Review of Oxford Messed Up by Andrea Kayne Kaufman Facing OCD

[Note: In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.]


When Grant Place Press contacted me about reviewing Oxford Messed Up by Andrea Kayne Kaufman, little did I realize the connections I would find with my own life.  The protagonist, Gloria Zimmerman, is traveling to Oxford to study feminist poets, and struggles with OCD.

I have a degree focused on feminist poets.  Reading poems written by these women, and writing my own poems gave me strength to deal with depression, OCD and other pain.   I was a very serious young woman, who didn't know she had OCD, but knew that I was often scared about symptoms in my body, and trying to be perfect.  Gloria knows she has OCD, but attempts to keep herself together with rituals, Klonopin, and Van Morrison's music.

Van Morrison's music is a source of strength to both Gloria, and her "loo-mate" Henry Young(the other protagonist who has had many traumas in his life).   As a girl, I  remember sitting on the floor going through my parents record collection, trying to understand what a Moondance was, and mesmerized by the album.

I was intrigued that one of the recommendations on the back of the book came from Susan Richman from OCD Chicago, a chapter of the International OCD Foundation.  Oxford Messed Up does indeed explore Exposure and Response Prevention Therapy(ERP), the standard for treating OCD, and is the only novel for the adult market that I've ever come across that does.

Henry is the catalyst for Gloria's ERP, and this shows the importance of rapport for willingness to do Exposures.  If I hadn't trusted my ERP therapist, I wouldn't have done any of the Exposures he suggested.  I believe that family and friends are often on the frontlines of working on Exposures with the ones they love who have OCD, and that self-help has been very important for many sufferers, especially Jonathan Grayson's book Freedom from OCD, and his model of GOAL support groups.

At the same time, though, I was ambivalent about Henry's quick study of ERP, and how unrealistic this might be.  I was able to suspend disbelief because I remembered reading somewhere that ERP, even incompletely done, can be better than years and years of talk therapy. I only wish more therapists were  quick as Henry--like the 6 or 8 of them I saw before I found Leonard, who actually specializes in OCD and was expert in Exposure Therapy, rather than asking me to simply avoid my triggers or use logic to make it all go away.  I would imagine a novelist's dilemma would be how to portray a series of ERP sessions with a therapist, in a way that would make good fiction.  

Gloria has contamination OCD, which I don't have, and which gave me a brief flash of disappointment, because this is the stereotype of people who have Obsessive Compulsive Disorder.   But she also has perfectionism, a mandate to be a "Superstar,"  which I identify with, and I liked that Kaufman showed how perfectionism can underlay everything, and that this may be slower to respond than other aspects of OCD.  If patterns have been in place for a lifetime, through family culture, personal history, combined with genetic heritage, that simply habituating to the "dirty world" isn't enough, and that compassion, love, understanding and hope are crucial to regaining a life that has been ordered by taking as few risks as possible, and trying to earn the love of others.  

I recommend Oxford Messed Up for it's improvisational dialogue both internal and external, for an inside look at the OCD thought process while facing fears, for the importance of hope, and of "fatalistic optimism"(as the characters describe the music of Van Morrison).

In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.

Built on Sinking Sand The House of OCD and Health Anxiety

It was the summer of 2006 when I sank deeply into the OCD with a full scale health anxiety crisis. OCD thinking is like an elaborate structure built on sinking sand. It appears so real and solid and indisputable and all the while your life is collapsing underneath you, and the logic is built on inherently unstable ground. OCD is an entire industry of thinking with very little to do with the outside world, except for the grain of truth that it inevitably latches onto.

Even writing about this summer stirs up the OCD. Part of my compulsion to make the anxiety go away was to make detailed notes about my symptoms, in hopes that I accounted for every possible thing, so my impulse, when writing this blog post, is to include every detail. The anxiety began when I agreed to take a medication which might alleviate a symptom that I obsessed about frequently. I took the medication, and started obsessing that I was getting a bladder infection, which was another one of my health anxiety themes. After fixating on every bladder sensation, and agonizing about whether to call my doctor, I finally did and she got me in at the end of the day. It is common(though perhaps not recommended) to treat women empirically if they have bladder infection symptoms, so that's what she did--no urine test.

And that began an elaborate building of health fear, one level on top of another. Because I'd had a severe headache with one antibiotic in the past, I said I wanted a different one, and in dodging one fear I landed in another as I began to obsess about getting a yeast infection from the 2nd antibiotic, and called my doctor who prescribed meds over the phone. I was overwhelmed with a surge of anger at my doctor for not doing a urine test since I had several bladder infections that turned out not to be, and since strong feelings set off my OCD, I was on very shaky ground.

Over the next weeks the OCD was compounded and grew at an alarming rate. I went to a different gynecologist, who was near my house, who did a lab test and said I did not have a bladder infection, and gave me more meds for the supposed yeast infection. I still felt urgency in my bladder, and even more urgency in my OCD desire to know exactly what was going on in my body, and perfectionistic self-condemnation for not perfectly diagnosing myself or advocating for tests, or for calling a doctor in the first place. The OCD thoughts were all about my defectiveness, and my responsibility to make sure I didn't get a kidney infection, and the imperative that I never make a mistake, and that I would be haunted by the pain and discomfort in my body.

I was on a quest to get relief from my anxious imaginings and my fixation on painful sensations in my body. I found a new family doctor, who said if I still had bladder urgency that I probably did have an infection, and she wrote a script for antibiotics, and reluctantly did a urine test at my request, but when I panicked that I did not do the test sample correctly, she went into authoritarian mode and told me to not get myself worked up, to just calm down. Well, if I could do that, I think I would have already. . .I went and cried in my car.

So here I was trying to decide whether to take another antibiotic, without test results, and the OCD structure was growing, as I felt a surge of hyperresponsibility that if I got a kidney infection it would be all my fault, so I'd better take the antibiotic. By the end of that week, I couldn't sleep at night, and I went into the doctor on a Saturday. The doctor on call was much calmer and kinder, and she prescribed another antibiotic that would be less likely to cause insomnia, but this antibiotic wreaked havoc with my digestive system. I went back to the doctor on call who happened to have my test results, and once again it showed I didn't have a bladder infection but that I did have blood in my urine, and she wanted me to see a urologist.

By this time I was a mess. My therapist Molly was on vacation. I went to see the therapist on call, and told her how I couldn't get this right, couldn't figure out what was wrong with my body, that I needed to try harder. She sat quietly for a moment, and then said that it seemed I had been working incredibly hard to find out what was wrong, with multiple doctor visits and relentless researching on the computer. I was baffled by this. This did not make sense in my OCD world, where I was never good enough, never finished, never solved, never certain.

She wrote a few sentences on a scrap of paper, and gave it to me:

May I be filled with lovingkindness.

May I be safe from inner and outer dangers.

May I be well in body and mind.

May I be at ease and happy.

This was a glimmer from outside the windows of the house of OCD, the possibility of another way to view the world. Feeling body symptoms can be hard enough without the "inner dangers" of OCD. I was to descend further into my OCD, but I had a moment of reprieve.

*********************
Thinking about it now, this is part 7.5 of my Medication Series, since it was my first OCD crisis after ceasing to take my antidepressant.

Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication

OCD Stop Free Online Treatment for OCD in Australia from Swinburne University

I received a message from a research assistant at Swinburne University of Technology in Australia about online treatment they are offering through a study by Swinburne's National eTherapy Centre. Their website mentions Exposure Therapy in conjunction with Cognitive Behavioral Therapy as effective treatment for OCD.

More about OCD STOP!

OCD STOP! online treatment is based on a face-to-face Cognitive Behaviour Therapy (CBT) already in use. Evidence shows CBT is the most effective treatment for OCD. The online program OCD STOP! is known to help reduce symptoms of OCD. This study aims to find out who can most benefit from this treatment.

OCD STOP is free, safe, completely confidential, and does not use medications.

The 12 week program provides information about OCD, and helps participants learn how to control their anxiety and better manage their OCD. During the trial participants receive assistance in the form of weekly email contact with a qualified therapist.

Participants in the trial will be randomly assigned to one of two groups, those undertaking a cognitive behavioural treatment program called Systematic Treatment of Obsessive Compulsive Phenomena or OCD-STOP, and those completing Progressive Relaxation Training. Irrespective of which program they are assigned, all individuals will be given the opportunity to take the alternative treatment at no cost.

The director is Prof. Michael Kyrios, an academic clinical psychologist.

Note: OCD Stop! online is free. There is also a group that meets onsite, with a nominal fee.



Swinburne is also offering a 12 week STOP Group for OCD, starting April 2012, at Swinburne's campus in Hawthorne VIC, Melbourne.The program cost $420 for the 12 weeks. You may be eligible to receive Medicare Rebates. Medicare rebates are only available for sessions attended. A Mental Health Care Plan and a GP referral for psychological group therapy are needed to obtain a Medicare rebate for the cost of the group. The next STOP therapy program is planned to commence in April 2012. To find out how you can register to participate in this group please contact the Clinic's Project Officer by phone (03) 9214 5528 or email psychprojects@swin.edu.au

OCD A to Z I is For Indecision

Indecision OCD has eaten up a lot of time in my life. I'll get the thought that I might make a mistake, or the wrong decision, and my anxiety rises, and my compulsions consist of checking items closely for flaws, reading labels repeatedly, picking up every item, making sure I look at every rack in the store, plus mental rituals of figuring out which is the best choice, and interminable research.

I am much better at making decision now, after doing exposures, and listening to exposure scripts on my ipod, and the "high tech"(as my therapist calls it) tool of flipping a coin to make certain decisions. If I am tired or vulnerable, I am more likely to start agonizing over ordinary decisions. Yesterday, I was in the consignment store looking for t-shirts, and found myself looking at all the racks twice, even though intellectually I knew that there wasn't anything. For so many years I feared "missing something valuable or important" and it's a hard habit to break.

I remind myself to make at least one decision at the grocery store by flipping a coin--this cereal or that cereal, buy this item, or leave it on the shelf. I remember the days when I'd pace the store for 1/2 hr trying to make one decision, and how if I thought of a criteria for my choice(ie. price), I'd start to debate in my mind if that was the right criteria to use. I'd break into a sweat, my face would get hot, and whatever else I needed to do in my life was put on hold. I hated myself for wasting so much time, and I'd come home exhausted and demoralized.

OCD often is about certainty. I want to know for certain I've made the right choice, in advance, before I ever choose the item, or use it, or whether I've chosen the right action for all time. We don't get that kind of omniscience. Even in the grips of indecision, I knew that sometimes I chose something, and it sucked, even after all my compulsions, but it took encouragement from my therapist and friends to take the leap, and take my best guess, or leave something to chance, or not know an encyclopedia of information for every choice I made. We trick ourselves into believing that we can predict the future with certainty, if only we tried hard enough.

Participants Wanted for Mt Sinai Hospital on Learning How Cognition Works in OCD

Behavioral and fMRI studies of cognition in healthy individuals and patients with anxiety

ID Number 11-1344

Principal Investigator(s) 
Emily Stern 

Department(s) or Division(s) 
Psychiatry 

Description 

The current research study is designed to learn more about how cognition works in individuals with anxiety disorders, specifically Obsessive-Compulsive Disorder (OCD).  This study uses neuroimaging techniques (fMRI) to examine the neural mechanisms underlying switching attention in individuals with a diagnosis of OCD.  

Potential participants may qualify to take part in this research study if they are between the ages of 18 and 50 without a history of serious problems with their health (such as a heart attack), emotions (such as depression) or nervous system (such as seizures), have received a diagnosis of Obsessive-Compulsive Disorder, and are interested in participating in psychological research.

Contact Information 
Alexandra Muratore
(212) 824-8995
sinaibrainlab@mssm.edu 

Recruiting Patients: Yes 

Link http://icahn.mssm.edu/research/clinical-trials/11-1344

Vacation and OCD It wants to come along

I'm getting ready to go on vacation. I know I am not alone in having my OCD get more active before travel to somewhere unfamiliar and away from routine. My husband said I am dramatically better than in past years, and he's right. Of course my OCD jumps all over this with, "Well, he just jinxed you. Can you live up to the pressure to be sane???" But I do know that in the past vacation was like a gauntlet of anxiety, with a big dose of anticipatory anxiety in the form of hypersensitivity to body symptoms, fears of getting a bladder infection, difficulty deciding what to pack, unplugging everything in the house, fear of dying while away.

This year though, although these same kinds of thoughts have occurred, I haven't latched onto them, and wrestled with them until I was a sweaty mess. I used to compulsively research vacations in order to try and get some kind of control, but I am learning that part of vacation is making it up as we go, and as daunting as my OCD finds anything spontaneous, I am making this an exposure, to have a good time dammit. . .OCD also came in the form of "am I enjoying this trip enough? Did I experience that right?" along with fear of not choosing to do the right activities at the right times, so again, big exposure time here, because the flashes of freedom, fun and joy I've had when I stay in the present moment are lighting the way.