OCD and Death

darknessAs some of us know, obsessive-compulsive disorder can take on many shapes and forms, limited only by the imagination of the person with OCD. In general, OCD likes to attack whatever it is we most value: our families, relationships, morals, accomplishments, etc. In short – our lives.

So it shouldn’t come as a big surprise that some people with OCD are obsessed with death. What better way for OCD to attack what is most important to us than telling us our lives are all for naught as we’re just going to die anyway?

It is not unusual for people to think about death. Personally, the thought comes into my mind often. At times it hits me like a ton of bricks that my time here on earth is limited, and this realization brings up various philosophical questions: What’s the meaning of life? Am I living my life the way I should, or want? Will it even matter that I was here? Is there life, or anything, after death? The list goes on.

I don’t have OCD so I’m usually able to let it all go after a few minutes. I realize the questions I have, for the most part, are unanswerable. I accept the uncertainty and go on with my life. For those with obsessive-compulsive disorder, however, obsessing about death can be torturous. People with OCD can easily spend hours upon hours a day obsessing over various aspects of death and dying, asking the same existential questions mentioned above, and then some. But they don’t stop there. They want answers to these questions and might analyze and research them – again for hours and hours. They might also seek reassurance, either from themselves, clergy, or anyone who will listen. It’s not hard to see that these obsessions and compulsions can literally take up an entire day and overtake lives. It is not uncommon to experience general anxiety as well as depression when dealing with OCD related to death.

So how is this OCD treated? You guessed it – exposure and response prevention (ERP) therapy. While we can’t control our thoughts about death, we can learn how to better react to these thoughts. Exposures might include those with OCD deliberately subjecting themselves to the thoughts they fear, typically through the use of imaginal exposures, while response prevention involves not avoiding or trying to escape these fears, but rather embracing the possibility they will occur. No seeking reassurance. No analyzing, researching or questioning these thoughts – just acceptance of them. In short, ERP therapy consists of doing the opposite of what OCD demands. In time, these thoughts that previously had caused so much distress will not only lose their power, but also their hold on the person with OCD.

Time and time again, we see how OCD tries to steal what is most important to us. Ironically, those caught in the vicious cycle of obsessions and compulsions related to death and dying are robbed of living their lives to the fullest. Thankfully, there is good treatment to help those with OCD learn to live in the present moment and work toward the lives they deserve.



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A Mother’s Day Post

mom and babyOn Mother’s Day I often share this post that I wrote in 2011….

If you ask mothers what they want for their children, most would say, “I just want them to be healthy and happy.”  Truly, isn’t that what we all want?

So we do everything in our power to make this wish come true. We love, we nurture, we make sacrifices, and we go to the ends of the earth to try to achieve this goal for our children: to be healthy and happy.

But sometimes we come up short. Because as much as we like to think otherwise, so much of life is out of our control. Sometimes our children aren’t happy, and sometimes they are not healthy. And sometimes, as hard as we might try, there is nothing we can do to make things better for them. Whatever type of illness they are suffering from, all we want is for them to be okay.

We are in our own little club, we mothers. I don’t know about you, but anytime I hear a story of sorrow on the news, or read of tragedy in the newspaper, I rarely think of the victim. Instead my first thought is always, “That poor mother.”  Because there is no stronger emotion than the love of a mother for her child, we feel deeply when other mothers are suffering.

And so on this Mother’s Day my wish is for all mothers out there to have happy and healthy children. And if that’s not where you’re at right now, I wish you the strength and courage to carry on toward that goal.

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OCD and Perfectionism

 A version of this post first appeared in August 2013:

by stuart miles freedigitalphotos.net

Is it a good thing to be a perfectionist? To answer this question, it’s important to understand the difference between adaptive and maladaptive perfectionism. This brief article defines these two types of perfectionism:

Adaptive/Healthy Perfectionism

This type of perfectionism is characterized by high standards of yourself as well as others, persistence in the face of adversity, and conscientiousness. Healthy perfectionism usually goes along with goal-directed behavior and good organizational skills.

Maladaptive/Unhealthy Perfectionism

This type of perfectionism is characterized by excessive preoccupation with past mistakes, fears about making new mistakes, doubts about whether you are doing something correctly and being heavily invested in the high expectations of others, such as parents or employers. An excessive preoccupation with control is also a hallmark feature of maladaptive/unhealthy perfectionism.

Hmm. Fear. Doubt. Control. All symptoms of maladaptive/unhealthy perfectionism. Sound familiar? It’s hard to have a conversation about OCD without including those three words; they are the cornerstones of OCD. It’s not surprising then, that many people who have OCD are also perfectionists. For the purpose of this discussion, the term perfectionist refers to unhealthy perfectionism.

When my son Dan’s OCD was severe, mistakes were not allowed. Procrastinating with schoolwork became the norm and then morphed into him only being able to work at a specific time of day.  He then became tied to the clock for all activities of daily living.  Fear. Doubt. Control. Perfectionism and OCD rolled into one. So many compulsions in OCD are wrapped up in perfectionism. Some people need to reread paragraphs, sentences, or words over and over again to make sure they get it right. Shutting off the stove must be done properly, checking the door lock, or checking anything for that matter, are all compulsions that need to be done perfectly. The list goes on.

Of course, the problem is perfection doesn’t exist, and so those struggling with OCD can never be certain they reread the paragraph correctly, or performed any compulsion perfectly.  Just as the need for control in OCD leads to a life that is out of control, the quest for perfection leads to a life not lived to its greatest potential.

I think most people would agree there is nothing wrong with wanting to excel, and striving to be the best person you can be. That’s different from being perfect. Perfection is an unattainable goal for all of us, as is certainty. A good therapist who knows how to treat OCD will also know how to deal with matters surrounding perfectionism. Those suffering from both issues can learn to accept the imperfection and uncertainty that surrounds us. Indeed, this is something we all need to do to live happy, fulfilling lives.

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Healthy Doubt Versus Unhealthy Doubt

crossing NYC street

This post first appeared on my blog in August 2013….

I’ve previously written about how I used to scrutinize my son Dan, trying to decipher which of his behaviors were OCD related. I finally realized my intense involvement in his life was doing us both more harm than good, and I was able to let go and just trust my son.

What I wasn’t aware of at the time is that sometimes those who deal with obsessive-compulsive disorder aren’t sure themselves if their thoughts and behaviors are related to their disorder. Because those with OCD often have good insight in regard to their illness, I just assumed they knew when what they were thinking or how they were acting was OCD based. However, from reading blogs and connecting with people, I realize this isn’t always the case.

So how do we know if certain feelings and/or actions are related to OCD?

In his book When in Doubt, Make Belief, author Jeff Bell discusses healthy (intellect-based) doubt vs. unhealthy (fear-based) doubt. I highly recommend reading this book, if you haven’t already. While theoretically it might be easy to distinguish between the two, Jeff, by using an example of a man deciding whether or not to cross a busy New York street, shows us how complicated it can be. As he says, “…the same fear-based doubt that can distort our thinking is also quite adept at masquerading as intellect-based doubt.” (When in Doubt, Make Belief, page 9).

In his book, as well as in this interview, Jeff talks about the five questions he asks himself to help determine the source of his doubt:

  1. Does this doubt evoke far more anxiety than either curiosity or prudent caution?
  2. Does this doubt pose a series of increasingly distressing “what if” questions?
  3. Does this doubt rely on logic-defying and/or black-and-white assumptions?
  4. Does this doubt prompt a strong urge to act — or avoid acting — in a fashion others might perceive as excessive, in order to reduce the anxiety it creates?
  5. Would you be embarrassed or frightened to explain your “what if” questions to a police officer or work supervisor?

If you answer “yes” to these questions, there’s a strong chance you are dealing with unhealthy doubt.

As the saying goes, knowledge is power, and the more people with OCD understand their disorder, the better position they will be in to fight it. A competent therapist can also help those with OCD distinguish between healthy and unhealthy doubt, giving them a clearer picture of how OCD operates.

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The Nonsense of OCD

by stuart miles freedigitalphotos.net

A version of this post first appeared in August 2013, and might be triggering for some people…..

As we know, it is the need for certainty that fuels the fires of OCD. Compulsions are performed to reduce anxiety by making sure everything is okay. For people with OCD to recover, they must refrain from doing these compulsions and learn to live with doubt. Indeed, every one of us has to live with uncertainty if we want to be mentally healthy. But it’s not easy. Over and over we hear from those with OCD and others who admit it’s just too difficult to do.

But is it really? If you think about it, we live with uncertainty all the time. When we wake up in the morning, how do we know we will even make it out of bed? Or to the bathroom? Unless all our loved ones are standing right in front of us, how do we truly know they are okay? Even if we can see them, how do we know how healthy they actually are? You get the idea. Aside from what you absolutely know to be true in this moment, everything else is uncertain.

So we all live with uncertainty every single day, and in most cases, don’t even think about it. Even those with OCD only deal with particular issues in regards to uncertainty. Often OCD latches on to what’s most important to an individual: staying healthy, not hurting others, maintaining relationships, and the list goes on. So while people with OCD struggle with obsessions, compulsions, and certainty in these targeted areas, they often easily live with uncertainty in many other ways. Many of us complain it’s just too hard to live with uncertainty, yet we actually do it all of the time.

OCD is such a strange illness. While I accepted a long time ago that the disorder makes no sense, I’m continually amazed at how absurd it really is. Some people with OCD who have germ and/or contamination issues might spend hours in the shower but have no trouble sifting through garbage. I’m sure everyone who lives with obsessive-compulsive disorder has their own examples. And while those with the disorder acknowledge and realize none of this makes any sense, it doesn’t matter. That’s just how OCD works.

To me, another odd aspect of the disorder is that a seemingly random obsession such as the fear of hitting someone while driving, or a compulsion such as needing to pick up twigs and branches and rocks so that nobody will get hurt by them, are actually quite common. I’ve heard from many people with OCD who always assumed they were the only ones who suffered from a particular obsession or performed a specific compulsion, only to find out that others do the exact same thing. Why? Why, for example, isn’t the fear of  a car exploding because it hasn’t been properly maintained a common obsession, but fear of not turning off the stove is? Where’s the rhyme or reason?

As far as I know, there isn’t any. I hate that this illogical illness has so much power and destroys so many lives. I wish everyone with OCD would realize how much smarter they are than this nonsensical disorder so they can find the courage to fight it head on. Now that’s one thing that would make sense.

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Is That an Exposure….or a Ritual?

by master isolated images freedigitalphotos.net


For the next few weeks I will be sharing some of my older posts. This guest post by Seth J. Gillihan, PhD, first appeared on my blog in September 2013….

In exposure and response prevention (ERP) for OCD, the OCD sufferer deliberately confronts situations and thoughts that provoke distress (the exposure part), and resists the urge to do compulsive behaviors (the response prevention). This combination eventually makes the situations and thoughts less upsetting and makes it easier to stop doing compulsions.

Most of the time it’s pretty easy to tell the difference between exposure and rituals. In the short-term, good exposures raise a person’s level of distress, whereas rituals lower distress. For example, consider a person with contamination-related OCD. This individual is likely to feel worried and anxious about touching a dirty sink, and probably would feel a drop in anxiety if she were to give in to the urge to wash her hands after touching the sink. In this case the behaviors that we would call “exposure” (touching the sink) and “ritual” (washing her hands) clearly are different.

However, it’s not uncommon for a person in ERP to get confused about whether something is an exposure or a ritual, and for good reason: Sometimes exactly the same behavior can serve as an exposure or a ritual.

Take the example of a person whose obsession is that his bank account will be compromised and he’ll lose all his money. A major trigger for his anxiety is looking at his bank account statements, where he often sees withdrawals that he does not immediately recognize. For this person, looking at his bank statements will be an item on his exposure hierarchy.

Now imagine that the person is working with his therapist on this exposure. At first the man reports strong anxiety during the exposure, and after a few minutes tells his therapist that the bank statement no longer bothers him. It might be easy to conclude that the exposure was successful and that the man quickly learned to tolerate the distress and uncertainty of viewing his bank statement. However, he reports that after he read each item carefully he recognized each transaction, and felt reassured that he needn’t worry. The problem, of course, is that the exposure turned into a checking exercise, with OCD masquerading as treatment.

As always with OCD, we have to ask what the function of the behavior is. Does it raise distress, enhance the sense of uncertainty, and encourage tolerance of negative emotions? If it does, it’s probably an effective exposure. Or does it try to provide a sense of certainty and a short cut to relief? If so it’s a ritual. Other examples include:

  • Looking at one’s clothes or body for suspicious spots that could be blood (exposure) vs. carefully inspecting these spots to make sure they’re not blood (ritual)
  • Watching where one is walking to see ambiguous items that could be biohazards (exposure) vs. staring at an item on the ground to see if it really was a biohazard (ritual)
  • Viewing erotic images to trigger uncertainty about one’s sexuality (exposure) vs. viewing the images to make sure one doesn’t get “inappropriately” turned on (ritual)
  • Feeling one’s car bumper for irregularities that might indicate having hit a pedestrian (exposure) vs. trying to confirm that the bumper has no signs of impact (ritual)

In all of these cases the behavior is easy to label once we consider its purpose. Careful attention to the nature of the exposures can ensure that valuable treatment time is not wasted and that recovery is achieved as quickly as possible.

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Let’s Talk about ERP Therapy

by stuart miles freedigitalphotos.net

A version of this post first appeared on my blog in July 2013……

If you’ve followed my blog for a while, you know I’m a big proponent of exposure and response prevention (ERP) therapy for the treatment of obsessive-compulsive disorder. I don’t delve into the details often, as I’m not a therapist or an expert on ERP. However, I do think it’s important for anyone whose life has been touched by OCD to have a good basic understanding of this therapy.

The premise behind ERP Therapy is straightforward: face your fears repeatedly, and eventually they will cease to frighten you. Sounds easy (well, at least to those of us without OCD). But as we know, nothing related to obsessive-compulsive disorder is simple, and in fact, ERP Therapy can get quite complicated. Just as an example, I’d suggest taking a look at this great guest post written by Dr. Seth Gillihan, on mental rituals, OCD, and ERP. His discussion and the ensuing comments demonstrate how important it is to work with an experienced therapist who really understands the complexities of OCD and ERP.

Like OCD, ERP Therapy is often misrepresented by the media and misunderstood by the general public. Reality shows where patients are asked to do things such as licking toilet seats do more harm than good. Someone with OCD who is already apprehensive about beginning treatment will surely stay away after seeing this portrayal.

So we need accurate, quality information. While this article, written by Tom Corboy, MFT of the OCD Center of Los Angeles, focuses on ERP Therapy for the treatment of Harm OCD, it can easily be applied to the treatment of other types of OCD as well. I love the analogy he uses in the last sentences when explaining ERP Therapy:

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts.  While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

I recommend reading the whole article, but also want to share Mr. Corboy’s clarification of some basic ground rules of ERP Therapy:

  1. We won’t ask you to do anything we wouldn’t do ourselves.
  2. We won’t ask you to do anything illegal, immoral, or dangerous.
  3. We will never force you do anything.

Just as we need to spread the word as to what OCD really is and is not, we also need to provide accurate information about exposure and response prevention therapy. I believe those who have already successfully undergone ERP Therapy for OCD are an invaluable resource. Was it different from what you expected? Were there any big surprises? How helpful was it to you? What were some of your best/worst experiences? Demystifying ERP Therapy might be all that is needed to inspire some people with OCD to commit to it. And as so many of us know, that can be the beginning of a new life – one free from the confines of OCD.

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