I think I have OCD.
April 7, 2017 7:35 AM   Subscribe

I've always thought I had anxiety, but now I think it's actually OCD. What's the best way to go about treating this?

Ten years ago I started developing symptoms of anxiety, or something like it. First I was convinced that I had something wrong with me (health-wise), then I was afraid to eat anything with dairy or eggs, even trace amounts, because I thought they would make me sick, and I started adding more and more things to my list of foods I was too afraid to eat. When I would feel sick to my stomach (probably because of all the anxiety) I would assume I would never be able to find a partner, leave the house, have a job, etc because I was clearly going to be sick FOREVER. Then I became afraid of being out of the house for long periods of time, or flying, or being in other places where I couldn't easily go to the bathroom JUST IN CASE I was sick to my stomach (and it became kind of a self-fulfilling prophecy.) I also spent a lot of time being afraid that I had HIV (complete with tingling hands and feet, racing heart, obsessively worrying about it, etc) despite not having ANY risk factors.

Eventually this "phase" passed, and life was pretty normal for a while. Then, a few years ago, I had another sudden onset of paranoid thoughts. This time I became obsessed with the idea that I was going to hit a pedestrian in my car while driving and kill them, which devolved into being afraid that I had or would unknowingly run over someone in the dark, and then that I would scratch someone's car while parking and not notice it and get arrested and go to jail. Being in the car became unbearable, and after calling the police on myself to try to file a report that I MAY have bumped someone's car in a garage, I stopped driving. I drive once or twice a year now when I absolutely have to and it's awful. I also became obsessed with being responsible for burning a building down, whether home or work. Space heaters, string lights, the oven, the iron, steam cleaners....everything that produces heat is scary and dangerous and I have quit using them as much as possible. I would go the office in the middle of the night, literally, to make sure I hadn't left something on at work and then lay awake the rest of the night worrying I didn't lock the office door again. I have to check the oven (and a long list of other things) multiple times when I leave the house, and on bad days, I have to go back to the house to double and triple check. I will think "Okay, I checked the oven, but then I turned around on my way out and what if I accidentally bumped the knob with my purse and didn't notice it and the gas is filling my house right now and I'm going to kill my dog and my landlord will hate me!" Around the same time I also became very afraid of rabies - the first sudden onset was after I petted/picked up a stray kitten briefly, and then became so convinced I had rabies and afraid of dying that I was considering lying to the CDC and hospital staff to say I had been bitten by something or other so that they would give me the rabies shots and I could be at peace again. At this time, I went to a doctor out of desperation and although he would not recommend getting the rabies shots (obviously) he did prescribe Lexapro for anxiety and I felt better within a couple of weeks.

So I have been taking Lexapro kind of on-and-off for the past few years. When I take it consistently, the anxiety/paranoia is a mild, dull roar in the back of my head. I still get paranoid thoughts and I'm afraid that I left the oven on and I don't drive, but the more outlandish and ridiculous paranoias don't come into my head as much. When I am having thoughts like "What if I left the oven on?" they are more thoughts, and I have less of the physical symptoms like feeling that I am going to throw up, racing heart, tingling limbs, that sinking feeling in your stomach, etc. I can remain more sane and aware that these things are anxiety and feel less convinced that it's reality.

Obviously the problems are still present, though, and the Lexapro has side effects I don't like. I feel dulled and numb overall, mentally and physically, which is why I keep trying to go off it. I read a lot of things about anxiety, but most of them seem tailored to treat things like procrastination, or feeling like people don't like you, or just a general sense of worry or stress. I don't have any of those symptoms. I don't think I've ever had a TRUE panic attack, though I have definitely felt panicky a LOT. The only other symptom I have that is more relevant to anxiety is sometimes I get obsessed/overwhelmed with making a certain decision (even innocuous things like which vacuum cleaner to buy) and weigh the pros and cons endlessly, which can be exhausting and annoying for me AND those close to me. So anyway, I am thinking that this may actually be OCD, because reading about intrusive/obsessive thoughts rings more true to me.

I could go back to my primary doctor and discuss this with him. But I don't really like or trust him. I could try to find a psychiatrist. I could try getting some books to read. I could try acupuncture. I could try therapy - would CBT still work? I don't really know how to get started and what I should do next. I'd like to be off meds if possible, or if not, maybe I should be on different ones?

Help please.
posted by anonymous to Health & Fitness (17 answers total) 4 users marked this as a favorite
I would start by finding a psychiatrist you trust. They should be able to recommend the appropriate medication (if any) and therapy for you.

Acupuncture and books are well-and-good, but you need real medical expertise to help you right now.
posted by schroedingersgirl at 7:54 AM on April 7, 2017 [5 favorites]

Oh my goodness, please go to a psychiatrist for a proper diagnosis and treatment. Finding the right meds combo takes time and expertise. There are plenty of options other than Lexapro, and different things work for different people anyway.

So I have been taking Lexapro kind of on-and-off

This seems like a bad idea.
posted by the_blizz at 7:55 AM on April 7, 2017 [3 favorites]

CBT is actually one of the most effective treatments for OCD. Look for a provider who has experience with OCD and with exposure and response prevention. This can absolutely get better!
posted by goggie at 7:56 AM on April 7, 2017 [3 favorites]

Adding that a psychiatrist may be able to help with medication, but the behavioral therapy gets at the root of the anxiety, teaching you tools and strategies to challenge those intrusive thoughts. A psychologist or experienced social worker would be the place to go for that.
posted by goggie at 7:57 AM on April 7, 2017 [2 favorites]

Also: OCD is an anxiety disorder.
posted by the_blizz at 7:58 AM on April 7, 2017

Oh my goodness, please go to a psychiatrist for a proper diagnosis and treatment. Nthing this.

PLEASE, do not crowdsource this, especially if you're dealing with OCD, which I am NOT saying you are.**

You note having thoughts that can run away from you and are not entirely based in fact -- because of this, I cannot implore you enough to see a prescribing psychiatrist for an evaluation.

Also, if you contact McLean Hospital's OCD Institute, they can give you a list of practitioners they've trained.

**I'm the parent of someone who needlessly suffered for YEARS from extremely incompetent treatment providers for his OCD. There are people who can really help, but there are lots of people who can make things worse. This is why I'm strongly advising you to not follow any advice here other than see a doctor. Talk to McLeans.
posted by yes I said yes I will Yes at 8:34 AM on April 7, 2017 [8 favorites]

Here is the Society of Clinical Psychology's page that summarizes the research support for different psychological treatments for OCD. A good psychiatrist should put you in touch with a psychologist or other practitioner that does one of these. Things to look for in a competent provider of one of these treatments include 1) assigning regular homework, 2) offering a limited, short-term course of treatment (typically less than a year), and 3) structuring the sessions in a goal-oriented way.
posted by quiet coyote at 9:00 AM on April 7, 2017

So, a few years ago, Mr. Cleverevans started having some serious anxiety. It centered around his fear that he was having a heart attack. He took himself to the ER three times in as many months. He had an EKG done, a stress test... he went through every procedure he could to check his heart, and he was deemed fit as a fiddle.

The fourth time he wanted to check himself into the hospital, I grabbed him by the collar and stopped him. I told him that this was NOT a heart attack. It was something else. And I also told him that we could not afford another unwarranted trip to the ER.

After much research, and him not eating for about a month and losing 30 lbs, we figured out that it was anxiety disorder. It had been manifesting itself for years in various forms: for a while, he went through a period when he was terrified of flying. That subsided and he became overly obsessed about his health, exhibiting behaviors that are synonymous with hypochondria.

Two things helped him:
1. Working with a certified Cognitive Behavioral Therapist. (CBT). I strongly recommend that you start the search for a CBT that you like and you feel you can work with. This person can give you the tools you need to deal with things when you get overwhelmed.

2. Working with a good psychiatrist who helped him find the right medication at the right dosage for him.

You say that Lexapro leaves you with side effects you don't like. Maybe there's a better medication out there for you. How are you getting the Lexapro, by the way?

Your stories about driving, and rabies, and burning the house down sound VERY familiar to me. You start with one thought, and it just escalates and escalates and escalates. You do everything you can to avoid certain situations. (This, incidentally, is called "avoidance behavior".) Just avoiding certain situations won't work. You'll eventually become imprisoned by your own fears.

The fact that you're here, talking about it, and that there's a part of you that knows these fears and behaviors aren't normal or reasonable, is a good thing. While IANAD, you sound like you have anxiety disorder to me, and you need help from a team of people in order to get it under control. But you CAN do it. I've known many people who have it and who have learned to manage it, with therapy and the right medication.

You also might have to accept that you might have to be on meds for the rest of your life. My husband went onto a dose of an SSRI, stayed on it for a year, went off it, flipped out, and then went back to a lower, really very small dose and he's stayed there. He's okay to stay on it for the rest of his life rather than go back to the anxiety. Maybe someday he'll try stepping down again, but for now, he's enjoying life.

It's a hard job finding the right people to work with, but that's what you must do. Think of it like you're assembling your team to help you work on this problem. Find the right people for your team. DON'T try to just treat this on your own willy-nilly. Get help.
posted by cleverevans at 9:14 AM on April 7, 2017 [1 favorite]

I am not a doctor, but I have OCD, and your symptoms are very much in line with that diagnosis, based on my personal experience and general knowledge.

Find a psychiatrist and begin a regimen of CBT, perhaps in combination with medication. CBT is hard work, but it is effective. If you're in the SF Bay Area, by chance, I can recommend some professionals who can help you.

Best of luck. You can find relief. You (and I) are going to be okay. Sending you good wishes.
posted by delight at 9:38 AM on April 7, 2017 [1 favorite]

I've said this before on the green and I will say it again: CBT for anxiety/OCD is literally the only therapeutic intervention I've tried that has worked, and I've been dealing with multiple diagnosed psychiatric disorders since I was 12 years old. The important thing, though, is to actually do all the "stupid" stuff the therapist asks you to do, or it won't be effective. This is not an intellectual exercise; it must be accomplished by doing the physical/tangible homework assignments.
posted by xyzzy at 10:41 AM on April 7, 2017 [2 favorites]

In case your anxious mind is messing with you, and it probably is... There doesn't need to be a debate regarding CBT vs. medication. Some people do well with CBT alone. For others, CBT can help only after the mess have lessened the anxiety.
posted by wryly at 10:52 AM on April 7, 2017

As an anxiety sufferer of many years, who has experienced many bouts of OCD / pure O, I have said here and elsewhere that citalopram has effectively preserved my mental health and ability to function in the world day to day for years now with no serious side effects.
posted by Martha My Dear Prudence at 11:05 AM on April 7, 2017

You have described textbook OCD symptoms- the oven, AIDS and rabies anxieties, even the fear of having hit someone with your car are all found in the literature.

While up to 76% of OCD sufferers also have an anxiety disorder, the recent DSM-V classifies OCD within its own category. This is because of the generation of obsessions of the kind you describe, which are not typically found in anxiety disorders. As such, while treating anxiety (with exposure and response therapy or anti-anxiety medication) can really turn down the intensity, you cannot expect it to rid you of the main characteristic of the disorder- which is the sense of intrusive uncertainty or doubt which leads you to repetitively check for potential harms, and even generate new possible harms- such that you eventually fall into these cognitive traps of harms that are extremely difficult to disconfirm (such as invisible germs).

Unfortunately, there is as yet no medication that directly tackles uncertainty- although I've read about some interesting trials for drugs that work on the glutamate signalling system. You need to find a therapist who has experience with OCD in particular, and who can help you to recognize and tolerate these unreliable signals of uncertainty.

You may wish to read an article I've recently published on OCD, which can be freely downloaded here.
posted by leibniz at 11:26 AM on April 7, 2017 [1 favorite]

yep. sounds like what I went through in 2002. My advice is see a Psychiatrist and Therapist at the same time. don't be afraid to say no to a pill if you can't handle living with the side effects. anafranil was extremely effective for me. fluvoxamine was ok but the side effects were awful. wellbutrin was ok, but no one tells you it loses effectiveness over time. also do a panel of bloodwork before and during medication so you can see if it is causing any problems. there is no shame in asking for help.
posted by evilmonk at 11:28 AM on April 7, 2017

I have OCD, a handful of anxiety disorders, and bipolar disorder. What you're describing sounds to me like textbook OCD. When my anxiety levels spike, my OCD gets worse. For example, when I was at a stressful job I hated, I flipped out over organizing the milk so that the oldest milk was in the front and the newer in the back. I was firmly convinced that if I didn't have it arranged perfectly, that someone was going to buy spoiled milk, and drink it, and get sick, and die. Then it turned into my MIL would buy the spoiled milk. And then it turned into I would buy it, and my kids would be the victims of my incompetence in FIFOing the milk.

I'm on a variety of meds for my psych stuff. But I'll nth everyone above, that CBT is the best thing for OCD. I learned how to challenge the intrusive thoughts, to ask myself for evidence they were valid, and when I couldn't find that evidence, to dismiss the thoughts. It's hard work. Sometimes it's impossible work. But it's vital work.
posted by The Almighty Mommy Goddess at 1:02 PM on April 8, 2017 [1 favorite]

Addressing only the talk therapy approach, ERP aka ExRP is a kind of CBT therapy, and generally considered to be the most effective treatment for the symptoms you report.
posted by dancing leaves at 7:57 AM on April 10, 2017 [2 favorites]

You might find this article interesting.
posted by Spiderwoman at 5:18 AM on December 6, 2017

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