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. 

Optimism

I've recently discovered that securing treating for OCD is almost as challenging as battling the disorder. In the last few days I've made some progress with my rituals, but have mostly been trying to make sure all the odds and ends with my new doctors are sorted out.

Insurance. The new treatment center I'm working with is "out of network" for my health insurance. This means that Blue Cross/Blue Shield will only cover part of my medical expenses. However, the people at AustinOCD suggested I try to get an exception granted to me since they're the only real specialists in town who treat OCD. I made lots of phone calls to BC/BS, and after speaking to many corporate bureaucrats, I've created an official request for them to cover my treatment costs. The people I spoke with said that there was a good chance for me to get coverage, so I'm optimistic.

Medication. I'm in the process of making my last medication adjustment. Two weeks ago I reduced my Ativan dosage by half, and right now I'm stepping off the medication entirely. Because of the difficulty of all my previous medication adjustments, I was very (very) nervous about this final one. I've also been informed that the withdrawal from this type of chemical, called a benzodiazepine, can be particularly hard.  I really don't want to lose any of the progress I've made, so I was bracing for impact with this med cessation. My anxiety has definitely been higher than usual, but I'm staying strong to get through this last withdrawal period.

Here are some things I'm looking forward to:

• My body chemistry being in balance again so I can start working on CBT/ERP with full force
• Getting to work again on my dissertation
• Watching Dancing with the Stars tonight with my mom (she's a big fan). 
• Spring 

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).

Yesterday was kind of hard for me. I woke up with higher anxiety levels, and doing my homework was really hard. I did, however, take the bus to school and stay out of the house until 4:23 (little victories!). I had initially planned to take the bus back from school as well, but I got too scared. I wasn't sure how long the ride would take, and staying out too late made me really nervous. But, I did make progress.

After I got home from work I got really scared and cried. Dr. E said that I might experience a "mid-week crash." So, I guess that's what happened. I'm trying to keep everything in perspective and remind myself that I'm still doing better than when I started on the medication. Like, that first week I went over to Tekla's house and was really nervous. I could barely stay an entire hour.

Also, I guess I should say that I need all the love and support that friends and loved ones can offer right now. Things are very hard still, and every little piece of homework feels like a battle. I would love any encouragement that anyone could offer!

Yesterday I successfully did my homework of staying out of the house until 4:15! I was also out of the house for 6 hours total. Yay! Today, however, I woke up feeling really anxious. Dr. E said this might happen. She told me that I might have a "mid-week crash," but that ups and downs in my anxiety are to be expected at this point. So, I guess that is what is happening today? My body is still adapting to the new meds and coming out of its funk.

Mostly, I'm regretting looking for information about SSRIs on the internet. I linked to the Wikipedia entry on SSRIs in one of my last posts, and the entry was all about how it's widely doubted if they even work! I did not need to hear that, internet. I'm trying to chalk it up the the internet being a weird, scary place that's not always full of the most accurate information.

Doctor #2

This morning I met with my counselor. She's a psychologist, who, for the purposes of this blog, I'll call Dr. D. Dr. D is another super-smart lady, and she runs marathons, and always wears these cute shoes that look like they came from J. Crew.

Anyway, I was talking to Dr. D today about my general malaise and how I've been feeling like my OCD really sucks and it's chronic and I'll have to deal with it for the rest of my life. Please excuse my use of a run-on sentence, but a long, smushed up list of bad feelings accurately describes my recent emotional state. She was very helpful in pointing out to me that OCD doesn't have to be chronic like other mental health issues such as Schizophrenia or Bipolar disorder. According to her, OCD can be treated and can go into remission. She reminded me that I am very high-functioning, and she hopes that my symptoms will, after I work at it, go into remission.

My homework for this week builds on the things I've been doing. 
Today: I'll be out of the house for 6 hours, stay out until 4:15.
Tomorrow: Take the bus to and from school, stay out of the house until 4:30 - 4:45.
Thursday I'll start doing the dishes again (Mom has been doing that).
Other homework includes hanging out with a friend at least once this week, and eating a yummy dessert after dinner (and allowing myself to enjoy it).

I also noticed that the leg jerking was kind of bad last night, but I'm assuming that was just because I increased my dosage of the Sertraline.

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.

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.