The last thing I expected was to receive an additional diagnosis. At least I’m better prepared to deal with it today than when I was diagnosed with schizophrenia eight years ago. Back then I felt like my life was over, that I’d be in a straightjacket for the rest of my days.
I took it upon myself to learn everything that I could about my disorder. I was simultaneously becoming aware of the stigma surrounding mental illness. I learned to advocate for myself in order to handle the reams of paperwork required for disability and health care. My life is stable today. Along with schizophrenia, I have PTSD, and I get help for both. A diagnosis of OCD has recently become another piece in the puzzle that is my life. Thankfully, I get help for that, too.
Of course, the first thing that comes into play is the stigma. The number of times I’ve heard someone say, “I’m so OCD!” the pop culture meme for explaining away control issues. At this point I’m aware of how social stigma functions, so I won’t be letting it get me down. Still, it’s out there in spades, pushing the self-stigma triggers ever more so, prompting mindful response over knee-jerk reaction. Dealing with another diagnosis is challenging enough without letting stigma derail my quality of life.
Obsessive-compulsive disorder (OCD) is an anxiety disorder. Obsessions are intrusive thoughts or unwanted impulses which create or exacerbate anxiety. Compulsions are repetitive behaviors or mental acts engaged in by the person trying to dismiss the obsession and alleviate their anxiety. Common obsessions might include fear of personal safety and bodily harm, of germs or illness, or aggressive impulses. Compulsions can include rituals like excessive cleaning and hand washing, hoarding, arranging and checking, or silently counting and repeating phrases and words. Often these behaviors are in no way connected to, or aid in, preventing the unwanted circumstance, and can interfere with normal routines, occupations, relationships, and social involvement.
Most of my obsessions center on bodily harm, disease, and intrusiveness. I spend up to an hour a day with my compulsions, sometimes longer. I clean, and hoard, and whisper to myself, in order to deal with the obsessions. These are more than mere coping mechanisms. They are my personal rituals. They prevent bad things from getting worse. When they don’t, I try other actions until I find one that does the job.
Things can get fairly intricate. I trace inanimate objects in my mind to keep them anchored in the room. When mouthing words, they need to match a rhythm and be in even numbered groups. Collections need to be ordered and displayed according to a pattern. The door lock needs to be checked and rechecked. I can’t leave the house until certain rules are met. Everything has to be done in secret. If caught counting or reciting, I make light of it. If caught checking or organizing, I rationalize it. This is my private world. I do things to keep the wolves at bay, to protect myself and others from harm.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) specifies that a person with OCD may have good or fair insight into their illness, or poor or absent insight and delusional beliefs. With poor insight, a person with OCD may not recognize that their obsessions and compulsions are illogical. They continue to act on their beliefs, repeating behaviors which have no relevance to the obsession. They can’t control it.
Levels of insight can vary depending on the severity of the symptoms. Early on, one might have good insight and be able to realize that their behaviors are irrational. However, if symptoms worsen and poor or absent insight is present, the OCD sufferer can appear borderline psychotic.
My father had OCD. I often wondered if I had that in common with him. So much of the last eight years has been spent dealing with schizophrenia and trauma-related issues that I hadn’t considered anything else. I didn’t want to come off as the poster child for comorbidity. Yet here I am, diagnosed with OCD, and already receiving treatment for it. If I hadn’t been so involved in advocacy, I might have shied away from the logical steps necessary to maintain sound mental health.
My meds are in place and I see my therapist weekly. The goal is to maintain a consistent reality check, such that it comes as second nature, rather than succumbing to fear. Keeping my self-awareness up and my insight focused, I should be able to contend with anything that comes my way.