I recently came across this wonderful article on values by Dr. Jonathan Horowitz. He defines values as “the things that are deeply meaningful for us,” such as important people in our lives, activities, experiences, and guiding principles. We all have our own unique set of values, and Dr. Horowitz has a lot to say about them and why we should pay attention to our own.
I’ve always believed that one of the reasons my son Dan never dealt with recovery avoidance is because his values were crystal clear to him, and he was determined to not let OCD get in his way. In an article I wrote over two years ago, I discussed two main roadblocks to recovery: fear and lack of incentive. When the incentive to recover outweighs the fear of treatment or recovery (yes, there are those with OCD who are afraid to recover), OCD sufferers can successfully battle their disorder. Here is what I specifically said about Dan:
Dan is an artist and has been passionate about becoming an animator for years. His hard work paid off when he was accepted into one of the best colleges in the world for animation. When OCD struck with a vengeance toward the end of his freshman year, there was no way he was going to give up his dream. Pursuing this dream was his main incentive to get better. In fact, he wanted help so badly that he couldn’t wait to spend his summer at a world-renowned residential treatment program for OCD.
We are fortunate that Dan found his passion at such a young age, as it served as such a powerful incentive for him to recover. Also, before severe OCD struck, Dan was a happy child with a lot of joy in his life. I think this knowledge of how wonderful life could be was also a strong incentive for Dan. He had a great life and he wanted it back. For those OCD sufferers who have struggled at length with depression or have never known happiness, the incentive to recover from OCD may not outweigh their fears.
So two of Dan’s values, art and joy, helped propel him toward recovery.
But when it comes to OCD, nothing is simple. As many with the disorder will attest, OCD tries to steal from you the very things that matter the most. Yup, your values. Is a loving relationship the most important thing in your life? OCD will make you question it. Working toward the career of your dreams? OCD might tell you it’s not for you or there’s no way you’ll be successful. Wouldn’t hurt a fly? OCD will try to convince you you’re a danger to others. In Dan’s case, OCD stole his joy, his art, and everything else that mattered to him. But thankfully, not for long. I am truly grateful that his incentive to get better outweighed his fears.
Once again, we see how complicated OCD can be, and for those who are struggling with recovery, perhaps identifying your values might be a good start. Certainly a good therapist can help you with that. If OCD has already stolen your values, maybe this realization might be enough to motivate you to fight back. And if everything that matters to you is still intact, please don’t let OCD control you any longer. Attack it with Exposure and Response Prevention (ERP) therapy, and all your values, the things you hold dear, will remain unscathed.
There was a time when my son Dan would go days at a time without eating. When he did eat, it would have to be specific food at specific times in specific places. There was no negotiating with him, and his health suffered. You might think he was obviously suffering from an eating disorder.
But he wasn’t. He was dealing with severe OCD.
While it can be argued that both OCD and eating disorders involve obsessions and compulsions, as well as the need for control, those who suffer from eating disorders typically obsess over their weight and/or body image. My son was not focused on either. His eating (or not eating) rituals stemmed from magical thinking, a cognitive distortion that is common in those with OCD. Maybe something bad might happen if he ate on Tuesday, for example. Eat that peanut butter sandwich before midnight and someone he loved might die. Others with OCD might restrict their food intake for other reasons, perhaps because they are concerned about germs and contamination.
In this great article on the OCD Center of Los Angeles Blog, Kimberley Quinlan discusses the similarities and differences between OCD and various eating disorders. Interestingly, orthorexia, a condition where sufferers obsess over eating a perfectly healthy diet, is the eating disorder (not yet listed in the DSM-5, but included in the category of “Avoidant/Restrictive Food Intake Disorder”) that is most similar to OCD. Obsessions revolve around health, and not weight and/or body image. Examples of compulsions include an inordinate amount of time reading labels for nutritional content, and avoidance of social situations where food choices might be questioned or challenged. So is orthorexia an eating disorder or a type of OCD? Are all eating disorders a subset of OCD? How do we classify these disorders and what does it all mean?
I’ve written before about my feelings about getting too caught up in the labels of brain disorders. Whether we are talking about OCD, eating disorders, GAD, depression, or other illnesses, we are just using words to describe specific symptoms, which often overlap. I think, in many cases, these labels are more helpful to health care professionals than sufferers, as they allow for diagnoses to be made. And the right diagnosis will hopefully lead to the right treatment.
Not surprisingly, Cognitive Behavioral Therapy (CBT) can be successful in treating eating disorders, just as it is with OCD (ERP therapy is a type of CBT). It follows that when symptoms of disorders overlap, treatment plans might too.
Both OCD and eating disorders can be devastating, even deadly, illnesses. They need to be diagnosed by competent health care professionals and then attacked full force. The good news is they are both treatable, and with the right therapy, sufferers can recover.
For those of you not familiar with the concept of mindfulness, it is the act of focusing on the present moment in a nonjudgmental way. Just noticing and accepting what is.
Anything strike you about this definition? To me, it seems as if mindfulness is the exact opposite of obsessive-compulsive disorder:
Focusing on the present moment? Those with OCD rarely do that. Instead they either find themselves immersed in the world of “what ifs,” worrying about everything that might go wrong, or agonizing over things they think might have already gone wrong. Lots of thinking about the future and the past. Not so much about the present.
And in a nonjudgmental way? If you have OCD, you’re probably laughing right now, because chances are you judge yourself all of the time. Whether it’s blaming yourself for bad things that might happen in the future or that possibly happened in the past, or thinking of what you did wrong or will do wrong or should have done differently, those with OCD are continually assessing their thoughts and actions. And because they often deal with cognitive distortions, these assessments are typically incorrect. One type of cognitive distortion is thought-action fusion, where people believe that thinking bad thoughts is akin to performing the action associated with the thought, or the belief that thinking these same thoughts can somehow make them come true. For example, new moms sometimes have thoughts of hurting their babies. Most will acknowledge the thoughts as having no meaning and let them go. But moms dealing with thought-action fusion might be horrified and immediately consider themselves terrible people, unfit parents, and a danger to their children, because what kind of mother thinks that way? Judgment judgment judgment.
My friend Bellsie over at Obsessively Compulsively Yours has some interesting thoughts on how mindfulness might help those with OCD, in relation to both cognitive decentering and Cognitive Behavioral Therapy.
Over the past year or so, I’ve tried to become more mindful in my own life. While I don’t have OCD, I am quite prone to “what ifs” and when I find myself heading down that road, I now easily (usually) stop myself and focus on the present moment. An act so simple, yet so powerful. And while I welcome the calm that mindfulness brings me, I am even more thankful for an additional unexpected benefit: gratitude. Focusing on the present allows me to stop and catch my breath, and when I do that I somehow become keenly aware of all the good in my life. Not in the past, and not in the future, but right now. Because right now is what really matters.
Last week I wrote about OCD and the importance of family involvement in treatment, and some of the comments I received proved to be real eye-openers for me. I realize that while I’ve previously acknowledged that writing about obsessive-compulsive disorder is a lot easier than having it, I am still somewhat naive when it comes to certain aspects of OCD. My general assumption has always been that family members, especially parents, are totally supportive of their loved one with OCD. This theory has been backed up over and over. I get comments and emails from family and friends of OCD sufferers who desperately want to help them. I connect with people at OCD conferences who want to learn whatever they can about the disorder so they can encourage and advocate for their loved one. I think of my own extended family who, when things were rough for Dan, offered to help out in any way they could.
While my own experiences are real, perhaps my view is skewed. Obviously I don’t hear from parents who are not supportive of their children. Why would I? And these same people are not attending conferences or reaching out to others or advocating for their loved ones. There are many reasons why this might be, such as believing their child should just “get over it,” or not acknowledging they are dealing with an actual illness. Maybe they’re embarrassed. To me, the reasons don’t matter much. What matters is there are people with OCD out there who are not only suffering, they are suffering alone.
This is heartbreaking. Even with all of the support in the world, OCD can be a devastating illness. But having to deal with OCD without that support? It’s hard for me to even imagine. And my guess is that many OCD sufferers who are unsupported are also ridiculed and totally misunderstood by those they love. Nobody deserves to be treated that way.
I want to make it clear that I am not talking about ignorance here. Ignorance is the lack of knowledge. Most of us who find ourselves catapulted into the world of OCD start off ignorant. I sure did. But we do what we’d do if our loved one had been diagnosed with any illness. We learn as much as we can about it and try to find appropriate help. Of course I know there is stigma to deal with. I know there are a lot of preconceived notions about OCD as well as a lot of misinformation. I know families and their histories can be complicated. I get this. But it shouldn’t matter. When your child is suffering you need to put all that baggage aside, learn the truth about OCD, and take appropriate action.
For those suffering with OCD who have not gotten the support they need from their families, it might be appropriate to take a step back and try to develop the support system they deserve. Good friends, clergy, social workers and teachers are some examples of people who could be helpful.
Unfortunately, I know I am likely preaching to the choir here. Those who have no interest in learning about OCD or helping their loved ones are probably not reading my blog. I just wish there was some way to reach them.
My friend Angie over at OCD in The Family recently asked her readers about their thoughts on parental involvement in their children’s treatment team. About a year ago, I wrote about some of my family’s disappointments in this area when my son Dan was at a residential treatment program. I think it’s an important topic that’s worth revisiting.
What I wrote to Angie, and what I firmly believe, is that parents are the experts on their children. Of course each situation is unique, and there are certainly exceptions, but in my opinion there are rarely people who know our children as well as we do. We take our children to psychiatrists, psychologists, and social workers, who see our children suffering, often in the worst condition of their lives. Good clinicians know how to treat OCD and other mental health disorders, but there is no way they can really know our children. That’s where I believe parents can be an invaluable resource, giving insight into who their children are when they are well; what makes them tick. This knowledge can go a long way in helping providers who are formulating a treatment plan.
Angie brought up an issue that is at the opposite end of the spectrum. Many parents automatically defer to the “experts,” assuming that they themselves have nothing to contribute. After all, these professionals deal with OCD all the time. What could they possibly tell them that they don’t already know?
What is needed, and what is most helpful, is collaboration. Therapists need to take parents seriously, and listen to what they have to say. Indeed, parents should be encouraged to be involved, even if they are inclined to “defer to the experts.” Another important ingredient in this mix is respect. I have heard from too many parents who have felt unwelcome in their own children’s treatment. This is unacceptable. What we all have to realize is that each of us comes into the treatment process with our own expertise. The therapist knows OCD and the parents know, and love, their child. Working together will likely culminate in the best possible outcome for the OCD sufferer. And really, isn’t that the goal?
When discussing the causes of obsessive-compulsive disorder, the general consensus is that a combination of genetic and environmental factors likely leads to its development. There’s talk of genetic predisposition, triggering events, and childhood trauma. Oh, how that last one makes me cringe, and whether it’s my imagination or not, I’ve often felt I was being judged as a parent. The stigma I deal with personally has more to do with “What kind of parent are you?” than “Your son has a mental illness.”
So it makes me think. What kind of parent am I? Did I, or my husband, traumatize our son Dan and contribute to the development of his OCD? Well, I really don’t know. I’m certain that Dan grew up in a safe and loving home. But we’re not perfect. Was I less than patient when “forcing” toilet training on him as his fourth birthday fast approached? Yes. Should I have paid more attention to him when we were focused on dealing with his sister’s serious illness? Probably. While childhood trauma is sometimes unavoidable (the sudden death of a loved one, for example), I think the way it is dealt with can either minimize the trauma or exacerbate it. Should I have been calmer and cooler at times? Sure. Looking back, there are definitely things I could have done better. There are always things I, or any parent, could have done better. Would it have mattered?
Almost three years ago, I wrote about the incident I believe might have triggered Dan’s OCD. I think about that, too. While it was obviously a traumatizing event for Dan (accidentally hurting a friend), it might not have had the same impact on a different child. Dan’s sensitivity, gentleness, and compassion for others made this occurrence particularly upsetting to him. A combination of factors.
Unfortunately, when talking about OCD and trauma in Dan’s case, I believe the trauma he endured after his diagnosis outweighs any he withstood earlier. He was traumatized by improper treatment, including talk therapy, as well as being wrongly and overly medicated. Physical and mental side effects were not only unbearable, they were downright dangerous.
And that “What kind of parent are you?” judgment I’ve felt at times? It saddens me to say I’ve encountered this scrutiny at the hands of some mental health professionals. The ones we turned to for help.
And so the stigma lives on. While never for a moment did I let my fear of being judged interfere with my mission of getting Dan help, this fear might deter others. The focus for mental health professionals, indeed for all of us, needs not to be on where OCD came from, or whose “fault” it is, but how it can best be obliterated. No stigma, no judgment, no trauma. Just understanding, respect, and proper treatment.