OCD: Common Concerns and Treatment Insights for Students - Psychiatry

Consultation on issues related to obsessive-compulsive disorder (OCD) patients?

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Hello Doctor,
I am a diagnosed patient with Obsessive-Compulsive Disorder (OCD) and I am currently a university student.
Six months ago, after experiencing a stressful event, my OCD symptoms flared up.
Initially, I recognized my irrational beliefs and behaviors, but later, as they became overwhelming, I sought medical help.
I have been receiving treatment from a psychiatrist for about six months now, and with medication and cognitive-behavioral therapy, including exposure and response prevention and mindfulness techniques, I have made over 70% progress.
However, I still have some questions that I need clarification on or would like to consult about, and I would appreciate your assistance.
Currently, I am taking the following medications:
- Sertraline / 150 mg per day
- Clonazepam / 1 mg per day
To outline my main symptoms: I spend a significant amount of time each day searching for legal information, including extensive case law and meeting records, analyzing every relevant case in great detail.
Not only that, but I also repeatedly review cases I have already seen, and I subjectively believe that some of my actions may meet the criteria for legal violations, which could potentially lead to legal repercussions, even though I have not yet been pursued.
(For example, I fear that posting photos might infringe copyright, or that comments I make online could be seen as public defamation, even when my words are appropriate.) Under prolonged and significant panic and unprecedented stress, I continuously engage in compulsive behaviors (searching) to alleviate the intense anxiety caused by obsessive thoughts (such as accidentally breaking the law, like running a red light).
For instance, there was an occasion when I accidentally spilled water in a convenience store, and after asking the staff to clean it up, I went home and began to fear that someone might slip on the wet floor and sue me...
etc.
I started to engage in compulsive behaviors like researching legal statutes and cases to suppress my anxiety.
Additionally, I still wake up every day with a haunting memory of something I did a year ago, fearing its potential consequences.
My thoughts are almost entirely catastrophic and related to legal issues.
Now, I would like to ask you the following questions:
1.
I have heard that OCD patients can apply for a disability certificate or a major illness card.
Is this true? However, I personally feel that my disability is not that severe, and those around me cannot perceive my symptoms.
I do not wish to be labeled as having a mental illness, even though I believe my OCD is moderate to severe.
Ideally, I want to be treated as an "ordinary person" by others.
I hope to actively pursue treatment quietly and coexist with my OCD one day.
2.
Since my first visit to the clinic, I have been paying out of pocket for my consultations because I do not want anyone, including family and friends, to know about my OCD.
I have also heard that psychiatric records can affect future insurance issues.
Therefore, I want to handle this matter myself.
I asked my doctor, and he stated that aside from the clinic's own records, and unless a court requests relevant information, no one else would know or have records of my condition.
I know that I cannot see psychiatric records on my health insurance portal, but I am unsure if there are any other systems that might have access to this information.
For example, can other specialists know that I have seen a psychiatrist? If not, how can I avoid potential drug interactions when prescribed medications by other specialists?
3.
Following up on the previous point, if I encounter a form from an insurance company or a job application that asks about my mental health, do I need to disclose my OCD? Since there are no records in my health insurance, can I choose not to disclose my OCD? I do not wish to use my OCD to gain any advantages; my military service was already determined before my diagnosis, and I do not want to undergo re-evaluation.
I want to fulfill my obligations (and I believe my disability is not severe) while also not wanting this condition to affect my future life.
I want to maintain my identity as an "ordinary person."
4.
After nearly six months of medication, I have noticed significant positive effects (including improved mood, increased confidence, and reduced OCD symptoms).
However, there are negative effects such as sexual dysfunction, including delayed ejaculation and fatigue.
I mainly want to ask about Clonazepam; it seems that this medication may cause cognitive impairment.
I do feel that I have become more forgetful, but I also find it somewhat relieving, as my obsessive thoughts are also forgotten.
This benzodiazepine is very effective for me; I can feel anxiety relief within half an hour of taking it, which is likely why my doctor recently increased my dosage from 0.5 mg to 1 mg daily.
I am concerned about the long-term side effects of this medication; will it permanently slow my thinking or make me less intelligent? (It seems that increasing GABA in my brain alleviates anxiety but also makes me forgetful.) Or will the side effects diminish over time? I have found many sources online stating that this medication is not commonly used for long-term treatment, yet my doctor prescribes it every time.
Therefore, I would like to know your clinical experience and any recommendations you might have.
Finally, I sincerely appreciate you taking the time to read my questions.
I understand that your time is very valuable.
Your professional opinion is invaluable to me.
Thank you again for your patience and expertise, and I look forward to your response.
Wishing you success in your work and good health.

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Mr. J, 20~29 year old female. Ask Date: 2023/06/03