I can help
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 ...
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
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!