Freedom From Obsessive-Compulsive Disorder: A Personalized Recovery Program For Living With Uncertainty

394 Pages·2003·4.04 MB·English

by  Jonathan Grayson

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eBook ISBN: 978-0-69815385-1
The Library of Congress has catalogued the Jeremy P. Tarcher/Penguin hardcover edition as follows: Grayson, Jonathan.
Freedom from obsessive-compulsive disorder : a personalized recovery program for living with uncertainty / Jonathan B. Grayson.
p. cm.
Includes index.
ISBN 1-58542-246-0 (alk. paper)
1. Obsessive-compulsive disorder—Treatment—Popular works. I. Title.
RC533.G725 2003 2003050723
616.85'22706—dc21
PUBLISHING HISTORY
Jeremy P. Tarcher / Penguin hardcover edition / September 2003
Berkley trade paperback edition / September 2004
Updated Berkley trade paperback edition / May 2014
Cover design by Elaine Groh.
Interior text design by Tanya Maiboroda.
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Version_1
To Cathy, Josh, and Jane
Precious are our memories, joyous are our future hopes,
and as for the present, our here and now, I couldn’t ask
for more.
Contents
Title Page
Copyright
Dedication
Acknowledgments
Introduction
PART I
Understanding Obsessive-Compulsive Disorder
1. Uncertainty: The Core of OCD
2. Causes of OCD: Biology and Learning, Not Biology vs. Learning
3. Obsessions and Compulsions: What Sufferers Fear and What Sufferers Do
4. Understanding the Role of Medication
PART 2
The Foundation of Your Program
5. Accepting Uncertainty: Your First Step
6. Exposure and Response Prevention: The B in Cognitive Behavioral Therapy
7. Tools to Counter the Voice of OCD: The C in Cognitive Behavioral Therapy
8. Designing Your Recovery Program
PART 3
Personalizing Your Program: Treatment Guidelines for Your
Specific OCD Concerns
9. Contamination: The Obsession That Spreads
10. Checking: The Pervasive Compulsion
11. Ordering, Symmetry, Counting, and Movement: Rituals of Perfection and Magic
12. The Primary Mental Obsessions: It Really Is All in Your Mind
13. Selected Obsessive-Compulsive Spectrum Disorders: OCD Problems with Another Name
PART 4
Recovery and Beyond
14. Building Supports for Recovery: Beyond Exposure and Response Prevention
15. In Recovery for Life
Appendices
Appendix A:
Therapy Scripts Starters
Appendix B:
OCD Resources
Index
Acknowledgments
I am where I am today because of the contributions and efforts of many people. As one might expect, I have
to start with my mother and father, Hal and Helen Grayson, who gave me the confidence to try anything,
the courage to fail, and the humor to appreciate it all. Thanks to Tom Borkovec, my mentor in graduate
school, whose wisdom, friendship, and curiosity about everything sharpened my thinking and whose
extreme patience taught me to write, thus making this endeavor possible. To Edna Foa, whose work with
OCD is still the cornerstone and core of our treatment. To Gayle Frankel, the members of GOAL, and
everyone I have worked with, this is for you (I’m sorry there isn’t enough space to name all of you): There
is no way to measure what I have learned about life from witnessing the courage you have displayed in your
quest for freedom. To my peers at my former center, the Anxiety and Agoraphobia Treatment Center, and
my current center, the Anxiety and OCD Treatment Center of Philadelphia: Joanne Dobrowski, B. J. Foster,
Lori Kasmen, Harold Kirby, Leslie Lenox, Kathy Rupertus, David Raush, Georgia Sloane, Linda Welsh,
Lee Fitzgibbons, Karen Landsman, and Tejal Jakatdar; you are my second family, providing support and
stimulation, never letting me get away with anything (well, not too much), and, in the words of Leslie,
making work a fun place. I also have to thank my longtime colleagues and friends, Charles Mansueto and
Alec Pollard. It’s as if we were there at the beginning and I can’t thank you enough for all of the inspiration,
discussion, and unrestrained fun.
I also want to thank my agent, Jessica Lichtenstein. She found me and made this book possible. Her
optimism and energy were a constant source of support. I can think of few tasks more painful than editing
an author’s first book. With the patience of a saint, Wendy Hubbert at Tarcher guided me through this
ordeal, and my gratitude to her knows no bounds.
And, most of all, my family. My son, Josh, whose life has filled me with more love than I would have
believed possible. Thank you for so cheerfully allowing me to make the vignettes of your trials and
tribulations part of my clinical repertoire. To his wife, Jane, for completing his life and ours. I want to thank
you in advance for your life stories that will undoubtedly become part of my clinical repertoire. Finally, to
my wife, friend, and lifelong partner, Cathy—everything is from you and for you. What a long, strange trip
it has been! For more than forty years, I have shared everything with you, and still you are the endless
source of all that I could ever want: a dream come true. Without your patience, sacrifice, support, and help
during this endeavor, this book wouldn’t be.
Introduction
I was standing in an open field, looking back into the forest and brush, watching
the others struggle their way out. It was raining. I had purposely taken everyone
off trail through trees and undergrowth so densely packed that forward
movement was a slow process of stepping over and through bushes and being on
guard for branches snapping back from whoever was in front of you. Melanie,
the fourth person to emerge into the freedom of the clearing, shouted, “I’m
having a great time!” The photographer documenting our trip for People
magazine snapped a picture. Seeing Melanie’s joy, it was hard to connect this
woman with the one I’d met seven months earlier at my former center, The
Anxiety and Agoraphobia Treatment Center in Philadelphia.
When I met Melanie at our first session, she was an extreme suicide risk—
all medications in her home, even aspirin, had to be locked in a safe. Her parents
wouldn’t permit her to carry more than two dollars at a time, fearing that access
to more money would enable her to commit suicide with over-the-counter
medications. She was an attractive and articulate twenty-nine-year-old with a
fifteen-year history of both obsessive-compulsive disorder (OCD) and body
dysmorphic disorder (BDD). Her OCD focused on issues of perfection. When
taking notes during class, if there were any cross-outs, stray marks, folds, or
creases in her notebook, she would feel compelled to discard the page. Similarly,
she wouldn’t tolerate any such marks in her textbooks and would cope with such
“imperfections” by not using the text. Though she found school a nightmare of
anxiety, Melanie did well in the courses she managed to complete. But many of
her attempts to go to school resulted in anxiety and depression severe enough to
require psychiatric hospitalization.
Melanie also felt as though she was horribly ugly—so repulsive that she
believed it was a burden for those around her to tolerate her presence. This is
what it feels like to have BDD, a form of OCD in which sufferers can’t stand
their own appearance. She spent endless hours agonizing over her hair and
makeup, trying to get ready to go out, but often wouldn’t be able to leave the
house. For more than fifteen years, she had no memory of ever being free from
her anxiety and despair.
Yet here she was on a camping trip. And not just any trip, but one that I’ve
been running almost every year for more than two decades as a therapeutic
journey for OCD sufferers. Even non-sufferers might find it difficult to spend a
weekend sleeping in tents, using latrines without the benefit of running water,
and taking torturous hikes through the mud and muck. For the OCD sufferers I
treat, especially those with contamination fears, the accomplishment of making it
through such an experience is often nothing less than a tremendous breakthrough
in their recovery.
This camping trip is just one of the approaches I’ve found to be of use in
working with OCD sufferers during the last twenty-five years. Earlier in my
career, as a faculty member in the Department of Psychiatry at Temple
University’s School of Medicine, I was part of a research team studying the
treatment of OCD. Though our research excelled at delineating the mechanics of
treatment—our results and findings regarding the behavioral techniques known
as exposure and response prevention are still the core of today’s treatment for
OCD—I felt the need to go beyond the actual treatment process.
I wanted to address issues our research was ignoring, such as relapse
prevention. So in 1981, with an OCD sufferer named Gayle Frankel (who was
then the current president of the Philadelphia Affiliate of the Obsessive-
Compulsive Foundation), I started the first OCD support group in the country.
Called GOAL (Giving Obsessive-compulsives Another Lifestyle), our group
was more than a place for sufferers to share their stories. Its purpose from the
beginning was to help sufferers understand their OCD and to make and maintain
treatment gains.
Helping people understand their OCD is the key to my treatment approach.
One of the greatest problems for those of you who suffer from this disorder is
the disparity between your inner world and the outside. For all of us, the person
we show the world is not exactly who we are; we all have our private thoughts,
opinions, and secrets. But, for you, the gulf between your private and public
selves is greater. No matter which aspects of your OCD everyone else sees, you
and I know it is only the tip of the iceberg. You understand the pain and