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OCD Awareness Week 2016

OCD Week 2016

It’s #OCDWEEK! Help raise awareness and understanding about obsessive compulsive disorder (OCD) and related disorders.

Welcome to #OCDWEEK 2016, a week organized by IOCDF to help raise awareness about OCD and related conditions!

If you visit IOCDF’s website, you’ll find information about local and online programs and events designed to help increase the general public’s understanding of OCD.

When I started this blog a few years ago, the internet was awash in misinformation about the nature of OCD. OCD was (more often than not) described in oversimplified terms, and the popular media largely mischaracterized OCD as a disorder defined primarily on the basis of excessive washing or checking behaviors. If you didn’t fit this mold, it was implied that you didn’t have OCD.

I was hoping that, through my writing, I might be able to address some of these misconceptions and bring awareness to some aspects of OCD and anxiety treatment that were often overlooked or poorly understood. For each person with contamination OCD or checking OCD, there was another person with Pure-O OCD wondering, “What’s wrong with me? Am I the only one who has these thoughts?”

On the surface, these various manifestations of the disorder can seem quite different, but truly, there are unifying concepts and processes that unite these disparate forms of the disorder and transcend obsessional content.

One of the marvelous things about attending an OCD support group is that you can learn so much about your own OCD by simply listening to how other people talk about theirs. Even with radically different symptoms, many people with OCD suffer the same way. They get trapped in the same types of reassurance-seeking behaviors and mental rituals. They fall into similar patterns of avoidance.

When you hear somebody else talk about their OCD — especially if it’s a different type of OCD — it can help you see your own OCD with fresh eyes, learn to take your own fears less personally, and ultimately relate to your own OCD in a different way. That’s one of the reasons why I so strongly advocate OCD support groups.

Although we have to continue to educate the “I’m so OCD” people of the world, we’ve come a long way.

There now exists a veritable army of OCD bloggers and OCDvocates, who have begun to candidly share their experiences with the disorder. They have written about what it’s like to live with the disorder, as well as their experiences in facing it through exposure and response prevention (ERP) and ACT. Their stories show that although treatment can be hard, it works.

In my role as a psychologist in Palm Beach Gardens, Florida, I am fortunate to be in a position to help people with OCD learn the tools and strategies they need to face their OCD head-on. It’s a glorious, often terrifying process, and I’m honored to serve as a guide along these journeys.

But I do find that I miss blogging. Because of that, I’ve decided to restructure my time just a bit, so that I can be more active in blogging again.

As I start to blog again, there are some topics that I know I’d like to discuss, but I’m also wondering what topics are most relevant for you. Where do you struggle most with your own treatment? What aspects of OCD most baffle you? Are there certain types of obsessive thoughts that have been inadequately addressed here or on other blogs? If so, let me know, and I can put some of these topics on my to-do list.

(FYI, the first few times you post a comment, it won’t be visible immediately, as it needs to be manually approved before it will appear on this site. In the past, due to some technological glitches, comments were being blocked from the site. I think I fixed the problem, so if you feel like joining in the conversation, please do–but also let me know if you happen to encounter any issues along the way.)

Thanks for visiting the blog and for being a part of the larger OCD community. Together, we can do great things.

OCD Awareness Week 2016 was originally published on Steven J. Seay, Ph.D.

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  1. Hello,

    My name is Drew and my biggest issue is with OCD guilty. I feel guilty about not only thoughts, but most of the time real life events. Are there certain strategies to use when the obsessions/anxiety relate to actual real life occurrences?

    • Guilt is often a problem with certain types of OCD, especially OCD characterized by unwanted thoughts. Many people feel guilty for having these thoughts, even though these thoughts happen on their own, outside of the person’s voluntary control. RE: guilt over real life occurrences, can you share an example so that I can get more context about what you mean?

      • Sorry for the delayed response, Dr. Seay. For example, looking at past sexual encounters and wondering if one crossed the line, obsessing over if you think you might’ve done something unethical at work, etc. Basically, things that some people may be able to recognize as something they shouldn’t have done, but are able to move on and learn from it.

        • It sounds like you might still be doing mental rituals around these events. It’s important to separate out the obsession (the pure intrusive thought) from your own reaction to it. These reactions (attempts to understand it, get clarity, not think about it, convince yourself you’re not a bad person, reassuring yourself or getting reassurance from others, researching how common the behavior is to try to normalize it) are the mental rituals. Performing even a single mental ritual strengthens and reinforces the OCD that attaches to these types of events. Typically, ERP for OCD for these obsessions involves imaginal exposure/scripting about these real events, as well as intentionally invoking these thoughts more often through signs/reminders/object triggers, etc. Just as with any type of OCD, response prevention in conjunction with the ERP is key. If you expose through scripting but don’t have good response prevention, you’re likely to make your OCD worse. Hope this helps!

  2. Re: suggestions for topics for posts…One topic I think there’s inadequate information on (over the web) is derealization/depersonalization/unreal feelings symptoms in relation to ocd. I’ve seen this described as a symptom of sensorimotor ocd in several places (including here on the pure-o symptoms post) but the reference is always very brief. There doesn’t seem to be information about how depersonalization/derealization feelings in relation to ocd differ from the “unreal” feelings in depersonalization/derealization disorder – i.e. how do they differ in frequency, intensity, character, etc. So much of what I’ve read about the symptomatology of derealization/depersonalization disorder seems relatable to things I experience during what I would call “ocd episodes” – when the obssessive thoughts are the worst/fastest/most intense/least brush-off-able. But I also see differences between what I experience and the symptoms of depersonalization/derealization disorder – for example, rather than describing everything as feeling “not real” I would describe it more as feeling like everything is “hyper-real” – like woah, I’m noticing everything really intensely, and not having normal emotional responses to stuff (like people talking to me), and the past and the present seem not as real as they usually do (e.g., my memories kind of feel like dreams). (I feel like I sound possibly psychotic writing that, so let me be clear that even when I’m feeling those things they strike me as ridiculous – just somehow scary anyway, because, like, what if reality’s somehow not actually even real? What if I never feel emotions again and then I decide to hurt someone? What if this feeling never goes away? haha, ocd thoughts. 🙂

    I’m also wondering if a general feeling of never being “in-the-moment” is more of an ocd thought, or would that also be considered a symptom of derealization, or both? If it’s a symptom of derealization disorder I’m less clear on how one would go about “exposing” to that.

    I’m really trying not to overthink any of this. However, the information out there is kind of non-existent and I feel like a description of ocd-related derealization feelings might make clearer to those who have them how they work in relation to ocd and make it easier to see how to do exposure to them or whatever…just a suggestion.

    • Thank you for this suggestion! It’s a great topic, and I can certainly understand the confusion. Even in thinking about how I’d address it in a post, I’m realizing that the topic is a bit muddled.

      I tend to think about depersonalization/derealization symptoms emerging primarily in the context of your fight-or-flight system getting revved up. If your fight-or-flight system gets activated, it’s very common to have symptoms of this type. These symptoms would be similar in all the examples you’ve mentioned (presumably, the same neural circuitry would be activated) — but the interpretation of these symptoms and how the DP/DR symptoms might be enhanced by your particular anxiety disorder might differ.

      When people develop a fear of depersonalization/derealization symptoms, then these symptoms can become recurrent and persistent (just like in sensorimotor OCD). Worries like, “What if these symptoms never stop? What if I always feel like this?” further fuel anxiety and increase attention to these depersonalization/derealization symptoms, which then tends to increase the frequency and intensity of them.

      Diagnostically, when I see people who have depersonalization/derealization symptoms, I tend to conceptualize them more in the context of panic disorder or OCD, as there is significant overlap with these conditions. Treatment then tends to target ERP and mindfulness-based skills. It’s critical to address the specific thoughts and meanings that one associates with their depersonalization/derealization symptoms.

      RE: the hyper-reality issue, that’s also common. When fight-or-flight gets activated, your eyes dilate, and–for survival reasons–your mind becomes hyper-attuned to what’s around you.

      Of course, the “weirdness” of this experience then gives OCD lots of ammo to use against you. If you notice that your thoughts or experiences are unusual, OCD may try to incorporate that into whatever pre-existing obsessions you have (e.g., What if I’m going crazy?, What if I’m turning into something bad?).

      Anxiety takes people out-of-the-moment, so most individuals with anxiety disorders can benefit from mindfulness practice. Anxiety, as a whole, tends to lead individuals to preferentially tune into their thoughts rather than other aspects of their experience.

      • Hi,
        I noticed you haven’t been posting on your blog in quite a while, but wanted to see if I could resurrect this thread because I have some more questions about the issue of DP/DR in relation to OCD. Specifically, I’m wondering how one can distinguish between DP/DR symptoms that are obsession-based (e.g., they become persistent and re-occuring because a person becomes afraid of them and engages in compulsions like constantly checking whether they still feel unreal), and those that occur in the context of disorders such as major depression or borderline personality disorder, as I’ve read many things that say DP/DR symptoms can occur in both of these conditions as well. I’m wondering about this because although my long-standing OCD symptoms (harm, existential, and reading/writing related themes) have finally decreased pretty much to the point of being non-existent thanks to ERP (which is amazingly wonderful), I still have persistent/recurrent DP/DR symptoms, even though I have done ERP around them. I am starting to wonder if they might be due to something else rather than simply OCD. The DP/DR feelings don’t cause as much existential obsessing when they occur now because I can identify what they are instead of freaking out and ritualizing, but they are not gone as much as my other OCD symptoms and I don’t understand why.

        Furthermore, they don’t only occur as a result of anxiety — they seem to emerge whenever I’m feeling any intense emotion, such as anger or sadness. When I’m happy/calm, I sometimes start to feel depersonalized/derealized, but I’m able to dismiss it and stop paying attention to those feelings relatively quickly; however, whenever I become distressed about something in pretty much any way they emerge and are much harder to get rid of. I’ve never had an episode of being sad or depressed that lasted more than a few days so I don’t think that these DP/DR symptoms are due to depression, but I do have a lot of the other symptoms associate with BPD (e.g. unstable sense of self, intense moods/mood swings, ongoing feelings of boredom/emptiness, persistent internal frustration (although I’m not outwardly temperamental), difficulty trusting people, feeling often like I wish I were dead even though with my logical brain I don’t actually want that, and stress/distress-related DP/DR symptoms) and I am starting to wonder if that might be the cause of my DP/DR symptoms rather than strictly OCD. However, I know that OCD can be sneaky and I don’t want to misinterpret something that might actually still be due to OCD. I also don’t want to pathologize normal experiences if my mood swings are just due to like, being twenty or whatever., or are somehow related to my residual OCD-caused DP/DR symptoms. Seriously, I’m not trying to diagnose myself or over-pathologize normal experiences. I’m just really frustrated that these things are not going away and want to find a way to help myself overcome them, but they don’t fit the pattern of OCD, so I don’t know what to do. I thought the intense moods might just go away on their own eventually, as when I had severe-ish harm OCD I felt kind of emotionally numb all the time, and when my symptoms finally started to decrease I thought that maybe my consistently intense emotions were just due to finally not having so many OCD symptoms and therefore not being as numb. However, that hasn’t been the case. It’s still like I feel everything so intensely all the time, even happiness — or it’s like I feel everything and nothing all at the same time — which is exhausting, but I don’t know how to make it stop. I also have a lot of trouble making friends, and am starting to wonder if my unclear sense of self/intense moods are contributing to that.

        I’m really hesitant to try to discuss this with a doctor IRL as the ones I’ve seen previously have either not been familiar with how to treat OCD (one told me to replace my obsessive thoughts, and I was just like “nope, that’s a ritual waiting to happen, that is — you really shouldn’t be telling that to people with OCD), or have told me that my symptoms “didn’t seem that bad,” even though I felt spectacularly awful at the time and was just not expressing it well because I’m kind of alexithymic. But I’ve also never encountered any writing about a similar situation, so I feel kind of at a loss here as to what I can do to help myself… Have you ever encountered anyone with OCD who also reported these type of experiences in addition to typical OCD symptoms (and if you have, what did you tell them)? Do you have any advice off the top of your head as to whether this is probably all still OCD related or whether it might be due to something else? Or do you have any tips for self-help resources I could look into for the intense moods problem?

        Thanks again for the detailed information on your blog. It has been very helpful to me previously in figuring out my mental compulsions and, well, not doing them anymore and reducing my OCD symptoms. 🙂

  3. Do you have experience with many clients have HOCD, with the H standing for homosexuality?

  4. What medications have you found to be most helpful with OCD?

    • Although the SSRIs are considered the “gold standard” in OCD treatment, there is no single medication that is best for most individuals. Determining the right medication for you is often based on a process of trial and error. Just make sure that if you’re trying medications, you hit the proper target dose for OCD (this varies by medication) and hold it for the proper amount of time (usually 2-3 months). Here is a good cheat sheet for target doses:

      Many people try the right medications, but they have a poor treatment response because they are not following these guidelines. The errantly conclude that medication can’t help them. But this is because they are taking a lower dose than necessary or simply not giving the medication adequate time.

      Last thing: Don’t forget that for OCD specifically, research has shown that ERP is more effective than medication alone.

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