OCD and Procrastination

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

When my son Dan’s obsessive-compulsive disorder was at its worst, he would spend hours at a time doing nothing (except obsessing and ritualizing of course), even though he so wanted to successfully complete his freshman year of college. It was frustrating and heartbreaking for me to watch. Why couldn’t he just do his work?

Procrastination in those with OCD is not unusual, and  my guess is there are many reasons why this is true. For Dan at this time, OCD was definitely calling the shots, telling him when and where he could or could not do his schoolwork. Also he is a perfectionist, which is a common trait for those with OCD. But he was dealing with unhealthy perfectionism characterized by fear, doubt, and control. It’s not hard to see how this could lead to procrastination. Mistakes were not an option, and the only way to not make mistakes is to just put off doing the task, or worse, not attempt it at all.

Ahh, avoidance.

Avoidance can be seen as a compulsion in OCD. Someone with OCD might avoid a potentially triggering situation, or at the very least, procrastinate as long as possible until the inevitable must be faced.

Perhaps another reason for procrastination is that many people with OCD have a propensity toward indecision. It is so important to make the right decision that it’s just easier to procrastinate, or even not make any decision at all, which of course brings us back to avoidance.

So how can those with obsessive-compulsive disorder stop procrastinating?

Obviously, getting the right treatment for OCD should help immensely, and is the most important step you can take. Another strategy involves using a timer to inform you it’s time to make a decision or start a task. Or if you are facing a particularly daunting undertaking, you can use a timer and tell yourself you only have to work for ten minutes to start, and then take it from there. You might find that once you’ve started, the task at hand is not nearly as difficult or frightening as you had anticipated. Scheduling a specific date and/or time on the calendar can also be helpful for those who procrastinate. And how about making a list, perhaps even including exactly when something should be done? Many of us love the feeling of crossing things off our lists. All of these suggestions help take the thinking, or ruminating, out of the equation, as timing has been predetermined.

Procrastination wastes precious time that should be spent living the lives we want for ourselves. Of course we all procrastinate now and then, but if it is affecting your life significantly, I hope you’ll get help. We all deserve to be able to live full lives – now, not later.

 

 

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After Residential Treatment

by digitalart freedigitalphotos.net

by digitalart freedigitalphotos.net

My son Dan spent nine weeks at a residential treatment program for OCD. When my husband and I decided it was time for him to come home, I was ambivalent to say the least. As I said in my book:

On one hand I was thrilled he’d be home in five days, and on the other hand I was terrified he’d be home in five days.

Many people who attend residential treatment programs for OCD are there because their OCD has become so unbearable that they feel they have no other choice. They are severely debilitated. As I’ve said many times before, Dan entered the residential program in the worst condition of his life. But he wasn’t the only one affected; our whole family also suffered.

Though my husband and I had our share of complaints about the program Dan was attending, there is no question the staff there knew how to treat OCD. In nine weeks Dan went from a young man who could barely function to someone who, for the most part, was able to manage his OCD and was eager to return to his life – the one he had before OCD took over.

But it’s so scary. And not only for the person with OCD. As family members we vividly remember the horror of what life was like before residential treatment. Yes, we can see our loved ones have made strides in treatment, and they do seem so much better, and sure they’ve gone “off-campus” to do all sorts of exposures, and it’s clear they now understand their OCD better than ever….

BUT…what if when they come out of their somewhat sheltered environment and into the real world, they end up back where they started? That is the thought that kept me up nights as we counted the days to Dan’s termination. Perhaps this concern was particularly relevant to us as we decided to remove Dan from the program against the recommendations of his team there. Still, I believe this is a common fear, not only for loved ones, but for the person with OCD who is leaving a safe, supportive environment and venturing back out into the world.

Of course there are things we can, and should, do to maximize the chance of a smooth transition. We can have good health-care providers in place, ready to continue ERP therapy. We can be vigilant about not enabling our loved ones and be sure to keep the lines of communication open. We can remain optimistic and confident that OCD can be beaten, even when dealing with some regression. We can maintain our senses of humor. And we can trust that those who have just gone through this intensive treatment will be better equipped than ever to handle whatever comes their way.

But still….what if?

It didn’t take me long to realize I needed to accept, and even embrace, the uncertainty of the situation, and of life. Sound familiar? This is exactly what Dan learned to do as part of his therapy – those with OCD struggle with the need for certainty, which is simply not attainable.

In Dan’s case, there were indeed many ups and downs once he left residential treatment, but we, like most people, were able to put aside the “what ifs” and deal with everything that came our way, until our son finally beat OCD. If our family could do it, yours can too.

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OCD and Chemical Imbalance

pillsWhile the cause of obsessive-compulsive disorder is not actually known, many professionals and lay people often attribute the disorder to a chemical imbalance. SSRIs, which are medications that affect serotonin, are known to reduce symptoms in a good number of people with OCD. So it is reasonable to deduce that serotonin levels in those with OCD must be out of whack, right?

Well, not necessarily. That explanation is way too easy, and certainly has never been proven. Drugs often help people with all types of illnesses, but how and why they help is not always clear.  And I’m not just talking about medications for brain disorders. There are a number of cholesterol medications, blood pressure medications, anxiety-reducing  medications, rheumatoid arthritis medications – just to name a few – that work to reduce symptoms. Different drugs work for different people, and we don’t always know why. Why does acetaminophen help my husband’s headache but only ibuprofen works for me?

But really, what’s the big deal if we just use an easy explanation of “chemical imbalance” when discussing the cause of OCD, even if it’s just a theory?

Well, for one thing, if those with obsessive-compulsive disorder, or their loved ones, believe their OCD is caused by a chemical imbalance, how will they feel if medication fails to correct this supposed imbalance? Depressed? Confused? Hopeless?

And if we believe that treating OCD is as easy as raising our serotonin levels, we might just be lured into the many scams out there promising a quick fix for OCD. Raise your serotonin levels and be free of OCD ! Ah, if only it were that easy!

As imaging technology advances (PET Scans for example) and more research is conducted, we are discovering that nothing is simple when it comes to OCD. Studies have shown that those with OCD have elevated brain activity in parts of the frontal lobes (particularly the orbital cortex) and the basal ganglia. This is important information that, on the one hand, brings us closer to understanding OCD and its causes, and on the other hand, raises even more questions. Throw in the fact that genetics and environment have been shown to play a big role in the development of OCD, and it is now easier to see how we can’t just attribute the disorder to a chemical imbalance.

So where does that leave us? Well, thankfully, we do not have to fully understand the cause of obsessive-compulsive disorder to treat it effectively. Exposure and response prevention (ERP) therapy, the evidence-based Cognitive Behavioral Therapy used to treat OCD, works. It literally saved my son’s life. So while the experts are busy at work trying to decipher what actually causes OCD, those who live with the disorder can commit themselves wholeheartedly to ERP therapy. Because one thing we do know is that OCD, no matter how severe, is treatable and can be beaten.

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“Just Right” OCD

by jackthumm freedigitalphotos.net

by jackthumm freedigitalphotos.net

 

If you or a loved one has obsessive-compulsive disorder, you know that OCD typically attacks what matters the most to you – 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 my son Dan’s case, OCD stole his joy, his art, and everything else he held dear.

And just when you think you’ve beaten OCD in one area, it shows up in another. I’ve often heard people compare obsessive-compulsive disorder to that whack-a-mole game found in arcades. You whack one mole only to be have another one pop right up. It never ends.

While most people with OCD might be nodding their heads now in understanding, not everyone’s OCD works this way. Those who deal with “just right OCD” experience thoughts and feelings that something is “just not right,” or is incomplete. While on the surface it might look similar to other forms of OCD, its symptoms are more likely to be driven by a vague discomfort or tension rather than the attack on values and ensuing anxiety as described above.

Let’s take the classic example of someone with OCD who washes his or her hands compulsively. In many cases, this compulsion stems from fear of contamination. Perhaps the person with OCD thinks he will spread germs to others or make himself sick if he doesn’t wash, wash, wash. This fear of illness or of causing harm to loved ones is the impetus for the hand-washing compulsion.

Those with “just right OCD” might present with the same hand-washing compulsion, but their obsessions are not related to contamination. Because they are grappling with strong feelings of incompleteness, people with this type of OCD feel compelled to wash their hands until this sense of incompleteness resolves and  everything feels “just right.”

It is interesting to note that those who deal with “just right OCD” are more likely than others with OCD to have a co-morbid condition such as tic disorder. In fact, it can often be difficult to differentiate between “just right OCD” and tics, so a good therapist is a must in getting a correct diagnosis and treatment. Also, not surprisingly, perfectionism and general inflexibility are also often associated with this type of OCD. For more info about “just right OCD” I recommend checking out this IOCDF fact sheet.

So how is “just right OCD” treated? You guessed it. The same way as all types of OCD – with exposure and response prevention (ERP) therapy. While there are many subtypes of OCD, and the disorder can morph from one type to another (remember our whack-a-mole analogy), the bottom line is OCD is OCD. All  kinds of OCD are fueled by doubt and uncertainty, and all OCD sufferers get caught up in the vicious cycle of obsessions and compulsions. But the good news is that, with the help of a good OCD therapist, all types of OCD are also treatable.

 

 

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OCD and Sleepwalking

by artur84 freedigitalphotos.net

by artur84 freedigitalphotos.net

Sleep is often a big issue for those with obsessive-compulsive disorder. In fact, this post on sleep written over three years ago continues to be one of my most popular. Too much sleep, too little sleep, trouble falling asleep and trouble staying asleep all have the potential to exacerbate OCD.

I find it interesting that those with OCD, as well as those who suffer from anxiety and/or depression, have an increased risk of sleepwalking. Researchers from Stanford University School of Medicine discovered this link. But what does it mean?

To be clear, sleepwalking doesn’t necessarily just mean walking in one’s sleep. It can also involve other motor activities, such as sitting up in bed, or doing routine activities such as getting dressed or making a sandwich. It occurs in the non-REM sleep cycle.

Let’s get back to what this increased risk of sleepwalking actually means. The lead author of the paper on this study, Maurice Ohayon, M.D., D.Sc., Ph.D., professor of psychiatry and behavioral sciences, says  “There is no doubt an association between nocturnal wanderings and certain conditions, but we don’t know the direction of the causality. Are the medical conditions provoking sleepwalking, or is it vice versa? Or perhaps it’s the treatment that is responsible.”

It’s the ‘ol which came first, the chicken or the egg conundrum. Does having OCD cause someone to sleepwalk? Or could it be that sleepwalking leads to OCD? To further complicate things, those who take antidepressants experience a higher than average amount of sleepwalking. As many of us know, SSRIs are antidepressants and are commonly used in the treatment of obsessive-compulsive disorder. Could they be the culprit? And how important is it to even figure this all out? Why does it matter?

To me, any research that sheds light on any aspect of OCD is welcome. Who knows what surprising breakthrough might arise from a particular finding? At the very least, health-care professionals can be made aware of the potential relationship between sleepwalking and various illnesses, so that its presence can serve as a red flag.

Maybe one of the reasons I find this subject so interesting is that I come from a family of very lively sleepers (talk about an oxymoron). As a young girl, my mother would walk down steps and then out the front door, only to be found on the sidewalk by kind neighbors who were familiar enough with her routine sleepwalking to gently guide her home. For as long as I can remember, I’ve talked, screamed, sung, and have had detailed conversations in my sleep. However, while other family members have exhibited similar sleep issues, my son Dan, who has obsessive-compulsive disorder, was not a sleep talker or walker as far as I know, though he certainly had his share of sleep problems when his OCD was severe.

There is so much we don’t know in regards to OCD, sleep, and their possible connection. What I do know is that for my son, and for so many others, getting proper treatment for obsessive-compulsive disorder resulted in the added benefit of a good night’s sleep.

 

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Treatment-Resistant OCD

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

Over the years I have received emails from people with obsessive-compulsive disorder who tell me their OCD is treatment resistant. In some cases they have been told this by a professional, and in other instances people have come to this conclusion on their own.

In writing this post, I figured it would be a good idea to first define treatment resistance in OCD. Surprisingly, I came across some conflicting information on several sites. Does it mean the patient has no improvement at all even when all proper therapies have been attempted? Does it mean there might be a small improvement but not enough to make a difference in the quality of life of the person with OCD? Does it mean nothing will ever help? Check out the definition of treatment-resistant OCD in this article:

Treatment resistant OCD is generally defined by two adequate attempts with SRIs. SRIs stand for a class of medication called antidepressants. They include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

While a few articles I read said that treatment-resistant OCD and treatment-refractory OCD were interchangeable terms, this one said they are very different, and went on to define treatment-refractory OCD:

True treatment-refractory OCD can only be determined if a person has tried, at a minimum, three different SSRIs at a maximum dosage for at least 3 to 6 months each (with the TCA clomipramine being one of them). They must have also undergone behavioral therapy while on a therapeutic dose of an SSRI, and lastly, have received at least two atypical anti-psychotics as augmenters while receiving behavioral therapy and taking the SSRIs.

With these varied (and somewhat vague…CBT for how long?) definitions, how can anyone  be sure what their health-care providers mean when they say, “Your OCD is treatment resistant?” The above definition of treatment resistance would have fit for my son Dan, as medication never seemed to help him. But he recovered from severe OCD once he embraced exposure and response prevention (ERP) therapy. His OCD went from severe to mild and he continues to do well seven years later.

It’s confusing to say the least. So many definitions and interpretations. Most of the articles I read focused mainly on all the possible combinations of medications that could be attempted before the label of “treatment-resistant” is applied. But hidden amid the treatment options of novel medications and neurosurgery was this sentence about Cognitive Behavioral Therapy (CBT):

As stated, most OCD sufferers have not received an adequate trial of behavioral therapy, which is ultimately the most effective way to beat OCD long-term.

While I don’t deny there are people out there who truly have treatment-resistant OCD, my hunch is there are many people with this label who can be helped with the proper treatment.

A valuable lesson learned from my son’s journey through severe OCD is that you can’t always believe everything everyone tells you. Whether you’ve been labeled treatment resistant by yourself or someone else, do whatever you can to get good ERP therapy. And then do yourself a favor and read this important article by Dr. Seth Gillihan; share it with your therapist if necessary. And don’t give up! I believe there is always HOPE for those with OCD.

 

 

 

 

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Interview on About Health

renjith krishnan freedigitalphotos.net

renjith krishnan
freedigitalphotos.net

On Monday March 21, 2016 I joined Dr. Michael Tompkins as a guest on About Health with Rona Renner. It was an informative hour spent discussing many aspects of obsessive-compulsive disorder, and listeners also called in with their questions. You can access the program here.

Thank you to Nurse Rona for helping to spread the word about OCD!

Posted in Mental Health, OCD | Tagged , , , , | 6 Comments