Managing obsessive thoughts about my mind playing tricks on me
March 19, 2016 2:10 AM   Subscribe

Late at night when I can't sleep, I think about whether my perceptions and memories are accurate. I become quite convinced that I am not a reliable narrator of my own life and it is very distressing. It's like I get trapped in thought loops. Do you have strategies for dealing with this?

Here are the major examples:

- When I was 13, I wrote a school report on depression and mental illness. I was interested in the subject because I thought it might apply to me. The following year I became severely depressed and suicidal and ever since then, for decades, I have had recurring thoughts that I "made" myself depressed by reading about the subject.

- As a teenager, I worried that I affected my "natural" sexual orientation because I read too much about sexuality and wanted to be special. I feel more settled in my identity as an adult, so I don't have these thoughts much any more, but it was a big preoccupation for years.

- I think about whether my memories of being abused are real. I read about false memories and worry if I somehow managed to make things up without knowing it. This is the most anxiety-provoking subject and I end up wondering if any of my memories at all are reliable and if my mind functions properly. I get very upset when I think about this and feel like a liar.

- My parents were alternately neglectful and overinvolved. I wonder if my perspective on them is accurate. They often said I was moody and caused conflict, and I was; perhaps my perception of them as emotionally abusive is me attempting to blame them for my own faults and difficult personality. I have similar thoughts about being bullied at school (i.e., that I thought others were cruel to me but really they were just reacting to my arrogance and rudeness).

I know this all sounds odd and that a normal person would be able to evaluate these thoughts and accept or reject them more easily, but believe me when I say it is a big source of distress for me and seems to happen almost every night since I went into treatment lately. I described this to my psychiatrist and she said it sounds like OCD symptoms arising from PTSD (but she doesn't think I have OCD itself). I also see a therapist and take medication.

I would like to know if anyone recognizes these kinds of feelings, has an idea of where they come from, and has any strategies to handle them. Thank you.
posted by fair isle sock to Health & Fitness (10 answers total) 6 users marked this as a favorite
Best answer: It makes sense that you would be ruminating more on this kind of stuff since you went into treatment. I find that dealing with trauma is like digging around in the bottom of a lake - the silt and sand gets up in the water and clouds everything, it makes it hard to see what you're really dealing with, but you can feel what you're dealing with even if you can't see it with your eyes. People don't make trauma up, they really don't, and your emotional response is proof that something did happen.

Somewhere along the line (pretty clearly from your parents' gaslighting) you learned that it was easier/better to deny your perception than to admit that bad things were happening, and like any traumatized person you then generalized this crucial coping skill to other areas of your life. But you're not stuck in the same situation anymore, you're not being faced with terrifying life-or-death feeling circumstances where the only possible answer is "deny everything I believe and accept what others say is true instead", and you now have the freedom to learn other coping mechanisms for the emotions you carry.

It sounds like you might be experiencing emotional flashbacks, which are a symptom of complex PTSD. If that sounds accurate to you, the best thing I can recommend is reading Pete Walker's book (CPTSD: From Surviving to Thriving). He walks through a lot of different coping mechanisms, talks about how different trauma coping strategies come to be, and generally provides the validation that you might be lacking. (I have had a lot of similar doubts especially with regards to sexuality and memory, and parents that were a combination of neglectful/controlling; this book was a HUGE help to me.) I also suggest reading up on the 4Fs trauma types because you mention it bordering on obsession, which is typical of someone who is locked into flight mode.

I can't tell if you're still purposefully reading invalidating materials but if you are the first step is to quit that. Don't hunt down information that tells you you're making it up. If you come across it, force yourself to get the hell away from it because it is increasing your distress and making it hard for you to function (I honestly treat these impulses like they are impulses to self-harm, just with words to the psyche instead of implements to the body). Seek out validation from other trauma survivors or people you trust. Write down a list of affirmations that you can go through instead - ideally ones that resonate with you or that you mostly agree with, just find positive counter-messages to the hurtful messages you've taken in to your heart. Treat the hurtful thoughts, the self-doubt, as if they were intrusive thoughts or suggestions from an extremely unhelpful student in your class who clearly hasn't read the textbook and who isn't worth your time to educate ("thanks Timothy" -> change subject).

The key is to 1) disengage from the negative messages ("no I'm not doing this, it just makes me feel like dirt and I get nowhere", and 2) respond to them with positive substitutions ("I was a child and all children deserve loving supportive parents" or "my emotions are proof enough that something happened to me, my experiences are valid even without concrete proof"). Best of luck!
posted by buteo at 7:30 AM on March 19, 2016 [7 favorites]

I'm going to go against the grain here and suggest that you might want a second opinion from someone who specializes in OCD. I think the trauma/OCD-as-a-coping-mechanism thing is popular among (some) psychiatrists right now, and I saw one for years (who did both medication management and talk therapy) who said the same thing. She treated my issues mostly as anxiety (perhaps partly because I had been diagnosed with OCD as a child and always resisted the diagnosis strongly) and we talked about my childhood and current emotional issues, and it was great to have someone to talk to, but otherwise I didn't really make any progress.

Eventually I got frustrated and started reading more on my own, and ended up trying CBT. The first person I saw didn't specialize in OCD either and still wanted to treat me from an anxiety perspective. Then I got into the OCD-specific psychiatry clinic at the teaching hospital near me and found a CBT therapist who specializes in OCD.

It really was night and day for me. It turns out that I have textbook OCD, and it used to be pretty severe. Treating it just as OCD - a problem of serotonin levels and cognitive-behavioral patterns - rather than digging up my past trauma, etc., allowed me to look forward and make real progress. I'd say I went from an extremely crippling, barely functional level of OCD to a place where I feel like a normal person with occasional OCD twinges/leanings, thank God. It's truly amazing.

YMMV, IANYD, IANYP, but it might be worth pursuing. Please note that, if it's the case that you do have OCD, that does not in any way invalidate your abusive experiences as a kid, nor does it mean that you weren't/aren't using your OCD as a coping mechanism. It just really changed the treatment plan, and that, I think, was what mattered for me.

By the way, the YBOCS is the gold standard for diagnosing OCD, but it should be administered by a trained professional, not taken yourself online, etc. If your psych has never administered the YBOCS to you, asking her to administer it to you might be a good first step, though if she already thinks it's not OCD, that may color her administration of the test. You may want to have a neutral psych administer it instead.

Good luck and hang in there!
posted by bananacabana at 9:21 AM on March 19, 2016

Best answer: P.S. To address your question about managing the thoughts more directly, in the meantime you might look at Jeffrey Schwartz's Brain Lock, which is essentially CBT for OCD at home. I imagine it would work as well for obsessive thoughts rising from PTSD as actual OCD, if that's the case for you.

He goes through four steps, one of which is refocusing your attention on something else - essentially distracting yourself until the compulsive urge to think about it (or, in other people's cases, to do an OCD ritual) goes away. This really helps me a lot.

So for you, maybe you have an engaging topic you can think about instead whenever these thoughts come up at night when you can't sleep. One thing that works for me is planning trip logistics, either real or fictional ("If the zombie apocalypse arrived and we needed to get to a nearby town on horseback, what supplies could we carry with us that would be most useful?"), but I am objectively weird. Maybe for you it's doing crossword puzzles on your phone (also helpful for me), or planning elaborate dinners (also helpful for me), or doing complicated math problems (not helpful for me due to my brain not liking numbers so much, but it might work for you). Whatever it is, it just needs to be engaging enough to take your mind off the obsessive thoughts for a little while. (And, yeah, any of these might be too stimulating to be helpful for falling asleep, but if you're anything like me, the obsessive thoughts are also too stimulating to let me fall asleep, so I might as well get my mind off them for awhile and get relaxed, and hopefully then fall asleep, rather than just going in circles with the OCD in a dark room.)
posted by bananacabana at 9:35 AM on March 19, 2016 [1 favorite]

P.P.S. (argh, sorry) I should have said explicitly that your type of thoughts, both in terms of the endless cycling and the specific worry about misremembering/misinterpreting past events/self-doubt, sounds very familiar to me from my OCD. Feel free to MeMail me if you want to chat.
posted by bananacabana at 9:42 AM on March 19, 2016

Best answer: Have you been evaluated for dissociative disorders? This sounds a lot like derealization and/or depersonalization (commonly caused by trauma).

It was clear I was suffering from dissociation, and I was so very happy to find a therapist who actually specializes in dissociative disorders, but for the heck of it I took the test (not available online as far as I know). I don't remember many of the questions, but my jaw dropped when I got to the one, "Do you often feel that others think you are lying when you are not?" I was an adult and had not known that was not a universal experience for people--I'd always felt like a liar!

It was extreme. When I was six months pregnant (I'd seen the ultrasounds, etc. with my own eyes) I panicked because people were expecting me to produce a baby and what if I'd made the whole thing up?!?! Therapy, therapy, therapy. I still have some dissociative tendencies, but a therapist who really understood my situation was a huge help.

If your therapist is not trained for this, it might be worthwhile to find someone who is. Many of my therapist's patients have Dissociative Identity Disorder (formerly multiple personality disorder). I don't, but it's on the same spectrum, and any expert in that field would be able to help with dissociative thoughts.

Best of luck, and memail me if you'd like.
posted by whoiam at 10:09 AM on March 19, 2016 [1 favorite]

This is kind of an anti-answer in that it is a hotfix rather than a solution to the deeper issue. I highly suggest taking into account what many of the other posters have said. With that said, though, I've found a great tool to keep me out of my own head when I wake up in the middle of the night and can't get back to sleep. - The Podcast That Puts You To Sleep | A Lulling, Droning, Boring Bedtime Story to Distract Your Racing Mind

> Sleep With Me is a bedtime story designed to take your mind off of the racing thoughts that keep you awake at night.

> As you listen you will find yourself distracted from your worries and drifting off into dreamland..due to the fact the story gets a little bit more boring with each passing minute

Worth a try!
posted by TimBridge at 10:10 AM on March 19, 2016 [1 favorite]

Oh, I want to add that I also had a psychiatrist who thought I was suffering from OCD. I can't say that was 100% wrong, but the medications didn't help, and the later diagnosis was a sure fit (YMMV, of course!).
posted by whoiam at 10:13 AM on March 19, 2016

Mindful meditation.

Just start clearing your mind and counting your breaths in 1-2-3...

... and out 1-2-3...

When a thought, say about the accuracy of your memories, comes into your mind, acknowledge it, think briefly about where it came from and then put it out of your mind.

...and counting your breaths in 1-2-3...

... and out 1-2-3...

Honestly, this is worked wonders for me, albeit for different aspects of my thoughts.
posted by humboldt32 at 1:30 PM on March 19, 2016

I tend to ruminate before bed as well. If I write down what I'm worried about before bed, I can tell myself, "Okay, I can worry about this tomorrow" and then can sleep better.

Usually by the next day the need to ruminate passes (until nighttime! then we start over again)
posted by Dressed to Kill at 8:19 AM on March 21, 2016

Response by poster: Just want to update that the Pete Walker book has been really helpful for getting at the roots of this. Thanks, all.
posted by fair isle sock at 9:18 AM on April 21, 2016

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