Tuesday, August 31, 2010

Self-Hatred Attacks: My Specialty in the Area of Anxiety and Discomfort

So I've heard anxiety and discomfort described in a number of different ways:  panic, stress, nervousness, disgust, shame, etc.  Tack on the word "attack" after any of the above descriptors and you have a name for those episodes where said feelings overwhelm the person experiencing them.  While I have most certainly experienced all of these emotions as part of my OCD, they don't quite capture the essence of what I feel when when my anger and frustration is not directed at a certain event or situation, but rather at myself.  Those times are more like "self-hatred attacks."  That's really the best way to describe those times of pure self-loathing and reproach.  Not pleasant.  Not at all.

I'm sure everyone experiences self-hatred from time to time, or even frequently.  But sometimes I feel like I have molded it into a highly refined art in and of itself.  Don't get me wrong.  I certainly don't presume to have the market corned on self-reproach.  I can be pretty bad sometimes, but I'm sure there are those out there who suffer far more and who have it far worse.  And I am much, much better than I used to be.  I just know that I can sometimes work myself into a literal "attack" of self-reproach where anything I do seems to trigger even more self-hatred.  I am aware that I am being irrational when these attacks occur, but at the same time, I can't seem to turn it off as much as I would like to.

To be honest, I used to punish myself physically when I was experiencing one of these "attacks."  I make an effort not to do that anymore and have addressed this issue in treatment.  I try to find other ways to get through it other than beating myself up and acting rashly, which just triggers more self-loathing and a desire to punish myself further in a vicious positive feedback loop.  But with that maladaptive coping mechanism eliminated from the mix, I have a hard time knowing what to do to make it through those times.

In the treatment of OCD, we often talk about exposing ourselves to things and situations that trigger discomfort and then sitting with that discomfort until it diminishes on its own.  When discussing my latest self-hatred attack today in therapy, I was given the answer to my question about what to do during those times:  nothing, if possible.  Just as with other forms of anxiety, the answer is not to act compulsively but to sit with the uncomfortable feeling and continue about my day to the best of my ability.  So simple, really, and yet I think this is the first time I really took it to heart for these sort of situations.  For some reason, I thought this was different.  But the answer is the same.  The fact is we all feel discomfort in life.  We can either fight it and resist it and go to great lengths to rid ourselves of it, or we can accept that we will probably feel crappy from time to time and do our best to continue on anyway.  Self-hatred attacks, I suppose, are no different.  I just have to learn to wait them out.

This is not to say that there are not tools to employ in the meantime.  There is work that can be done on the cognitive side - thought restructuring and other things of that nature - to point out the distortions and identify healthier and more realistic ways to look at things.  But in the end, I guess it's the same:  the best way to thwart the anxiety is to do nothing.  The best way to overcome the self-hatred is not to self-punish or act compulsively, but to keep moving forward despite that feeling.  Acting in a self-punishing or compulsive manner only fuels the fire.  It tells the brain that the feeling of self-hatred is important and needs to be dealt with in a punitive manner.  Instead, doing nothing returns the feeling of self-reproach back to its place as just that - a feeling.  Like other thoughts and feelings that trigger the desire to act compulsively, it can probably be strengthened or weakened depending on the behaviors we choose.

Certainly not an exact science!  But I am learning!  How do you deal  with "self-hatred attacks?"

Saturday, August 28, 2010

Sometimes I'd Rather Hide

Yes, sometimes I'd rather hide.  Hiding is easier.  Absorbing myself in the world of OCD ritual is easier.  Solely focusing on one singular aspect of my life and devoting all my attention to it is easier.  Avoidance is easier.  Easier.  Easier.  Easier.

But boring.  I suppose.

So for the past 24 hours I have really avoided doing anything other than eat, sleep (on my bay window sill...because, well, I feel too "dirty" to sleep in my bed), and sit in front of my computer searching for something to hold my interest and fulfill the void of doing nothing while procrastinating life.  Yes, life.

And the reason for aforementioned procrastination? Answer:  The dread that comes with the need to shower.

I have not slept in my bed.  I have not gone out (other than to buy more shower products - I came home from my trip to discover that my bottles of soap and shampoo and the like had fallen off their rack...or at least I am assuming this because the rack had been moved and my shower products set along the side of the shower...so I felt the need to buy more because it's been a long week and for some reason I just didn't feel like fighting myself on this one...the bottles felt "contaminated" so I went and bought more...oh my...).  In fact, I even wanted to go out (go figure!) and had the opportunity to go out, and yet the dread of showering, the avoidance, overcame the desire to get out, have a good time, and possibly drink a couple beers.

So yeah.  No bueno :(.  Not going out because you feel like you need to shower, and not showering because you have been avoiding it for so long that it has taken on monstrous proportions, does not equal a fun and exciting Saturday night.  Not that I mind that so much.  It could be any night of the week for all I care.  But tonight I did want to get out of the house, and my refusal to challenge my OCD kept me from it.  That's what I care about.  I care about getting stuck, putting off things like showering, and not getting the things I would like to get done actually done because of my avoidance.

I'm so much better, but there's still lots of room for improvement!   The realization of all that I could do if I did challenge OCD is real incentive to keep moving forward.  There's a reason to work hard because there is so much I would like to do!

Update:  After 48 hours of shower procrastination I finally did it!  I'm clean at last :).

Friday, August 27, 2010

That Lost Feeling

Sometimes when I come home from a vacation (or sometimes when I start one) I find myself floundering to adjust to the changes around me.  I like vacations.  I also like coming home and getting back to my independent lifestyle - my schedule, my routine - especially after spending a significant amount time with my family.  But sometimes abruptly returning to my usual world leaves me feeling off balance and unsure how to proceed.  Basically, I feel lost.

Being with my family, and only my family, is like existing in another universe.  When I am initially catapulted back into that environment, it's strange.  On the outside, I go on as usual.  I talk, I laugh, I smile and comment.  But part of me is somewhere else.  That part of me is distinctly aware of the sharp change in my surroundings, and I feel like I have to re-learn how to exist in that space.  Meanwhile, I keep a protective barrier around me, a bubble of reminders of "who I am."  The me I present to my family doesn't feel like the whole me.  I am toned down.  I adjust myself to fit their rhythm, but I am acutely aware of the difference between "normal me" and the "me" I display to them.

But then something funny happens:  as the days go by and I spend more and more time with my family, and only my family, I notice the differences between the two worlds less and less.  I adjust to their ebb and flow, and with time, I become integrated into to it - I once again feel synchronized with my family's dynamics.

It's as if I am normally racing down a river, moving at my own pace, weaving back and forth freely as I see fit.  Then I come upon my family, also paddling down the river, and I slow down and steer straight to fit within their formation.  At first, I am constantly aware of the changes I must make to match their pace, but then, with time, I adjust.  I get used to moving within their world again.  But then there is a fork in the waters, and I go my way while they go theirs.

I am again free to move about as I please.  But now it feels foreign.  And the rocks and trees that obstruct my path seem to leap out of nowhere.  I feel as though I have forgotten how to weave myself comfortably into my normal life, just as I initially felt uncomfortable adjusting to my family's pace.  I want to be the "normal me" again but feel as though I have grown rusty.  I didn't mind if being with my family didn't immediately feel natural.  But if I don't immediately feel comfortable in my home environment, in being the "normal" me, I become upset.  I fear that I have forgotten how to be myself, the "me" I prefer to be.  I fear that I have grown vulnerable and soft.

But perhaps OCD is at play here.  Just as the more I wash, the less confident I feel in my cleanliness, the more I fight to regain my "normal" demeanor, the more disoriented I feel.  If I could just let myself relax, muscle memory would take over, allowing to move smoothly around the obstacles and at the pace of my usual life.

It's the same OCD trick, my own personal Chinese finger trap of the mind.  The more desperately I try to make things "right," the more "off" they end up seeming and the more important the fact that I feel "off" seems to become.  If I could just stop struggling, stop trying so hard to fix things, they would likely fix themselves on their own.

Just being able to recognize this - that fighting to rid myself of this or any other feeling only digs me that much deeper - is helpful.  It saves me from the mental turmoil of trying to make things feel the "right" way, and it allows me to actually feel "right" far sooner. I have to trust that I will again grow accustomed to the freedom (and obstacles) of my usual life, and that I will fall back into the rhythm I am accustomed to.

...and if I don't, well, I can deal with that when and if it occurs.  OCD all too often demands a solution now for a problem that may or may not actually arise.  Accepting this uncertainty and dealing with the consequences when and if they do occur, however, seems to be the ticket to freedom.  And that's the hard part - riding out the discomfort without compulsively trying to eliminate or reduce it.  I may not yet be willing to apply this wholeheartedly to my washing rituals, but I can try to put this concept into practice in other areas of my life.  Even if I am not necessarily fighting the main battle, I think that by using all that I have learned about fighting my OCD when and where it helps makes me that much  better prepared to fight my all-too-common enemy at its most challenging points.

And, in the meantime, it simply makes my everyday life that much better.  Which is definitely worth it.

Wednesday, August 25, 2010

Too Many Thoughts, Too Little Time

Over the past several days that I've been out of town, I've missed writing here and having the chance to read and respond to others' posts.  It actually makes me a little anxious being away, which is why I have been half trying to keep myself away intentionally and half avoiding it unintentionally because I don't want to write something incomplete.  I don't want to begin putting my thoughts down if I might have to stop before those thoughts have been captured accurately.  And, I have been avoiding reading and commenting on others' blogs because I have difficulty looking at just a few if I can't read them all.  I am always too anxious and eager to read more.  So, for the most part, I have been avoiding it altogether.

Nevertheless, I think this has been good for me.  I still have a couple days more of my trip and separating myself from this site and the internet in general is probably a healthy change of pace.  Getting out of my head, out of my usual routine, and out into the world is good for me, but getting myself to do just that usually seems incredibly difficult, this trip included.  I made the decision to go more out of guilt and fear of letting down others than out of my own desire to be here.  However, I am actually enjoying myself as I would have before my latest wave of OCD issues, and in some ways, perhaps even more.

Trips like the one I am on, where my mind is NOT constantly at work, where I have a lot of free time to just think but not a lot of opportunities to ritualize, are great opportunities to practice just being in the moment.  As cheesy as this may sound, I often struggle with this on vacation.  When there is mental downtime (even when my body may be hard at work - walking and exploring) and there is nothing to fully demand my attention, I find myself constantly trying to figure out what's next.  The days become a to-do list of recreational activities to check off rather than enjoy.  I am constantly thinking of the next "task" ahead and wondering when the current activity is going to be over.  And then, as if that wasn't enough, I find myself wondering if I am in fact enjoying my leisure plans the way I am "supposed to" or if I even really like doing such things at all. 

And of course, with all that convoluted obsessing, I begin to feel a bit numb and removed from the things I am doing.  The enjoyment is compromised by the obsessing about enjoyment. :)

So, while I am NOT so actively fighting my most recent and impairing contamination symptoms, I am succeeding at fighting my OCD in others ways - ways that have improved my general vacation experience and have made it better, in some ways, than such trips have often been in the past.  Just being in the moment and appreciating the place I'm at, when I'm at it, without passing judgment on my choices of activity or trying to evaluate my level of enjoyment, has made my vacation that much better.  All that I have learned over the last year in treatment has helped me remain much more emotionally stable and present (and perhaps the meds have helped some, too).

I feel like the treatment mantra of "you can't control your thoughts; you can't control your feelings; but you can control your behavior" has been incredibly helpful.  I now know that, while I could choose to mentally punish myself for something I did or for feeling a certain way about something during my trip, I also know that I don't have to - beating myself up for feeling a certain way or doing a certain thing is a choice.  And doing so doesn't help.

Also along these lines, I have learned that it is not helpful to try make myself feel guilty for not feeling the "right" way at the "right" time and in the "right" situation.  It doesn't make me anymore likely to feel the way I think I "should" feel; instead, it just upsets me.  Now I know that this, too, is a maladaptive strategy that I have long used to force myself to feel and act in certain ways...a strategy that I am just now learning to overcome.

So, it's been refreshing to get away - to be in a different world both mentally and physically.  But I will be looking forward to reading all that others' have written in the meantime, when I get back home.  Similar to the way I used to look forward to listening to all the messages collected on the family answering machine or sorting through all the missed mail when I was a kid, I now look forward to having lots of posts to read when I come home!

Friday, August 20, 2010

Rough Days

Today was a ROUGH day for me, as much as I can let myself admit that.  I overslept this morning and got to my therapy appointment late.  Normally I can deal with this because I am just so glad to be there getting help, even if my time is cut short by my tardiness (often a product of some sort of OCD business...).  But today, wow, I just shut down.  I just didn't know what to say.

Normally I am overly loquacious when it comes to therapy appointments.  I always seem to have a million things that I want to say or ask for which there is never enough time.  So it must have been strange for my therapist indeed, when I just kind of sat there, looking down at my exposure log, listening but making limited eye contact and not saying much in response.  I was just so wrapped up in my frustration and anger at myself.  I just couldn't seem to pull myself out of it long enough to really think and engage in the conversation.  Meanwhile, it seemed like the worst was coming true - my thoughts and feelings somehow managed to get between me and the work I wanted to get done with my therapist.  Even when I have felt like something wasn't "perfect," like something might distract me from trying to make progress during my session, somehow my therapist and my eagerness have always managed to make me forget whatever it was that I feared would somehow "ruin" my limited time in his office.  But today I was just stuck in a rut of self-loathing that seemed to have no way out.

Few people ever see me in these kind of moods because I make a point of bottling it all up inside and hiding it away. The self-loathing forbids me from admitting that I am upset or acting out on it.  When I do let it slip, when I withdraw from the people around me or make a sharper remark or two than I normally would, that escalates the anger at myself.  The internal monologue goes something like:  "Stop that!  Suck it up!  Why aren't you strong enough to just hold it all in?  What's wrong with you?  You can't act this way!  Stop sulking!  That's not acceptable behavior.  Snap out of it!"

So I internally wrestle with my desire to escape, to let out my frustration, and the resulting wrath that ensues if I don't manage to hold it all in and act as if nothing is wrong.  It's a self-fueling fire, and once it begins to burn it just feeds on itself, growing stronger and stronger.

Needless to say, once these moods start, it can take me a while to get out of them.  Today it took, well, pretty much all day.  I was pretty upset at myself.  I was supposed to hang out with friends tonight, too, and I made up an excuse to get out of it.  Depending how they go, social situations can either suffocate the flames...or they can quickly turn an already out-of-control blaze into a full-on conflagration inside my skull.  Tonight I didn't feel up to taking that chance.  I was struggling to keep it together already, and the prospect of having to put on a fake smile and positive demeanor for a group of friends who wanted to drink and have a good time just didn't seem like something I wanted to do at that time.  I'm kind of glad I didn't.

But that, too, is something I often struggle with - that is, knowing when I should make myself go out and "stop sulking" and when I should just let myself be and forgive myself for canceling plans and my desire to just be alone and not have to work so hard to seem "fine."  It really is a battle, especially when I am already upset at myself.  There just seems to be no good answer.

Anyways, I am mostly recovered now.  I still feel a little fragile but overall I am feeling more positive and hopeful now.  I don't hate myself...for the most part :).  Instead of going out, I finished my packing at a reasonable hour, packing for a trip that I am both excited for and afraid of at the same time.  The fact that I am leaving tomorrow was probably one reason my frustration with myself was so overwhelming today.  I had a lot I wanted to address with my therapist about this trip.  I wanted a game plan.  And well, I didn't have time to devise one with him, but I know I can do it anyway.  I am at a point where I am not so completely and utterly reliant upon the rules developed in my sessions.  At this point, I can actually devise my own washing limits, and though they are generally far more lenient than those my therapist and I devise together, I can nevertheless set them and with some success, adhere to them.  Before, my OCD would not let me off the hook, would not let me challenge my compulsions, unless it was an assignment set in stone.  But I have gotten better at that.  I do have some autonomy.

Anyways, it has been an emotionally draining day.  Does anyone else have such spells of rampant self-loathing?  How do you handle them?  How do you continue about your day despite them?

Wednesday, August 18, 2010

OCD vs. Me, High-School Style

Maybe I am young and naive to believe such a thing, but I like to think (and sincerely hope) that I will never work as hard as I did in high school ever again.  High school, looking back, was like one long OCD marathon that kept me constantly exhausted and feeling like I was on the verge of emotional breakdown.  I pushed myself so hard because the alternative seemed unacceptable.  I wasn't sure how I would be okay with myself if I didn't.  So I pushed, and pushed, and pushed, and as such, my life was school, and school was my life.  It was a love/hate relationship - a relationship saturated with the compelling force of a mental disorder.

I'm pretty sure that at times my teachers both appreciated and were simultaneously annoyed by my dogged attention to detail, perfectionism, and tendency to push my limits - theirs and my own.  I was almost always the last one to finish a test, making the rest of the class wait in impatient silence long after most others had completed their work.  I was the one always begging for more time, making teachers wrestle with their desire to be firm but also not wanting to upset someone who always worked so hard.  I was the one who went above and beyond on even the smallest assignments, but then, I was in a "gifted" class full of students who often did the same.  Regardless of their reasons for going above and beyond, I felt trapped.  I felt like I had to not only live up to the standards they set but also those I had previously set for myself.  Every new assignment was a formidable challenge, a new trial of my creative skills and intelligence.  I had to prove myself again and again and the bar was constantly being raised.

I couldn't prioritize.  I couldn't tailor the amount of effort I put into an assignment according to its relative worth, because any time I didn't live up to my evaluation of a previous performance, I wrestled with my self-identity.  It was never enough because OCD was the one setting the bar, and OCD was the one evaluating my work.  Not me, not my teachers, but OCD.

It didn't help when some teachers praised my self-sacrifice.  I remember one instructor commenting admiringly on how I regularly persevered despite all the demands on my time and lack of sleep.  He said that I reminded him of a relative who spent his life sleeping only four hours a night and working multiple jobs during the day.  He praised this relative for his impeccable work ethic and his ascetic self-denial for the sake of accomplishment.  But I didn't hear praise.  I heard, "Some one else lives this way.  You must continue to push yourself and do the same if you ever want to get anywhere, if you want to achieve anything in life.  If someone out there is working just as hard or harder, and others commend them for living that way, then you must try to live up to such an example."

So looking back, what may have been meant as a compliment was, for me, only translated into more pressure and more anxiety.  It felt similar to how someone praising me for spending hours every day washing my hands might feel now.  I didn't like thinking that life was supposed to be the way I was living it, but I didn't feel like I had a choice if others believed such a lifestyle was praiseworthy.  Admitting to myself that I found the prospect of such expectations overwhelming would be, at least in my mind, accepting defeat.  It would be proof that I was somehow defective - that something was wrong with me and I just couldn't keep up.

The voice in my head would prattle on:

Someone else lives this way, why can't you make yourself do the same, and do so happily, without complaint?  What is wrong with you?  Why do you always feel like you are straining to keep up with others?  

I had to keep pressing forward, meet said invisible challenges, and continue on.  I couldn't fold as much as I sometimes wanted to.  

Who would you be?  What would you become without these self-imposed standards? 

My work-ethic and the product of that work-ethic seemed to make me as a person.  Putting in three times as much effort for that one extra point was my trademark.  My talent was my ability to push myself harder than most others for minimal extra gain.  That was what set me apart - my ability to keep pressing onward where others chose to fold, when others recognized that the effort, the cost, was not worth the potential gain.  That was what I was good at.  That, I assumed was the only reason I excelled, the only reason I stood out.  That was what set me apart and made me "me."

Or so I believed.  Looking back, so much of my behavior, my goals, my beliefs, and my whole approach to life at that time were built on the faulty foundation of OCD.  I wish I could say that I was in control, that I was the master of my disorder, using it to my advantage, to push myself to excel when and where others gave up.   But I don't think I can say that, because I was hardly aware, if at all, that I had a choice.  I mean, rationally yes, I knew I never had to do anything.  I didn't have to keep working on that project.  I didn't have to write and re-write that essay.  I didn't have to come up with an even more creative theme for that assignment.  But choosing not to, even when it would have been advantageous to me overall, didn't really seem like an option.  I felt stuck.

Rather than harnessing and channeling my disorder to my benefit when and where I could, I was ruled by it. I was constantly being pulled in a million different directions out of a fear of what would happen if I cut those ties in deliberate disobedience.  I feared the consequences of what might occur, of who I might find out I "really was" or who I would become, if I didn't put more effort into this assignment or that activity just because I could.  It didn't matter if, in the bigger picture, it was taking a toll on my physical and mental health; if I could work harder, I felt like I should.  Battling to complete something, to finally accept that it was "good enough" to hand in, was a constant struggle.  I thought I was winning the war because I could push and deny myself where others chose not to, but it was at a cost that I didn't really feel like I had much control over.  I made a lot of sacrifices, not always because I wanted to, but because I was afraid not to.

Needless to say, my perfectionistic tendencies had more specific consequences.  Perhaps I will go into those another time.  But reflecting on those grueling four years of my life reminds me of why I want to break free, why I DO want to cut those invisible ties pulling me in a million different directions.  They may not be pulling me in exactly the same direction as they once did, but they are still there, tugging at me in new and different ways.  And as much as I may feel like I NEED to obey now, resigning to the will of OCD is resigning myself to the kind of life I felt I had to live in high school - a life dominated not so much by what I wanted to do as what I feared not to.

Sunday, August 15, 2010

Letting Myself Be Free

I often have a hard time knowing what to do because I sometimes feel like I am forcing myself, or even choosing, to perpetuate my OCD through the performance of rituals.  I get confused and go around in circles in my head, wondering if, unlike everyone else out there with OCD, I should be held more responsible for my symptoms and am less deserving of help because I might actually be "making myself" have the disorder.  However, trying to figure this question out is next to impossible, and I suspect that needing an answer is really just another compulsion - feeling like I need to know the answer to this before I can engage fully in treatment is just another OCD trap.

On the flip side, I often have a hard time with myself because I feel like I should be performing more rituals and doing them better.  Instead of feeling bad for choosing to do compulsions, as described above, I feel bad for not choosing to do them, as well.  After all that I have learned about OCD, after all the time I have spent in treatment trying to deliberately NOT perform rituals or to perform them poorly by OCD standards, I somehow still often manage to fight with myself about whether or not to engage in a compulsion and then get angry at myself if I don't perform it or don't do it "well enough."  The internal self-abuse is sparked, and as much as I know the more responsible thing to do, in the long run, is to avoid compulsions and get my OCD under control, OCD is always saying, "No, no, no, you're wrong you lazy slob!"  And it's hard not to listen, not to give in to satisfy the OCD voice which says "you're not doing your rituals for the wrong reasons.  You're not doing them or doing them half-heartedly because you are lazy and don't want to, not because you want to fight your OCD."

And the solution according to OCD?  "If you don't feel like doing rituals, it must be because you are lazy, so you must do them, because you are just a terrible, lazy human being if you don't."  According to OCD, I can only NOT do rituals when I really really WANT to do them, which are the times when I feel like I need to perform them the most and have the hardest time not giving in, in the first place.  Thus, listening to OCD is a lose/lose situation.  It keeps me feeling like I can't fight back pretty much all the time by distracting and disorienting me when fighting back would be easiest.  I want to fight.  I want to get better.  But OCD has found a pretty sneaky way to slow the process down.

Nevertheless, I am starting to let myself off the hook in certain situations.  I ignore the OCD voice in my head that says, "Hey, you need to ritualize better!  No excuses!  This time, this situation, is no exception!"  There are more and more times when I choose to just do what I want despite the continual looping of OCD's little monologue in the background, a monologue that is constantly judging every move I make for what seems like almost all the time.

The thing is, pressing play on this loop track in my head isn't always involuntary.  In fact, sometimes I choose to play this voice in the background, probably compulsively.  And really, I'm not exactly sure why.  Why do I insist on making it harder for myself?  Why do I need to intentionally question what I am doing?  All I can fathom is that I am somehow checking, somehow trying to ascertain whether I have made the right decision or not.  It is something that can get me stuck on decisions as small as whether or not I should stop washing my hands at 40 seconds...or 50 seconds...or 60 seconds this time around, whether I should start washing my arms at the top or the bottom in the shower, whether just going once through my washing routine is okay or if I need to repeat it.  Every minute decision can be challenged when I am in a particularly bad state.

But just as I am learning to disregard the involuntary sound of this insidious OCD monologue, I am also learning to disregard the feeling that I have to play it over and over again every time I am confronted with the decision of whether to engage in compulsive behavior or not.

I am learning to give myself a break, to turn the constant voluntary version of the interrogation off, and to let myself just be - to stay in the present.

Thursday, August 12, 2010

Recovery, Anxiety, and Learning to Live a More "Normal" Life

A lot has happened for me this week - a lot of change and growing momentum pushing me forward into recovery.  And of course there is a fair share of anxiety to go along with this process, and that anxiety doesn't arise solely from cutting back on the rituals that brought me comfort, either.  There is also secondary anxiety created by the time that suddenly seems to be laid out in front of me - time that was previously occupied by compulsions is slowly be re-released for other potential uses.  

I am not used to feeling like I have excess time. 

Even without a real job, OCD can be a full-time occupation.  Fighting OCD (or giving in to its demands) has literally been my all-day everyday job for many months now.  Just the necessities of daily life took up my time for almost a year.  If I had free time, there was always something else I could be doing, there was always another load of laundry, trash to take out, general cleaning to do.  Just keeping up with these tasks while dealing with the compulsions they triggered swallowed up most of my time.  And when I had done as much of that as I could for the day, there didn't seem like much else I could do - much of the world and its potential activities were off-limits for one reason or another due to OCD.  There were possibilities but none of them were open to me.  I was trapped.  I didn't feel the need to occupy my time with anything else, because in my mind, there was nothing else that I could realistically pursue!  It was the waiting game, waiting for the day when the boundaries would melt away.  Except, I rarely felt like I was waiting because, like I said, just doing the little things - cleaning and caring for myself - filled my day.  But just this week things seem to have already become a bit more normal.  I seem to have somehow caught up with life for a moment, and that is both interesting and frightening.

The other day a friend of mine came over and asked a question that bewildered me:  "What do you do with all your time?"  While I am sure I had been asked this before, it caught my attention this time.  I had never really thought about "what I did with all my time" because there never seemed to be a lack of things that needed to be done.  OCD thoughts were always there pestering me to do or not do this or that.  OCD accounted for my time by making everything take longer.  It still does to a certain extent, but I feel as though I am starting to see an opening, and I, too, begin to wonder - what do I do with my time?  How did I fill it before - even just a week ago?  I suspect that I was spending much of that time engaged in rituals - figuring out how to do things that needed to be done and mentally retracing things I had completed to make sure I had done them "right."  And a lot of time was also spent in avoidance and procrastination, as well.  A job seemed out of the question.  I could hardly keep up with life as it was.

So what's finally made things begin to change?  I think the gradual improvement I have seen over the last several months got me really close to this point and now recent modifications in my treatment have gently nudged me over the edge, accelerating my progress.

First, there was the realization that no matter how hard I tried, there was always going to be a "missing piece" to the answer, the elusive key to jump-starting my recovery.  No matter how much time I had with my therapist, no matter how many books and websites I read, no matter how much I wrote about my experiences here in an attempt to straighten myself out and push myself forward, I was eventually just going to have to start trusting my therapist and doing what he suggested.  I would have to stop waiting for everything to seem "okay" before doing it.  And I would have do my exposure homework more reliably and without fighting it every step of the way.  I am finally starting to feel like I have a firm grip on the wagon, a grip that will help keep me on board and fall off less frequently.

Second, recognizing that I was probably at a point where additional therapy could be useful, my therapist and I devised a plan to meet more frequently.  Plus, my therapist has begun working additional hours on additional days of the week, which has allowed me to go in at more evenly spaced intervals throughout the week.  I never go more than a few days without therapy.  I finally feel amply supported.  If I feel my determination waning, I know that I will be seeing my therapist again soon.  There is less opportunity for giving up and reverting back to old habits in between sessions.

Finally, in just this past week, I started taking a very low dose of Seroquel, which has very tangibly done at least one thing:  allowed me to better regulate my sleep.  Ever since this bout of severe OCD began I have had a hard time falling asleep, which was a very strange experience for me, indeed, since I have spent most of the last decade of my life being perpetually sleep deprived by the demands of school and work (and, looking back, a lot of OCD, too!).  Not being able to fall asleep was a foreign concept to me since I spent most of my time trying, in vain, to keep myself awake.

I think this new difficulty sleeping has probably been in large part due to the high dose of Zoloft I have been taking.  Since starting to take this medication and consistently increasing the dosage, I have loved the fact that when I wake up in the morning, I actually feel awake, but that has come with the not so great side effect of also making it harder for me to get to sleep in the first place.  But now, within an hour of taking the Seroquel, I feel a sleepiness that I have rarely felt over the last several months.  And I now go to bed because I am actually tired and not because dawn is fast approaching and I feel like I should at least try to sleep.

Sleeping more regularly is helpful because the days and nights don't blur together.  I have more of a regular routine by which to structure my time and care for myself.  And being rested and taking care of myself helps me fight my OCD.

It's remarkable how I am just now relearning something so basic, so simple, as making time to meet my body's needs.  For years my sleep, hygiene, exercise, and nutrition have been the victims of my hectic schedule (and again, now that I know about it, a lot of OCD perfectionism, as well).  The idea of going to bed before absolute exhaustion, making time to eat and relax, and to just in general, have a routine, seems like such a luxury to me.  I am so used to pushing myself to my limits and burning the candle at both ends, that, as I recover and try to establish a more sustainable lifestyle, it is strange to experience things like going to bed at a regular hour and not having day and night blend together.

It is a foreign experience indeed.  But I am hoping that, as I learn to recognize and battle all the OCD habits that made regular life before my relapse a tiring race in and of itself, I can also learn to live a much more "normal" life.  Whatever that means :).

Anyways, I feel like I am embarking on a new phase of improvement, which I find intriguing but also frightening.  Learning how to live again, without the constant demands of OCD, is new and strange territory.  But with it comes the possibility of being freer than I have been in years, and perhaps freer than I have ever been in my life.  The prospects of what I might be able to do with OCD in check are exciting.  These possibilities keep me going when, in the meantime, this in-between place is somewhat strange and confusing.

I am certainly not out of the woods yet, but the way ahead is starting to become a bit clearer.

No Matter What, Don't Listen to Me!

Michael Gambon as Albus Dumbledore in Harry Po...(Image via Wikipedia)
There is an analogy that strikes me as being particularly representative of what it is like to fight OCD in the moment, and sometimes I have to remind myself of this analogy before I begin something that I know will catch OCD's attention and lure it in.  For lack of a less nerdy reference, this analogy involves a scene from the 6th Harry Potter movie (and maybe the book, too, I just haven't read that far in the series, so I wouldn't know if it happens the same way in the original).   Though it is probably a common movie scenario, the Harry Potter version is just the one that comes to mind.

If you have read Harry Potter, you will probably know what I am talking about better than I do.  Forgive me for any inaccuracies.  If you haven't, well, like I said, I think it's probably a common theme. The scene to which I am referring is one in which Harry Potter has accompanied headmaster Dumbledore on a mission to retrieve an object of particular importance, a locket, which happens to be one of the so-called Hocruxes (goodness I feel terribly nerdy!!! sorry!!).  Anyways, to reach said locket, a number of difficulties must be overcome, the last of which is to drink a sort of mysterious liquid potion from a basin, at the bottom of which lies the desired locket.  Before beginning to drink the potion, Dumbledore warns Harry that no matter what, he must make sure the headmaster drinks all of the liquid.  Even if Dumbledore begs to stop drinking, even if he indeed cries for mercy, Harry is to ensure that Dumbledore continues until all the liquid is gone.

So what on earth does any of this have to do with OCD?  Well, I sometimes feel like I am Dumbledore in this scene, when I am fighting the urge to perform compulsions.  Under the strain of anxiety, the disorder can hijack the mind in a way that is sometimes hard to appreciate when calm and relaxed.  It is easy to say, when not in the moment, "Yes, I will make myself stop washing after x amount of time."  "No, I will lot let myself start over."  "No matter what, I will not engage in this compulsion." Etc. Etc. Etc.  But when that moment comes and the strong, almost magnetic-like desire to make things "feel right," to perform the compulsion that will bring the illusion of safety or certainty, takes over, it is not so easy to stick to the original goals made beforehand.

These are the times when I really feel like I could use my own metaphorical Harry, an outside force unaltered by the intoxicating potion of OCD to force me to move on, no matter how I beg, no matter what new justifications for compulsive behavior OCD fabricates.  In the moment it can be truly hard to believe that there is any way out but the compulsive way, and I feel like I need someone or something not under the influence of OCD to stop me.

But because I don't have a Harry, I try to create my own sort of safety net to ensure that I follow through and do what needs to be done.  In situations where I know I am likely to find myself under the spell of OCD, I try to remind myself beforehand, that no matter what that sneaky voice inside my head comes up with this time, I must not listen.  I must stick to the plan devised while my rational mind was still active, before it was overcome by the overwhelming trance of anxiety and the desire to succumb to compulsive habit.  It's almost as if, if I brace myself for what I know is coming, I can sometimes remember, even when the urge is at its strongest, to resist performing compulsions.

This is certainly not a foolproof method.  All too often, that logical voice gets drowned out by the false promises of OCD:

"Come on.  This time is different.  This is not the situation you expected.  You have to do the compulsion now.  Really, this time is different.  This time it's not just OCD and it really matters."

In the moment of anxiety the lies can seem like truth, and the truth like lies.  It all gets turned around as doubt clouds all sense of reason.  But if I remind myself enough, sometimes that memory - that knowledge that, no matter what, I should not give in - breaks through the muddled storm of confused thought.  Sometimes I can grab ahold of that reminder and pull myself through to the other side.  Sometimes, I can in fact, be my own guardian, my own Harry.  But like most things related to recovery, it is a learning process, and the more I practice, the better I get.

Sunday, August 8, 2010

Seeing the OCD as the Problem

There is a blog about eating disorders that I like to read which I have referred to here before.  I like reading this blog because a) I can relate in the sense that, for a brief stint in my life, I suffered from an eating disorder in addition to OCD, and because b) the author has a wonderful writing style an ability to capture her thoughts and feelings in a way that draws many parallels with my OCD way of thinking.

I was reading some of her past posts today and found one titled "Seeing the ED as the Problem."  In this post she discusses how she had to fight to identify the ED, the eating disorder, as the issue, and not the various things that got in the way of her desire to exercise and restrict.  Her behavior and attitude towards the eating disorder were described as being "ego-syntonic" or basically in line with her self-image.  It wasn't something she shuddered at and wanted banished from her life completely (in which case the ED would have been ego-dystonic), rather, she believed that her weight really was the problem and welcomed the opportunity to exercise and limit what she ate to remedy the perceived problem.

And this is where I get confused...oh so confused.  I have often read that OCD and eating disorders differ in that OCD is, by definition, ego-dystonic, and eating disorders are generally ego-syntonic.  If you were to ask someone with OCD if they would like to banish the thoughts and horrible feelings they cause, they are supposed say, "YES!  Take this terrible disorder away from me!"  Even the author of this blog, who also has experience with OCD, said that, when she was a teen and was suffering from both OCD and the eating disorder, she would have gladly gotten rid of the OCD stuff but wasn't really hoping that someone could magically free her from her ED-related thoughts and her desire to engage in ED behavior.

So then, people often draw a line between EDs and OCD because, technically, one is supposed to be ego-syntonic and the other, ego-dystonic.  But in my mind, and in thinking about my experience with both disorders, the lines aren't nearly so clear.  I really feel like my ED was just an extension of my OC thinking - it was just directed at my body image and weight instead of other common OCD targets.

I am not really educated in psychology.  I haven't studied these things and maybe I am interpreting them incorrectly.   And I am still sorting out my own OCD thinking and even a little bit of ED thinking, as well, so perhaps I am not really in a position to clearly see and judge these things because I am still in the midst of them.  But right now, the boundary between OCD and EDs seems somewhat artificial.  And just like the author of the ED blog sometimes struggles to see the ED as the problem, I still struggle with seeing my OCD as the problem.

No, this is not completely and 100% true in all circumstances.  I do recognize that my behaviors are probably exaggerated relative to the degree of risk they are designed to eliminate. But I still cling to such behaviors with tenacity, because, on some level, I still believe they are necessary.  To a certain extent, I still believe that the behaviors aren't the problem; instead, it's my inability to always do things the "right way" that I see as being problematic.

Perhaps the difference is the level of "insight."  I mean, isn't that, to some degree, what makes the difference between ego-syntonic and ego-dystonic behaviors?  If both are generally seen as being destructive to living a healthy and fulfilling life, isn't the ability to recognize that such behaviors are in fact destructive, what makes something ego-dystonic instead of ego-syntonic?  Doesn't the individual with an ego-syntonic view of his behavior cling to his way of doing things even if they are maladaptive and interfere with living a fulfilling life, while the individual with an ego-dystonic view of his symptoms wishes that he could stop the behaviors but can't figure out how to without experiencing crippling anxiety?

The reason I get way too wrapped up in all this and go around and around in circles in my head with this question is that I often struggle to see OCD as the actual problem.  I, in a very sick and twisted way, feel like I want my OCD.  Instead of seeing my OCD strategies for fighting anxiety as the issue, I see my inability to do things "correctly" as the real problem at hand.  So for example, instead of seeing my rigid and exacting rules for cleaning as the problem, I see my reluctance to engage in cleaning when there are such rigorous demands and my resulting to failure to keep things clean as further proof that I am inherently "defective" and thus, need to force myself to adhere to such rigorous cleaning guidelines.  OCD, as I sometimes see it, is really the thing that protects me from becoming a slob, a heathen living in filth, when, in reality, OCD makes it harder for me to do any sort of cleaning in the first place because of the all-or-nothing demands it thrives on.  How is this different from seeing my ED as something that I had to endure, the thing that protected me from swelling up into an immensely overweight individual, rather than the thing that constantly made me feel fat in the first place?

So to me, the line between OCD and eating disorders isn't always that clear.  In particular, the way my eating disorder presented itself just made it seem like another manifestation of my OCD.  I'm not trying to suggest that all cases of EDs and OCD are one in the same.  Some people, like the author of the ED blog, seem to experience these two disorders very differently.  But for me, drawing such a line between the two seems artificial and counterproductive, because I think the way I approach one is also indicative of the way I approach the other, at least to a certain extent, anyway.

Sometimes I wonder if this is why I struggle so much in fighting the OCD.  Rationally, I know that OCD is a problem.  Living my life this way isn't going to work out forever.  As I listed in a previous post, there is a lot I would like to be able to do now and in the future that OCD could keep me from doing if I don't fight it.  But, at the same time, I cling to my OCD.  I want it.  I feel like it keeps me from turning into a slob with sub-par standards in many different areas of life.  Since I am fairly convinced that it has played a not-so-minor role throughout much of my life, I am afraid of what I might become without my obsessions and compulsions.  Sometimes I cling with fervor to my OCD way of thinking and behaving because I think it keeps me safe.  I think it makes me an "acceptable" person.

So I have to remember that OCD is the problem.  OCD is what leads me to believe that I need the compulsions just to be who I am, to be acceptable, in the first place.  OCD is not keeping me safe.  It is hurting me.  It is taking time and the chance to enjoy my life freely as it happens away from me.  OCD isn't saving me from myself.  It is planting the idea that I need to be saved from myself in the first place.

It may not always be easy to remember but, OCD, without a doubt, is the problem!

Saturday, August 7, 2010

OCD, Shame, and Guilt

There are times I occasionally realize that I have been carrying around a lot of shame and/or guilt about my OCD, but I often come to this realization not when I am actually feeling these feelings, but when I discover they are no longer there in a particular setting or situation.

Twice today I had that surprising experience.  The first was at the pharmacy.  I was there getting a new prescription filled (that is another long OCD-filled story) and I was advised to do a "consult" with one of the pharmacists on staff because I haven't taken this particular medication before.  During these kind of consults they usually just give me a quick run down on whatever my new drug is - potential side effects, what to do, what not to do, etc.  Well, today I actually had questions about my new addition, and it was as I was asking these questions that I realized I felt far more at peace than I usually do just being in the pharmacy and in particular when talking to the pharmacist.  The lack of concern I had for how others there might perceive me suddenly made me realize all the shame and guilt I had been carrying around each and every time I went in to get a prescription filled.

It was a strange and revealing moment - noticing my comfort in this situation made the contrast between my usual feelings and how I felt in that moment all the more obvious.  Normally, I realized, I felt like a fraud each time I walked into the pharmacy.  I thought, well, they must see my prescription and think, "What's wrong with her?  She looks normal enough.  Why is she taking such a high dosage of anti-depressants?  She doesn't look depressed at all..."  I felt like I didn't deserve to be taking medication, like no one would believe I really needed it because, inside, I didn't even really feel as if I really deserved it.  All this time, I realized that, even though I agreed to take these meds and even though I am now somewhat attached to them and fear what might happen if I stopped,  I still didn't feel like I really was supposed to have them.

My hands are no longer obviously red and raw.  I don't think I look tormented or act strange when I am in the pharmacy.  In general, unless I am really right in the middle of an OCD crisis, I am quite genial with the outside world.  And this makes me feel like no one must believe there is really anything wrong with me, that I am just another member of an over-medicated, over-diagnosed generation.  And in fact, I still have a hard time believing that there is anything wrong with me, at least not wrong enough to warrant medication, my frequency of therapy, and not working.  I often feel like I don't deserve any of these things, and that is what my relative peace while in the pharmacy today made me realize.  I am still often convinced that no one really believes I have a problem or need the treatment I am getting.  But today made clear that this is not really a reflection of others' actions and attitudes, but rather my own.  The more worried I am about what others might be thinking, the more likely I am to believe that their thoughts must be negative.

So for once today, as I stood there in line at the pharmacy, I didn't feel like I had to prove myself.  I didn't feel like they were looking at me doubtfully as they retrieved my drugs.  It was a strange moment, and I don't know why it happened, but it did.  And it made me aware of these feelings of shame and fraudulence that I hadn't previously realized were triggered in this setting.

My second moment of insight came later in the day when I was out with a friend for dinner.  I have known this friend for quite some time.  He knows about my OCD and saw me at my worst and hated it.  It broke his heart to see me like I was.  I am doing much better now, but still, whenever I hang out with him, I am often hesitant to talk about things related to OCD because I always feel like he tenses up, whether he brought up the subject or not.  I feel like I can see the disapproval in his posture, hear it in the way he talks, and sense it in the tone of his voice.  I am convinced he wants it gone from me.  Banished.  I feel like any small compulsive thing I do draws his negative attention and saddens him.  He doesn't want IT to be there anymore.

Tonight however, I was talking about the OCD conference with him and the various things I saw and did while in DC.  As I was telling him these stories, I noticed how comfortable I was.  Normally, OCD is my secret.  I keep it as hidden as possible and say as little as possible about it when he asks.  But tonight I was gregarious and open about my experience.  I told him how I had met another sufferer whose story was much like my own.   I told him how nice it was to finally talk to someone freely and openly about all that had happened, someone who understood from personal experience and could relate, someone who wasn't upset by my sometimes strange actions and way of doing things.  I told him about all sorts of things that I normally keep to myself.  Things that I hide and almost cherish as a secret part of myself because I don't want to be misunderstood.  Because I don't want everyone to know about my oddities anymore than they already do.  I am usually so afraid they will judge, that they will give me stern or disapproving looks, or that they will shake their heads in disappointment with me.  But tonight I shared freely, and in return, he was not any of those things I thought he would be.

And that's when I realized:  as much as he has displayed many of the reactions and emotions I have described above at various times in the past, he is not always so disconcerted by my thoughts and feelings about OCD.  Part of what has often made him seem so impatient, so not understanding of the disorder, is the fact that I, myself, was ashamed of it.  I assumed he would react in negative ways to what I thought or said in part because I felt he should:  I was ashamed of my behavior.  I was embarrassed by my condition.  And I felt guilty for not being better or for not being further along.  Or, if I did manage to go out and enjoy myself, I felt guilty for even being able to do that despite the fact that I was still supposedly suffering from pretty bad OCD.  My desire to keep it all hidden away and locked up, my shame, my guilt, made me think, once again,that others believed my OCD should be kept hidden, that my story was shameful, and that I was guilty for not doing better.  But something happened tonight which made me realize that this is not necessarily true.

Today it suddenly made sense that, though sometimes such negative emotions are portrayed by others, often it is not so much what they are actually doing or saying as it is what I think they are doing or saying.  It is more often what I think that ends up making me feel like I have something to hide, like I should feel shameful and guilty.

Maybe the pharmacists do think my case is strange.  Maybe my friend still hates hearing about my OCD and secretly believes that, if I just tried, I would be doing better. But today, I got a glimpse of another point of view - a point of view where not everyone is suspicious and condemning of my behavior.  A perspective from which not all is seen as a failure.  And you know what?  It was nice.  I was able to talk confidently with the pharmacist without feeling like she was secretly scrutinizing me, and I was able to openly tell my friend stories from the conference, stories he seemed to actually want to hear.  For once I felt like I deserved to walk into that pharmacy just as much as anyone else, and for once I wasn't afraid to share my thoughts about OCD with a close friend.

And, well, like I said - it was nice.

Thursday, August 5, 2010

Trust, Forgiveness, and Relinquishing Control


Like this sign, exposure therapy might seem a bit odd at first glance.  You mean I am supposed to walk through the mud?  You mean I am supposed to not wash when I feel like I should?  Why on earth would I want to do that? 

A big theme for me this week has been the issue of trust, and by that I mean, trusting my therapist.  I agree with his exposure recommendations.  I don't think that the things he asks me to do are ridiculous or unnecessary.  And I really do believe that, if I were to go with his suggestions, I would get better.  I have had enough experience with this disorder, recently and in my past, to feel confident in the use of CBT.  If it means I have to temporarily walk through the mud, so be it, I understand the purpose and know enough to believe that it works.

I have also read lots of literature on OCD, am quickly developing my own little OCD library, and even went to the International OCD Foundation's annual conference to learn even more about the disorder and others' experiences with it.  I feel like I have become a sort of amateur expert on the topic of OCD and its treatment.  So with all that I know and have experienced, what's the hang up?  The thing is, even if I know what I need to do to get better, I'm still waiting for it to feel "right" before I commit wholeheartedly and without exception, especially when it's most difficult.

This is not a new issue for me.  From the beginning I have dragged my feet through the work of recovery.  I have come a long way, but it has been a bumpy road full of OCD potholes, wrong turns that have lead me back to previous points, and lots of second-guessing at every intersection where my OCD urges and my therapist's recommendations have crossed paths and gone off in two different directions.  I have taken a lot of detours that I knew were probably unnecessary, "just to be safe," and I have often come to those intersections, known which way my therapist would recommend, and still turned the other way, convinced that it was not yet the "right" time to commit to my destination of recovery.  "Not yet!" OCD protests, "You're not ready!  It would be careless to set off down that path at this moment in time.  Wait another day, wait until your next session.  When you see your therapist again you can double check that your directions are correct and then you can continue onward in your journey.  Just don't go yet.  It would be irresponsible.  You must wait!"

OCD likes to tell me that it's too late in the day, that I don't have the right supplies, that I may have heard the directions wrong, or that maybe my therapist would change his mind if he knew how this time was different.   These are just a few of the infinite excuses OCD comes up with to stall the journey.  It knows I know the way, so instead of leading me down the wrong path altogether, it does everything it can to stall the inevitable by talking me into waiting, or making a wrong turn just this one time, because, you know, this one, well, "it's different."  Secretly I want to go barreling down the road to freedom, and yet OCD doubt keeps me moving forward at a crawl, telling me that the time will come when I can put my foot on the gas...just not yet, not all at once...

But I am starting to realize that even OCD is running out new excuses to give.  I have built so much trust in my therapist over the last several months.  Even by my standards, I feel that he understands what's going through my head enough to know just how one simple change can wreak havoc on a number of different things in my world in domino-like effect.  At first I felt like he didn't understand, and that often kept me from complying.  I felt like even he, an OCD specialist, couldn't see how one simple suggestion, one exposure, shattered not one, but a thousand OCD rules at once in many intricate and complex ways.  I have spent a lot of time trying to explain, but no matter what, the answer pretty much stays the same - do the exposure.  Whether or not he understands "perfectly" what is going on inside my head, the recommendation remains.  At this point, after all the setbacks and explanations and new strategies to get me to do what I know I need to do to get better, I have faith that my therapist knows what he is doing and that he knows what he asks me to do may be more complicated to me than it outwardly seems.  And yet, the answer, the solution to the problem, again remains the same.

So if time and time again, despite the various excuses OCD comes up with, the directions to reaching my destination remain the same, at what point will I learn to ignore OCD's voice and continue on the path I know my therapist would recommend?  How many books do I have to read?  How many different ways do I have to be given the same answers until I finally believe them?

I have been looking for that missing piece, the answer or that bit of knowledge that will make me feel certain that the the way ahead is correct, so I can head down the road to recovery confidently and in full force.  But this elusive search is the problem in and of itself.  When will enough be enough?  When will I be convinced that the this time the answer is "right?"  I can't ever feel completely sure or completely certain.  It's time to give up the hunt for such unobtainable certainty and buy into my therapist's directions and recommendations, whether they always feel right or not.  It's time to accept that it will feel wrong sometimes, and that's where forgiveness comes in.

Instead of beating myself up for complying when it feels wrong, for being "careless" in the moment and not waiting for a chance to double check, I need to be mindful and forgiving at these times.  If I have made a mistake, if I somehow fail to wash in a circumstance where I really should have, so be it - I am at least still heading in the right direction.

I have waited for the "right" time long enough.  Though it sometimes feels like complete and utter blind trust even with all that I know and have learned, I still need to do what my therapist has recommended.  I need to take that risk, and let him guide me down the road to recovery.  After all, that is what I am paying him for, right? :)  My internal compass doesn't always work quite right, so for a while, I need to trust someone else's.

Tuesday, August 3, 2010

Starving Away Failure, Washing Off Laziness: My Fear of Becoming My "True Self"

As I sit here munching away at my dark chocolate covered espresso beans, reading the latest updates of the various blogs I follow, I begin to get that all too familiar feeling of crawling in my skin...I want it off, NOW...and by that I mean any excess fat on my body.

Unlike feeling dirty, there is no immediate fix for suddenly feeling fat out of the blue.  I can't just go wash it off to purge the feeling of panic,  nor can I perform rituals, that though time consuming, can, at least for a short while, banish the feeling of disgust.  I suppose there are methods that some people use - laxatives, diuretics, vomiting - that have fairly quick results, and thus I can see the appeal of them, but even when I was wrapped up in my eating disorder and at my worst, I never used these compulsive methods to make myself feel better, to get rid of that feeling of disgust.  My perfectionistic tendencies and eating disorder-related OCD told me that using those methods was cheating, that it was the easy way out.  The problem, my distorted thinking told me, was that I was inherently prone to laziness - to not exercising enough and not limiting what I ate as well as other people, especially skinny people.

My disordered thinking told me that the way to remedy this was not to cheat (which would only be more proof of my inherent laziness), but to fix myself by exercising more and eating less.  To me, the shape of my body was proof of my failure in these areas, and the solution was to force myself to workout "enough" and restrict "enough."  I wanted to prove to myself that I could regulate my diet and workout just as well as everyone else, even if it never felt like enough.  I felt like I forever needed to battle "my true nature" if I didn't want to devolve into the fat and slovenly human being I feared I was by default.

I see a lot of parallels between these thought patterns and my current fear of devolving into a dirty, filthy, unkempt human being if I don't force myself to carry out elaborate cleaning rituals.  I am afraid to discover that the "real me" is someone who seems intolerably lazy and gross, and thus I guard against becoming such a person by performing excessive compulsive washing.  I am afraid to stop because, though I recognize that my behavior is maladaptive and extreme, such precautions seem to protect me from a state I feel as though I could not tolerate (just as the person with harm obsessions might avoid certain situations and thinking certain thoughts to prevent himself from becoming the murderer he fears he might really be, or just as someone with fears about his "true" sexual preferences - either heterosexual or homosexual - will avoid situations and encounters that make him feel that he may "really" be the preference that he does not want to believe he is).

But I digress. Today as I looked in the mirror a little too long, analyzing a little too closely, I suddenly felt that need to escape my body instantaneously, to make my "fat" disappear.  I am not overweight.  In fact I am probably at the ideal weight for my height.  But looking in the mirror, certain parts of my body seemed to grow out of proportion.  Normally I am pretty okay with my weight these days.  But today I was planning to go ice skating, an activity, which for me, has almost always been inextricably intertwined with my body image, and usually in a negative way.  By looking at my body through my former "figure skater point of view," suddenly the figure which I am usually reasonably comfortable with was no longer good enough.

Competitive figure skaters (a group I once belonged to) are an interesting breed.  There are those who are naturally skinny, those who are not (though there seem to be fewer and fewer people in this category the higher up you go), and then there are those like me who, though we may be considered average or even thin within the general population, are a bit on the bigger side in the thinner-than-average world of figure skaters.  I didn't look like a pre-pubescent girl (because I wasn't one) and thus, I felt fat.  I remember a fellow skater once bemoaning the fact that she had hit 90 pounds, which made me, at my slender 105 pounds, feel like quite the heifer at that time.  I look back now and realize that 105 pounds was nothing and 90 pounds probably would have landed me in the hospital, but when looking at my body through that mindset in which basically achieving the figure of a little girl was the goal, I felt revoltingly bulky.

Getting dressed to go skate just for some fun and exercise this afternoon seemed to bring back the warped sense of body image I carried with me for much of my time in the sport.  I began looking at my body, my figure, through that old distorted lens.  Though I am more mindful now of how, depending on my mood and what activities I will be engaging in, my perception of body image can change, that feeling of crawling in my own skin can still overwhelm me with anxiety and a desperate desire to do something about it NOW.  But because I am more aware of the fact that how I perceive my reflection in the mirror doesn't always have as much to do with physical reality as it does my emotional state, I can sit with the discomfort without provoking my anxiety further.  Instead of berating myself for being a "failure," I can accept the discomfort and recognize that beating myself up or trying to do something drastic about it would only make the feeling worse.

As with any obsession, doing something to eliminate the anxiety as soon as possible, a compulsion, may seem like the way out, but in the end it only fuels the distorted thinking even more.  Getting angry at myself and swearing to adhere to a new diet plan may seem like the sensible solution in the moment, but in reality it only heightens my anxiety and sets me up to feel even more uncomfortable in the long run.  Doing such things reinforces the idea that I do need to change the way I look if I want to  feel okay, when really, if I sit with the discomfort long enough, it will subside on its own. 

Monday, August 2, 2010

Off-Limits: Things I Have Lost to OCD

So one of the things my therapist has asked me to do between now and my next session is to write down the things that I have lost due to OCD, the things that I am currently missing out on, and things that I could lose in the future if I continue to feed, through my compulsive behavior, this feeling that I NEED my OCD. 

Although I have always felt this way to a certain extent, I suppose this feeling that "I need the disorder to be me" has become one of the core reasons I now continue to engage in some compulsions, in addition to my original contamination fears and my version of moral scrupulosity with cleanliness.  My therapist warned me that this a dangerous path to go down - the idea of just resigning myself to OCD's demands because it is "my cross to bear" is a slippery slope that can easily lead to unnecessary loss.  With that in mind I thought I would begin contemplating the things that I have lost, continue to lose, or could lose in the future if I simply accept OCD as a burden I must live with rather than fighting it.

In my preliminary thoughts about this list, I realized one thing:  many of the things that I have lost, I don't really care about.  I can list a ton of things that OCD didn't allow me to do or still doesn't allow me to do, and yet I think, "yeah, so?"  I can think of things that I did because of OCD whose consequences I either don't care about or am even kind of grateful for.  So I have to dig deeper, because when I do continue the list I begin to notice things that I really would have liked to do that I didn't have a chance to pursue as a result, either directly or indirectly, of my OCD.

I am very accepting of my past.  I don't regret much because I am so grateful to have landed where I am today - to not only have discovered that I have OCD at this point in my life, but to have, by truly remarkable chance, ended up under the superb guidance of my therapist and to have access to the wonderful resources that the treatment center where he works has to has to offer.  In fact, it scares me to think that anything might have gone differently in my life that might have prevented me from ending up exactly where I did and when, because it honestly seems too good to be true.  Even putting that down in writing is slightly frightening because OCD says that spelling it out so explicitly will take that feeling away or somehow dampen how good it seems!

So perhaps instead of listing the things that have I lost to OCD, I will try to consider things that I might have had the chance to do had I found the treatment that I now have sooner in life.  It is easier to think of things that I would have liked to do, rather than things I would actually change, because like I said, it scares me to think about how I might have done anything differently because I am so grateful to have ended up where I am now.  I fear that had any number of things gone another way, I could have ended up somewhere else entirely, without the quality of help I needed or even without help at all. 

But say I somehow had ended up with the same resources I now have when I was yonger...how might I have used that help to change and accomplish other things?  What do I hope to be able to do now that I know I have OCD and have outstanding treatment for it?  And finally, what do I hope to be able to accomplish in the future that just letting OCD take its course would undoubtedly jeopardize?  This is what I have come up with so far:

What I might have worked on or done in the past had I known about my OCD and gotten proper treatment:
  • Taken the chance of rejection and applied to Ivy League colleges.
  • Tried to get a job as an SI leader (a student who has done well in a previous college course and tutors others in that subject).  This is a position I secretly wanted but didn't see how I could ever manage with my self-doubt and inability to manage my time.
  • Taken advantage of my professors' office hours in college to ask the questions I really wanted to ask and learn from the knowledge they had to share.
  • Read, read, read...oh how I would read and devoured more books!
  • Might have gone for leadership positions in the organizations I was involved in (like band) - positions I wanted but was too afraid of going for.  I either feared being rejected and not getting the position, or getting the position and feeling like I was failing at it.  I was also afraid to pursue these positions because every last minute was taken up by the things I already had on my plate - things that took more time than they should have because of OCD!  I hardly had enough time to do the work I already had, much less sleep, eat, and relax on a regular basis!
  • Developed the autonomy and confidence to take the risk of pursuing what I wanted rather than what seemed like the right or most certain path - the path that was safe but not what I really wanted! (i.e. med school and "real" scientific research - these are the type of things that were "safe."  Grad school didn't provide the same sort of job certainty that pursuing medical school did, and the type of research I was more interested in, studies in cognitive neuroscience and psychology, weren't considered the MOST scientifically stringent form of research by others compared to more purely molecular biology-type work...the type of research I got myself involved in.)
Things I would like to do now that OCD either compromises or prevents me from doing altogether:
  • Date.
  • Read books I would like to read (especially those about OCD!).
  • Save money that could be spent on fun things or saved for the future rather than being wasted on things like soap, shampoo, body wash, laundry, laundry detergent, and replacements for the variety of articles I throw away because I think they are "contaminated" and many other things along these lines.
  • Treat my clothes with more care - since I wash everything on hot and more frequently than I normally would, my clothes are wearing out and shrinking faster than than usual.
  • Get a job or volunteer.
  • Do dishes and cook.  (I haven't cooked in almost a year - for a while it was just too hard to feel clean long enough to assemble a meal that didn't just involve nuking something.  Then I was afraid to wash dishes because they were so dirty, and when I did do them, it took me forever!  Now I still don't do dishes or use them, but while this and my resistance to cooking are still in part due to my fear of being contaminated or cleaning things "wrong" and having it all devoured by time-consuming rituals, it is also in part due to my fear of losing the sense of self that I have developed over the last year - I am afraid to feel too free, too "normal," too fast, after being out of commission for quite some time.  I am afraid that it will result in some sort of identity crisis.  So while I still have many rituals that hamper my enjoyment of life, I cling to them tightly out of fear of falling apart....but as with any fear, the only way to find out whether that fear is worth the compromised quality of life that it results in, is to do exposure and face it! To do the experiment and test the hypothesis!)
  • Have an income (and stop delving deeper into my savings to pay for my living expenses).
  • Actually keep my home clean.  This may sound paradoxical, since I have contamination fears, but I have a hard time cleaning because of OCD, and as a result things are often dirtier than I would like them.  If I could just clean without it becoming a huge, compulsive, and extremely onerous task, I could keep my home at least looking clean even if I felt that I had cleaned things "wrong" or "not well enough."  (I have always had difficulty initiating cleaning processes, even before I developed severe contamination concerns, because once I got started, it always seemed like there was more to do...it was never good enough or clean enough, and I would just resign myself to occasionally performing long cleaning marathons.  Even then I would often still not feel like I had cleaned well enough, or if I did meet the constantly evolving cleaning expectations of my mind, I would be exhausted and frustrated by the fact that it it took me four or five or a million times longer than the average person.)
  • Enjoy being in my twenties and the freedom and flexibility I have at this time.
Things that I can do in the future if I overcome some of my OCD challenges and learn to better regulate my symptoms:
  • Channel my attention to detail and persistence so that I can use it for things that I want to accomplish rather than what I feel I should accomplish.
  • Go back to school and do it on my terms, not OCD's, and see if I can succeed and perhaps even do better and be happier without giving into the disorder's demands.
  • Get a cat (or two!) and be able to take care of it...I have always, always wanted a cat but have never had one.
  • Handle having kids (sometime very far, far, far in the future, if I have that wonderful opportunity).
  • Help others with OCD more effectively by having had, and by learning from, the whole first-hand experience of using CBT/ERP to overcome and conquer OCD challenges successfully.

And finally, I'd also like to mention a few things that challenging my OCD has allowed me to do thus far:
  • Start this blog.
  • Consider exciting job opportunities for the future.
  • Take the chance of remaining single and to consider pursuing new relationships.
  • Attend the OCD conference, where I learned more about OCD and had the wonderful opportunity to meet more sufferers like myself! 
Of course, this list is far from exhaustive and I'll probably develop it further offline, but these are at least some of the big highlights in the list of things I might have done had I gotten treatment earlier, things I hope to do soon if I can get my current symptoms under control, and things I want to do in the future that OCD, if left un-managed, could jeopardize.

These are the reasons that, at this point in my treatment, and with all the knowledge I now have about OCD and the methods used to overcome it, I should really start putting that knowledge into practice more consistently to help myself achieve the things I would like to achieve.


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