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Hello, I Suffer From A Severe Form Of Obsessive Compulsive
Question: Hello,
I suffer from a severe form of Obsessive Compulsive Disorder (OCD). In the past years, therapy helped me identify the mechanisms of my disease and I now understand very well what CBT and ERP are about. In spite of that, my overall progress remains very limited because of my poor insight. I believe that "poor insight" is a synonym of Overvalued Ideation (OVI).
Although I am willing to comply to the protocol of Exposure therapy, I have trouble pushing through the discomfort since my degree of conviction in the truth of my obsession is very high. I read that most of OCD sufferers have good insight and recognize the irrational nature of their obsessions. But since I am often deeply convinced that my obsession is valid, exposure often becomes unbearable. There are times when no amount of cognitive restructuring can help me understand that my fear is groundless.
Is there any way for me to diminish the intensity of my belief in my obsession when cognitive restructuring has failed ? Would it be legitimate if I would tell myself that this unshakable degree of belief is in itself a symptom of the disease, just like obsessions and compulsions are symptoms, and from this point start to detach myself from it ? What can be done when OVI hampers progress in therapy ?
Thank you very much for your time !
I suffer from a severe form of Obsessive Compulsive Disorder (OCD). In the past years, therapy helped me identify the mechanisms of my disease and I now understand very well what CBT and ERP are about. In spite of that, my overall progress remains very limited because of my poor insight. I believe that "poor insight" is a synonym of Overvalued Ideation (OVI).
Although I am willing to comply to the protocol of Exposure therapy, I have trouble pushing through the discomfort since my degree of conviction in the truth of my obsession is very high. I read that most of OCD sufferers have good insight and recognize the irrational nature of their obsessions. But since I am often deeply convinced that my obsession is valid, exposure often becomes unbearable. There are times when no amount of cognitive restructuring can help me understand that my fear is groundless.
Is there any way for me to diminish the intensity of my belief in my obsession when cognitive restructuring has failed ? Would it be legitimate if I would tell myself that this unshakable degree of belief is in itself a symptom of the disease, just like obsessions and compulsions are symptoms, and from this point start to detach myself from it ? What can be done when OVI hampers progress in therapy ?
Thank you very much for your time !
Brief Answer:
Consultation
Detailed Answer:
Hello,
Thanks for using Heralthcaremagic.
I read your query and understand your concerns about the limited progress made in treatment of OCD and poor insight.
From the available description it appears to me that your level of conviction is high but it does not mean you have poor insight. Your choice of words and your ongoing engagement with ERP and CBT is enough to tell me that you are well aware about the disorder and ready to do whatever is required. It is also true that OCD individuals have some overvalued ideas and they recognise the irrational point about their ideas and same is true in your case.
I must inform you that almost all of the OCD sufferers have some valid reasons for their obsessions but the ongoing distress experienced makes them different from delusions and to some extent from overvalued ideas.
Now regarding making progress as a part of CBT the irrational thought need to be challenged and structured in positive way. I find your statement in the query quite valid which equates obsessions and compulsions with overvalued ideas.
In case your psychiatrist agrees I feel adding low dose of antipsychotic to the current treatment is rational approach to manage the ongoing problems of OCD. In similar situations I often add low dose antipsychotic such as 1 mg risperidone or 2.5 mg olanzapine which often yields better results.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Consultation
Detailed Answer:
Hello,
Thanks for using Heralthcaremagic.
I read your query and understand your concerns about the limited progress made in treatment of OCD and poor insight.
From the available description it appears to me that your level of conviction is high but it does not mean you have poor insight. Your choice of words and your ongoing engagement with ERP and CBT is enough to tell me that you are well aware about the disorder and ready to do whatever is required. It is also true that OCD individuals have some overvalued ideas and they recognise the irrational point about their ideas and same is true in your case.
I must inform you that almost all of the OCD sufferers have some valid reasons for their obsessions but the ongoing distress experienced makes them different from delusions and to some extent from overvalued ideas.
Now regarding making progress as a part of CBT the irrational thought need to be challenged and structured in positive way. I find your statement in the query quite valid which equates obsessions and compulsions with overvalued ideas.
In case your psychiatrist agrees I feel adding low dose of antipsychotic to the current treatment is rational approach to manage the ongoing problems of OCD. In similar situations I often add low dose antipsychotic such as 1 mg risperidone or 2.5 mg olanzapine which often yields better results.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much, Dr. XXXXXXX !
When you say that almost all of the OCD sufferers have some valid reasons for their obsessions, do you mean that they find their obsessions highly plausible although they know these obsessions are irrational ?
Regards.
When you say that almost all of the OCD sufferers have some valid reasons for their obsessions, do you mean that they find their obsessions highly plausible although they know these obsessions are irrational ?
Regards.
Brief Answer:
Yes it is true
Detailed Answer:
Hello,
Thanks for follow up.
Yes this is true although there is contrast images of obsessions and their explanations. It can be otherwise stated that due to anxiety and discomfort of obsessions many of us start believing that there is something wrong, albeit differently.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Yes it is true
Detailed Answer:
Hello,
Thanks for follow up.
Yes this is true although there is contrast images of obsessions and their explanations. It can be otherwise stated that due to anxiety and discomfort of obsessions many of us start believing that there is something wrong, albeit differently.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Above answer was peer-reviewed by :
Dr. Remy Koshy
Thank you very much for your answer as well as for the explanation !
Brief Answer:
You are always welcome
Detailed Answer:
Hello,
Thanks for your positive feedback.
I am glad to know that information was useful and informative for you.
If you have any further query, I would be glad to help you.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
You are always welcome
Detailed Answer:
Hello,
Thanks for your positive feedback.
I am glad to know that information was useful and informative for you.
If you have any further query, I would be glad to help you.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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