OCD in general is something that many people aren't eager to share with others. After all, many popular depictions of OCD display the disorder as comical at best, and it's never fun to be known as the guy (or gal) with the mental disorder. This is especially true in the case of something like ROCD, where the disorder is directly related to those we would be most likely to turn to for support. The prospect of facing our significant other and saying, "Honey, I know I love you, but I have a disease that makes me think I don't. I know that hurts, but I'd like you to stick with me even if I feel compelled to tell you that I'm not sure I love you," isn't terribly appealing. Unfortunately, social support is a great predictor of positive outcomes in mental illness, so it's probably in our best interest to turn to someone. Still, it's easy to be skeptical of the help others will provide? Will they understand what we're experiencing, or just advise us to get out of what they assume is a bad relationship?
I've been to nervous about possible misunderstanding to even tell my therapist about my ROCD symptoms (though I plan to change that soon), and I only mentioned once (very offhandedly) to my fiance. How about you? Has anyone shared their struggle with their significant other, friends, or therapists? How did it go? Did they take it well, or in retrospect do you with you'd kept it to yourself? I'd love to know the best way to approach this (and I'm sure lot's of other people would like to know, too).
Monday, March 22, 2010
Monday, March 15, 2010
ROCD Book
If you've done much googling re: ROCD, you've probably come across a website offering a book written for the partners of those suffering from ROCD. "Sleeping with ROCD", by D.M. Kay, purports to offer advice and information to those who are in a relationship with an ROCD sufferer.
Like the only other source I've found on this topic (Dr. Phillipson's site), this book seems to be pretty much a one-of. I can't find it on Amazon, and hence I can't find any reviews. Has anyone read it? If so, did you find it useful? I'd love to find more information on this disorder, but so far info seems to be scarce. If you can speak to the value of the book, please do so. The more resources we have at our disposal, the better.
Your meds - don't stop taking them
To medicate or not to medicate, that is the question. If you've ever been diagnosed, or even if you've only considered seeking medical help for your symptoms, odds are you've dealt with this question. Medication offers the promise of many benefits - in combination with therapy, it's been shown to be the most effective treatment available for mood and anxiety disorders (OCD included). But of course, medication often carries side effects. Some are just a pain in the ass. When I first started taking meds, I was on Prozac. Although my depression and obsessions improved somewhat, I couldn't sleep. I eventually had to switch to Zoloft as a result.
Others, however, are more problematic because they bear a striking resemblance to the conditions you're taking them for. Take a look at the side effects for most SSRIs, and you'll see nervousness and anxiety on the list. That your meds might make your anxiety worse is bad enough. Even worse, though, is the paradox this can create. Let's say you start taking meds, and gradually your condition improves. But maybe not everything goes away. Maybe the depression gets a lot better, but you find that anxiety and obsessions are still lingering. Eventually, you might start to think that your depression is gone, and you might actually start blaming your meds for the anxiety (it's listed on the bottle, after all).
You'll find a bevy of articles and forums posts urging you not to do this. After all, if you're feeling better after taking meds, why stop? If you're like me,though, you'll do it anyway. If you're like me, you'll also regret it. I was supposed to go to the psychiatrist about a month and a half ago. At the time, I was doing fairly well, both in terms of depression and obsessions. So I forgot about the appointment. When I checked my voicemail about 3 weeks later and found out I had missed the appointment, I wrote it off. I was doing well, after all, so why go back to a doctor who would make me talk about my problems? I decided to leave well enough alone and just assume that the storm had passed. Mistake.
I ran out of Zoloft about 3 weeks ago. And about 1 week ago, things stated to go downhill. My obsessions returned, I started feeling depressed, etc. I've set up an appointment to go back to the psychiatrist,but I can't get in until April. In the meantime I'm hoping my Dr. will write me a hold-over prescription until she can see me.
The moral of the story - don't stop your meds abruptly. Depression, anxiety, and OCD are chronic conditions. Some people need to take medications for years, others might need them their whole life. This is nothing to fret about. After all, many diseases require lifelong treatment (diabetes, for example). Never give up on your treatment because your feeling better - those pills just might be the reason you're doing as well as you are. I know I'll sound like a commercial when I say this, but seriously, only your Dr. is going to know when and if you should be changing medications and doses. If you really disagree strongly with their opinion, than get a second one. But trust me, don't let the second one come from you.
Anyone else stopped their meds and regretted it? Or the opposite - any stories of successful withdrawal?
Others, however, are more problematic because they bear a striking resemblance to the conditions you're taking them for. Take a look at the side effects for most SSRIs, and you'll see nervousness and anxiety on the list. That your meds might make your anxiety worse is bad enough. Even worse, though, is the paradox this can create. Let's say you start taking meds, and gradually your condition improves. But maybe not everything goes away. Maybe the depression gets a lot better, but you find that anxiety and obsessions are still lingering. Eventually, you might start to think that your depression is gone, and you might actually start blaming your meds for the anxiety (it's listed on the bottle, after all).
You'll find a bevy of articles and forums posts urging you not to do this. After all, if you're feeling better after taking meds, why stop? If you're like me,though, you'll do it anyway. If you're like me, you'll also regret it. I was supposed to go to the psychiatrist about a month and a half ago. At the time, I was doing fairly well, both in terms of depression and obsessions. So I forgot about the appointment. When I checked my voicemail about 3 weeks later and found out I had missed the appointment, I wrote it off. I was doing well, after all, so why go back to a doctor who would make me talk about my problems? I decided to leave well enough alone and just assume that the storm had passed. Mistake.
I ran out of Zoloft about 3 weeks ago. And about 1 week ago, things stated to go downhill. My obsessions returned, I started feeling depressed, etc. I've set up an appointment to go back to the psychiatrist,but I can't get in until April. In the meantime I'm hoping my Dr. will write me a hold-over prescription until she can see me.
The moral of the story - don't stop your meds abruptly. Depression, anxiety, and OCD are chronic conditions. Some people need to take medications for years, others might need them their whole life. This is nothing to fret about. After all, many diseases require lifelong treatment (diabetes, for example). Never give up on your treatment because your feeling better - those pills just might be the reason you're doing as well as you are. I know I'll sound like a commercial when I say this, but seriously, only your Dr. is going to know when and if you should be changing medications and doses. If you really disagree strongly with their opinion, than get a second one. But trust me, don't let the second one come from you.
Anyone else stopped their meds and regretted it? Or the opposite - any stories of successful withdrawal?
**UPDATE**
Just wanted to note that I've added two links to the blog. The first goes to the International OCD Foundation. They're dedicated to researching and treating OCD. The second goes to OCD Online, a website set up by Dr. Steven Phillipson. A far as my searching has been able to reveal, he's the only person with a "Dr." in front of his name talking about ROCD, so he's really the only authority on the subject around.
If you know any links that provide useful info on OCD in general or ROCD in particular, feel free to pass them along. If I check it out and agree, I'd be happy to add it to the list. I'll also be adding more links of my own as time goes on, so check back often for more useful links.
If you know any links that provide useful info on OCD in general or ROCD in particular, feel free to pass them along. If I check it out and agree, I'd be happy to add it to the list. I'll also be adding more links of my own as time goes on, so check back often for more useful links.
Misery Loves Company: The Co-morbidity of Depression and Anxiety Disorders
You may have wondered why my previous posts talk so much about depression when the title of this blog states that it's concerned with ROCD. Well, wonder no longer. If you read my previous post (The Unbearable Uncertainty of Psychiatric Medicine), you know that I've been diagnosed with depression and, later, agitated depression. So why am I so concerned with ROCD? Because I believe I suffer from it in addition to depression, but that my OCD has been overlooked.
And there's at least some reason to think I might be right. Studies have shown that roughly 50% of patients in the community who are diagnosed with a mood disorder (such as depression or bipolar disorder) also meet the criteria for an anxiety disorder (such as generalized anxiety disorder, OCD, or panic disorder). Among those in primary care situations (whose condition is presumably worse),that figure is 75%. In other words, about half of those who suffer from depression also have an anxiety disorder. Why? That's less clear. Researchers have several competing hypotheses. One is that mood and anxiety disorders are caused by very similar biological mechanisms. Afterall, both seem to respond to the same medications, so it makes sense to postulate that they share a common root. Still, while many people with one disorder have the other, not all of them do, so this can't be the whole story.
Another viable hypothesis is that the two types of disorder feed into each other. If you spend a good part of your day feeling anxious or obsessing over the reality of your love, you're probably not going to be very happy, are you? Likewise, if you're feeling down all the time, you're likely to find yourself worrying about the future more than most.
These are both theories for now - we know that depression and anxiety are often co-morbid, but we don't know why. Have any of you been diagnosed with both a mood and anxiety disorder? Or are any of you (like me) convinced that you have both even though you've only been diagnosed with one? I'd love to hear your thoughts on this.
And there's at least some reason to think I might be right. Studies have shown that roughly 50% of patients in the community who are diagnosed with a mood disorder (such as depression or bipolar disorder) also meet the criteria for an anxiety disorder (such as generalized anxiety disorder, OCD, or panic disorder). Among those in primary care situations (whose condition is presumably worse),that figure is 75%. In other words, about half of those who suffer from depression also have an anxiety disorder. Why? That's less clear. Researchers have several competing hypotheses. One is that mood and anxiety disorders are caused by very similar biological mechanisms. Afterall, both seem to respond to the same medications, so it makes sense to postulate that they share a common root. Still, while many people with one disorder have the other, not all of them do, so this can't be the whole story.
Another viable hypothesis is that the two types of disorder feed into each other. If you spend a good part of your day feeling anxious or obsessing over the reality of your love, you're probably not going to be very happy, are you? Likewise, if you're feeling down all the time, you're likely to find yourself worrying about the future more than most.
These are both theories for now - we know that depression and anxiety are often co-morbid, but we don't know why. Have any of you been diagnosed with both a mood and anxiety disorder? Or are any of you (like me) convinced that you have both even though you've only been diagnosed with one? I'd love to hear your thoughts on this.
The Unbearable Uncertainty of Psychiatric Medicine
I'd like to start this post by noting that I have the utmost respect for psychiatric medicine. Before the 1950s, someone suffering form a mental disorder would have been psychoanalyzed at best and burned at the stake at worst (or at least shunted off to a sanitarium). In just 60 short years we've taken the treatment of disorders like depression and OCD from laying on a couch talking about your dreams and your mom to SSRIs, SNRIs, anti-psychotics, and a host of other psychoactive medications. We
Still, being only 60 years old makes psychiatry a fairly young medical discipline, and the field is still going through some fairly obvious growing pains. Anyone whose been diagnosed with a mental disorder will be very familiar with how these pains manifest themselves. I was diagnosed with major depressive disorder about 7 months ago, and later that diagnosis was changed to "agitated depression". Psychiatric medicine has been making a big push recently to have the public view psychiatric disorders like OCD the same way they view diseases like diabetes and cancer. Diabetes, in fact, is the disease I've probably seen used most often in analogies. You wouldn't blame someone for their diabetes, so you should blame them for their (insert disorder here).
Such analogies are all well and good, and indeed are supported by substantial research on genetic and biological contributors to mental disorder. Still, there is one key difference between mental disorders and conditions like diabetes that makes being diagnosed with and treated for the former a harrowing and doubt-ridden process.
Suppose you were experiencing frequent urination and excessive fatigue. Plug those in to webMD, and you'll find that you could have (among other things) a urinary tract infection, type 1 diabetes, or mono. If your doctor suspects you have diabetes, one of the first things they'll do is prick your finger. If your blood-sugar level is too high, your doctor has a pretty solid reason to think it's diabetes (and not any of the other potential culprits). The diagnosis is unpleasant, but hey, at least you know for sure - and your doctor nows how to treat it, and why that treatment will work.
Now let's try a different scenario. You're feeling sad and you find yourself worried more often than not. You go to a psychiatrist or psychologist. They ask you some questions, then diagnose you with major depression (or dysthimia, or generalized anxiety disorder, or OCD, or any of several disorders that present those symptoms) and prescribe an SSRI. There's no blood test, no body scan, no X-ray. That's because, although researchers have some good ideas as to what might be going on inside your brain when you feel depressed or anxious, they don't know the specifics. For example, the standard medication for depression, GAD, and OCD is SSRIs like zoloft or prozac. This is because affecting neurotransmitters like seratonin seems to alleviate symptoms of anxiety and depression. The resulting assumption is that some dysfunciton in these transmitters causes mood and anxiety disorders.
What we don't know, though, is why this is the case. Monamines might play a role in both depression and OCD, but is this because they have a common biological cause that is split into different symptoms by environmental factors or because they stem from seperate biological processes that just happen to both affect monamines?
For me, I've really struggled with the uncertainty of my diagnosis. I was diagnosed with depression first. When I kept reporting atypical symptoms, such as racing thoughts, irritability, anxiety, and emotional numbness, I was diagnosed with "agitated depression", which is basically depression with mild psychotic/anxiety overtones. I still don't think that's an accurate diagnosis (during the trip I was diagnosed my therapist also screened me for schizophrenia and bipolar), but of course there's no way to know.
How about you? Have you struggled with accepting your diagnosis? Do you wish there was a blood test for mental disorders? Would you want to take it there was?
Still, being only 60 years old makes psychiatry a fairly young medical discipline, and the field is still going through some fairly obvious growing pains. Anyone whose been diagnosed with a mental disorder will be very familiar with how these pains manifest themselves. I was diagnosed with major depressive disorder about 7 months ago, and later that diagnosis was changed to "agitated depression". Psychiatric medicine has been making a big push recently to have the public view psychiatric disorders like OCD the same way they view diseases like diabetes and cancer. Diabetes, in fact, is the disease I've probably seen used most often in analogies. You wouldn't blame someone for their diabetes, so you should blame them for their (insert disorder here).
Such analogies are all well and good, and indeed are supported by substantial research on genetic and biological contributors to mental disorder. Still, there is one key difference between mental disorders and conditions like diabetes that makes being diagnosed with and treated for the former a harrowing and doubt-ridden process.
Suppose you were experiencing frequent urination and excessive fatigue. Plug those in to webMD, and you'll find that you could have (among other things) a urinary tract infection, type 1 diabetes, or mono. If your doctor suspects you have diabetes, one of the first things they'll do is prick your finger. If your blood-sugar level is too high, your doctor has a pretty solid reason to think it's diabetes (and not any of the other potential culprits). The diagnosis is unpleasant, but hey, at least you know for sure - and your doctor nows how to treat it, and why that treatment will work.
Now let's try a different scenario. You're feeling sad and you find yourself worried more often than not. You go to a psychiatrist or psychologist. They ask you some questions, then diagnose you with major depression (or dysthimia, or generalized anxiety disorder, or OCD, or any of several disorders that present those symptoms) and prescribe an SSRI. There's no blood test, no body scan, no X-ray. That's because, although researchers have some good ideas as to what might be going on inside your brain when you feel depressed or anxious, they don't know the specifics. For example, the standard medication for depression, GAD, and OCD is SSRIs like zoloft or prozac. This is because affecting neurotransmitters like seratonin seems to alleviate symptoms of anxiety and depression. The resulting assumption is that some dysfunciton in these transmitters causes mood and anxiety disorders.
What we don't know, though, is why this is the case. Monamines might play a role in both depression and OCD, but is this because they have a common biological cause that is split into different symptoms by environmental factors or because they stem from seperate biological processes that just happen to both affect monamines?
For me, I've really struggled with the uncertainty of my diagnosis. I was diagnosed with depression first. When I kept reporting atypical symptoms, such as racing thoughts, irritability, anxiety, and emotional numbness, I was diagnosed with "agitated depression", which is basically depression with mild psychotic/anxiety overtones. I still don't think that's an accurate diagnosis (during the trip I was diagnosed my therapist also screened me for schizophrenia and bipolar), but of course there's no way to know.
How about you? Have you struggled with accepting your diagnosis? Do you wish there was a blood test for mental disorders? Would you want to take it there was?
What is Relationship Substantiation OCD?
I'm working under the assumption that you find this site via one of two types of google searche:
- "rocd", "relationship substantiation", "relationship ocd", or some other such permutation.
- "am I in love with my girlfriend/boyfriend/husband/wife" or some other general search involving the "realness" of your feelings for someone important to you.
If you've come here via the first route, then you probably already stopped by Dr. Philipson's article and thus have a solid working definition. If you came via the second route (or otherwise missed over the aforementioned article), then this post will help to fill you on what may be the cause of your worries and doubts.
Relationship obsessive compulsive disorder (hereafter referred to as ROCD) is an informal term for a specific flavor of OCD that centers on doubts concerning the reality of one's feelings for one or more important others. I say that ROCD is an "informal term" because the guidebook of psychiatric diagnosis, the DSM IV, doesn't differentiate between different forms of OCD based on their subject. So you wouldn't be likely to be diagnosed with ROCD anymore than you would to be diagnosed with "Germ OCD" or "Counting OCD". Still, for those who suffer form a particular form of the disorder, seeing their symptoms grouped and labeled can help to alleviate the sense of isolation and fear that such symptoms can bring.
This seems to be true of ROCD more so that probably any other flavor of the disorder (except, perhaps, the distinct but often related phenomenon of HOCD, which, though not the main focus of this blog, will be given due attention in time). Usually, ROCD is talked about in conjunction with romantic relationships, although one could theoretically experience similar doubts in relation to anyone toward whom you do (or think you should) feel love or affection. ROCD typically manifests itself as baseless doubts about the reality of one's previously unquestioned love for another, undue fixation on minor flaws that were previously unnoticed or rightly observed to be irrelevant, uncertainty as to whether the person you are with is "the one", and a near constant state of checking for confirmation of one's feelings.
Like most forms of OCD, ROCD tends to revolve around "spikes", or periods of intense anxiety set off by some stimulus in the environment. A typical ROCD spike might go something like this: You're hanging out with your fiance', having a good time, when you lean in for a kiss. After the kiss, you exchange "I love you". Then the spike hits: do I really love her? What if I'm lying to her? Did I really enjoy that kiss? How can I know for sure? In the wake of the spike, the ROCD suffer will place the rest of the interaction under the microscope, looking for evidence to invalidate their doubts. The reaction to every kiss will be examined, gauged, and compared to past kisses (Was this as good as it used to be? What if we're falling out of love?) and/or some ideal of what a kiss should be (Did that kiss make me feel like he kiss of true love is supposed to? What if it didn't?). Jokes and laughs will be evaluated (Did I really think what she said was funny? Was I just laughing because I'm supposed to?), and minor flaws will be attended to as though they were grave offenses (She said she was going to make us tea, but then she got on her laptop. If she loved me, wouldn't she have gotten me tea?).
Spikes can also occur in the absence of one's significant other. The sufferer may find his or herself analyzing how much they miss their partner when they are not with them in order to determine if they are sufficiently distraught, and feelings of contentment or enjoyment in the absence of one's partner may be interpreted as evidence that their love for their partner is absent or insufficient to justify a committed relationship.
It's not hard to see how such spikes, accumulated over time, can lead to an incredible amount of torment for the one experiencing them. Often, those who suffer from ROCD will enjoy the company of their significant other and, on some level, know they are in love with them. However, the constant barrage of what if's and doubts will not abate. This is a common factor of all forms of OCD: those who are obsessed with germs cannot dispel the thought that a stranger's hand may be crawling with lethal pathogens, those obsessed with the idea that they may have hit someone with their car cannot stop themselves from worrying about this possibility, and those who experience images of inappropriate violent or sexual acts cannot relieve the anxiety these thoughts bring. Another common thread in OCD is that suffers often know just how ridiculous their fears are. Most suffers know that the strangers hand is not coated with the Ebola Virus, that the bump they felt was a pothole and not a pedestrian, and that they would never even dream of acting on the inappropriate images that flood their minds. Yet the anxiety persists. Similarly, those suffering from ROCD may know that their partners flaws are insignificant (or even endearing), that it is ok to enjoy leisure time alone, and that their feelings of love are present and genuine. Still, the doubts refuse to abate.
Because the doubts that ROCD elicits cause sufferers to place their thoughts, behaviors, and feelings under the microscope, the disorder can set up something of a feedback loop. Because we doubt our feelings, we examine them closely to see if they are real. Feelings such as love and affection are natural, automatic feelings, however, and looking for them purposely is almost guaranteed to snuff them out. Thus, our search will almost always be in vain, thus feeding our doubts and intensifying our self-defeating search. Further, such self-scrutiny tends to be spurred on by anxiety, and anxiety tends to overshadow any positive feelings that might otherwise be present. In other words, it's very hard to feel warm and affectionate while you're busy being anxious about whether you're feeling warm and affectionate.
I hope this post conveyed the essence of ROCD, at least enough so that we can all be on the same page when we talk about the disorder. In summary, ROCD is a flavor of OCD in which one doubts the reality of one's love for another. This doubt causes one to constantly evaluate romantic moments, expressions of love, and even time apart to determine if these events elicit the proper and expected emotions. This scrutiny tend to snuff out normally naturally feelings like love and affection, and thus the search for confirmation actually increases our doubt.
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