{"product_id":"freedom-from-obsessive-compulsive-disorder-isbn-9780425273890","title":"Freedom from Obsessive Compulsive Disorder","description":"\u003cb\u003eNearly six million Americans suffer from the symptoms of obsessive-compulsive disorder, which can manifest itself in many ways: paralyzing fear of contamination; unmanageable “checking” rituals; excessive concern with order, symmetry, and counting; and others\u003cbr\u003e\u003cbr\u003e\u003c\/b\u003e\u003ci\u003eFreedom from Obsessive-Compulsive Disorders\u003c\/i\u003e provides Dr. Johnathan Grayson's revolutionary and compassionate program for finally breaking the cycle of overwhelming fear and endless rituals, including:\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cul\u003e\n\u003cli\u003eSelf-assessment tests that guide readers in identifying their specific type of OCD and help track their progress in treatment\u003c\/li\u003e\n\u003cli\u003eCase studies from Dr. Grayson’s revolutionary and profoundly successful treatment program\u003c\/li\u003e\n\u003cli\u003eBlueprints for programs tailored to particular manifestations of OCD\u003c\/li\u003e\n\u003cli\u003ePreviously unexplored manifestations of OCD such as obsessive staring, Relationship OCD (R-OCD), obsessive intolerance of environmental sounds and chewing sounds\u003c\/li\u003e\n\u003cli\u003eTherapy scripts to help individuals develop their own therapeutic voice, to motivate themselves to succeed\u003c\/li\u003e\n\u003cli\u003eNew therapies used in conjunction with exposure techniques\u003c\/li\u003e\n\u003cli\u003e“Trigger sheets” for identifying and planning for obstacles that arise in treatment\u003c\/li\u003e\n\u003cli\u003eInformation on building a support group\u003c\/li\u003e\n\u003cli\u003eAnd much more\u003c\/li\u003e\n\u003c\/ul\u003e\u003cbr\u003eDemystifying the process of OCD assessment and treatment, this indispensable book helps sufferers make sense of their own compulsions through frank, unflinching self-evaluation, and provides not only the knowledge of how to change—but the courage to do it. | \"Dr. Grayson... writes about [OCD] with the mind of a scholar and the heart of a healer. Anyone who is plagued with chronic doubt, anxiety, and destructive rigid social behavior should read this book, and listen to what it says.\" —\u003cb\u003eDaniel Gottlieb, Ph.D., host of NPR's \u003ci\u003eVoices in the Family\u003c\/i\u003e\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e\"Not just another self-help book, this is an actual course of interactive therapy that breaks the cycle of fears and ritual. Dr. Grayson's uniquely empathetic and effective approach offers readers the understanding and motivation they need to get well—and stay well.\"—\u003cb\u003ePatricia B. Perkins, J.D., executive director, Obsessive-Compulsive Foundation\u003c\/b\u003e | \u003cb\u003eJonathan Grayson, PhD\u003c\/b\u003e, is the director of the Anxiety and OCD Treatment Center of Philadelphia. A nationally recognized expert who has worked with OCD sufferers for more than three decades, Dr. Grayson was awarded the Patricia Perkins International OCD Foundation Lifetime Achievement Award in 2010 for his work with OCD. In 1981 he organized the first OCD support group in the country, to which he still donates his time. He lives in Philadelphia. | \u003cp\u003e\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003eAcknowledgments\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003eIntroduction\u003c\/p\u003e\u003cp\u003eI 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 \u003ci\u003ePeople\u003c\/i\u003e 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.\u003c\/p\u003e\u003cp\u003eWhen 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.\u003c\/p\u003e\u003cp\u003eMelanie 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.\u003c\/p\u003e\u003cp\u003eYet 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.\u003c\/p\u003e\u003cp\u003eThis 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 \u003ci\u003eexposure and response prevention\u003c\/i\u003e are still the core of today’s treatment for OCD—I felt the need to go beyond the actual treatment process.\u003c\/p\u003e\u003cp\u003eI 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 \u003ci\u003eunderstand\u003c\/i\u003e their OCD and to make and maintain treatment gains.\u003c\/p\u003e\u003cp\u003eHelping 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 frustration of being locked in a strange world in which you know that your thoughts and behaviors make no sense. It is as if you have simultaneously lost your mind and, at the same time, are so sane that you are a witness to the loss. You are an expert at knowing what OCD feels like, but fully understanding your plight is another story.\u003c\/p\u003e\u003cp\u003eYou may have heard many explanations for your OCD—it’s a chemical imbalance, it’s a learned behavior. These are explanations, but they are no better than saying a car works because it has an engine. Knowing that a car has an engine doesn’t tell you how to fix a car that’s not running. For you to fully understand your OCD, a meaningful explanation needs to be more than logical and scientific. It must address your feelings and experience and answer questions such as: \u003ci\u003eI’m staring at the stove and can see that it is off. Why don’t I know that it is off?\u003c\/i\u003e If an explanation touches you, and you can’t help exclaiming, “That’s me!” then you understand.\u003c\/p\u003e\u003cp\u003eIf you suffer from OCD, you have probably seen many different professionals, tried numerous medications, and read any number of books dealing with anxiety and OCD. This book, however, is different. It is not simply a cookbook explaining how to recover from OCD, because overcoming OCD requires more than simply following instructions. Treatment without understanding is like painting by numbers; there will be some improvement and symptom reduction, but you want more.\u003c\/p\u003e\u003cp\u003eTo go beyond symptom reduction and stop OCD from controlling your life, I believe you’ll do better as a master artist. The “master artist” has the understanding to create and fashion his or her own work. This book offers the self-guided version of the treatment program used at my center, where helping sufferers understand their OCD is the crucial first step to recovery, because they can’t truly agree to therapy if they don’t understand their OCD and the treatment process.\u003c\/p\u003e\u003cp\u003eYour success depends upon your becoming an equal partner in designing your recovery program. As you’ll find in this book, with understanding you won’t follow a treatment protocol, you’ll design your own. Copies of the forms, worksheets, and other materials found in this book are also available for free download from www.FreedomFromOCD.com. \u003c\/p\u003e\u003cp\u003ePart 1 of this book, Understanding Obsessive-Compulsive Disorder, will help you to truly understand your OCD experience. You will begin to answer the questions that plague you—for example: \u003ci\u003eHow can I not know what I know? Why can’t I stop ritualizing?\u003c\/i\u003e In making sense of your OCD, you will begin to realize that this disorder doesn’t set you apart from the rest of humanity. You will come to recognize that the difference between you and non-sufferers is a matter of degree, not unlike the differences between social and problem drinkers. In the case of drinking, getting drunk isn’t the problem; it is how often and how much it interferes with your life. For OCD, it is not rituals, seemingly irrational thoughts, or anxiety that differentiates the sufferer from the non-sufferer, but how much these interfere with your daily life. This section will also address the role of medication in recovery and the cognitive behavioral techniques that you will use in your OCD program.\u003c\/p\u003e\u003cp\u003eIn Part 2, The Foundation of Your Program, I will demystify the process of OCD assessment and treatment, allowing you to design a recovery program for yourself that you can understand and believe in. Then I will guide you through the initial steps of assessing your OCD.\u003c\/p\u003e\u003cp\u003eYour newfound understanding will be transformed into practical knowledge as you use the tools and instructions I provide to further assess your OCD and prepare the materials you will need in your self-guided recovery program. The most important of these will be the “scripts” you will be creating to keep up your motivation, fight discouragement, and overcome difficult hurdles. These scripts will help you address one of the greatest difficulties in carrying out a self-guided OCD treatment program: the absence of a therapist to provide you with support specifically targeted and appropriate to your needs of the moment. Although a book can’t replace an experienced therapist, sample therapist scripts are provided, along with directions that will enable you to adapt them to your own needs or to create your own. These scripts will appear throughout the book. Ideally, your recovery program should be a collaboration between you and an experienced OCD therapist. This book is meant to be used as an adjunct to therapy or at times when you can’t find a therapist.\u003c\/p\u003e\u003cp\u003ePart 3, Personalizing Your Program: Treatment Guidelines for Your Specific OCD Concerns, is the heart of this book and focuses upon the different manifestations of OCD. Each poses special challenges that need to be addressed when designing a recovery program, particularly if most of your OCD symptoms seem to fall into a single category, such as obsessions focusing on contamination or violent thoughts. The chapters in Part 3 will provide guidance for modifying and individualizing your recovery program through examples, adjusted treatment guidelines, and scripts.\u003c\/p\u003e\u003cp\u003eEven when your obsessive concerns seem to have a single focus, they may affect your life in more ways than you realize. For example, if you have contamination concerns, you may find that, in addition to washing your hands, you check the environment for contaminants and mentally ruminate about what you have or have not touched. Or if violent thoughts are your focus, you may spend your time both trying to figure out what it means that you have such thoughts and trying to find ways to prevent the thoughts from coming into your mind. Because of this, you will discover advice throughout Part 3 that you will want to incorporate into your recovery program.\u003c\/p\u003e\u003cp\u003ePart 4, Recovery and Beyond, will help you complete your recovery. Working alone on your recovery can be hard. I provide you with guidelines for using family and\/or friends as helpful supports during treatment. However, sometimes you will want help from someone who knows exactly how you feel. For this purpose, I also provide instructions for setting up an effective GOAL support group.\u003c\/p\u003e\u003cp\u003eYour recovery program doesn’t end when you feel you have overcome your symptoms. Maintaining your gains is a process that requires continued effort. In the last chapter, you will discover why “slips” are normal and how, when you prepare for them, they don’t have to lead to a complete relapse.\u003c\/p\u003e\u003cp\u003eThe good news is that, while OCD can be a devastating and debilitating psychological disorder, surprisingly it is one of the most treatable. Current research holds that 70 percent of those suffering from OCD will significantly benefit from a treatment involving exposure and response prevention (the treatment of choice for OCD). This should be a time of hope and optimism for finding treatment.\u003c\/p\u003e\u003cp\u003eThe key, though, is finding therapists who are truly experienced in treating OCD, who know how to properly use exposure and response prevention instead of offering traditional talk therapies or nothing more than medication. When Melanie, my camping trip client, first came to me, I found that her psychiatrist had been underprescribing the SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant she had been taking. When this was rectified, she went from being an extreme suicide risk to a moderate one. Her OCD and BDD, though identified early in her previous therapies, had never been properly treated. Her course of treatment with me included exposure and response prevention, and seven months later she was camping and having a great time. One year after that trip, Melanie was no longer controlled by OCD, BDD, and depression; had completed two semesters of school with ease; had spoken at the annual national conference of the Obsessive-Compulsive Foundation about her recovery; and had gone on her second OCD camping trip.\u003c\/p\u003e\u003cp\u003eToo often I am faced with seeing another Melanie—someone who has needlessly suffered for years. \u003ci\u003eFreedom from Obsessive-Compulsive Disorder \u003c\/i\u003eis my solution. I believe that OCD, when properly understood, is not a disorder of hopeless torment but one that can be overcome. Conquering OCD is hard work, but not as hard as what OCD sufferers already go through every day. So, I invite you, like my campers, to find the hope and courage to journey with me to a better place.\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003e \u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003eChapter 1\u003c\/p\u003e\u003cp\u003eA few years ago, I was in a doughnut shop, waiting to be served. A well-dressed woman was sitting at the counter next to me. When her server—Jared, according to his name tag—brought her doughnuts, she had a special request. “Would it be okay if I pay you after I eat?” she asked. “I’m not going to run out or anything, but I just washed my hands, and if I go into my purse to touch money, they will be dirty and I’ll have to wash them again.”\u003c\/p\u003e\u003cp\u003e“Do you realize how dirty money is?” she continued. “Money is handled by so many people that anything could be on it. That’s why they don’t allow cashiers to both handle money and serve food. In fact . . .” She went on for quite some time, ignoring or pretending not to notice Jared’s expression, which silently said, \u003ci\u003eWhat is wrong with you? Fine, pay later—just let me get back to work.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003eThe answer to Jared’s unspoken question was \u003ci\u003eobsessive-compulsive disorder (OCD)\u003c\/i\u003e. And the woman in the doughnut shop—to my trained eye, an OCD sufferer—is not alone. I am often struck by how many people I pass on any given day—driving my car on the highway, walking through a mall, sitting in a movie theater—who likely have OCD as well. Statistically, for every forty of the thousands of faces I see, one is suffering or will suffer from OCD. When I was in graduate school in the late seventies, I was taught that OCD was a rare and hopeless disorder that only affected about .05 percent of the population (1 in 2,000). However, in the early eighties, I quickly realized that these figures had to be wrong. At that time, I was working at Temple University’s School of Medicine with Dr. Edna Foa, who was on the first of her many National Institute of Mental Health (NIMH) grants that researched and pioneered today’s treatment of OCD. Everyone I discussed my work with seemed to know of someone who exhibited OCD symptoms (significant symptoms, like those of the woman in the doughnut shop, not the little habits and rituals all of humanity engages in on a daily basis). I wondered, \u003ci\u003eHow could OCD be simultaneously rare and yet so common that everyone knows someone with it? \u003c\/i\u003eSince then, worldwide studies have found lifetime prevalence rates for OCD to vary between 2 and 3 percent—about one in every forty people.\u003c\/p\u003e\u003cp\u003eFor the most part, OCD sufferers are able to remain invisible. There are exceptions, of course: those of you who make no effort to hide your compulsions, whose suffering is obvious, if in nothing else, in your inability to function. The billionaire Howard Hughes, for example, suffered from OCD so severely that his life was reduced to a tortured and limited existence. His seemingly bizarre habits and lifestyle, coupled with his wealth and fame, attracted the media like a magnet.\u003c\/p\u003e\u003cp\u003eThe way OCD looks to outsiders is a far cry from what OCD really is. To outsiders, the disorder is what the press shows us—extreme cases of people who claim they have to do things that make no sense to themselves or others. But the truth is that when you have OCD, something is happening to you, you are \u003ci\u003enot \u003c\/i\u003ecrazy, and there \u003ci\u003eis \u003c\/i\u003esomething you can do about it.\u003c\/p\u003e\u003cp\u003eWhy doesn’t the outside world have a better understanding of OCD? One problem is that many of you are experts at hiding all or almost all of your rituals, so you appear to have, at worst, a minor problem. Colleagues at work just think of you as a neat freak, or as that man with the odd but harmless habit of circling his car a few times in the parking lot after locking it. You function in the world, and you don’t appear to be in obvious distress. Unlike the extreme cases publicized in the press and on talk shows, your OCD doesn’t seem to be much of a difficulty to live with. There are a number of reasons you may strive to hide your fears and rituals. For many of you, concealing your problem is necessary to keep your job and preserve your relationships. Another reason you may try to hide OCD is that you simply want to avoid the humiliation of being labeled “crazy.” So even if you engage in a few small rituals—enough to have others label you a neat freak—you make sure no one sees how anxious you are underneath that “neatness.” This ability of yours to successfully function under stress has a special name: \u003ci\u003ecompetence.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003eAnyone who is successful in the world has this ability. Imagine coming to me for treatment. If, during your first session, you found me shaking, stuttering, and discussing a terrible problem I was having at home, you’d quickly decide you were in the wrong place. You’d expect that whatever problems I might have, I would pull myself together and do my job. There is only one difference between me and you: I don’t rely on using this competence as often as you do.\u003c\/p\u003e\u003cp\u003eCompetence works both for and against you. On the one hand, it allows you to function in the world. There are many accomplished individuals whose OCD we’d never know about if they hadn’t admitted to the problem publically. Actor-director Billy Bob Thornton, as well as former host of Nickelodeon’s \u003ci\u003eDouble Dare \u003c\/i\u003eshow, Marc Summers, are both very forthright about their OCD and have managed to find ways to have successful careers. It is important for you to recognize this strength in yourself. Some of what I will be asking you to do later will seem very hard, but what you are doing now is also very hard. How many of your colleagues and friends who don’t suffer from OCD could function as well as you if they were under the same constant level of anxiety and stress? Bravery is not a feeling; bravery is how you behave when you are scared. You are among the bravest people I know. The strength and competence you are accustomed to using in order to get through your daily life can help you succeed in treatment.\u003c\/p\u003e\u003cp\u003eBut competence can also work against you. It has led many of you to delay seeking treatment. After all, if you are trying to hide your problem, seeking treatment might be a flag to others that something is wrong. If your OCD started when you were a child or an adolescent, you may have felt especially afraid that adults, if they discovered your secrets, would confirm that you were going crazy. Jessica, for example, came to my center at age sixteen after having hidden her OCD for five years. During the previous school year, she had begun to obsess about harm coming to her family and felt the need to protect them with numerous rituals involving movement and symmetry. Every time she went through a doorway, she felt she had to touch the left and right sides of the doorway to protect her family. She would continue to do this until it “felt right.” Her OCD only became evident to her teachers and family when her anxiety became so intolerable that she no longer felt capable of hiding her pain and rituals. In “crashing,” she was one of the lucky ones. She worked very hard in treatment and was able to overcome her OCD. I have worked with sufferers who successfully hid their OCD for twenty years or longer.\u003c\/p\u003e\u003cp\u003eWhere does this leave you? Trapped with anxiety, painful thoughts, rituals you feel you can’t control, and the frustrating knowledge that you logically know your fears and compulsive actions make no sense. You don’t understand what is happening, and you are surrounded by people who understand even less about it than you do. Often your friends and family are aware of your OCD and will try to offer helpful advice: “You don’t have to wash your hands again—they are clean.” “The door is locked, we can leave now.” “Yes, for the fiftieth time, I’m sure you didn’t hit anyone on the way home; you can stop asking.”\u003c\/p\u003e\u003cp\u003eMost of the time, you don’t listen to the advice. Others tell you not to worry, because your fears make no sense. You already know this. Their exhortations merely confirm your suspicions that you must be losing your mind. So you desperately try to hide your symptoms, because who wants to be thought of as crazy? Though you may succeed in appearing “normal” to the outside world, you know something that non-sufferers don’t: You know how anxious you feel.\u003c\/p\u003e\u003cp\u003eYour family would like you to stop ritualizing, but you know they have no idea what stopping will do to you. Indeed, there have likely been occasions in which you tried to resist ritualizing. Even though your most feared disaster didn’t occur, your anxiety probably increased. In the end, you may have gone on a binge of ritualizing that lasted far longer than usual. And as anyone with OCD knows, five hours of handwashing isn’t simply washing your hands over and over. It is a hell in which every repetition is accompanied by mounting frustration and anxiety: \u003ci\u003eWhy can’t I stop? Why don’t I know my hands are clean when I know they must be? How long is this going to last? \u003c\/i\u003eOn such occasions, you didn’t stop ritualizing because you finally felt you got it right; you stopped because of exhaustion. The whole process felt crazy and out of control.\u003c\/p\u003e\u003cp\u003eNo matter what disaster you may fear with your OCD—illness, death, or whatever—usually the feeling that “I can’t take another second” or “I will lose control or go crazy” is almost certainly present. In the previous \u003ci\u003eDiagnostic and Statistical Manual of Mental Disorders-IV,\u003c\/i\u003e the psychiatric handbook for diagnosing mental disorders, OCD was listed as an anxiety disorder. This probably comes as no surprise to you. Although OCD has been given its own category in the \u003ci\u003eDSM-V,\u003c\/i\u003e we know that anxiety is the driving force behind OCD: an anxiety that feels overwhelming and endless, an anxiety that spirals out of control as attempts to reassure and neutralize fail over and over again. So, even if your obsessions and compulsions are literally attempts to avoid potential disaster, they are also attempts to \u003ci\u003emake your anxiety stop. \u003c\/i\u003eIn order to avoid intolerable out-of-control feelings, to avoid going crazy, you ritualize. Ritualizing may not make sense to your friends and family members, but they don’t know what will happen to you emotionally if you stop. Given all they don’t know about OCD, listening to their advice \u003ci\u003ereally \u003c\/i\u003ewould be crazy!\u003c\/p\u003e\u003cp\u003eDespite its crucial role in OCD, anxiety is not the defining feature of OCD. OCD has many different faces—contamination concerns and handwashing; repetitious checking of doors, stoves, and locks; concern about violent or sexual thoughts. How can so many different manifestations all stem from the same problem? What ties them together? What is the core of OCD and the source of the painful anxiety it evokes? In preparing to write this book, I created a survey questionnaire that asked sufferers and their families to describe their experiences with OCD. It was disseminated at my center and over the Internet.\u003c\/p\u003e\u003cp\u003eIra, a forty-eight-year-old man, has suffered from OCD since he was nineteen years old. The following excerpt from his survey response provides us with an answer:\u003c\/p\u003e\u003cp\u003e\u003ci\u003eI work in the city, and it’s such a filthy place. If I could have my way, I wouldn’t go there, that way I wouldn’t have to go near so many dirty people—people sneezing, coughing, touching everything—but that’s where my law firm is. During the day, I’m not too bad. I have dirty clothes for wearing outside and decontaminated clothes for home. I make sure to keep my hands away from my mouth during the day, and I’ll only go out to lunch at certain clean restaurants.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003e\u003ci\u003eBut when I get home, that’s when the ordeal begins. I make everyone in the family come into the house through the laundry room. That way they can take their clothes off down there, go straight to the downstairs shower to wash, and then put on house clothes. I have everyone keep house clothes separate from going-out clothes. The going-out clothes have to be washed three times before I\u003c\/i\u003e \u003ci\u003efeel they are clean. After I’m done with them, I run the empty washer two more times to get it clean enough to wash the house clothes.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003e\u003ci\u003eMy laundry procedure is as follows: I take a shower and put on gloves to take the going-out clothes to the washer. I carefully put them in and then put the detergent in and turn the machine on. I then take the gloves off, throw them away, and wash my hands. When the cycle is finished, I get another pair\u003c\/i\u003e \u003ci\u003eof gloves, put the detergent in, and start the machine. Then I throw away those gloves and wash my hands. Then I do this one more time. When the final load of the night is done, I clean the outside of the machine with ammonia during each of the two cleansing cycles.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003e\u003ci\u003eWe go food shopping on Saturday. All cans and packages that can be washed are. For boxed goods, I put on gloves and carefully open the top of the box and peel it away, so that nothing inside could possibly touch the outside. Then I put the contents in decontaminated Tupperware containers. The kids’ school books and papers used to be a problem—I didn’t want to let them into the house, but I knew I couldn’t do that, so we have a special homework room and homework clothes for them.\u003c\/i\u003e \u003ci\u003eI hate this problem and what it’s done to me. I have a great family; they put up with me, even though I put them through hell. I know none of it makes sense, but you don’t know what it feels like, trying to be so perfect to get things clean that you know don’t really have to be. No one else does this, but then I think about getting AIDS or my family getting it. And what if I was the unlucky one to somehow get it from something someone with AIDS touched.\u003c\/i\u003e \u003ci\u003eWhat if . . .  \u003c\/i\u003e\u003c\/p\u003e\u003cp\u003e—IRA\u003c\/p\u003e\u003cp\u003eIn Ira’s description, you can see all of the many defining features of OCD: anxiety, painful thoughts, rituals he feels he can’t control, and the frustrating knowledge that his fears and compulsive actions make no sense. But it is in the last line of the excerpt that he provides us with the answer to our question about the source of anxiety in OCD: “What if?” The intellectual and emotional uncertainty of “what if” is, I believe, the root of most OCD symptoms. By \u003ci\u003eintellectual, \u003c\/i\u003eI am referring to our ability to question any aspect of our lives, for example, wondering if the door is locked or how you will do on tomorrow’s test. \u003ci\u003eEmotional \u003c\/i\u003euncertainty refers to our feelings about unpredictable events, usually things that in some way threaten us or the people or things that are important to us.\u003c\/p\u003e\u003cp\u003eThe core of OCD is trying to get rid of uncertainty in our lives in an attempt to be 100 percent certain. Everyone, sufferer and non-sufferer alike, knows what certainty feels like. There are numerous aspects of our lives for which we take this feeling for granted: My car is in the driveway; I am sitting on a sofa at this moment, reading a book; the sun will rise tomorrow. However, while all of us feel certain about many things, the truth is that the absolute certainty we feel is an illusion. An event may be probable or improbable, but neither is an absolute. The inability to feel or be certain is reasonable. My car \u003ci\u003emay \u003c\/i\u003ehave been stolen and \u003ci\u003emay \u003c\/i\u003eno longer be in the driveway. Rather than reading a book on the sofa, perhaps I’m actually in a state mental institution experiencing a very realistic and remarkable hallucination. Do I have any evidence to the contrary? No, after all, by definition if I’m delusional and hallucinating, my senses are not to be trusted. Certainly no one around me can answer the question—my wife might be part of my delusional system, merely saying what I am making her say. As for the sun rising, some cataclysmic cosmic event might destroy the sun tonight, in which case there will be no dawn tomorrow. Improbable is not impossible.\u003c\/p\u003e\u003cp\u003eTo better grasp the deceptive nature of certainty, take a moment to imagine someone you love who is not in the room with you right now. Is this individual alive? If you answered yes,\u003c\/p\u003e","brand":"Berkley","offers":[{"title":"Default Title","offer_id":48338543739109,"sku":"NP9780425273890","price":20.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9780425273890.jpg?v=1769572619","url":"https:\/\/k12savings.com\/es\/products\/freedom-from-obsessive-compulsive-disorder-isbn-9780425273890","provider":"K12savings","version":"1.0","type":"link"}