Murphy's Law- OCD?

Besides my standard contamination OCD, I also have what I consider a general "Murphy's Law" OCD- where I assume the worst case scenario will happen. I think this probably falls somewhere between OCD and General Anxiety Disorder (GAD). I tend to have one big picture worry floating through my head at all times. Usually it's something with about a 0.1 - 1 % (or sometimes less) chance of happening, but when I'm really worried, it seems like about a 50% chance. For instance, the neighbor's cat and rabies, or worrying about my sister's house while she's out of town.

Today, it's that a friend has asked me to mail him an expensive item that I borrowed several years ago and then promptly forgot about. I'm convinced that it will be stolen from his front porch. However, despite the fact that if I chose to, I could actually take a road trip and return it to him in person, I'm not going to do that. I'm going to mail it, and sit with the worry. Ugh, but good, I guess.

It's too hot to blog

I live in the Pacific Northwest, where a typical "hot" day is 90. Today it was 104 (and is still 100 at 8pm), tomorrow may be even hotter. It's too hot to blog! I did get some good exposures in today. An example: my sister is out of town, and I'm worried that something terrible will happen to her house in this heat. But I'm just sitting with that uncertainty, rather than going over there and checking. I also had a good exposure involving a piece of cake at work. Anytime your exposure makes you eat a piece of cake, it's a pretty good day!

The Joy of the Accidental Exposure

While I think of today's exposures as accidental, they weren't really. I don't usually put myself in the position for unplanned exposures, since I try to control everything. But today I had two of the many social events referenced in this post. First I went on a hike with a friend with a dog. Then I went to a high school reunion picnic. I didn't wash my hands after the hike, even after brushing some dried mud off my legs. I ate picnic food. I hesitated a little, but ultimately, it felt great to eat. And I really didn't feel that stressed about it. Little by little, scary things are turning not so scary.

Hugs

I don't hug people. All those germs, you know. Last night I went to my high school reunion. Boy, do those people hug. I must have hugged about 30 people, and I didn't cringe once.

Social Anxiety

I have a mild case of social anxiety. I sometimes don't go to events that I'll otherwise enjoy, because the anticipation of that first entrance, where I'm not sure if I'll know anybody, is so high.

I also hate scheduling to get together with people, because I'm always worried I'll get sick and cancel, and they'll be mad. That's all OCD, though.

So I've been trying to not just schedule a lot of events, but schedule them close together. Somehow, I get even more nervous that way.

In the next 2 weeks, I've got 7 social events on the agenda, with a few more possible. They are all things I'm actually really excited to do, but I'm still a little edgy about it all. That's what this is all about, though.

Back on Track

Well, I was going to post a cool picture of my cat bite. He got me with 4 different teeth. But my camera is terrible, so you can't really see it.

Anyway, my rabies anxiety has waned.

And I'm getting back on track with my exposures. For a while I've felt like the floors in my house are contaminated. So I've been lying down on them sometimes. And at least once a day touching all the floors (except the bathroom) without washing my hands afterwards. Sometimes it's easier than other times, but I always forget I've even done it within a few hours.

This week my assignment is to add touching the bathroom floor to the mix.

Haha, the trouble with OCD is you can't really celebrate your victories with "normal" people: "Hey guess what, I touched the bathroom floor this morning!" Well, I'll be happy anyway.

Oh, Man

Today's exposure was not recommended. The neighbor's cat bit me. Now I'm sure I going to get rabies. I used to volunteer at the local shelter, and several cats bit me there. We were always supposed to tell a staff member, because they were required to quarantine the cat for 10 days. I never told, because that just seemed harsh, when the cat usually had given me some "warning" that I ignored (the cat did today, too. I guess I'm just stupid). For some reason I never worried about rabies at the shelter, and the wounds never got infected, either. But today, I'm worried. Chalk it up to the inconsistent nature of OCD, I guess.

In any case, the recommended approach is 10 days of observation; outside of observing, I think I'll be avoiding that cat from now on.

43 days a year?!!

So today at work I learned that tomorrow I'm getting new computer. As I sat and worried about the tech guys touching my keyboard with their "dirty" hands, I looked at my adding machine. And I did a calculation. I estimated how much time I waste worrying, or not sleeping well, or looking up stuff on the internet to reassure myself. When I added it all up (it's pretty rough, but I don't think it's too high), I estimated that I spent more than 43 full 24-hour days worrying every year. Think of how much I could get done, or how much fun I could have, or how much extra sleep I'd get if I could give my worry up. I figure the illnesses I'm so worried about probably make me miserable about 6 days in a typical year. That's 7 times less than I currently make myself miserable. It's an eye-opener for sure.

Today was not a good day

I was feeling guilty about canceling on my aunt. Then I discovered mold growing under some vinyl flooring in my basement. I wouldn't normally be worried much about mold (despite being allergic), but I'm currently making a quilt for a friend's wedding. I already have vague fears about "contaminating" the quilt. Releasing mold spores throughout the house didn't help.

Oh, well, tomorrow is another day.

Ups and Downs

I'm really really excited about the success I've had this week. Today I went to the grocery store down the street just to use their bathroom. It's a very clean bathroom, but in five years, I've never been in it except to wash my hands, and then I always use a paper towel to open the door. Today I used the bathroom and afterward opened the door with my bare hand. Whew! A first step at least. My anxiety was about a 7 as I walked home, but by the time I got there, it had already dropped to about a 2.

But I also cancelled a movie date with my aunt. She's currently undergoing chemotherapy and last week had to reschedule her chemo because she got sick. I'm now terrified that I'll get her sick and she'll have to reschedule again and it will be ALL MY FAULT. I haven't been sick with a contagious illness since 2007 (I guess excessive handwashing will do that for you), but I'm still always convinced that I'll be sick tomorrow. Which of course means I'm contagious TODAY without realizing it.

ERP Breakthrough

I was back at work today after my OCD-inspired vacation and I had an exposure breakthrough. I experience the habituation piece of ERP pretty regularly. That's when during an individual exposure, the anxiety slowly eases over the course of minutes or hours. It's much more rare that I've totally overcome my fear of something. Usually even if it's easier to face it, I still feel a little stress and just force myself to do it anyway. But today, a coworker brought some paperwork over to my desk. I usually feel a sense of dread, because I know I'll want to wash my hands after touching it. But today, she handed it to me, and all I thought was, great, I could really use that. I thumbtacked it to my bulletin board and went back to my computer. It felt awesome!!! (Now, if she'd had symptoms of a cold, that would have been another story, but we'll save that exposure for another day. :) )

A Big Exposure

More than a year ago, I was on the bus, and the woman next to me vomited. An objectively gross experience, I think. But my OCD took it over the top. She didn't actually vomit on me, and I don't think I even got splashed, but in my head, everything was contaminated. I took a shower and washed all my clothes, but I wasn't sure what to do with my backpack and its contents. So for the last 18 months, it's lived in a corner of my bedroom, where I've been afraid to touch it. (Yes, that's logical, put the "horribly contaminated" object next to your bed!)

Last night I decided enough was enough. I pulled everything out of the backpack. There were some good things in there, including a check for $72- oops! And some not so good things, including something that used to be food and was now a brown liquid- ick. I vacuumed up 18 months worth of dust, threw the backpack in the wash (due to the drippy brown liquid) and reclaimed a corner of my room. It was pretty scary, and my anxiety jumped pretty high later in the evening, as I continued to wear the clothes I had on while I cleaned. But today it feels great!!!

Finding a Therapist for your OCD

Based on my own experience, and reading about other people’s experiences, it’s extremely difficult to overcome OCD without the help of a good therapist. It can be very difficult to find one who’s both good and a good match for you.

The absolute key is finding someone who can help you with Exposure and Response Prevention (ERP).

If you have insurance, it makes sense to start within their system.

If you have an HMO (as I did), see if they have anyone who has experience with OCD. But you’ll need ask about ERP. My current HMO had me see 4 different therapists over about 6 months, and none ever mentioned ERP. I went outside the system at that point.

If you don’t have insurance, or find the therapists your insurance covers not helpful, or your insurance is so good that you can see anyone and be reimbursed, then your search begins.

The Obsessive Compulsive Foundation has a fabulous database of people who treat OCD. You can search by state and city, or by zip code. I believe therapists self-refer to the database, so there’s no guarantee they’re great. But I’ve seen two therapists from this list, and both really knew what they were doing.

If you’re lucky enough to find more than one person in your area, arrange a consultation meeting if possible. Most therapists will talk with you briefly at no charge to see if your needs and their skills are a good fit. Among the issues to consider: do their views about taking medication match your own, do you prefer someone of the same or different gender, do you just plain feel comfortable when talking with them? A good resource on this issue, including questions to ask, is this OCFoundation brochure.

Rates vary a lot. Generally (although not always) a Masters level therapist will charge less than a PhD, who will charge less than an MD. And an experienced Masters level therapist may well be just as good or better than an MD with little experience with OCD. Some therapists will work on a sliding scale, and you may be able to see someone a little less frequently than normal to keep costs down. You'll have to work a little harder this way, but I think it's doable. Consider what an incredibly important investment this is in you, and see if there's anyway to swing the cost, if you're paying on your own.

Hopefully this works. But what if there’s no one in your state or city?

Some therapists will work via phone consultation. Or, if you find a therapist you otherwise like and trust, see if they will work through an ERP self help book with you.

If your therapist isn’t a good match, don’t give up. My current therapist moved to town a year ago, after practicing a number of years in another state. If I hadn’t checked back at the OC Foundation database, I wouldn’t have found her.

Patience and persistence can be important; there is a therapist out there for you.

Confession

Okay, so I'm proud of the ERP success I had below. But I do have to confess that the only reason I was able to go to the store on a Monday is that I took yesterday and today off. Why did I do that? Because my boss leaves for vacation on Wednesday, and I "couldn't" take the chance of getting sick and then getting her sick on her vacation. Ugh. So there's still plenty of work to be done.

Fun with Exposure

For years I haven't used carts or baskets at the grocery store. For the last few months, I've been using the small baskets. The last frontier is to use a grocery cart that has a place in the front for a germy kid to sit. If you'd told me 6 months ago that I would have used that cart without disinfecting it or me, I'm not sure I would have believed it. Yesterday I went to a fabric store and I used the cart. I even put my fabric right where the germy kid would have been.

I tried to up the ante by using the store's restroom. It was an objectively yucky bathroom, and I just couldn't do it. I did touch the yucky door handle with my bare hand on my way out, though.

When I do tough exposures, I try to rate my anxiety on a 1-10 scale, and then watch it fall. After touching the bathroom door and then picking out my fabric, I was at about a 9. It fell by the time I left the store. While waiting for the bus (oh, did I mention I took the bus, the busiest bus in the system, to go to the store?), I ran my hands through my hair and up and down my arms, to really "contaminate" myself. My anxiety still only jumped back to a 7 at that point.

It jumped back up a little more on the bus, as this bus was full of little kids, and it was crowded.

But I did it.

MY OCD Hierarchy

So, the first step of my ERP was developing an OCD hierarchy. You start with stuff those lower on the hierarchy, to get some success under your belt, and then you keep moving up until you take out the hard stuff. That's the theory anyway.

Here's an abridged list of my hierarchy (abridged only to avoid boredom, not to take out anything embarrassing). It goes from easiest to hardest.

Wash hands before emptying dishwasher
Avoid unknown spots on the sidewalk
Change clothes after riding the bus
Check stove before bed
Avoid touching my sister's kids
Don't let my towel touch the floor or bed
Clean the bathroom only when I can jump in the shower afterwards
Drop things and don't pick them up because now they're dirty
Don't like other people touching food I will eat
Wash hands if someone at work gives me a document that others have touched
Don't use a cart or basket at the store (carry items in my hands or my cloth shopping bag)
Wash hands after I come home from shopping
Avoid other people touching or hugging me
Avoid people with colds
Check the apparent health of the grocery clerk before checking out
Avoid all doctor's offices
Won't touch the bottom of shoes
Avoid public restrooms
Carry Purell at most times
Avoid the dentist
Avoid porta potties

Exposure and Response Prevention

Studies have shown that the best treatment for OCD is Exposure and Response Prevention (ERP). ERP is pretty much just what it sounds like. A person with OCD exposes him or herself to something that they fear, without performing the usual compulsion afterward. For example, for me this might include riding the bus home from work without changing my clothes when I get home, and without washing my hands as soon as I walk in the door.

For a checking compulsion, it might include leaving the house without double- (or triple- or more) checking that the door is locked.

For a perfectionist OCD-er, it might mean purposely disorganizing a dresser drawer.

For someone with what is called "Pure OCD" (usually defined as having disturbing thoughts without physical compulsions), this usually would involve letting those thoughts come without trying to push them away, or without asking someone else for reassurance that you would never actually act on the thought (it appears to me that the most common forms of "Pure-O" are the fear of being homosexual and the fear of harming or killing someone close to you.)

ERP can be really difficult. Even if the danger isn't real, the fear is. But it's by far the most effective treatment. ERP works in two ways. One, because your body can't maintain an extremely high level of anxiety for a really long time (this is known as habituation), the fear you feel while not performing a ritual will always come down in time. And over the long term, as you expose yourself to feared activity and nothing terrible happens, your brain actually learns that the activity isn't so scary after all. Pretty awesome, really.

OCD History- Part 2

As I noted in part 1, I was diagnosed with OCD at age 25 in 1997. I was lucky, really. My health insurance was a giant HMO, they randomly assigned me an MSW therapist. Actually, she was completing an internship. But she knew it was OCD from day 1. And she knew that Exposure and Response Prevention (ERP) was the best therapy for it. Unfortunately she wasn't experienced with ERP, so my treatment was only partially successful. The other unfortunate aspect was that her internship ended 4 months into my treatment. At that time she and I agreed that I would be able to continue my treatment on my own. But I had never had to face any of my most feared exposures, so I only improved a little.

The next 7 years, I did okay, if not great. I survived mostly because I lived by myself (so I didn't have "dirty" people to contend with), and for 5 of those years I dated a guy who naturally washed his hands a lot and was pretty accommodating of my "quirks."

My OCD worsened in 2004 when I moved back to the town where my whole family lives. They are not good hand washers, and I always worried about getting sick when around them. I also worried about getting them sick. But the worst problem was that when I moved, I broke up with the accommodating boyfriend. Now I was dating again, with a whole host of worries, mostly imagined: boyfriends who didn't wash their hands enough, STDs, pregnancy, colds and flus to be shared. Not so surprisingly, most of my relationships lasted 4-6 months, at which time the boyfriend got a little freaked out by my ever increasing anxiety.

I sought treatment again in 2006. I went through a series of 4 therapists through my HMO: I was told to meditate, learn breathing techniques, count how often I did my compulsions. Despite the fact that I told them I had OCD, not once was ERP mentioned. Next I tried a psychiatrist. My entire first (and only) session consisted of her listing all of the possible medications I could take; again ERP was not mentioned. I'm not opposed to medication, and I've taken both Paxil and Prozac briefly, to jump start my ERP, but I didn't want it to be the focus of my treatment.

Finally in late 2006, I found a therapist who specialized in ERP. He was okay, but after about 3 months he declared my work "finished." What about the fact that I woke up each day filled with dread? Well, he said, that would get better if I just kept practicing. We were to ignore the fact that without him, I didn't ever practice again.

During 2007, I went back to school and I was too busy to date, so my OCD was pretty mild. After 2008 passed, with me remaining too scared to date again, I decided enough was enough. And hallelujah, a new ERP therapist had moved to town. I was going to try again.

My new therapist is awesome! I will write more soon about her approach. I made great strides for the first two months, had a huge setback when a close relative was diagnosed with cancer, and am beginning to make great strides again. More on that later, too.

OCD doesn't mean "super clean"

The women featured on Dr. Phil (see previous post) both had contamination OCD. For both of them, this meant that they cleaned their houses for hours and hours each day, until they were spotless.

I'm proof that contamination OCD doesn't always work that way. This photo? My toilet. Why am I collecting toilet paper rolls, you might ask?

Well, the frugal practical me wants to save them to start seeds. The OCD me things they may have "toilet" germs on them, and that reusing them is a bad idea. The result? I don't want to touch them, and they live on my toilet. Brilliant!

OCD on Dr. Phil

Today Dr. Phil featured a woman with OCD. It's always interesting to me to see how the talk shows handle OCD. This show was quite respectful. At the same time, it's just not possible to really make clear what Cognitive Behavioral Therapy really entails. They did interview a woman who'd been on the show 7 years before. She had undergone treatment and was doing great. She said, "it's the hardest thing you'll ever do." But worth it.

OCD History, Part One

My OCD started up in the summer of 1997, when I was 25. While a lot of people have symptoms of OCD as children, it's also apparently pretty common for it to hit people in the early twenties. Weird. For me, it seems to have been related to my first serious relationship, I think both because I was now exposed to another person's germs on a regular basis, and I had another person to feel responsible for.

While many people's OCD takes extremely different forms over time, mine has been very very consistent. My OCD takes the form of a mild version of "checking," mostly doors and the stove before I leave for work or go to bed at night.

But my main OCD has always been "contamination" OCD. I hate being touched, hate being around sick people, have trouble with public bathrooms. I always want to inspect things before I touch them or sit on them, and (have the urge to) wash my hands about 50 times a day. OCD's quirky, though, because while the sterotype of OCD is the person who takes a 2 hour shower, I don't even shower every day. And when I do, my showers are about 7 minutes long. Just a simple hand wash is all it takes to make me feel better. It's just that sometimes those simple handwashes have to happen every 10 minutes. Suddenly it's not so simple.

But I don't stop there. I often try to make other people I'm around wash their hand more than they'd like, too. For some reason, people don't like that. Go figure.

And, add to that what I call the "OCD Cascade." It goes something like this:
-I didn't wash my hands after riding the bus
-I'm sure to get a cold, or a stomach flu, or disease x from all the germs I touched on the bus
-I will give it to my coworker who's about to go on vacation
-She will be sick on her vacation and will attribute it to me
-She will hate me
-She will give me a bad peer review
-I will be fired.

WOW!! My rational brain can see it's silly, but there's a part of me that really believes that not only is it possible, but that it's LIKELY.

Next, a little bit about my past attempts at overcoming my OCD.

Another OCD Blog

It's always surprised me a little bit how few accounts there are online of people overcoming OCD. Or even dealing with OCD. Considering that everyone and their dog appears to have a blog. I know when I'm struggling with OCD, I sometimes just want to read an account of someone who has successfully gone through Exposure and Response Prevention treatment.

I can't quite figure out if once you're doing well, you don't want to dwell on your OCD anymore, or it there's more to it. In any case, I started with a new ERP therapist in January of this year. So, yeah, perhaps it doesn't bode well for me that it's six months later, and I haven't progressed too much. But I'm hoping the blog will add a little more accountability.

So, my next few posts will tell a little more about my history with OCD, prior attempts at treatment, and why I'm determined to make this work this time.