Is this OCD? What should I do about this?
April 28, 2023 12:49 PM Subscribe
I have created chaos in my life and relationship by breaking up and getting back together with my partner twice over the past year due to my obsessive rumination about the relationship not being right and compulsive urges to break up. I have also struggled with severe bouts of body dysmorphia and obsessive thinking about other themes as well as some minor disordered eating/obsessive dieting. I’m on a new anti-anxiety medication right now but it’s too soon to tell if it’s working. I’ve been in therapy for a decade but think I need to find a new therapist because it’s not helping. What should I do?
So I’ll start with the relationship stuff. I’ve been in an LTR for several years. When I look at the relationship objectively, it is generally good, with some issues like any relationship has. (I don’t want to get into the details because I feel asking for feedback on that is the same checking/reassurance seeking behaviour that I should avoid.) But in the past year I have struggled with extreme bouts of anxiety and rumination over whether the relationship is right for the long term and as a result I have ended the relationship twice. I get obsessed with the idea that we won’t be compatible anymore in 5 or 10 years and then we’ll have to break up then and I’ll have caused so much more damage to their life and then I’ll be too old and ugly and nobody will ever want me again.
When I broke up, I felt momentarily better but then became consumed with the same obsessive thoughts, this time that I had made the wrong decision by breaking up. So there is no peace down either pathway. I have recommitted to the relationship and my partner has been very understanding and decided to take me back, but I am consumed by guilt and I know I cannot do this again and will have to work to regain their trust. And of course, the act of recommitting has brought my obsessive thinking into overdrive again. I will note that neither of us want marriage or children, but I still feel horrible about the thought that I have made the wrong decision and will have to break up with them again down the line.
This is my first serious relationship, but it’s not my first bout of this kind of obsession. When I was single, it was herpes in all forms; I had a weeks-long meltdown after I accidentally drank out of the glass of a friend who sometimes gets cold sores. After an ex had a bedbug scare, I became so obsessed with bedbugs that I covered all my furniture in plastic wrap and was up at 3am crawling around with a flashlight. I have bouts of severe anxiety about losing my hair (I’m a cis woman) despite a dermatologist telling me I have no signs of hair loss; I spent years obsessing over some barely-visible fine lines on my face in my early 20s, and every time I’ve gone on a sensible diet to lose 5 holiday pounds or whatever I end up escalating into borderline starvation. Health anxiety was my biggest problem when I was younger, and I thought I was cured but I have realized that the anxiety has just taken different forms.
I honestly can’t think of a time in my life when I wasn’t obsessing over something. Before I started obsessing about the relationship being “right”, I was consumed by obsession that my partner would leave me, or that I wasn’t attractive enough for them, and so on and so forth. It’s pretty bad. I’ve been very resistant to trying medication just trying to “tough it out”, because there are always a few days here and there where I do feel better. I’ve finally caved and am trying an anti-anxiety med but I’ve only been taking it for 2 weeks so it’s too soon to tell it it’s doing anything.
So…this sounds like OCD, right? I’ve been in therapy for many years but I don’t think my current therapist is helping and she doesn’t try to direct our sessions toward any sort of treatment protocol. So I’m thinking about looking for a therapist who specializes in OCD but I’m not sure what to look for.
I also tried to get an assessment from a psychiatrist, but I live in Canada and it’s not very easy to do that. I asked a GP but was told that medication is the same for anxiety or OCD so there is no point in getting a diagnosis. Is that true?
I guess I’m just looking for hope by posting this and some kind of direction. I don’t know if I can repair my relationship or what the future holds for me and it’s pretty scary right now. I feel like a terrible person and a big mess who can’t trust myself.
So I’ll start with the relationship stuff. I’ve been in an LTR for several years. When I look at the relationship objectively, it is generally good, with some issues like any relationship has. (I don’t want to get into the details because I feel asking for feedback on that is the same checking/reassurance seeking behaviour that I should avoid.) But in the past year I have struggled with extreme bouts of anxiety and rumination over whether the relationship is right for the long term and as a result I have ended the relationship twice. I get obsessed with the idea that we won’t be compatible anymore in 5 or 10 years and then we’ll have to break up then and I’ll have caused so much more damage to their life and then I’ll be too old and ugly and nobody will ever want me again.
When I broke up, I felt momentarily better but then became consumed with the same obsessive thoughts, this time that I had made the wrong decision by breaking up. So there is no peace down either pathway. I have recommitted to the relationship and my partner has been very understanding and decided to take me back, but I am consumed by guilt and I know I cannot do this again and will have to work to regain their trust. And of course, the act of recommitting has brought my obsessive thinking into overdrive again. I will note that neither of us want marriage or children, but I still feel horrible about the thought that I have made the wrong decision and will have to break up with them again down the line.
This is my first serious relationship, but it’s not my first bout of this kind of obsession. When I was single, it was herpes in all forms; I had a weeks-long meltdown after I accidentally drank out of the glass of a friend who sometimes gets cold sores. After an ex had a bedbug scare, I became so obsessed with bedbugs that I covered all my furniture in plastic wrap and was up at 3am crawling around with a flashlight. I have bouts of severe anxiety about losing my hair (I’m a cis woman) despite a dermatologist telling me I have no signs of hair loss; I spent years obsessing over some barely-visible fine lines on my face in my early 20s, and every time I’ve gone on a sensible diet to lose 5 holiday pounds or whatever I end up escalating into borderline starvation. Health anxiety was my biggest problem when I was younger, and I thought I was cured but I have realized that the anxiety has just taken different forms.
I honestly can’t think of a time in my life when I wasn’t obsessing over something. Before I started obsessing about the relationship being “right”, I was consumed by obsession that my partner would leave me, or that I wasn’t attractive enough for them, and so on and so forth. It’s pretty bad. I’ve been very resistant to trying medication just trying to “tough it out”, because there are always a few days here and there where I do feel better. I’ve finally caved and am trying an anti-anxiety med but I’ve only been taking it for 2 weeks so it’s too soon to tell it it’s doing anything.
So…this sounds like OCD, right? I’ve been in therapy for many years but I don’t think my current therapist is helping and she doesn’t try to direct our sessions toward any sort of treatment protocol. So I’m thinking about looking for a therapist who specializes in OCD but I’m not sure what to look for.
I also tried to get an assessment from a psychiatrist, but I live in Canada and it’s not very easy to do that. I asked a GP but was told that medication is the same for anxiety or OCD so there is no point in getting a diagnosis. Is that true?
I guess I’m just looking for hope by posting this and some kind of direction. I don’t know if I can repair my relationship or what the future holds for me and it’s pretty scary right now. I feel like a terrible person and a big mess who can’t trust myself.
Im sorry you're going through this. It sucks. You sound like you've got something OCD-adjacent. Diagnoses in mental health are really shorthands for therapists to refer to vague groupings of problems, rather than the highly specific and measurable criteria used for physical illnesses. A therapist who is trained to treat OCD will still have a better understanding of how to help you than someone who is a general talk therapy counsellor.
I recommend you find out which techniques, or modalities as they are formally called, are used to treat OCD and find a therapist in your area who can provide it privately for you (assuming you've got funds accessible). Therapists will generally provide a quick 15 minute assessment for free to understand your predicament and see if they can help you - they will not find out you lack a formal diagnosis and automatically reject you, don't worry. Good luck! Switching from talk therapy to one specialised in my issues had a huge effect on me, and I'm sure it will for you too.
posted by wandering zinnia at 3:05 PM on April 28, 2023 [3 favorites]
I recommend you find out which techniques, or modalities as they are formally called, are used to treat OCD and find a therapist in your area who can provide it privately for you (assuming you've got funds accessible). Therapists will generally provide a quick 15 minute assessment for free to understand your predicament and see if they can help you - they will not find out you lack a formal diagnosis and automatically reject you, don't worry. Good luck! Switching from talk therapy to one specialised in my issues had a huge effect on me, and I'm sure it will for you too.
posted by wandering zinnia at 3:05 PM on April 28, 2023 [3 favorites]
What a strange thing for your GP to say. Try again to get in with a psychiatrist (even if you have to wait awhile—the GP can manage meds until then), and you need to find a therapist trained in OCD, specifically exposure response prevention— there is lots of data to support the effectiveness of ERP. Note many therapists are NOT actually trained in OCD and appropriate therapeutic interventions, so people often find themselves, like you, deeply suffering with no improvement in symptoms despite months or years of therapy, and thinking something is wrong with them. OCD is a very biological illness, and a very treatable one. Good luck.
posted by namemeansgazelle at 4:43 PM on April 28, 2023 [4 favorites]
posted by namemeansgazelle at 4:43 PM on April 28, 2023 [4 favorites]
Most certainly take the good advice above. I agree that you need to change your therapist, and I'm certainly not impressed with your GP. However, keep taking your current meds until you are established with a psychiatrist, and then follow their prescribed meds.
posted by BlueHorse at 6:53 PM on April 28, 2023 [1 favorite]
posted by BlueHorse at 6:53 PM on April 28, 2023 [1 favorite]
I’ve struggled with anxiety to varying degrees for a couple decades. The most helpful guidance (supplemented by helpful prescriptions) I received was when I was at my personal worst, obsessing over a truly distressing relationship situation. I was doing repetitive behaviors specific to my anxieties linked to the particulars of this difficult relationship situation. It was impacting my ability to get thru my day to day, in addition to the effects of my (elevated) familiar anxiety symptoms. A psychiatrist told me that obsessive thoughts and behaviors were on the same spectrum as the panic attacks and pervasive worry I was used to experiencing. For me, that and a med change were what I needed. Knowing that it was my “regular” anxiety manifesting in a more intense way was a relief for me.
posted by OrangeVelour at 8:16 PM on April 28, 2023
posted by OrangeVelour at 8:16 PM on April 28, 2023
I'm so sorry you're going through this. It's really difficult and exhausting. It might be illuminating for you to look up "Pure O" OCD.
This sounds so familiar — I have been plagued with similar thoughts for most of my life — but there is definitely, definitely hope. Once I found a medication that worked for me, my obsessive thoughts reduced 75%, and that was before I even started therapy. It was like night and day.
It's true that many of the same medications are used for both OCD or anxiety, but the key is finding the one which works for your specific brain chemistry — which, unfortunately, can be a bit of a roll of the dice, whether you're treating anxiety, OCD, or even depression. I think the most important thing is to find a doctor who will work with you, patiently, to try out different meds until you hit on one that makes a significant difference in your symptoms. This is often a psychiatrist rather than a GP, since psychiatrists have more experience prescribing for specific conditions, titrating doses, being attentive to side effects, etc.
To me, the fact that your GP doesn't think diagnosis is important indicates that they might not be this kind of attentive prescriber. I would keep trying for a referral to a psychiatrist. In Canada, if you can find a doctor whose office is part of a primary care network, they often have more established connections to specialists like psychiatrists.
Because the nature of the obsessions often shifts or changes, a mindfulness-based therapist with a strong Buddhist background really helped me address the underlying thought pattern and experience less distress about looping thought patterns when they did recur.
posted by fire, water, earth, air at 8:46 PM on April 28, 2023 [2 favorites]
This sounds so familiar — I have been plagued with similar thoughts for most of my life — but there is definitely, definitely hope. Once I found a medication that worked for me, my obsessive thoughts reduced 75%, and that was before I even started therapy. It was like night and day.
It's true that many of the same medications are used for both OCD or anxiety, but the key is finding the one which works for your specific brain chemistry — which, unfortunately, can be a bit of a roll of the dice, whether you're treating anxiety, OCD, or even depression. I think the most important thing is to find a doctor who will work with you, patiently, to try out different meds until you hit on one that makes a significant difference in your symptoms. This is often a psychiatrist rather than a GP, since psychiatrists have more experience prescribing for specific conditions, titrating doses, being attentive to side effects, etc.
To me, the fact that your GP doesn't think diagnosis is important indicates that they might not be this kind of attentive prescriber. I would keep trying for a referral to a psychiatrist. In Canada, if you can find a doctor whose office is part of a primary care network, they often have more established connections to specialists like psychiatrists.
Because the nature of the obsessions often shifts or changes, a mindfulness-based therapist with a strong Buddhist background really helped me address the underlying thought pattern and experience less distress about looping thought patterns when they did recur.
posted by fire, water, earth, air at 8:46 PM on April 28, 2023 [2 favorites]
Just want to note before OP starts obsessing over their GP being bad for not providing a psychiatrist, I'm in Canada and I've heard the exact same thing from multiple GPs. They're not being negligent, just realistic, because this is how stuff is here. I've lived in two major Canadian cities and had 3 GPs and two social workers due to some major mental health stuff. They've all told me straight up that getting a psychiatrist appointment without actual hospitalization is nearly impossible. I was able to see one because of a unique program in my city, but getting a referral through a GP usually means a multi-year wait. If you have money you can go the private route, and that's what I plan to do if I ever need to change my meds again. But for the foreseeable future my GP just refills my meds and monitors things.
And this is besides the issue that trying to change GPs in Canada is very difficult — another multi-year wait to find one, and then a lot of scrutiny as to why you changed. None of them are required to accept you, so if you don't have a good reason they might just decline if they think you're going to be a problem.
Anyway, your GP can prescribe OCD meds. Your GP can also officially diagnose OCD, you don't need to see a psychiatrist for that. The boundary between what is and is not OCD is fuzzy — diagnoses of mental health issues are usually a best-guess, not an objective truth. It's up to you whether you want a "real" diagnosis from a psychiatrist or whether you're fine with just treating your issues "as if" you had OCD. But whether you want a psychiatrist or not, for the short term you need to create a treatment plan. An OCD-specific therapist and/or a social worker can help you create that plan and talk through options.
posted by 100kb at 1:06 PM on April 29, 2023 [1 favorite]
And this is besides the issue that trying to change GPs in Canada is very difficult — another multi-year wait to find one, and then a lot of scrutiny as to why you changed. None of them are required to accept you, so if you don't have a good reason they might just decline if they think you're going to be a problem.
Anyway, your GP can prescribe OCD meds. Your GP can also officially diagnose OCD, you don't need to see a psychiatrist for that. The boundary between what is and is not OCD is fuzzy — diagnoses of mental health issues are usually a best-guess, not an objective truth. It's up to you whether you want a "real" diagnosis from a psychiatrist or whether you're fine with just treating your issues "as if" you had OCD. But whether you want a psychiatrist or not, for the short term you need to create a treatment plan. An OCD-specific therapist and/or a social worker can help you create that plan and talk through options.
posted by 100kb at 1:06 PM on April 29, 2023 [1 favorite]
I think you need both treatments, for now. Therapy and medication. I don’t know if this has any resonance with you but I have cyclical depression (hormones) and it has been helped tremendously to finally get some medication even though it comes and goes. And the therapy that I finally got (from someone with a focus on mindfulness) was also a help with rumination and other issues. Clearly, this is affecting your life and livelihood. Taking medication doesn’t have to be forever and it may take a few tries to get it right. That’s okay. And I still get depressed which is annoying. But the therapy and medication makes things tolerable and manageable.
posted by amanda at 10:18 PM on April 29, 2023
posted by amanda at 10:18 PM on April 29, 2023
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posted by shadygrove at 1:44 PM on April 28, 2023 [1 favorite]