Uncertainty

OCD at its core is the inability to accept uncertainty. Life is uncertain and no one can predict the future, and for someone with OCD they will try relentlessly to try and to figure out how to reassure themselves and predict the future. OCD knows you the best out of anyone and will use that as a weapon against you. The content of the OCD does not matter it can shift to different forms and will try any angle to get your attention. If it isn’t getting a reaction it will change its approach until you fold. Remember it is not about getting rid of the thoughts, but living with them and changing your reaction. A common hurdle with dealing with OCD is the inability to accept that having these thoughts and ideas are natural and everyone experiences them. A sufferer will become so terrified that they start to resist and carryout compulsions, which just makes things worse. I met Jonathan Greyson at the conference, someone I have been admiring for years, his books, videos, and work have truly changed my life and my outlook on OCD. At the conference he told me an important message when OCD keeps attacking responding with “maybe it will happen or maybe it wont” the idea here is that we don’t know what will happen and being okay with living with MAYBE will help the brain be okay with any thoughts. I would highly recommend practicing this technique, any thought that pops up that triggers fear respond with this, I know it is easier said then done especially because OCD can be present all moments of every waking hour, but it gets easier the more you practice. Doing this while practicing ERP to purposely challenge your fears will help significantly. It is extremely important to find a therapist who is trained in ERP the IOCDF website has an approved list of therapists who know how to treat OCD:

OCD Conference 2019

I just came back from the annual OCD conference in Austin, TX and it was incredible! I encourage anyone who is suffering with OCD to attend the conference, not only are you around pioneers in the field like Doctor Johnathan Grayson and Jon Hershfield, but to meet like minded individuals is just so incredible. The conference was full of resources, talks, peer supports and so much more!

Here are a few key take aways:

  1. The doctors from Bergen Norway came to present around the 4-Day Bergen Treatment
  2. Brainsway TMS received FDA approval and will be getting approval in Canada most likely by the end of this year
  3. ERP (Exposure Therapy) is the gold standard
  4. ACT (Acceptance and Commitment Therapy) helps with pushing yourself past the thoughts and the pain by practicing mindfulness and radical acceptance
  5. Suffers with OCD are the kindest, bravest and most compassionate people I have ever met I will hold on to these incredible interactions for ever.

Next years conference is hosted in Seattle!! See below for information:

https://www.ocd2019.org/events/26th-annual-ocd-conference/custom-38-ae4b5eb661f7421da58d467be6eba399.aspx

Living With Someone Who Has OCD. Guidelines for Family Members

Great Article and Tips from the IOCDF website:

From the Experts

These articles are about special topics related to OCD and related disorders. For more general information, please visit our “About OCD” section.

(From Learning to Live with OCD)

By Barbara Van Noppen, PhD and Michele Pato, MD

This article was initially published in the Spring 2009 edition of the OCD Newsletter

In an effort to strengthen relationships between individuals with OCD and their family members, and to promote understanding and cooperation within households, we have developed the following list of useful guidelines. These guidelines are meant as tools for family members to be tailored for individual situations, sometimes more powerfully employed with the help of a therapist with expertise in working with OCD.

1. Recognize Signals

The first guideline stresses that family members learn to recognize the “warning signals” of OCD. Sometimes people with OCD are thinking things you don’t know about as part of the OCD, so watch for behavior changes. It is important to not dismiss significant behavioral changes as “just their personality.” Remember that these changes can be gradual, but overall different from how the person has generally behaved in the past.

Signals to watch for include but are not limited to:

  • Large blocks of unexplained time that the person is spending alone (in the bathroom, getting dressed, doing homework, etc.)
  • Doing things again and again (repetitive behaviors)
  • Constant questioning of self-judgment; excessive need for reassurance
  • Simple tasks taking longer than usual
  • Perpetual tardiness
  • Increased concern for minor things and details
  • Severe and extreme emotional reactions to small things
  • Inability to sleep properly
  • Staying up late to get things done
  • Significant change in eating habits
  • Daily life becomes a struggle
  • Avoidance
  • Increased irritability and indecisiveness

People with OCD usually report that their symptoms get worse the more they are criticized or blamed because these emotions generate more anxiety. So it is essential that you learn to view these features as signals of OCD and not as personality traits. This way you can join the person with OCD to combat the symptoms, rather than become alienated from them.

2. Modify Expectations

People with OCD consistently report that change of any kind, even positive change can be experienced as stressful. It is often during these times that OC symptoms tend to flare up; however, you can help to moderate stress by modifying your expectations during these times of transition. Family conflict only fuels the fire and promotes symptom escalation, (“Just snap out of it!’). Instead a statement such as “No wonder your symptoms are worse— look at the changes you are going through,” is validating, supportive and encouraging. Remind yourself the impact of change will also change; that is the person with OCD has survived many ups and downs, and set backs are not permanent. You must adjust your expectations accordingly which does not mean to not expect something!

3.Remember That People Get Better at Different Rates

There is a wide variation in the severity of OC symptoms between individuals. Remember to measure progress according to the individual’s own level of functioning, not to that of others. You should encourage the person to push him/herself and to function at the highest level possible; yet if the pressure to function “perfectly” is greater than a person’s actual ability it creates more stress which leads to more symptoms. Just as there is a wide variation between individuals regarding the severity of their OC symptoms, there is also wide variation in how rapidly individuals respond to treatment. Be patient. Slow, gradual improvement may be better in the end if relapses are to be prevented.

4. Avoid Day-To-Day Comparisons

You might hear your loved ones say they feel like they are “back at the start” during symptomatic times. Or you might be making the mistake of comparing your family member’s progress (or lack thereof) with how he/she functioned before developing OCD. It is important to look at overall changes since treatment began. Day-to-day comparisons are misleading because they don’t represent the bigger picture. When you see “slips” a gentle reminder of “tomorrow is another day to try” can combat self destructive labeling of “failure,” “imperfect,” or “out of control” which could result in a worsening of symptoms! You can make a difference with reminders of how much progress has been made since the worst episode and since beginning treatment. Encourage the use of questionnaires to have an objective measure of progress that both you and your loved one can refer back to (for example, the Yale Brown Obsessive Compulsive Scale) Even a 1-10 rating scale can be helpful. Ask “How would you rate yourself when OCD was at it’s worst? When was that? How is it today? Let’s think about this again in a week.”

5. Recognize “Small” Improvements

People with OCD often complain that family members don’t understand what it takes to accomplish something, such as cutting down a shower by five minutes, or resisting asking for reassurance one more time. While these gains may seem insignificant to family members, it is a very big step for your loved one. Acknowledgment of these seemingly small accomplishments is a powerful tool that encourages them to keep trying. This lets them know that their hard work to get better is being recognized and can be a powerful motivator.

6. Create a Supportive Environment

The more you can avoid personal criticism the better – remember that it is the OCD that gets on everyone’s nerves. Try to learn as much about OCD as you can. Your family member still needs your encouragement and your acceptance as a person, but remember that acceptance and support does not mean ignoring the compulsive behavior. Do your best to not participate in the compulsions. In an even tone of voice explain that the compulsions are symptoms of OCD and that you will not assist in carrying them out because you want them to resist as well. Gang up on the OCD, not on each other!

7. Set Limits, But Be Sensitive to Mood (refer to #14)

With the goal of working together to decrease compulsions, family members may find that they have to be firm about:

  1. Prior agreements regarding assisting with compulsions;
  2. How much time is spent discussing OCD;
  3. How much reassurance is given; or
  4. How much the compulsions infringe upon others’ lives.

It is commonly reported by individuals with OCD that mood dictates the degree to which they can divert obsessions and resist compulsions. Likewise, family members have commented that they can tell when someone with OCD is “having a bad day.” Those are the times when family may need to “back off,” unless there is potential for a life-threatening or violent situation. On “good days” individuals should be encouraged to resist compulsions as much as possible. Limit setting works best when these expectations are discussed ahead of time and not in the middle of a conflict. It is critical to minimize family accommodation to OCD.

8. Support Taking Medication as Prescribed

Be sure to not undermine the medication instructions that have been prescribed. All medications have side effects that range in severity. Ask your family member if you could periodically attend their appointments with the prescribing physician. In this way you can ask questions learn about side effects and report any behavioral changes that you notice

9. Keep Communication Clear and Simple

Avoid lengthy explanations. This is often easier said than done because most people with OCD constantly ask those around them for reassurance. “Are you sure I locked the door?” or “Did I really clean well enough?” You have probably found that the more you try to prove that the individual need not worry the more he disproves you. Even the most sophisticated explanations won’t work. There is always that lingering “What if?” Tolerating this uncertainty is an exposure for the individual with OCD and it may be tough. Recognize that the person with OCD is triggered by doubt, label the problem as one of trying to gain total certainty about something that cannot be provided, this is the essence of OCD and the goal is to accept uncertainty in life. Avoid lengthy rationales and debates.

10. Separate Time Is Important

Family members often have the natural tendency to feel like they should protect the individual with OCD by being with him all the time. This can be destructive because family members need their private time, as do people with OCD. Give them the message that they can be left alone and can care for themselves. Also, OCD cannot run everybody’s life; you have other responsibilities besides “babysitting.” You need and deserve time to pursue your interests too! This not only keeps you from resenting the OCD it is also a good role model to the person with the OCD that there is more to life than anxiety.

11. It Has Become All About the OCD!

Whether it is about asking and providing reassurance to the family member with OCD or talking about the desperation and anxiety that the illness causes, families struggle with the challenge of engaging in conversations that are “symptom free,” an experience that feels liberating when achieved. We have found that it is often difficult for family members to stop engaging in conversations around the anxiety because it has become a habit and such a central part of their life. It is okay not to ask ”How is your OCD today?” Some limits on talking about OCD and the various worries is an important part of establishing a more normative routine. It also makes a statement that OCD is not allowed to run the household.

12. Keep Your Family Routine “Normal”

Often families ask how to undo all of the effects of months or years of going along with OC symptoms. For example, to “keep the peace” a husband allowed his wife’s contamination fear to prohibit their children from having any friends into the household. An initial attempt to avoid conflict by giving in just grows; however, obsessions and compulsions must be contained. It is important that children have friends in their home, or that family members use any sink, sit on any chair, etc. Through negotiation and limit setting, family life and routines can be preserved. Remember it is in the individual’s best interest to tolerate the exposure to their fears and to be reminded of others’ needs. As they begin to regain function, their wish to be able to do more increases.

13. Be Aware of Family Accommodation Behaviors (refer to #14)

First there must be an agreement between all parties that it is in everyone’s best interest for family members to not participate in rituals (Family Accommodation Behaviors). However, in this effort to help your loved one reduce compulsive behavior, you may be easily perceived as being mean or rejecting, even though you are trying to be helpful. It may seem obvious that family members and individuals with OCD are working toward the common goal of symptom reduction but the ways in which people do this varies. Attending a family educational support group for OCD, or seeing a family therapist with expertise in OCD, often facilitates family communication.

14. Consider Using a Family Contract

The primary objective of a family contract is to get family members and individuals with OCD to work together to develop realistic plans for managing the OC symptoms in behavioral terms. Creating goals as a team reduces conflict, preserves the household, and provides a platform for families to begin to “take back” the household in situations where most routines and activities have been dictated by an individual’s OCD. By improving communication, and developing a greater understanding of each other’s perspective, it is easier for the individual to have family members help them to reduce OC symptoms instead of enable. It is essential that all goals are clearly defined, understood, and agreed upon by any family members involved with carrying out the tasks in the contract. Families who decide to enforce rules, without discussing it with the person with OCD first, find that their plans tend to backfire. Some families are able to develop a contract by themselves, while most need some professional guidance and instruction. Be sure to reach out for professional assistance if you think that you could benefit from it.

Barbara Livingston Van Noppen, PhD is an Associate Professor in the Department of Psychiatry and Human Behavior and Assistant Chair of Education Keck School of Medicine University of Southern California.Dr. Van Noppen provides CBT supervision and didactic education to psychiatric residents in the USC Keck School of Medicine program.

Michele Tortora Pato, MD is the Della Martin Chair in Psychiatry and Associate Dean for Academic Scholarship at the Keck School of Medicine-USC.

ROCD – When OCD Infiltrates Your Relationship

I found a horrowing tale of ROCD written by

CRISTIANA BEDEI25 MAY 2019, 00:30https://www.refinery29.com/en-gb/relationship-ocd-symptoms-treatment

It was 2017 when Hannah*, 33, had her first obsessive thoughts about her husband and their relationship of over 15 years. “Within days, I had a complete nervous breakdown and ended up in A&E,” she recalls. Increasingly anxious about coping with a mortgage and two children, Hannah started having panic attacks and was then diagnosed with obsessive-compulsive disorder (OCD), a condition she now believes she has had since her teens.”I would spend my days worrying, What if we lose our house? What if I have a car accident?and then one day I had this thought, What if I don’t love my husband? – and that one stuck,” she says. It became the only thing she could think of, up to 40 times a minute, all day, for days on end. “It consumed everything, I was extremely distressed and the thought of not being together and breaking up our family would then fill me with such anxiety [that] I would have a panic attack.”OCD is a common mental health condition causing persistent, unwanted thoughts and compulsive behaviours. Cleaning rituals and repetitive checks are probably its best known symptoms but OCD can manifest in other ways, often unheard of. With Hannah, it made her doubt she’d ever been in love and she would compulsively google relationship information, before cognitive behavioural therapy (CBT) helped her break the exhausting cycle. “I had to be very careful who I entrusted with my struggles,” she warns, “as all it would take would be for someone who didn’t understand to say ‘Sounds like you just don’t love him anymore’ and that would be enough to trigger weeks of horrendous anxiety.” When OCD has relationship-related symptoms, it is sometimes referred to as ‘relationship OCD’ or ‘rOCD’ – especially online, on message boards or in support groups – but these are not official medical terms, as clinical psychologist and columnist Linda Blair explains. Charities like OCD UK also discourage their use, to avoid confusion.”It’s certainly common for people with OCD [to] overthink anything that is important to them,” Blair says. When it comes to romantic relationships, that can include obsessively questioning whether someone is ‘the one’, comparing to others, researching relationships online, suspecting infidelity or to have cheated themselves and not remember it, even. Despite being absolutely torturing, these specific symptoms are not very frequent, according to Blair, who has almost 40 years of clinical practice. They might be more likely if there is a particular concern with the person’s past or current relationship experiences, though.”If there’s actual doubt out there as well, that makes your OCD a lot worse,” says Valerie*, a 27-year-old from the East Midlands, who managed to come out of a very triggering, long-distance relationship. “A lot of things [my ex] used to say to me didn’t add up, basically, there was a lot of distrust and the obsessions and thoughts would come in,” she remembers. Social media also made it worse, enabling more compulsive checking and obsessive thinking: “I went through this shit time of not eating, lying on my bed, doing nothing, literally refreshing Facebook page, then Instagram page and Facebook page and Instagram page, just to see what was going on.” The more she checked, the more she thought she had reasons to check and jump to the worst conclusions; it was all-consuming.Obviously, anyone can question their relationship or become fixated with monitoring their partners but that – as problematic as it may be – doesn’t mean they have OCD, Blair points out: “OCD has to be all-pervasive, in other words [it] has to interfere with what we call activities of daily living, the things that you would normally do.”Diagnosed at 16, after a series of panic attacks made it hard for her to attend school, Valerie says she’d always been very self-deprecating and often second-guessed why anyone would want to be with her. Being with an honest and supportive partner for the past year and a half has really made a difference, but she still finds herself uncontrollably questioning her boyfriend’s motives and thinking he might leave. “Sometimes I’ll focus on specific people and be like: ‘Why don’t you want her? She’s great, she can do this and this.'” And having had to take time off work to take care of her mental health and start a new cycle of therapy hasn’t helped with her fear of not being good enough.Blair says that with such obsessive thoughts it would be helpful to try and avoid confronting your partner continuously to get reassurance, because if their patience wears out a bit, you may end up feeling even more anxious. If possible, confide in a trusted friend or family member to put things into perspective, she suggests. “If you don’t get any relief there, then I would seek professional help,” she adds. “I would go first to my GP and say: ‘Look, I’m so troubled by these thoughts. I don’t have proof for them, but I am troubled by them and they’re causing me not to be able to function well.'”Talking to someone calm and objective, who can challenge you in constructive ways – a mental health professional, usually – can help. With therapy, it’s possible to reduce the amount of time when obsessive thinking and compulsive habits take over and find appropriate thought-blocking techniques – things that make it impossible to think about anything except what you’re doing, Blair explains: “Like counting backwards from 500 by 13, or naming all the different shades of blue or figuring out all the songs of your favourite rap artist.” Finally, you would work towards adding more enjoyable things to your life than being consumed by OCD.Getting better is absolutely possible, as Chris, 42, proves. This father of two from Norfolk has been with his wife for 20 years; his OCD first started at 17, when he left a medical training course because of violent intrusive thoughts. “I was imagining doing horrible things to patients, so I had to walk away from that,” he says. He didn’t seek help and the condition died off for a few years, until his obsessive thoughts came back, this time focusing on his wife and family. “I started to experience [thoughts] that my wife would be cheating on me, or leaving me, or that something was going to happen with the boys,” he remembers. Things got to the point where he had to stop working, as he couldn’t leave his wife or his children alone, he had to be with them constantly. “The fact that I thought I was going crazy caused me to go to some very dark places, I started self-harming and doing some very nasty things to myself that could have been disastrous,” he admits. Following a mental breakdown, 12 years after his first symptoms, he finally sought help: “Seeing the GP is the best thing I ever did,” he says, encouraging anyone in a similar situation to do the same, as soon as possible.”[Now] I’m a lot better, the relationship OCD is minimal,” he says. After several cycles of therapy, including CBT, Chris has learned to manage his obsessive thoughts about something happening behind his back or to his wife and family. “Ten years ago, [relationship-related] OCD was never talked about, now it’s starting to be discussed,” he notes. “It’s a good thing, it can only lead to more acceptance.”
If you are struggling with OCD, you can contact charities OCD ActionOCD UK orNo Panic.Samaritans runs a 24-hour support line on 116 123.*Names have been changed to protect the subjects’ identities.

NEW SHOW ABOUT OCD

I have been a huge fan of Rose Bretécher for years, she has been an incredible advocate for OCD, and has brought OCD into the mainstream media. She has been featured in several newspapers, magazines, documentaries and now she has been working on a miniseries based off her life and book Pure. Take a look at the trailer below!