Your Questions Answered

Please feel free to ask questions about OCD and OCD treatment here.  The questions should be of general interest to everyone and not personal questions particular to your situation (those are best asked through private e-mail).   Please forgive me in advance if I don’t answer your question timely or if it doesn’t get answered.  For your answers look for my posts in this section rather than a reply to your comment.

111 Comments

  • Dr. Grayson,

    I am an OCD sufferer who has used prescription medications in the past, but noticed only slight results. It is possible that I did not stay on the medications long enough.
    I would like to try medication again, but did not like the sexual side effects I experienced before.
    What are your recommendations? Which medications have fewer sexual side effects?

    Thank you very much.

  • Hello Dr. Grayson,

    Can you please comment about reassurance seeking as a ritual? My OCD fears are related to self harm and the concern that my anxiety will get so bad that I’ll “feel like I have to die”. I have cut down drastically on seeking reassurance from others, but my therapist has said that I am still reassuring myself – especially in the midst of strong anxiety attacks and when I’m in triggering situations (hospitals, places I can’t leave, etc). Her advise is to listen to my script all the time, but especially in those moments.

    Can you comment on self-reassurance as a ritual? I’ve found it hard to expose myself because my script only seems to effectively prompt fear when I’m in the throes of an anxiety attack (which happens infrequently). Sometimes I feel like if only I had contamination fears it would be easy to identify my exposures…

    Thanks,
    Canadian with OCD

  • Hello Dr. Grayson,

    I have been doing exposure therapy for my obsessive thoughts (violent and sexual) and have been noticing improvement. Recently a doubt entered my mind about doing exposure therapy.

    In your book you mention that the goal of exposure therapy is to habituate to the obsessions by purposeful prolonged exposure to reduce the associated anxiety. There has been some research that suggests that violent exposure (video games, tv, etc.) can lead to a greater propensity to violence and that exposure to pornography can lead to changed attitudes towards rape and abuse. If there is any truth in this then habituating to violent and sexual stimuli can lead to negative changes.

    I find that many people who do not have ocd have a negative reaction to exposure therapy based on the above idea.

    What are your thoughts about that?

    I would be curious to read research studies which show that this is not the case.

    Thank you for your time and for your dedicated efforts to helping people suffering with ocd.

  • My ocd feels more like an impulse control behaviour. I have this compulsion (which I believe I act upon and is noticed by others) to look at people’s private parts, whether they be male or female. I fear humiliating myself and embarassing or annoying the person I’m looking at in this manner. I know how my ocd started: It got triggered after a humiliating sexual situation where I felt degraded and practically molested (even though I was an adult at the time). I have done years of therapy and I’m not any closer to a solution. This has robbed me of my life. I find it very difficult to have any type of interpersonal interaction, even minor. Could you please give me specific steps as to what to do?

  • How do you feel about the new reality television series, “OBSESSED?” It seems to me that the therapists involve mostly adhere to your methods through how they handle exposure, but don’t seem to be as in line regarding learning to live with uncertainty.

    I’d be curious to hear your opinion on it.

  • Dear Dr. Grayson,

    I was reading a book the other day (the “Happiness Trap” by Russ Harris) and in the book thoughts are differentiated from mental images. He says that thoughts consists of words.

    My question is that if this is true is then how does one approach obsessive mental images as opposed to thoughts using ERP.

    I have problems with obsessive thoughts and obsessive images which do not necessarily occur together.

  • I agree with you Jen. They are using exposure and response prevention and I think this is good for the public to see. I do wish they would stress uncertainty more. Also, I wish they would do a better job of trying to help non-sufferers understand that although involves horrible suffering, that it isn’t crazy.

  • Aaron, with regard to ERP and images, I would have a few questions, before I can answer. First is what is the nature of the images? Second, and this is critical, what are the reasons you want the images to leave? Individuals can have many reasons and the kind of exposure would depend upon the reasons. For some, they simply don’t want the images. For others, they fear that having the images in their mind may mean something about them. And there are other possibilities. What applies to you?

  • ***WARNING to readers: If you are depressed you may not want to read this since it contains depressing thoughts and reasons to commit suicide. ***

    Dear Dr. Grayson,

    It seems like my OCD is trying to force me to be depressed and suicidal. Clinically, I may be a little depressed, but definitely not at all suicidal. I have never attempted suicide, I am not impulsive, and I have no plan. Yet, I keep thinking “I hate life” “Nothing matters” “I want to die” “I should shoot myself in the head.” And the OCD will address me specifically and say “You are going to die anyway so you may as well do it on YOUR terms“ “Life is too difficult; your corpse will be a protest” “There is nothing to live for” “No one should try to prevent you from committing suicide unless he does not really love you since your life is causing suffering” “You have the right to kill yourself” “You do not need to put up with mental pain; you can kill yourself.” Before I know it I will start to write a suicide note in my head. Then the OCD says “Aha! So you ARE suicidal! After all, why write a note unless you are suicidal?” I answer that these are just thoughts and then the OCD says “Oh, reassuring yourself, huh? Looks like you are not being treatment compliant. Looks like someone is trying to practice thought suppression. Haven’t you read Wagner’s book? You really are not good at dealing with these thoughts at all.” OCD also says “If you keep having these thoughts you will be depressed and suicidal so you better stop them” or it says “You ARE depressed and suicidal” or it says “If these thoughts do not bother you then maybe you will commit suicide” or it will find within me a feeling of sadness and say “So, you ARE depressed and hence suicide MAY be an option for you. Better do something to prevent that.” Yet I have insight. If I didn’t maybe I would call 911 and say “I think I am suicidal!” That would be terrible.

    For now, to deal with this, I try to remind myself that I do not believe these thoughts but then I am accused (by myself) of not being treatment compliant. So then I remind myself that even that thought is OCD. The cycle continues and I try to ignore it, viewing it as annoying noise. Any thoughts? Should I listen to my depressing and suicidal thoughts repeatedly? Thanks!

    Oscar

  • Hello Dr. Grayson,

    I was looking at purchasing your book on Amazon, but it seems that many customers also buy “The OCD Workbook: Your Guide To Breaking Free From Obsessive-Compulsive Disorder” by Bruce M. Hyman, along with your own — the two appear quite similar. I wonder if you’re familiar with this guy and if you think using both books would be a wise idea? He does go further into what he calls “imaginal” exposure techniques, or exposure “in vivo,” and I figured it would be helpful to me since I suffer from extreme pure-o Religious OCD. Perhaps in combo with your “accepting uncertainty” approach, which he too uses but may not stress as much.

    Any thoughts?

    Regards,
    Armin

  • I have similar OCD thoughts to Oscar, but mine are more specifically: “I could get so anxious and feel so awful that I won’t be able to hold on and will kill myself” or “I could get so anxious that I won’t know what to do and will feel like I have to die”. Often these are accompanied by images of hospitals, me ‘losing it’ in public, having to be forceable medicated or intervened upon, note being able to work and live a ‘normal’ life, etc. etc. etc.

    I should note that the ‘suicide’ specific thoughts only present themselves typically in high stress situations/times. The exposure script I use says “my anxiety could get so bad that I will feel like relief is impossible. It could get so bad that I will feel like death is the only escape, etc. It could get so bad that I will have to go on disability, etc”. The script does not really raise my anxiety though. My therapist has suggested that this doesn’t really matter, but I am bothered that it doesn’t raise my fear level. I worry that it isn’t adequately challenging/exposing me. Perhaps more OCD?

    Thanks,
    Jen

  • Hi everyone. i’m new here. i appreciate much if someone can answer my question and put my mind a bit at rest. Does anyone know if people with ocd do have a greater chance of developing bipolar disorder?

    Thanks. 🙂

  • Dr. Grayson,
    How does an OCD suffer use Exposure/Response therapy for movement-type obsessions. Specifically,numerous times during the day, I must move my head/neck and shoulders a certain way & a certain number of times because I dont feel my body is balanced. Also, I must stare into space with my eyes a certain way many times a day to check that I am not going blind. This type of problem doesnt seem as clear cut to work on as “touching toilet seats”.
    Thanks for any suggestions!

  • I’ve been running an OCD support group in Miami, FL for about 10 months. Originally, I tried to follow your G.O.A.L.S. format: topic discussion, goal review/setting, and lastly normal venting. Due to my own troubles and the group’s reluctance to set goals, we eventually skipped the first two parts and just vented. Eventually, I got frustrated with the group’s lack of direction and progress, so I brought back all three sections again recently. Some of the members were excited about this renewed sense of order (and hope). My question: How strict should I be on keeping people on topic? I find people tend to drift off topic and I’m not sure if I’m doing them a service by reminding them that they can vent later after we cover topics and goals. Also, should new members be given more leeway to get off subject since they have more to say and haven’t yet bonded to the group? Thank you!

    • It is hard to keep people on task, but it is very important. Try to gently remind people before the discussion that you will be doing this. Remind that the support group is to help with OCD and the structure is to help everyone.

  • “The questions should be of general interest to everyone and not personal questions particular to your situation (those are best asked through private e-mail)”

    Dr Grayson, can I contact you through a private e-mail? How do I do this, I don’t know where to send my specific questions. Thank your for answering me

    Nina

  • Dr. Grayson, I have OCD and my problem is that when I’m confronted in a social or work setting I stare surreptitiously at peoples privates (like nina in another post) I’ve had this condition for about 15 years and I’m at my wits end. I’m a guy and my problem occurs when with both men and women — it has nothing to do with my sexual orientation or sexual frustration; I’m straight and I have a girlfriend. I have comorbid BDD and so feelings of being perceived as a freak are also in play. It’s the ultimate self-sabotage; the most humiliating thing I can do — and of course, I don’t want to do it. My question concerns how to create an effective ERP program. Should I make a scrapbook of clothed fashion photos (interestingly enough, naked people and pornographic photos are completely non-threatening) and then go through the ritual of trying not to stare, staring anyway and feeling anxious and terrible? I can induce the same feelings and anxiety this way. In the real world, I don’t stare directly, but surreptitiously. So, should I be staring directly or surreptitiously at the privates in the photos? How long per day? What are the scripts that should accompany this? Any suggestions would be welcome! Thank you, Simon.

  • Dear DR. Grayson, My husband suffers with the most severe OCD that involves incessant checking. It’s not just locks, faucets, etc.–it’s everything!! He even walks backwards at times to see if anything dropped. He checks pockets in clothing,my handbag,& it takes forever to get him out of the house or if we go anywhere he has to check under tables or chairs. I won’t take him to any store due to his checking. At times his checking looks so suspicious to others that they think he doing something wrong. He’s on some meds but they don’t help much. It’s very frustrating living with him, but I love him & he’s smart, funny, articulate. He can’t work due to his ocd & has been either fired or asked to leave a job after a short time. Do you have any ideas that would help him to try to control his checking. Please help. Thank you

  • Felica, obviously the answer to your questions could be/are a whole book. For a brief answer, check out my post: The Right Treatment For OCD

  • hi!dr grayson ,i suffer from a form of ocd where i cant stop noticing things like noises or noticing my eyes blinking or noticing songs repeating i have a hard time concentrating on my studies,i live in india and have suffered badly at the hand of doctors here,they either sedate me or hand me prescription drugs that always worsen my condition,please tell if could purchase your matter regarding dis form of ocd ,or do u offer treatment in phone calls which work overseas,the society here is ignorant over these conditions and i cant even seem to share it with my parents..thanku in advance

  • Dr Grayson,
    I have your book, and I read it often to help me. Its inspiring, but also tough love, and I appreciate that. I have homosexuality as the obsession of my OCD (I have been diagnosed 3 times) and I really, really struggle with the idea of acceptance. I am among the 40% of people who feel some sort of arousal/groinal response to the thoughts (which disturbs me) and so I am curious to hear how I can accept not only the intrusive thoughts but the automatic physical components to my obsession? I feel as though “acceptance” is meaning its true, and as hard as I try I cannot get myself to fully accept being gay. I can tolerate the posibility, but do I have to say it?

  • Dear Dr. Grayson,

    I’ve read your book and really enjoyed it. You wrote a bit about reading compulsions and the feeling that one has not understood what she has read. However, I wondered if you had any tips for exposure exercises targeting perfectionism related to writing?

    To begin with, I am a perfectly good writer. There is no real reason for me to be concerned that anything I am writing will not be up to standard. However, one of the areas that my OCD impacts the most is my ability to write prose. This is a huge problem, as I am a student at an Ivy League university and therefore have to do quite a bit of writing for my classes.

    I spend an ENORMOUS amount of time changing the wording and phrasing of my sentences until they are “just right” and have the right “flow.”

    I have a lot of trouble devising ERP’s that I can actually follow through on. It is very difficult for me to “just write faster.” My exacting standards are so ingrained in me that I can spend hours on a single paragraph without even realizing it. I write and rewrite and tweak the wording until the cows come home–and most of the time, I am largely unaware that I’m doing this. I just get sucked in. And even when I do realize that I’m engaging in the compulsions, it’s very hard for me to stop. It’s terribly easy for me to slip back into my usual way of writing (and rewriting, and re-rewriting).

    I have major issues producing rough drafts. It’s like the writing has to be perfect before I can move on.

    I have tried using timers, but doing so does not really change **how** ‘m going about the writing–I just end up not finishing the paragraph within the allotted time.

    Please, do you have any ideas for ERP’s I could do to try to address this? I spend my entire life just trying to finish my school work (which I usually don’t)–to the exclusion of pursuing anything that is remotely meaningful to me. There are so many things I want to do with my life, but instead I am spending hours in front of the computer screen trying to finish this sentence or that. It’s miserable.

    Thank you in advance,
    Sarah

  • hi.

    how i can try the expose/response and “acceptance” in a “paranormal” pure o – OCD? example: my sister maybe is possesed by a demon? (im not supertitious or religious!).
    I cant accept the existence of posession or evil souls so…
    the “maybe yes, she is posessed” dont work…

    pd: sorry for my english, im from spain.

  • To Jota,
    You say that you can’t do ERP to the possibility that your sister is possessed by a demon. The fact you aren’t religious or superstitious doesn’t play a role. The critical question in developing an exposure for you depends upon your feared consequence. If you are going to say that you know she can’t be, but spend time trying to convince yourself that it is utterly impossible, I would argue that you ERP would need to focus on the possibility. If on the other hand, the worst fear regarding this obsession has nothing to do with the possibility of her being possessed, then what is painful about the thought. One possibility is that what you hate most about it is simply having the thought and it seems to you that the constant thought just ruins everything. If this is the case it is functioning like a ‘neutral obsession,’ that is, where the feared consequence is simply that it won’t stop, your life will be ruined and nothing more. Later this month, an article I wrote about neutral obsessions will be available on my home website (www.ocdphiladelphia.com). However, if this is your feared consequence, write me and I will e-mail you a copy. If it isn’t a neutral obsession, then what is your worst fear regarding this thought, without trying to figure out whether or not it makes sense?

  • Dr Grayson,

    Based on the comments i see above I too have pure o neutral obsessions where the feared consequence is that my obsessions will ruin my life whether that obsession is a song stuck in my head, when im sad fearing i might get clinical depression, fearing my OCD itself is/will ruin my life. I went through a period when my girlfriend told me she had a ghost in her house and i obsessed over the possibility i might have one in MY house. It wasnt fear of the ghost per se but the thought i might believe it and how that might lead to abandonment by people and my life would be ruined. Im doing ERP around the consequences of what could happen if I got clinical depression and since im somewhat sad now im afraid i might get worse from doing this. With these neutral obsessions, driven by a fear of ruining your life what is a good approach? I read your article Obsessing about Obsessing but i didnt quite understand the ERP approach mentioned. Can you comment on this? Thanks!

  • Hi Dr. Grayson,

    I was wondering if you could address the comments above by Oscar and Jen. I too fear that the anxiety will become so overwhelming that I will eventually kill myself. When I do exposure, should I just focus on the possibility that my life will be ruined by my anxiety and that I may never have a family, job (eventually kill myself). Your book and obsessing about obsessing article give me hope. Its just that every time I flood myself with the thoughts my OCD seems to get worse and I become more hypervigilant.

    • Patrick,
      It is very hard to cope with obsessing about obsessing, because if feels like your worst fears are actually coming true; that is, if I obsess life will be terrible. And, indeed, while you are obsessing life feels terrible. In addition, explaining and understanding the goal of treatment in this case is somewhat abstract. I’m glad you found the article helpful (which will soon be available with some other articles on my website: http://www.ocdphiladelphia.com), because sufferers often misinterpret what I say and think it translates to: just live with it.
      I think part of the problem with the exposures you are doing is that you are including the feared consequences, but reminding yourself why you want to do treatment or what you expect to get. Again, the goal isn’t to stop the thoughts, but to get to the point that you don’t care they are there. In the article I remind people that if a loved one were to die, two weeks after the death, thoughts about them would pop in your mind, interfere with your concentration and you wouldn’t be able to get rid of them. You wouldn’t call these obsession, but the reason isn’t because they are real, but because you don’t try to get rid of them or stop them.

      Again, this is a treatable problem, but not a simple one. A lesser exposure you might try is making a tape/cd/mp3 that every 40 seconds to 90 seconds just says it. It is to remind you of your obsession, so that while the script is playing, it won’t be possible to get your obsession out of your mind. I would have this playing day and night and only turning it off when I’m in a place where it isn’t appropriate to wear headphones (business meeting). You could wear it with family, friends, while watching tv, etc. The goal isn’t to focus on your obsessions more or less. If they increase because of this, that is okay and if they decrease that is okay. The core goal of the tape is that it helps to interfere with wishing the obsession would stop, since that can’t happen while the tape is on. This is very important, because whenever this wish occurs, you do become depressed. It is still advisable to seek the help of a professional and if they aren’t familiar with OCD, I’d be happy to consult with them.

  • Dr. Grayson,

    I have an interesting form of OCD, at least I think so, that involves my relationship. My fiancee’ and I moved in together last October. Prior to this, everything was great in our relationship, with a lot of love. About a week after she moved in, I started to obsess over whether or not I found her attractive, which led to “do I find her sexually attractive” which led to “I should break up with her.” I became depressed and saw my medical doctor, who prescribed medication for me for the depression and generalized anxiety disorder. The medication worked for a time, and I felt like my old self again. Well, recently, I’ve fallen right back into the hole. Now, I am focusing on my fiancee’s looks, and constantly compare her to other girls, with the returning thought “I find those other girls attractive” which leads to “I should break up with her.” It is a constant thought, lasts 24 hours a day, and leads me to consistently check her pictures, as well as stare at her to compare her to other girls. In normal times, this does not happen. Does this sound like some sort of OCD, or am I making this up as a front for a deeper issue? Thanks for any advice. I’d be very interested to know if this could be correctable with some sort of therapy.

  • Hi doc,

    1.Is medication needed forever to control ocd, in severe ocd? before treatment it was severe, now i’m free from symptoms after CBT+medication therapy.

    2.will the dose can be redcued after a while, or may the dose that bring you symptom free should continue?

    Thank you,
    Yaron from Israel.

  • Dr Grayson,
    I see a lot of writing out there about OCD behaviours such as a fear of germs, but I was wondering if you could comment on a type of OCD that involves touching or moving things certain amounts of times until they feel “right”?
    To use myself as an example, I will often put down a glass and then feel like the place it is sitting or the way it is turned is wrong, and will have to pick it up and put it down numerous times. Often I will try to avoid putting it down a certain number of times (like 4 or 6) because that number feels wrong somehow. Sometimes I will put the glass down on odd numbers to try and “cancel out” the wrong placements with right ones, and then finish with a “right” placement. I will do the same with touching things, like a curtain or my hair. My obsession with “right” numbers even extends to reading sentences over or writing things more than once.
    I was wondering what thoughts you had on this type of OCD, and whether exposure and response therapy can be used to treat this problem? Any thoughts on the matter would be greatly appreciated. Thank you.

  • Hi Doc,
    I’ve been told by my therapist I have severe, “just right” ocd. I have not had success with meds, Luvox and zoloft. I get STUCK in an action/movement. I willhavw to repeat this action, until I figure out or feel I can let it go, stop, and move on.

  • …Whoops I didn’t finish, sorry. Sometimes I’ll look down at something, spot, crumb, etc. on the floor and feel the need to keep looking at it or pick it up. I’ll be trapped and paralyzed for hours because of this. But at least I will come through it, and get unstuck, move on with life.
    But the real problem is, sometimes no matter what I do, it doesn’t work and I’m STUCK on an action for years! Time moves on, but I don’t. Simply bending over a sink counter to place an object back in drawer, I glanced down at another object and in that INSTANT became stuck. Searching, urge to inspect, repeating to find what I need to feel to “get passed” it.
    I’m suffering with a stuck event right now! A day year ago! What could I do to get passed an event/movement/action that you feel you absolutely must, to feel yourself again! How could I apply a technique or ERP on a passed action. I’ve certainly tried everything. Even contimplated destroying the object still there.
    Thank you for any advice or suggestions!

  • Hi Dr.Grayson,

    Met you at the OCF conference back in August and went on your “virtual camping” trip. I was impressed how you helped people with a number of fears. Did you see Nightline on Monday? I was on that segment, with you. (Faye with the germ obsession)
    Since the conference I’v worked really hard on the germ/contamination stuff, but I’m now flaring up with something different. Scrupulosity. When I worked on the germ fear, the scrupulosity got worse. I’m afraid even if I can overcome, or mostly overcome the scrupulosity, that something else will spring up. Please help. Also can scrupulosity be treated with erp? Thanks for your time!

  • I have been performing ERP for the last few weeks. I have OCD which focuses on my love for my bf. My problem is that now I feel numb. The panic is easing but the love has not come back, I just feel like I have accepted that I dont love him and that is it? Is this a normal stage in recovery and how do I get past it? He is the best person I have ever met and loves me more than anything, there is nothing that has changed in our relationship other than he asked me if I was sure I was happy in our relationship and bam everything went wrong!
    Anyhow just wondering really if this is normal!
    Thanks

  • Hi Dr. Grayson,

    Can you please comment about dealing with obsessions that change over time? I’ve had OCD for years and my fears have not always been consistent (although I recognize themes). Can you also please comment on why OCD comes and goes? and what to do when you feel ‘good’? When I feel good, I feel relief and don’t expose or listen to my tapes. Partly this is due to the fact that I feel like I deserve to relax into good feelings but also because they don’t provoke anything in me on good days, so I don’t bother!

    Inevitably though, I have a bad day…

  • Dr Grayson
    I’ve read your book and I think I have Religious OCD but I’m not sure. your book really helped me but I’m still suffering. I live in iran and I want to know what else I can do to help me? any books? or… .
    and how i could be sure that my problem is OCD?

  • Dr. Grayson-
    How do deal with a smart, stubborn teenager with scrupulous OCD who is adamant about not getting treatment? He fears he will anger G-d if he receives any tx?
    thanks for your time
    Liz

    • Liz, it is always very hard to give suggestions about how to help someone who is refusing treatment. You have three difficult issues going on at once. The first is that he is a teenager and so all of the normal problems teenagers bring will be funneled into this. The second, and this is critical, if you can get him to go to treatment, are there any OCD specialists in your area. Scrupulosity is a very treatable form of OCD, but it is one in which the therapist’s knowledge of OCD is critical. The International OCD Foundation (www.ocfoundation.org) has a list of therapists who may be near you. However, after finding a name on the list, you may want to call them to find out if they know anything more about that provider. Last, depending upon the form of scrupulosity, much of how we try to get someone into treatment has to do with helping them to recognize the uncertainty within their own beliefs. For example, I might point out that if God always knows what is in their heart, even if they don’t, then why would it be a sin to listen as opposed to an act of faith. In fact, their refusal to see a therapist could be sinful, since it assumes that God wouldn’t be able to tell the difference. However, this approach depends on knowing more about that individual’s system of scrupulosity and, again, an experienced therapists is very important. I’m sorry I don’t have the answer that works, your situation is a very hard one to be in.

  • I have a mental OCD and part of my compulsion is reassurance seeking. I am trying to not seek it, but I also don’t want to feel hopeless. What can reassure me? For example, is it okay to take reassurance in the fact that I didn’t lose my mind today?

    • Kim, if you will check some other posts on this site, you will discover that at the core of your OCD (and everyone’s) is not wanting to tolerate uncertainty in the area of your concern. The goal of treatment is not trying to get to be certain – or reassured – but to learn to live with uncertainty. In areas of your life not affected by OCD, you do this constantly. When your loved ones aren’t with you, you don’t know if they just died in an accident, but you don’t check – you decide that because you feel they aren’t hurt that they are not hurt. However, this belief isn’t a truth. So your plan to deal with them possibly being hurt is to hope they are okay and wait. I believe that you don’t want to be maimed and paralyzed. However, every time you get into a car, you risk some idiot ramming you and leaving you this way. And you drive any way. You may even risk death to see a movie. Why? Do you know that you won’t be hurt? However, you can’t simply decide to live with uncertainty, but you can decide you want to learn how. This doesn’t answer your question simply, but if I were able to do that in a short paragraph, then you would figured this out long ago. Obviously treatment with an experienced OCD therapist would be good. There are good books about OCD and, as you would expect, I like mine the best (see sidebar of blog for info about it). I hope this is helpful.

  • Dr. Grayson,
    I asked you an earlier question about reassurance. I have read your book and I am working off of it now. I thought I had this pure-o obsession licked a year ago, but I’ve had a terrible relapse. The truth is, I never really dealt with my most terrible fear: hurting my children.
    Now, I’ve started the higher hierarchy exposures, but I’m afraid I wasn’t ready for them. Instead of having reasons to work on OCD, love my kids, my husband, etc. I keep thinking I should just leave them, that it’s just not worth the risk and they’d be better off without me.
    I’m having trouble with hopelessness. I’m not taking any medicine, I’m starting to worry that I’m depressed and that this will lead me to actually act on my fears.
    Please give me advice. I desperately need it.

  • Dr Grayson,
    I’ve been diagnosed with OCD (harm annd sexual) a year ago after suffering for 20 years. A year later after intensive outpatient(IOP) therapy and weekly psychotherapy sessions I’ve made remarkable improvements. But it seems that my OCD bothers me when I think back to memories of my youth and teen age years. Like everybody I did stupid things as a youth, but it seems I dwell on them more than others. And allot of “what if” questions keep poping up. Is this OCD or something else? .

    I also have problems when I’ll never see someone again. I avoid them or try to leave them quickly. I recently had my therapist walk me to the lobby on our last visit because of the high anxiety and fear that i’d have a harm thought and never see her again. I fear travelling more that 20 or so miles away because of this. Is there a way of tackling these problems? Thank you.

    • Mike,
      Your what if questions certainly sound like OCD. The goal with memories is not trying to get rid of them and if you don’t like what you did back then, not trying to feel good about them. However, the what iffing about how life may have been different if you hadn’t done those things is a very specific fantasy assuming life would have been better if you had behaved differently. Actually, if may have been worse, you will never get to know. Remember real life is never as good as a fantasy, because we don’t put garbage in our fantasies.
      As for your second issue, exposure and response prevention is still the treatment. It is true, you may never see them again. And if you are thinking that your harm thought may be the cause of this, then treatment will have you take that risk. Not to prove you can’t make that happen. All we know about your ‘powers’ is that you have a low hit rate. So we would have you working on having the harm thoughts and if someone did die, we would want to help you live with that, to never know for sure if you played a role and to stay in treatment. Now let’s say you ‘kill’ a second person on a separate occasion, we still want you to stay in treatment. However, if you can get rid of three people on separate occasions (three people in one car crash would only count as one), then we want to figure out something else to do with you and we’ll call the CIA, because they will probably have some use for you. The goal is learning to live with uncertainty, learning to live with potential loss, and learning to have any kind of thought in your head and having you learn to be comfortable without trying to control your thoughts or behaviors.

  • Dear Dr. Grayson,
    I’m reading a book by Lee baer titled “The Imp of the Mind” about bad thoughts and urges and there is a passage there that confused me and ( i have to say) spiked me a bit.

    here it is:

    “All of us have witnessed friends who drink too much alcohol and then act inappropriately, perhaps doing some of the embarassing or dangerous things that OCD sufferers fear doing. Why is this? What is happening in the brain to cause this? Dr. Savage explains that alcohol and or recreational drugs such as barbiturates suppress the activity of our brain’s frontal cortex, whose main job is to control and supress the primitive aggressive and sexual impulses from the lower areas of our brain. When we drink or use drugs , our frontal cortex is no longer able to do its job properly making us more likely to act on our impulses.
    Because of this for any one who worries about doing something dangerous or embarassing- such as someone with OCD- getting intoxicated with any substance is usually a bad idea.”

    Does it mean that an OCD sufferer with thoughts about killing people is more prone to act on this thoughts under the influence of alcohol or drugs than any regular person?

    The author also refers that some people with OCD who got drunk (and blackout) obsess in the morning after about what they did while under the influence of alcohol (false memories etc).

    but in this case avoiding alcohol might not be (at least in theory) avoiding expusure?

    Thank you

    • I think Lee is saying that for someone with this kind of OCD, drugs or alcohol seem particularly scary. I wouldn’t say do exposure by getting high and intoxicated nightly. However, if you don’t have an alcohol problem then we would encourage drinking in your usual way as exposure.

  • Dear Dr. Grayson,

    I got spiked yesterday reading an article on Newscientist about people becoming sick or dying by sugestion, they call this process “nocebo effect”

    My questions are:
    For example, how can an OCD sufferer scared of cancer deals with this situation?
    The more he tells himself that he will not die of cancer , the more he will think that he will die of cancer which may create in this way a “nocebo effect”.
    It seems like a catch-22 situation.

    Furthermore, In case I don’t follow a certain OCD ritual (as an exposure exercise) how can I avoid being sugested by my mind of the “negative consequences” of my action?

    I don’t know if I was clear , but I would greatly appreciate your answer.

    Thank you

    yours,

    Bernardo

    • Bernardo,
      Sorry for the delayed response. You’ll be happy to know that we have seen this problem before. The short answer is that in all of life we live with risk. Every time you get into a car you risk death by some idiot crashing into you. If this isn’t your obsession, you take this risk without a thought. The situation you describe from the article is not common; that is, you are more likely to die in the car crash than from the double combination of getting cancer and having worsened by suggestion. So, if you need to avoid such low risk events, then you need to start avoiding many other dangers that you currently don’t. Or if you were going to attack OCD, it would mean that you want to take the goal of learning to live with uncertainty. That is, accepting that there is some possibility that your fears could come true, but that the effort of trying to avoid thinking negatively is so hard and stressful that it isn’t clear which is unhealthier. The bottom line is that it is sad that for all of your ritualizing, you never get the prize, safety from potential death. Treatment means learning to live with uncertainty (notice I say learning, it would be wonderful if it were as easy as a simple decision) and actually doing exposure and response prevention — not to prove that you can’t harm yourself with thoughts, but to get used to living with the risk of the thoughts, the same way you live with the risk of car crashes. And if you don’t drive, I can assure you that you are exposed to numerous other dangers that you fearlessly permit.

  • Hello Dr. Grayson,

    The more I look into it, the more I realize I do have OCD. I’ve worried excessively over harming myself, harming loved ones, but lately my biggest worry has been “obsessing over obsessing”. I hate the fact that I may have to deal with OCD forever. My biggest fear is, like several others here have said, that I won’t be able to tolerate my worries and may end up killing myself. I realize that is absolutely not what I want to do, I’m not suicidal, I’ve got far too much to live for. It’s the fact that I have so much to live for, however, that makes the idea of suicide even more worrisome. The more I think about it, the more it feels like some day it could become reality. (I can totally relate to everything Oscar said). I have a wonderful life with a wonderful, supportive (although not reinforcing) girlfriend of four years, and when I’m going through periods of anxiety, I feel like I’m not the boyfriend she deserves.

    I’ve definitely been through periods of remission and happiness, and the periods of time where I can accept anxiety and be happy regardless far outweigh the times when I’m consumed by worry, but when I’m in those times of worry, it feels like it’s just never going to let up. I feel like I have a relatively good understanding of my OCD because I like to consider myself an intelligent person (definitely a “thinker”, which contributes to rumination). I understand the irrationality of my thoughts, but it bothers me that I worry about them despite my realizing their irrationality.

    I’m willing to do as much as I can for treatment, but as a college student (it feels like college is what brought this on in the first place), I have little time and little money. What are some good treatment options for someone like me? I plan on buying your book as soon as I can, and thankfully, I’m in the Philadelphia area, where there seems to be a lot of resources on OCD. I’m scheduled to see a Psychologist for free through my school on the 23rd, so hopefully with medication and therapy, I’ll be able to return to the times when I can let my anxieties pass easily.

    The point of my question is that I find it’s very easy to lose hope in my ability to reclaim life, and I was wondering if you had any suggestions on how a stressed-out college student like me can help myself.

    Thanks and God Bless,

    A.J.

    • AJ, certainly I like to think that my book can be helpful. In the Philadelphia area there is a free support group that encourages and helps its members to work on exposure and response prevention. It meets in Bala Cynwyd and if you are interested, you can contact me through my center’s website: http://www.ocdphiladelphia.com, so that we can screen you for the group (screening is free). I hope this gives you some hope and a good place to start.

  • Dear Dr. Grayson,
    I had a question about double checking. I have ocd about double checking everything. It’s so ingrained in brain that without thinking I double check. I want to stop the double check but that 2nd check causes more uncertainity.
    I don’t know how to break the cycle.
    Thankyou

    • My answer will be easier said than done. The goal is to be uncertain, because research has shown that the only people who are certain are stupid people and most sufferers of OCD are above average intelligence, so certainty isn’t an option for you. To work on living with uncertainty, the way we would interfere with double checking is not only to not check, but to do things wrong. For example, if you double check locks, we would have you close the door, turn away from the door and turn the lock to the position that might be locked without looking. Doing this quickly and purposely not trying to feel the lock. Then there would also be a paper flap taped over the door lock, so that when you took your hand away, it would fall down and you wouldn’t be abld to accidentally check. Again the goal is learning to live with risk.

  • Dear Dr Grayson,

    Thank you for the wonderful website. I’m wondering about thoughts arising out of nowhere. I’m not sure they are the same as ‘intrusive’ thoughts as I’m not thinking them.

    For example, I could be sitting there thinking about how bad my football team has played of late, then suddenly, something totally unrelated like ‘found the book’, or ‘there were six’ or anything just arises in my mind. The crucial thing here is that I do not (consciously at least) think them.

    What are these arising out of nowhere?

    Basically then, what are these arising phrases/conversations/words I am having?

    Thank you very much for your time and effort

    PS: I am seeing a psychologist soon.

    • Mark,
      This may seem strange to you, but there thoughts are never intrusive — that is, all thoughts are normal, whether they are horrific, abhorrent, or, as you say, random. The human mind is constantly coming up with all kinds of thoughts and situations. What makes a thought and OCD problem is when the individual wants to know something about the meaning of the thought (e.g. Why am I having this thought? What does it mean about me? Will I do something because of it?) or if the individual want the thought to stop. If the sufferer attempts to do either, the thoughts will become more frequent. One reason for this is that if you are trying to avoid a thought, the only way to do so is to look out for the thought, which means you think it and then exactly what you wish wouldn’t happen did. What you are describing sounds like a variation of what we call neutral obsessions. Neutral, because there is nothing obviously horrible or scary about the subject or content of the obsession other than the fact the sufferer is bothered by having the thoughts. If you would like an article on neutral obsessions, go to my center’s website: http://www.ocdphiladelphia.com, and e-mail me a request for the article.

  • I was wondering how to help a teen who is having trouble writing and taking notes in school and now having difficulty in verbally answering a direct question and speaking to others. Also this person is having trouble merely pointing to the correct answer on a paper.
    Thanks so much.
    currently in therapy and on medication for ocd and add.

    • Regina,
      First, I’m hoping that the therapist you have is experienced in treating OCD or is receiving supervision from someone who is. If s/he hasn’t mentioned exposure and response prevention as part of the treatment method, then he is in conflict with the International OCD Foundation, the American Psychiatric Association’s treatment guidellines for OCD and the American Psychological Association. This was the easy part of the answer. I can only answer your question in general, since what I describe is usually the issue for reading and writing problems, but not always. Usually, the issue is wanting to be sure that everything they read or hear is perfectly understood, however, understanding is measured by feeling, not actual understanding. The feelings are very painful and compelling, so the sufferer feels sure that then need to do their rituals to understand. It is further complicated by the fact that the rituals actually interfere with understanding, which further reinforces the feeling in the individual that the rituals are necessary. Your teen may have ADD, but some sufferers with this problem get this as an diagnosis when the problem is purely OCD. Again, I don’t know your teen, so I don’t know if this is or isn’t true for him/her. As for notes and speaking, it is usually similar to the reading in that the sufferer wants to be exact in communicating and isn’t sure they will be properly understood. The first step of treatment is helping the individual understand the issue and helping them to learn to accept the uncertainty of not understanding or communicating perfectly. This is the hard part to do. The next part is designing exercises to challenge the OCD. The problem with what I’m telling you is that although I’m describing what we do, it doesn’t answer the critical magic question of exactly what can you do to help your teen take these steps. I’m afraid I would need much more information to have an idea of what to do, but I hope this provides you with some direction.

  • Hi Dr. Grayson,

    No question……just a thank you for helping so many people and insisting that ERP be the treatment for OCD. I am so thankful that my son had the proper treatment. He went from having severe OCD at the age of 19 (not eating or being able to move from one particular chair) to being a successful college junior who is living his life fully. He has not even needed any medication for the last year and a half. And it’s all because of his and his therapists commitment to ERP therapy. Thank you for all you do and keep up the great work!

  • Hi Dr. Grayson,

    From your experience, can taking birth control (e.g. Alesse) interfere with SSRIs (specifically Cipralex) and/or has birth control been known to aggravate OCD?

    Thanks
    Jane

  • Dr. Grayson,

    If ocd is associated with disgust of an animal can erp work?

    For example, being afraid of as well as disgusted with a specific animal which leads to compulsive need to clean everything that might have been touched by that animal. Will the animal phobia prevent erp from working?

    • No, what you describe is not a problem for treatment. The key issue is not only doing exposure, but what is your goal? Do you want to overcome disgust or be ruled by OCD and your feelings? If you want to learn to live with uncertainty (I assume in your case that this would be never knowing what has or has not been in contact with an animal), then proper treatment and dedication on your part will work.

  • Dear Dr. Grayson,

    In your book, I noticed you mentioned fears of radiation as a possible symptom of OCD. So before reading any further, please rest assured that this question is not in any way a manifestation of my OCD. My OCD primarily centers on contamination and disorder fears.

    My questions…

    Has any research been done to date to determine if OCD behaviors lessen (or even resolve) in an electromagnetically ‘clean’ environment? I ask because I have read several books on the subject of radiation dangers including ‘Cross Currents’ and ‘The Body Electric’, both by Nobel prize nominee Dr. Robert O. Becker, and B. Blake Levitt’s ‘Cell Towers – Wireless Convenience? or Environmental Hazard?’ and ‘Electromagnetic Fields: A Consumer’s Guide to the Issues and How to Protect Ourselves’, and apparently genetic expression can be affected by these exposures to manmade sources of electromagnetic and microwave radiation. Could this be why identical twins don’t necessarily both go on to develop OCD?

    Also, not only does my case of OCD mimic some of the most severe cases mentioned in your book, but I now experience debilitating symptoms upon exposure to things like fluorescent lights, cell phone and wifi towers, radio antennas, and the like…symptoms that sound a lot like Electrosensitivity (or Microwave Sickness).

    I know I hadn’t even heard of OCD until an Oprah show in the 1980’s. Is it possible that OCD really was rare at one time and that exposure to some new technology is merely increasing the incidence of OCD?…like FM radio perhaps? or the very first cell phones? I know the severity of my OCD increased exponentially in the mid-90’s, right alongside the monumental increase in the number of cell phone users. By any chance do you have any stats on the incidence of OCD over the years?

    Thanks for reading this and for an excellent book!

    Carol

    • OCD has been around for a very long time. It was under-diagnosed and thought to be rare, but this is more the result of sufferers hiding their symptoms and the mental health field not understanding the disorder. Even today, we frequently run into mental health professionals who mis-diagnose OCD if it doesn’t involve handwashing or simple checking. Becker’s book is considered controversial, so that not all of his conclusions are supported by the entire scientific community. The earlier sections on his book about the mammalian potential for regeneration has much research and further studies need to be done. Some of his concerns about the negative effects are still not considered substantiated. At this point in time there is no link between electromagnetism and OCD. In addition, if OCD were the result of electromagnetism, we wouldn’t be seeing the genetic linkage that we see that precedes the 1980’s when looking at family histories. Untreated OCD often does get worse over time, so your experience wouldn’t really be evidence.

  • Dear Dr. Grayson,

    I actually have such severe OCD that most of my house actually IS appearing disgusting and IS in desperate need of cleaning, even to so-called ‘normal people’, simply because I spend so much time OCD-ing one single item or one small corner of my home that I don’t get very much done and have seriously fallen behind as a result of all this.

    My question…why hasn’t this cured me? Isn’t this ‘exposure’ of the greatest magnitude? Some of the rooms in my home probably have not been vacuumed or dusted in over 6 years, yet I’m still bothered by the dirt and dust and disorder in those rooms and keep thinking about it.

    I thought the anxiety was supposed to lessen over time? Instead, it seems like I just gave up on cleaning them at all? In fact, I think the only thought that gets me through is that I keep telling myself that one day e-v-e-n-t-u-a-l-l-y I will get to OCD cleaning those rooms, too…if I live long enough, that is…

    Help?

    Carol

    • Carol,
      No this isn’t exposure. Despite the fact that the house is dirty, you are constantly wishing and attempting to clean up. Even the rooms you avoid, because you don’t get to them are not by a decision to confront the issue. Exposure is not only a behavioral situation, but a reflection of what the sufferer is trying to do. You are not wishing to cope with contamination, but are wishing it could be less and that you could clean more efficiently, but still relatively perfectly. I assume one reason it takes so long to clean anything is because you attempt to do so perfectly, thus your behavior is one of constantly ritualizing. Exposure is a decision to live with uncertainty and to cope with the potential consequences; again, it is not living in squalor and constantly fearing the potential consequences and engaging in rituals. I hope this explains some of your predicament to you.

  • Dear Dr. Grayson,
    My wife became sick with the flu twice last year, Ever since i have gotten OCD of Germs. I dont want to go out, i dont eat out nor allow my wife or kids to eat out. We havent gone to the mall, restaurant or anywhere for that matter. I wash my hands 100 times a day. Havent seen friends or family members in this whole time fearing they might be sick and get my family sick. What can i do to get my old life back where i can go out and enjoy life like i did before. Also, Do you provide private therapy session on the Internet? Thank You

  • Dr. Grayson,
    I have a problem of wanting the ideal ‘princess’ girlfriend that we see in childrens cartoons etc. When I first decided to ask my girlfriend out I thought she was cute and nice, but I wasn’t like ‘wow! shes completely beautiful!” I struggle because some girls give me that ‘wow’ aesthetic factor when I see them but I’m scared because my girlfriend matches me in personality and I love being with her. Her looks didn’t bother me a couple of months ago, now I find myself staring at her a lot and not wanting to look at pictures that she doesn’t look good in, only wanting to look at the ones she does look good in. Is there some way of getting over this or am I always going to be wanting ‘my girlfriend’ in that ‘princess body’?? Thank you!

  • My daugther is 20 years old and has been suffering from OCD since she was about 4 years old. She has had medication in the past, but has been off it for about 5 years now. She is now completely relasped….she doesn’t work, see her friends or basically leave her room. She was showering every time she used the bathroom and had to wash all her clothes and bedding each and everytime she used the bathroom. Now she only uses it twice a day…..but stays in the shower for about 1 1/2 hours each time…..and if she touches anything when she gets out she must start all over again. She also cries…..really howls because it is all too much for her and she can’t face having to do these rituals day after day. I brought her to our psych hosp but she presents so well that they said she does not need to be hospitalize. She is completely paralyzed….her life is an agony and I enable her so much because I cannot bear to see her in such pain. I dont know where to go or who to turn to…….

    • To Tamara about her daughter:
      You are describing a very difficult situation as you know without easy answers. Your daughter certainly needs someone experienced in the treatment of OCD and hopefully if you can find someone through the International OCD Foundation (www.ocfoundation.org). Your daughter may need an inpatient OCD program and three very good ones are the OCD Institute in Boston, the Houston OCD Treatment Center and Roger’s Memorial Hospital in Wisconsin. I know these may not be near you, but they are probably the three best specialized OCD inpatient units in the country. I hope this helps.

  • Hello Dr. Grayson, I am a health care professional and my work requires me to read a lot of important information. I am having tough time reading and understanding. I feel like I’ll miss important information and I end my re-reading and further re-reading. Any suggestions of how to overcome this. I am trying to live with uncertainty but the anxiety is so overwhelming.
    Thankyou

    • To DCO about his reading problem:
      It is very good that you are attempting to cope with uncertainty, but to do so successfully means setting up a program in which you do more than simply read something once without re-reading. In treatment we have ways of making sure you will miss some things and we work on making re-reading more difficult. IAs you know, whatever you may be missing is nothing compared to what this is causing you to miss in life. Yes, you might miss an important piece of information, but the reality is that all of us periodically misread and you are attempting to cope with the fact that you could miss something and someone would fail to benefit because of that. In health care, as in every field, none of us are perfect and as much as we wish to avoid them, mistakes will happen. In fact, if I try to hard to make mistakes I will make them, because too much of my attention is on avoiding mistakes and not the task at hand. Part of living with uncertainty is deciding how you will try to cope with mistakes in a positive way (not I will give up and run away, but how will I work on coping with the guilt and other consequences and then continue in my career). Obviously the answers may be simple, but they are far from easy and can be hard to implement on your own.

  • Hi Dr. Grayson,

    I am an avid reader of your research and refer to your book continuously. I have a pernicious case of OCD as many people on this site do. I have obsessing about obsessing but my primary fear is that I will be constantly anxious or at least anxious enough to ruin my life (not have a job, GF, kids, etc.) Basically, I fear that I will not be able to continue coping (eventually committing suicide).

    My question for you is what do I do when I am in a state of perpetual anxiety (which can last the majority of the day). In your book, you describe a case of a girl who must learn “that we don’t always feel the way we wish.” But, I have days where I am perpetually anxious and continuously ruminating about being poor, homeless, not being able to hold a job etc. I try to say this may happen but I am continually anxious. I feel like my brain is trying to avoid the anxiety. Then I fear what if I’m making my OCD worse? What if I’m ruminating, thus undermining ERP.

    So when I am in the throes of panic I should just say “Ok I may be anxious forever and be unable to cope. This is my life. I’m not able to enjoy anything because my brain is in terror mode but I’ll just keep doing the things in life that are meaningful to me even though I am suffering.”

    Also with the dot labels and “this is it” on my tape recorder, when I see the dot or hear the “this is it” do I consciously bring the thought to mind and ruminate on it?

    Sorry if this is a lot but as you can see I need help,

    I am in the midst of Clinical Psychology Doctoral Interviews and pretty much doubting everything.

  • Dear Sir,
    I am Shambhavi Srivastava from India. One of my friend is going through Obsessive compulsive disorder. I was hoping you could guide me a little. While my friend consulted a psychiatrist, despite of the medication provided things have not really gotten any better. I had a few concerns and was wondering if you could be kind enough to help me out.

    1) My friend has been trying to get off the medication and look at other ways to deal with his repeated thoughts and obsessing about it. Can getting addicted to having the medicine everyday be harmful for him? he tries to distract himself when such thoughts do come but it hardly provides any relief most of the time. Is there anything else that he can try apart from psychotherapy and medication ?

    2) Is there anything that I can do to make him feel better in anyway possible considering I am the only one aware of his OCD apart from him.

    I request you to please reply as soon as possible…….for I am absolutely clueless in relation to how to go about things and I’m afraid that things with him might be getting worse.

    He constantly obsesses over thoughts of not being able to study or do his work, not being able to get the desired result, not being able to remember what he is studying while he studies……and ends up rereading or redoing the same two three lines again and again without any result. the moment he starts any work in office….he enters the circle of unending thoughts of what if he cant do it.

  • Dear Dr. Grayson,

    I am from the EU and suffering from periodic OCD. I try to cut my questions short, most will be of interest for other sufferers:

    Do you have any clinical experiences with vitamin ,,Inositol”-treatment for OCD. Does one really need to take 18 grams to see
    benefits? Can ERP also be used for pure obsessions; would ERP also be useful for other anxiety disorders like GAD?

    Most european experts agree that OCD is biologcally and learned based. However my OCD is running on and off, 2 years of
    beeing normal and happy follow months of OCD pain, ruminating and anxiety with total exhaustion, then after some month the
    OCD is again fading even w/o SSRIs. If I or ,,we, the sufferers” who have it on and off have learned something wrong, then why
    we do not have it 24/7? Or is it rather rare that one has pure obsessions cyclical? Is that something close to bipolar disorder
    only without the highs, just cycling between normal and OCD?

    Thank you very much!

    GF

  • Hi Dr Grayson,

    I have suffered from OCD since I was a little girl. At that time OCD manifested itself as frequent hand-washing, Religious rumination etc. As I grew into adult hood and started dating the main theme has been what the message boards seem to call “ROCD” or “Relationship OCD” which im sure you are familiar with. Practically every relationship i’ve had has been ruined due to this – i.e picking faults in a partner, thinking the worst possible thing about them until I cant handle it anymore and break up with them.

    I’ve been with my current partner for about 16 months. We get on really well and im comfortable with him. BUT (the big but) Every day there are these horrific ruminating anxieties – e.g “You have no friends therefore You’re a Loser, you’re not good enough for me, Your eyes are too big” (the list goes on) and its the constant catastrophic thinking that upsets me so much.

    Im currently seeing a therapist and also a psychiatrist who has put me on new medications to calm the anxiety – But, I often feel like although they are doing a good job of treating me, I really feel like because ROCD is not widely known that im not getting the proper “treatment” for this debilitating form of OCD – when you dont know if what you are thinking about this person is true or not. Also baring in mind that I live outside USA/UK in a smaller country where very little is known about the different types of OCD.

    I dont want it to ruin another relationship!

    If ERP is the “gold standard” for OCD, how do you expose yourself to fears when the fear is the relationship itself?
    Is there anything I can do/tell my therapist that might help my treatment better going forward? (They are open to it being this type of “Relationship Substantiation OCD” however I think the treatment would be rather different than to someone who say, has frequent hand-washing compulsions seeing as mine are just thoughts and not compulsions.

    I thank you for your help.

    Regards

  • I find that Ambien somehow helps with my severe ocd. It is almost like Ambien attacks the unwanted thoughts at the subscious level. Unfornuately, it is also why I take 2 Ambien a day.

  • Posted by somebody else on another forum – interesting.
    This is just a hypothesis of mine, but I do believe that the Ambien allows your subconscious mind to receive more rest as in you get more REM sleep at night and therefore your brain is “ready to go” much more then without the Ambien. With your condition it should really help afterward because lack of REM sleep will cause your brain to become tired which in turn would cause any mental illnesses or disorders, like OCD, to become worse and more pronounced. As to why it helps my RSD/CRPS while on it, I think it is something similar but instead more to do with my central nervous system in its entirety. This is just a guess, but a logical one, so don’t take it as fact! I am not a Doctor and I did not sleep at a Holiday Inn last night either, rofl.

  • hi i have had ocd for 2 years onset was around my first pregnancy adn now i am pregnant agian. i went to see an expert on cbt. he told me that i could be ‘cured’ and that he doesnt believe that exposure therapy will be 100% effective for me because i will not get that instant feedback that no harm came from the exposure e.g. like someone afraid of height would if they climbed up a ladder and didnt fall off. i am very disheartened because i have had some success with exposure therapy but had a big scare a “unanticipated exposure to blood at a water silde whilst trying to give my son a normal day out. i just didn’t know how to get back on that horse after that. what do you say f someone is doing exposure e.g. writes a list of fears grades them and works through them and half way through this gets exposed to there greastst fear? my therapist that i did the exposure with did say at the start he knows exposure therapy but from the point of view of social phobias not ocd. unfortunately he did not know how to answer question i just asked you. i really dont know where to turn as the guy that does cbt without exposre is an expert i had to go to the big city and pay alot of money to see him and all he seems to say is that i’m stupid. which i know already i mean i know the probabilites of the possibility of the things that scare me actually occuring are ridiculiosly low i always have. but the ocd part of my brain is screaming at me that there still a chance do the ritual or youll never hear the end of it. do you think cbt can effectively treat ocd without exposure? ow i forgot to say i live in rural australia and once had another (not previously mentioned) the local psychologist tell me i fully justified in been cautious because they have found sperm on shopping trolleys! so the resources here arent great. do you know of someone in australia who does good exposure? i am totally incapacitated at the moment e.g. cant leave hte house ect n am very worried about how all this crap is affecting my family.

  • dr grayson
    hello again i have question related to your post no one should do exposure and response prevention. you mentioned that “There is a 1 in 4 chance your children may have OCD and your behavior teaches them that OCD is something to cope with or not.”
    what is the source of this stat? im curious as to whether it is based on something like twin studies raised apart e.g. purely genetic factors or a combination of both.
    i mean r u saying that the fact i have ocd means my child has a 25% of getting based on observing my behaviours or just based on a predisposition i have passed along to him.

    in a long grapple with the decision of whether to take previously untrailled medication for my ocd symptoms which have both onset and excerbated in pregnancy. i have spoken with a geneticist/tetraologist by the name of debra kennedy at the royal womans hospital in sydney.
    she gave me some general stats. because i basically i had to weigh up the risks associated with taking ssris in pregnancy with the effects of my worsening symptoms on my toddler.
    She said there is a 1 in ten chance based on purely genetic factors that a child with one parent with a mental disorder i.e chemical imbalance some view ocd as syptomatic of.
    if there both parents have a mental disorder there is a 50/ 50 chance.
    She said that there is nothing you can do about the genetics. and unfortunately as it is not ethical to have controls (e.g.non symptomatic groups of pregnant women taking ssris) that they just do not know the long term effects of these meds on these children, but if there is it s nothing glaringly obvious. my questions centred around behavioural and intellectual development not only in the formative years but when a lot of this kicks in at puberty. Which there have been no studies done on except on one ssri.
    Also there was a 6x increase in the risk of the baby developing pulmonary hypotension which can be hard to diagnose and as the baby is been deprived of oxygen until it is daignoised; brain and possibly life threatening. i mean these are psycoactive drugs i would be exposing my fetus to.
    her overall recommendation was that in trails done of 3 groups of woman and their childrens development up to the age of eight. (unmedicated, medicated in ppregnancy and breastfeeding and medicated when breastfeeding) the group who did not take the meds had the worse outcomes (milestone delay ect). My situation was unsual in that onset of ocd had developed in my first pregnancy and because of pregnancy and breastfeeding i had never trailled the ssris so after been told there a 50% chance that any ssri will have any affect and only a 30% reduction in symptoms at best i told her to go fuck herself.

    Then again i am hanging on by the skin of my teeth. so if anyone reading this is on the meds and pregnant i think this is a very personal decision and either way your screwed so good on you for doing the best you can.

    sorry i tend to waffle my question is where is this one in four stat from.? does it differentiate between people who actively sought treatment i.e either cbt meds or both an parents who didn’t?
    also does mindfulness conflict with either cbt or exposure?

  • hi
    i just have one more question.
    my ocd expert said that he didn’t see the value in impatient treatment his reasoning was twofold one that ocd is a battle that should be fought in yu r own environment. and two that often group therapy is not streamlined (in australia). he said that others in his field get excited with initial improvements are made but he said when they get home this is harder to put into practice and often of no long term benefit. what do you think have you seen people benefit from inpatient programs?
    i dont know if this is my ocd but when i contacted a few of the major public hospital in sydney they said that in austraia our public system is overloaded which crisis situations and therefore only deal with panic attacks and ocd if the sufferer is about to jump off a building(ie literally sucicidal).
    they also said often ocd especially my subtype (contamination) get worse in hospital.
    my ocd was very happy with the last comment because i do make effort to try and do things despite been frightened of stuff like having to share a bathroom come in contact with people of unknown hep c status all the ocd crap.but here was a health professional saying yeah your ocd is right.
    in australia the private hospitals do offer ocd tailered preograms this is what my ‘expert’ was commenting on when he said there often not streamlined.”what some gradutae sitting there reading everything out of a manual” however his strength is not erp. as someone who actively practises erp if you believe there is value in impatient programs for people with “garden variety” cointamination ocd. and if so what sorts of question should i ask them to ascertain if they have e3xpertise and an erp program that is likely to be beneficial?

  • Dear Dr.Grayson,
    If I want to get the treatment from you, how can I make an appointment, do you have evening or weekend hours.
    Thanks
    Namasi

  • Dear Dr Grayson,
    My daughter is adopted from China and is now 17 years old. She was diagnosed with Tourettes Syndrome when 5 and has been on many medications but is now just on Abilify(15mg) and concerta(18mg). She has never been in therapy for OCD but her pattern of behavior lately has been magnified. She has since 10 bought traded and swapped electronics. She has had over the years dozens of cell phones, and i-phones. Within a day or so of getting a new electronic will claim it was broken and return it or trade it for another model. She may switch back and forth between cell phones to Iphones to the latest upgrade in any electronic and most recently has traded in a new i-pad, claiming it was broken, had it replaced and traded it for a PC and finally traded that in for 100 in cash. This becoming a predictable pattern.Thousands of dollars have been spent over the years Just this week she took a debit card and had the bank convert it into a credit card and bought a $200 cell phone. Naturally we are in touch with the bank and will have the card removed. The card was issued by a well wisher who wanted to teach her how to budget and prepare for college.Because she presents well most people don’t know she has a disorder and think they are helping.Although her behavior does not seem to match any of the disorders mentioned in your book I believe it has a ritualistic quality or a cyclical pattern to it. We live in Brooklyn and would like to have her seen by a therapist ASAP.

  • Hi Dr. Grayson,
    I have started seeing a behavioral psychologist regarding my OCD, and I have not had any luck with medications that don’t have untenable side effects. I have primary mental compulsions, mostly with reading just about everything I see, repeating what I’ve read over and over, and counting just about everything, my breaths included. My psychologist is working with me on these issues. She suggested I contact you regarding one particular issue, however. While my compulsions are primarily mental, they have a physical component as well. I have divided my mouth into four quadrants- top-left, top-right, bottom-left, bottom-right. Everything I do, including reading, repeating, counting, and breathing, needs to fit into these four quadrants. The movements aren’t obvious enough to where others notice, but the muscle movement is sufficiently significant that on my bad days, my mouth muscles end up hurting. Do you have any suggestions I can try to help alleviate this symptom?

    Thank you,
    Douglas

  • I am wondering if Douglas has tried Exposure Response Prevention Therapy in regard to these “quadrants?” Maybe start off by forcing yourself not to put your breathing into a quadrant for a certain amount of time, and work your way through these compulsions……

    I’m not a professional…just putting my two cents in!

    Good Luck!

  • I had problems with meditation up until recently. I kinda couldn’t focus. I think staying focused is what matters and that’s why doing meditation doesn’t work for everyone. I found a quiet place for me in my house and that gave me the extra focus I needed. It works better now!

  • Dear Dr. Grayson,

    I read you book a few years ago and still think it is one of the best written about OCD. My OCD is writing down every thought I think may be of some value.
    While in a conversation sometimes I will be holding three or four thoughts I feel I need to remember and become more focused on that than the conversation, If I happen to forget one of the thoughts before I get it written down I will obsess any where from hours to days trying to remember what it was even if it it insignificant. If I do remember the anxiety will subside and I will feel free to forget it with no anxiety. Sometimes I have filled pages of paper with random thoughts that seem like madness to someone who would glance at the page. I have seen similar writing that Charles Manson has done in prison. My writing can be sideways upside down all around the paper in no type of order. I try to resist the compulsion to write down such minor thoughts and write only things which will require my action. I tell myself I can let the little things go like a line from a movie I heard in my head, a piece of a conversation, or the last commercial on TV. I still find the thoughts repeating in my head until I do forget then the anxiety sets in for hours or days. I went to an OCD doctor in my area but he was no help and only prescribed medication which was minimal help at best.
    I am unsure how to apply your methods to my OCD.

  • I would like to know more about rage and OCD specifically as it relates to school age children.
    How common is rage and severe behavioral issues occuring with OCD. Especially when these did not exist before OCD?
    I am curious how dealing with rage fits in with treatment.

  • In the last three years or so I was diagnosed with OCD. I recently read an article called emotional contamination. Bascially anything that I associate with a horrible roommate that I had in the past I have the urge to throw out, because it makes me feel “dirty”.

    Eventually everything becomes contaminated because the contamination spreads from one object to the next. I have thrown out clothes sold tvs and even sold my car in the pursuit of “decontaminating” my life but nothing works.

    I was on meds for awhile which seemed to help some. I am no longer on medication and recently seeked helped from a physiologist, however he had never heard of emotional contamination.

    I know that I need help but I have no idea where to find it. I have tried to seek help, but as of yet have not found a psychiatrist/physiologist familiar this sub type of OCD. If you know anyone in the Philadelphia area that is familiar with this sub type of OCD PLEASE let me know so I can get in a treatment program.

  • Hello Dr Grayson,
    My son is 25. He has had OCD since age 11. Right now he is trying to direct his own treatment, using ERP. It seems his primary fear seems to be dying, but it also has the component of being confined, closed in, under, or immersed in water. He has told an oral account of his own death by drowning, with many vivid descriptions of his feelings and sensations. I felt he should write down this story, but he says he is not able to. If he writes it, he says it then becomes “set” and it is far too fearful for him. He did write the one word, drowning, on a paper, but he quickly neutralized it by thinking of another way of dying, a less scary way, like having his throat cut. When he works on accepting that there is always a risk he could die by drowning, how does he prepare himself to deal with the aftermath of his own death? Does imagine how others will grieve for him, who will drive his car, what will become of his possessions? It just seems confusing. Thanks if you can comment on this.

    • To Kathy whose son has OCD focused on fears of dying. The difficulties he is having with directing his own treatment may reflect the need for a professional to help, since I can’t really provide more than some suggestions in a forum like this. You mention that his feared consequence of writing down the story is that it will be set. I don’t know if he has additional feared consequences regarding death; that is, I don’t know if he cares about the distribution of his worldly goods after his death. His scripts should only include the fears and feared consequences he has. What he has revealed to himself is that part of overcoming OCD is risking an obsession to become set and if it did become set, what would be a positive way of coping this.

  • I just read Jen’s post and would like to say that I think a therapist trained in Exposure Response Prevention Therapy could definitely help with your OCD. They would work with you on exposing yourself to items you feel are contaminated while you resist your compulsions. Good Luck! As I’ve said before, I’m not a professional……I’ve just been through a lot with my son who had severe OCD (he’s doing great now, thanks to ERP Therapy).

  • Dear Dr.Grayson,
    First, I wanted to say thank you for this website. I seem to be stuck on an OCD theme that does not seem to be talked about much. I am talking about false memories. My mind will take random scenarios at a party from years ago and say that perhaps I slept with some guy there and forgot. Then my mind creates that memory and although I know deep down I did not sleep with anyone at that party, the “false memory” feels so real. When I tried to do ERP, I became even more confuses and started believing the memory even more. Could you please tell me if ERP is wrong for this type of obsession? I have had it for 2 years now and I would really appreciate if you could help me out. I feel hopeless. Thank you so much!

  • Hello and thank you for this blog,

    I started several heavy medications to treat OCD because I was having extreme panic attacks. Now I feel sedated and am starting the ERP but I’m having a hard time getting anxious in the exposures. I’m still having intrusive thoughts that annoy me but I don’t feel as panicked as I did before starting the heavy medications. Would you suggest going down on the medication so I can work on ERP? Have you ever recommended this?

  • Hello Dr. Grayson, Thank you for your reply dated Dec 16. It just clicked for me when you described how my son revealed something to himself by realizing he cannot write about the fear or it will become set. So writing it would be like having to face it head on, whereas just saying words about it, the words would be said and gone. But the writing remains, and acts as a mechanism to make the thought unavoidable and thus the need to adjust to it. So then he should be considering how to make himself write this down. Because he is so very afraid, he might have to start by writing out small scenes, like being in a boat leaking far away from shore? I honestly don’t know if that scene would raise his anxiety at all. I will discuss this with him and talk about what might work. In the next couple days, he is planning to enter a partial hospitalization program. He pleaded to go to this program and now that it is arranged, he is hedging. He needs it very urgently. Thank you again.

  • Dr.Grayson,
    I am going thru peri menopausal hormone changes and am once again having a dreadful time with ruminating thoughts. The other episodes where these obsessive thoughts ‘took over’ my mind were at puberty and after delivery of my first baby. They are related to fears of damnation (for past sins) and blaspheming God- also the fear of harming my baby. I’ve been trying to just label these recents thoughts with the understanding that God inherently knows I suffer this disorder and will not judge me as ‘evil’ for allowing the thoughts- but I’m wondering what meds would help and I’m starting hrt replacement to help re balance. Any thoughts on CBT or DBT or perhaps another therapy that would help me would be appreciated. It’s worsening the bad insomnia/anxiety I initially developed just prior to the obsessions. I don’t do any rituals other than a quick prayer- talking with God.
    Thanks,
    Nina

  • Dear Dr. Grayson

    I am so glad to know you as an Assistant Clinical Professor of Psychiatry that work about Anxiety and OCD Treatment, i find your website when i was searching about OCD, i am 29 years old woman and i have anxiety and OCD , there is 4 years that i use Clomipramine10 (Anafranil) and Alprazolam0.5 ( Xanax) under medical supervision, sure i am better but yet I’m involved with the disease.
    Dear Dr.Grayson you’re very kind to me if you can answer to my questions :
    1. Whether will fully recover Anxiety and OCD diseases ?
    2. Whether can i get pregnant until i have this disease ?
    3. What do I have to do to resolve completely my problem ?
    4. Whether do i need to behavior therapy besides pharmacological medication ?

    Best regards
    Massy
    From Tehran-Iran

  • Hi Dr.Grayson. If someone experiences violent thoughts against ones small child together with violent temporary urges to act on them does that mean he has ocd or is he a total nut case? and what if a person has such thoughts/feelings and together while feeling remorse feels a certain sense of power if he would ever act on the thought? This has been causing the person emense anxiety and pain because no one wants to view themselves as being crazy! HELP please. Sam.

  • I’ve been feeling much better lately and no longer have those crazy thoghts and urges nor do i fell a sense of power(i think the medication is kicking in) THANKS Dr.Grayson!!!

  • Hi Dr. Grayson,

    In your book, you touch briefly on fear and anxiety as both the obsession and feared consequence, but you don’t go into detail about how to treat this form of ocd. Can you offer more advice here, please, for people who are afraid of panic and anxiety? I am currently in a cycle of OCD where I am extremely anxious every day (at least in the mornings) to the point where I feel like I almost can’t handle it. How do you fight fear of your worst consequence coming true when it feels like it is (feeling anxious and panicky almost non-stop)?

    • Throwing this out there as someone who suffered for a very long time with both OCD and severe anxiety–try Claire Weekes’s work, particularly *Hope and Help for Your Nerves.* It’s an oldie but, in my opinion, a whole dimension better than other works I’ve tried on anxiety. In my case, learning more about anxiety as a symptom that felt overwhelming but couldn’t actually hurt me gave me enough strength to tolerate it until it finally stopped being a constant trigger. It was then easier to work on other OCD issues unrelated to “fear of fear.” Good luck.

  • Hi Dr Grayson. I am wondering whether you know of people who are compulsive planners and list makers. I always keeps a diary (as in a planning diary), write lists, keeps records of goals, money etc. But the planning doesn’t really pay off and I seem to spend more and more time on it all at the expense of other things. I feel the need to get everything “completely sorted out and organised” yet when I do, that doesn’t give me any relief. I think, for example in the case of time scheduling that it would be hard to keep to. So soon enough I feel the need to revisit it and make changes or do a whole new schedule. Another example: writing out your goals should be a good thing. But I keep going back to it all the time. I have to keep looking and I worry that I’ve forgotten something. Then I worry that there is too much there and I can’t do all of it. I am not sure of why I do these things, other than a want to better myself and I do have a general sense of anxiety about many things in my life. I am currently not achieving that much in life and I fear it’s because of all the wasted time trying to plan. It’s really embarrassing. I wouldn’t know who to talk to. Could you please give any advice? Thank you. Emma

  • Hi Dr. Grayson. I am at my wit’s end. I have an obsession about obsessing. As soon as I conquer one obsession being body focused or sleeping, or writing or ready or blah blah blah, a new one comes. How can I make an exposure hierarchy when I have an infinite number of them. It is so DEMORALISING! My friend who also has OCD is recovering rapidly because of repeated exposure to contamination, but for me as soon as I defeat one another takes its place. I do not know what to do, how to address this. I try to look for commonalities with my obsessions, but every new one comes with its associated flavour. For example I have maladaptive perfectionism, I avoid grammar and spelling mistakes, I have worked hard and repeatedly to reduce its potency. To some degree I have but then as soon as it bothered me less a one centred on breathing came. What am I to do when there seems to be an infinite number of obsessions my brain can draw one to keep me ensnared in the rumination and checking cycle?

    • Vincent, actually there are some posts on this site that discuss obsessing about obsessing. We are planning to make some articles available at some point and one is about this very problem. In the meantime, you can e-mail me directly and I can send you a copy of how to cope with this.

  • Dear Dr,

    I came across your wonderful site and i must admit u are a great help to public at large. Please help me with my problem. To make long story short i was in a relation with a guy who has OCD, we had constant fights because i used to trigger negative emotions..like used to tell me that my parents are getting me married somwhere else. He used to tell me not to be negative as he is an OCD. we broke up many times and then patched up. But this time after a fight wen i asked him whether he wants to continue the relation or not, he said he is bored with me, this relation, my suspicion,my cribbing. i stopped contacting him since then but i hope he will come back himself.

    You being an experienced doctor having researched in this filed so intensively, please tell me whether he will patch up with me again? will he come back himslef? or i need too convince him to come back.

    Please Sir i request you to help me answer my doubt. I will be waiting for your response. Please reply back. I request you Sir.
    GOD BLESS YOU ALWAYS.

    • Aditi, you are asking me to help you to obsess. Overlooking the fact that I don’t know the answer to your question, your goal needs to be working on your problem. If I were to say he isn’t coming back, I don’t think you would stop waiting. If I were to say he is coming back, you’d keep waiting. Again, working on your issues needs to be the focus. As for waiting, it is never a good idea to put your life on hold. Move on. If you find another love and he were to come back, his loss.

  • Does anyone know anything about inositol? I’ve done a little searching but was wondering if anyone had any experience with it for OCD treatment?

    Thank you.

    • There was some talk about it some time ago. I haven’t seen amazing results from it. For information on how to take it you can go to Fred Penzel’s site, http://www.wsps.info. The 23rd article of his on the site is about inosital.

  • Hi Dr. Grayson: Can you suggest any exposures for scrupulosity relating to laws and regulations, rather than religion? For example, suppose you worry about things like not complying with all the tax laws or violating a professional conflict of interest policy. These rules are complex, open to interpretation, and sometimes ignored in practice (for example, most people don’t pay state “use tax” on items they order online even though they’re supposed to – see http://onforb.es/HV2HZM). But you don’t usually know how the rules are interpreted or how seriously they’re taken, so you go to great lengths to understand and comply with the letter of the law. Thank you for your time!

  • Your book says that GAD is essentially the same as OCD. I was wondering if you could give some examples of exposures or scripts for GAD. For example, suppose you are worrying about things like what to do about your aging mom or and how to handle an interpersonal conflict at work. These are real problems that require solving because you have to figure out a plan for your mom, but you are ruminating excessively. What would a good exposure be here? Would it just be to limit the time you spend problem solving or are there other things? Also, with the constantly shifting worries of GAD, I know scripts need to focus on the core fear but I’m having a hard time getting more specific than, “I might end up miserable and people might hate me.”

    • Sorry for the delay in responding. Almost all script exposures have the same components, whether for OCD or GAD. What is the feared consequence you are concerned about and if that happened how would you attempt to cope with it in a positive way? Even if you are going to die in 5 months from cancer, do you want to make the best of those months or do you want to be consumed with anxiety. It is true that the coping is a second best choice to what you wish for, but if the reality happens, you would cope in some way. Your script would also include, why you would settle for second best and the answers are usually that you have no choice and in learning to do so, you get to live in the present and appreciate it more. In the case of your mom, you are stuck making guesses about what will work best for her and you can’t do better than that. Your guesses may not turn out the way you wish, but that doesn’t mean that the alternative that you didn’t choose would have turned out better. As for ending up miserable, I would hope you’d find a way to cope with the consistences if they turned out badly and as for people hating you, some people might and how would you choose to cope with that loss. If your plan is to beat yourself up if something goes wrong, then I’d add getting therapy in my script to help cope with the reality of what happened.
      I hope this is helpful.

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