An excerpt from OCD: A Guide for the Newly Diagnosed (2012):
Introduction
Jason has always been “meticulous” and, as he often remarked, liked to get his day off “on the right foot.” When Jason awakened, he would get out of bed on the right side only. Most mornings, he did this only once, but over the last few months, he’d started to feel very uncomfortable the first time and would have to get back in bed and get out again several times until he felt that he had “gotten it right.” He would then brush his teeth, carefully brushing each tooth front, back, and top repeatedly, beginning with the bottom-most rear tooth and moving clockwise. It was starting to take Jason well over thirty minutes to brush his teeth, and many times when he finished, his gums would be sore and bleeding. Then Jason would begin his showering routine, which he did in a meticulous manner too.
Jason wasn’t afraid anything bad would happen if he didn’t do things in a certain way; he just felt uncomfortable unless he did them in a specific way, and this discomfort didn’t go away until he got it right. Jason tried to limit these types of routines, but it seemed like they were spreading. Now he had to make his bed a certain way and close the doors and cabinets just the right way or he felt extremely uncomfortable and he would repeatedly make and unmake the bed and close and open the doors until he felt right. The basement door was particularly frustrating for him because it was a hollow door and he did not like the way it sounded when he closed it—it just didn’t sound right. Jason’s morning routine now took him over two hours to complete, and he was getting up earlier and earlier to make more time for it. Even so, he was getting to work an hour late, sometimes more, several times a week. His supervisor spoke to him about his tardiness, which didn’t help. Now he was anxious about losing his job and, along with getting less sleep, he was having even more difficulty speeding things along in the morning. He had started to take off days from work to catch up on his sleep or if it looked like he’d be several hours late.
When Jason noticed he was having trouble getting to bed at a reasonable time because he now needed to do things just right in order to get to sleep, he panicked. He thought he was going crazy—really losing it. His family and friends told him that perhaps the stress at work was making him so anxious, but when he thought about it, he realized that it was his routines that were adding stress to his job, not the job itself. Still, Jason didn’t know what was happening to him until he went to the Employee Assistance Program representative at work who told him that he might have OCD.
Shame, Fear, and Denial
Often, people with obsessive-compulsive disorder (OCD) know that something is amiss but are reluctant to seek help. This is unfortunate because we know that most people who seek and participate fully in treatment improve, sometimes greatly.
There are a number of reasons you may be reluctant to seek treatment for your OCD. You may feel ashamed by what you think of as the bizarre nature of your obsessive thoughts. You may believe that having the thoughts you do means you are an immoral or terrible person and so you feel ashamed and reluctant to tell people about these thoughts. You may have tried many times to stop your washing or checking rituals because you know that the washing or checking is excessive, but you feel powerless to stop. It’s not easy to tell someone that you are aware your behavior doesn’t make sense but that you have to do it anyway.
In addition to the shame you feel, you may be afraid to seek help for your OCD, fearing that you will lose your job, marriage, or children if people find out you have OCD. A former client told me that she suffered for years with obsessions that she might molest her children. She did not tell her parents or even her husband about these thoughts because she feared that they would tell the authorities and they would take away her children. You may have read something about the treatment of your OCD, particularly about exposure, and now you worry that this will only make your symptoms worse or truly create the catastrophe that you are working so hard to prevent. Fear, like shame, may cause you to attempt to suppress your obsessions (try to keep them out of your mind), which only makes things worse. As you try not to think about the disgusting or terrifying thoughts or images that come into your mind, you realize that they are coming with greater frequency and intensity. This, in turn, makes you believe that you might be going crazy or that what you fear may indeed be true.
Given the shame and fear that you may feel about your OCD symptoms, it is natural that you might deny or minimize the severity of your symptoms. Even though you are fully aware that your thoughts are irrational and your compulsions are excessive, you might find it difficult to admit that you are having a problem.
The Way Out
The way out of the shame, fear, and denial begins with awareness and education about your OCD. It is essential that the person with OCD (and his or her family) increase his or her understanding of the condition and become knowledgeable about available treatment options and resources. The way out also depends on finding the right treatment and the right treatment provider. The objective of this book is to show the way out, through understanding, support, and education.
How to Use This Book
This book is a primer for people recently diagnosed with obsessive-compulsive disorder who want basic information about the condition and its treatment. Throughout the book, I will use the terms “obsessive-compulsive disorder,” “OCD,” and “condition” interchangeably to describe the disorder. Although the book does not extensively cite research findings, I have based the book on the extensive research available, which goes back to the investigators who first described the condition well over fifty years ago. In addition, I have tried to stick to research about the condition and its treatment that is widely accepted by most expert investigators rather than presenting information that is either speculative or incomplete.
I have organized the book along the path most people take when first diagnosed with the condition:
Although I have written the book mainly for people with OCD, I hope that family members, friends, psychotherapists, physicians, employers, and coworkers find the book helpful too. At times, family members and friends are more aware that something is amiss than the sufferer. Many people with OCD manage the condition through its ups and downs for years and seek treatment only when symptoms create more distress and disruption in their lives than they can continue to tolerate. I hope this book reassures those of you with OCD that there is help and that it provides a useful resource for you, your family members, and friends, for many years to come.
Introduction
Jason has always been “meticulous” and, as he often remarked, liked to get his day off “on the right foot.” When Jason awakened, he would get out of bed on the right side only. Most mornings, he did this only once, but over the last few months, he’d started to feel very uncomfortable the first time and would have to get back in bed and get out again several times until he felt that he had “gotten it right.” He would then brush his teeth, carefully brushing each tooth front, back, and top repeatedly, beginning with the bottom-most rear tooth and moving clockwise. It was starting to take Jason well over thirty minutes to brush his teeth, and many times when he finished, his gums would be sore and bleeding. Then Jason would begin his showering routine, which he did in a meticulous manner too.
Jason wasn’t afraid anything bad would happen if he didn’t do things in a certain way; he just felt uncomfortable unless he did them in a specific way, and this discomfort didn’t go away until he got it right. Jason tried to limit these types of routines, but it seemed like they were spreading. Now he had to make his bed a certain way and close the doors and cabinets just the right way or he felt extremely uncomfortable and he would repeatedly make and unmake the bed and close and open the doors until he felt right. The basement door was particularly frustrating for him because it was a hollow door and he did not like the way it sounded when he closed it—it just didn’t sound right. Jason’s morning routine now took him over two hours to complete, and he was getting up earlier and earlier to make more time for it. Even so, he was getting to work an hour late, sometimes more, several times a week. His supervisor spoke to him about his tardiness, which didn’t help. Now he was anxious about losing his job and, along with getting less sleep, he was having even more difficulty speeding things along in the morning. He had started to take off days from work to catch up on his sleep or if it looked like he’d be several hours late.
When Jason noticed he was having trouble getting to bed at a reasonable time because he now needed to do things just right in order to get to sleep, he panicked. He thought he was going crazy—really losing it. His family and friends told him that perhaps the stress at work was making him so anxious, but when he thought about it, he realized that it was his routines that were adding stress to his job, not the job itself. Still, Jason didn’t know what was happening to him until he went to the Employee Assistance Program representative at work who told him that he might have OCD.
Shame, Fear, and Denial
Often, people with obsessive-compulsive disorder (OCD) know that something is amiss but are reluctant to seek help. This is unfortunate because we know that most people who seek and participate fully in treatment improve, sometimes greatly.
There are a number of reasons you may be reluctant to seek treatment for your OCD. You may feel ashamed by what you think of as the bizarre nature of your obsessive thoughts. You may believe that having the thoughts you do means you are an immoral or terrible person and so you feel ashamed and reluctant to tell people about these thoughts. You may have tried many times to stop your washing or checking rituals because you know that the washing or checking is excessive, but you feel powerless to stop. It’s not easy to tell someone that you are aware your behavior doesn’t make sense but that you have to do it anyway.
In addition to the shame you feel, you may be afraid to seek help for your OCD, fearing that you will lose your job, marriage, or children if people find out you have OCD. A former client told me that she suffered for years with obsessions that she might molest her children. She did not tell her parents or even her husband about these thoughts because she feared that they would tell the authorities and they would take away her children. You may have read something about the treatment of your OCD, particularly about exposure, and now you worry that this will only make your symptoms worse or truly create the catastrophe that you are working so hard to prevent. Fear, like shame, may cause you to attempt to suppress your obsessions (try to keep them out of your mind), which only makes things worse. As you try not to think about the disgusting or terrifying thoughts or images that come into your mind, you realize that they are coming with greater frequency and intensity. This, in turn, makes you believe that you might be going crazy or that what you fear may indeed be true.
Given the shame and fear that you may feel about your OCD symptoms, it is natural that you might deny or minimize the severity of your symptoms. Even though you are fully aware that your thoughts are irrational and your compulsions are excessive, you might find it difficult to admit that you are having a problem.
The Way Out
The way out of the shame, fear, and denial begins with awareness and education about your OCD. It is essential that the person with OCD (and his or her family) increase his or her understanding of the condition and become knowledgeable about available treatment options and resources. The way out also depends on finding the right treatment and the right treatment provider. The objective of this book is to show the way out, through understanding, support, and education.
How to Use This Book
This book is a primer for people recently diagnosed with obsessive-compulsive disorder who want basic information about the condition and its treatment. Throughout the book, I will use the terms “obsessive-compulsive disorder,” “OCD,” and “condition” interchangeably to describe the disorder. Although the book does not extensively cite research findings, I have based the book on the extensive research available, which goes back to the investigators who first described the condition well over fifty years ago. In addition, I have tried to stick to research about the condition and its treatment that is widely accepted by most expert investigators rather than presenting information that is either speculative or incomplete.
I have organized the book along the path most people take when first diagnosed with the condition:
- Chapter 1: What Is Obsessive-Compulsive Disorder? The first step is to search for accurate information about the condition and its treatment. This chapter presents basic information about OCD, including its prevalence, its onset, and current theories about what may cause it.
- Chapter 2: Get the Right Diagnosis. For those who have not yet received a formal diagnosis or have self-diagnosed OCD, this chapter describes the process of seeking and getting an accurate diagnosis, which is the starting point for an effective treatment. Not all mental health professionals are familiar with OCD and some may miss the diagnosis, particularly if symptoms are more subtle than the classic symptoms of washing and checking. This chapter guides you through the diagnostic process, explaining what a mental health professional needs to know to give you the right diagnosis and how to describe your symptoms accurately.
- Chapter 3: Find the Right Treatment. The next step in the process is to find the right treatment. This is not as easy a process as you might think and is in fact one of the most frustrating aspects for those newly diagnosed with the condition and their family members. This chapter describes the most effective treatments for the condition and presents other treatments, less well understood but used at times for more serious symptoms.
- Chapter 4: Put Together Your Treatment Team. Once you find the right treatment for your condition, this chapter walks you through the process of finding your treatment team. The team may consist of prescribers, psychotherapists experienced in the psychological treatment of OCD, support groups, or other team members who may be helpful for your particular situation. This chapter describes how (and where) to find a knowledgeable therapist to treat your OCD, how to get the most out of every treatment session, how to pay for treatment, and how to deal with other issues that can occur over the course of treatment.
- Chapter 5: Find the Right Support. This chapter describes how to seek appropriate support from the important people in your life and from additional sources of support, such as face-to-face and online support groups.
- Chapter 6: Develop a Recovery Attitude. This chapter describes perhaps the single most important feature needed to manage OCD now and for the long term—a recovery attitude. The chapter describes the essential features of a recovery attitude and explains why this is key during treatment and after treatment ends. A recovery attitude includes healthy habits such as getting enough exercise, proper nutrition, and sleep to enhance both your general health and your resilience when managing your OCD on a day-to-day basis.
- Chapter 7: Unhealthy Coping and Other Psychological Issues. People who struggle with OCD may at times turn to unhealthy ways to cope with their suffering, such as alcohol and drugs. This chapter describes what to watch out for and how to get help for problems with substance use. It also describes other psychological issues or conditions, such as depression, that can arise when someone has OCD.
- Chapter 8: Workplace or School Issues. This chapter describes what happens when OCD begins to affect performance in the workplace or in school. This chapter offers suggestions for what to do if this is happening and describes your legal rights in the workplace and the classroom.
- Resources and References. For those wanting more detailed information, I have added a list of references and other resources at the end of the book, including websites and organizations that may be of interest to those with the condition as well as to their friends, family members, and mental health professionals.
Although I have written the book mainly for people with OCD, I hope that family members, friends, psychotherapists, physicians, employers, and coworkers find the book helpful too. At times, family members and friends are more aware that something is amiss than the sufferer. Many people with OCD manage the condition through its ups and downs for years and seek treatment only when symptoms create more distress and disruption in their lives than they can continue to tolerate. I hope this book reassures those of you with OCD that there is help and that it provides a useful resource for you, your family members, and friends, for many years to come.
