AMA about being OCD

[Chad]

This weeks topic is on the subject of Obsessive Compulsive Disorder or OCD.

We all see patterns in life and like the things around us to fit into those patterns. We all have daily rituals that we do to help us get through our lives. But what happens when our need to conform to these patterns and rituals is motivated by external forces and disrupts our ability to live our lives as we would like?

What are the causes?

What are the effects?

What is life like living with Obsessive Compulsive Disorder?

For this round of AMAs I have asked two of our own who live with and have very kindly offered to talk about their experiences with OCD:

tombombodil
IronJelly

Please be respectful as this is a potentially sensitive topic dealing with personal issues. Ask any question you want but don't push the issue if our SMEs do not want to answer it.

With that, I open this round of Fear the Boot's AMA: OCD.

[tombombodil]

Hello everyone! tombombodil here. I'm not exactly sure what to put in the introduction, but here goes.

I have lived with severe OCD for as long as I can remember, the symptoms really kicking in around 2nd grade. I've been through dozens of difference medications, about 9 different psychotherapists over the course of roughly 16 years (the last 7 of which were spent with one guy who was one of the main reasons I've made it as far as I have). I've been hospitalized twice, and almost hospitalized a few more times than that.

I've personally struggled with compulsions to sort, clean (not my hands ect. it wasn't a germs thing), and organize. I was also a compulsive spender when I was old enough to have my own money, and had serious issues with Magic the Gathering and other collectable games (not an issue now, but I had to quit for several years during the worst of it). Symmetry was also a big problem for me, as well as things being even and "balanced", my penmanship has always been pretty awful so writing anything took forever because it had to be "perfect", I had the stereotypical open and close cupboards an equal number of times, and even things like, when I was running, if I scratched one knee I'd have to scratch the other.

Also I know this isn't an Anxiety AMA, but I also had terrible chronic anxiety, the worst the head of children's hospital psych ward in Bellevue had ever seen (I'm a referenced case in handful of papers on the subject). I mention it here because the two are inexorably intertwined for people who so suffer from both, as failing to complete ones compulsions is a huge source of anxiety, and completing compulsions can alleviate anxiety, so each exacerbates the symptoms of the other. A pretty cruel cocktail.

The good stuff: I'm better. Through years and years of therapy, unbelievably supportive parents, medication, and most important of all, my own determination, I have made as close to a full recovery as it is possible to achieve. OCD isn't something that can be healed, like certain types of diabetes you just learn to manage it and minimize the impact it has on your life. I have very few symptoms now, the techniques and training have allow me to keep any compulsion or impulse in check, as well as being on the lowest therapeutic dose of a couple medications that are more there as a safety net than a necessity.

As far as causes, we don't know. There's a lot of "Research indicates" involving different brain chemistry and biological causes, but we don't really know much.

Textbook symptoms of OCD is a circular pattern of obsessions (something that occupies your thoughts and is both unpleasant and out of your control, ie you can't just choose to ignore it) the anxiety caused by these obsessions, and the compulsions (actions) you execute to fulfill the obsession and alleviate the anxiety.

These patterns can range from pretty sensical (washing your hands all the time because you're anxious about getting sick) to completely arbitrary (opening and closing ever cupboard in your kitchen exactly 5 times every time you leave that room). Both of these however, can be just as crippling as the other, and how much "sense" an obsessession makes has no impact on how diabilitating it can be.

Most people have a little bit of OCD somewhere in their life, but it becomes diagnosed when it inhibits the functions of normal daily life.

Thanks to Chad for putting this together and I look forward to hearing your questions.

[runester]

Thank you for starting this off, tombombodil.

1) Does some of the "OMG, I'm so OCD about my DVD collection!" style comments and meme's bother you? I'm referring to the use of of this, along with other forms of mental illness, in casual conversations.

"He's a little bipolar on Monday's."
"Redbull and Vodka make me so schizophrenic!"
etc.

2) Are there things that other people do that make it harder for you to manage your symptom's?

3) Is it more challenging to manage your symptom's in a group setting, like FtC?

[tombombodil]

runester

1) You know I really doesn't. A lot of the time I feel like it should, but I think just because of the type of guy I am that kind of thing just doesn't bother me.

Now a comment like that involving OCD is actually less inacurrate than other mental illnesses because people do have very mild OCD about their DVDs and Books, it just isn't nearly severe enoughto cause any real problems and so they wouldn't get diagnosed at a mental health clinic.

2) The only time other's actions make it harder for me is when they directly trigger my compulsions. Someone being very cluttered or disorganized would be an example. Now due to the nature of my particular set of obsessions, this kind of thing would only really be a problem if I was living with the person (especially since I have such a solid handle on it all).

There was a period where I had to disassociate with all my MtG friends for a lot of the same reasons a recovering alcoholic has to abandon his drinking buddies, even if they don't have a problem with it like he does, so that falls under this question too. (Although it's worth noting that there is a fundamental difference between compulsion and addiction).

3) Again because most of my obsessions are things like sorting and cleanliness, it would only really be an issue if fear the con was a month long and I was constantly exposed to triggers caused by the behavior of other people. Someone with the most stereotypical obsession of germs, would likely give you a very different answer

[xRazoo]

How do you go about managing and reducing the impact of your symptoms?

If you don't manage or try to reduce your symptoms do you find that they get worse?


I'm specifically asking these questions because I have noticed some OCD type behavior of my own and am wondering if I can manage it myself or if I'm completely blowing this out of hand and these are just quirks and not necessarily OCD.
I wash my hands approximately 30-50 times a day and must do it if I leave my desk/touch anything that affects my hands texture. I can't even imagining not doing this as I cannot focus on anything else until it is done. I won't be able to use my keyboard/mouse without thinking "My hands are dirty, they feel dirty. I have to wash them now." This isn't about germs, but about the texture difference in my hands if I don't wash and completely dry them frequently or after touching certain things.
I also decorated and furnished my own room about two years ago just before starting college. I have found that symmetry and alignment are extremely important to me along with a few other things about the state of the room. It is down to the point where I am spending excessive amounts when cleaning/decluttering my bedroom making sure the rug is exactly parallel to my desk and bed. I also have to check all of my furniture to if it is parallel to the wall and evenly spaced.

Thank you for doing this AMA as well. Very awesome.

[IronJelly]

Chad, thanks for choosing tombombodil and me for this.

I'm sorry I'm a tad late to the thread. I just got back from lunch, and until I go home in a few hours, I'll probably be posting intermittently while also working.

I should probably start by saying that, in relation to runster's first question, my OCD isn't medically diagnosed. I consider myself as having it because I notice certain things that, irrational as they may be, tend to make me really really nervous and unfunctional. While that could be misconstrued as quirkiness, in truth, I've had severe incidents. For example, last year, in preparation for an award ceremony at my office, the plaques and awards from the last two years were taken down from a wall I can see from my desk. I know, and understand that this is not a major ordeal, and that it should not have any effect on me. I know that nobody else in the office had the issues I did, but I also know that the wall was (and still is) wrong. Just the same way you might feel if you shake hands with a four fingered man. It's subtle, but it's fundamentally jarring. I would find myself often looking at the now blank wall, and just feeling like it was looming there, almost in mockery of me. Like it was holding all sorts of unanswered questions. It got severe enough that I would lose track of time looking at the wall, and my work suffered.

I first noticed these around the time I was five years old, which was also the time I suffered my first migraine. Certain, seemingly random things would just sort of stick in my mind and unsettle me. Sometimes it was something that makes some sort of perverse sense (eg, my sister would leave the paper from a tampon on the ground, and I would avoid the place where I saw the paper for like a week, even when it was gone. But i was too young to know more than that the paper represented something icky), and sometimes it would be something unpredictable (I have difficulty clearing the table if my grandfather leaves an odd number of items on his plate at the end of the meal).

The compulsion to clean only really affects my bathroom. I realized after living with my sister as long as I did, that I simply have to have my own bathroom, because it has to be spotlessly clean or I can not go. Again, I can try to justify this as a hygiene issue, but I am aware that it's personal, and there's not really a physical reason I can't void my bowels while the floor is dirty or something, but I simply can not bring myself to do it.

I'll see if I can answer the questions too:

Thank you for starting this off, tombombodil.

1) Does some of the "OMG, I'm so OCD about my DVD collection!" style comments and meme's bother you? I'm referring to the use of of this, along with other forms of mental illness, in casual conversations.

"He's a little bipolar on Monday's."
"Redbull and Vodka make me so schizophrenic!"
etc.

It doesn't bother me unless the person saying it says it all the time about everything. I know it's incorrect to say something like "I'm OCD because I alphabetized my DVD collection," sure, and if someone comes along and says "I'm OCD because I can't watch any of my James Bond Movies unless I've already watched You Only Live Twice at least twice this week," I may chuckle (that's a really contrived example), but I'd also at least have a chance to point out that the second trait is absolutely an OCD trait.

2) Are there things that other people do that make it harder for you to manage your symptom's?

Yep. I have a major issue with "surprises" and things that happen suddenly, or off-schedule. Even minor things tend to cause me a deal of discomfort or even anger. A lightbulb burning out, for example. As such, there are times when there is no way the person who set me off would have known what they did. People are naturally curious, so if they catch me, for example, counting the seconds after a door slams, they tend to point it out, sometimes loudly, which just makes it worse

3) Is it more challenging to manage your symptom's in a group setting, like FtC?

Do I have a room somewhere with a bathroom other people are not using? Yes? Then I'm probably fine.

[IronJelly]

How do you go about managing and reducing the impact of your symptoms?

If you don't manage or try to reduce your symptoms do you find that they get worse?

I'm specifically asking these questions because I have noticed some OCD type behavior of my own and am wondering if I can manage it myself or if I'm completely blowing this out of hand and these are just qwerks and not necessarily OCD.
I wash my hands approximately 30-50 times a day and must do it if I leave my desk/touch anything that affects my hands texture. I can't even imagining not doing this as I cannot focus on anything else until it is done. I won't be able to use my keyboard/mouse without thinking "My hands are dirty, they feel dirty. I have to wash them now." This isn't about germs, but about the texture difference in my hands if I don't wash and completely dry them frequently or after touching certain things.
I also decorated and furnished my own room about two years ago just before starting college. I have found that symmetry and alignment are extremely important to me along with a few other things about the state of the room. It is down to the point where I am spending excessive amounts when cleaning/decluttering my bedroom making sure the rug is exactly parallel to my desk and bed. I also have to check all of my furniture to if it is parallel to the wall and evenly spaced.

Thank you for doing this AMA as well. Very awesome.

The biggest thing that helps for me is just knowledge. If I stop, breathe, and remember that whatever is bothering me is a non-issue to everyone else, I can usually force myself to try to see the underlying cause. With the empty wall I mentioned earlier, I'm now sitting where I can't see it. I know it's there, I see it when I come in in the morning, but I can work without it overwhelming me.

Thanks for the question.

[tombombodil]

How do you go about managing and reducing the impact of your symptoms?

There are several steps to dealing with your OCD (using the royal "you" here). There are several things that make this process easier: the counsel and guidance of a mental health professional, prescription medication ect. But the one thing that is required is introspection. You're the only person who really knows what your obsessions are, and if you aren't honest with yourself, no amount of meds, support, or counseling will be enough. Ok then.

(Also this is just the method my Psychologist used, it worked for me, but it isn't the ultimate answer or anything)

One: identify your compulsions. What triggers anxiety, or discomfort. Write them all down, and note which ones are the worst and cause the most issues. I recommend creating a numerical scale to keep track of how bad the compulsions are on a day to day basis; essentially keep a log of it.

Two_1: This is the big one, and I'm while it worked for me, it might not be universal. What my Psychologist used, was something called Controlled Exposure Therapy. More commonly used to deal with phobias, you essentially force yourself to resist the urge to act out your compulsion for slightly longer and longer increments of time, until you can truncate them to the level of not being disruptive.

Two_2: You will need to develop methods for dealing with the discomfort and anxiety that will inevitably be caused by Two_1; things like breathing exercises, counting down from 100, things to distract yourself; I've known people who listen to loud music with headphones. This is also where medication can be particularly helpful as it essentially lowers the amount effort you have to exert at every point by reducing the power of both the urges themselves and the anxiety caused by not fulfilling them.

Three: Once you have a handle on your compulsions, you have to regiment your life in a way that maintains the status qou. You don't need to build your life around it, but you will have to make the methods you used in Two_1 and Two_2 into daily routine.

This is a very simplified outline of the process I went through, but for me it worked. Also note that it took me 7 years (5 of which were spent in Two_1 and Two_2) and a lot of that time was miserable; but I came out the other-side infinitely better for it. Also it's not something I would recommend undertaking without some level of professional guidance

EDIT: Just in case anyone gets the impression that Exposure Therapy is in the camp of "just face your problems and get over it" (and no judgement because it can come off like that) here's an analogy to dispel that notion:

Lets say you have a broken leg. "Facing your fears and getting over it" would be putting a makeshift brace on your broken leg and just trying to walk around. Exposure therapy would be physical therapy with the guidance of a medical professional."

If you don't manage or try to reduce your symptoms do you find that they get worse?

I'm no longer in the reducing symptoms phase, but yes, absolutely yes. I'm at the point where my methods of managing them are as second nature as brushing my teeth, but before I had gotten this far, if I went a day or two without actively monitoring my behavior, there was immediate deterioration. It's not the same but the analogy demonstrates the point better: What happens if someone who is diabetic stops taking their insulin, because they took it earlier and now they feel fine?

[Wayne]

I have often wondered if I have a mild case of OCD that has just gone undiagnosed. I always thought people with OCD were that way about everything though and had to be extremely neat people. I am not at all neat and organized with my own stuff.

I HAVE to straighten displays in stores. My wife knows this and will walk down isles poking boxes and knocking them over. I will not just fix them, but if she pulls me out of the isle I will make an excuse like going to the bathroom and make my way back to the isle to fix it before leaving the store because it will have been in my head the whole time.

Even though I know I have locked the doors I feel the need to check them before I can go to bed. I have gotten up multiple times in the same night before just to verify that the door is in fact locked.

I have to wash my hands immediately before every meal.

I save every video game twice before I accept that it is saved.

A stack of anything cannot go unstraightened and has to be sorted based on size. Pat handed me a stack of nudie girl cards from Las Vegas and before I could look at any of them they all had to be facing the same way and sorted by size.

I suffer from diagnosed Depression, Anxiety Disorder, and Panic Disorder so I would not be even slightly surprised to find out that I have other nondiagnosed issues. I have noticed that the anxiety medication has made a difference in how much my display issues bother me. While on the medicine I can leave displays alone if I don't personally see them get messed up.

[Wayne]

Here is an online test. I scored a 19.

http://psychcentral.com/ocdquiz.htm