27 July 2015

Something old

Many people find change difficult, however, for those with OCD it can be a particular challenge - and not just when dealing with significant life events, but a whole host of more trivial matters.

One 'change' that dismays me is when things wear out or break and require replacement. A number of elements contribute to that dismay.

The first is that I can't stand shopping; faced with a world of choice, I'm almost incapable of making a decision. Rather than face that ordeal, I avoid replacing items until they become completely unserviceable.

The second factor is having to accept that the item concerned has become so far removed from perfect. While I can gradually adjust to an unmoveable stain in a shirt or a scratch on a table, it's somewhat harder to accept that final transition to unusable.

The third, and main, reason is that I feel more comfortable using, and being surrounded by, familiar objects. 

I was upset, therefore, when I recently noticed a two-inch tear across the back of the top half of my favourite pyjamas. They had earned the tag of favourite by dint of being the perfect mid-season nightwear: a combination of lightweight material and full-length sleeves and legs. 

Initially unable to accept their terminal state, I wore them again the following night - and woke up to find the tear had doubled in length. I felt almost bereft as I finally bundled them into a rubbish bag. They were so old that I couldn't remember when I'd bought them, yet still I felt disappointed that they had let me down. 

And how would I ever replace them? Could another pair of similarly perfect pyjamas possibly exist? And if they did, how long would it be before I could bring myself to wear them? On the odd occasion that I do buy new clothes, I invariably leave them in the wardrobe for months, to maintain their perfection.

To avoid the need for change, I'm currently creaking along with several other household items. 

There's the television with the hit and miss sound quality, necessitating constant tweaking of the two volume controls to eradicate either a buzzing noise or a thundering bass tone.

Image courtesy of taesmileland/
Then there's the laptop with the malfunctioning external power connection that works only if I tweak the cable in the socket a certain way. 

And finally, there's the portable radio with the loose connection to the on-off dial, which means I never know whether it's going to come on or not.

I'm too used to these things to be able to give them up of my own accord; no doubt, as so many times before, it will be circumstance that finally forces my hand*.

Oh, and as for the pyjamas, I came across a pair in my chest of drawers that I bought last year for a hospital stay, but didn't wear. In a light fabric, with three-quarter length sleeves and long legs, they're an ideal replacement and instant new favourites...hopefully for the next 10 years, at least!

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*A couple of hours after writing the first draft of this post, the aerial snapped off the radio - I now have a new one.

20 July 2015

The comfort trap

During my recent interview with consultant psychiatrist Dr Raj Persaud, we discussed whether OCD can be cured, which is something I also wrote about earlier this year.

I've always seen the disorder as a chronic condition that has to be managed in the same way as any chronic physical ailment, such as back pain, eczema or asthma. Dr Persaud, however, was of the firm view that it is completely treatable...if you want it to be.

Since then, I've reflected on our discussion, and on my own situation, and can see that I've become caught in 'the comfort trap', as Dr David Veale and Rob Willson call it in their book, Overcoming Obsessive Compulsive Disorder. That is to say, I'd rather continue to live with some rituals than face the challenge of trying to eradicate them.

The key treatment approach for the condition is exposure and response prevention (ERP). This entails resisting your compulsions and allowing yourself to feel the resulting discomfort and anxiety, which should diminish over time, after repeated exposures. The fact of the matter is, you're going to feel worse before you feel better, and that's a somewhat off-putting prospect. 

My own forays into this therapy have been sporadic. Although I've managed to reduce my symptoms from moderate to mild, I've never grasped the nettle and applied the principles of ERP across the board. Now I realise that this is because I haven't had enough of an incentive to do so.

At its current level, OCD doesn't stop me functioning in any significant way: I'm in a relationship, hold down a job and have a good social life. My remaining compulsions are time-wasting, but haven't taken over my life or stopped me from doing anything I really want to. While that waste of time is regrettable, it has proved insufficient motivation to pursue a full recovery.

Image courtesy of artur84/
How big an incentive do you need, though? I once met a woman at a support group who was unable to touch her children due to her contamination fears, yet still she baulked at the idea of ERP. 'It sounds so hard,' she told the group facilitator. I was mystified: how could any treatment be harder than not being able to hold your own children? Her case shows how tight a grip the disorder can have.

So what would be sufficient reason for me to seek to escape its influence once and for all? The only circumstance I can imagine, would be if I wanted to share my home with somebody else on a permanent basis. That's unlikely to happen, though, as my partner and I both enjoy our independence too much!

Living with OCD is a far from comfortable experience, yet it can sometimes seem that way compared to the alternative of fully engaging with treatment: perhaps a case of 'better the devil you know'? That may seem a strange contradiction, but we're dealing with a strange and complex condition.

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If you have OCD, do you think full recovery is possible?

13 July 2015

Can't clean, won't clean

A comment you often hear from people with OCD, in response to inaccurate representations of the condition, is 'It's not all about cleaning!'

What they mean is that cleaning compulsions don't result from a desire to clean, but from the anxiety that is caused by not cleaning. This anxiety most often arises from a fear of contamination, either to themselves or a loved one.

Sometimes, though, the fear is of something far removed from cleaning, such as a plane crash: an impossible consequence of having a dirty home. Whatever the underlying cause of the compulsions, sufferers don't want to clean; they have to.

For me, the condition is definitely not about cleaning. My obsessive need for order means any activity that disrupts my environment provokes both anxiety and compulsions, so I actually avoid cleaning...for three to four months at a time: the final clean of 2014 was in early December, the first of 2015 was in mid-March, and the last one was at the end of June. 

Many people who've seen my flat - or desk, or car - find this hard to believe, mistakenly equating a tidy environment with a clean one, but now I have proof of my slovenly habits.

Photos: Helen Barbour
Partway through the last clean, I stopped to take photos of the squalor: specifically my living room table divested of the ornaments that usually decorate it and which I never move. In the shot to the right, you can see where they were from the voids in the dust! The second picture shows them all reinstated after I'd dusted and polished the table.

Putting items back with the necessary millimetre precision takes longer than the actual cleaning and is incredibly stressful. There usually comes a point when I suddenly register the extent of the 'chaos' I've created and feel like crying at the effort it will take to restore my usual order. 

When I have finished, I'm then also compelled to face the unpleasant reality of having to destroy this newly reclaimed perfection, though I avoid it for as long as possible. 

Once I've cleaned the toilet, for example, I put off using it and have even contemplated visiting the local pub to avail myself of their facilities, in order to delay the dreaded moment for a few more precious hours.

Likewise with the kitchen bin: I hate using it when it's newly disinfected and has a fresh liner inside. Instead, I put my rubbish in supermarket bags, which I leave next to the bin. In fact, after my last clean I did that for five days. It's both an unsightly practice and illogical, given that the extra bags don't fit in with my usual patterns.

If, after all this, you still don't believe how infrequently I clean, please do come around at, say, the end of September, and check for yourself! 

Incidentally, the late Quentin Crisp once said, on being asked why he didn't clean his home, 'After the third year, the dust doesn't get any worse.' Even I don't want to go that far, but I think he had a point...

6 July 2015

When you've gotta go...

Anxiety manifests in a multitude of different ways and one that can be a cause for some teasing is 'toilet anxiety', from which I've suffered for as long as I can remember.

In my case, this isn't, as you might think, a contamination issue and is entirely unrelated to my OCD; I'm simply worried about not being able to get to a toilet when I need one.

It seems that this is quite a common problem - in its mildest form, at least. For those who are badly affected, however, this can severely restrict their lives. It may influence their choice of job, result in them avoiding social engagements, or even lead to agoraphobia.

I believe my anxiety originates from a bed-wetting incident that happened in late childhood - when it really shouldn't have! I was certainly old enough to be embarrassed and to conceal the incident. To this day, if I wake up and feel the slightest need to go to the toilet, I have to visit the bathroom, for fear of being caught short.

Image courtesy of Keerati/
I also plan carefully in other areas of my life, for example, avoiding drinking anything in the hour before I undertake any journey longer than half an hour, and relieving myself at the very last moment before departure. 

Sometimes I go to more extreme lengths. A few months back, I heard that there were travel problems en route to my boyfriend's - a 45-minute drive away - so packed an impromptu in-car toilet of empty water bottle and funnel! I have no idea whether I could have successfully employed them, but just knowing they were to hand reduced my anxiety.

A couple of adventure holidays have presented particular difficulties.

While on a ship in the Arctic, we made trips out either in small Rigid Inflatable Boats, with no facilities, or on land, accompanied by guides carrying guns to warn off any polar bears that crossed our path. On land, you couldn't make a toilet stop without an armed guide standing over you - a prospect that was just too embarrassing to contemplate.

Unfortunately, the tour leader only announced the itinerary for the day after breakfast, so I had to dehydrate myself until I found out what time we'd be going out...and then sprint for the tea urn the second he revealed that we'd be onboard until lunchtime.

During a holiday in Iceland, where both the population and vegetation are sparse, squatting behind the tour group's minibus was often the option.

Needless to say, I announced 'I'm going behind the bus' every time we stopped, in case I couldn't last through the next driving stretch. In joky response to my repeat visits, the driver took to revving the engine so that exhaust fumes belched into my face! As he looked like a Russian assassin - cropped, blond hair and sunglasses permanently attached to his face - I didn't like to complain.

Much like my OCD, I've learned to live with this particular form of anxiety. I'm aware, however, that it is possible to retrain your bladder, so that it doesn't expect so many toilet stops, thereby gradually eradicating the fear that it won't hold. 

Like so many conditions, it takes effort and application to overcome, but it can be done and it could be life-changing.

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You can find out more about the various conditions related to toilet anxiety on Anxiety UK's website.