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    Dr. Steven, my name is Alejandra and I haven currently started seeing a therapist for obsessive thoughts, anxiety and rumination. I have been told by the therapist that I show ocd tendencies. I believe I have Pure-O ocd because all of my obsession are mental. They range from obsessing over an underlying illness that I may have, to doubting my love for my partner, to questioning my sexuality-regardless of a completely heterosexual past/present, to the latest thing that has crossed my mind, fear of attraction to my own brother. It is horrible and these feelings make me feel extremely upset with myself and I believe along with the ocd/anxiety, there is mild depression. Yesterday, I had a good day, but today has been a setback. I am emailing you because ultimately, one of the most important things to me is my relationship with my boyfriend. He is so wonderful and when I am not doubting everything, I come to acknowledge how deep my love and affection for him is. My biggest fear I guess, is losing him to the ocd/anxiety. I lack hope and faith lately, which may be because of the depression. I know I am seeking reassurance, and I know that reassurance backfires... But I need some hope. Some motivation/advice/anything. I want to feel good, how I felt yesterday. And I want to feel secure with what I know I want and who I know that I am, without doubting every single thing. Help me keep my relationship/my sense if self. My boyfriend has always been there for me, and he brings out the best in me. I no longer want to be plagued with questions and "what if's."

  • Dr. Steven Brodsky Says ...
    Dr. Steven  Brodsky

    Dear Alejandro:

    I'm sorry to hear of your plight.  This advice does not constitute

    treatment and I wouldn't want to diagnose someone by email. However,

    the symptoms you describe (reassurance seeking, repeating, testing, checking, endless internet research, etc.) are typical among the OCD sufferers I treat

    in my practice. OCD can take literally thousands of different forms as

    unique as the individual, not just the ones you read about. OCD is an

    anxiety condition in which the sufferer has unwanted thoughts or

    worries and feels compelled to get rid of the thought by either an

    action, avoiding certain situations, or by mentally reassuring

    themselves (or asking others to reassure them) that their worry is

    irrational. None of these measures works and, in fact, only make the

    worry worse in the long run. OCD does not mean you are going crazy, it

    is simply an anxiety condition and nothing more. About 6 million people

    suffer from OCD in the U.S. alone.

    The good news is that OCD is very treatable, and medication might not

    be needed indefinitely, if at all. Hundreds of studies support that the

    most effective treatment for OCD is "exposure response prevention"

    (ERP), which is a special type of behavior therapy designed

    specifically for OCD. ERP is the only treatment endorsed by the

    Obsessive Compulsive Foundation. ERP enables sufferers to very

    gradually overcome their fears and let go of their compulsions at a

    pace with which they feel comfortable, so they are never overwhelmed.

    Results are achieved in a matter of months not years. ERP is more

    effective than medication, therapy and medication combined, or any

    other kind of therapy. Medication provides only temporary or partial

    relief and has side effects; symptoms just come back when you end the

    medication. ERP provides permanent relief, essentially eliminating OCD

    forever.

    Most of my clients benefit from ERP alone with no medication. If

    someone is on medication already, however, I recommend staying on it

    until therapy is complete and then gradually reduce and eliminate

    medication while continuing the therapy for another several weeks or

    months to assure that symptoms don't return.

    There are about a dozen medications used for OCD. The most popular are Luvox, Zoloft, Lexepro,

    Celexa, Prozac, Zoloft, Effexor, and Anafranil, which is an older

    medication, and many other medications.

    One very helpful book on OCD is written by my former client, Linda

    Maran, and is called "Confronting the Bully Of OCD," which describes

    her therapy with me. It's a wonderful success story written from the

    perspective of a former OCD sufferer who overcame it. Two helpful books

    written by professionals are "Stop Obsessing" by Edna Foa and "When

    Once Is Not Enough" by Gail Steketee. The movie "As Good As It Gets"

    with Jack Nicholson is a depiction of an OCD sufferer, although aspects

    of it are inaccurate.

    I don’t know where you live. I practice in mid-town Manhattan (34th St.

    5th Ave.), northern New Jersey (near the GWB), and Rockland (near the

    Tappan Zee), and would be happy to arrange an appointment

    at 212-726-2390. If you live outside of the New York metropolitan area,

    you can find a local therapist by contacting the Obsessive Compulsive

    Foundation (www.ocfoundation.org) or the Association For Behavior and

    Cognitive Therapies (www.abct.org), or the NJ OC Foundation

    (www.njocf.org) or Central (Upstate) NY OC Foundation at

    (http://www.cnyocf.org/Providers_List.htm). Check them for an OCD

    specialist in your area. Please note, by "local" and "your area" I mean

    within a 2 hour trip, so be flexible about how far you'll look; trust

    me it's worth the trip. If they don't have someone in your area, ask

    them if they know of a similar organization in your region that could

    make a referral to you. Such organizations would have words such as

    "OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. For

    those with limited funds, the most affordable option is some large

    prestigious hospitals associated with a medical schools have clinics

    with low fees that accept insurance and Medicaid/Medicare with words

    such as "Anxiety," "Depression," "Fear and Phobia," or the above terms

    in it's title. Usually the therapists in these hospital clinics are

    junior therapists-in-training--such as psychology graduate students or

    medical students--but they are supervised by very experienced licensed

    professionals. Once you get names of therapists, you have to call and

    interview the therapists by phone.

    If you are considering another therapist, there are TWO "TEST

    QUESTIONS" you must ask them before you make an appointment: (1) Is ERP

    the main technique they use? If they don't, forget about using them.

    And (2) How many people have they SUCCESSFULLY treated FOR OCD? They

    should have treated at least a dozen people (a few dozen in

    metropolitan areas), the people should not longer have obsessions or

    compulsions or should not be taking medication any more. They should

    NOT say they just helped people "live with" their OCD better.

    Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVER

    BEFORE due to a new law, called Timothy's law, that went into effect in

    2007. Although I am out of network, as are all private specialists

    competent to treat OCD, the new law mandates all insurance companies to

    cover treatment for OCD (which they term a "biological condition") at a

    higher rate (as much as 70%) and usually for more or unlimited

    sessions. So whether or not the therapist is in-network doesn't make as

    big a difference as it used to. In fact, even with HMOs, if you can't

    find and ERP specialist within network they are required to cover them

    out of network.

    If you can't find anyone in your area, I offer phone

    sessions for those outside of the New York Metropolitan area. It's not

    ideal, but it's a lot better than going to someone who is not an expert

    on OCD. I can be reached at 212-726-2390.

    By the way, would you mind emailing me back to tell me how you found my

    website? Was it through a link off another website or through a keyword

    search, and, if so, which keywords and on which search engine? Your

    feedback will help me make this information more accessible to other

    people. If you found this information helpful and would like others to

    benefit from it, please consider providing a very brief rating of my

    services at Health Grades (about 10 seconds)

    at http://tinyurl.com/GradeDr-Brodsky. Or consider providing a brief

    review to Angie’s List at http://tinyurl.com/RateDrBrodsky or call in a

    review at 888-888-5478 (one word is sufficient).

    I hope this information has been helpful. I only want to ensure you get

    the right kind of treatment, regardless of whether that is from me or

    someone else.  May I only hear good news from you in the future!

    Sincerely,

    Dr. Brodsky

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