November 28, 2010

Obsessive Compulsive Personality Disorder (OCPD)

I’ve often wondered if I have OCPD.  I still don’t know.  None of my therapists have actually said that I have OCPD, but I know that I have perfectionistic compulsions….mostly as they relate to my OCD themes (gay OCD and relationship OCD), but since my OCD themes are so tied into life and relationships, I think it can be hard to distinguish. 
OCPD is a condition where the person is preoccupied with rules, orderliness and control.  Hmmmm….sounds like a lot of us with OCD hey?  I struggle with this definition, and yes – I can become obsessive about trying to “figure out” whether I have OCPD.  I don’t know why it matters so much.  I think because if I do have OCPD, there is less hope for recovery.  (Feared Outcome here – that I’ll suffer from this hell forever, and will destroy more relationships.  That I’ll never find “peace”.)
So – in my compulsive way, I’ve been doing some research on the internet about how to know if one has OCPD.  I’ve also asked my therapist.  She didn’t give me an answer. 
Here are some examples of the common signs of OCPD:
-          Excessive devotion to work.  Not me.  Well……I shouldn’t say that.  I definitely am not a workaholic.  I don’t really garner a lot of enjoyment from my job.  But in my last position, I was so anxious about perhaps being fired, or not succeeding, that I spent a lot of time working.  And when I wasn’t at work, I was thinking about it A LOT. 
-          Inflexibility. Not me.  I don’t think.  But I am (or can be) stubborn.  Do those mean the same things?
-          Inability to throw things away (even when the object is of no value).  Definitely NOT me. 
-          Lack of generosity.  Not me.  I consider myself to be generous.  But the OCD/Doubting side of me says “are you sure?  Do you have any examples of that?  Maybe you should check in your past for examples.”
-          Limited expression of affection.  I wasn’t raised in an overly affectionate family.  But I definitely like affection, and I like to give affection. 
-          Perfectionism.  Yup.  I’m definitely a perfectionist.  In a lot of ways.  People would look in my car and say “no way – you’re not a perfectionist.”  This summer, my niece stayed with me for six weeks and when I mentioned that I’m a perfectionist she said “YOU?!”  But I’m definitely a perfectionist about many things. 
-          Preoccupation with details, rules and lists.  This one is an odd one for me.  I work in marketing, and an attention to detail is important – especially when proofreading an ad prior it goes to print.  However, I suck at this.  My attention to detail is horrible.  But I can walk into someone’s house and immediately pick out if there is a photo hung crooked on the wall.  The preoccupation with rules is tough too.  I’m the first person to break a rule if I think it’s stupid (self-righteousness isn’t listed as a sign of OCPD!), but when provided with the rules for a scenario, I am pretty concerned with sticking to them for FEAR of being reprimanded. 
-          Reluctance to allow others to do things. Another hard one to answer.  I’d love it if everyone else did the things, but really do like it when they do it my way.  :o)

When all is said and done, there is no clear cut “answer”.  How many people - OCD or not - can't look at that list and identify on some level with some of it?  Of course, my OCD wants me to have an answer - to know for sure.  As I write this, I can feel the anxiety building slightly, and a little voice inside my head saying “you might have OCPD.  This would be horrible!  Maybe this would mean that you are receiving the wrong treatment, and you will continue to struggle forever, and continue having difficulty with relationships etc etc!  You better figure this out.”  I’m not going to listen to this voice though.  In the end it doesn’t matter.  I’m doing the best that I can, and having a diagnosis, or another label isn’t going to suddenly cause all of my struggles and issues to go away.  I will continue to plug along with my treatment, regardless of what that annoying little OCD voice says. 

November 18, 2010

Are you "out of the OCD closet"?

I’m not.  Well – that’s not true.  My parents and my boyfriend know the details.  A few of my friends know the “basics”.  But, for the most part, very few people know that I have OCD.  There are several reasons:
1.       First of all – there’s the mental health stigma in general.  So many people are “scared” of anything surrounding the topic of mental health.  I don’t know if this is because they have been there once or twice before themselves, and it was so painful that they are afraid that talking about it might “bring it back”, or if people are still fairly non-compassionate about depression and anxiety, and still think that those of us who suffer from mental health issues should just “snap out of it”.  The few people who know the “basics” know that I have depression and anxiety.  That’s it. 
2.       Then there’s the relatively wide-spread misunderstanding of OCD and what it is about.  For the majority of people, when OCD is brought up, they think either “hand washer” or “perfectly clean house”.  Believe me – I am neither of those - and those who know me can see that very clearly.  Don’t get me wrong.  OCD peaks its ugly head up every now and then in those areas too.  I like to “feel clean”, and I like my house to be clean in a certain way - my specific way - but to look from the outside into my life, one would never think “she has OCD”.  Leading me to the primary reason that I don’t tell people that I have OCD. 
3.       Most people know so little about OCD that they have never heard of Pure O OCD – those of us who’s obsessions and rituals are mostly in our heads.  They have never heard of someone who worries that he/she might be gay, or who worries that he/she might act on a violent thought.  Most people with very little knowledge and understanding of OCD probably wouldn’t understand.  They would probably think that those of us who doubt these things are in denial, or are potentially dangerous.  But then again, maybe I’m not giving people enough credit. 
The other day something very distressing happened.  As part of my therapy, I have been trying to immerse myself in my fear as much as possible.  I have put pictures of lesbian couples up on my bathroom mirrors.  I have the gay newspaper laying out on my coffee table.  I have post-it notes spread throughout my house reminding me about ritualizing, and how certainty is an illusion, etc.  On that particular day, I also happened to have Dr. Grayson's book out on my living room coffee table.  Obviously due to being “in the closet” with my OCD (I love that pun given my current OCD fears!), whenever I have friends coming over, I take down all the photos and put away all of the “evidence”.  I knew my boyfriend was coming over that morning, but he is used to all of this.  As I said – he is fully aware that I have OCD and how it is currently manifesting.  He is also usually very thoughtful about warning me if he is coming over with someone else.  But…….the other day he forgot. 
I was in the kitchen and he arrived with his friend Mark.  Panic suddenly hit me.  All I could think of was the newspaper sitting on the coffee table, and that Mark would surely see it.  I desperately tried to signal to my boyfriend my terror and concern, but he did not catch on.  Knowing that strategy wasn’t working, I came up with another one.  Any fly on the wall would have found this scenario laughable.  It was like watching an old “Three’s Company” episode.  I asked Mark if he had tried any of the preserves that I had recently made.  “Have you tried my pepper jelly?  What about my peach jam?”  Mark, confused, said that he hadn’t.  (I’m sure he wondered why I was asking this random question!) So I sent them out to the garage to get some.  “Go on.  Take Mark out to the garage to let him pick out all the preserves that he could want!” And on and on it went.  But not before I saw Mark wander over to my coffee table and take a look at what I had sitting smack dab in the centre – my gay newspaper, and my OCD book. 
Mark ended up leaving very quickly.  It was obvious something odd was going on.  As soon as he left, I let into my boyfriend with intense anger.  I was very anxious.  Mark saw the newspaper and he was going to think that I was in the process of coming out of the closet.  Why else would I have a gay magazine on my coffee table?  He was going to spread the word to all of his friends, and all of our acquaintances in the small community in which we live.  I absolutely freaked.  How could my boyfriend be so careless? 
Of course my boyfriend felt horrible, and apologized profusely.  Somewhere, deep down inside, I knew that I was over-reacting.  I knew that the most therapeutic response would be to take the risk that Mark did in fact see the newspaper, and that he might in fact think that I am coming out of the closet as a lesbian.  After all – as my boyfriend said – there are lots of reasons why you could have a gay magazine on your coffee table.  Perhaps I picked it up because I saw an interesting article on the cover.  Or, even more likely – perhaps a gay friend of mine brought it over.  Can you see how someone without OCD was able to think objectively?  My boyfriend even said that he doubted that his friend Mark even noticed.  There was no way that I was taking that chance. 
In the end I decided that the best thing to do would be to let Mark know that I have OCD, and not mention the gay newspaper.  So, my boyfriend went to see Mark and let him know that the reason things were awkward and weird is because I have OCD, and I had left an OCD book on my coffee table, and felt weird about it.  Mark’s response?  “Yeah – don’t we all have OCD?”  (Which is interesting in and of itself!  On one hand, his response showed acceptance towards me.  On the other hand, it also proves my points above – the lack of knowledge that people really have about the disorder.)
It’s all over now, and later in the day I was able to joke about it with my boyfriend.  I apologized for freaking out, and he apologized for being careless.  This is a perfect example of how people close to people with OCD have to follow along with rituals.  And when they don’t – LOOK OUT.  When I mentioned this situation to my therapist, we laughed.  She said a situation like that is inevitable, and gave me some other examples of similar situations that her clients have had.  I know now that next time I will have to face the anxiety and the feared consequences.  Let's hope it doesn't happen again. 

November 13, 2010

Feared Outcomes - An important step to consider.

I have been doing ERP now for about four months.  I have read many OCD books, and all of them discuss the importance of doing Exposure & Response Prevention in order to recover from OCD.  However, Dr Jonathan Grayson takes it one step further in his book “Freedom from Obsessive Compulsive Disorder”.  He emphasizes the necessity of getting in touch with your feared outcome (s) related to your specific OCD fears.  This is particularly important, because one can have several different feared outcomes related to one specific OCD fear, and if they are not addressed, recovery may not be possible, or may take longer. 
Discussing my feared outcome (s) is not something my OCD therapist has initiated, and my OCD therapist is from one of the larger OCD treatment facilities in the United States (we Skype on a weekly basis).  Why hasn’t she delved further into my OCD fears to help me to understand what my feared outcomes are?  I have no idea.  But it certainly does remind me that it takes years of experience in treating this emotional disorder to become thoroughly familiar with the way the disorder manifests, and skilled enough to treat it effectively.  (My therapist is relatively "young" in the field.)  That being said, my therapist is much better than the one I had until three months ago (he was giving me reassurance that my fears wouldn’t happen!), and I am making progress.  So – I have decided to use Dr. Grayson’s book as a “supplemental therapist”, and I have done the “Feared Outcomes Exercise’ myself. 
I have found that knowing and addressing my specific feared outcomes has helped me a lot, perhaps because most of my rituals are mental in nature.  Every time I exaggerate my fear in my head, I exaggerate it to the point of my feared outcome coming true.  I then remind myself that although my feared outcome coming true would not be an ideal situation, that I would have to learn how to cope. 
Two of my feared outcomes related to HOCD are:
1.       That I am in denial about being gay and that someday I will suddenly realize that I am a lesbian and will have to break up with my boyfriend and leave the life we have built etc etc.
2.       That I am missing out on the chance of true (perfect) happiness by not becoming gay (ie: there is someone "better" out there for me and it may be a female)
Two of my feared outcomes related to ROCD are:
1.       That I am missing out on the chance of true (perfect) happiness by not breaking up with my boyfriend. (ie: that there is someone “better’ out there for me)
2.       That I am in denial about loving him, and someday I will realize that and either have to leave him or have to live with him forever, unhappy and unsatisfied. 
I also have the fear that I don’t really have OCD, and that I might be better off in Psychodynamic Therapy.  And the list goes on………
Notice the irony here?  On one hand I’m scared I’ll have to leave my boyfriend because I love him, but on the other hand I am scared that I’m in denial and that I’m missing out on true happiness.  OCD just doesn’t make sense, which is why logic doesn’t work when battling this disorder! 
My next step is to do some script writing.  I plan to do some imaginal exposure, write out some scenarios where my feared consequences come true, and tape them.  I will then listen to the scripts several times per day.  I have been avoiding this task, because I know imagining my feared outcomes so vividly will give me a lot of anxiety.  I have been avoiding my thoughts for so long now that I don’t even know if I will be able to do it.  It’s my goal for this week. 
Have any of you gone through the process of considering your feared outcomes? 

November 8, 2010

Around & around we go - moving up the hierarchy

Well.  Today is one of those days where I can honestly see my progress.  I can logically list all of the things that I’ve done on my hierarchy that I would never have faced a year ago.  But I can’t feel it.  I feel incredibly anxious.  More anxious than ever, in some ways.  How is that progress???  So ironic, that a few days ago I felt like I had “the world by the tail”, and today I feel like I’m right back there again.  I’m trying not to spend too much time trying to figure out why I’m back there.  I’m pretty sure it’s because I’m getting to the top of my hierarchy, and some of my exposures are getting really hard.  When I wrote my last post, I had almost habituated to the item on my hierarchy that I was working on, and I was feeling so confident.  It was time to move on to the next item on my hierarchy.  So I did.  And WHAM!  The obsessing and ritualizing started all over again.  It seems like this is a pattern for me.  As soon as I expose myself to something harder on my hierarchy, my anxiety goes sky-high and therefore it’s harder to not ritualize, and it’s pretty much impossible to exaggerate my thoughts (see previous post). 
Has anyone else had this experience? 
It is so very frustrating and demoralizing.  All the old thoughts come rushing back.  And now there’s even more thoughts to go with the old thoughts.  My mind sure can come up with new ways of presenting the same old doubt.....and that definitely gets my attention! That “elusive uncertainty” that I referred to in my two previous posts seems that much harder to grasp and accept.  I feel like I’m back at “NO WAY – there’s no way I can accept the possibility that these things might happen”.  The “thought stopping”, “analyzing” and “avoiding” starts again.   And I can’t imagine doing any of the things that are further up on my hierarchy.  It just seems far too overwhelming for me.  It’s during times like these that I can really relate to Fellow OCD Sufferer's comments about needing that therapeutic support as she is facing her fears.  The last two days have been very difficult for me, and I still have another day and a half until my next therapy appointment.  Thank God for therapists who know what they are doing.
On the positive side, I am bound and determined to continue doing my exposure – no matter how hard it gets.  No matter how many disturbing, exaggerated, out-of-left-field thoughts come to my mind.  But it sure is hard to not try and find the answer.  And I definitely am taking it one day at a time.  I can’t wait until my session with my therapist on Wednesday.  Wish me luck. 

November 4, 2010

That UNCERTAINTY thing.....

I’ve been doing a lot better these last few days.  I had a session with my psychologist on Tuesday morning.  We talked a lot about the elusive idea of “accepting uncertainty”.  We also talked about what to do about mental ritualizing. 
I have always been stuck on the ritualizing portion of my OCD.  During times of intense struggle, when I’ve gone waaaaay down the “rabbit hole”, I’ve often thought that this horrible disorder would be so much easier to tackle if my rituals were behavioural in nature.  No offense to my fellow OCD sufferers who have behavioural rituals – this disease is horrible in its own right.  These thoughts come during periods of self-pity when I wish everything in my life were easier.  That being said, several experts in the OCD field have commented that the Pure Obsessional sub-type of OCD can be more difficult to treat, due to the fact that our rituals don’t tend to be behavioural in nature.  Of course, this “black or white” rule is not necessarily accurate either.  I actually think that most people with OCD have some behavioural rituals, and some mental rituals as well.  Anyway – I digress….back to my original thoughts. 
Since most of my rituals are mental compulsions, I have struggled with not only recognizing them and catching my thoughts, I have also struggled with the fact that I can’t do "typical" response prevention.  I can’t stop thinking.  With OCD treatment, we are counseled that we cannot stop our thoughts.  Just as we cannot stop our obsessional thoughts, we cannot stop any thought.  Dr. Jonathan Grayson emphasizes this idea in his book “Freedom from Obsessive Compulsive Disorder”.  So what do I do?  I have been doing exposure for several weeks now, some weeks with greater success than others.  The weeks that I have less success, I know that I am doing a lot more “figuring out”, mental checking and mental reassuring.  However, it sometimes takes me several days to recognize this, and I think this is one of my greatest hurdles that I will need to overcome in order to fully recover.  I brought this concern up with my psychologist on Tuesday and she said that awareness (ie: mindfulness) is essential.   She suggested that whenever I notice an obsessive thought, to agree with it.  She said that not only should I agree with the obsessive fear, that I should EXAGGERATE the fear; take it to the next level.  We practiced a few times during my session.  Wow – did that do the trick!  She could visually see the discomfort I was feeling.  So, rather than arguing with my thought, trying to diminish the importance, or telling myself that this thought will never happen, I am actually purposely making it worse.  I’ve practiced this “skill” for the last few days and it has made such a difference.  It has also helped me to “thicken my skin” with regards to living with uncertainty. 
I am almost finished Dr. Grayson’s book, and I will definitely be reading it again.  There are so many little snippets of information and motivation contained in that book.  In my last post, I wrote about my concern that I may not overcome my OCD because I didn’t feel ready to accept the uncertainty related to my OCD fears.  Dr. Grayson actually includes a great exposure script that addresses this concern exactly.  (Go figure!  I’m not the only person with OCD who struggles with this! Sarcasm.) I read it, and will read it as many times as I have to, especially when I feel myself struggling with this notion again.  I have also been challenging myself a lot more in the living with uncertainty area.  For example, yesterday after I took my dog out to the bathroom, picked up her poop, and dropped it in the garbage can I thought “There could be some germs on my hands now.  I could get worms or something.”  I thought of the OCD sufferers who have contamination issues that would never take the chance that there were germs on their hands.  Or worse yet – worms.  Those sufferers would immediately go into the house and wash their hands, most likely several times over.  I didn’t do that.  I noticed the parallel between my OCD theme and my inability to function with any sort of uncertainty, and compared it to this situation.  I then went inside, went to the fridge and pulled out something to eat. 
I really can’t be sure of anything in life – no one can.  There are some things that I feel sure of, but that doesn’t necessarily mean anything.  I have been reminding myself of this, and though my OCD mind still chirps in and wants to argue with me, it is a fact.  And I can’t argue with that. 
I think I’ve had a few steps forward.  I’ve got a long way to go.  But at least I’m moving in the right direction. 

November 1, 2010

Living with Uncertainty - the goal of recovery

I’ve learned so much about OCD and recovery since my latest "OCD breakdown".  Dr. Jonathan Grayson’s book “Freedom from Obsessive Compulsive Disorder” was very helpful for a few reasons:
1.       Dr. Grayson addresses my sub-set of OCD.  Very few books about OCD actually dedicate much time discussing Pure Obsessional OCD, let alone Gay OCD. 
2.       He addresses the need to be able to learn to live with uncertainty in order to fully recover from this horrible disorder.  I agree completely!  When I initially read Dr. Grayson’s book, I don’t think I fully grasped exactly what he was talking about.  “You mean I have to learn to be OK with the idea that someday I might realize I’m in denial and actually a lesbian?  I have to be OK with the idea that not “trying to figure this out” might cause me a lifetime of unhappiness?  I have to learn to be OK with the fact that someday, I might decide that I’m gay, that might mean breaking up with my boyfriend and not only hurting him immensely, but ending all of my hopes and dreams?”
Learning to accept uncertainty with regards to whatever theme one’s OCD takes seems like a crazy notion.  But I totally get it.  On some days I feel like with this goal I am resigning myself to a life of despair.  LOGICALLY I completely understand what Dr. Grayson is saying.  It makes complete sense to me. After all, he is correct – there is as much, or greater chance that I’ll get hit by a car when driving my car to the grocery store, but I don’t stop driving, do I? 
Dr. Grayson also discusses getting clear about what your feared consequences are and facing those “head on”.  This is something else that I have never done, and when I try to think about it now – whoa!  It’s tough.  This aspect will definitely need to be integrated into my treatment. 
Last night was a rough night for me.  I did some exposure yesterday and immediately started with the mental checking - trying to remember things about my past to decide whether or not I have ever felt any sort of attraction for a woman.  In the middle of the night I woke out of a dead sleep and started ritualizing again.  And I HAD TO FIGURE IT OUT RIGHT THEN.  If I didn’t, wasn’t I being neglectful to myself and my boyfriend?  If there is ANY POSSIBILITY that I might be in denial about my sexuality, shouldn’t I be trying to figure it out RIGHT NOW so as not to hurt anyone?  As you can see, I am still struggling with living with uncertainty about whether or not I am, or will become a lesbian. 
I hate having these thoughts.  But I’ve also realized that because my rituals are mostly mental in nature, I can quickly fall into the “mental checking” and “figuring out” rabbit holes without even realizing it.  And before you know it my anxiety is sky rocketing, and I am not sure why.  Then, I want the thoughts gone even more. 
Ultimately I have to accept that someday I might realize I am gay.  This is a goal I am working towards, but I can honestly say I am not OK with right now.  Wow – that’s a huge risk to take.  Does this mean I’m not ready for treatment? Does this mean that every exposure I do is for naught?  (You don’t have to answer those questions – they have become obsessions too.) 
I certainly hope not.