Tag Archives: obsessive compulsive disorder

A Missed Dose

In the last 28 years I have not skipped or missed a dose of medication.

Wednesday night as I huddled in the ER (for the second time in two weeks) the team of doctors and nurses surrounding me looked started as I told them this fact. I guess it never occurred to me that this might be unusual in any way, but in an emergency room where they’re relatively used to patients with mental illness suddenly stopping their medication and sailing into big episodes that might be landing them there… well, I quickly felt that the staff probably did not believe me.

It is true, though. And while most people would try to praise this as an act of good self control or healthy living I fear that the truth is actually somewhere in the realm of the opposite.

You see… when I was 17 I was taking an antidepressant that (little did I know) was slowly dissolving any semblance of sanity I had left at the time. Despite the fact that it was making me worse and worse, I took it religiously. At the time I was being treated for obsessive compulsive disorder, and frankly there were many things in my life that I needed to do religiously or I firmly believed I would die very suddenly.

I have always been the sort of person that once a routine has been established I have a very very hard time deviating from that routine, even when it is harming me. For the last several months, for example, I have eaten one large fried egg over medium and a slice of buttermilk toast for breakfast every day (at least, every day that I could eat). There are times when I struggle with the notion that I probably shouldn’t eat so many eggs (hello cholesterol), but the best I can do when I feel really ballsy is switch out the buttermilk toast for an english muffin. Not eating this breakfast is… well… wrong.

Anyway, at 17, taking said antidepressant religiously and spiraling into a very dark, weird place I was quickly in an psychiatric inpatient hospitalization situation. Within 24 hours I became outrageously ill, and I’m talking the most ill I had ever felt in my life up to (and even after) that point. Eight hours of uncontrollable vomiting and dry-heaving, and dizziness to the point of being unable to even dress myself.

This also happened to be the time when one of the nurses decided to display an abuse of power, laughing at my sudden illness, yelling at me, accusing me of having an eating disorder, and refusing to help me for several hours. By the time I was able to deduce that I was having withdrawals from my usual medication regimen, the damage was already done, and the fear this experience had instilled in me took root very firmly.

I could not and would not ever stop taking any medication suddenly for any reason again if it was in my power, and the paranoia and fear that manifested from this situation has often swung me into the danger zone in the opposite direction. What I mean is that while I don’t feel compelled to stop taking my medication suddenly (or act cavalier about keeping up with taking it), I have become even more obsessive and paranoid about taking these pills. To top it off, I’ve had many instances of not being able to remember if I took them or not, and then accidentally taking them several times over just in case I had forgotten.

Realistically this doesn’t provide a much more safe environment, and suffice it to say that withdrawal of many drugs is probably extremely preferable to overdose.

I had been feeling really rough on wednesday, a lot of the dizziness and nausea from the week previous had returned. By the time I took my dosage of lithium for the night, I vomited it back up in a matter of minutes.

Though I had already been advised earlier in the day to go to the ER by my doctor to receive intervenes nausea medication and fluids, it wasn’t until the panic of suddenly being lithium free for the first night in four years set in that I was heading straight for the hospital. I was certain that if I didn’t feel horribly sick already (and I did) I was headed for a night of fire and brimstone.

By the time I got to the ER I was hitting patches of uncontrollable crying. I was terrified, and even though the seasoned internet sage reported I would likely only experience mental and mood symptoms from the missed dose, the way my body reacts to medications (or lack thereof) has been significantly different than the norm in almost every situation. I had no way to know what might happen next.

So the doctors dealt with the nausea and the fluids, and when I brought the idea of “missing” (or losing, rather) my lithium dose that night the doctor instinctively told me to take it again when I got home.

Now, given my history, this is something I had already considered myself. However, I had been pretty dehydrated for a week or so and I was concerned because dehydration can lead to lithium toxicity. When I said this to the doctor, I also mentioned that I have already experienced lithium toxicity before and wouldn’t like to do it again. His conclusion was that they would check my lithium levels in the blood they had already taken earlier when I checked in.

Thirty minutes later he walked into my room and commented that my lithium levels were a bit higher than he expected. He advised I wait until the next night to continue with my lithium.

Among the papers I was given when I headed home for the night was the lab report that included my lithium level. It was nearly twice my regular level.

When I read that I was immediately glad I had gone to the ER and not just taken the lithium again. If I had, I would have undoubtedly experienced lithium toxicity, as I was nearly there already. For the first time I felt grateful for having vomited… and I can’t help but feel slightly mystified at the possibility that my body was rejecting the excess lithium all on its own.

I am now back on track with my medications and working with a GI specialist to try to pinpoint the source of my stomach issues. It is a little funny how not eating can make eating something as basic as plain white rice taste amazing!

I Follow the Rules; Now You Follow the Rules

Apartment hunting may be the optimal task for hypomania. I have been making flurries of phone calls, refreshing my local craigslist page every twenty minutes, and attempting to jump into these listings with the knowledge that apartment hunting often operates on a first come first serve basis.

Last weekend that meant showing up for a local open house an hour early to ensure we arrived first in line (yes, I am taking this very seriously, but you’ll see why in a minute). Frankly, it is a wonder I ever imagined the situation would be handled in a civilized way… as it turned out, before the landlord even opened the unit there were 12 other people there to look (besides us) and two of them walked immediately to the landlord (before seeing the property) and handed him a completely filled out application and deposit check.

I felt slightly better after seeing the place (it was tiny and terrible) and concluding it wouldn’t have worked for us anyway. It has been three years since we’ve moved into a new apartment, and I don’t know if people have just quit caring about the rules (shit, I guess I am almost 30 now) or if it was always this way and I was just young enough the last time around that I didn’t expect anyone to actually follow them.

Fast forward to a week later and I’m beginning to think these “rules” I’ve imagined are simply that: imaginary. Every place I have called I’ve had to keep calling and calling until I got someone on the line, every landlord who said they would call me back or give me some kind of advantage has failed to follow through. Turns out in this situation there are no rules; I’m smack-dab in the middle of the apartment-hunting wild west.

The idea of set, commonly-known “rules” has always been a problem for me, I believe that is a big part of where my OCD symptoms like to swirl around and cause mayhem. I’ve subjected myself to an incredible amount of rules since childhood, starting with anything as simple as:

Don’t wear pink and red together.

Follow-up or returning phone calls should always happen within 24 hours.

Always wait for a break in conversation before leaving.

Of course, there are more complicated and/or irrational rules too… things like:

If I wrap a blanket around my feet a certain way, nobody will kill me in the night.

If I am worried the bus will come before I reach the stop, I can perform a repetitive little chant that will keep me from losing my shit (and hopefully from missing the bus).

If I am camping and I see a stranger I want to talk to I have to wait 24 hours before speaking to them.

These ideas may seem simple enough, but my mind has often been clouded with millions of rules all piled up around each other. A rule for every situation, rules for getting dressed, rules for the order in which I can brush my teeth and wash my face. Rules about what I eat or can cook or where I can eat out. Rules about when I can or cannot call or text someone else, and what kind of contact is appropriate on which holidays. That, unfortunately, is just the beginning.

Having rules like these have always helped me know what kind of decisions to make and how to behave in certain situations, but they have also been like a curse. I have always required myself to do certain things at certain times, and not to do certain things at other times. Through childhood and adolescence this was a pretty intense burden to deal with, and what is probably worse is that I have had  a very difficult time not projecting these rules onto other people and expecting them to adhere to them without any explanation from my end.

Many times my mother told me (generally referring to herself), “you have unrealistic expectations of people!” Having this pointed out over and over again didn’t help me change that fact, particularly because I felt caught in the same vortex. I had unrealistic expectations of myself (it is practically impossible for me to get all the rules right 100% of the time, and if I don’t I have had panic attacks from feelings of impending doom or death, physical pain and anxiety, general feelings of horribleness, and the constant voice telling me how much of a failure I am) and I didn’t know how to break through them. These rules were ruling my life, and while I was running around trying to follow them it seemed outrageous to me that nobody else seemed to care about the rules. Wasn’t everyone born with the same sort of rules programed into their brains? Didn’t they feel the pain of failure that I felt? Didn’t they have a cruel voice in their heads too? How could these people operate without caring if they did things “right”?

Yesterday morning was like stepping back through time. My new therapist hadn’t called me yet, and a nearby apartment’s landlord who said he’d call me back hadn’t. Instead he reposted the page for the apartment on craigslist without giving me the first spot in line I thought I had deserved because I had contacted him before anyone else had.

I thought my head was going to explode, and I fell back into the frustration formed by those rules and those unrealistic expectations I have (practically unknowingly) for others. I clenched my fist and was pissed, knowing that if I was that therapist or that landlord I would have called because it was the right thing to do. It was one of the rules!

It has been a long time since I have considered myself a “perfectionist”. That is a word I try to avoid, because it dangles something unattainable in front of me that I know (no matter what I do) never feels quite perfect enough. Even those moments where I feel a sense of achievement and even perfection there never seems to be anyone around who understands all the odd hoops and rules and the terrifying earnestness that goes into achieving something that way. All I am left with is a shiny gold star and emptiness.

I liked to believe that the OCD symptoms I had as a child and teenager have long since vanished. Realistically, they’ve been overshadowed by the seemingly more pronounced and intense symptoms of bipolar disorder, and in moments of anxiety and stress they jump out. Over the years I have found small ways of coping with the overwhelming feeling of being controlled (and thereby controlling others) by practicing breaking certain rules. Doing so reminds me that breaking them doesn’t end in the stark conclusion of life vs. death; but often (when I can pull it off) makes me feel much more free. This is something that waxes and wanes in intensity for me, but I want to do a better job remembering that there is a sense of irrationality behind these rules that have (for whatever reason) taken hold of me.

When Therapy Doesn’t Work

I’m a firm believer that therapy has helped me a lot. It has helped me understand things about myself I didn’t know before. It has helped me move on and get closure from trauma. It has also been a space for me to be able to express all of my frustrations (without bringing down everyone else in my life). I have learned the so-called “tools” in therapy to help me cope with anxiety and bipolar episodes as well. In fact, I often suggest to people dealing with any issue they find to be overwhelming (not just mental illness) that they see a counselor or therapist to talk about it. Something about talking about our problems out loud helps us understand them better, so overall I think it is a win-win situation.

While all that sounds great (and it is all true), finding a therapist who is a good fit can be challenging. On more than one occasion I’ve found myself in a position where the benefits I was receiving from therapy was being outweighed by negative parts of the experience.

In the past I’ve had issues with the attitudes of therapists, whether that was from being aggressive (which was a turn-off for me), or being too passive (not seeming to care about my issues). I’ve had issues with therapists who had conflicting viewpoints from me (though rarely). I’ve had issues with therapists who didn’t know enough about the issues I was dealing with to provide a well-educated viewpoint.

The one issue I have had with therapists that I consider a hands-down deal-breaker is disorganization.

As someone who lives with Bipolar Disorder, OCD, and Anxiety, there is a certain level of reliability that I require from my health care providers. That includes my primary doctor, my prescribing psychiatrist, and my counselor or therapist. There are times where my condition requires emergency treatment, and I need to be able to rely on my team to get the help I need.

I always feel that I am in a constant state of reminding people that they should expect quality treatment from their doctors, therapists being no exception to the rule. You wouldn’t believe how many people I know who continue to see and pay therapists who do not act respectful to them, who don’t call them back in a timely manner, or who make them feel worse after a session than when they came in. Essentially, this is a situation where you are paying someone to provide support to you… if they aren’t doing that, what is the point?

The difficulty comes in finding the right match, and that many therapists have continued to have paying patients despite providing poor care. If people seeking out therapists aren’t demanding great service, how can we expect to find that great service without creating that demand?

At the same time, I understand that therapists are human. They’re human! Some of them have even gotten into their current field because of their experiences with depression or mental illness in their own lives, which I think is awesome. This is one of the reasons why I think there is a certain level of negotiation you can turn to when it comes to interacting with a therapist.

I’ve been having trouble with my most recent therapist since I began seeing her. I knew part of it was because I liked the one before her so much and we’d worked so well together, so when I reached the point where I was having trouble connecting with her (the new one), we talked about it. Since then I found she was much more attentive and empathetic to what I was saying, which really helped me feel more at ease.

Over the last year and a half, we’ve had ups and downs. For a while she was rarely on time, but began showing an active interest in fixing that, so I let it go.

What I can’t let go, however, was last week’s Lithium emergency. She told me on Tuesday she would contact my (potential) future psychiatrist about a prescription, and then never called me back. She also seemed wildly cavalier about the notion that I would suddenly be unmedicated… which is a big red flag for me. If one of the people on my healthcare team doesn’t care when I am experiencing an emergency, I know I need to shift that position to someone who will. Even giving her the benefit of the doubt (she could have been busy?) I would rather work with someone who has the time to help me.

Six months ago I was worried sick about the prospect of changing therapists, but now I think it is necessary. I am only hoping the clinic will allow me to switch to another person there, instead of having to reach out to other clinics in the area.

The Long Shot

Yesterday’s adventure (of trying to hunt down an emergency Lithium prescription) started out with an electric jolt to my need to find a solution. It ended with what might be the biggest miracle I’ve experienced since 2014 rang itself in 4 months ago.

Being threatened with only having five days of lithium left (and no refill or psychiatrist to speak of) I kicked it in to high gear yesterday morning.

pleaded with my primary care doctor’s receptionist to land me an appointment at the end of the week (as a last resort) to which she generously complied.

I asked my pharmacy to send a request to my old psychiatrist’s office for another refill, even though I knew that would be a big shot in the dark.

Finally, after running some errands in the sunshine (wasn’t it supposed to rain all day yesterday?) I stepped into the clinic where I see my therapist (and should eventually be seeing a psychiatrist).

My therapist, a contemplative woman who is a great listener and empathizer, is a little lacking in the area of organization. She had no memory of leaving me a voicemail last week that said, “oh yeah, come in Tuesday at three and I’ll write you in for an appointment, only call back if you want to cancel.” Thankfully (considering my frustration around the Lithium issue) she agreed to see me despite never having actually made the appointment.

She told me she was 99% sure that the house psychiatrist would not be willing to refill my medication, something I expected to hear anyway. She told me to try calling my old psychiatrist’s office and pleading with them, something I didn’t feel so great about.

When I asked when I would be able to make an appointment for an intake with the clinic psychiatrist there (I gave them my paperwork a month ago) she said they didn’t make appointments. They just went through whatever people had applied in the order they were received. For that reason, she claimed she could not give me any idea of how long I would be waiting (“at least a month” was all she could say) or any indication of exactly when I would be seeing this phantom psychiatrist.

This sent up some BIG red flags for me. I have never associated my therapist’s personal disorganization with the clinic itself, having seen other therapists there that had no trouble calling me back or being on time or scheduling my appointments, but having to put the faith of my future mental health treatment in the hands of someone who isn’t willing to give me anything more than their word that I’ll eventually see them… well, I don’t operate on a currency made of promises. To me an appointment is an agreement (which exists on paper or in a computer somewhere) on both ends that we will meet, and without that I have nothing.

On top of that, how can I be expected to know how long I need my new Lithium prescription for if I have no idea when I will be able to see the doctor who is supposed to write the next one? That doesn’t make sense.

I walked out of the clinic feeling totally defeated, and in a small fit of hysteria (overlooking the busy freeway) I called my old psychiatrist’s office.

That’s when I’d remembered something I’d been told a few months earlier. An anonymous tipster revealed to me that the psychiatry department of my previous psychiatrist (which did not take any of the insurance plans I was now forced to apply for through the healthcare reform) was considering taking one, JUST ONE, of the plans available. They told me to select that plan, and then call at the end of April to see if the plan would be accepted. I knew this was a huge long shot, but if you remember… I was extremely upset about having to leave my previous (kick ass) psychiatrist. Because of this tip, I had selected the plan in question and yesterday (as April had ended) I found myself in a position to ask their office if something miraculously had changed.

When the receptionist said (what sounded like) yes (I could barely hear over the roar of the traffic) I ran to the nearest building and popped inside to make sure I hadn’t imagined it.

You mean, I thought, not only can I begin seeing my previous psychiatrist again, but he can also then refill my medication in the next couple days?!?

I hadn’t, in my wildest dreams, imagined that scenario would have worked out! It is not very often I have two large, looming problems solved with one phone call, and I thanked the receptionist profusely.

It is so nice to know that these two big issues are now taken care of, and that I don’t have to rely on what seems to be a particularly flaky system to try to receive care. I was extremely upset to have to give up my whole healthcare team when everything changed over with the health care reform, and now (through a couple good tips and a lot of good luck) I am back to having my original healthcare team back.

The trick at this point will be to keep them, because Corey and I will need to move within the next few months. In order for me to keep this insurance and these doctors, I have to remain in King County, something that is another long shot (as housing prices have skyrocketed) but something I also feel more and more compelled to make work since it will be worth the work!

In Psychiatry Limbo

May first has come and gone, and I am now covered under my (selected but previously withheld) insurance provider under my state Medicaid program.

It has been two months since my last visit to my psychiatrist, and now that I have this new, shiny insurance I can potentially begin to see one (but not the same one) again. I made about 15 unnecessary phone calls to my insurance folks and psych providers in my area before deducing that the simplest route will probably be for me to see the psychiatrist who works at my current therapist’s office.

Despite making this decision, there are a lot of questions swirling in my head about how this is going to work. My previous psychiatrist was linked to a hospital, so getting lab work done (to track my lithium levels or other side effects) was extremely simple. Seeing a psychiatrist in a building above a Mexican restaurant leaves me thinking things probably wont be so straightforward anymore… and I am eager to meet him to find out exactly what that will mean for my care and time management.

Realistically, at this point I am pretty well off. My old psychiatrist wrote me a prescription for six months worth of medications, so I am in no way hurting in that department. My eagerness to meet this new doctor is really just coming from my own impatience and curiosity about what kind of man he is, and what he can bring to the table for me. 

I was a little disappointed to find that my last visit to the clinic did not result in making an appointment with this psychiatrist. New insurance means I had to do the intake paperwork all over again, and my only option was to check a box suggesting I am interested in seeing someone for medication management. I’m finding I’m a little nervous, because  my last doctor had a six week waiting list before I could do an intake with him. If I haven’t even had a chance to make an appointment with this person, how much time is going to be tacked on to that inevitably lengthy wait?

I feel I must add that for most people in most areas throughout the country, the wait time probably isn’t as high. The big trouble is that here, in Seattle, there is a huge demand for psychiatry and only a few good doctors in the area to meet that demand. Now that the healthcare reform has made these doctors draw lines in the sand about what patients they will and will not take, the ones who accept the lowest (and most common) form of insurance (state Medicaid) are totally swamped.

Again, I know I can wait. I know I can be patient about this… I’m not exactly looking to rush into trying any new medications in the next few weeks (as I’m taking a break from all that). I just feel uneasy not having a psychiatrist at my beck and call, because things can change for me from tolerable to intolerable (to say the least) for me with the blink of an eye.

I’m heading to the clinic tomorrow, and hopefully I will be allowed to make an appointment. Just having a solid date, somewhere out in the future, floating around (even if I can’t touch it) makes me feel more at ease with the whole idea of being in psychiatry limbo.

Obsessing Over Food

Even though I was diagnosed as a teenager with Obsessive Compulsive Disorder (due to primarily overwhelming obsessive thinking I couldn’t seem to control), the majority of my obsessive compulsions as a child were centered around food.

Yes, I was that childhood friend, the one you invited over for dinner and wouldn’t eat any of the food at your house, save a hamburger bun with some ketchup on it. In fact, my diet was based largely on ketchup, usually with a side of a potato product or bread. We joked that I was a purveyor of “the white and yellow diet” because I would only eat foods that were white or yellow (minus the ketchup).

If the texture was wrong, I couldn’t eat it. If the color was wrong, I couldn’t eat it. If the taste was wrong, I couldn’t eat it. To ensure that all foods met my needs, I picked them apart thoroughly, looking for anything despicable in there that might turn me off before I ate them. This earned me the nickname, “the Inspector” -something that I thought was hilarious at the time but does sting slightly now.

I realize a lot of kids are picky, but this was much more intense. If the food didn’t fit my standards, I wouldn’t eat.

As I’ve gotten older, I’ve been introduced to new foods. New flavors, new textures, and I’ve come to appreciate that the crunchiness of a cucumber (though very difficult for me to handle previously) is something I’ve practiced eating and now enjoy. I stopped picking through food and have attempted to embrace the action of taking a bite blind… something that has gone well, up until recently.

A couple months ago I was at a Japanese restaurant and bit into a clump of sand that was swirling around the bottom of my miso soup. I was instantly repulsed, and the childhood voice boomed in my head, “see! Why didn’t you look for that??”

A few days later, it was a hotdog I was eating. I bit into the meaty cylinder into something hard. I threw it down immediately, and was green for the rest of the day.

A few days later I bit into a bone in a breakfast sausage at the hospital where I was getting my blood drawn.

After drinking a glass of water only to see a spot of black mold sitting at the bottom of the glass, the truth of my past came flooding back.

“You can’t trust it, you can’t trust food” it said.

Ever since it has been like taking one step forward and two steps back. I have banned all processed meats, including processed meats in casings in my diet. I am willing to eat ground meat, but only if I am cooking it myself and can personally guarantee what’s inside. No soup. No deli meats with rubs unless the rub has been concocted by me. And that is only the beginning. I can feel the window that I’ve worked so hard to open closing, and I feel helpless to stop it.

I’ve found crap in my food once a week for the last couple months, like some kind of cruel clockwork reminder. How is that possible when I’ve gone years without anything like this happening? It is all I can think about, and when I stop thinking about it for a second… something else goes horribly wrong and I wind up with a mouth full of something inedible.

I realize the issue here is that I am too sensitive. One wrong move on my food’s part is enough to make my world come crashing down, and then obsess over it for days, weeks… even months at this point. Really, as a child, finding a bug in my food was on par with finding onions in there, and I’ve been able to get over the onion bit. The bugs though (minus fruit flies in my tea) -not so much.

This is something important to me, as I’ve been extremely proud of the changes I’ve made in my eating habits and my thinking (even if not as permanent as I hoped) and I expect that when I talk to my new psychiatrist this is going to be one of the things that needs to come up.

In the meantime I will just have to retreat into the world of potatoes and eggs and macaroni. Perhaps pulling back my forces will allow me to muster for another all on food assault.

Journalist Comes Out About Having Mental Illness

I want to share an article that I found interesting, it is a post written by Mark Joyella, a journalist and former television reporter who has just recently come out about having a mental illness to help fight the stigma that surrounds it.

His article, Screw Stigma. I’m Coming Out takes us on a journey through his fear of being identified as a mental health consumer to a place where he feels comfortable sharing his OCD diagnosis.

For someone in the public eye, I found this article to be extremely thoughtful and well written, as well as reflective. I think his journey can be related to anyone who has questioned their own diagnosis or felt self conscious about the idea of having a mental illness, not just for folks who have an OCD diagnosis.

In any case, I suggest checking it out… and for Mark Joyella, a big high five – thank you for being brave enough to come forward about your experiences!