Most of what I’ve written up to this point has focused on Tourette’s Syndrome. A common theme with the diagnosis of TS is the possibility of one or more associated conditions – co-morbids.
As with anything else, the symptoms of a co-morbid condition have to be severe enough to cause significant impairment in order to warrant a separate diagnosis. Simply being a little scatterbrained isn’t enough to warrant a co-morbid ADHD diagnosis, nor is the need to wash your hands a little more than normal sufficient to warrant a diagnosis of co-morbid OCD. The symptoms have to have enough impact to justify the diagnosis, which means that in many cases the symptoms of the co-morbid condition can be more difficult to deal with than the tics from TS.
That’s the case with me and OCD. My tics can be a real pain in the neck sometimes (pun intended), and have landed me in physical therapy from time to time, but OCD worms its way straight into your head.
OCD describes two separate phenomena that, more often than not, go hand-in-hand: obsessions and compulsions. Obsessions are intrusive thoughts or thought patterns. Sometimes these show up as images. Sometimes they’re urges. Sometimes they’re runaway thoughts you just can’t reign in. Compulsions, on the other hand, are repetitive behaviors, patterns of behavior, or mental acts you feel compelled to do, for want of a better term. In the classic case these often happen in response to or to ward off obsessions, but they don’t necessarily have to. They can be their own thing.
Like the tics associated with TS, the severity of obsessions and compulsions will vary over time. Sometimes they can be so mild that you’re only peripherally aware they’re there. Other times they color everything you think and do. And, like tics, they can be triggered by outside events.
I don’t have many compulsions. In a previous post I mentioned that I don’t step on cracks, or more accurately I don’t step on color divisions. The example I used in that post was walking through a crosswalk. I have to have my feet either only on bare pavement or only on the white lines, but not both. On bad days I have to step on the same number of white lines with each foot. As awkward as this sounds, I’ve managed to take up most of the slack by adjusting my stride. When I’m walking with other people they hardly ever notice.
Years ago I had a hand washing compulsion. But like the not-stepping-on-cracks thing, for the most part people around me rarely noticed because we, as a society, have created so many opportunities for people to wash their hands discretely. For me it wasn’t just about washing my hands, though. I had to rinse them clean. At one point I was seeing a doctor for my OCD, and just before each appointment I’d stop by the restroom to (can you guess?) wash my hands (surprise!) But for some reason they stocked the restroom with the goopiest, stickiest, slimiest lotion soap known to humankind. During one of my sessions I was particularly agitated, and the doctor asked what was wrong with me. I think I was holding my hands like they were coated in dead fish goo. “Why would a doctor who treats people for OCD keep lotion soap in their restroom?!” I don’t think I ever convinced them there was anything wrong with this. I also don’t think they saw the humor.
I should probably leave the hand washing compulsion on that lighthearted, self-deprecating note, but that would be a disservice to other people who have that compulsion. It’s not always funny, and it’s not always safe. When that one was at its worst I had to scrub my hands with undiluted bleach and Scotchbrite pads. Months of doing that damaged the skin on my hands to the point that it’ll never really recover. (Remember that part about causing significant impairment? Not kidding.)
But for all that the worst part of OCD for me is the obsessions. The intrusive thoughts. The spiraling negative feedback loops. I’m going to save intrusive thoughts for another post. They’re a touchy subject for reasons I’ll get into when I write about them. For now I’m going to focus on spiraling negative thoughts.
Have you ever had a conversation that you felt you got the worst of? Then for the next hour or so you play it back in your head, trying to figure out what you should’ve said? Trying to figure out what they might’ve meant by what they said? Wondering how that could’ve gone better? Instead of doing that for an hour, do it for months, replaying every conversation you have, wondering what you said and did wrong, wondering if you’re chasing off every friend you have. Wondering why anyone likes you at all. Now extend that not just to conversations, but to everything you see and do.
Negative feedback obsessions are the classic case of Catch-22: damned if you do, and damned if you don’t. Every gut instinct is telling you that the worst case scenario is going to happen, so your every thought is drawn there. How to deal with it. How to get through it. Trying to figure out what people will do and say, and trying to figure out all the ways the situation could get even worse.
It’s easy to say, “But when you find yourself thinking that way, couldn’t you just focus on positive things?” It’s not that simple, though. Not considering the worst case scenario feels negligent. If you don’t plan for it you’ll be unprepared when it does happen. You won’t deal with it. You won’t get through it. You’ll be caught by surprise by the things people will do and say, and when the situation gets worse you’ll be left standing like a deer in the headlights.
The people around you tell you that you’re over-reacting, and what they’re saying makes sense. But your mind is telling you the worst is yet to come. You begin to doubt your own doubts, and wind up in a situation in which no one is advocating for you, not even yourself. You’ve second-guessed yourself so many times you don’t know what to believe any more. You don’t know whether to cry or scream, and find yourself wishing it was all just tics.