Tag Archives: ocd

OCD Virtual Conference!


The first event of its kind, this virtual event has programming for everyone in the OCD community: individuals with lived experience, their family members and supporters, and the professionals who treat them. Running from Friday, July 31 through Sunday, August 2nd, this virtual event will feature 70 talks, 36 discussion groups, and 160 presenters!

I encourage anyone who is suffering with OCD or has a loved one suffering with OCD to attend this years conference!

To register simply go to the link and click the register button in the top right corner!

https://event.vconferenceonline.com/microsite/html/event.aspx?id=1634

ROCD

Relationship OCD is a very common and confusing form of OCD. COVID-19 has really impacted the way we live with more people working from home and layoffs on the rise. ROCD can really take advantage of these situations being around your partner 24/7 is not easy to begin with and this is a perfect catalyst for ROCD to be triggered.

Dr. Stephen Phillipson describes ROCD as:

“It’s a subset of OCD where a person is preoccupied with establishing whether their feelings for their partner are sufficient to maintain the relationship or be in the relationship.

People with ROCD have a tsunami of emotional distress over often more meaningless aspects of their partner, in terms of whether they would be a suitable partner, and so there is a tremendous amount of endless navigation or rumination about the qualities of what they think are correct or justified to continue in the relationship with.There is just an endless preoccupation, there is an endless answer seeking, sometimes even reassurance seeking from one’s partner.

Common symptoms of ROCD involve endless answer seeking and endless rumination about their partner’s qualities, and whether their internal feelings justify being in the relationship. They become very focused on their level of arousal as a proof that the person that they are with is justified to remain with. The probably is, the more that we focus on and put pressure on ourselves to have a very passionate response, the less likely we are to have that response. So it’s common that there is a tremendous amount of sexual malfunctioning or sexual apathy, because of that inverse relationship between the pressure to be sexually aroused, and then the way the brain responds to that pressure to be sexual, it’s very paradoxical.

There can be a focus on a partner’s appearance there can be a focus on a person’s character. I’ve had patients have associations about loved one’s own dating history, in terms of how long did their partner wait before they engaged in certain sexual acts as if that would provide them with reassuring evidence, or uncomfortable evidence about their partner’s character.”

A common thought process for people with ROCD is to check if their significant other has good character or if they are attracted to them. They tend to have intrusive thoughts that try to paint a horrible picture of your partner. This can be very distressing on a relationship, your partner becomes the target of the intrusive thoughts which can lead to a lot turbulence in the relationship. ROCD in specific is very difficult to deal with as relationships by nature are difficult and complex knowing when you have legitimate concerns vrs OCD is sometime hard to navigate. I encourage anyone who is going through ROCD to speak with a trained OCD therapist to help them navigate this subset.

What is OCD?

Picture a scene from a horror film playing over and over again in your mind, but this horror film is not any horror film it is about yourself, your loved ones and innocent people. The horror film is vivid with images and words popping up. You are left feeling helpless and terrified and doubting who you are as a person. How could I think these things? Do I want this? Who am I? Will I snap?

OCD wants you to be afraid of the horror film and always be enslaved to its storyline. But just like a horror film the audience knows it is not real, without the suspenseful music, special effects and graphic images it wouldn’t impact the viewer. OCD feels real because of the graphic images, thoughts and things the person cares about. If the sufferer can be an audience member and realize it is not real, sit back be uncomfortable but know that nothing is actually happening OCD will loosen its grip.

Pin on Affirmations and Thoughts

Coronavirus & OCD

Great article by Shayla Love on how to navigate Coronavirus when you have OCD.

One of the best and most effective ways to try and stay healthy during the Covid-19 outbreaks is to wash your hands. Wash them for at least 20 seconds, and be thorough—get all the spaces between your fingers, and underneath your nails. After you touch something, wash your hands again. Then wash them again before eating or picking at your face. Also, carry around alcohol-based hand sanitizer.

Experts additionally advise that people don’t get too close to others who appear to be sick—they can spread virus particles through droplets that will get into your nose and mouth. Be wary of surfaces in common areas, and disinfect those surfaces frequently.

These are evidence-based recommendations, but for someone with Obsessive Compulsive Disorder (OCD) and contamination and health anxieties, this advice can start to veer into uncomfortably familiar territory. It sounds an awful lot like the anxious thoughts they have on a daily basis, even when there’s not a new virus spreading around the globe.

For many people with anxiety and OCD, the news and well-meaning (and accurate) CDC and WHO guidelines can trigger bouts of intense anxiety and compulsive behavior. It can spark intense worries about getting coronavirus, feeling like you already have it, obsessing about what might happen if you get it, cleaning, checking, or experiencing physical symptoms of anxiety: like dizziness, breathlessness, tingling, chest pains, and more. After all, even people without OCD or anxiety are exhibiting compulsive-like behavior: buying out stores of hand sanitizer and canned goods, overstocking on masks that don’t help much if you’re not sick yourself.

I know a bit about this firsthand. When I was a child, I obsessed over whether or not my hands were clean, washing them constantly. After I washed them, I told myself I wasn’t allowed to touch anything, lest I infect them again. I would clench my fists and avoid opening doors or touching tables. If my hands even touched the insides of my shirt, they would feel contaminated to me. As an adult, I’ve also obsessed about getting various diseases, from rare autoimmune disorders to MS to bronchitis—when these obsessions would take hold, I used to sit in doctors offices weekly to try and diagnose what I thought I had.

I’ve been in therapy for OCD for several years now, where I’ve made a lot of progress on not responding when anxious thoughts arise. (Thoughts don’t ever really go away altogether, but you can get better at reacting to them.) Even though I’ve made big strides in recovery, the coronavirus outbreak can bring on a little voice in my head that says things like: A ha! See, I was right that every surface is an infected cesspool that will kill you. And: I knew it wasn’t safe to touch anything, and also you should start showering in bleach.

These outbreaks are serious: There are more than 82,000 cases of coronavirus diagnosed worldwide so far, and almost 3,000 people have died. There are currently 135 cases of coronavirus in the U.S. in 16 states, but likely many more to come as testing for the virus becomes more widespread. But how can a person with OCD manage, when suddenly confronted with messaging coming from all directions that sounds almost exactly like intrusive OCD thoughts?

Understand the reason why it’s so triggering

Covid-19 demands us to pay attention to the concepts of cleanliness and disease. And the advice to constantly wash your hands or clean surfaces gives people more reasons to think about those behaviors, said Jon Abramowitz, a clinical psychologist at the University of North Carolina.

People with OCD are often trying to do the opposite: “T[hey] take their attention away from cleanliness and get through their day acting as if the worries in their head about germs and contamination aren’t relevant,” said Shala Nicely, a therapist specialized in treating OCD. “Then the media and authorities say, actually—this is relevant.”

The CDC can also use words like “frequently” or “often” to describe how often hands should to be washed. This can cause a lot of distress to people with OCD because they can worry about the specific meaning of those words, said Jon Hershfield, the director of The OCD and Anxiety Center of Greater Baltimore. “How do I know that I am washing my hands ‘frequently’ as opposed to every hour or after every contact with a public surface?”

All this attention to germs, hand-washing, or illness can bolster anxious thoughts on those topics, and so if you’re having more of them, that’s completely normal. The trick is to not let it trickle out into your behavior, which validates those thoughts.

Follow official guidelines, but don’t go above and beyond

Of course, there is validity in the need to wash your hands while a virus is spreading, so how to toe this line? Nicely suggests borrowing a technique used in OCD therapy called exposure and response prevention, or ERP. In ERP, a person is exposed to something they’re anxious about, and then tries to not do the response that makes the anxiety go away. For example, not washing your hands after you touch the ground before eating something.

During an outbreak, Nicely said she wouldn’t recommend people to stop washing or sanitizing things entirely, but consider the exposure in a different way. The “exposure” becomes to pick one legitimate source for prevention, like information from the CDC, and follow it—but that’s it. Don’t do anything above and beyond what they advise and don’t listen to the guidelines and rules that OCD starts to set in your brain.

“OCD thinks it’s an authoritative figure on all things having to do with safety, and then it tells you what you should do,” Nicely said. “But I think it’s important to understand that OCD is not the authority on this. It does not have the knowledge to be telling you how to wash your hands.”

To make sure you’re staying within the realm of adaptive behavior, Hershfield said it can be helpful to observe what you’re doing and whether it’s changing over time. “If on Monday I am washing for 30 seconds before eating, but on Tuesday I am washing for 60 seconds, this is something to be concerned about,” he said. Once you follow CDC recommendations, tell yourself it was enough. If thoughts like, did I do it rightare you sure we did it for long enough, or let me check what I cleaned one more time come up—acknowledge them, but then let them go.

Don’t be glued to the news

Coronavirus articles are everywhere, and yes it’s important to stay informed. But Nicely also suggests not becoming too entrenched in the media coverage, and finding what works for you in the balance of being up-to-date versus knowing too much.

People with OCD can tend to be overly informed. “We become experts at whatever subject our OCD wants us to Google,” she said.

Figure out how infrequently you can check the news and still get the information you need without making you too anxious. Maybe it’s once a day, maybe it’s once a week. It could be that the best thing for you is not checking at all, and relying on and trusting friends and family to give you updates that you need to know, like any cases in your area.

“Compulsively checking the news, ruminating over what will happen in the future, or mentally reviewing what you’ve heard about the virus all create opportunities for obsession,” Hershfield said. “Focusing on the present moment, even if that includes being anxious, and working with ‘OK, this is where things are for me right now in this moment’ is your best bet.”

Accept that there is going to be uncertainty

OCD and anxiety are rooted in an intolerance of uncertainty. Ultimately, all exposures in therapy are about teaching a person that they can handle not knowing what’s going to happen when they do something that scares them.

“You can’t see viruses, so it’s impossible to know if you’re 100 percent safe,” Abramowitz said. “People with OCD tend to assume danger unless there’s a clear guarantee of safety; and hearing about the virus every time you turn on the news makes it seem like it’s easy to get.”

That’s why you might be tempted to wash your hands again, or read another news article. Because you’re trying to be more certain that you won’t get it or give it to someone else.

“We feel like if we know something we can control it, but that’s unfortunately an illusion,” Nicely said. “Knowing the current stats about the outbreak doesn’t give a person any more control over it.”

If you can accept that there are a lot of unknowns and try to live with the discomfort, it will go a long way to managing stress during the outbreak.

Don’t be too hard on yourself

All of that is easier said than done. Nicely and Abramowitz said this is going to be an extremely difficult time for many people with anxiety and OCD, and so it’s important to be kind to yourself during this process.

“Say to yourself, I’m going to do the best I can but sometimes I’m going to mess up,” Nicely said. “I’m going to be super anxious and that’s all okay. The other problem all of us with OCD can face is we want to do it perfectly. We might think: I didn’t perfectly follow the CDC guidelines and I should beat up on myself. Instead, be really nice to yourself and say, wow, this is a really hard situation for everybody.”

Calm In The Storm

When OCD wins it is hard to get out of the cycle it can really knock you out for a few days. OCD leaves the suffering questioning over and over again who they are, did they do something properly, is something horrible going to happen? Am I actually a monster and this is not OCD? The main reason why OCD is called the “doubting” disease is because a sufferer will never be able to satisfy it with any answer and you will be left in an endlessly struggling of arguing with yourself and carrying out compulsions. OCD is in conflict of the person true values and intentions that is why it is so debilitating and painful. It is okay when you are having a big spike to just allow the feelings and pain to exist and trying to remind yourself that this too shall pass.

Remember ERP is the gold standard of treatment, it is very difficult to ask someone who is really triggered to engage in ERP because their anxiety is already so high.

This is a really good video on how ERP works and why OCD sufferers can benefit from it:

Obsessive-Compulsive Disorder and Secrecy

Great article by:

Albert Rothenberg, M.D.

Creative Explorations

https://www.psychologytoday.com/ca/blog/creative-explorations/201910/obsessive-compulsive-disorder-and-secrecy

A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients’ secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.

More than with many other psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one’s clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.

The feelings of shame and desire for secrecy strongly influence patients’ open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.

Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.

Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.

How much is “excessive”? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?

At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.

For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations.

Obsessive-compulsive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.

Mental IMAGES

OCD is defined as: Obsessions are unwanted and repetitive thoughts, urges, or images that don’t go away. They cause a lot of anxiety. These obsessive thoughts can be uncomfortable. Obsessions aren’t thoughts that a person would normally focus on, and they are not about a person’s character. They are symptoms of an illness.

I wanted to shed light on mental images in OCD, a lot of times people who do know about OCD know about the intrusive thoughts or the compulsions. But what about the mental images? Many people who suffer with OCD are plagued by mental images that are often disturbing & distressing in nature. This makes the fears amplified to the point of the individual now picturing in detail their worst nightmares. Aaron Harvey describes it in an interview with Cosmopolitan.

“One of the things I have to deal with the most is harm OCD, and it’s really challenging. When I step into the shower and see the razor blade, it will automatically trigger [an image of] me, like, mutilating my genitalia. If I react to those images, they just get worse. It’s kind of like living in a nightmare. …I’ve struggled with sexual identity as a result of repeated, intrusive sexual thoughts about men, despite being straight. During sex, I may have dozens of intrusive thoughts spanning incest, violence, and other unwanted imagery that steals the beauty of the moment. I have graphic flashes of friends and strangers engaging in bizarre sexual acts” – Aaron Harvey (creator of instrusivethoughts.org)

The images are extremely debilitating, and getting to a point where you are okay with just allowing them to pop in and out is extremely painful and difficult. The images cause a lot of distress, so suffers gut reaction is to try their hardest to get rid of the thoughts. But as we know trying to push away and resist the thoughts fuels OCD and makes it worse.

ERP is a great tool against the images, exposing yourself to the images and not allowing yourself to engage in compulsions will allow the reaction subside. To really challenge yourself purposely try and think of the images and confront the discomfort.

Exposure Response Prevention, commonly referred to as ERP, is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions.

Exposure therapy starts with confronting items and situations that cause anxiety, but anxiety that you feel able to tolerate. After the first few times, you will find your anxiety does not climb as high and does not last as long. You will then move on to more difficult exposure exercises.

Being asked to face your fears is perhaps one of the bravest aspects of treatment, and is where the approach of the therapist is most valuable, helping a person understand the cognitive reasons behind an exercise and being there to help encourage and motivate them to face the challenges it involves.  If the therapist actually participates in the exercises too, this helps build up trust and confidence in what they are asking the person with OCD to do.