Angst

Great idea. Do your own research on your recurrent themes including the language. Use your ‘critical eye’ - observe yourself on what you do. Highlight the repetitive stuff - in research it’s called content analysis. Part of therapy is learning to observe what you do. It’s the first stage of therapy. If your compulsions are in the physical world then with a critical eye observe the repetitive actions of repeatedly checking the front door, the gas tap, the water tap. If your compulsions are in the mental world then observe the repeated thoughts. As said by OCDJONESY the evidence is there in your threads. ‘It is right there staring you in the face.’

Hi Han38 Why do you need an ‘official’ diagnosis? If an official diagnosis means a medical diagnosis then I think a GP and a psychiatrist can provide it. This is the required route for the student disability grant in England. There are different rules and practices as to whether you need an ‘official’ diagnosis for other purposes such as welfare payments. The crucial factor for welfare payments such as PIP is the impact the diagnosis has upon your ability to function in doing daily tasks. In terms of employment protection under the disability discrimination laws an official diagnosis is needed if you need to negotiate with your employer for ‘reasonable adjustment’ in your workplace: for example negotiating for flexible hours or changes in the physical arrangement of work. ‘Reasonable’ basically means the costs of the adjustment are not too costly or disruptive. If you do not tell an employer about your diagnosis then you have no protection. Like DRSI I was a patient of a Community Mental Health Team and the psychiatrist there provided a diagnosis of OCD. He also referred to a specialist unit at the Maudsley Hospital for OCD and Trauma and they conducted a clinical interview after competing a long questionnaire on OCD which involved a treatment plan at the Maudsley. But many people take the self diagnosis route where they follow a self help book to improve their wellbeing. When you say that the GP referred you to steps to wellbeing then this could be the Access to Psychology Therapy or Talking Therapy route in England where the NHS provide treatment for people with anxiety and depression problems. You will generally receive therapy from a ‘wellbeing practitioner’ trained in CBT techniques. This would not constitute an official diagnosis for gaining access to a student disability grant. I doubt whether an employment tribunal would accept that this would give you an official diagnosis of OCD if you took action against your employer for not providing reasonable adjustment at work. I know little about private medical insurance but I suspect a diagnosis from a psychiatrist or perhaps a clinical psychologist would be needed. Interesting to hear people’s experience on this. So as said - why do you need an official diagnosis? There are diagnoses and then there are diagnoses.

Your GP is doing the best he/she can do. Options still available are contact Diabetes UK about the new treatment proposed and the Zoom groups by OCD UK. Sometimes you need to progress chase or get somebody to do this for you. Hence the role of the advocate. So try Victim Support again. In the UK it is not just mental health you have to push through but on so many things - broadband, water supply, getting a reliable plumber or builder, getting supplies. Companies and organisations employ progress chasers. Or a substantial amount of time is spent by employees on getting things done which you think should be automatic. I have spent days trying to get through to the tax authorities. I know it is difficult if you are feeling low. In England we have Community Mental Health Teams where people are discharged against their will. There has to be a ‘throughput’ with finite resources, and, the resources seem to get more finite every year. For space in the CMHT system for new patients existing patients are discharged. Through it is odd that the excuse in your case is that we cannot help everyone. Perhaps it’s a sign of the times. When I was a patient in the CMHT the excuse was that we don’t want to encourage ‘dependency’. But generally the people who did the discharging had good resources in terms of money and support networks whilst the people discharged had little money and not much of a support network. I know it is not much saying your experience is common. That is why I am saying connecting with charities like Diabetes UK and OCD UK might help. I know little about Scottish politics but would your local MSP be able to help? As a family we were helped by a local MP to get things moving in the case of our mother’s health support.

Mi Marko How far did you get in getting trauma therapy? I am a diabetic too, it is difficult to control if you are feeling low and having poor self esteem. When my OCD and depression was at its worse I lost a whole lot of weight. I went three clothes sizes down. My blood sugar control was tip top. But for me, as I told my GP, mental anguish is not the way to control blood sugar levels. I had to force myself to eat and ate just enough to keep body and soul together. Depression has different effects - some eat a lot more, some eat a lot less. I was on a similar drug regime to you but the dose of the antipsychotic was at the lowest possible dose. I came off it with no problem. If I remember correctly, you are at quite a high dose, as you talked to your GP about reducing it. What does your psychiatrist say? The particular antipsychotic you are taking has the effect, in some cases, of increasing appetite. I would talk to the people on the Diabetes UK helpline about the new drug which has been proposed and the alternatives available. As well as attend one of their support groups. Do you attend any of the Zoom support groups run by OCD UK.

Good advice from Lucuk90 The sense of urgency is a feature of OCD. We don’t think rationally if we are in a state of urgency that’s why fraudsters play upon it as well as it being a sales tactic. You are placing yourself under stress. Searching your memory can easily become a compulsion as you seek a certain answer - a confirmation of your identity. Perhaps your friend has a false memory. Who knows. Leave it alone. You were fine until your friend who you haven’t seen for 15 years uttered a comment.

Hi wj1 Not sure how you can check a memory to prove that you did not do something. You say that you are doing exposures by bringing to mind phrases that were said in the situation - ‘repeatedly telling some phrase that someone may have told that time’. I don’t think that we humans have a very good memory of things that people said in the past. At the best we remember the gist of what was said. And that gist may not be very accurate or fuzzy. You use ‘may’ a lot in the post - ‘may have harmed someone’ and ‘may have told’. This indicates that you are uncertain and seek certainty. These ‘mays’ are ‘what ifs’ - what if I harmed someone, what if a person said this. What would happen if you left the event or supposed event alone.

Tough one. You say - ‘I can’t take anymore and will use what advantages I have’. It is not just your daughter it also the dynamics of the family that are important. There is a form of therapy called ‘family therapy’ where the interpersonal dynamics of the family are incorporated into the therapeutic context. It is used in hoarding - which used to be fall under the OCD umbrella - where the emotional impact of the hoarder upon the family is explored. Family therapy is used for other disorders as well. You are a carer - being a carer can be a tough thing to do. A friend of mine who is astute and politically wise set up a carers group to support herself and her son who has a bipolar diagnosis. She is a go getter, a successful politician who was at the time also a mayor. So are there carers’ groups in your area. Perhaps contacting social services would help to see if they can provide support for you. It depends, as all things, on the person you see. I knew a man who described a drive in the country with his parents when he was 14 in East Anglia. They came across a big house. His parents left him there. It was an asylum where he remained for sixteen years until his sister arranged for release and accommodation. This was obviously years ago and the man was middle aged when I knew him. Quite cruel alternatives no longer exist, but still it is better than being dumped on the streets. Your daughter is being protected by you - despite the interpersonal problems. So suggestions - look for carer groups, look for family therapy in your area, try social services. A diagnosis -even in a tough environment - will increase your bargaining power to increase your resources to care for your daughter as well as facilitate your daughter in improving her life. Like many things nowadays, it’s a struggle.

Hi OCD slave Haven’t checked your past posts but from memory this post is very similar to a previous post. Because I remember the bit about artex ceilings. I said that I had recently moved into a new property and the survey pointed out artex ceilings and that they may contain asbestos and how to carry out work on them. You also mentioned that you did not like the idea of tradesmen doing work on your property because they could tread in asbestos which you mentioned was present in your housing estate. Your post triggered a series of posts which contained advice on this and how minimal the risk was. Probably hundreds and thousands of properties in the UK have such ceilings and depending on the year that they were done the material may contain asbestos. You are imagining the worst possible outcome from working being done and this is stopping you from having work done. If the electrics need doing I would say that this was a priority. Not having work done will not only diminish the quality of life for you and your family it will also diminish the price you will get for your property if you wish to sell it in the future. Your present frame of mind will restrict the range of choices that you will have in the future. Your mind is serving you a false dilemma - letting things be/doing remedial work which carries risks. The much greater risk is not doing work on your property. Your language is OCD biased ‘complacent about risks’ if you do work. Switch your monologue to the very small risk is manageable and hundreds of thousands of households do such work in similar contexts to yours every year. Why not read the past posts on this subject? OCD involves the misinterpretation and over inflation of risk.

Hi Snowbear What are the alternative approaches to OCD cognitive therapy in the UK context? And do they have empirical research indicating their efficacy? The National Institute for Clinical Evidence refers to research which support evidence based clinical practice in all areas of medicine and therapy including OCD. This way we move from personal experience to population experience and the related probability that a course of treatment will work. For example, we may know a person who smoked 60 cigarettes a day and lived to be 105. But the general experience is that smoking leads to premature death. We know that certain courses of treatment for OCD work better than other courses of treatment. The authors of Break Free from OCD and Overcoming OCD have had published research mentioned by NICE. These publications use Theory A and Theory B. It is empirically backed up by NICE. It is best to have therapy with a therapist. The homework such as postponement and worry time should be part of a planned approach. Misrepresentation of risk is perhaps the core of OCD thinking.

Postponement is a critical component of therapy. I used it to postpone checking things in my physical environment. It is a form of exercising behavioural control over one’s actions. You do not respond obediently to a thought or impulse you use your rational mind to subdue the demands of your intuitive and emotional thinking aspect of your brain. The postponing or deferring an immediate impulses is an important skill. Another aspect of this is deferred gratification where we defer doing things that give us immediate pleasure to focus our attention on completing things that need doing - so much evidence that children who do this are more successful in life. In the UK therapists use Theory A and Theory B to explore the content of one’s thoughts. This is the cognitive aspect of therapy. Where we rationally explore the content of our thoughts to see if they have a basis in reality. This is part of building up a model of how our OCD works and provides the basis for agreed homework or behavioural experiments or ERP to help retrain our emotional thinking aspect of our brain. Good source of information on how this works is CBT for OCD book written by the specialist OCD at the Oxford Centre including references to the work of Paul Gilbert on evolution, brain regions and types of thinking.

Hi Mini I didn’t attend a jury trial. I was negotiating an exemption but at the same time I got a post saying I had to attend. Then another post saying that I didn’t have to attend as they had too many jurors on their books for the period. They apologised for this and said if I wanted I would be exempt from jury service. I think Robin43 and wonderers have the answer. Keep it general. I’ve moved twice in the past four years so I don’t have the paperwork. Presumably it will be on the system. I’m in a better place than four years ago so wouldn’t bother me now. Just to repeat myself I would keep the request at a high level.

Hi PemB Personally, I would do the eating disorder treatment. I would follow the advice. You could have both disorders. There is an overlap of symptoms between diagnostic categories. I am no expert on eating disorders but I think weighing food, measuring yourself could well feature in eating disorders. Could you get your GP to refer your to a psychiatrist for a clinical assessment?

The standard measure to indicate whether you have OCD is a number of OCD questionnaires which measure the impact on a patient’s life of having OCD which includes the amount of time doing compulsions as well as the emotional intensity of distress caused by the disorder. You receive a score. There is not a rigid boundary of having OCD and not having OCD. Research into OCD uses these questionnaires to see whether a course of treatment reduces the intensity of OCD. To receive treatment at the specialist centres you need to score high on these questionnaires as well as undergo a clinical interview conducted by a psychiatrist who specialises in OCD. There are degrees of OCD. The worst cases of OCD indicate a serious functional impairment which substantially impacts on the quality of life of a patient. There is no universally accepted set of biological markers in the world of mental illness and disorder so medical questionnaires and clinical interviews are used. Compare this with the biological markers to indicate whether you have cancer or do not have cancer.

Hi Giusss To respond to the first paragraph. It seems an odd request given that anxiety is a forward thinking emotion designed to prepare us for a future problem. Many people with OCD have a surfeit of anxiety and asking them imagine future problems is I think rather odd. In therapy I have been asked what are your goals. To respond to the second paragraph. I see myself as having much less of my checking OCD. In the U.K. there is a notion of recovery and part and parcel of the recovery movement is to read and listen to people who defined themselves as recovered. A crucial part of the recovery process is to set goals which your mental distress has stopped you from achieving. The recovery group and therapists help you accomplish your goals. It could be doing a course, doing a hobby, travelling, going back into work, finding a new job or whatever. I have one such recovery group. They are a motivational source to get you out of a mental rut.

Correction - should say ‘would NOT contact the bulb’.

I felt I was going mad when as part of my checking regime I stared at a lampshade to ensure that it would contact the bulb and cause a fire. It was a relief when reading Overcoming OCD, first edition, that such staring was a common feature of OCD checking behaviours. Don’t be so hard on yourself. The fact that you can observe yourself doing things is a positive, in mental health parlance it’s called insight. A good sign of recovery. Likewise, don’t be too hard on yourself on the self talk you use, you use the word control. Could you replace the word by saying you have routines? Routines are important to eat a good diet and keeping things clean and in order. You are engaging in catastrophe thinking. If I lose control goodness knows what will happen! That thinking is part of OCD. Even if you check this evening. So what! As I said don’t be so hard on yourself.

Hi Pemb I referenced you in a post yesterday as having a good idea regarding perceived flaws in an object. I can identify with you as I have experienced a loops of checking. You have really good insight - seeing your actions through the lens of the logical and rational brain. We think in two ways our gut instinct or intuition and our rational and logical brain. Your rational brain sees things clearly but your intuition tells you things are wrong. These two ways of thinking are called the dual process of thinking in cognitive science. CBT is a chance to explore our thinking and conduct experiments. To use your rational mind to do ERP that is not to check. And showing your emotional brain that there is no need to do the checking. In this training of your brain - the limbic regions - you can use techniques to calm your emotional brain which is agitating for you to do compulsions - mindfulness or soothing things to quieten down the agitation. Some people find medication helpful to quieten the thoughts or impulses. I see medication as an adjunct to retraining your brain, for use in the short or medium term. I knew before therapy there was an irrational aspect to my behaviour. Therapy and exposure or ERP enabled me to reduce the emotional aspect of thinking by retraining my mind or brain not to do the compulsions.

Using stuff causes wear and tear and an object that was once perfect becomes imperfect. Certain old teddy bears and toys which are pristine and in their original packing are sold at a much higher price than those items that are worn out. But you have to wait decades for the price to increase and what is collectable can become uncollectable e.g. dark hard wood furniture. And in regard to the toys, there is a high emotional cost that a child did not play with these items. Toys are good for child development. Supermarkets reject vast quantities of food that are not perfect enough yet taste good. Oddbox thus markets odd shaped vegetables. It is a common feeling that people like ‘perfect’ goods. There is symmetry OCD where things have to be arranged perfectly so there is perfection OCD. The checking compulsion described in the posts indicate that it is OCD. Good advice by PemB - welcome the thought that things became less precious so you can focus on their real value and purpose. Though we might want to keep the best china and cut glasses for special guests!

Hi boey12 At the last OCD UK conference Dr Drummond of Springfield Hospital at Tooting did a presentation on medication and OCD which included a section on antipsychotics or another name for them is grand tranquillisers. There should be access via OCD UK to a video recording of this presentation. For all cases where antipsychotics are prescribed nowadays it is always the lowest dose possible including those who hear voices, see things, smell things, physically feel things that other people cannot hear, see, smell or feel. At Springfield Hospital which is one of the specialist centres for OCD and BDD it is standard recommendation to use antipsychotics. If you go to their site you will see a pamphlet on the role of antipsychotics in OCD and BDD treatment. Always of course, you can ask you teen’s team for further information.

You are trying to calculate whether you had enough days at peace to outweigh the days at which you were not at peace. Why? It is in the past. It cannot be changed. In these circumstances, if you wish to do memory exercises, I would extract the periods which were deemed as good in order to learn lessons to improve your life. What makes life good? Is it company or activity or a plush hotel or good food or weather or whatever. Kinderman at the University of Liverpool defines -as a significant feature of rumination - dwelling on negative experiences. So, exclusively focus on the positive - the days where you were at ‘peace’ and aim to replicate these days. Therapy is about learning about new ways to think and behave to make ourselves happier. So, do not ruminate, do subjective consumer research! What made you feel good, at peace with yourself? And do these things again and again.

Just to add -with a lot of help - I changed environments in a two step move. I am now one check and out. Sadly the people I cared for have passed on. But has left me with a very strong feeling that carers need care. This is course a political issue about money and realistic ‘care in the community’ rather than empty rhetoric. And the building of social bonds in the community. And the extra burden of OCD overdoing things does not help!

For me, checking is at its highest when there is a set of stressors in the environment. For example, looking after properties when one of them needed to be sold to accrue sufficient funds to pay for a relative’s care. Or if there have been a series of break ins on the street including rapes and a neighbour in the block is cavalier about securing the front door. We once hit the front page of The Sun about what was happening on the street. Or caring for a loved one and checking that I have issued the correct medicine and administered the eye drops correctly. For me the stressors feed my checking OCD and I carry out checks to the nth degree with an enormous amount of repetition. I think stress causes a lot of mental ill health including the stress of being poor and not having a strong social support network. Money gives you choices including paying for therapy and indeed the dentist given the lack of NHS provision.

The purpose of a diagnosis is to chart out a course of treatment. What therapy has your psychiatrist proposed? It could be OCD or BDD. You say people think bad things about you thinking ‘hey, how ugly she is’. How do you know this? Years ago I knew a young man who thought he was ugly and heard people commenting upon his ugliness. He said he heard his neighbours saying this when he was in his bedroom. We talked about this. I said it was unlikely as he lived in his parent’s house. And the house was detached. He wore his hair long to cover up his face. He and other people in the group talked about whether he was really ugly or his illness or disorder led him to believe he was. Anyway it worked. It was what is called a Theory A and Theory B approach. What was also really helpful was him getting a girlfriend, have his hair styled and attending social functions.

I know nothing about the Scottish mental health system. But if I were you I would look for an advocate to represent me and try to get some psychological treatment. To say that you need therapy for trauma before you can have CBT and at the same time say that there is no such treatment in your area seems to block you to any psychological therapy. Your mental health team appear to be saying to you there is no alternative to drugs to manage your condition. It is true that certain types of drugs like you are taking can aggravate diabetes. Are there any mental health groups and diabetes groups that you can contact so you can talk through your problems? You need to take on board the dietary advice that you would have received. As I was typing I see that Snowbear has replied - it is a good idea to see your GP and the role of the ICB is interesting. I also agree that the word depression also occurs to me.

Sounds as if the experience is becoming a prime candidate for rumination - going over and over again a sales interaction. The thing about morality and OCD is that it attacks our moral worth and identity. Much more than is normal. In your case you are feeling a deep regret that you did not stop her or simply said I forgot to scan that item. To feel a moment of regret might serve a purpose, but to drench yourself in regret serves no purpose morally or practically. The customer herself might not have known that an item had not been scanned. You need to forgive yourself -show compassion towards yourself. It is a minor thing. A minor mistake. I think reassurance is needed as you are new to the job and that your experience of hyper morality is a common experience amongst those of us that have this feature of OCD.