Struggling with OCD: A Journey Through Unwanted Thoughts and Treatments

Pain

I have been suffering from obsessive-compulsive disorder (OCD) for over three years.
I have been taking medication at Cheng Kung University Hospital, but the results have not been good.
I have tried Zoloft, Prozac, Luvox, and Cymbalta, but none have been effective.
Only Zoloft makes me feel happy, but it does not help with my compulsions.
Initially, I had intrusive thoughts about knives and scissors that I couldn't shake off.
I found it very distressing, but I couldn't stop thinking about them.
I became afraid of knives and scissors and didn't dare to use them.
Later, I started having intrusive thoughts about bricks as well.
At one point, the images of knives and scissors disappeared, but I found myself mimicking cutting motions with my hands, which eventually also faded away.

I have attempted suicide in the past and have been hospitalized twice.
I have experienced unwanted sexual thoughts about women, where I felt compelled to touch them inappropriately, even though I didn't want to.
Currently, I have intrusive thoughts about harming children, and I am afraid to hold my own child.
When riding my motorcycle, I constantly think about accelerating into a wall.
I have recurrent thoughts about hitting someone on the head with a brick or banging my head against glass.
I find myself repeatedly imagining these scenarios, where things appear to grow larger and smaller, disappearing and reappearing.

I know I don't want to act on these thoughts, and I understand they are irrational, but I can't seem to distract myself, even when I try to keep busy.
I find myself rereading the newspaper repeatedly, which is truly distressing.
I once combined my medications with Trazodone, but I gained ten kilograms.
What should I do?

Gao, 30~39 year old female. Ask Date: 2003/11/18

Dr. Chen Guangpeng reply Psychiatry

Dear patient,
I empathize with you as you struggle with your symptoms and the lack of effective treatment.
There is still significant room for research and treatment of obsessive-compulsive disorder (OCD), and the efficacy is not particularly high (at least 20-40% of cases remain difficult to manage).
The main strategies include pharmacotherapy and behavioral therapy.

In terms of pharmacotherapy, there are several types of medications that can be tried, along with options like electroconvulsive therapy (ECT) and stereotactic surgery.
A treatment protocol was proposed in 1992 that may serve as a reference.
Since you are currently receiving care at National Cheng Kung University Medical Center, you may have already tried two major classes of medications; I wonder if the dosages and duration have been adequate?
Consideration of other types of antidepressants (such as MAOIs) or adjunctive agents, as well as the potential for ECT and stereotactic surgery, and whether behavioral therapy has been implemented, are all additional options to discuss with your attending physician.
I believe you are not at a point of despair yet, so keep pushing forward!

Reply Date: 2003/11/18

More Info

Struggling with Obsessive-Compulsive Disorder (OCD) can be an incredibly challenging experience, as you've described. Your journey through unwanted thoughts and the various treatments you've tried reflects the complexity of managing this mental health condition. It's important to acknowledge that OCD is not just about the compulsions or rituals; it's also about the intrusive thoughts that can lead to significant distress and impairment in daily functioning.

From your account, it seems that you've been prescribed several medications, including Zoloft (sertraline), Prozac (fluoxetine), Luvox (fluvoxamine), and others, with varying degrees of effectiveness. It's not uncommon for individuals with OCD to go through multiple medication trials before finding the right one or combination that works for them. SSRIs (Selective Serotonin Reuptake Inhibitors) like Zoloft and Prozac are often first-line treatments for OCD, but they don't work for everyone, and sometimes the side effects can be challenging to manage.

Your experience with intrusive thoughts, particularly those that are violent or sexual in nature, is characteristic of OCD. These thoughts can be distressing and lead to feelings of shame or guilt, especially when they conflict with your values and desires. It's crucial to understand that having these thoughts does not mean you will act on them; they are a symptom of the disorder. Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), is considered one of the most effective treatments for OCD. ERP involves gradually exposing yourself to the thoughts or situations that trigger your anxiety while refraining from engaging in compulsive behaviors. This process can help reduce the power of the intrusive thoughts over time.

In addition to medication and therapy, there are several strategies you can employ to help manage your OCD symptoms:
1. Mindfulness and Acceptance: Practicing mindfulness can help you observe your thoughts without judgment. Accepting that these thoughts are part of your condition rather than a reflection of your character can reduce their impact.

2. Journaling: Writing down your thoughts and feelings can provide an outlet for your distress and help you identify patterns in your thinking.

3. Support Groups: Connecting with others who have OCD can provide a sense of community and understanding. Sharing experiences and coping strategies can be incredibly beneficial.

4. Healthy Lifestyle Choices: Regular exercise, a balanced diet, and adequate sleep can positively affect your mental health. Physical activity, in particular, has been shown to reduce anxiety and improve mood.

5. Limit Information Consumption: If you find yourself obsessively reading or watching things that trigger your OCD, it may be helpful to set boundaries around your media consumption.

6. Professional Support: If you haven't already, consider seeking a therapist who specializes in OCD. They can provide tailored strategies and support that align with your specific experiences.

It's understandable to feel overwhelmed, especially when dealing with the distressing nature of OCD and its impact on your life. Remember that recovery is a journey, and it's okay to seek help along the way. You are not alone in this struggle, and with the right support and treatment, it is possible to manage your symptoms effectively. If you ever feel that your thoughts are leading you to harm yourself or others, please seek immediate help from a mental health professional or a crisis hotline. Your safety and well-being are paramount.

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