Sounds of Bipolar: Audio Post

Here’s the Deal

Link to the Howie Mandel interview the post below is about.

Here’s the Deal—

I’d like to conclude this “series” with a clip from Dr. Drew.  Not normally a favorite show of mine—I like to stick to classier ones such as “Secret Life of an American Teenager” and “Bachelorette”. However, this one contains great information about OCD.

In 2009, Howie Mandel, the famous comedian, actor, and TV game show host revealed that he battles severe OCD. His “coming out” was completely accidental—it was during a moment of an OCD induced panic attack when he needed help.  I try to be very intentional about revealing my mental illness for two reasons. One, to save the world by raising awareness—so altruistic of me I know!  But two, selfishly—when I’m in crisis the last thing I want to do is explain the illness. Instead I just want to be able to reach out for help.

I love the way Howie describes OCD as a broken record. I’ve spent three posts trying to explain it—and he sums it up in about 100 words!  This analogy does a good job of explaining a key part of OCD—the thoughts are not abnormal, it’s the inability to transfer away from those thoughts.  This is more obvious in Howie’s struggle with germs than my struggles with repugnant obsessions.

I know the people in my company must have thoughts about avoiding germs—one of the main swag we give away is hand sanitizer.  At a recent conference,  I stole the entire basket of them and started passing them around to friends and strangers alike. I even demonstrated the proper use of them! Now, I’d had a few drinks, so my co-workers think it’s just a fun “drunken” story. In fact, it still gets retold at happy hour.  What they don’t know is that I had spent all morning obsessing about the germs I was getting shaking hands as I was meeting new people and well with the lowered inhibitions I did what I had been fantasizing about all day!

Howie has similar experiences where to the outside eye his compulsions are “funny” or “cool”, such as his fist bumps on TV shows instead of handshakes or his shaved head. What the outsider does not know is the intense anxiety that causes these actions.

One other interesting issue raised in the interview is just mentioned in passing. Dr. Drew mentions that in some way OCD can be a “gift” as there can be benefits from it, such as the ability to intensely focus on something. Howie responds “if this is a gift, I’d love to return it”. Normally, I totally agree with this point of view—I’d even be willing to pay for someone to take it back! However, I did write a post of why my husband is lucky I’m bipolar, so in some ways I do think there can be good in the disease.  What do you think? Should I look for the good in the disease? Is there benefit to acknowledging the slight benefits of the disease (you’ll never convince me these benefits outweigh the costs!)?

In conclusion, while I do not envy Howie’s intense struggle with OCD, I do envy his ability to reach so many people and begin to fight the stigma of mental illness. While I share with friends and family, I don’t have a nationally televised audience listening to me! But hopefully, I’m taking small steps in raising awareness and being able to say to fellow strugglers, “me too”.

There’s several other interviewsout there about Howie.  The one by ABC 20/20 is particularly interesting as it focuses more on the compulsions he has related to his OCD.

Here’s the link for the video I’ve been talking about.

http://www.youtube.com/watch?v=K-5nVzSkHbM&feature=related

My Personal OCD

Disclaimer: I would rate this post as PG-13

If I defined my relationship with OCD on facebook, the status would most definitely be “It’s complicated”. On one hand, it is the most manageable part of my mental illness. The medication prevents majority of the thoughts and the techniques I’ve learned manage the ones medication does not prevent. On the other hand, it can be the scariest and most disturbing part of my mental illness.

My struggle with OCD began at a very young age. I had several hamsters when I was younger. In true Nicole fashion, I liked the dwarf hamsters (the under dogs) and named them adorable things like Precious. I remember checking my hamster’s cage to make sure he had water several times before I would go to bed.  Then I’d lay awake waiting for my parents to go to sleep so I could get up and check it again. While lying in bed, all I could see was my poor hamster lying dead in his cage from dehydration.

I remember having disturbing thoughts of cutting myself as early as the age of 10. I have very vivid memories of thinking of cutting my legs, but more often my female parts. I never understood why I was cutting these parts, but now I’ve learned that this is “normal” since most OCD obsessions relate to violence and sexual perversion. The thoughts would appear without warning and plague me throughout the day. Even at night I could not escape them, as I would dream about harming myself.

As I got older and learned more about sexual acts and self-harm, the thoughts became more graphic and more frequent. [Side Note: The increase in frequency is a typical pattern of untreated OCD]. I told myself I was simply hearing voices—it was like the imaginary friend I had when I was younger. Except this friend was mean to me! Hearing voices is not particularly comforting, but it’s definitely more comforting than believing the horrible thoughts were my own.

I then started obsessing that I had been molested when I was younger—it got to the point that I had to quit volunteering with the church youth program because being around young children caused significant amounts of stress and anxiety. As the thoughts became more frequent I started avoiding certain people and situations that triggered the thoughts, or I believed had taken part in the abuse. While it would have been a great excuse if the situations were things like cleaning the bathroom or doing homework. But they weren’t. It was spending time with certain family and friends.

The thoughts continued to plague me. While on a road trip in college, hoping to restore the memory of the abuse, I   took a detour to South Carolina to see if I could find the house that I lived in when I was younger. Which if you know me is completely hilarious because sometimes I can’t even find my apartment now, let alone have a sense of direction for a house 15 years ago. I realized that, but the irrationality of the OCD thoughts had taken over.

I started to question if I was turned on when I taught young children swimming lessons, or took the Sunday school children to the bathroom.  Was I going to hurt one of them? Otherwise why would I be thinking these thoughts?!

I researched “repressed memories” and tried several techniques to bring those memories to life, hoping that remembering them would allow me to treat them—but I couldn’t because those memories did not exist. I was never abused.

It took me over a year of therapy to finally discuss the issue with Rick; by that time I had done enough research on OCD to know the thoughts were obsessions and not true. I bribed myself with slushies for a week before I finally brought it up. But his response was perfect; “First I’ll tell you what we’re not going to do—we’re not going to go back looking for memories that don’t exist.  What we are going to do is teach you how to handle/manage your OCD so it stops controlling your life.” I’ll discuss these techniques in a later post, but it was these sessions that finally freed me from the control of obsessions.

Opening up about my OCD is the scariest part of my illness. It makes me afraid that people will not want me around them or their children. Then I’ll have to turn into a crazy cat lady, and I don’t like cats nearly enough for that! I think it’s the one of the hardest mental illnesses to understand. After all, people without mental illness have feelings of intense sadness and stress, so on some level they can relate to depression and anxiety. But obsessions and compulsions are foreign to those who do not experience them.

Maybe at a later date I’ll share some of my journals when I was struggling with dark OCD thoughts…but the goal of this post was to provide an overview of my OCD experience.

The way Einstein understands OCD

Part Two: The “academic” side of OCD

Earlier this week, I shared an experience I was having with OCD. That experience was relatively minor, and a bit humorous.  While annoying and intrusive, the experience was not disturbing.  Wanting white clean teeth is a normal feeling and desire that many people have—the difference is that no matter how hard I try, I’m just not able to let it go.

In this post I want to go into a bit more detail about the disease that affects 1.6% of American Adults: the symptoms, the diagnosis, medication, and  the research surrounding it.

Question One: So, what is OCD?

“Obsessions intrude suddenly into your mind and are unwanted, inappropriate, and distressing. Once an obsession occurs it captures your attention, and it is very difficult to think of anything else.  Even if you are able to distract yourself from the obsession, the relief is only momentary because obsession occur again and again. OCD obsessions refers to unwanted, unwelcome, recurring thoughts that happen against your will and that are about unpleasant topics.”
Source: Overcoming Obsessive Thoughts : Christine Purdon and David Clark

Question Two: And in English that means?

An average human tends to produce over 25,000 thoughts a day. It’s a bit like a slot machine. The numbers, signs, and symbols are constantly running through the machine, and then by an outside force (pulling the lever in this case) the numbers stop. Let’s say one symbol is an ax—the chemically balanced brain might see it and think “hm, I could hack the person next to me with that”.  Their next thought would likely be “that’s weird” and then they’d move on to spin the dial again.  An unbalanced brain could think the same initial thought, but the response is different. They are unable to spin the dial again. Instead, thoughts of harming someone with the ax continues to plague them. Then they might think, “Wow to think that must mean I have violent tendencies”, and they run from the machine in fear. Eventually they might start avoiding casinos all together to avoid having obsessive thoughts.

A compulsion is an act repeated in the exact same way every time in an effort to “neutralize” a disturbing obsession. A study found that 61 percent of their sample of individuals with OCD had checking compulsions, 50 percent had washing compulsions, 36 percent had counting rituals, 34 percent needed to ask or confess, 28 percent showed symmetry and precision behaviors, and 18 percent showed hoarding (Overcoming Obsessive Thoughts). Checking can include counting, checking/seeking reassurance from other that harm hasn’t occurred, or mental self-reassurance (ie: determining how well characteristics of known pedophiles to match your own characteristics).

Question Three: So I’m actually OCD when?

Like any mental illness, OCD is difficult to diagnosis because worries and anxieties are a normal and expected part of life.  However, OCD obsessions are more extreme than “normal” experiences. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) that is used by mental health professionals to diagnose mental illnesses. To be diagnoses with OCD:

• You must have either obsessions or compulsions.
• You must realize that your obsessions and compulsions are excessive or unreasonable.
• Obsessions and compulsions significantly interfere with your daily routine.

Your obsessions must meet these specific criteria:

• Recurrent and persistent thoughts, impulses or images are intrusive and cause distress.
• The thoughts aren’t simply excessive worries about real problems in your life.
• You try to ignore or suppress these thoughts, images or impulses.
• You know that these thoughts, images and impulses are a product of your own mind.

Compulsions must meet these specific criteria:

• Repetitive behavior that you feel driven to perform, such as hand washing, or repetitive mental acts, such as counting silently.
• These behaviors or mental acts are meant to prevent or reduce distress about unrealistic obsessions.

Basically obsessions are having thoughts that are intrusive, unwanted, uncontrollable, uncharacteristic, and you are trying hard to resist them. The compulsions are acts you feel an urge to perform are intended cope with negative feelings or consequences. They are intentional, repetitive, excessive and make you feel a loss of control.

Source: Mayoclinic.com .

Question Four: So, my treatment options are?

The first drug class of choice tends to be SSRIs, such as Lexapro, Prozac, and Paxil. If that doesn’t work, another type of antidepressant called a tricyclic antidepressant such as Clomipramine, are available. These drugs are likely to have more side effects than SSRIs.

A combination of the two can also be prescribed. Like any mental illness, therapy (in combination with these medications) such as cognitive behavior therapy can be extremely effective. A licensed practitioner will likely employ some type of Exposure and Response Prevention. This treatment involves slowly exposing the individual to the distressing thought, and working on adapting the mental response to the external event. For example, if you struggle with thoughts on hitting people—you might work on patting someone on the back and identifying the false thoughts that you are a violent person.

These treatments can be very effective at managing the distress and intrusiveness caused by OCD. However, the longer it goes untreated the more disruptive to the individual’s life it can become. I’ll explore how this was the case for me in the next section.

For more good information on treatment, and OCD in general, visit: http://www.ocfoundation.org/index.aspx

Question Five: What are some examples?

I shared a less serious example of a OCD experience in the last post. However, obsessions are more often about more disturbing topics such as harming self or others, thoughts or urges of sexual acts you find personally disgusting, or blasphemous thoughts and actions.  The following two examples are from Overcoming Obsessive Thoughts:

Mario is a forty-three-year-old financial planner with two teenage daughters and a solid marriage that has just celebrated its twenty-second anniversary. He is a conscientious and hardworking university graduate who volunteers for a number of worth community causes, is well-like by neighbors and friends, and is admired for his determination and well-balanced approach to work, family, and community. And yet, Mario’s day is filled with unwanted thoughts of violence and aggression toward others; thoughts of kicking a pregnant woman who passes him on the street, of punching a colleague in the mouth for no apparent reason, or lunging toward his wife with the knife he is using to cut up vegetables. These unexpected and unwanted intrusive thoughts are extremely upsetting for Mario because they are totally against his character. After all, he is a fine, outstanding family man with strong moral values who is polite and gentle toward others. But here he is, plagued by violent and repulsive thoughts and images.

Cara is a twenty-four-year old mother of a four-year-old boy. She is a proud, loving parent who wants to provide the very best for her son. But shortly after arriving home with the infant, Cara, began having thoughts or doubts about whether she might sexually abuse the child. While changing her diaper or bathing her, she wondered if she felt sexually aroused. This doubt became so frequent and troubling that she avoided bathing or changing her daughter and relied on her husband or visiting friends to do so. Her days were fraught with high anxiety and fear.

Conclusions….

Hopefully, this gives you a bit of background about OCD…I eased you into OCD with the light post….a more academic understanding…and more intense one is to come…..

Daily flossing can add up to 6.4 years to your life….

After today, I’m going to live forever.

I’ve flossed over 100 times in the last 2 hours.  Literally, I lost track at a 100.

What? I’m sure you’re scratching your head in confusion. Well, a few posts ago I talked about walking the balance of pretending things are ok and letting people know I’m struggling.  In the vein of trying to open up more, I thought I’d share an OCD struggle I’m having right now.

I went to the dentist this morning, and they asked if I was a coffee drinker because there was a small stain on one of my front teeth. I’m not. So they said, “oh no big deal, just make sure you floss in the C-pattern and it will go away”.  I’m sure anyone with OCD knows where this story is going.

Well one area I’ve always struggled with OCD is germs.  I think about them all the time.  My grandma once told my husband that I used to wash my hands until they were red and chapped when I was younger. Flying in airplanes is terrible for me.  I’m not scared of heights (my dad is a pilot), but instead I’m constantly picturing the germs I’m being exposed to and can literally feel them running all over my body (ok not literally, but it sure feels that way).

I’ve been obsessing about flossing since the appointment. Since I don’t drink coffee the stain must be germs taking over my mouth. And thanks to those tramatizing cartoons they showed me when I was younger (see example below) I have a very detailed image of what they look like. So,from the minute they mentioned it, my fingers have been itching to touch some floss. However, I know it’s not good for me to over floss.  So instead I’m sitting at my desk mentally flossing.  And not just thinking about flossing, but literally moving through my head and flossing around each tooth, paying particular attention to the one with the stain.  And when I finish, moving back to the beginning and doing it all again.

I’m obsessing about it so much that I can’t focus on work. I’m hard at work (hardly working really) on writing a training plan and all I can see in my head is an image of the spot where they told me had a small stain. And then starts the flossing….

I can’t remember any of my techniques for dealing with OCD right now because I’m so completely focused on the tooth with the stain….and flossing to remove it.

I have a card with my OCD tool set on it—but it’s sitting at home somewhere in the dungeons of my desk because I have not needed it in a while.  I’ll have to go home at lunch to find it; the time it will take to do that will be made up for in an increase in productivity in the afternoon.  I hope.

Now…back to adding years to my life