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    Kaden M (he/they)

    Accepting My LGBTQIA+ Identity Has Helped Me Manage My OCD

    I’ve been meaning to write this piece for a long time. Each time I sat down to type, I would immediately stop. Write about something else. Or nothing else. Nothing at all. Today is different. Today is the day I write this piece, and hopefully share it with someone who… needs it. In 2008, at the lovely age of 14, I found myself being plagued and bombarded with intrusive thoughts. Now, it didn’t happen overnight; in fact, I had been dealing with undiagnosed obsessive-compulsive disorder (OCD) likely all my life. What happened during my eighth grade year was that the content of the thoughts shifted from not just fears and worries about natural disasters and whether my family was safe; the content now included obsessive, intrusive thoughts with either sexual content, or me questioning my sexual orientation on an endless loop. I was trapped in a nightmare, or so it felt. I think the most nightmarish thing about it was the fact that no one knew… the fact that I felt so ashamed and self-loathing, that I chose to confide in nobody for several more years.I had compulsions that went alongside my obsessive thoughts. I knew they were irrational. This included knocking on wood in certain increments, googling my every question on the internet, repeating the same phrases over and over in my head, and squeezing my eyes shut until the thoughts went away (which rarely ever worked, as compulsions tend to worsen obsessive thinking and intrusive thoughts). Sometimes I punished my body by fixating on my weight, the number on the scale, something that would eventually develop into anorexia. I struggled with co-morbid body dysmorphia and hated so many things about my appearance, ranging from my eyebrows and hair to my chest and stomach. Now, while this sounds like your classic OCD story, there’s a little more to it I’d like to share. Mental illness (particularly OCD), I believe, thrives on resistance. The more one resists the thoughts, the stronger and louder they grow, yes? What I learned was at the root of my OCD was more than just fear and a dysregulated basal ganglia (the part of the brain associated with the disorder)— I also hated myself. My body. My essence. Who I was. This self-loathing… I hate to say it, but it lasted until quite recently, well over a decade from eighth grade. I struggled with intrusive thoughts about being gay or bisexual or questioning. I couldn’t stand the uncertainty, the unknown. I wanted to be straight so badly, the internalized homophobia roaring inside of me. Now I know the truth at 27 years old— that maybe the best way to fight my OCD is to avoid labeling it with specificity at all. Perhaps I am not necessarily “gay or straight” the way my OCD wants me to say, no. Rather, I am a human who questioned their sexuality for a long time, and today, I am finally OK with the fact that I am member of the LGBTQIA+ community. Some days I wonder which specific label fits best (bisexual? Pansexual? Asexual spectrum?) but I know that if there’s one way to piss off my OCD, it’s to say that I am just a person who loves other people and that I am “not straight”— for once in my life, this is finally an acceptable answer. I have done tons of OCD treatment (including exposure response prevention therapy, transcranial magnetic stimulation and medications) as well as seven years of work on self love, acceptance and trauma, to get here. My experience is not indicative of anyone else’s — a lot of people obsess about the sexuality that they “aren’t” (ie., someone who is straight obsessing that they are gay), but in my case, I think the answer was less black and white. I also question my gender identity at times too, but today I am realizing that perhaps for once my OCD is not driving the car, that some level of questioning and fluidity is healthy and normal. And that, that feels amazing. In summary, I am honored to be part of the LGBTQIA+ community as well as relatively in remission from my OCD. I am no longer tortured and plagued by obsessive thoughts and compulsions at a near constant rate. I am honored to be me, and hope that I can promote a powerful message to those who are struggling with OCD, their identity or a combination. It can get better.

    Community Voices

    Therapy is exhausing.

    I'm now in week three of actually doing exposures for my ERP therapy. The first couple weeks we focused on less serious obsessions about rust, but yesterday we dove into something much more bothersome: my violent intrusive images. The gross scary picture I had to look at has come into my mind a few times already, and I am doing my best to lean into the uncertainty, I really am. But I don't know if I have the strength to do it by myself without getting swallowed up by the fear and despair. Even when I haven't been thinking about it, I have just felt so exhausted all day today and yesterday. I'm randomly crying and I can't focus very well. I know that it has to suck before it helps, but I don't know how to tell if this is productive distress tolerance or unproductive wallowing in bad feelings. Anyone else who is doing or has done ERP, how do you tell if you're properly leaning into uncertainty and tolerating the associated pain, and when you've taken on an exposure that is too much at the moment and is just overwhelming you with pain? #OCD #ObsessiveCompulsiveDisorder #ERP #exposureresponseprevention #Therapy #IntrusiveThoughts #Dissociation

    It's OK to Give in to Anxiety and OCD Compulsions Sometimes

    Last night, I gave in to anxiety and did a compulsion. Well, sort of. I went over to my partner’s for dinner and was planning on spending the night, something I have done countless times before. At the same time, I couldn’t stop thinking about my cat, Jade, who gets very upset when I leave for more than a few hours. She weaves in and around my legs meowing any time she thinks I might be leaving, and when I get back she wants me to pet her constantly. Logically, she’s a cat. She has food, water and a litter box. She’s fine. But on the other hand, she is a very emotionally bonded, nervous cat, and I start to feel really bad when I leave her alone. Also, you can’t out-logic obsessive-compulsive disorder ( OCD ).   Rather than continuing to read and work on my homework at his place, I became wrapped up in the anxiety. I began feeling terrible for leaving her, and I had an urge to go back home immediately. I knew going home would be giving in to the anxiety and OCD. I also knew if I went home, it would make leaving her all the harder the next time. I have to be able to leave my house and have a life. I tried to question what would be working toward my values, but both my partner and my cat are part of my values. Plus, when in a thought spiral, it’s hard to think too straight about values. I’m all for doing exposure and response prevention (ERP), but at the same time, we sometimes don’t have the emotional capacity to resist. And that’s OK. In the end, I decided to go home — well, sort of. I decided to go home but delay the compulsion by half an hour. I looked at my phone and scheduled that I could leave at 10:30 p.m. I had to sit with the anxiety until then. This is a common technique in ERP. If you can’t resist doing the compulsion altogether, delay it. This is how I did my first exposure ever in treatment. I used to have a fear of anything touching my nose. OCD told me I would breathe in that smell instead of oxygen, and die. My first exposure was to touch something with a mild smell to my nose: a piece of chocolate. Then, the goal wasn’t to completely resist washing off my nose forever. The goal was to wait five minutes before doing the compulsion. The next day, the goal was 10 minutes. Then 30. Then an hour, until I could go without washing my nose. Exposures are not black or white, resist or compulse. In dialectical behavior therapy (DBT), we call this type of compromise “walking the middle path.” So, I laid down on his couch while he worked, and I rode the anxiety wave. Every once in a while, he came over to give me an encouraging squeeze. I mostly kept my eyes closed as I felt the fear, though I checked the time every few minutes. By the time it hit 10:30 p.m., I was noticeably calmer. I had let myself feel the anxiety, and a lot of it had come down. I would say my subjective units of distress (SUDS), a tool for measuring anxiety, went from a 7 out of 10 to a 3. I almost considered staying again. I decided though I had done enough work facing anxiety for that evening, and I went home. Sometimes, anxiety wins. Sometimes, I win. Sometimes we both win, like in this case where I did the compulsion and was able to delay it. It’s OK to have compassion for yourself if you do the compulsion. It doesn’t mean a relapse; sometimes it’s just a lapse, or a blip, even. I’m always doing my best. And I’ll try again next time. Morgan

    How Contamination OCD Treatment Will Change Because of COVID-19

    My therapist stands up, walks over to the bookshelf in his office, and picks up two red apples that are sitting on one of the shelves. The apples look out of place next to his personal library of psychology books, collection of fidget toys and various decorations. He grabs two plastic knives from the same shelf and hands me a knife. He hands me one of the apples. Silently, he then sits on the floor, cross-legged, and waits for me to join him. I am reluctant; I know what is coming. I finally take a seat on the floor, cross-legged as well. I can feel the carpet beneath my legs as I hold the apple in my left hand and the plastic knife in my right. My therapist begins to cut into his apple. He cuts it flawlessly into slices, an impressive feat since we are using plastic knives and just cutting the apples in our laps without the use of a table or other hard surface. A few seconds later (though these seconds feel like days), I begin to slice my apple as well. I am not as talented at this freestyle cutting as he is. My slices are jagged and uneven. My therapist then places an apple slice on the floor and rolls it around. He makes sure each side of the apple slice touches the carpet multiple times as he rolls it over and over. I am cringing on the inside. But I know what I must do next. I slowly place my apple slice on the floor. I roll it over once, then twice, then a third time. I pick it up and look at it, disgusted. I can’t help but think of all the germs that are on that floor, embedded in the carpet, and now on my apple slice. My therapist picks up his apple slice and holds it near his mouth. I know he is waiting for me to do the same. In another short period of seconds that felt like days, I begin to raise my apple slice to my mouth as well. I stare at it, examining it as if I could physically see all the germs that now tarnish it. Sometimes, I expect that I actually will see the germs; but, of course, I never do. My therapist and I are there, stuck in what can only be described as an excruciating time vortex, preparing to eat apple slices off the floor. We stare at each other for a few seconds. He can sense my hesitation, my disgust, my anxiety . Alternatively, I can sense his support, encouragement and faith in me. We share these feelings without ever saying a word. I look down at my apple slice and then raise my gaze again to meet my therapist’s eyes. He waits for me, patiently. With our eyes still locked, I move my apple slice closer to my lips. He mirrors me, doing the same. And then we both take a bite. Exposure and response prevention therapy, or ERP, has long been considered the gold-standard treatment for obsessive-compulsive disorder (OCD) . ERP is in the family of cognitive behavioral therapy, or CBT. ERP often looks a lot like what I just described above; a trained therapist encourages their clients to face their fears head-on and then refrain from engaging in any sort of compulsive or compensatory acts. This particular “exposure” I described is based on my irrational and debilitating fear of germs, contamination, and illness. Over the course of many months, my therapist and I worked through a series of exposures in which I was intentionally confronted with a feared situation (germs) and encouraged to face these fears head-on (as I did when I ate the apple slice off the floor). Over time, ERP retrains the mind, and the feared stimulus becomes less and less threatening. The idea is that ERP serves as a bit of an “overcorrection” — in other words, eating apple slices off the floor in my therapist’s office for a couple of months ultimately allowed me to be able to eat out at restaurants without having a full-blown anxiety attack if I didn’t have my hand sanitizer with me. To paint an even more graphic picture for you, eating apple slices off the floor was not the most harrowing exposure I did to try to combat my fear of germs. Over a series of months, my therapist and I rubbed apple slices on public restroom sinks, doorknobs, elevator buttons and the backs of toilet tanks. Each time, I shook my head, said I could not do this, and stared at the apple slice waiting for the germs to appear. I thought if the germs appeared, or if I felt them in my hand (which I sometimes believed I did), I could say, “Look! I was right!” But the germs never appeared. My therapist was always patient, yet always unwavering. He never forced me to do anything, but encouraged me nonetheless. And, eventually, I (almost) always ate the apple slice. As you may have surmised by now, these events took place months ago. I have not seen my therapist in-person for quite some time now, and I do not know when we will physically meet again. Treatment of OCD has entered uncharted territory due to the threat of the coronavirus (COVD-19); it is no longer expected, advisable or safe for clinicians to conduct ERP in the way I described above. The “illogical” fears of many people living with OCD have suddenly become logical; people without OCD are engaging in cleaning and sanitizing behaviors that go well beyond the “normal standard” prior to the pandemic. For those of us with OCD — the fears we have spent months (and years) trying to untangle and strip of power have suddenly become quite real, with no foreseeable end in sight. I have the unique experience of being both a person with OCD and a therapist myself. I wonder how clinicians like myself (and my own therapist) will have to adapt and change the way we treat OCD going forward. The “gold-standard treatment” is not so gold anymore. The way we treat this disorder will have to be reflective of the times we are living in. Understandably, not much research has been done yet with regard to OCD treatment in the midst of a global pandemic. But some researchers, clinicians and other professionals have begun to devise a new and improved discourse for treatment of this disorder, given the circumstances. According to Fineberg et al. (2020), clinicians should give consideration to the use of medication for the treatment of OCD during this time. Specifically, “based on the risks associated with exposure and response prevention (ERP) in the pandemic … pharmacotherapy should be the first option for adults and children with OCD with contamination, washing or cleaning symptoms during the COVID-19 pandemic.” ERP as it has been done traditionally (as I described above) is no longer safe for either the client or the therapist. Therefore, medication (when prescribed by a doctor and taken with compliance) might be a helpful option for clients with OCD to consider and discuss with their treatment team. In particular, the use of selective serotonin reuptake inhibitors (SSRIs) has evidence of success in alleviating the symptoms of this disorder. Additionally, Fineberg et al. (2020) offer suggestions from a cognitive-behavioral perspective regarding how to adjust one’s ERP treatment plan during this time. Fineberg et al. (2020) recognize that it may “be difficult to disentangle OCD -related cleaning and checking compulsions from rational COVID-19 -related safety behaviors.” Therefore, the authors “recommend significantly tailoring CBT to take into account the CDC guidance.” Clients with OCD should no longer be expected to stop washing their hands completely, even if this was part of their exposure plan prior to the pandemic. Instead, Fineberg et al. (2020) suggest, the therapist should focus on supporting their clients and “trying to prevent them from deteriorating.” The authors suggest using activity scheduling and behavioral activation with clients to combat the unfortunate reality that “obsessions often expand to fill a vacuum of time.” With too much time on their hands and fewer in-person exposure opportunities (as well as the looming threat of a global pandemic), clients with OCD can be more prone to increased obsessional thoughts and compulsive acts. Treatment providers who see clients diagnosed with OCD are currently facing a unique and unprecedented predicament. My therapist often helped me realize that my fears around germs were irrational, or at least not as bad as the catastrophic scenario my brain had concocted. Now, however, he has his own fears around contamination and illness related to the pandemic. He has to take care of himself and his loved ones. It would be unsafe and inadvisable for us to continue engaging in ERP the way we had been doing it for many months. The way we treat OCD has to change; there is simply no way around it. Treatment protocols will have to be adjusted for the foreseeable future, and possibly forever. I am curious to see how this pandemic and its aftermath impacts both my treatment and that of my clients. We have no choice but to use the information at our disposal from both OCD experts and public health officials to make the most educated decisions moving forward. Only time will tell how COVID-19 influences OCD symptoms, diagnosis, and treatment in the long term. But I believe we can say with certainty at this point that I will not be eating apples off the floor of my therapist’s office again for quite some time. Struggling with anxiety or OCD due to COVID-19? Check out the following articles from our community: How Can You Tell the Difference Between Anxiety and COVID-19 Symptoms? 6 Tips If You’re Anxious About Being Unable to Go to Therapy Because of COVID-19 What to Do If the Coronavirus Health Guidelines Are Triggering Your Anxiety or OCD Mental Health Resources to Help You Cope During COVID-19 An Activist-Therapist’s 15 Affirmations for Hope Amidst COVID-19

    Community Voices

    New here, just started ERP - overwhelmed


    #ObsessiveCompulsiveDisorder
    I've had OCD since early childhood, with emetophobia and agoraphobia as a result, and just started intensive ERP therapy. My anxiety during exposures has come out as more depressive - urges to self harm or suicidal ideation instead of panic. I wasn't expecting it, and my therapist is aware and supportive, but it's just caught me off guard. Has anyone else experienced this when exposed? Any ways to get through it? #ERP #MixedEpisodes #OCD #Emetophobia #Selfharm #SuicidalIdeation

    5 people are talking about this
    Community Voices

    Starting E&RP

    I’m starting exposure and response prevention therapy next week. I’m both excited and nervous. Have any of you gone through ERP therapy? Did it work for you? #Anxiety #ObsessiveCompulsiveDisorder #ERP #Therapy

    2 people are talking about this
    Community Voices

    response prevention

    <p>response prevention</p>
    Community Voices

    What are your thoughts on accommodations in school for #ObsessiveCompulsiveDisorder ?

    Sometimes accommodations help, and sometimes they unintentionally can make OCD symptoms worse. I had an accommodation by which I could type instead of handwriting my homework because handwriting with my perfectionistic rewriting compulsions was so painful. The accommodation did let me do homework faster, but I wasn’t working on resisting my compulsions, just avoiding them. Eventually I did overcome this aspect of OCD through #ERP for which I am grateful. I think accommodations to help students with are helpful, but treatment is even more. What do you think?

    Community Voices

    #livingwithocd is like being a puppet, and OCD is the puppeteer. You have to do everything it says unless “something bad will happen.” Sometimes you feel like a zombie because of the endless compulsions and intrusive thoughts. Soon it’s hard to remember where OCD ends and you begin. With#ERP and #CBT , you can slowly learn the tricks behind the puppeteer and break away from its strings.

    2 people are talking about this