I'm Back, Baby!!
Hey, y’all, I’m back and doing much better. After taking a few months off I’ve been able to focus a lot on my mental health. And with a lot of hard work and therapy, I feel much more prepared to come back and write for fun again. I’ve recently received a new diagnosis that has brought a lot of clarity to me, and through understanding my disorder, I’m a lot more capable of treating it in the present. I also have a lot more insight on previous behaviors and I’m able to have a bit more grace for myself in a lot of ways.
If I’m honest, I’m hesitant to share the diagnosis. I want to because I find this is a really good medium for me to express myself. I feel like having a blog where I mostly talk about myself, my life, and how I think, I’m able to be vulnerable in a safe way that allows people to have a better understanding of me. However, this disorder is genuinely one of the most misunderstood disorders ever. It’s common, and you’ve heard of it, but more than likely, most people reading this have no idea how the disorder works or what it looks like. I don’t blame anyone for not knowing, the stereotypical pop culture version of it is incredibly pervasive.
I think more than almost anything else, I am most terrified of being misunderstood or not taken seriously. So much so that I’ll go to extreme lengths to avoid those things. Such as learning HTML and buying a website domain to build a website and put my every thought and opinion on it. I’m terrified that by sharing an aspect of myself, it will only lead to more misunderstandings. But unfortunately, it’s for this exact reason why I should share it.
I have OCD. I was diagnosed with it fairly recently, but now that I know the symptoms better, I can remember showing signs of it as early as 5 or 6 years old. But before I talk about my own personal experience with the disorder, I want to explain how it actually works so there’s no confusion. Obviously I’m not a doctor. I’m going to oversimplify everything I’m talking about in order to make a nice, digestible blog post that any layperson could read in one sitting. If you’ve somehow stumbled here looking for genuine, in depth research and analysis into OCD then… I cannot stress enough how wrong of a place you’re in. I’m a graphic designer who reads Wikipedia articles as a hobby. This isn’t health advice, check my sources, and take everything I say with a grain of salt.
Symptoms
OCD is not perfectionism, a love of symmetry, or excessive cleanliness. It’s an anxiety disorder characterized by intense intrusive thoughts and the immense lengths sufferers go to avoid those thoughts becoming reality. “Intrusive thoughts” are another aspect of the disorder that is entirely misunderstood by most people. Intrusive thoughts don’t mean impulsivity, or making bad decisions. Normally whenever I see or hear people talking about intrusive thoughts, it’s about how they dyed their hair on a whim or ate 3 donuts when they felt full after 2. Intrusive thoughts are a lot more intense than that. They cause distress and tend to be disturbing or graphic. If you’ve ever been standing in a high place and had the sudden urge to jump, or to push someone else, that’s an example of an intrusive thought. Everyone experiences these to some degree, they’re distressing thoughts that don’t align with your personality or moral values.
The primary thing that distinguishes normal intrusive thoughts versus OCD is the reaction to these thoughts. If you’re able to shrug off a distressing mental image after a few moments, congratulations, you (probably) do not have OCD. If these thoughts do control and dictate several aspects of your life, however, it stops being “normal thoughts” and starts becoming an obsession. Hence the O in OCD. I think about an obsession probably once every few minutes. Most of the time when I start thinking about my obsessions, it’s extremely difficult to stop. That is, unless I do something about them. That’s the C in OCD, compulsions. I don’t want to talk too in depth about my own obsessions, but let’s say that I’m obsessed with getting rid of germs. My compulsion might be to wash my hands. But because obsessions don’t go away for long, in order to keep those at bay, I might find myself washing my hands 10 times in a row and still feeling unclean.
I sometimes spend anywhere between 2 to 12 hours on any given day dealing with my obsessions. They rule my life in ways that almost certainly sound unbelievable, and sometimes even silly, but nonetheless are extremely distressing and make my life far more difficult than it needs to be. My obsessions control the way I walk, how I eat, the way I communicate with others, how I cook, clean, and take care of myself, how I perform at work, how I dress and present myself, the hobbies/media I engage with, and so much more. There isn’t a facet of my life that’s not touched by OCD in some way. But… why? Going back to the handwashing example, why wouldn’t I eventually start to feel more clean after a 2nd or 3rd time washing?
The same reason a person with depression doesn’t stop being depressed after a couple of good days. And the same reason an autistic person doesn’t understand social cues after a couple good social interactions. And the same reason a narcoleptic person doesn’t stop having narcolepsy after a couple good nights of sleep. It’s a disorder. The brain isn’t working properly and is overcompensating in ways that are detrimental to the livelihood of the person suffering with it.
Why OCD Happens
Unfortunately, research into OCD is fairly recent. The how’s and why’s are unclear because research is still being done. I’m going to present a theory that makes the most sense to me, but understand that it is still a (game) theory. OCD is called a network-based disorder, meaning that it isn’t the summation of symptoms, environmental factors, and behavior, but also has biological components. For example, a person might experience depression due to the loss of a loved one. But a person chronic depression likely has issues processing chemicals in the brain like dopamine or serotonin in addition to those other factors. Except with OCD, we wouldn’t say someone is “experiencing OCD,” we’d probably call it “overthinking.” The major difference between OCD and overthinking comes from the CSTC loop, or the cortico-striato-thalamo-cortical loop.
The CSTC loop has several functions and is way too complicated for me to explain here. What you need to know is that when information is being taken in and your brain needs to make a decision, the process begins in your prefrontal cortex, then moves to a bunch of other locations in your brain, then goes back to the prefrontal cortex. It gets really complicated and impacts most parts of the brain, but for my purposes today, all you need to know is the prefrontal cortex is responsible for information gathering and decision making, and everything else is responsible for movement, planning, learning, motivation, and rewards. If you have ADHD, you should be familiar with this system! Yours doesn’t work either! Hence the whole issue with delayed gratification and inability to start/transition tasks. OCD uses the same formula, but gets drastically different results. In the CSTC loop, there is a direct and indirect pathway through the brain. The direct pathway is all about starting actions/behaviors, while the indirect pathway is all about preventing action. If you have Turret’s, you should also be familiar with this system! Yours doesn’t work either! This is why tics happen, the indirect pathway is dysfunctional.
So how does the CSTC loop work in the case of people with OCD? Well, in short, it doesn’t. At least, not well. The direct pathway is hyperactive resulting in the sufferer being repeatedly told by their brain that in order to solve their problems they must take increasingly distressing or laborious tasks. In a healthy person’s mind, the CSTC loop looks like:
I am hungry. > Food would make me feel full. > I want to eat food. > I am going to eat food. > The loop closes, the brain is satisfied, and the problem is resolved.
But in the brain of someone with OCD, it might look more like this:
I am hungry. > Food would make me feel full. > Wait, is the food safe? > I should check the best by date to make sure it’s safe. > The best by date says it’s fine, but how do I know someone didn’t tamper with it? > I live alone, so I know it wasn’t me. > But how do I know someone didn’t break in? > I should check my security camera. > Nothing’s shown up, so I must’ve done it myself and forgot. > I should research how amnesia works, maybe check my carbon monoxide alarm. > Ad infinitum. The loop never closes, the brain feels all out of sorts because it can’t solve the problem, and the sufferer is unable to feel safe enough to eat despite all evidence.
The loop is never able to close and the sufferer is never able to reach a conclusion. Every time they reach the natural, logical conclusion to their thoughts their brain sends them on another, deeper spiral. In this example, a person without OCD would end their loop after checking the food label if they have doubts. But because our brains are so certain in the danger present in making a “wrong” choice, it will never feel satisfied. It will convince us that we have false memories, that we’re being tricked somehow and we can’t trust reality or our own judgement. The only thing that supplies an immediate feeling of “rightness” or “completeness” or “goodness” is engaging in our compulsions. In this example, the compulsions would be checking food date, checking for intruders, researching amnesia, and overthinking. For a few brief seconds after engaging in compulsions, the brain feels like the loop is closed. But not forever. Within another few seconds, the loop begins again, this time stronger.
Treatment
It’s like itching a mosquito bite. The more you scratch, the itchier it gets. The only way to prevent the itchiness from getting worse is to not scratch it at all. OCD works much in the same way. We can’t avoid the CSTC loop, it’s a necessary function of our brains. Without it, we would be unable to make decisions at all. What we have to do is ignore our brain and choose the indirect loop. We have to reject our compulsions and the thought spirals.
This is unbelievably difficult. It is so impossible to tell when an action is a compulsion or entirely reasonable. Our brain categorizes them in the same way. Similar to how a person with motion sickness can’t reason their brain out of being motion sick, a person with OCD can’t reason their brain out of the loop. Only encourage it to refocus its attention to something else. For the last few weeks, I’ve been working with my therapist to use exposure and response prevention (ERP) therapy, which is tantamount to psychological torture. I’m being facetious, but I genuinely cannot imagine a worse feeling than how using it makes me feel.
But that’s the thing. Compulsions provide extremely short term relief in exchange for a lifetime of being unable to use the indirect pathways for basic tasks. I don’t obsess over food contamination personally, but if I did, the solution would be to eat food I’m convinced is going to make me sick. Even if I understand on a logical level that the food won’t hurt me, the second I have a normal experience like getting food poisoning, having diarrhea, throwing up, or otherwise feeling ill, my brain is going to convince me that the reason I feel that way is because I ate food that was tampered with. I’ll have to overcome these thoughts by living with uncertainty. I would have to be okay with the fact that I’ll never have definitive proof of knowing with 100% certainty that my food hasn’t been tampered with. Nothing will ever be good enough in my brain. I’ll have to be okay with the uncertainty and discomfort.
Let me put it this way. I imagine that since you’re reading my blog, you have some form of neurodivergence or mental health condition. What if the most effective form of treatment for your condition was to just pretend like you don’t have that condition. If you have ADHD, just stop procrastinating! Just, stop being impulsive! Just stop hyperfixating. If you have depression, just stop feeling depressed. Just pull a lust for life out of your ass. Just enjoy stuff and ignore anhedonia. If you have autism, just understand social cues. Just know what people mean when they’re vague and indirect without having to clarify. Stop caring about uncomfortable textures, and ignore the need to stim forever.
The idea is ridiculous. Obviously those aren’t going to work for any of the conditions I listed. But genuinely imagine the pit in your stomach that would form after a trusted mental health advisor told you that the most effective treatment method is to ignore your condition. Imagine how you would even begin to navigate life surrounding that during the best of times. Now imagine how you’d be able to cope when something stressful happens. When someone passes away, when you suddenly lose a job, when a long term partner breaks up with you, when your car breaks down and you can’t afford a fix.
And yet, in the case of OCD, this works!!! It works insanely well! Annoyingly well! Infuriatingly well!
My Personal Experience
It’s been a month since I’ve started working with my therapist on dealing with my OCD. My life has improved drastically. I want to back up a bit and talk about the road to me getting a diagnosis, because I don’t think it’s at all typical. I’ve mentioned before that I can trace symptoms of OCD as far back as when I was 5 or 6 years old. I specifically remember a period of a few months where every day I would imagine a swear word in my head and I would pray to Jesus asking for forgiveness. Every time I read a swear word, every time I heard one on TV, and every time one would randomly appear in my head without my internal dialogue intentionally saying it. I remember my fear and anxiety got so debilitating and it became difficult to play or talk to my friends because I was so busy praying for forgiveness. I remember feeling so convinced I was destined for Hell. Eventually, I stopped praying every time I heard/thought of/saw a bad word. And slowly, but surely, I stopped randomly imagining swear words.
This kind of thing would happen a lot throughout my life. I would have an obsession, spend a horrible few months suffering with it, intuit my way out of the obsession, and eventually, my life would return back to normal. I would still have obsessions, but they would be much more manageable and were easier to ignore. Honestly, a lot of my obsessions were also things that were entirely reasonable to be worried about. I would obsess over my academic performance, on my quality as a partner and friend, on my hobbies and art. And most of my compulsions weren’t too unreasonable, I was just going absurdly over the top with them. I would brag about my near 15 hour work days in college as if that was a normal and good thing to aspire to, and not me being obsessed.
My Personal Experience (The Sad Stuff)
Since I started therapy in December last year, I hadn’t experienced a flare up in obsessions in some time. Or at least my obsessions were easier to hide. I’ve always had an interest in psychology and had a decent enough grasp on OCD before doing more research, but before my therapist brought it up, I had never genuinely considered it was a thing I had. That was until a really intense event in January occurred where I was incredibly destabilized. A big dramatic blow up happened and my worst fears were “confirmed” true (in the same way they would be “confirmed” true in the food example if I were to get sick.. which is to say, I felt as if my fears were confirmed, when it was really just an unrelated bad thing). I think it unwise to go into detail discussing the worst of my obsessions in a place that’s viewable to any random stranger on the internet. But the worst of my obsessions revolve around how I’m perceived in relationships. I don’t want to be a bad partner or friend. Obviously no one wants to be bad, but I don’t think I can go into more detail than that. There are very specific aspects to relationships I want to get perfect and I stop at nothing to make sure I do everything right.
Except, nothing I did worked. I obeyed my every compulsion and took every thought I had at face value. And when that event happened, it cemented to me that no matter what I do, I’m everything I hate about myself. And not only that, but everyone else knows it. Everyone knows the deep depravity of my soul and I’ll never be good, or clean, or kind. Redemption is impossible because I’ve already made my bed. The only thing that will bring me close to goodness again is agonizing over how corrupted and evil I am. Not true, obviously, but that’s what I felt.
It’s now been 5 months since then and all my current, biggest obsessions directly center the event. Not in obvious ways, but in ways that are so niche and abstract it’s genuinely laughable. Everything stems back to this. And it was directly because all my obsessions stem from the same place that my therapist was able to identify a pattern. Every session I would walk in and rehash the same events, but never directly. I would talk about some other stressor I was experiencing, and eventually, relate it back to the January situation. It didn’t set off alarm bells initially to my therapist because it was a genuinely really big life change that would have affected anyone greatly. But it wasn’t until I started experiencing “weird panic attacks” that she connected it to OCD.
I’ve had panic attacks before. But about 2 months ago I started experiencing what felt like a panic attack’s meaner, more intense older brother that lasted until I physically exhausted myself enough to pass out. They definitely would start out as panic attacks, but they were always triggered by an obsession. I would have an intense spike in anxiety triggered by overthinking, and next thing I knew, I would be awake at 3 in the morning curled up on the floor sobbing for 12 hours straight. Once they started, there was nothing I could do to stop them. I would lay awake thinking in the same unhealthy loops that never ended. Not until I was too tired to think. Throughout these I would engage in every healthy and unhealthy coping mechanism I had at my disposal. I would try everything from venting to friends to self harm to journaling to getting so drunk/high I couldn’t move to make it all go away. By the time I was diagnosed, I was experiencing them up to 3 times a week.
My Personal Experience (The Happy Stuff)
Things got really bad and they weren’t getting better. Until my therapist diagnosed me with OCD and we began ERP.
Despite how much shit I talked it earlier, I think it has been genuinely instrumental in saving my life. I feel a lot more peace, generally speaking. I still spend WAY too much time obsessing than I’d like. Most days I just don’t have it in me to ignore every compulsion. I’m picking my battles, only tackling a few at a time. I don’t exactly keep a numbered list of my obsessions, and they change day to day, but there’s probably a few dozen of them. Some of my darkest, most deep rooted ones I really don’t have the capacity to handle.
But the smaller ones? Those I can handle. And the more I do, the less the bigger ones bother me. Don’t get me wrong, it’s a daily battle that starts from the second I wake up and doesn’t end until I fall asleep. ERP is a lot of things, but “easy” is probably the most antithetical word to describe it with. But it is getting easier.
Part of it has also been being able to identify obsessions when they show up at all. There’s so many aspects to myself I thought important, but are actually obsessions. Like actually posting here every month. I don’t think it ever came across, but I would feel more dread than I could possibly describe whenever I wasn’t able to get a Dal Report out by the end of the month. I felt like a bad person when I didn’t post. The way I used to GM my previous campaign was also 100% an obsession. I was, frankly, insane with how I planned it. The lengths I went to immerse my players were unnecessary, unrealistic, rightfully unappreciated (because I was insane and unreasonable) and lead to me getting so burned out, I have no idea when I’ll be GMing again. I don’t think my feelings were ever really externalized to my players, luckily, but the pure hatred and contempt I held for myself if I flubbed a line of dialogue, forgot to set moody lighting, or miscalculated a roll was astronomical.
But, it’s getting better. Therapy is going really good for me and I’m honestly proud of myself and the progress I’ve made these last few weeks. You’ll see a lot more of me again here. Except this time, I’m not going to be promising any upload schedule or consistent topics/themes. I’ll write what I want, when I want, and it’ll be posted here. Read it or don’t.
Sources
https://www.healthline.com/health/ocd/ocd-brain
https://www.ncbi.nlm.nih.gov/books/NBK553162/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/obsessivecompulsive-disorder-ocd