly recommend you watch them.
I am functional in the wider world, compared to some whose lives get put on hold. But there is solid truth in these, even if they don’t describe me exactly. There is a compulsive foot-touching balance shown in the first video and that is spot on, as are touching objects an even number of times, as well as a couple of smaller items. There are some rather important internalized emotional components I totally relate to in the second video as well, which is why I’ve included it.
So we have:
1 – Everyday Experiences
2 – Relationships
3 – The Science
1. Everyday Experiences (Click Image)
2. Relationships (Click Image)
3. The Science (Click Image)
Most people confuse OCD with Perfectionism. These two are not the same thing. OCD sufferers tend to be aware that what they’re doing is irrational. However, people with “Perfectionism” don’t realize what they’re doing is irrational and are more unable to see what they are doing is “not right”. So, here is a great article on OCD vs. OCPD (perfectionism). They are similar but different:
In a world where constant rumination, non-stop cyclical replaying of things done and where at times anxiety prevails, it’s pretty obvious that it’s not sustainable in the long term even if I’ve lived with it for decades. Seriously, who wants to deal with that sort of stuff for the rest of their lives? It’s tiring and the thought that “This is fine” isn’t an option at this point now that the genie is out of the bottle. It has to be addressed (full disclosure, I told a lovely woman once, that I needed to do some “Soul Searching”. It wasn’t a throwaway line, I knew something was wrong with my decision-making processes. I just didn’t know what). So, after setting up my story, I’ll write about a part of what this blog is about and that is that OCD…is like a douchey roommate thats always creating trouble, leaves dirty dishes in the sink, leaving unlocked doors, doesn’t flush…uhhh…I mean, it’s about seeking assistance and working on stuff…
Therapy – It won’t get better without professional help because how do you change something that is not completely fixable on your own? What are the treatment options? First off, after I’ve done quite a bit of research, and after a few tries, I found a therapist that deals specifically with OCD and Anxiety-related conditions (So, I work on both OCD and Social Anxiety). It won’t happen overnight and will take a lot of effort. So…here we go…
ERP – Exposure Response Therapy (the below quotes pulled from IOCDF.org):
“OCD takes over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.”
“The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been triggered. All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms.”
“That said, this strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior. When you don’t do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.”
So, this involves slowly introducing scenarios that might trigger OCD, in essence confronting them directly and sitting through them. For instance, I’d need to purposely put myself in an uncomfortable thought position that requires making a choice. Let’s say – “going out and purchasing a shirt” and experiencing the uncomfortable feeling of choice, or driving my car, in the rain, after I washed it the day before (I’ve cancelled plans because of worrying about getting my car dirty). It could be deciding on a phone without getting lost in over-thinking the purchase, or forcing myself to step on sidewalk seams or catching myself doing even number movements when anxiety spikes. Let’s add – avoid seeking “reassurance” from others that “everything is fine” over and over again (which you will hear about later) or maybe just choose take a vacation to a specific location without over-thinking and, hopefully, in the end being somewhat “comfortable” that there is not a 100% answer to everything. So, you just sit with that uncomfortable scenario, acknowledge it and experience it till you start to inoculate yourself against that particular obsession/compulsion/anxiety spike after doing it so many times. Seems counter-intuitive but by constant exposure you get used to it. And doing this treatment while being fully aware it could pop up somewhere else…including the danger of becoming obsessive about OCD….no joke.
Mindfulness: If you hear me talk about OCD, in person, you’ll see me “spin up”. It puts the anxiety into overdrive and I start talking much faster and louder (because it’s not fun to discuss and as I said earlier, I’m pretty guarded and self-protecting). And the same could be said about just about anything that promotes anxiety (although sometimes my conflict avoidance causes me to shut down instead, since my anxiety and emotions will skyrocket, out-of-control and off to Mars, over personal, or heated, discussions). But what it entails is, basically, mellowing out. Just focusing on the here and now and the environment around you, at that moment in time, and throwing in relaxing things like Diaphragmatic Breathing.
Medicinal: I’ll have to take Selective Serotonin Reuptake Inhibitors (SSRIs) to assist in stabilizing my anxiety and compulsions until such time I can ween myself off. Think of anti-depressants like Zoloft, Lexapro, etc. People with OCD/Anxiety do commonly deal with depression from time to time (as do a lot of people) and occurs at a higher rate with OCD sufferers, so SSRIs help address those issues (remember – I originally sought out help for Situational Depression). But it also, coincidentally, helps with OCD symptoms, when taken in higher doses than you would normally take an SSRI. This is because of the aforementioned lower levels of seratonin that sufferers with OCD, typically, have. It’s not 100% deal. You can’t just treat it with a magic pill but it does add a little additional help. So, you can think about SSRIs, and their relation to OCD, sort of like Viagra. It covers more than one thing aside from it’s original intent. For instance – Viagra was originally supposed to be a cardiovascular pill, but “big surprise!” It just happens to allow the patient to…ummm…throw footballs through tires, work on lawnmowers or compels people to sit in separate tubs…in front of a lake…or something…
Sleep: My mind races at night, so for many years to quell my over-thinking and rumination I have relied on an average of 75 mg of Benadryl (which is a lot) at night to shut my mind down to get sleep. Well, once my anxiety/rumination is under control, there should be healthier methods I can employ to get proper shut eye. Good sleep does make a big difference on how I feel but I need to back off the self-medicating…then again…maybe all that Benadryl is why my allergies don’t bug me so much.
Group: I found a group here, locally, and that has been good in that seeing people who also have OCD (with differences in how their compulsions present themselves) I’m able to compare notes and not feel alone with this. I’ve learned a lot talking with people that have had years of working with this and has allowed me some important insights. I’ve only had a couple of months, so it’s a constant learning experience and that’s been great. When you’re telling someone what you’re going through and they nod their head in acknowledgment, you feel like you’re not the only one experiencing things and that’s been reassuring. These groups are all pretty informal. Conversations come and go naturally and it’s not odd feeling or anything. Let’s just say, it’s not the dark, weird and somber environment as it’s presented in a movie like Fight Club.
Support: Sharing it with friends and family that can offer a bit of support or understanding is extremely helpful. I don’t expect empathy, as most people I know likely don’t have it but hopefully some understanding. It’s a bit distressing because you’ll wonder how they’ll treat you. So far, it’s been fine and I’ve had a strong base of support. I’m thankful to have these people in my life, they haven’t treated me any differently, have been extremely supportive and many just shrug it off as “no big deal”. It’s been a nice thing to have.
Found this nice infographic that ties everything together nicely. I definitely have a moderate tie-in to Anxiety disorder. Specifically – Social Anxiety.
My Obsession and Rituals are –
1 – “Excessive Doubt/Dread of Uncertainty”
2 – “Just Right/Just So/Perfect”
3 – “Magic Numbers”
4 – “Symmetry and Order”
Like I said before, I don’t have germ issues but I can most definitely relate, even if mine manifests itself differently. It’s a wonderfully made video done by a gentleman and a story about his childhood OCD (more info about him at gabriel-wilson.com):