Stress, Obsessive Compulsive Disorder, and Sleep
anonymous Asks ...
I have a hard time getting to sleep because I have to check everything in the house a number of times before I can force myself to stay in bed. And often once I am in bed I will have to get out to go and check on the kids again and to make sure I didn't forget to lock all the doors and windows etc. Does this mean I have OCD? I also have this annoying habit of counting things, like seconds or steps and once I get started it is hard for me to stop. I have always done the counting thing but I am going through a stressful period as I ave lost my job and now my craziness is much worse than it ever has been before.
David Shannon Says ...
Obsessive Compulsive Disorder (OCD) is an anxiety disorder, characterized by repetitive thoughts (obsessions) and/or behaviors you feel pressured to repeat over and over (compulsions). To be diagnosed with OCD, the obsessions and compulsions must be present for at least an hour a day, and cause significant problems in a person's life, affecting things like relationships, jobs, or health. OCD can be triggered by stress, which fits with your current circumstances. However, it is also thought to be a chronic condition, and may require monitoring and treatment for the rest of one's life. This does not mean that the symptoms are always present, at least not to the same degree. But the tendency or susceptibility to obsessive thinking and compulsive behaviors persists, even as the symptoms may vary in strength, frequency, and the effect they have on your life. The key to living with any chronic condition is to find the most effective ways to manage the symptoms, so that they have the least negative impact on one's life. Such compulsive thoughts and behaviors can also be symptoms of other conditions such as depression and anxiety.
Both counting, and compulsively checking things repeatedly, are symptoms of OCD. You say that you have always done the counting thing, which may indicate that at least mild symptoms of OCD have been going on for a quite a while. But that is mostly an annoyance. Feeling compelled to check things over and over, however, is making it difficult to get to sleep, and that can negatively affect both your health, and your ability to cope with your situation in a positive and productive way. You may have intrusive and repetitive thoughts that make you anxious, and your compulsive behaviors may be a way to try to control that anxiety.
OCD is treated with both medications and psychotherapy, particularly what is known as cognitive behavioral therapy. CBT teaches you how to notice negative thinking, and to replace or modify specific thoughts that are causing you problems. It is widely used to treat depression, anxiety, and some personality disorders.
Medications are intended to correct imbalances of chemicals in your brain, known as neurotransmitters. Inadequate serotonin has particularly been associated with OCD, as well as dopamine and others. These same neurotransmitters play a role in depression, anxiety, and other conditions. The antidepressants known as selective serotonin reuptake inhibitors (SSRI's) are often prescribed to treat OCD. They may take weeks or months to become fully effective. Each person can react differently to a particular medication, so it may be necessary to try more than one, before finding what works for you. It would be understandable if you are also depressed and anxious about being unemployed, with all the practical difficulties that result from that. Finding the right medication(s) might help alleviate all of those conditions. I would encourage you to talk about this with your doctor. They may want you to see a psychiatrist, but most primary care physicians are knowledgeable and experienced in prescribing these meds. There may also be other physical problems going on that could be affecting both your mood, your behaviors, or your sleep.
A combination of medications and psychotherapy is often the most effective. So you may want to see a therapist as well. You could start with either a doctor or a therapist, but problems sleeping might best be dealt with first by the doctor. In the short term they might prescribe an anti-anxiety medication or a sleeping pill, to give some relief, while you give an SSRI enough time to work. If you are using alcohol or other chemicals, you should talk about that with both your doctor and your therapist. You may be trying to self-medicate. Those things might actually be at cross-purposes, or at least not work as well as specific prescribed drugs might. Alcohol does not mix well with many medications, and often makes them them less effective.
There are some things you can do yourself now, to start managing your thinking and compulsive behaviors. I suggest making a list of all the things you get up to check on. As you make your rounds, check off each item on the list. The next time you feel like you have to check all those things, have the list next to your bed, and notice that you have recently done so. This may help reduce your anxiety about them. It may not be enough to keep you from repeating the process, but you may find that you do not have to do it as many times before you are able to fall asleep. If you reduce the repetitions from 10 to 3, or from 30 to 20, or even have to do it one less time, you should consider it a success. If you do this every night, you may gradually need to do the whole routine less than before. You might also notice that some items are more important than others, so you may eventually be able to shorten the both list and the routine.
I also suggest writing down all your thoughts that go through your mind, that may contribute to your compulsive behaviors. Some of those thoughts will repeat frequently, if not every time, and those would make up the obsessive pattern. Just getting them out of your head by writing them down may make thinking about some of them less necessary. Make a list on the left, with another column on the right, and write down things you might say to yourself that are more accurate, more positive, or at least more balanced than each item on the left. That is a basic CBT technique and something you can get started on by yourself. Working through them with a therapist will help you become better at noticing and challenging such thoughts. A therapist will likely notice more instances of such thinking than you do at first. They can help you interrupt the thought process long enough to do something about it. They can help you find the replacement thoughts that will be most effective. The more you do this, the less power such negative thinking will have over you, and you will find yourself doing it less.
Medications and psychotherapy may not "cure" you completely. But they are ways to manage your symptoms. As you become better at that, the symptoms will interfere less with your life. And you will undoubtedly feel better. Best wishes, both for relief from these symptoms, and for getting your life back on track.