Tag: OCD

A white bottle of white pills spilled out on a black background

Feeling Shame about Psychiatric Medication

Genevieve2 Comments

The first time I experienced shame related to mental illness, I was 11 years old and caught in the torturous intrusive thoughts and compulsive behaviors of OCD. Therapy did not go well because I found it nearly impossible to overcome my shame and embarrassment enough to participate. There were times when I was so appalled at myself for having intrusive thoughts that I genuinely feared my parents might stop loving me if they knew what I was struggling with.

The shame about mental illness started early, and the shame about taking psychiatric medication soon followed. Therapy was not going to work, so when I was 13, I agreed to start taking Zoloft. I remember leaving my psychiatrist’s office with my mom after that appointment and just sobbing in the middle of the parking lot. I felt so broken in such horrifying ways, and I thought that taking the medicine meant I was failing to fix myself.

Where My Pill Shame About Psych Meds Started

It felt like a very adult thing, taking medication. I’d carefully dole the pills out into their respective days in my weekly organizer. When I took them, I’d count them over and over and over – One, two. One, two. One, two. Sometimes, I would ask my mom, “Is this two?” and point to the pills in my palm. The root of that counting compulsion was the fear that I might accidentally take more than I was supposed to and overdose. OCD had such a hold on me that I doubted my ability to count to two.

Zoloft completely changed my life. Once I reached 200 mg, it was like my brain had been rebooted and all the bugs were gone. It was amazing. I took it for a few years and then came off it. Although I slip into old patterns sometimes, the OCD never returned in anywhere near full force.

Self-Criticism about Depression Medication in Adulthood

As an adult with treatment-resistant depression, I have mixed feelings about psychiatric medication. The Zoloft helped when I was a kid, but it was still something I considered to be shameful – something to be hidden. Whether that pill shame stems more from my own insecurities, my family’s attitudes, or societal messages, who’s to say? All I know is that I’ve never been able to shake that feeling, despite years of therapy and much contemplation on the irrationality of my beliefs.

I’m always hesitant to write about this. I want to emphasize that I know the way I think about psychiatric medication is unhealthy, and I don’t think anyone else should feel the way I do. It’s odd that being aware of that doesn’t seem to change my thoughts about myself. So, I guess this is a “don’t do what I do, but if you do, you’re not the only one” kind of a post.

A hand holding several pills of different sizes and colors in its palm.

Sometimes, I accept that taking psychiatric medication for my depression is the right choice for me. It keeps me safe-ish and mostly functioning, so I try to appreciate the benefits and set aside my gripes on the subject. When my depression worsens, though, all of that goes out the window. I start thinking that I’m lazy and selfish and a horrible burden on my loved ones. Much like when I was younger, I tend to view my psych meds as daily reminders of my inability to fix myself through force of will.

Psych meds help me attain the activation energy needed to use healthy coping skills, but I also know that making behavioral changes can improve depression on its own. In my brain, if I’m not “better” yet, I must be doing therapy wrong or not trying hard enough to implement new practices.

But, Do I Need Psychiatric Medication?

I’m so tied to ideas of independence and self-sufficiency that benefiting from my depression medication feels wrong. It almost feels like cheating. I tend to think that if I make progress while taking meds, I didn’t really earn it.

Whenever I try to change the medications I take and my depression gets worse, it seems like proof that the work I was doing to help myself wasn’t enough to even make an impact. If a change in my medication sends me tumbling back down the mountain, was I supporting myself at all with other strategies? It’s a discouraging thought that leaves me teetering between believing that I need to try harder and nothing I do will make a difference.

You would think that the solution to that would just be to stay on my meds, but my mind is a convoluted mess, so it’s not that simple.

Is the Improvement from Psychiatric Medication Real?

I try to remember that during the times when my depression has been much better, I don’t feel so strongly about how medication helped me get there. That suggests that I’m not seeing things clearly when I’m depressed.

Photo by Anna Shvets: https://www.pexels.com/photo/pills-fixed-as-question-mark-sign-3683053/

Then again, maybe I don’t care about it when I’m better because the medication is influencing me in such a way that I forget about the beliefs I held before. Maybe I’m seeing the truth about myself and the pointlessness of life more clearly when I’m depressed, and that perspective is covered up by my medication when I’m feeling better. I know that sounds wild, but sometimes I’m moderately convinced by this weird logic.

Self-Compassion and Treatment-Resistant Depression

I’ve spent years trying to learn how to be kind to myself and accept that my mental illness is not my fault. I know that I’ve made progress, but sometimes, it just falls apart. It’s like I’m climbing a flimsy ladder, and every once in a while, I slip and go crashing through the rungs below me. And then I’m in an undignified heap on the ground, berating myself for not accomplishing my goals and using medication when I shouldn’t need to.

I don’t give myself any space to accept that there’s something not right in my brain, and it’s okay if I can’t fix it by myself. I know this cognitively, and yet I can never seem to fully convince myself of its validity.

Do you relate to any of what I wrote in this post? Do you see your medication differently? I’d love to know.

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COVID-19 and Anxiety: Caution vs Compulsion

Genevieve3 Comments

Yesterday, my city declared a local disaster emergency. A growing number of presumptive cases of COVID-19 in my county have led officials to close all city facilities. This has given me pause when it comes to the complexities of COVID-19 and anxiety.

I was diagnosed with obsessive-compulsive disorder when I was about 11, and I dealt with many different obsessions over the years. Perhaps the longest-lasting obsession I had revolved around contamination and germs. For the last several years, I’ve been blessedly free of OCD, and when an old obsession pokes its head out, I’m fairly quick to oppose it by doing an exposure. Since the start of the media coverage of COVID-19 in Wuhan, I actively tried not to let it worry me too much. I could feel the pull of anxiety, coaxing me into watching the news coverage and letting it take over my life. Of course, I stayed informed but did my best to not obsess.

Now, my own city is seeing dramatic effects of the virus, both in increasing cases and in the social results of widespread, repetitive media coverage. Many of our city facilities were closed several days ago, and our city council has decided today to close them all. This afternoon, I finally made the trip to my pharmacy, located in a grocery store, to pick up my medications. The sight of so many empty shelves was unnerving. The only fresh vegetable remaining was lettuce. The bread aisle was sparsely populated with hamburger buns and a few loaves of whole wheat. A man asked the pharmacist where the thermometers were and was told there were none left.

I bought my items and went home, then washed my hands several times between unloading groceries, putting them away, and cleaning the counter they sat on. I’ve been cleaning my phone case, our door handles, and even my sunglasses after touching them while out. Am I simply being cautious, or have I crossed the line into compulsions?

For people with anxiety disorders, dealing with COVID-19 and anxiety during the pandemic puts them in a confusing position. People are being encouraged to be extra careful about handwashing and touching potentially dirty items. Events have been canceled and gatherings are recommended to be limited, making it easy to justify complete isolation due to anxiety. So when the behaviors that normally indicate a disorder are socially sanctioned, what do you do?

I can tell that going to the pharmacy triggered something, and where before I was simply careful, I’m now afraid of things in my own house because they came from outside, and I haven’t cleaned them. This alarms me because it’s exactly how I used to feel in the grips of contamination OCD. It’s overwhelming to suddenly feel like nothing around you is safe to touch.

This coronavirus could live on surfaces for two to three days, so maybe constant cleaning and disinfecting are completely warranted. I imagine many people are feeling this despite never experiencing feelings like it before. Nobody really knows how much is too much, and this is exactly why OCD is so tricky. In non-pandemic times, contamination-focused OCD is fed by a seed of doubt (indeed, every kind of OCD is fed by doubt). It can feel shameful because you know that your compulsions are irrational. Now, it’s unclear what rises to the level of irrationality. Maybe the compulsions I usually try to avoid are precisely what I should be doing.

There is no blueprint for handling COVID-19 and anxiety. I think it’s reasonable to increase your awareness of surfaces you might normally touch and to wash your hands more frequently. However, I know that for me, allowing myself to engage in my old compulsions is a slippery slope. It might be acceptable to do right now, but it will be harder to stop the longer I let it go on. It’s a balancing act, and I have to decide how much my anxiety is serving a purpose now versus how detrimental it is and could be in the future.

I’m certainly not going to tell anyone how to keep themselves safe. I am, however, going to tell myself to be cautious about being too cautious. As long as I can leave the compulsions behind again when life approaches normal, I’ll be okay.

Stay safe,

Genevieve

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An Encounter with Contamination OCD

Genevieve7 Comments

I haven’t been consumed by OCD in several years, something I’m immensely grateful for. That particular kind of mental torture is truly awful and not something I would wish on anyone. One of the subsets of OCD that I had was contamination OCD. My body and belongings had to be whatever my disorder deemed to be “clean,” or else some unnamed disaster would occur. There were often no actual illnesses I was afraid I might contract – I was just terrified of potential contamination by unknown germs/viruses/entities.

The Endless Compulsions

Beyond the fear, maybe the worst part of contamination OCD was how time-consuming it was. If something was “dirty” and it touched something “clean,” or if I touched the dirty item and then the clean item, they were both dirty. I spent a lot of time planning out sequences of actions that would combine touching dirty items because otherwise, I would spend half the time washing my hands raw so as to not contaminate anything else. My hands were always painful. I scrubbed them under hot water until I’d stripped them of any moisture barrier. Any movement cracked and split the skin open, which, ironically, made my bleeding hands perfect entry points for bacteria and viruses. But, OCD is not swayed by reason and rationality. It creates doubt that can’t be rooted out with reassuring facts.

Contamination OCD After Recovery

For the most part, I don’t deal with OCD anymore, contamination OCD or otherwise. My day-to-day life is not consumed by it like it was before, but every once in a while, I encounter something that stirs those obsessions up. My perfectionism around self-harm is one, and tapeworms appear to be another.

Unexpected OCD Triggers

I’m not squeamish, despite what you might think after learning of my past with contamination OCD. Again, OCD is not rational. Parasites are fascinating and don’t bother me from afar, but when I found a tapeworm segment in my dog’s stool, I felt the familiar stomach twisting of contamination OCD.

Once the initial shock passed, I found myself thinking about all of the things I would have to clean. First and foremost, the hand that held the poo bag. I must not touch anything between there and home, not even to put my hand in my pocket. The bed in her crate would need to be washed, and all of my sheets and blankets because she often snoozes on my bed. Should I wash her leash and harness? Perhaps I should stop petting her– would that be going too far? On second thought, that would be impossible. I’ll just wash my hands every time I touch her. So, like, 80 billion times per day.

OCD is Irrational

Keep in mind that the most common species of tapeworm is passed to humans only when you ingest a flea that carries the tapeworm eggs. Not likely. There is also a species of tapeworm that can be passed from dog to human through ingested feces on unwashed hands, but it’s not common in the U.S., and I’m a frequent hand-washer as it is. In other words, it’s very unlikely that I would get tapeworms from Stella.

I Fell into Old Patterns

That night, I lay in bed, Stella at my feet, and tried to control my rising panic. The vet was closed for the holidays, so I had left a message. Having no idea when they would return my call, I did what any smartphone-wielding person would do; I looked it up. Unfortunately, Google played the role of the reassuring-but-clueless friend who says something terrifying right at the very end of the conversation.

“Oh, it’s very uncommon for people to get them? OH, you might not show signs until years after ingestion?!”

Not gonna lie, my concern for Stella was overshadowed by my selfish, irrational fear for myself. The thought of something living inside me usually doesn’t bother me. After all, we are made up of more bacterial cells than human cells. Maybe it’s an evolutionary adaptation to be totally wigged out at the thought of parasites taking up room in your gut.

Facing Contamination OCD with Exposures

The good news is, I realized that I was obsessing about this right before I returned to the scariest thought of them all: “What if I already have tapeworms?” This is good news because it really kicked me into the best way to face OCD thoughts, which is to say, “Yeah, and?”

In the dark in more ways than one, with my tapeworm-host dog not three feet from me, I had to say, “Maybe I do have tapeworms. What am I gonna do about it right now?” Just sitting with the uncertainty brings you to the stunning realization that there is absolutely nothing productive about rumination. So, with a little more deliberate relaxation, my hypothetical tapeworms and I went to sleep. Well, maybe not the tapeworms. Do tapeworms sleep?

Living with Uncertainty

I still don’t know if I have tapeworms, and it’s honestly probably something that I’ll worry about off and on for a while. I do know that I’m much better at squashing obsessions than I used to be, maybe because I know it’s something I’m prone to and can catch it early on. Stella is on a deworming medicine and continues to behave like a dog. That is to say, eats anything and everything with gusto and drinks water out of the Christmas tree stand when nobody’s looking.

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Can You “Grow Out Of” Childhood OCD?

Genevieve1 Comment

When I was 10, I felt compelled to tell my parents “I love you” every time they left the house. Going to the grocery store? I love you. Going to work? I love you. Going to the mailbox? I love you. The fear that something catastrophic will happen to family members is a common manifestation of childhood and adolescent OCD. I thought that if I failed to carry out this ritual, my parents wouldn’t know that I loved them if or when something terrible occurred.

I was also preoccupied with germs; my hands were cracked and bleeding from excessive washing, and I worried constantly about contamination. I always walked a specific pattern on the rug in the hallway, and I carefully watched the family dog to be sure I’d notice when he winked at me–so that I could wink back. I couldn’t tell you why I had to wink at the dog, I just had to.

I knew that these behaviors were irrational, and yet the anxiety it caused me to resist the compulsions seemed unbearable. I was afraid to go to sleep because I worried I might sleepwalk and harm my family in the middle of the night. Nearly every evening, I would tearfully confess my intrusive thoughts to my mother, convinced that she would be afraid of me for thinking such awful things. OCD commanded almost every aspect of my life.

Did I Grow Out Of It?

My parents tried to get me into therapy, but I was shy and ashamed, and simply refused to participate. So, I started taking an SSRI, slowly titrating up to the maximum dose. And incredibly, it worked. Suddenly, I was free from the torturous anxiety and embarrassing compulsions. I could be a kid again. Two years on, I slowly came off my medication. We waited, on edge, for symptoms to return, but they never did. I’ve often wondered why I never relapsed. It seemed impossible that something that had plagued me for so long had just vanished.

Thanks, PubMed

I wanted to know if other people had experiences similar to mine, so I headed over to trusty ol’ PubMed. I found several articles that explore the topic of OCD remission. Some have woefully small sample sizes and others are barely longitudinal, but there does seem to be a higher rate of OCD remission in the pediatric population than the adult population. The factors that influence this aren’t very well understood; some studies show that an earlier onset of symptoms predicts better outcomes, while others associate earlier onset with chronic, adult OCD. Don’t you just love conflicting results? I do, however, think these results can be reconciled.

Maybe It’s About Treatment, Not Age

A study published in 2014 followed up with children and adults with OCD over a three-year period. Children achieved remission more quickly than adults who had juvenile-onset of symptoms, but the age of onset did not affect the likelihood of remission. Instead, the authors show that the less time passes between the onset of symptoms and receiving treatment, the better the outcome.

This fits with the statistics on OCD treatment. In a different study by the same authors, children went an average of 1.5 years before receiving treatment, whereas adults reported a wide range of latency periods. On average, they went 14.5 years before receiving treatment, although the standard deviation was close to 12 years. Clearly, some adults suffer in silence for decades before getting treatment.

It’s plausible, then, that children who receive treatment soon after developing symptoms see remission more often, but children who endure a longer period of uninterrupted symptoms are more likely to have chronic OCD into adulthood.

The Takeaway

Multiple studies emphasized the importance of early recognition and treatment of childhood-onset OCD. Overall, I was encouraged by what I found during my deep dive into the literature. The sources I found all seemed to agree; long-term persistence of childhood-onset OCD is less common than it is for adult-onset OCD.

After all this, I’m still not sure whether I grew out of OCD. It’s difficult to determine whether anybody grows out of it without treatment because study samples come largely from inpatient and outpatient treatment centers. I will say that I occasionally get a sticky thought that reeks of OCD, but I set it aside fairly easily.

In a completely anecdotal way, this seems to me like the pathways that I was stuck in as a child had a chance to be rewired while I was on medication. Now, my brain can cope with intrusive thoughts pretty much like anybody else’s.  If I had known that the chances were pretty good that I wouldn’t suffer from OCD forever, it might have been a little easier to cope as a child.

Treatment with ERP and medication offers adults and children relief from their OCD symptoms. So, if you have a kid with OCD, know that remission is possible. And for all the adults with OCD, know that there is hope, and you are not alone. Adults absolutely achieve remission as well. A 40-year follow-up study found that of 251 participants, improvement was observed in 83%. Those are pretty good odds!