Vomit phobia related contamination worry- what should I do to reduce but not avoid compulsions?

[dksea]

9 hours ago, BelAnna said:

Did you used to spend a lot of the time worrying in the past?

Absolutely.  It was on my mind a lot.  It made me afraid to go out and be social, to travel, to eat things I didn't know where "safe", etc.  I carried stomach medicine with me and would use it at the slightest sign of "trouble".  Riding the bus across town to visit my then college girlfriend was an exercise in stress management.  I'd sit near the front of the bus, I'd carry a plastic bag in my pocket.  I'd know where the stops where and how long in between they were.  I'd imagine what I'd say to the driver if I started feeling sick.  It was miserable.  It took time but I don't do any of that anymore.  It's liberating.
 

9 hours ago, BelAnna said:

Also did you have contamination issues related to other obsesssions?

No, contamination itself has never been an issue for me.  I'm not a complete slob or anything, but I am definitely not a tidy or overly fastidious person.  I don't fit the stereotype of the OCD "neat freak" by a long shot.
 

9 hours ago, BelAnna said:

I had some horrendous stomach bugs when I was younger and I think that those alongside traumatic memories (life or death situations with family members) and IBS from Histamine intolerance (apparently I threw-up from this every Friday night as an infant- we probably ate something high in histamine each Friday) has just really messed things up for me! I do have an O+ blood type, which apparently makes you much more susceptible to Norovirus (according to research, not pseudoscience) so I wonder whether if I had caught fewer bugs, I'd not have to struggle with this!

Its not unusual for someone to be phobic about a situation that caused them trouble in the past, or for an OCD sufferers fear to key in on things they worry about more.  And sure its possible that had you not had those problems you wouldn't have this particular struggle.  Its normal to wonder that from time to time, we all do.  But regardless of what MIGHT have happened, we know what DID happen and where you are now.  That should are your primary focus, dealing with the here and now of your situation and how you can improve it.  Try to avoid the rumination about the past, as tempting as it is, it doesn't actually help much if at all.  Unfortunately we don't (yet) have time machines so we can't change the past

 

Quote

I avoid all the normal Emetophobic related situation (situations where people might experience motion sickness, public toilets, rollercoasters etc.) and then any situation where I could catch a stomach bug- which basically covers most situations in the outside world (shopping, opening letters, using cashpoints, medical appointments (e.g. GP appointments), going to the cinema/theatre, eating sandwiches, handling shoes and coats, visiting friends/family etc.). It's a bit of a double whammy. 

And as a result of all that avoidance you miss out on LIFE.  You live in constant anxiety.   You are unable to enjoy situations on a regular basis in order to slightly reduce your odds of something non-fatal and of low odds.  Its possible you could have enjoyed every single one of those situations and never gotten sick from it.  Its possible you could have enjoyed them and maybe gotten sick but then gotten over it and enjoyed more.  Instead you are trapped, the thing you fear the most MAYBE less likely to happen (but you don't actually even know that).  You get the worst of both worlds.  All the anxiety and distress, none of the fun.  You may not be jumping in boiling water, instead you're in water thats slowly been brought to a boil.  You avoid shocking pain by accepting slow progressive pain.  Its an irony of OCD, we end up suffering more in our avoidance and other compulsions than we do from merely living with the fear.

[BelAnna]

12 hours ago, dksea said:

And as a result of all that avoidance you miss out on LIFE.  You live in constant anxiety.   You are unable to enjoy situations on a regular basis in order to slightly reduce your odds of something non-fatal and of low odds.  Its possible you could have enjoyed every single one of those situations and never gotten sick from it.  Its possible you could have enjoyed them and maybe gotten sick but then gotten over it and enjoyed more.  Instead you are trapped, the thing you fear the most MAYBE less likely to happen (but you don't actually even know that).  You get the worst of both worlds.  All the anxiety and distress, none of the fun.  You may not be jumping in boiling water, instead you're in water thats slowly been brought to a boil.  You avoid shocking pain by accepting slow progressive pain.  Its an irony of OCD, we end up suffering more in our avoidance and other compulsions than we do from merely living with the fear.

That's so good that you don't struggle with Emetophobia any longer. It sounds like it was pretty awful in the past. 

Also thanks for putting things into perspective- you are completely right that I miss out on life with this. There are other complicating factors including Social Anxiety, ADHD and other OCD, which make it even harder to live a normal life but I'm sure if someone could zap away the Emetophobia and contamination OCD my life would be much easier.

I do need to face situations- my family want to go for drive through fast food (very unusual for us but there's a particular menu on at the moment) on Sunday so that will be an exposure task as I'm scared of eating fast food as it involves eating food prepared by teenagers (who might not have good hand hygiene or might have recently been sick) and eating with my hands. 

 

 

Edited October 24, 2019 by BelAnna

[Closed for repairs]

You know we are all going to say, go to the drive through.

I sympathize with your wish to avoid 'orrible teens, but most of them are pretty good at not dying of food poisoning, and most of us survive repeated encounters with fast food of various kinds probably with way lower standards than the average chain drive through...

[BelAnna]

3 hours ago, Closed for repairs said:

You know we are all going to say, go to the drive through.

I sympathize with your wish to avoid 'orrible teens, but most of them are pretty good at not dying of food poisoning, and most of us survive repeated encounters with fast food of various kinds probably with way lower standards than the average chain drive through...

Haha thanks Closed for repairs! I know my friends used to pop to a burger van after nights out in our teens/early 20s (having had contamination OCD since I was 7 ruled that out for me!) so I guess McDonalds is better than that! 

 

[leif]

On 19/10/2019 at 05:12, BelAnna said:

That's brilliant though that you've been making progress each day. 

I can't use public toilets either. About five years ago I did do some CBT with another Psychologist and managed to walk into the loos in cafes (and even used the cleanest one with the no-touch approach (e.g. hovering and using tissues for the flush, door handles, taps)) but I've since gone back to being terrified of them again! I find multiple-cubicle toilets the most anxiety provoking because I've heard people vomiting in them in the past and every spillage and mark is a problem so for long car journeys I hold-it in (and avoiding drinking) for up to 10 hours as service station toilets are a no-go. Obviously though using loos on the go is a part of normal life so it's great that you're starting to tackle the fear. Are you having CBT with a therapist or doing self-directed CBT only? 

 

 

 

 

Hi Belanna,

Sorry took  me so long to reply. i'm not coming on here as often these days, partly because i'm not feeling as bad as i was a couple of months ago--so i guess that's a good sign in a way!

I've never really had a proper therapist for OCD so I mainly just worked on workbooks, and then had some counselors I could talk to about general stuff (they weren't trained in CBT for OCD so they weren't helpful for that.) I've found the easiest things for me to tackle were ones i could approach in small increments--either by reducing compulsions little by little, or by approaching something i avoided little by little. This worked best in things i was doing daily--so things like showering, or going to the toilet etc, or by visiting public places i was avoiding. So i was able to go from a showering process that took about 7 hours to it taking 15 minutes by doing that. And i do find that doing those exposures daily helped me to learn how to handle the anxiety in small enough doses so that surprise exposures became more manageable. It's still a challenge that sometimes i win, sometimes i lose...

Have you talked to your psychologist about the possibility of revisiting CBT practices? Do you find EMDR helpful at all? I've heard about it being used experimentally for OCD and have been interested in exploring that myself.

 

[BelAnna]

On 25/10/2019 at 03:39, leif said:

Hi Belanna,

Sorry took  me so long to reply. i'm not coming on here as often these days, partly because i'm not feeling as bad as i was a couple of months ago--so i guess that's a good sign in a way!

I've never really had a proper therapist for OCD so I mainly just worked on workbooks, and then had some counselors I could talk to about general stuff (they weren't trained in CBT for OCD so they weren't helpful for that.) I've found the easiest things for me to tackle were ones i could approach in small increments--either by reducing compulsions little by little, or by approaching something i avoided little by little. This worked best in things i was doing daily--so things like showering, or going to the toilet etc, or by visiting public places i was avoiding. So i was able to go from a showering process that took about 7 hours to it taking 15 minutes by doing that. And i do find that doing those exposures daily helped me to learn how to handle the anxiety in small enough doses so that surprise exposures became more manageable. It's still a challenge that sometimes i win, sometimes i lose...

Have you talked to your psychologist about the possibility of revisiting CBT practices? Do you find EMDR helpful at all? I've heard about it being used experimentally for OCD and have been interested in exploring that myself.

 

That's amazing that you've managed to reduce showering from 7 hours to 15 minutes without a therapist!That's great that getting used to small amounts of anxiety is having a big effect on the more major unexpected exposures some of the time.

I have spoken to my Psychologist but he does seem more interested in doing EMDR, which I actually don't think is doing anything!

I'm concerned that most of the "evidence" for EMDR is actually based on Pseudoscience; for example the reason why EMDR therapists think that mimicking REM sleep is useful for processing trauma is based on the traditional notion that REM sleep is the part of sleep in which dreams occur; but Neuropsychologists now know that dreams occur in every phase of sleep, not just REM so as far I'm aware there's no particular reason why inducing rapid eye movements should help with trauma processing! I don't really know what to do though as my Psychologist seemed annoyed when I tried to stop  EMDR sessions earlier in the year! I guess I need to do more self-directed CBT. 

Which books did you find particularly helpful?

Hope you're ok! 

Edited October 27, 2019 by BelAnna

[dksea]

1 hour ago, BelAnna said:

I have spoken to my Psychologist but he does seem more interested in doing EMDR, which I actually don't think is doing anything!

I don't have any direct experience with EMDR, but the descriptions of it do sound a bit pseudo-sciency to me and the studies that have been done seem to be mostly focused on PTSD rather than OCD.  Its unfortunate that your psychologist doesn't seem to be taking your concerns about the treatment seriously.  

[leif]

15 hours ago, BelAnna said:

That's amazing that you've managed to reduce showering from 7 hours to 15 minutes without a therapist!That's great that getting used to small amounts of anxiety is having a big effect on the more major unexpected exposures some of the time.

I have spoken to my Psychologist but he does seem more interested in doing EMDR, which I actually don't think is doing anything!

I'm concerned that most of the "evidence" for EMDR is actually based on Pseudoscience; for example the reason why EMDR therapists think that mimicking REM sleep is useful for processing trauma is based on the traditional notion that REM sleep is the part of sleep in which dreams occur; but Neuropsychologists now know that dreams occur in every phase of sleep, not just REM so as far I'm aware there's no particular reason why inducing rapid eye movements should help with trauma processing! I don't really know what to do though as my Psychologist seemed annoyed when I tried to stop  EMDR sessions earlier in the year! I guess I need to do more self-directed CBT. 

Which books did you find particularly helpful?

Hope you're ok! 

 

13 hours ago, dksea said:

Its unfortunate that your psychologist doesn't seem to be taking your concerns about the treatment seriously

I agree with dksea--it's too bad that if you don't think the EMDR is even helping and CBT is the proven method for OCD that he wouldn't be willing to go that route. 

Yes, self-directed CBT worked really well for me especially for the more daily straightforward stuff. It was necessary for me as it was really consuming my life and since the rituals took so much time i couldn't arrange to see a therapist. So every night at the end of a day of rituals i would just sit with my book and work at it. I was lucky that medication was helpful for me too though. The book i used was "Getting Over OCD--a 10-step workbook for taking back your life." It's by Jonathan Abramowitz. I see another book always recommended on this site though so you could go with that one. Have you ever tried using a cbt book?

Toilets continue to challenge me because its not as easy to take 1 step at a time as i get thrown a lot if i see anything on the toilet seat, or anything on the floor etc. It doesn't help that a lot of non-OCD people in the world don't especially like public toilets either--just confirms my fear of them! I think back to when i used to use them without any thought and I sure would love to get back there!

 

[dksea]

8 hours ago, leif said:

It doesn't help that a lot of non-OCD people in the world don't especially like public toilets either--just confirms my fear of them!

This would be a good area to put the cognitive part of CBT to work. 
Its true that many (most) people don't particularly look forward to using public toilets, but they still use them often.
Discomfort or dislike does not prove a fear is valid.
Most people don't like waking up in the morning to go to work.  That doesn't mean its rationale to be afraid of having a job.
I don't like some vegetables, like beets.  That doesn't mean its rational to be afraid of beets.

The key question with OCD is not "is thing X safe/not safe".  Nothing is 100% safe.
The key question with OCD is: "Is my behavior reasonable in this situation"

If you use the toilet, its reasonable to wash your hands.  Its not reasonable to wash them 10 times and then take a shower.
If you see something unpleasant on the ground, its reasonable to take a few steps away to avoid it.  Its not reasonable to assume you've been contaminated and need to disinfect everything you were wearing.
Its all about proportionality of response.
 

[leif]

On 28/10/2019 at 17:50, dksea said:

The key question with OCD is not "is thing X safe/not safe".  Nothing is 100% safe.
The key question with OCD is: "Is my behavior reasonable in this situation"

Thanks dksea for your usual good advice and wise words

I don't want to distract from Belanna's topic so won't go on too much here. But the reasonableness when it comes to toilet seats is what keeps catching me. There is just way too much grey in the judgement of toilets so it leaves me confused as to whether something is actually reasonable to use. I will keep working at it though. 

[dksea]

4 hours ago, leif said:

There is just way too much grey in the judgement of toilets so it leaves me confused as to whether something is actually reasonable to use.

Let me suggest some rules you should follow (its what I do)
- If there is nothing obviously visible on the toilet seat, its fine to use
- If there is a little bit of "stuff" on the seat (urine, feces, etc.) take some toilet paper wipe it off, throw in the toilet and then use
- If there is a noticeable amount of "stuff" on the seat, eh, pass, use another one or wait

To me noticeable is more than can be wiped off with just a few pieces of toilet paper folded together.  A few splashes of urine? A little streak of brown?  No worries.  Noticeable amounts of either? Eh pass (unless its a dire toilet emergency).

I can't say you'll be anxiety free by following this guidelines, and especially initially your "little bit" for "noticeable" will probably be stricter than mine.  If you start with at least using the toilet if there is no obvious amount thats something at least.  And by obvious I mean you don't spot it when you initially walk in to the stall, (i.e. you didn't spend time looking for it).  

Use the toilet, do a good job (not extreme) of washing your hands after, and move on.  You'll be fine

 

[BelAnna]

10 hours ago, leif said:

Thanks dksea for your usual good advice and wise words

I don't want to distract from Belanna's topic so won't go on too much here. But the reasonableness when it comes to toilet seats is what keeps catching me. There is just way too much grey in the judgement of toilets so it leaves me confused as to whether something is actually reasonable to use. I will keep working at it though. 

Hi Leif,

Don't worry about that at all- it's useful for both of us to discuss the loo issue anyway! I can see what you mean about normal people disliking public toilets too and also about the toilet seat issue. In my family most people 'hover'/squat rather than sit on the seat but they don't feel anxious about using public loos. Obviously it sometimes helps to take things to extremes so maybe sitting would be helpful for you to recover from this fear but I don't think it's essential for everyday public loo use. 

Personally I wouldn't like to just wipe something off the seat and use it unless it was an antimicrobial wipe that I used to wipe it off but that's probably partly because I see everything through an OCD lense! 

On 29/10/2019 at 00:50, dksea said:

Its true that many (most) people don't particularly look forward to using public toilets, but they still use them often.
Discomfort or dislike does not prove a fear is valid.
Most people don't like waking up in the morning to go to work.  That doesn't mean its rationale to be afraid of having a job.
I don't like some vegetables, like beets.  That doesn't mean its rational to be afraid of beets.

The key question with OCD is not "is thing X safe/not safe".  Nothing is 100% safe.
The key question with OCD is: "Is my behavior reasonable in this situation"

If you use the toilet, its reasonable to wash your hands.  Its not reasonable to wash them 10 times and then take a shower.
If you see something unpleasant on the ground, its reasonable to take a few steps away to avoid it.  Its not reasonable to assume you've been contaminated and need to disinfect everything you were wearing.
Its all about proportionality of response.
 

This is helpful! 

5 hours ago, dksea said:

- If there is a little bit of "stuff" on the seat (urine, feces, etc.) take some toilet paper wipe it off, throw in the toilet and then use
 

I think probably this varies person to person? I know lots of people choose to squat rather than sit OR to use a different loo if they see anything visible on the loo seat. 

Edited October 30, 2019 by BelAnna

[leif]

@dksea @BelAnna

Thanks to both of you for carrying on the discussion--it's really helpful and I'm glad if you find it so as well Belanna

13 hours ago, dksea said:

Let me suggest some rules you should follow (its what I do)
- If there is nothing obviously visible on the toilet seat, its fine to use
- If there is a little bit of "stuff" on the seat (urine, feces, etc.) take some toilet paper wipe it off, throw in the toilet and then use
- If there is a noticeable amount of "stuff" on the seat, eh, pass, use another one or wait

To me noticeable is more than can be wiped off with just a few pieces of toilet paper folded together.  A few splashes of urine? A little streak of brown?  No worries.  Noticeable amounts of either? Eh pass (unless its a dire toilet emergency).

I can't say you'll be anxiety free by following this guidelines, and especially initially your "little bit" for "noticeable" will probably be stricter than mine.  If you start with at least using the toilet if there is no obvious amount thats something at least.  And by obvious I mean you don't spot it when you initially walk in to the stall, (i.e. you didn't spend time looking for it).  

Use the toilet, do a good job (not extreme) of washing your hands after, and move on.  You'll be fine

 

Thank you so much for the practical rules. That is really helpful. I am at the point where i can use a public toilet that looks visibly clean and dry(still hovering), so the next step of using a toilet with water or pee on it would be a good next step. I'm sure i'll still be hovering over top, but at this point when there is any water or pee on the toilet (which seems to be all the time with my keen ocd eye!) , i can't use it at all. I'm too afraid of accidental contact if i try to hover, and i'm too afraid to wipe it up with toilet paper. So i will make it my goal to wipe it up, then hover...i'm sure i would have to sanitize my hands after wiping it up as just the thought of that makes me extremely anxious! Maybe first just wiping a toilet seat without using it afterward would be a good next step for me. 

How are you making out lately Belanna?