OCD with intrusive, obsessive thoughts: what next?
March 23, 2017 6:03 PM Subscribe
After years of wondering why I am constantly experiencing intrusive, obsessive thoughts about things I'm failing to do or otherwise screwing up, I have come to suspect that it is highly probable that I may have a form of OCD. I will be bringing this up with my therapist and psychiatrist, respectively, when I see them next. In the meantime, I'm seeking some advice from those who have been diagnosed with or are familiar with the condition.
Quick context: 30 year old cis het woman in the US, already diagnosed and treating for ADHD Inattentive Type, Depression, and Anxiety. I take medication for the three aforementioned diagnosed conditions, and have undergone several years of CBT.
I have always allowed my anxiety to run my life, especially before I was aware of/diagnosed with ADHD. I used my anxiety to overcome the hurdles of ADHD. In other words, when my ADHD made me withdraw or fail to act, I'd let my anxiety go full blast so that I'd be so worried about what it was I wasn't doing or getting done that I'd have no choice but to actually get it done. This is how I got through high school with very good grades, as well as how I made it through both my undergraduate and graduate degrees.
I only owned up to my anxiety a few years ago, after already being in treatment for depression and ADHD. My psychiatrist heaved this sigh of relief and said that he's observed that I am highly anxious and was glad to hear me acknowledge it (I had previously brushed it off when he attempted to discuss it with me- I'd dismiss what he called "anxiety" as "hyperactivity from being ADHD"). I take Ativan (1mg up to 3 times a day, as needed). I also engage in vigorous daily exercise and am part of a Zen meditation group.
Despite treating my anxiety with not only medication but also CBT, exercise and meditation, I find myself in a near-constant state of "what am I forgetting to do / what will happen because I already know I didn't do this or that / what will happen if I make that mistake / what would my life be like if I'd done this instead / why am I worrying so much / does the fact that I am worrying so much mean something else is going on / what can I do about this / ... " and so forth. It is a loud, never-ending ticker tape of BREAKING NEWS ANXIETY. The thoughts are not only obsessive, they are also intrusive and will pop into my mind without any kind of meaningful prompting. I definitely have an obsessive sense of impostor's syndrome, as well.
I know that I've always had obsessive thoughts and worries, but in the last three years, it has really, really escalated into something where I am basically paralyzed from doing most things I love.
I'm too paralyzed by my worries to read a book. I am too paralyzed by my worries to put on a record I enjoy and just chill out listening to music. I am too paralyzed by my worries to get back in to the job search, which is why my 'career transition' has been ongoing for like five years. I am too paralyzed by my worries to exercise some days (and so while I'm still fitter than the average person, I'm way less fit than I used to be and would like to be for my health and happiness). I am too paralyzed by my worries to address actual, real obstacles and dilemmas I am facing and use the obsessive worries as an excuse to shift focus away from the reality of said problems. Sometimes I even have intrusive thoughts about bad things that could hypothetically happen to other people, and feel immediate shame (and consequently a spiral of anxiety, worry) over the fact that such a terrible thought popped into my head. I also have a tendency to obsess over faux pas or embarrassing mistakes I made years and years and years ago that, logically, I know no longer matter, but continue to haunt me in the form of intrusive thoughts.
I am really tired of living this way. It has zapped me of my strength to the point where I no longer feel motivated to do anything except show up for work, get work done at an adequate level, maybe go to the gym for an hour or two before going home, then sitting on my butt and either drifting off into a distracted world of me and my obsessive thoughts, or watching a movie or TV. Occasionally I may leaf through a copy of the New Yorker, or organize a drawer in my room, or manage to sweep up or wash the dishes. I realize that part sounds like depression, and I acknowledge it may be that, but it seems like in those rare moments when I *don't* feel anxiety or obsessive thoughts, that's when I suddenly also feel motivation again (a sudden kind of, 'oh, there's no obstacle here after all, let's get it done). The anxiety is making me paralyzed which in turn fuels the depression and then demotivation, or perhaps the demotivation and then depression.
Again, I will be addressing this with my doctors to confirm there's an actual diagnosis to be made here. Right now, I would love to hear from those who have been diagnosed with OCD (in particular OCD that involves intrusive/obsessive thoughts) and what your experience has been like, techniques you use to overcome obsessive thoughts, recommended reading - anything that might help me gain a better understanding and context for OCD as it may, potentially, apply to me.
Quick context: 30 year old cis het woman in the US, already diagnosed and treating for ADHD Inattentive Type, Depression, and Anxiety. I take medication for the three aforementioned diagnosed conditions, and have undergone several years of CBT.
I have always allowed my anxiety to run my life, especially before I was aware of/diagnosed with ADHD. I used my anxiety to overcome the hurdles of ADHD. In other words, when my ADHD made me withdraw or fail to act, I'd let my anxiety go full blast so that I'd be so worried about what it was I wasn't doing or getting done that I'd have no choice but to actually get it done. This is how I got through high school with very good grades, as well as how I made it through both my undergraduate and graduate degrees.
I only owned up to my anxiety a few years ago, after already being in treatment for depression and ADHD. My psychiatrist heaved this sigh of relief and said that he's observed that I am highly anxious and was glad to hear me acknowledge it (I had previously brushed it off when he attempted to discuss it with me- I'd dismiss what he called "anxiety" as "hyperactivity from being ADHD"). I take Ativan (1mg up to 3 times a day, as needed). I also engage in vigorous daily exercise and am part of a Zen meditation group.
Despite treating my anxiety with not only medication but also CBT, exercise and meditation, I find myself in a near-constant state of "what am I forgetting to do / what will happen because I already know I didn't do this or that / what will happen if I make that mistake / what would my life be like if I'd done this instead / why am I worrying so much / does the fact that I am worrying so much mean something else is going on / what can I do about this / ... " and so forth. It is a loud, never-ending ticker tape of BREAKING NEWS ANXIETY. The thoughts are not only obsessive, they are also intrusive and will pop into my mind without any kind of meaningful prompting. I definitely have an obsessive sense of impostor's syndrome, as well.
I know that I've always had obsessive thoughts and worries, but in the last three years, it has really, really escalated into something where I am basically paralyzed from doing most things I love.
I'm too paralyzed by my worries to read a book. I am too paralyzed by my worries to put on a record I enjoy and just chill out listening to music. I am too paralyzed by my worries to get back in to the job search, which is why my 'career transition' has been ongoing for like five years. I am too paralyzed by my worries to exercise some days (and so while I'm still fitter than the average person, I'm way less fit than I used to be and would like to be for my health and happiness). I am too paralyzed by my worries to address actual, real obstacles and dilemmas I am facing and use the obsessive worries as an excuse to shift focus away from the reality of said problems. Sometimes I even have intrusive thoughts about bad things that could hypothetically happen to other people, and feel immediate shame (and consequently a spiral of anxiety, worry) over the fact that such a terrible thought popped into my head. I also have a tendency to obsess over faux pas or embarrassing mistakes I made years and years and years ago that, logically, I know no longer matter, but continue to haunt me in the form of intrusive thoughts.
I am really tired of living this way. It has zapped me of my strength to the point where I no longer feel motivated to do anything except show up for work, get work done at an adequate level, maybe go to the gym for an hour or two before going home, then sitting on my butt and either drifting off into a distracted world of me and my obsessive thoughts, or watching a movie or TV. Occasionally I may leaf through a copy of the New Yorker, or organize a drawer in my room, or manage to sweep up or wash the dishes. I realize that part sounds like depression, and I acknowledge it may be that, but it seems like in those rare moments when I *don't* feel anxiety or obsessive thoughts, that's when I suddenly also feel motivation again (a sudden kind of, 'oh, there's no obstacle here after all, let's get it done). The anxiety is making me paralyzed which in turn fuels the depression and then demotivation, or perhaps the demotivation and then depression.
Again, I will be addressing this with my doctors to confirm there's an actual diagnosis to be made here. Right now, I would love to hear from those who have been diagnosed with OCD (in particular OCD that involves intrusive/obsessive thoughts) and what your experience has been like, techniques you use to overcome obsessive thoughts, recommended reading - anything that might help me gain a better understanding and context for OCD as it may, potentially, apply to me.
I have OCD with intrusive/obsessive thoughts (and also compulsive rituals). The things that have made the most difference for me are SSRIs (I take 20 mg Prozac daily) and CBT therapy with someone who specializes in OCD.
It took me a couple years to find the right med/dose for me, but it is really, really worth the annoyance of working with a psychiatrist and finding what works best, in my opinion. I had a couple of other meds/doses that worked okay but not great, some that had a lot of side effects, and some that just made everything worse. It was a frustrating case of trial and error, but again, totally worth it in the end.
It can also be hard to find a therapist that does CBT specifically for OCD. I started doing CBT with someone who was more focused on anxiety/depression and actually ended up getting some (inadvertently) counterproductive advice. I now drive an hour each way for my weekly appointments to my OCD-specific therapist and consider it a wonderful use of my time/money.
As far as reading, Jeffrey Schwartz's Brain Lock is pretty widely recommended, and sort of explains the tenets of CBT in a "do it at home" way. I found it to be somewhat helpful but also somewhat triggering (I tend to be very impressionable about content of my obsessions, so reading about other people's specific obsessions didn't help me).
If you have any religious components to your OCD (also called scrupulosity), I found The Doubting Disease and Can Christianity Cure Obsessive-Compulsive Disorder? (don't like that title but do like the book) helpful.
I'm not sure what other information would be helpful to you right now, so I'll just throw out a few other things and please feel free to MeMail me if you want more information or have other questions.
* It sounds like what you're talking about could definitely be OCD. I've been there with the endless ticker tape of worries, the bad thoughts about others and resulting shame, and the inability to read/listen to music/etc. Definitely seek treatment - I can read and listen to music and enjoy life now and it's sooooo much better.
* I noticed a strong correlation with my menstrual cycle and my OCD. Things tended to get worse the week or so before my period and better on my period. Hormones can definitely play a part. Not sure if this applies to you.
* If the thoughts/worries are affecting your work, consider using something like the Pomodoro Method for getting things done at work. It helps me stay on track and essentially shove the OCD thoughts to one side and say "I'll deal with this later, I'm on the clock right now."
* Other things that help me when I'm in an obsessive spiral are talking to other people, specifically NOT about my thoughts/worries (something about the interaction/having to be "on"/focusing on what's going on with someone else/etc. gets me out of my head), dumb iPhone games, knitting (the repetition is soothing), and crossword puzzles.
* Long-term, I've found meditation to be really helpful. I do a prayer-based form called Centering Prayer, but I think anything mindfulness-based would be awesome. You mention meditation, but I'm not sure what type you do. For me, the focus on *letting go* of thoughts (watching them come in and go out, etc. etc.) has really helped me realize that a lot of my thoughts are just ridiculous noise and I can ignore them even if they annoy me, etc.
Good luck. OCD is no fun, but it is treatable, and mine has gone from "hard to function in daily life" to "a thing that's frustrating but doesn't generally stop me from living." MeMail me if I can answer other questions, etc.
posted by bananacabana at 7:09 PM on March 23, 2017 [5 favorites]
It took me a couple years to find the right med/dose for me, but it is really, really worth the annoyance of working with a psychiatrist and finding what works best, in my opinion. I had a couple of other meds/doses that worked okay but not great, some that had a lot of side effects, and some that just made everything worse. It was a frustrating case of trial and error, but again, totally worth it in the end.
It can also be hard to find a therapist that does CBT specifically for OCD. I started doing CBT with someone who was more focused on anxiety/depression and actually ended up getting some (inadvertently) counterproductive advice. I now drive an hour each way for my weekly appointments to my OCD-specific therapist and consider it a wonderful use of my time/money.
As far as reading, Jeffrey Schwartz's Brain Lock is pretty widely recommended, and sort of explains the tenets of CBT in a "do it at home" way. I found it to be somewhat helpful but also somewhat triggering (I tend to be very impressionable about content of my obsessions, so reading about other people's specific obsessions didn't help me).
If you have any religious components to your OCD (also called scrupulosity), I found The Doubting Disease and Can Christianity Cure Obsessive-Compulsive Disorder? (don't like that title but do like the book) helpful.
I'm not sure what other information would be helpful to you right now, so I'll just throw out a few other things and please feel free to MeMail me if you want more information or have other questions.
* It sounds like what you're talking about could definitely be OCD. I've been there with the endless ticker tape of worries, the bad thoughts about others and resulting shame, and the inability to read/listen to music/etc. Definitely seek treatment - I can read and listen to music and enjoy life now and it's sooooo much better.
* I noticed a strong correlation with my menstrual cycle and my OCD. Things tended to get worse the week or so before my period and better on my period. Hormones can definitely play a part. Not sure if this applies to you.
* If the thoughts/worries are affecting your work, consider using something like the Pomodoro Method for getting things done at work. It helps me stay on track and essentially shove the OCD thoughts to one side and say "I'll deal with this later, I'm on the clock right now."
* Other things that help me when I'm in an obsessive spiral are talking to other people, specifically NOT about my thoughts/worries (something about the interaction/having to be "on"/focusing on what's going on with someone else/etc. gets me out of my head), dumb iPhone games, knitting (the repetition is soothing), and crossword puzzles.
* Long-term, I've found meditation to be really helpful. I do a prayer-based form called Centering Prayer, but I think anything mindfulness-based would be awesome. You mention meditation, but I'm not sure what type you do. For me, the focus on *letting go* of thoughts (watching them come in and go out, etc. etc.) has really helped me realize that a lot of my thoughts are just ridiculous noise and I can ignore them even if they annoy me, etc.
Good luck. OCD is no fun, but it is treatable, and mine has gone from "hard to function in daily life" to "a thing that's frustrating but doesn't generally stop me from living." MeMail me if I can answer other questions, etc.
posted by bananacabana at 7:09 PM on March 23, 2017 [5 favorites]
You are so not alone. It's hard for me to write a comment about this when what I could write is a book, but to start with, The Imp of the Mind is indeed excellent. For general coping, I would recommend When Things Fall Apart and The Mindful Path Through Worry and Rumination, but you may have already read those, since you are in a meditation group. I also liked Things Might Go Terribly, Horribly Wrong.
Here's an exercise I do when I am anxious about a thing -- I sit down and journal it out, like so:
OH MY GOD [A] COULD HAPPEN WHAT IF [A] HAPPENS
Okay. That is very worrisome. What would have to happen in order for [A] to take place?
First [B] would have to happen.
Then [C] would have to happen.
Then [D] would have to happen ...
Really break it down: you would have to have made a particular mistake, then a particular person would have had to have noticed it, then that person would have had to be angry about it, then that person would have to decide to take action about it, then that person would have to determine that the action was feasible, then they would have to have the resources to pursue it ... This helps because you're not lying to yourself, trying to say that something is impossible. You're just gaming out how likely it is or it isn't. It's a calming exercise.
Ask your doctor to be sure that your medication is doing what it could be. It sounds like you could be on something that works better, since you are suffering so much, but obviously I have no expertise.
posted by Countess Elena at 7:19 PM on March 23, 2017 [3 favorites]
Here's an exercise I do when I am anxious about a thing -- I sit down and journal it out, like so:
OH MY GOD [A] COULD HAPPEN WHAT IF [A] HAPPENS
Okay. That is very worrisome. What would have to happen in order for [A] to take place?
First [B] would have to happen.
Then [C] would have to happen.
Then [D] would have to happen ...
Really break it down: you would have to have made a particular mistake, then a particular person would have had to have noticed it, then that person would have had to be angry about it, then that person would have to decide to take action about it, then that person would have to determine that the action was feasible, then they would have to have the resources to pursue it ... This helps because you're not lying to yourself, trying to say that something is impossible. You're just gaming out how likely it is or it isn't. It's a calming exercise.
Ask your doctor to be sure that your medication is doing what it could be. It sounds like you could be on something that works better, since you are suffering so much, but obviously I have no expertise.
posted by Countess Elena at 7:19 PM on March 23, 2017 [3 favorites]
One of my kids has bad thought OCD, ended up being hospitalized and going to McLean Hospital's OCD Institute for 3 months that turned his life around. It CAN be done.
You don't mention your friends and/or support systems, so apologies if this isn't relevant. One of the most important things we had to work on as a family was how we had been working with my kid's reassurance seeking. Years earlier we had been taught to basically shut down his train of thought but telling him we weren't going to engage. McLean taught us that as long as we were doing that, we WERE still engaging just by noting we had heard him.
Our support work was to completely ignore him, not even to respond, "I'm not engaging in this because it's reassurance seeking." It was REALLY HARD. Like, he would text me asking if I could get Chipotle for dinner but because I didn't know if this was the beginning of the worry train and he was really checking in on me and asking when I'd be home (which was his thing), I had to literally not open the message so he could see I didn't see it and wasn't going to respond. It took MONTHS for this to become okay.
So as you gain more tools and work on this, there may be a component where your support system needs to learn how to help you in a way that feels really counterintuitive and unhelpful, but it can and will help you.
Lastly, I strongly recommend contacting the OCD Institute and asking for recs of Harvard/McLean trained clinicians in your area. They have an amazing methodology that really works.
posted by yes I said yes I will Yes at 2:46 AM on March 24, 2017 [1 favorite]
You don't mention your friends and/or support systems, so apologies if this isn't relevant. One of the most important things we had to work on as a family was how we had been working with my kid's reassurance seeking. Years earlier we had been taught to basically shut down his train of thought but telling him we weren't going to engage. McLean taught us that as long as we were doing that, we WERE still engaging just by noting we had heard him.
Our support work was to completely ignore him, not even to respond, "I'm not engaging in this because it's reassurance seeking." It was REALLY HARD. Like, he would text me asking if I could get Chipotle for dinner but because I didn't know if this was the beginning of the worry train and he was really checking in on me and asking when I'd be home (which was his thing), I had to literally not open the message so he could see I didn't see it and wasn't going to respond. It took MONTHS for this to become okay.
So as you gain more tools and work on this, there may be a component where your support system needs to learn how to help you in a way that feels really counterintuitive and unhelpful, but it can and will help you.
Lastly, I strongly recommend contacting the OCD Institute and asking for recs of Harvard/McLean trained clinicians in your area. They have an amazing methodology that really works.
posted by yes I said yes I will Yes at 2:46 AM on March 24, 2017 [1 favorite]
As someone who has significant, lasting trauma impacting my adult life from my parents/therapist doing the "no reassurance, no acknowledgment" thing, I'd take that on a kid by kid basis. It is GREAT for some kids, but certainly not all of them.
posted by colorblock sock at 2:53 AM on March 24, 2017 [5 favorites]
posted by colorblock sock at 2:53 AM on March 24, 2017 [5 favorites]
I, too, have OCD that manifests in intrusive thoughts sometimes. I take fluoxetine (Prozac) daily to keep it at bay, but I could tell you stories...
Here's a benign example: one day I was driving down the freeway when I happened to glance down at my shoe. "The knot on the shoelace on the left foot looks weird..." I thought. I looked back up and kept driving, but my brain said "Take another look at that knot." Before I knew it, I was staring at my shoelace again.
This went on for about five minutes, with me literally having to force my eyes not to shift down to my shoe while going 60 mph down the highway. That's when I knew I needed medication. It wasn't safe.
Prozac makes me sweat a lot, by the way, so be on the lookout for side effects. But it is worth the trade.
posted by tacodave at 2:56 PM on March 24, 2017
Here's a benign example: one day I was driving down the freeway when I happened to glance down at my shoe. "The knot on the shoelace on the left foot looks weird..." I thought. I looked back up and kept driving, but my brain said "Take another look at that knot." Before I knew it, I was staring at my shoelace again.
This went on for about five minutes, with me literally having to force my eyes not to shift down to my shoe while going 60 mph down the highway. That's when I knew I needed medication. It wasn't safe.
Prozac makes me sweat a lot, by the way, so be on the lookout for side effects. But it is worth the trade.
posted by tacodave at 2:56 PM on March 24, 2017
Aw! Yeah, start seeing someone. It's very normal and can be helped. A lot can be mediated by exercise, too, and meditation. I have OCD & I have a similar subtype (unfortunately a stalker found out and started trying to target me as 'gifts of understanding', it was bizarre), so maybe don't share too much on public forums.
posted by semaphore at 9:01 AM on March 26, 2017
posted by semaphore at 9:01 AM on March 26, 2017
I know this is an old thread, but I just stumbled upon this article, which I found very useful for my own OCD.
Good luck.
posted by Spiderwoman at 5:17 AM on December 6, 2017 [1 favorite]
Good luck.
posted by Spiderwoman at 5:17 AM on December 6, 2017 [1 favorite]
This thread is closed to new comments.
posted by thesmallmachine at 6:34 PM on March 23, 2017 [2 favorites]