OCD and Organized Chaos

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

This week I’m sharing a  revised post from 2011….

As I said when I first began blogging, I am not an expert on obsessive-compulsive disorder. In fact, sometimes I feel the more I learn about the disorder, the more confused I become.

Latest case in point: Many  people with OCD deal with compulsions that revolve around the need to arrange things in some type of orderly fashion. Maybe certain items need to be lined up or spaced an exact distance apart from each other. Or perhaps there can only be a set number of items visible (usually an even number). This type of OCD is often referred to as evening up OCD. (To prove how not an expert I am, when I first heard this term I thought it referred to OCD in the nighttime!). Evening up compulsions can also include mental compulsions such as counting, as well as other compulsions such as tapping or touching things a specific number of times. So I get it. Order, symmetry, evenness are important to many people with obsessive compulsive disorder.

Then why is disorganization so common in those with the disorder?  One of the first things I said to my son Dan when  he told me he had OCD was, “Why is your room so messy? Isn’t it supposed to be really neat?” My ignorance showing through again. Many people with OCD have unbelievably messy living areas. I’m not talking about hoarders. That’s a whole ‘nother blog. I’m talking about not being capable of keeping your space and belongings in any kind of order.

When Dan was suffering from severe OCD, I saw his dorm room, and that memory still haunts me.  There were papers and artwork, sketchbooks, schoolwork, clothes, art supplies, paint, books, towels, food, and toiletries, all completely covering the floor. He said that once he lost control of the order, he just couldn’t get it back. Is it that his OCD took so much time and energy that there was nothing left for daily living tasks?

For others with OCD the need to do everything “perfectly” leads to procrastination in cleaning. They wait until they feel they have enough time, motivation, and focus to clean perfectly. Chances are that time never comes, and like Dan, the chaos builds.

Another explanation some people with OCD give for not being able to keep their living space neat and clean is the fear of germs. While it might seem counterintuitive (if they’re afraid of germs, you’d think they’d clean up), it makes sense in a convoluted way. Perhaps a piece of food was dropped on the floor while cooking. Now the person with OCD feels that food on the floor is seriously contaminated and won’t touch it, so there it stays on the floor. Before you know it there are “germs” everywhere, and nothing can be cleaned or put back in its proper place.

It’s not hard to see that giving in to OCD’s demands creates the world that those with the disorder are trying so desperately to avoid. They’re deathly afraid of germs, but are now surrounded by them. They crave order, yet are living in chaos. The list goes on.

Thankfully, nobody has to live this way if they are willing to get help. The vicious cycle of OCD can be beaten with exposure and response prevention (ERP) therapy, and the ability to keep a clean home will be just one of the many benefits of freedom from OCD.

 

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OCD and Driving

by khunaspiz freedigitalphotos.net

by khunaspiz freedigitalphotos.net

My son Dan was fearful of driving and hesitant to take driving lessons. Having driven with him a bit, my husband and I could see he was a conscientious, cautious driver and we encouraged him to work toward this important goal, which he did. We didn’t know at the time that he was struggling with obsessive-compulsive disorder.

Whether you have OCD or not, driving can be scary. It’s a huge responsibility, and one mistake could mean the difference between life and death. Every time we get behind the wheel our lives are at stake. When you think about it, it’s a wonder any of us have the courage to drive at all!

When you think about it.

That’s the thing. Most of us don’t think about it. Perhaps some drivers are acutely aware of the dangers of driving, but I think that typically, once we gain experience and build up our confidence, we become more comfortable driving and the worrying dissipates. It might actually become an enjoyable thing to do!

But as we know, when you’re dealing with OCD, life is rarely that simple. As Dan’s OCD worsened, he became more fearful of driving, even th0ugh he already had his driver’s license and some experience. He stopped driving on highways, and would only drive on roads he felt were “safe.” When I commented that he was a good driver and was likely to remain unharmed, he responded with, “I’m not worried about getting hurt; I’m worried about hurting someone else.”

His comment seems to reflect some common fears those with OCD face in reference to driving. They are worried about others, not themselves. “Did I cut someone off and cause an accident?” “Did I hit someone without realizing it?” Hit and Run OCD, as it is known, involves compulsions which might include checking the spot (over and over again) where you think you might have hit someone (and often there was never even another person in sight), watching the news or calling hospitals to see if there are reports of accidents, and mentally reviewing the events leading up to, during, and after the “accident.” Couple these compulsions with the vivid mental imagery those with OCD often experience, and it’s not difficult to get an inkling of the torment those dealing with hit and run OCD might feel.

So they avoid driving. Maybe, like Dan, they start avoiding certain roads and routes. Maybe they restrict their driving to certain times of day, when the roads are less likely to be crowded. As time goes on, OCD places more and more restrictions on where, when and how they can drive, often resulting in them giving up driving altogether. After all, isn’t that the “safest” thing to do?

Thankfully, driving was not a huge issue for too long for our son. He had places he wanted and needed to go and the only way to get there was to drive himself. So he did. OCD didn’t win that battle.

It all comes down to embracing uncertainty and living the lives we want for ourselves. Exposure and response prevention (ERP) therapy can be extremely helpful for those with hit and run OCD, as well as for those without OCD who struggles with driving fears. With the right help, we can all go anywhere we want – literally and figuratively.

 

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OCD and Indecision

choicesI’ve been an advocate for OCD awareness for almost ten years now and while I feel that some progress has been made in the public’s understanding of the disorder, we still have a long way to go. One of the more difficult concepts to get across, I believe, is just how debilitating obsessive-compulsive disorder can be. Maybe because many people, on some level, can relate to some of the more common obsessions and compulsions, they also believe they “know how those with OCD feel.” Perhaps these people are afraid of germs or everything has to be “just so.” But in reality, unless they actually have obsessive-compulsive disorder, they have no idea of the torment those with OCD experience.

One aspect of OCD that I believe falls into this category is indecision. For whatever reason, I seem to be coming across more and more people with OCD (and those with depression as well) who are affected by this issue. But not affected like those of us without OCD. While those of us without the disorder might agonize over important decisions and possibly even lose a night’s sleep, those with OCD might be paralyzed with fear over any decision – large or small.

For example:

Reviewing breakfast options over and over again in your mind, trying to determine the best combination of food to eat. The perfect meal always seems to be just out of reach, so a decision is not made, and the meal is skipped.

Thinking of, praying about, and analyzing the pros and cons of attending a particular event for days on end. Not being able to come to a decision means missing the event, and then the worrying (for days) begins over the repercussions of not showing up.

Deciding what shirt to wear to work and fearing that whatever you choose might lead to someone you love getting hurt (you know it makes no sense, but still, you never know…).
You’re late for work so you grab a shirt and for hours after repeat the phrase, “Nobody will get hurt.” You’re not able to concentrate on anything else for the rest of the day.

In the above examples, avoidance is evident, as is the need for certainty. Perfectionism often plays a role in indecisiveness as well.

It’s not hard to see how lives can almost be destroyed by this level of indecisiveness. I hope these examples have illustrated how indecision in those with OCD differs from “regular” indecision. And while these situations can indeed be debilitating, there is a solution. As I’ve said over and over again, OCD, no matter how severe, is treatable. Addressing cognitive distortions and embracing exposure and response prevention (ERP) therapy are both life-changing decisions that should be easy to make.

 

 

 

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OCD and Dating

by nenetus freedigitalphotos.net

by nenetus freedigitalphotos.net

With Valentine’s Day just around the corner, it seems like a good time to bring up the topic of OCD and dating. I’ve previously written about the heartache relationship OCD (R-OCD) can cause, and it’s certainly not hard to see how having obsessive-compulsive disorder can affect all aspects of dating. Indeed, the presence of any illness can easily complicate relationships.

Of course, each relationship comes with its unique issues, so there is no “one size fits all” playbook to handle the presence of OCD. There are, however, questions I feel should always be considered:

When (not if) should you tell your significant other about your obsessive-compulsive disorder?

Although those with OCD are very good at hiding their symptoms, I think beginning a relationship based on dishonesty is never a good idea. Your partner will realize something is up, and by this point, you will likely have already told a good number of lies to cover up your OCD. In my opinion, as soon as you realize your relationship is likely more than a one or two date thing, it’s time to discuss your OCD.

What exactly should you say?

That’s a tough question, and of course each person will need to say something different. I think it’s important to stress that OCD is not who you are, but something that you deal with. I also believe you should stress that you are working hard on fighting your obsessive-compulsive disorder and with a lot of hard work and proper treatment, it can become an insignificant part of your life. Of course you can only say this if it’s true, and if you are not actively fighting your OCD, I think you need to be honest about that as well.

Should I share details about my OCD?

Again, the answer here will vary. Those who are already feeling very close to their new partner might want to share more than those whose relationship is not quite there yet. I do think concrete examples can be helpful in understanding OCD. For example, you might say something like, “Remember I really didn’t want to go to that restaurant you suggested? I know it might have seemed as if I was being selfish, but the truth is my OCD made me believe that restaurant was contaminated and I didn’t want to put either of us at risk. I know it makes no sense, and I am working on fighting my OCD, but at that moment, I wasn’t able to move forward.”

And perhaps one of the scariest questions:

How will my significant other react?

Excellent question, and a big one for those with OCD who struggle with accepting uncertainty. The answer, of course, is you won’t know until you tell them. Reactions might range from the other person walking away to total acceptance and understanding. However for most people, my guess is it will be somewhere in between. Hopefully your significant other will want to learn more about OCD and how they can best support you.

Which brings us to another important reason for being honest with your partner. Unless educated, he or she will likely accommodate your OCD, and as we know, this is counterproductive to beating the disorder. He or she needs to learn how to support you properly. Fighting obsessive-compulsive disorder is truly a team effort.

In my opinion, if a relationship is meant to be, it will withstand whatever trials and tribulations come its way. We all have our issues but when you find the right person, you can deal with them better together than you can alone.

 

 

 

 

 

 

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OCD and Thinking about Thoughts

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

I’ve written before about the fact that there really are no “OCD thoughts.” As I explain in this post: “…when you get right down to it, there’s OCD, and there are thoughts, but there are no OCD thoughts.” Certainly disturbing thoughts might be more vivid, intense, and frequent in those with obsessive-compulsive disorder, but the content of these obsessions  is typically no different from those who do not have OCD. You name it, most of us have thought it! It’s our reaction to these thoughts that differs.

I wrote the post mentioned above because I felt it was important for those without OCD to understand that people who do have the disorder do not have thoughts that are any “wilder and crazier” than the rest of us. There is so much misinformation and misunderstanding surrounding obsessive-compulsive disorder that I felt it was critical to set the record straight regarding “OCD thoughts.”

What I didn’t think about at the time was how crucial it is for those who actually have OCD to understand that their thoughts should not, and cannot, be divided into “regular thoughts” and “OCD thoughts.” Thoughts are thoughts. Period.

Why is this distinction, or I should say lack of distinction, so important? What’s the big deal about calling disturbing thoughts “OCD thoughts?”

Jon Hershfield does a fantastic job addressing this question. In this post, which I highly recommend reading, he asks, “..how can we view our most challenging or disturbing thoughts as our own without getting caught up in false beliefs about who we are as people? Here I think we can benefit from distinguishing between content and process.”

Jon goes on to explain the difference between content and process. In one example he compares the content of thoughts to the ingredients in soup – content is simply what the soup (or thoughts) is made of. Process is more akin to our reaction to the soup. We might love the taste, or think it’s way too spicy or even inedible. In those with OCD, it is the process (how they react to their thoughts) that deserves attention and ultimately needs to be addressed and modified, not the content (what the thoughts are comprised of).

Jon goes on to give a great argument as to why content is not important in dealing with OCD:

If your first response to any thought is to disown it (i.e. “that’s not my thought”), then you are starting off by framing your thought as a threat and this is what kicks off the obsessive-compulsive loop. There is nothing to disown. It’s just what you happened to notice going on in the mind. If you want thoughts to stop being intrusive, you have to stop treating them like they are intruders. If you want them to come and go with ease, you have to allow them free passage.

I love it!

If you want thoughts to stop being intrusive, you have to stop treating them like they are intruders.

To all those struggling with OCD, I highly recommend taking Jon Hershfield’s advice. Focus on the process – the part where you are now likely dealing with things such as guilt, avoidance, and compulsions. Change your reaction. How you might ask? You guessed it – by embracing exposure and response prevention (ERP) therapy.

 

 

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OCD and Relapsing

by tiverylucky freedigitalphotos.net

by tiverylucky freedigitalphotos.net

As most of us know, overcoming obsessive-compulsive disorder is no easy task. It takes hard work, enormous effort, courage, and dedication. When those with OCD regain control of their lives, it is reason to celebrate. It is an amazing accomplishment – which is why when a relapse occurs, it can be heartbreaking.

In this wonderful article written by Dr. James Claiborn, a relapse is defined “…as a return to the same level of symptoms as before treatment.” Basically, the person with OCD is back where he or she started. Relapsing should not be confused with a lapse, which is a temporary and/or partial return of some symptoms.

I am incredibly thankful that my son Dan has not relapsed since overcoming severe obsessive-compulsive disorder almost seven years ago. Has he lapsed? I’m sure he has. He still  has OCD and while he has the tools to fight and manage his disorder, I’m guessing there are times when anxiety takes over and it’s just too difficult to do what is necessary to keep OCD at bay. But it’s not the end of the world, and I think Dan realizes this. Similar to a dieter who has one piece of chocolate cake, it’s a lapse. You acknowledge it, accept it, don’t beat yourself up over it, and strive to fight harder tomorrow.

Interestingly enough, Dr. Claiborn discusses how the interpretation of a lapse can contribute to an actual relapse. Many people with OCD deal with cognitive distortions such as black and white thinking and catastrophizing. They also have a strong need for certainty, and often live with hyper-responsibility and perfectionism as well. These are all examples of absolute thinking which can affect how they view a lapse. Dr. Claiborn explains:

…If the person has a lot of distress and concludes they need to engage in some compulsive behaviors, then they have experienced a lapse. If they then engage in some absolute thinking, such as, “all my hard work in ERP is a waste because I still have obsessions and I have to do the compulsions,” they are on the path to a relapse.

Not surprisingly, part of a good relapse prevention plan involves addressing this absolute thinking. To put it simply, it’s all how you look at it. While lapses are bound to happen, Dr. Claiborn suggests they be looked at as learning experiences and not signs that a relapse is imminent. There is a lot of good information in his article, which I highly recommend reading.

Once again we see the importance of having a good therapist who really understands obsessive-compulsive disorder and how to treat it. While being skilled in exposure and response prevention (ERP) therapy is of the utmost importance, addressing relapse prevention is also a must. Because when you get right down to it, getting well is only half the battle. The other half is staying that way.

 

 

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OCD and Twins

photostock freedigitalphotos.net

photostock freedigitalphotos.net

It is widely accepted that the causes of obsessive-compulsive disorder involve both genetic and environmental factors, and this theory has been supported by research. While OCD has been known to “run in families,” this doesn’t really tell us whether genes or environment plays a more prominent role in the development of the disorder. Studying twins who were separated at birth affords us the opportunity to separate these two factors. Unfortunately, as far as I know, OCD has never been studied in this manner.

There is no shortage, however, of twins with OCD who’ve been raised together, and I find their experiences fascinating. While their stories might not give us the answers we are looking for (in fact, I think they raise even more questions), they highlight the agony of OCD – times two. Continue reading

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