OCD Symptoms: Coping with Intrusive Thoughts and Sleep Issues

The previous diagnosis from the physician was obsessive-compulsive disorder (OCD)?

My symptoms appeared suddenly.
At the end of February, while trying to sleep in the early morning, I suddenly had intense self-harming thoughts (like wanting to gouge out my right eye...).
For the next two months, these thoughts kept recurring, which made me very depressed and low in mood, and I experienced insomnia.
Sometimes, the thoughts were so overwhelming that I would vomit in an attempt to resist them, fearing that I might actually do something foolish.
Later, I consulted a psychiatrist who diagnosed me with obsessive-compulsive disorder (OCD) and prescribed 21 days' worth of sertraline.
However, I was afraid of having to take medication continuously, so I hesitated to take it and relied on willpower to overcome these terrifying thoughts.
It wasn't until mid-April that these thoughts gradually diminished.
Although they are not as intense now, they still occasionally resurface.
Currently, I am experiencing insomnia, having trouble sleeping at night (waking up in the middle of the night and finding it difficult to fall back asleep) or sometimes unable to sleep at all.
I constantly feel like there is something anxiety-provoking in my mind (which I believe is related to those thoughts), making it hard for me to sleep.
Could this be a residual effect of OCD, or do I need to take the sertraline prescribed by my doctor? I had my wisdom teeth removed in mid-February; could that have caused some brain injury? Or is it possible that the upcoming military service is causing unconscious stress? I really don't know...
I would greatly appreciate your guidance.
Thank you!

Roy, 20~29 year old female. Ask Date: 2008/05/27

Dr. Chen Wenyu reply Psychiatry

Hello Roy,
It seems that you are experiencing quite a bit of stress! However, there is no need to worry too much about the side effects of medication.
Currently prescribed antidepressants by psychiatrists have a high safety profile, with minimal side effects, making them suitable for long-term use.
The medications for obsessive-compulsive disorder (OCD) and depression are the same, which indicates that if obsessive thoughts cannot be eliminated, depressive symptoms are likely to become more pronounced, leading to insomnia due to constant rumination.
These issues are interconnected.
From your description, it appears that your obsessive thoughts have improved, but your stress and sleep quality have not.
I recommend that you continue taking the medication prescribed by your doctor.
During your treatment, take some time to reflect on why your symptoms initially presented with such strange and negative thoughts, and why, after some time of treatment, you are able to cope with stress more easily and think positively.
Understanding the differences in your mental processes can help you learn to manage your emotions when facing stress in the future, which would be a constructive therapeutic experience.
Thank you for your letter!

Reply Date: 2008/05/27

More Info

Your situation sounds incredibly challenging, and it's understandable that you're feeling overwhelmed by intrusive thoughts and sleep disturbances. Based on your description, it seems that you are experiencing symptoms consistent with Obsessive-Compulsive Disorder (OCD), particularly the presence of intrusive thoughts that cause significant distress. These thoughts can often lead to anxiety, depression, and sleep issues, which you are currently facing.

OCD is characterized by unwanted and intrusive thoughts (obsessions) that lead to compulsive behaviors or mental acts aimed at reducing the anxiety associated with those thoughts. In your case, the self-harm thoughts you mentioned are particularly concerning and can be very distressing. It's important to recognize that these thoughts do not reflect your true desires or intentions; they are a symptom of the disorder.

The sleep issues you are experiencing, such as difficulty falling asleep, waking up during the night, and feeling anxious about the intrusive thoughts, are common among individuals with OCD. Anxiety can significantly impact sleep quality, leading to a cycle where poor sleep exacerbates anxiety, which in turn makes it harder to sleep. This cycle can create a sense of helplessness, as you described feeling like you are unable to escape the grip of these thoughts and the resulting emotional turmoil.

Regarding your concerns about medication, specifically sertraline, it's important to understand that selective serotonin reuptake inhibitors (SSRIs) like sertraline are often prescribed for OCD and can be effective in reducing the frequency and intensity of intrusive thoughts. While it's natural to have reservations about long-term medication use, SSRIs can help restore balance to neurotransmitters in the brain, which may alleviate some of the distressing symptoms you are experiencing. It's worth discussing your concerns with your psychiatrist, as they can provide guidance on the benefits and potential side effects of the medication, as well as alternative treatment options if needed.

Additionally, cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered one of the most effective treatments for OCD. This therapeutic approach 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.

It's also important to consider the impact of external stressors, such as the upcoming military service you mentioned. Anticipatory anxiety about significant life changes can exacerbate existing mental health issues. Engaging in stress-reduction techniques, such as mindfulness, meditation, or deep-breathing exercises, may help you manage anxiety and improve your overall well-being.

In summary, your symptoms are likely related to OCD, and the intrusive thoughts you are experiencing can lead to significant distress and sleep disturbances. It is advisable to consult with your psychiatrist about the potential benefits of taking sertraline and to explore therapy options such as CBT. Remember, you are not alone in this, and seeking help is a crucial step toward recovery. Taking care of your mental health is essential, and with the right support and treatment, you can work towards managing these symptoms effectively.

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