FAQ

My mom has been staying with me recently, and though she has a first-hand glimpse of what I've been going through, she (understandably) has questions about the manifestation of OCD. The disorder isn't realistically represented in popular culture, so there are a lot of misconceptions about it. I thought I'd write a little bit of information for anyone who might be reading this journal that has questions.

• OCD is an anxiety disorder arising because of neurological malfunctioning. Anxiety is your brain's warning system, but if you have OCD, the warning system doesn't work correctly. Therefore, you experience the sensation of danger even when you know everything's fine.
• Individuals living with OCD usually understand that their obsessions and compulsions are irrational and excessive. In TV shows and movies, OCD individuals are often portrayed as enjoying perfection, order, or cleanliness. Someone who enjoys excessive perfection or cleanliness might have Obsessive-Compulsive Personality Disorder. With OCD, however, the individual knows that their fears are irrational, but can't stop feeling afraid. They also won't enjoy performing compulsions: the only reason they do the compulsions is to relieve anxiety. 
• OCD isn't primarily about cleanliness. True, some sufferers do fear germs or dirt, and this variety of the disorder is called contamination OCD. However, other iterations of the condition might make the person fear causing or receiving harm, breaking moral codes, or getting rid of personal possessions. 
• Finally, it's often not easy to identify a person that has OCD. Frequently, when I tell someone about my disorder, they'll say "I would have never known!" or "You seem so put together!" The reality of OCD, however, is that about 2-3 million adults and 500,000 children experience the illness at any given time. Most people with OCD hide the disorder out of embarrassment. In fact, OCD has been linked to above average intelligence and high achievement. 

If you google image search "OCD brain" you can see pictures that show how an OC individual's brain works differently than those who don't have the disorder. I'm very open to answering questions from friends or family, since it's important to me to raise awareness about the realities of the illness. 

Fun Home(work)

I met with Dr. M again today for my second-ever visit with AustinOCD. We talked about my progress last week, which consisted of just "poking" at little rituals and habits that I have. He said I'm in great shape and am going at a good recovery pace. That was nice to hear because it's kind of hard to tell if I'm taking on enough. Most notably, I made it out of the house 'til 4:15 (yay!) and ate some foods that are "off limits."

I've officially discontinued the Ativan - big relief! No more medication adjustments for a while.

My homework for this week  involves two things:

• Keep "poking" at my rituals and habits (but don't try to take on too much right now).
• Find ways to be purposefully imperfect. Dr. M said that OCD tends to make you want to do things perfectly, and that going out of my way to make errors, mistakes, and slip-ups will help my recovery. He suggested things like: including typos in emails, not doing all of my makeup, or leaving out dirty dishes. 

Also, I learned that Dr. M is familiar with Alison Bechdel, one of my favorite authors. I mentioned her book Fun Home in our meeting today, and he said the name was familiar to him. Apparently, he's read her comic strip Dykes to Watch Out For. Exciting!

New Doctors!

I just got back with my meeting with the director of AustinOCD, and overall I think the meeting went well. The director of the center is Dr. M and he kind of looks like Richard Attenborough from Jurassic Park. The meeting was mostly "patient education" about OCD and what happens in the brain with this specific disorder. Dr. M refers to it as a "neurological glitch." This glitch happens in your frontal cortex, so you perceive danger where there is none.

Here are some of the other relevant things I learned from the meeting:

Medication: Dr. M discussed the medication switch I went through recently, and said that because I had such a hard time when I was starting the new medication, it might actually indicate that this particular med is going to be a good fit with my brain. It's kind of complicated, but because of something called "downregulation," when an SSRI is a good fit with your brain, it floods your body with serotonin, and so (at first) you end up producing less and so feeling worse. In the long term, though, once I adjust, it might indicate that the particular chemical in the Sertraline will help me a lot.

Prognosis: I had been nervous because when I first spoke with Dr. M he had referred to my condition as "severe." That totally freaked me out. I mean, yes, things have worsened with my condition, but it's scary to hear someone say you have a "severe" illness. He addressed that today with me - he said it sounds like the anxiety/"suffering" I've been going through is severe. However, he says he's very optimistic about my treatment based on my history with OCD and current disposition.

Rituals: My homework this week is to "poke" at my OCD - just try to change little things in my rituals. I had been trying to tackle some ritual-changing on my own, and told him I started with trying to stay out of the house later because it was such a "big" ritual and so obnoxious. He asked why I'd started with something big and suggested I try to do small things instead. He emphasized I take on modest goals at first. Especially at the beginning of recovery, he said, it's a mistake to do too much.

Overall, I'm pretty positive about things right now, but it's soooo hard to just make slow, small gains. I am impatient and want to fix every problem right now.

My recent flare-up of my OCD has caused me to re-think my relationship to the condition, as well as how others perceive me. Like a lot of people living with OCD (I hate to say "OCD sufferer" since it sounds so depressing) I've hidden my quirks and rituals from friends and family. Now that my OCD is more pronounced, it's a little bit harder to hide.

I've noticed something interesting about how I represent the condition to others. Whenever I do an OCD ritual in front of someone else, or whenever a compulsive behavior might seem odd to another person, I have a knee-jerk tendency to say "Sorry." Sometimes I apologize multiple times.

Case in point: at night, my  rituals necessitate I walk in a certain pattern in front of my coffee table. Mom, who's been staying with me, sometimes sits on the couch and when I walk in past her I have to ask her to move her legs so I can get by. I feel so awkward and bad asking her to move her legs, and I usually blurt out "Sorry, you're not in the way, it's just me."

Of course, there's a lot of feminist writing on the topic of women saying "Sorry" more frequently than men. It makes me wonder when and where it's appropriate to apologize for my OCD. Obviously, I didn't choose to have OCD, but I can (generally) choose how and where I give into it. Is apologizing to others just making me feel more ashamed about the condition? Is it appropriate or socially convenient?

So, I haven't blogged in a little while. Things got kind of messy as I stepped down off of the Ativan that I was taking. Apparently, the withdrawal that people experience when they wean themselves off of benzodiazepines is pretty intense. My anxiety was peaked on Sunday and Monday.

My doctor has added a mood stabilizer, Seroquel XR, to help augment the SSRI that I'm on. It made me groggy the first few days I was on it (Monday and Tuesday) but it's gotten better.

I guess the big news is that I'm going to try to start working with the Austin OCD Center as an outpatient. It's pretty expensive, and my insurance isn't that great, but my family is going to help out with the costs.

Finally, I had lunch to day with Rachel, and it felt great to get out (and also, to eat hotdogs).

Doctor's Visit

I just met with my psychiatrist, Dr. E (who I've been calling my "doctor" in my earlier posts). She wanted to see me today to check in about how the recovery was going and see if we needed to make any adjustments. She's this shorter, perky lady who is very, very smart; so, it's very nice to see her. Also there are only particular types of women that I know who legitimately look good in pantsuits, and she is one of them.

In list-form, here's the situation:

Medication: My mood has been getting better, little by little, over the past two weeks. Dr. E says this is a good sign since that means I'm responding to the newer medication, an SSRI called Sertraline. Because I'm responding to it, I won't need to be put on an additional, heavier, medication in order to amplify the effects of the Sertraline. However, we are going to increase my dosage of my SSRI, starting today. I'm going to stay on the supplementary, short-term medication (Ativan) for the moment. Over the course of the next three weeks I'll wean myself off of that one.

Mood Stuff: I should continue to feel better, and the crying jags should start to taper off. I've been getting stuck in them only every other day or so. Dr. E says that I might have a some rough days, but that that's ok. Overall, the strings of "good" days should continue to get longer and longer.

Rituals: The increased dosage of the meds should eventually, in conjunction with my work with my counselor, help the rituals reduce in number and duration. I've had several little victories this week: I went back to work, I cooked dinner for myself, and pushed my rituals back to 5:25.

For the future: I'm going to see how I adjust to the new medication and check back in with Dr. E in four weeks.

Right now Mom's still staying with me, and she might be here for the next two weeks. I'm really grateful that she's been able to stay, even though I feel bad for keeping her here so long.

Mostly, right now I'm feeling really bummed because of something I talked about with Dr. E. Up until now, I'd been living with the assumption that my OCD was mild. Because of recent events, though, I've had to talk with Dr. E about the extent of my anxiety and she seems to think that the condition wasn't mild at all. According to her, I was, sort of just managing, and working my life around my OCD. Today in her office, I was asking (as I often do now),

"How did this happen? My OCD used to be so mild."

And she responded, "Was it really mild?"

Even a few hours a day spent performing rituals adds up. That's a lot of time. I guess I've been enjoying feeling like mine was a marginal, super-mild case of OCD. I felt like I didn't really have to think about it that much. I'm trying to come to terms with the fact that I actually have, for realz, OCD. I'm trying to stay positive about this - because my doctors know the full extent of my condition, and I'm not trying to pretend like everything is fine, they can treat the disorder better. But it's hard to admit the way I've actually been living - it means owning up to the depth of the problem.

My "homework" has been going well so far. I commonly feel two conflicting things now that the medication is starting to kick in: 1) Realization that the things I worry about are irrational, but 2) A simultaneous fear and need to perform my rituals in order to make myself feel better.

Maybe it would help if I explained my rituals a little bit. I remember reading about OCD in Alison Bechdel's graphic novel Fun Home. The protagonist, Alison, begins experiencing childhood OCD symptoms around age 10. Though each case of OCD is different, one of the compulsions she experiences reminded me of my own case:

If my day went well, I tried to duplicate as many of its conditions as possible. And if it didn't I made small adjustments to my regimen. Life had become a laborious round of chores. At the end of the day, if I undressed in the wrong order, I had to put my clothes back on and start again.

This is very similar to my experience with OCD. Repeating trusted behaviors is a variety of OCD (some others include checking, counting, or washing) and it's how my condition manifests. As much as I love Bechdel's novel, it's a little frustrating for me, as an OCD sufferer, to watch her recover all by herself. She describes her OCD as a "spell" - just a brief period of her life where she's OC (of course, this really isn't accurate, and a close reader of the novel can see OC symptoms well into her adulthood). I guess what I do want is for there to be more awareness in the general public about how debilitating OCD can be, and how necessary it is for patients to find treatment with trained doctors.

I guess I'm trying to wrestle with the fact that OCD is generally a chronic condition - it should persist my entire life. My doctors say that my recently worsened symptoms are probably a product of life stress, but even given my eventual recovery there's still going to loom the threat of relapse for, well, ever. Blerg.

This is a blog about my recovery from OCD. I thought it might help for me to start of with some basic details about my condition, and how it has changed in the last month.

2009 - 2012

I was diagnosed with OCD in the spring of 2009. At that point the condition was very mild, and my rituals (physical things I do to reduce my anxiety) were not very intrusive in my life. I was put on a low dose of an SSRI (Lexapro) to manage the condition, and began work on Cognitive Behavioral Therapy (CBT). CBT is a type of therapy where patients gradually exposes themselves to anxiety-provoking scenarios. I was successful with the CBT and the medication. Though I had a few ups and downs, overall, I was improving steadily with my OCD recovery.

2012 - 

According to my doctors, OCD naturally waxes and wanes. This past January I had a series of panic attacks and experienced a sharp increase in my OCD symptoms. Basically, my anxiety and rituals both increased a lot. In order to manage my anxiety in the short term, I've been put on a heavier, temporary anti-anxiety medication (Ativan). My doctor wanted to see if my anxiety would stabilize and return to normal levels on its own. We waited for two weeks, and my anxiety levels had not improved. Therefore, my doctor decided I needed to be on a different medication, and on a much higher dose. So, about a week ago, I switched medications, and increased the amount I was taking. 

Details about my OCD

Rituals: OCD is a condition where an individual experiences distressing thoughts (obsessions) and tries to use rituals or physical acts (compulsions) in order to mitigate their anxiety. Right now, my rituals take up most of my evenings. I'm working on minimizing, little by little, the rituals that I perform. 

Medication: Right now I'm on two medications, a temporary anti-anxiety medication (that I mentioned above) and a long-term SSRI (Sertraline). The SSRI will take some time to kick in, so right now I'm waiting to start feeling the full effects of the medication. I have a meeting with my doctor next week to talk about reducing the temporary medication, and increasing my SSRI dosage. 

Complications: Adjusting to the new medication is a little tricky, and my body has been doing some wonky things during the transition period. I've been experiencing on-and-off nausea, intermittent crying jags, and some nocturnal myoclonic jerking. According to the doctor, these side-effects should wear off as I adjust to the medication. 

Prognosis: My counselor (psychologist), who specializes in anxiety-related disorders, has been having me do little pieces of "homework" every day. Basically, I try to do one thing each day that makes me anxious, such as breaking a small piece of a ritual. My doctor (psychiatrist) says that my ability to do this homework is a very good sign - most people going through medicine transitions aren't even able to do that.  So, it's very positive for my recovery that I'm able to tolerate the anxiety of working against my OCD, if only in small pieces.