Coping Strategies

OCD and Procrastination

When my son Dan's obsessive-compulsive disorder was at its worst, he would spend hours at a time doing nothing (except obsessing and ritualizing of course), even though he so wanted to successfully complete his freshman year of college. It was frustrating and heartbreaking for me to watch. Why couldn't he just do his work?

Procrastination in those with OCD is not unusual, and  my guess is there are many reasons why this is true. For Dan at this time, OCD was definitely calling the shots, telling him when and where he could or could not do his schoolwork. Also he is a perfectionist, which is a common trait for those with OCD. But he was dealing with unhealthy perfectionism characterized by fear, doubt, and control. It's not hard to see how this could lead to procrastination. Mistakes were not an option, and the only way to not make mistakes is to just put off doing the task, or worse, not attempt it at all.

Coping Strategies

What Happens After Residential Treatment?

My son Dan spent nine weeks at a residential treatment program for OCD. When my husband and I decided it was time for him to come home, I was ambivalent to say the least. As I said in my book:

On one hand I was thrilled he'd be home in five days, and on the other hand I was terrified he'd be home in five days.

Many people who attend residential treatment programs for OCD are there because their OCD has become so unbearable that they feel they have no other choice. They are severely debilitated. As I've said many times before, Dan entered the residential program in the worst condition of his life. But he wasn't the only one affected; our whole family also suffered.


OCD and Chemical Imbalance

While the cause of obsessive-compulsive disorder is not actually known, many professionals and lay people often attribute the disorder to a chemical imbalance. SSRIs, which are medications that affect serotonin, are known to reduce symptoms in a good number of people with OCD. So it is reasonable to deduce that serotonin levels in those with OCD must be out of whack, right?

Well, not necessarily. That explanation is way too easy, and certainly has never been proven. Drugs often help people with all types of illnesses, but how and why they help are not always clear.  And I'm not just talking about medications for brain disorders. There are a number of cholesterol medications, blood pressure medications, anxiety-reducing  medications, rheumatoid arthritis medications - just to name a few - that work to reduce symptoms. Different drugs work for different people, and we don't always know why. Why does acetaminophen help my husband's headache but only ibuprofen works for me?


“Just Right” OCD

If you or a loved one has obsessive-compulsive disorder, you know that OCD typically attacks what matters the most to you - your values.

Is a loving relationship the most important thing in your life? OCD will make you question it. Working toward the career of your dreams? OCD might tell you it’s not for you or there’s no way you’ll be successful. Wouldn’t hurt a fly? OCD will try to convince you you’re a danger to others. In my son Dan’s case, OCD stole his joy, his art, and everything else he held dear.


OCD and Sleepwalking

Sleep is often a big issue for those with obsessive-compulsive disorder. In fact, this post on sleep written over three years ago continues to be one of my most popular. Too much sleep, too little sleep, trouble falling asleep and trouble staying asleep all have the potential to exacerbate OCD.

Coping Strategies

Treatment-Resistant OCD

Over the years I have received emails from people with obsessive-compulsive disorder who tell me their OCD is treatment resistant. In some cases they have been told this by a professional, and in other instances people have come to this conclusion on their own.

In writing this post, I figured it would be a good idea to first define treatment resistance in OCD. Surprisingly, I came across some conflicting information on several sites. Does it mean the patient has no improvement at all even when all proper therapies have been attempted? Does it mean there might be a small improvement but not enough to make a difference in the quality of life of the person with OCD? Does it mean nothing will ever help? Check out the definition of treatment-resistant OCD in this article:

Treatment resistant OCD is generally defined by two adequate attempts with SRIs. SRIs stand for a class of medication called antidepressants. They include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

While a few articles I read said that treatment-resistant OCD and treatment-refractory OCD were interchangeable terms, this one said they are very different, and went on to define treatment-refractory OCD:

True treatment-refractory OCD can only be determined if a person has tried, at a minimum, three different SSRIs at a maximum dosage for at least 3 to 6 months each (with the TCA clomipramine being one of them). They must have also undergone behavioral therapy while on a therapeutic dose of an SSRI, and lastly, have received at least two atypical anti-psychotics as augmenters while receiving behavioral therapy and taking the SSRIs.

With these varied (and somewhat vague…CBT for how long?) definitions, how can anyone  be sure what their health-care providers mean when they say, “Your OCD is treatment resistant?” The above definition of treatment resistance would have fit for my son Dan, as medication never seemed to help him. But he recovered from severe OCD once he embraced exposure and response prevention (ERP) therapy. His OCD went from severe to mild and he continues to do well seven years later.

It’s confusing to say the least. So many definitions and interpretations. Most of the articles I read focused mainly on all the possible combinations of medications that could be attempted before the label of “treatment-resistant” is applied. But hidden amid the treatment options of novel medications and neurosurgery was this sentence about Cognitive Behavioral Therapy (CBT):

As stated, most OCD sufferers have not received an adequate trial of behavioral therapy, which is ultimately the most effective way to beat OCD long-term.

While I don’t deny there are people out there who truly have treatment-resistant OCD, my hunch is there are many people with this label who can be helped with the proper treatment.

A valuable lesson learned from my son’s journey through severe OCD is that you can’t always believe everything everyone tells you. Whether you’ve been labeled treatment resistant by yourself or someone else, do whatever you can to get good ERP therapy. And then do yourself a favor and read this important article by Dr. Seth Gillihan; share it with your therapist if necessary. And don’t give up! I believe there is always HOPE for those with OCD.


OCD and Reading

As many of us already know, obsessive-compulsive disorder often latches on to the things that matter to us most. Your family and friends mean the world to you? Let's give you harming obsessions. You love to travel? OCD will set you up with fears of flying and staying in hotels. The list of possibilities is endless.

One of the obsessions that I often hear about that makes me particularly sad is reading. For so many people, reading is a simple yet vital part of their lives. Whether reading a newspaper for information, a textbook for studies, or a novel for sheer pleasure, OCD can proceed to take these everyday activities and turn them into vicious cycles of obsessions and compulsions.


Obsessive Decluttering

Hoarding has gotten a good deal of attention in the media over the last few years, and many of us are familiar with the fact that hoarding and obsessive-compulsive disorder are often related. The DSM-5, which is the classification and diagnostic tool of the American Psychiatric Association (APA), lists both hoarding and OCD in the category of Obsessive Compulsive and Related Disorders. In some cases, hoarding is even seen as a compulsion in OCD.

But what about the opposite of hoarding? What if you aren't able to keep anything? What if you feel compelled to rid yourself of your belongings and can't bear the thought of any "stuff" hanging around?


OCD and Neurofeedback

I came across a very interesting article a few days ago about a possible new treatment for OCD on the horizon. Nope, it's not a new medication, deep brain stimulation (DBS) or focused ultrasound. It involves real-time functional magnetic imaging (rt-fMRI), which is a type of brain imaging that gives patients immediate feedback regarding their neural activity. In other words, it utilizes neurofeedback.


The Truth About ERP Therapy

Last week, I wrote about how exposure and response prevention (ERP) therapy, the evidence-based psychological treatment for obsessive-compulsive disorder, is anxiety-provoking. Many people with OCD are aware of this fact, and it is often one of the reasons given by OCD sufferers for not attempting ERP. It's too scary.
Who wants to deliberately expose themselves to intense fear and anxiety?