Posted by Adam on May 16, 2002, at 21:35:29
In reply to Need OCD info and experiences, posted by BarbaraCat on May 16, 2002, at 14:42:06
Hey, Barbaracat,
I have an "OCD Spectrum Disorder," often referred to as "Body Dysmorphic Disorder (BDD)" or "Dysmorphophobia", or even "Body Dysmophia". Say all those ten times fast.
Depending on who you ask, I have just another form of OCD, or I have a different illness with some similarities to OCD. Regardless, BDD is best treated with the same therapies used to treat OCD; the current gold standards are cognitive-behavioral therapy (CBT, with emphasis on the behavioral) and selective serotonin reuptake inhibitors (SSRIs, examples are Prozac and Paxil), either alone or in combination. There is no good evidence that psychoanalytic/psychodynamic therapies or non-serotonin potentiating drugs like desipramine have any efficacy for either OCD or its spectrum disorders.
Given the obvious practical similarities between OCD proper and what I've got, I tend to take a somewhat positivist view: If it looks like a duck, etc., it's a duck. In other words, I have OCD.
Well, if you're in agreement with that, we can proceed. BDD can be defined simply as an obsessive preoccupation with a purely percieved or relatively minor physical defect, with the accomanying behaviors associated with this preoccupation. These behaviors may include repeated examination of the defective feature, changes in posture or attire to compensate for the defect, avoidance of mirrors or other reflective surfaces, desire for or even the seeking out of surgical correction for the defect. I had all of these symptoms, and them some.
To this day, despite what I have learned, I still dislike my face. Specifically, I don't like my chin. I think it's too small. Sometimes I really hate it. By hate, I mean hate. I think it's fair enough to say I have a smaller-than-average chin. Maybe plastic surgery would improve my looks a little, I don't know.
However, the reality is, in my mind, at some level, I'm a freak. I'm deformed. I'm hideous. I would do anything to change my face, to make it "right".
Before I got treatment, I used to think about my chin constantly. I would push my chin outward to make it look bigger; sometimes my jaw muscles would ache from doing this persistantly. I hated catching my reflection without warning. Despite this, I spent a lot of my spare time in front of a mirror examining my chin. Actually, I would use two mirrors so I could check out my profile from different angles. I would stare at my natural profile (horror!), and then I would push my chin out so that I looked "better". Over and over. Day after day, whenever I could find time alone. More and more as time went on.
All this started around age 15 or 16, and by the time I was in my early twenties, it had become a seriously debilitating problem. Sometimes I could barely stand to be in front of people. How I ever managed to date anybody is beyond me. You can bet this terrible problem had an impact on my personal life. One thing about OCD: It's a big, dark secret. NO WAY did I want anyone to know I was checking myself out in mirrors all the time. I would have died of embarassment. This is one of the hallmarks, if you will, of OCD: You know it's almost insane. You may not know you've got an illness, but you do know nobody else would understand. I both believed in my self-perception, and yet recognized how unreasonable it was. Or, at least, I knew how unreasonable I would appear to someone else.
What's also treacherous is the seeking of reassurance once you've opened up a little about the secret. Since I had did have girlfriends, I would eventually break down and ask: Is my chin too small? Invariably I would be told "Oh, it's not that bad," or "What do you mean? It fits your face," or, at worst, "Well, yeah, maybe a little, but you have such nice eyes and cheekbones, and I love your smile." All I would hear was "Well, yeah, maybe a little." Nothing else mattered for long. Soon, I would just ask again. I quite litterally drove someone away with my persistant need to be told I was OK. From that experience, I learned not to ask so much as to be dumped over it, and nothing more.
It really was terrible. It's still hard sometimes, though not nearly so bad as in the past. The worst thing, I think, was simply not knowing I had a problem besides being a hideously deformed freak. Just learning I had this illness was major improvment. How I found out was kind of amazing, but that's a whole other story I won't tell here. Anyway, once I got diagnosed, I started getting therapy.
Behavioral therapy is no fun. It can range from simple chages in daily habits to elaborate forms of torture. An example of the former was I had to stop checking and posturing in some mirrors, and avoiding my reflection in others. You would think I would be happy to be free of time-consuming ritual checking, but it was very, very difficult to give it up. Really, my whole approach to mirrors needed to chage. I had to avoid avoidance, and check all checking.
The worst was still to come. This particular therapist used the Death Star approach to your worst nightmares, with cheerful enthusiasm. He actually would hire professional actors, give then a scenerio, and let them improvise. My scenerio: I step up to a salad bar in a restaurant, and two rude patrons in a booth catch sight of me. They barely make an effort to conceal their derision as they verbally shred me for their own amusement. This tender dialog was tape-recorded and handed over to me, to listen to every day on my Walkman, while riding the train to work, for instance.
These people were awful. "Shh. Wait. Hey, look at that guy over there. Where? Oh, THAT guy! Yeah! I mean look at him! I know! He has, like, NO CHIN! He looks like a ferret! That's it, a ferret! Ferret-face! Oh, my God, what a freak. I am Ferret Man, from the planet Ferreton! Shhh-shhh, he can hear you! Do you think he's ugly? What, you have to ask?" And so on.
Cruel. And very painful. It hurt so much I would be in tears sometimes, because this is exactly the kind of thing I just knew went on whever I was in a public place and people saw me.
So, some of the therapy for OCD involves breaking habits, and some of it involves exposure. If you had a contamination obsession, you can imagine what a good therapist would have you doing: You might wind up, eventually, sticking your hands in a bucket of dirt, after which you are NOT allowed to wash them.
Exposure causes a lot of anxiety. The whole big theory about OCD, as I undersand it, is that anxiety over an obsession often leads to some action to help relieve the anxiety. This becomes a vicious cycle. The rituals that the typical OCD sufferer uses to deal with their anxiety are a direct response to the nature of the obsession; they are fleetingly helpful, and typically lead to more obsessing, with the resultant increase in ritualistic behavior. The ritual does nothing to dispell the irrational obsession (it might even reenforce it), and the temporary relief it brings only leads to a greater dependance on the ritual. You wind up spending more and more time obsessing, and more and more time engaged in useless, repetative behaviors. The key is to break the cycle, to stop the OCD sufferer from giving into the obsession and engaging in rituals and avoidance. One is weened off of the rituals, and forced to confront what is the most anxiety-provoking with exposure. If all goes well, one is increasingly desensitized, anxiety is reduced, and the obsessions eventually lose their strength.
Long-winded, I know! But I think some time is worth spending on my story, or something like it, to get the insight needed to really answer the questions that you asked. I spent a long time on the psychotherapy aspect for two reasons: one, it's clearly the most complex way to deal with OCD so it takes more effort to get a feel for it, and two, in my oppinion, when it works, it is preferable to drugs. If a drug works for you, I think you simply find relief from obsessions, and hence will not feel compelled to engage in ritualistic behavior. Typically, people who discontinue drug therapy for OCD relapse. However, the research tells us that people who are successfully treated with cognitive-behavioral therapy have a much lower rate of relapse. Drugs don't teach you very much, while therapy does. Unfortunately, some people do not respond, or only partially respond to therapy. In those cases, I think drugs are appropriate. In some studies, the combination of drug therapy and behavioral therapy was superior to either alone. At any rate, therapy has no troubling side-effects, and SSRIs unfortunately do sometimes. I think CBT should be the first-line treatment for OCD, and, if that fails, drugs should be added.
I hope this is helpful, BarbaraCat!
poster:Adam
thread:106680
URL: http://www.dr-bob.org/babble/20020510/msgs/106726.html