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Lost between Therapy and the Abyss


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I don't know what to do and what to expect anymore, but I don't want the usual buck yourself up, think positive, get out the house and do something positive responses because if I could do that I wouldn't be here. I always get irritated when I hear people tell me, "well if you don't like your life, then change it!". I always think to myself that if I could change it that easily then I would just be lazy and not "unable/hindered" to help myself.

I have been in various CBT and CAT therapy over the past 5 years and have got nowhere. I am now on medication which helps slightly to take the edge off. In previous CBT the therapist even suggested that it might not be the right time for me to be doing CBT because I wasn't doing the exposure that I'm supposed to. I am now lost in the abyss. My life has fallen apart, I see no resolve, nothing positive, and I'm just soo tired of living.

About three years ago I quit my job as I couldn't take the strain of OCD an my life anymore and I just waited to die or be saved. Unsurprisingly neither happened and now I am three years further down the line, in an even worse state and have given up on life, and don't even really dream of a better life in the way I did before, I get exhausted just thinking about the future and the effort/struggle of surviving let alone living.

The point to this post is, what am I supposed to do, what are you lot doing and what should I expect from here on. Therapy hasn't gone anywhere, medication only slightly lessens the problems, and so what am I supposed to do, just wait for a lightening bolt of realisation, inspiration or an epiphony? I don't understand what the plan from here out should be. I have to remind myself that I'm not normal and that I'm the victim in this condition just to stop hating myself for a few mins.

Where do I go from here?

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Hello numb. No one here is going to tell you to just get over it or buck up. We are all at various stages of recovery and we've all been at the bottom of the barrel.

Could you please give us a short description of how your OCD manifests and what you've tried to do to beat it?

Edited by PolarBear
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My OCD manifests itself in sexual thoughts, magical thinking and contamination. The contamination is 50% of it all and of contamination 80% is a fear of sexual fluids etc. When I was at University the primary problem was magical thinking, so life was hard and took ages to complete tasks but I didn't in many ways feel so constrained. Over the years the primary thing has become contamination and it has gone on so long and isolated me so much that I am completely unable to understand normal behaviour, levels of hygiene, levels of disgust and how to behave.

The contamination and to some part the magical thinking has meant that I couldn't function at work, I kept retyping, rereading, checking, questioning myself and was so scared of making a mistake, this meant I was very unproductive and would make silly mistakes because I was so busy trying to not make them and burying my head in the detail. I also couldn't touch certain things and couldn't use the toilet at work anymore.

Jump forward in time and I'm now unemployed trapped in my parents house unable to leave the house without going through serious cleaning, showering, routines and new clothes each time. I go through bleach wipes, paper towel, rubber gloves, toilet rolls, like there is no tomorrow. I basically feel disgusting and contaminated everyday all my possessions, bed, floors, surfaces, items are contaminated to varying degrees, requiring different treatment and levels of cleanliness. The only three environments that I can keep clean are my car, tumble dryer, and a few shelves in a cupboard but this is almost impossibly hard to maintain.

I try to keep things clean to such a level that is almost impossible because I see things in my mind on a particle and cellular level. The chain of touching things and contact make everything impossible. I would literally have to throw all my items wash some clothes, step out of the house into new shoes and live somewhere else just to feel evenly slightly non-contaminated.

I find it almost impossible to accept what my therapist says in terms of cleanliness normality. I can't accepted it unless I one day hear it from real people who tell me honestly. Not a summary of what my therapist says is normal. I wish I could accept what he is telling me or accept certain things but I can't. I don't know how I am supposed to get better if I can't no matter how hard I want to, believe, trust or process what he says. It is almost like I was born without the part of the brain that gives natural instinct to these issues.

I have been through CBT which didn't work out because the therapist wasn't engaging at all. I then did therapy with a good therapist but the CBT started wondering into CAT and general therapy. I have then been through CAT again. The problem is the inevitable one of having to do the thing you fear the most and not being able to cope with it. What am I supposed to do then just have to feel guilty and accept that it is my fault because "if I wanted to change and help myself enough, I would engage and carry out the exposure exercises". Where does that leave me, waiting for my life to fall apart more and one day hoping to change?

My psychiatrist who is in charge of me at the local trust has actually said that for someone like me he would opt for therapy once a week for the rest of my life over a short stay at the Maudsley specialist clinic. He says for people like me who have had a pretty damaging life the tools they have are of little help. He said it is not the severity of the OCD but more catching it early as an almost smaller part of someone life. He thinks that my hope is for a change and shift in my personality and perception as I get older.

Everyone seems to feel that my life isn't going to change for the better until I get out more, make friends, enter a relationship and mix more with normal society. While I think that is true, to get to that stage I need to be emotionally better than I am now. It is like the chicken and the egg situation. I don't know what to do, what is expected of me at this stage and how to get out of the rut. I have always had goals that have kept me going and now there are no goals, no structure, no dreams, no point, no nothing I am just starring into the Abyss.

 

Edited by Numb
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20 minutes ago, Numb said:

y psychiatrist who is in charge of me at the local trust has actually said that for someone like me he would opt for therapy once a week for the rest of my life over a short stay at the Maudsley specialist clinic

What do you think of this suggestion? Is it something you would consider? Do you think it could help you? Maybe start a thread asking other forum members about it...

21 minutes ago, Numb said:

Everyone seems to feel that my life isn't going to change for the better until I get out more, make friends, enter a relationship and mix more with normal society.

Well yes of course! But you have serious reasons that a prohibit all these things so I think it's not helpful advice! All it does is put pressure on. Obviously the people around you want a better life for you, but I understand the feeling of not being in control of making that happen.

My OCD has never been so bad as this, and I really feel for you. However, you obviously do have a goal. You want to be less ill. I know this because you have taken the time to come on this forum. You are asking for help and advice. You are attending therapy even if you can't do the homework yet. 

I really believe in keeping goals realistic, but not giving up hope either. this is not your fault. It's nothing you chose. You have no reason to hate yourself. In fact that might be a good place to start?

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Numb, can you at least agree that all the compulsions you do aren't working for you? I mean you've described your current life and it sounds quite bad, so wouldn't you agree that all the washing and cleaning isn't making your life better?

Your psychiatrist is dead wrong about having to catch the disorder early. I agree that is preferable but I suffered for 40 years in secret and finally sought help. I am now fully recovered. Never say never.

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8 hours ago, PolarBear said:

Your psychiatrist is dead wrong about having to catch the disorder early. I agree that is preferable but I suffered for 40 years in secret and finally sought help. I am now fully recovered. Never say never.

I agree as I think I have had OCD in one form or another for 25 years! I am now 37 and have only just found this forum! I think this is very common. 

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Yes all the compulsions and stress and restrictions have effectively ruined my life, and I now pretty much function as a human and don't live my life. However, although I could completely stop and expose myself to everything I fear, I don't know how I would live with myself. I don't know how I try to convince myself that it is okay and to not feel disgusting all the time.

I think I also don't know if I feel quite the same as most others. I'm not so sure that I feel my fears and compulsions are irrational. It is almost like I want to be clean to a certain standard but it is almost impossible to function and maintain to that standard. I don't know how I will ever come to accept that it is okay. I also do dislike myself and sabotage myself mentally.

I think I was wrong about what my psychiatrist was saying it wasn't exactly the length of time of having OCD. I understood what he was saying in so far as it applied to me but I can't remember exactly what he said. I think he was saying that people who have had a rough upbringing in many ways with possibly co-morbid mental illness as opposed to people who have had somewhat normal lives but have OCD in what would otherwise be a relatively normal and healthy upbringing/integration in society. The tools available to the Trust (CBT) for the former type of people don't really help. 

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Your brand of OCD is no different than others. OCD is lying to you when it says you must be ultraclean. So far you've been going along with the lie and look where that's got you.

You have to start small. You don't just stop your compulsions. You have to do cognitive work, you have to slow down and stop compulsions in an orderly fashion and you need to do exposure work.

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15 hours ago, Numb said:

I'm not so sure that I feel my fears and compulsions are irrational. It is almost like I want to be clean to a certain standard but it is almost impossible to function and maintain to that standard

So the issue here is, that your brain has created an 'ideal'. Because of this, of course you aren't going to accept normal standards of cleanliness. Of course you aren't convinced. This is because you are being ruled by an IDEA. You have an idea in your head of an ideal level of cleanliness in order not to feel disgusting. The trouble is, an ideal is never reality. It's something we want. You are never going to match your ideal. You are always going to fail. And you are stuck in a loop of trying. 

 

15 hours ago, Numb said:

I also do dislike myself

I wonder if this wanting and believing in ideals affects how you think about yourself? Do you mind me asking where exactly does this dislike come from? If it's not too personal...

when we are ruled by ideals we can find no peace and no ease. We think if we give them up then we will feel worse or be worse. But actually when we give them up, when we let go, beautiful things can happen. We can see the beauty in imperfection. We don't have to endlessly and ineffectually strive. We can accept ourselves and the reality we live in. We can start to accept contamination.

We are clean and dirty, good and bad, in control and totally without control, that is our reality. Exploring this can allow us to love ourselves and others for who we truly are. This is the work I am trying to do at the moment.

My trouble is I have an ideal around 'mental perfection'. In the same way you can't accept normal levels of dirt, I can't accept normal levels of mental imperfection. I am constantly striving to rid myself of my 'bad qualities'. To never think a bad thought. To be a better me, a more acceptable version of myself. I always fail.

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PolarBear this is the thing it is all on me having the confidence to say I am not disgusting, my standards are high and unrealistic, accepting contamination, and almost believing in myself. If I don't feel strong enough to believe that then I am stuck with severe OCD but no way of resolving it. If part of the reason I cannot accept it or believe it or even live with the consequences because of some personality disorder or defect then where do I go from here. I just feel like I walking through a door marked therapy only to be greeted with a mirror where instead a therapist should be. I feel as if the flawed thinking person (me) is now the person who is supposed to have super strength and pull myself out of it/believe in myself/cure myself.

JennieWren I think you have hit the nail on the head and very accurately summarised the problem. The reason why much of my therapy got dragged down with CAT was because certain past situations seem to have led to flaws in my thinking and personality and that then affected my ability to move forward. So therapy almost felt like for OCD and some sort of personality disorder. I have set very high standards for myself and I cannot tolerate my own failure. I realised fairly recently that with my state of my mind/personality I am never going to be happy because my expectation is soo much higher than my ability, health, resources, that I am bound to not meet the expectations. Inevitably that will lead to disappointment and get me nowhere. I wish I could accept my failures and not be so hard on myself but I just can't seem to turn the switch off or lower the standards. I think part of it is because much of the bad times in my life I escaped by dreaming one day would be different and that somehow convinced myself it was going to be better.

I am astounded and confused as to how a human brain like mine can exist whereby it dislikes itself and sabotages itself. As to why, I think this is part defect in the brain and part social trauma. Death of parent, bullying at school, under achieving at school, social and physical isolation, difficulty making friends. Later in life I made decisions about moving abroad and studying that led to further isolation, and then later my alcoholic mother made my life a living hell. So basically I haven't had very many people who liked me and told me I am nice or worthwhile person.

Apart from the obvious discomfort for me. I can imagine if someone saw certain behaviour by me and thought it was dirty/wrong/disgusting/below their standard. I would be devastated and so fear getting anywhere close to that state. I think I am scared also to drop the standard because I am scared of people not liking me because of imperfection.  I do genuinely believe that some of my contamination concerns have got so out of control because I have lived a very sheltered isolated life and I haven't talked about or identified normality for some issues.

Edited by Numb
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11 minutes ago, JennieWren said:

@Ashley what do you think is the correct treatment for OCD when the person in question has a experienced trauma and a lot of suffering growing up? Can CBT still work?

Hi Jennie (I’m aware that I’m not, in fact, Ashley!). From experience, a dual-treatment approach is effective, whereby CBT is employed for the OCD and counselling for the trauma. EMDR is another, quite new technique for processing traumatic events. As I understand it results have been mixed. Whether the two would be offered concurrently or sequentially might depend upon the individual. Hope this helps (and isn’t completely at odds with what Ashley will respond with).

Edited by OceanDweller
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On 18/12/2017 at 19:40, Numb said:

Yes all the compulsions and stress and restrictions have effectively ruined my life. However, although I could completely stop and expose myself to everything I fear, I don't know how I would live with myself. I don't know how I try to convince myself that it is okay and to not feel disgusting all the time.

I think I also don't know if I feel quite the same as most others. I'm not so sure that I feel my fears and compulsions are irrational. I don't know how I will ever come to accept that it is okay. I also do dislike myself and sabotage myself mentally.

Been there, done that, got the t-shirt. :mf_tshirt:

Believing I wouldn't be able to live with myself if I allowed my world/ myself to become contaminated kept me stuck for 40 years. Then I learned about how CBT works and started to change the way I thought in quite fundamental ways (contamination isn't unbearable or even a real threat, it was only the way I thought about it that made me perceive it as unbearable. ) 

I also learned to love myself, flaws and all. That made the idea of being well again (after decades of seeing myself as abnormal and scarred by OCD) easier to accept.

On 18/12/2017 at 19:40, Numb said:

I think he was saying that people who have had a rough upbringing in many ways with possibly co-morbid mental illness as opposed to people who have had somewhat normal lives but have OCD in what would otherwise be a relatively normal and healthy upbringing/integration in society. The tools available to the Trust (CBT) for the former type of people don't really help. 

Utter rubbish. :mad:  People who've suffered trauma in their lives have the MOST to gain from CBT by learning how to process their thoughts differently. People who've yet to develop their social skills have more to gain from CBT than the well-adjusted self-confident individuals. So if anything you are one of those who can expect the greatest benefit from properly administered CBT.

It may not even have to be CBT from a specialist in OCD - mine wasn't.  It's about understanding the principles and applying them to each condition. (For me that was PTSD, depression, OCD. I chose to tackle each one in turn, but there's no reason you can't tackle them all together.)

Once I learned to change the way I thought about things all the bad stuff from my past became irrelevant and ceased to impact on my present life, or to restrict my recovery from OCD.

1 hour ago, Numb said:

certain past situations seem to have led to flaws in my thinking that then affected my ability to move forward.

Yup. :yes: But the good news is these thinking flaws aren't permanent. Neither is your personality set in concrete. 

You need to access some good CBT which will enable you to recognise where and how your thinking leads you astray and then practise, practise, practise until thinking 'normally' becomes second nature.

2 hours ago, Numb said:

I can imagine if someone saw certain behaviour by me and thought it was dirty/wrong/disgusting/below their standard

This is an example of one of the thinking distortion/ biases you need to address. You have no reason to assume that others judge you as you judge yourself, or that they even use the same criteria to assess others that you use. In thinking your faults are 'reality' rather than viewing them as mere opinion (in this case your opinion of yourself) you set yourself up to feel flawed no matter what you do. This may account for your - incorrect - belief that your brain has some kind of physical defect or malfunctioning. It hasn't, at least nothing permanent and nothing that can't be reversed by changing the way you've habitually learned to think. 

2 hours ago, Numb said:

I do genuinely believe that some of my contamination concerns have got so out of control because I have lived a very sheltered isolated life and I haven't talked about or identified normality for some issues.

It's not about identifying normality. That kind of thinking suggests there is a 'normal' standard for things and you either fit the mould of normality or you don't. A better way of approaching it is to look at what drives you to set the goalposts where you set them and then decide if that's based in emotional reasoning (and therefore typically skewed), or based on reality and understanding. 

On 17/12/2017 at 00:15, Numb said:

I feel as if the flawed thinking person (me) is now the person who is supposed to have super strength and pull myself out of it/believe in myself/cure myself.

Therapy hasn't gone anywhere, medication only slightly lessens the problems, and so what am I supposed to do? Where do I go from here?

 

:yes:  That's exactly what CBT allows you to do. You become your own therapist and discover the super-strength was in you all along but you just didn't know it. 

It's important to understand that this belief you'll have to accept and then live with feeling awful is nonsense. How you imagine you'll feel on 'acceptance' is totally based in your current interpretation of the world. But once you learn to change that interpretation you feel very differently and the situation you now fear so much evaporates and ceases to be a possibility. 

If medication helps you start the recovery process that's great, if not, equally fine. Although it helps some people, medication is not strictly necessary for recovery.  

CBT is the way forward. If it hasn't worked yet then you need more CBT.

You may need a different therapist who can explain it in a way that makes sense to you, or therapy that targets the root thinking problem instead of the symptoms. You may need several courses of CBT, gradually chipping away at the distorted thinking and building up better thinking behaviours over time.

But three things I guarantee:

1) it's never too late to start the journey to recovery

2) nobody, no matter what past events they've endured or how many co-morbid conditions they have, nobody is beyond treatment

3) CBT will work if you let it, if you understand what you're trying to achieve and consistently practise the changes. 

:) 

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1 hour ago, JennieWren said:

what do you think is the correct treatment for OCD when the person in question has a experienced trauma and a lot of suffering growing up? Can CBT still work?

Absolutely it can :yes: (as my reply to Numb hopefully demonstrates.)  

We're all individuals, so depending on the overall picture and the two people involved (patient and therapist) the focus of CBT may vary, either initially or as therapy progresses and certain areas are targeted in turn. 

One of the worst things about suffering abuse/trauma is you come to see yourself as permanently scarred and therefore believe you can't be fixed. So you either stop trying or put all kinds of mental obstacles in your path to ensure you never get well. You keep telling yourself you don't deserve to be well/happy, and then you make it a self-fulfilling prophesy by (often unconsciously) sabotaging your own recovery.

The most important message I learned on my recovery journey has been that nothing is fixed or permanent - not even the past that's been and gone. 

The past is every bit as flexible as the here and now. How we perceive it can be changed, how we choose to interpret it, the meaning and significance we give it in relation to our life as a whole - these are all open to change.

When we learn to re-frame our thoughts using a more realistic and open-minded approach, our feelings towards what happened can change too. Our memories don't alter, but they take on a different significance. Instead of feeling scarred and crippled by past events we become empowered by them and are able to live fuller, more content lives because of having gone through them. Please note, this is NOT Pollyanna thinking, or blind optimism, or fooling yourself, or lying to yourself about your true feelings, or forgiving the abuser, or belittling what you went through.

It's about taking a different perspective on things, choosing to give the past less significance than the present and future. It's about understanding how your thinking at the time of the event(s) and subsequent to them has been skewing your perception and your current thoughts and feelings. 

In short, it's about understanding the 'vicious flower' which is part of what you learn in CBT. 

 

 

 

vicious-flower-model.jpg

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