NOTE: If you’re reading this because you’re plagued by obsessive thoughts or anxieties and are frightened about what that means, please know that help is available. The International OCD Foundation is a great place to start. Click here for more posts about OCD and anxiety and why you have nothing to fear.

You can read each section of this five-part essay separately here. For a PDF version suitable for printing and giving as a very creepy gift, click here.

"Imploding Spiral Toroid" by M.C. Escher

I was sitting in a booth at the Olive Garden, when I vividly imagined getting my stepfather’s shotgun out of the basement and blowing my head off.

The fact that I just publicly admitted to eating at the Olive Garden should indicate how important I consider what I’m about to tell you.

It was January 29, 2010 at the Olive Garden in Bethel Park, PA 1Store #1345 (Village Square) for enthusiasts. that I first started down the path to understanding that I have obsessive-compulsive disorder. I’d actually been rolling along with OCD for many years — decades — before that, but like most people with the disease, I didn’t know it. And in the moment of shock after realizing that I’d just visualized putting a gun into my mouth, OCD certainly wasn’t what I was thinking about.

Four months earlier, my wife Sophie and I had left on a Virgin Atlantic flight out of Washington DC to live our long-time dream of traveling around the world. We had a nine-month, five-continent trip planned, but just four months and two continents in, we were running out of steam. We decided to return to the US, crash with my parents in Pittsburgh for two weeks, recharge our batteries, then finish the trip. In the back of my mind, though, I’d already started feeling like I didn’t have the energy, will, or even the desire for five months on the road through India and southeast Asia. A few days later I was sure of it. That filled me with a vague but comprehensive anxiety that I was letting down not just Sophie, but also all my friends who were following our progress online and, most importantly, myself for wimping out on my dream.

I’m not going to take any more space describing the root of that anxiety or analyzing why I felt it. 2If you’re interested, you can read a little about that here. That’s because I want to talk about OCD, to make you understand what it is and what it does. And even though OCD is an anxiety disorder, the subject of that anxiety is entirely unimportant. That’s the first vital point I need you to understand. I’m giving you the background of that trip for clarity’s sake, but this is not a story about fears of disappointing others, or suicidal thinking, or even fears of suicidal thinking. Those are the MacGuffin, as Hitchcock would say. They get the story going, but they aren’t what the story’s about. They’re the murder in Rear Window. Or if you prefer fruit metaphors, they’re the cantaloupe that carries the listeria bacteria.

The important thing is that I had all this anxiety, and at some point the thought entered my mind, “Man, these problems would all just disappear if I were dead.” 3I hope it will become clear as this essay goes on how hard it was for me to type that last sentence. It felt wrong to think it. I knew I didn’t want to kill myself. Just the fact that I’d conjured the idea upset me, so I put it aside. But a few hours later, I was in the Olive Garden, imagining suicide by shotgun. That image simply popped into my head, as close to literally as I’ve ever experienced anything “popping into my head.” I was thinking about pasta, or visas, or whether I’d finally started to like Diet Coke, and then suddenly I pictured killing myself. I remember pausing for a minute, thinking about how strange it was — like I’d for a second intercepted someone else’s thought stream. The image felt strange and alien and certainly not good. In fact it felt frightening and bad, and I didn’t want it to come back. But it was gone, so I chalked it up to a brain fart and went on with lunch.

Later that afternoon, the image came back. Then it came back again. And again. It seemed to be arriving from a place outside of myself. My brain kept bringing the image back — obsessively — even though I tried not to think it. Worse, the more it popped in there, the more I started to feel like I was losing control of my reaction to it. I knew very clearly that I didn’t want to shoot myself or commit any kind of self harm, but I was filled with the anxiety that I wouldn’t be able to stop myself from doing it. I worried that if I was left alone I would compulsively go into the basement, get out the gun, and use it right then and there. At one point I even snuck down there, opened the closet, and looked at the gun, just to prove myself that I could do it without shooting myself. It made me nauseous and scared, and I went back upstairs to find Sophie as quickly as I could without making her realizing that anything strange was happening.

My parents were out of town for a couple of days, so Sophie and I were alone in the house. That night in the basement den, a few feet from the shotgun, we laid on the couch together and watched The Mysteries of Pittsburgh on cable. The image still occasionally showed up, but being there with Sophie relaxed me, and I was able to not worry about it. The Mysteries of Pittsburgh is a lousy movie. It’s also a lousy movie which, it turns out, ends with one of the main characters killing himself by jumping off a building. I watched it, silent.

Getting ready for bed a few minutes later, I started seeing myself jumping out of the second floor bathroom window onto the driveway below. I imagined the same thing from the bedroom window. And the shotgun scene kept making itself known. My anxiety began to snowball into real fear, but I still wasn’t so scared that I was willing to say anything. I’d dealt with anxiety my whole life, crippling anxiety so bad that at times I’d been unable to get out of my house in time for work, but I knew that every night when I climbed into bed with Sophie, it would melt away and I’d be able to sleep. That night wasn’t any different.

The next morning, I woke up early and immediately thought about killing myself. The gun. The windows. The feeling was the same — I didn’t want to do it, but I was afraid I wouldn’t be able to help myself. The thoughts came faster and wouldn’t stop. I was scared and worrying that something was deeply wrong with me.I was going insane. I had a brain tumor, psychosis, schizophrenia. Sophie was lying asleep right next to me, and I thought about waking her and telling her what was happening, but I didn’t want to do it. I imagined life playing out in front of me. If I woke her, she would think I was out of my mind. Unquestionably. But she’d still have to get me help, take me to the hospital or a doctor. From that point on, I thought, I would be the Guy Who Wants to Kill Himself. I would be crazy. I would never have a job or a friend again, because I would be the suicidal freak. I couldn’t let that happen.

Then suddenly I saw myself hanging from the ceiling fan with my belt around my neck. I shook Sophie awake, shouting through tears, “Something’s wrong with me! You have to help me.”

"Proto-Form (B)" by Josef AlbersOf course what I expected to happen was wrong. Sophie hugged me and said, steadily and calmly, “Tell me what’s wrong.” I explained what had been happening the best I could while being, for the first time in my life, completely and utterly panicked. I howled and gasped, barely able to breathe. I’d experienced minor panic attacks before, but nothing that went past the point of losing control. I’d blown by that now. But even though I was hyperventilating and bawling about killing myself, Sophie didn’t think I was crazy, not for a second. She stayed calm and promised she would help.

It might seem obvious that she or any spouse would react that way. We’d been married for ten years; she knew her husband hadn’t suddenly lost his mind. But I’m pointing it out here because there’s another very important point that I need you to understand. OCD is sometimes called the Doubting Disease, because no one who suffers from OCD believes they have a disease. Until you finally understand that you have OCD, you think your anxieties, obsessions, and compulsions are all normal things that everyone experiences. Or you think that, okay maybe other people aren’t worried about the things you’re anxious about, but that’s because they are wrong. “They just don’t understand that we’ll all burn to death if I don’t check the stove one more time.”

And worst of all, when the disease gets really bad — and OCD will always get worse if it’s left untreated 4This isn’t an exaggeration. Unchecked OCD intensifies in an unending feedback loop. It’s part of the nature of the disease. — so bad that you finally think something might be broken in your head, at that point you’re afraid to tell anyone. You’re too ashamed, or you doubt your own sanity. “How can I possibly tell anyone that I can’t stop thinking about killing myself? I’m a maniac!” You feel embarrassment and fear and think that no one will understand or want to help you if they were to find out the truth.

Everyone who has OCD believes those things to some degree, but they are wrong. I’m telling you how Sophie reacted so that you can understand. I’m talking now to a hypothetical OCD sufferer that I’m imagining reading this. If someone loves you, they will not turn their back on you. They will help you. If you feel alone, you can find a doctor who will listen to you and help you and understand that you’re not crazy. With OCD you have to get beyond that doubt, because you will need help to get your disease under control. Getting that help is the hardest step. It took me over thirty years and fear for my own life before I took that step. But that morning in bed telling my wife, “something is wrong with me” was one of the most important things I’ve ever done. I divide my life into two parts: before and after I asked for help.

Okay so of course Sophie helped me. We were in Pittsburgh at the time, a city we’d lived in for several years before moving away 18 months earlier. Sophie’s dealt with clinical depression, and had a psychiatrist in the city who’d helped her tremendously. She asked if she could call him for me. Despite a lifetime of anxiety, I’d never seen any kind of mental health specialist, but I said yes right away. He happened to have a canceled appointment that day and said he’d see me at noon, about four hours later.

Those four hours were long and hard. I remember lying sobbing on the couch, suicidal images appearing uncontrollably in my mind, and grabbing my head yelling, “Why won’t they stop?” But the amazing thing is, in the midst of all that, because of Sophie’s calm and the prospect of seeing a doctor whom we both trusted, I was able to, for a minute here and there, relax and, once, even laugh. It had already begun to sink in that the horrible consequences I’d imagined weren’t necessarily going to happen.

I say it was amazing, but it wasn’t really. I know now that I was actually already taking the first step to overcoming OCD: realizing that there was nothing wrong except what my mind said was wrong. When I had a second of calmness and rationality I was, without trying, just ignoring the part of my mind telling me over and over that I wanted to kill myself. There’s absolutely no reality to irrational anxiety. That’s its secret. And so as soon as you make the irrational anxiety go away, the entire problem just evaporates, because there was no problem. If my hypothetical OCD reader is a hipster, imagine Jennifer Connelly in Labyrinth telling David Bowie’s goblin king, “you have no power over me.” Of course, that’s easier said than done, and I’m getting ahead of myself.

We made it to the doctor, and with Sophie sitting next to me, he listened closely while I explained to him, crying, what had happened. He asked us both of a lot of questions, about my history with depression (none) and anxiety (lots). He was able to conclude pretty quickly that I wasn’t a danger to myself. He told me that what I was going through was so common that he could give me a book about it. 5The Imp of the Mind by Lee Baer. Honestly, I never brought myself to read the whole thing out of anxiety that it would tell me the doctor was wrong and that I would kill myself. It says a lot about OCD that even now, knowing the truth, I feel such a strong sense of anxiety about that book that my reading it would take a strong act of will. After taking proper precautions for my protection on the slim chance that he was wrong, the doctor sent me home with a temporary prescription for Xanax 6An anti-anxiety drug. and an appointment to start treatment in three days, after the weekend. He said one sentence that I won’t ever forget and that kept me going through the next three very difficult months. “You and Sophie are going to have a long, happy life together. This is just a bump in the road that you’ll get over.”

He knew that I was experiencing a textbook form of OCD, but it’s one that takes some explaining.

"Run-a-Round Charlie" by Gene MerrittMost people think of OCD sufferers as maybe Jack Nicholson in As Good As It Gets, viciously cycling through the same precise routine every day, washing his hands with multiple bars of soap and frantically avoiding every crack in the sidewalk. Or maybe as Monk, that TV detective who’s so darn lovable because of his adorable severe mental illness. Those are both in fact manifestations of OCD, but they don’t comprise the extent of the disease. And they don’t resemble me nor what my psychiatrist recognized in my symptoms.

To help you understand how my obsessive suicidal images relate to a charming, ethnically indistinct goofball touching every parking meter he passes, I’m now going to give you a brief capsule description of the nature of OCD. It will be overly simplistic and will filter vital facts through my own interpretation, so please don’t use it for any term papers or game-show research. 7For a more complete — and exceptionally clear and fascinating — explanation of OCD, read Jeffrey M. Schwartz’s excellent book Brain Lock. I’d recommend it to anyone interested in the bizarre workings of the brain, but it’s intended for OCD sufferers, for whom it’s a must read. Reading Brain Lock pushed me past a major sticking point of my treatment and made me 100% accept that I had OCD, which finally allowed me to take control. I can’t stress enough how important that book was to me.

OCD results from a problem with biochemistry which causes a malfunction in the part of the brain that controls thought processes. Imagine your thoughts as a playlist of MP3s, something like:

  1. Read the word “cookies.”
  2. Think about cookies.
  3. Remember that you’re out of cookies.
  4. Desire to go to the store immediately to buy cookies.
  5. Decide not to buy any cookies because of what happened last time with the Double Stuf Oreo Cakesters.
  6. etc.

A normal brain grabs the top thought in the playlist, processes it, shuttles it off to any other part of the brain that needs to deal with it, then moves on to the next thought. The brains of someone with OCD doesn’t do that properly. My brain will get caught on a certain thought in the playlist and loop it right back up, front and center in the brain. Those thoughts play on repeat over and over. 8Note that the person doesn’t want to think those thoughts repeatedly. It’s purely a result of screwed up brain chemistry. It’s not unlike the brain of a Parkinson’s patient repeatedly telling a muscle to twitch.

When that happens, those sticky thoughts become obsessions. And OCD is an anxiety disorder, which means that the thoughts that become obsessions are ones that cause anxiety. 9And once those anxieties become obsessions, they cause more anxiety. Which causes more obsession. Repeat. In that way, untreated OCD snowballs to severity that can be mistaken for psychosis. And because people want to act on their anxieties, those obsessions often lead to compulsions. The classic example of this is the OCD hand washer. A person with OCD might become obsessed with the thought “I am dirty.” It plays over and over in his head. He reacts to it by washing his hands, which gives him a temporary sense of relief. But because his brain doesn’t work correctly, the “I am dirty” thought always returns. So he washes his hands again. The hand washing becomes his compulsion — a ritual reaction to his obsession. That obsession-compulsion loop continues, increasing its frequency, until it cycles out of control. 10How out of control can it get? Think of Howard Hughes, who’s become an archetypal “crazy guy,” peeing into jars and demanding constant blood transfusions. He had OCD that spiraled out of control. That’s all.

It’s important to note here that every time an obsessive thought returns, it feels just as real as the first time. This can be very hard to understand for someone who’s never dealt with obsession. Even now, with my OCD well under control and knowing everything I know, I will occasionally be frozen with fear at the sudden thought that I am going to get up and kill myself. It feels like the truth every time. My favorite illustration of the perceived reality of obsession comes from Jeffrey Schwartz’s Brain Lock. He describes a patient who was obsessed with the idea that he had razors on his fingertips. He wouldn’t touch his family out of fear that he’d cut them. It seems silly — couldn’t the guy just look at his fingers and see that there weren’t any razors on them? The answer is yes, and he did. But as soon as he’d look away again, his brain would replay the thought “I have razors on my fingertips,” and even though he’d just proven he didn’t, that thought felt like the truth.

You’re probably getting the point that the obsessions of OCD sufferers are complete irrational nonsense. They might start off in some understandable or rational anxiety (“Are my hands dirty?”), but as an anxiety becomes more severe, it becomes more and more irrational. Everyone’s experienced this at least a little bit. You hear there might be some layoffs at your company, and within a few minutes you go from fearing that you might lose your job to being pretty sure that you’ll be living in a PODS crate calculating the cost/benefit analysis of selling each of your organs. A normal person puts their anxiety aside and comes back to rationality, but someone with OCD cycles through it endlessly. On each return trip the anxiety becomes more severe, more irrational, and feels more urgent. This feedback loop eventually leads to anxieties that seem utterly insane to everyone but the person with the obsession. A hand washer might think something like, “If I don’t wash my hands, somewhere a puppy will die.” I at one point was obsessed with the idea that I would walk into the kitchen and chop off my hand with a meat cleaver. It felt completely real to me, as sensible an anxiety as worrying about my dwindling bank account.

I’m hoping at this point you’re beginning to understand what was going on with me when I was clenching my skull, filled with images of killing myself, begging it to stop. I was experiencing a severe obsession. My brain had stuck on the thought “you are going to kill yourself” and was playing it over and over. But the more important, more confusing thing I need you to understand is that the obsession didn’t mean that I was going to kill myself or that I wanted to kill myself. It in fact meant the exact opposite. To loosely put it in terms of the hand-washing metaphor, instead of my brain saying, “I am dirty. I must wash my hands,” it was saying, “I must not wash my hands, or I will become dirty.”

In other words, I became obsessed with thoughts about killing myself not because I wanted to kill myself, but because I was so frightened of killing myself. 11Here’s a tidbit that will either make this clearer or more confusing: later my anxiety evolved from fear that I would kill myself to fear that I wanted to kill myself. This type of looping bad thought, an obsession without a compulsion, is an extremely common manifestation of OCD, and it’s what my psychiatrist immediately recognized when I first spoke to him. The example he gave me is of a new mother, holding her baby at home, who suddenly realizes how easily she could toss her child out the window. The thought horrifies her and sickens her. She knows she’d never hurt her baby. But the thought keeps coming back, and frightens her more and more. She starts to avoid holding the baby when no one else is around out of fear that she’ll act on the obsession. Then she becomes afraid to be alone with the baby at all. Eventually her anxiety about the obsession becomes so severe that she refuses to be around her baby, period. In my case, I was filling the roles of both the mother and the baby. I was terrified that I might hurt myself.

The key here is that people suffering from those types of bad thoughts will never act on them. We’re obsessed with the bad thoughts precisely because we don’t want them to happen, so we would never do anything to make them happen. 12My psychiatrist once told an OCD patient who was terrified she might act on a violent obsessive thought, “If you do it, we’ll write it up as a case study of the first known occurrence.” But because of the nature of OCD and how real those thoughts seem, it’s incredibly difficult to convince ourselves that they’re not a reflection of reality. We honestly feel that we’re going to compulsively act on those thoughts, just as much as the guy honestly believed he had razor blades on his fingers. Convincing ourselves of the truth — that the thoughts are just nonsense, our brains churning a piece of crap over and over — is the secret to getting our OCD under control. But that’s very, very hard.

Richard Serra's "Sequence" photographed by Lorenz KienzleOkay so I’d been diagnosed with OCD. From there it got a lot harder before it got easier. It took me me three months of cognitive behavioral therapy and trial-and-error with multiple medications before I had things well under control.

Actually, that’s a little bit of a lie, the part about it getting harder before it got easier. Because in a very small sense, it immediately got easier. Within minutes of leaving the psychiatrist’s office, I was smiling and laughing. Because I wasn’t crazy. It had never occurred to me that I could have OCD, or anything so common that a doctor could recognize it right away and tell me that I was going to get better. And best of all, he didn’t think I was going to kill myself. I read the first couple of pages of the book he’d given me 13The Imp of the Mind by Lee Baer. It described exactly — exactly — what I experienced and talked about other people who’d gone through the same thing. It gave me an overwhelming sense of relief.

Of course, that didn’t last very long. Rationality was briefly overcoming my irrational anxiety. But just as quickly, my broken brain churned the irrational thoughts right up again, and they felt just as real as the first time. Not only that, but my anxiety was starting to adapt.

My obsession mutated from the simple fear that I was going to kill myself to the fear that the doctor had misdiagnosed me and that I was in fact suicidal and, thus, would kill myself. I didn’t read any more of the book, because I was scared that I’d find something to support that refined anxiety. 14And at that stage I would’ve found something, because I would’ve adapted any fact to fit my anxiety. As time went on, whenever I came close to getting a handle on a particular anxiety, it would evolve into something slightly new that I hadn’t developed a resistance to. Meta-anxiety was common — I’d have anxiety about having anxiety, which in turn somehow meant I was going to kill myself. I’d come up with multiple layers of meta-meta-anxiety so complex that I can’t even explain them to myself anymore. 15That kind of mutating anxiety is standard operating procedure, and it’s worse in creative people. Creativity becomes something of a curse, because you’re able to fashion all sorts of complex new anxieties without realizing that you’re creating them out of nothing. Once I described a particular new fear to my psychiatrist, and he laughed at me and said that he was endlessly impressed at the anxieties I was able to invent for myself.

And while I kept birthing those mutant anxieties, the old ones still stuck around. Plus all sorts of simple variations spun off from that original suicide fear, kind of daughter anxieties. A big one concerned kitchen knives, specifically the fear that I’d stab myself in the stomach with one. Fear that I would go into the bathroom and take a handful of Xanax. While riding in a car, fear that I’d open up the door and let myself flop out onto the highway. I mentioned the meat-cleaver thing yesterday. I think at one point I feared that I’d slit my wrists with the tiny safety razor in my pill cutter. I could go on.

Needless to say, all these things made me afraid to be alone. Sophie and I had of course by now canceled the rest of our around-the-world trip, and neither of us were working. We’d moved into a temporary furnished apartment in Pittsburgh. So we were home together all the time, and it was weeks before I was by myself other than when one of us were in the bathroom. 16Fun side note: The bathroom had so many mirrors on the walls that you could sit on the toilet and see the back of your head. Our landlady thought we were idle aristocrats. But I wasn’t idle at all. I spent all my time endlessly working over obsessions, frozen to the couch, afraid to go anywhere. I thought that if I went into the kitchen, I’d stab myself. And I couldn’t go into the bedroom, because I had to walk through the kitchen to get there.

I could write another four parts of this story just about my mental adventures over those three months, so to avoid that I’m going to focus on my treatment, to help you understand what’s involved. To start with, I’ll mention that research has shown over and over that most OCD patients experience better results with a combination of cognitive behavioral therapy (CBT) and medication than with either treatment alone. Luckily my doctor at the time is one of the (increasingly rare) psychiatrists that handles both.

I’ll get the medication part out of the way quickly, because it involves far fewer fun stories about me acting like a lunatic. A whole class of selective serotonin reuptake inhibitors (SSRI) are approved by the FDA as effective pharmaceutical treatments for OCD. SSRI are well known anti-depressant drugs like Paxil, Luvox, Prozac, etc. Often, as in my case, those are combined with an anti-anxiety benzodiazepine like Xanax or Klonopin. I was quite lucky in that finding my ideal medication cocktail required a minimum of experimentation. SSRI are notorious for behaving differently in every patient, but I only switched SSRI once (from Luvox to Paxil, because I was getting some palpitations from Luvox). I moved from as-needed Xanax to daily Klonopin. And from there it was just a matter of raising and lowering the dosage of each until we found the combination that worked the best. When I say “just,” it still took three months. But that’s a relatively short time. SSRI can take weeks to kick in, and dosage adjustment can’t even start until that happens. Some patients take many months to find the right medications in the right amounts to help them with a minimum of side effects. 17Which by the way I’ve been lucky enough to have few. The most interesting are the effects on my dreams. Klonopin tends to suppress dreams, while Paxil tends to make them extremely vivid. That amalgamates into enjoyable weirdness. Remind me to write about it sometime.

The CBT for OCD is way more engaging. It’s surprisingly simple, but exceptionally difficult — sometimes so difficult that patients can’t bring themselves to get through it and end up suffering from their disease much more than they need to. And I’m not suggesting that I’m somehow better or stronger than other OCD sufferers for succeeding with my CBT. If anything, my success lies with the nature of my particular brand of OCD. But I’ve thought a little about why I was able to do some of the hard stuff when other patients fail, and I think it’s because I had three things going for me.

One is that I’m good at finishing work when it’s assigned to me. As a student I always did my homework, and when I have a job, 18I used to have a job! if my boss asks me to do something, I try very hard to do it really well and on time. Partly that’s just because I don’t like letting people down or getting in trouble. So in a way I just saw CBT as homework: “This is your assignment. You have to get it done or Mr. Doctor will be unhappy.”

The second thing I had going for me is actually the opposite of the first. Except in situations like work and school where I voluntarily put myself in the position of being told what to do, I really, really hate being told what to do. I hate being coached. I hate unsolicited advice. I hate being told what to think to the point that I will argue against people making a point I agree with, if I feel like they’re being too bossy. And at some point in my treatment, which I’ll talk about later, I realized that OCD is nothing more than my broken brain trying to tell me what to do. I didn’t like that at all, and so I more or less said, “Fuck you, brain. You aren’t the boss of me. And I’m going to prove it.” I would’ve punched my brain in the nards, but I learned early in my therapy that brains don’t have nards.

Lastly, also hate-related, is that I’ve got a big hate on for not being good at things and an even bigger one for failing. I’m not competitive, but I get very angry and disappointed if I try to do something and don’t do it well. When I was having trouble getting started on the hardest step in the CBT process, my doctor, knowing I like video games, tried to frame it in that context. He said, “Think of it as a video game. Each time you let your anxiety get the upper hand, it gets a point. Eventually your OCD will win.” I thought, “This guy doesn’t know shit about video games.” But the idea stuck with me, and he was right to set it up as a contest. I started to see my OCD as my brain — which was already trying to tell me what to do like some kind of asshole — trying to set me up to flunk. It thought I wasn’t going to be very good at this CBT stuff and would probably fuck it up and lose. That was all I needed. From that point on CBT was a literal challenge, and if I didn’t finish it, I’d fail.

So the first technique the doctor gave me was an easy one intended to help me get enough of a grip on my anxiety to be able to progress through more difficult treatments. It’s a piece of cake and promotes rationality. Whenever I felt anxious, I’d get a notebook and write down a specific description of the fear. Underneath that I’d list any reasons why the fear might be rational. Then I’d list any reasons why the fear might be irrational. Obviously the evidence of irrationality outnumbered the evidence of rationality, sometimes by like 12 to zero. But the benefit of the exercise wasn’t in the numbers. The benefit came from the fact that the simple act of making the lists forced me to think about each anxiety head on. Just doing that pokes holes all through an irrational obsession and brings some calmness and rationality. Then later when the obsession returned and seemed totally and completely plausible, because it inevitably does with OCD, I could go back and read my notes for that fear and realize, “Nothing’s changed. This is the exact same garbage anxiety I had when I wrote this, and it’s just as irrational now as it was then.”

CBT wasn’t easy anymore after that. The next step was to quit the writing and, when I felt an anxiety, to just let myself feel it. I was supposed to acknowledge the anxiety, note that I was experiencing it, and just allow it to hang there while I went on with whatever else I was doing. Anyone who’s ever been anxious (which is everyone) can tell you that anxiety is not pleasant. The moment you start feeling it, you want it to stop. That’s compounded when you think that the very presence of your anxiety is going to compel you to jump in front of a bus. I didn’t enjoy it or understand the point of it. I wanted my anxieties to go away; I didn’t want to make friends with them. But eventually I found out that getting chummy with my anxiety was a baby step to emptying out a drawer and letting it move in with me. 19You might have noticed by this point that today’s part of this essay is already twice as long as the previous three. Sorry. I’ve decided that I’m just going to go ahead and post it all today, because there’s still one more section to come.

That shacking-up step would be the core of my CBT and is proven to be the most effective behavioral therapy for anxiety disorders (and one that you should definitely not undertake without a doctor guiding you through it). It’s called exposure therapy. In the simplest terms, it’s intentionally exposing yourself to whatever causes you anxiety and making it cause you anxiety until it doesn’t cause you anxiety any more. Like lowering yourself into a freezing pool until the water stops feeling cold. An example of exposure therapy is taking someone who’s afraid of flying, and showing them footage of airplane crashes until they’re not scared anymore. It’s about as much fun as it sounds.

Exposure therapy seems crazy, but it’s effective because it calls irrational anxiety’s bluff. It takes advantage of anxiety’s secret that I told you about earlier — that it only exists in your mind and has no actual bearing on reality. Once you expose yourself to enough of whatever makes you anxious, your brain more or less tires of producing anxiety and just stops. It quits bluffing. And once your brain stops grinding out anxiety, the whole problem disappears, because there never was any problem other than anxiety.

For OCD sufferers with a clear obsession-compulsion chain, designing exposure therapy is pretty easy. You feel compelled to wash your hands? Too bad. You can’t wash your hands. Just sit here and feel the anxiety for five minutes. Then for ten minutes. Then twenty. Etc. etc. over days, weeks, months. But for OCD sufferers with intrusive thoughts, it’s harder to figure out how to set up treatment. If I’m afraid of killing myself, I’m already not killing myself. And actually killing myself would be counter-productive. So my doctor and I started with one of my simpler obsessions, which was causing me some anxiety but not nearly as much as my core obsession. I worked on the fear that I’d stab myself with a kitchen knife.

My first exposure therapy assignment was simply to spend thirty minutes a day using knives. It says something about the nature of OCD and the irrationality of obsessions that it took me a couple of days to find the right behavior to make me anxious. 20For the sake of length, I’m skipping over the week I spent rationalizing not doing the therapy. When I used knives as normal in cooking, I didn’t feel any anxiety, because I enjoy cooking, and I was thinking about the recipe and not about my obsession. I was very pleased with myself at how little anxiety I was feeling — look at me go! — until I realized that I was missing the whole point. I needed to face the anxiety, not find a way to avoid it. So I discovered that when I wasn’t cooking, if I just opened the drawer full of knives and stared at them, I’d get anxious. So that’s what I did for the first week. I stood in the kitchen, staring at knives for half an hour every day, feeling like I was going to barf.

You can understand why exposure therapy often knocks people off the treatment wagon. Exposure therapy requires you to position yourself directly in front of what frightens you and let it frighten you as much as it can. For the therapy to work, you have to let it frighten you a lot and for a long time. We all know what fear feels like — real, middle-of-the-night, “there’s an intruder in my house” fear. We don’t want to spend every night thinking there’s an intruder in the house. Imagine if you believed — if your broken brain made you really and truly believe — that if you didn’t wash your hands, your family would die. Then imagine that you had to sit on your hands and not wash them for as long as possible every day. Could you do it? 21I want to point out that part of the reason I was successful with exposure therapy is that, as bad as my OCD seemed, it’s relatively minor. The level of fear I felt during exposure therapy, while certainly not pleasant, was nowhere near as hysterically severe as in people with the worst cases.

But the thing is, exposure therapy works. You can actually feel it working, both in the short term and the long term. For the first several of my knife sessions, I would very quickly peak at a high level of anxiety and stay there until I hit my preset time limit and ran out of the kitchen. But pretty quickly I started noticing the level of anxiety I felt during the sessions lessening. The anxiousness would start to wane before the end a session, earlier and earlier each time. Then the plateau of the worst anxiety would get progressively lower. Then both. You finally know you’ve gotten somewhere with exposure therapy when you desperately want a session to end not because you’re anxious, but because it’s so freaking boring. It becomes as dull as staring at a drawer full of knives if you have no fear of (nor interest in) knives. 22Actually, after a few days I had progressed to upping my anxiety level by sitting alone in the living room with a large knife in my hand. It was especially fun when Sophie would walk into the room and find me silently contemplating a santoku.

Once I got a handle on the knife thing and knew I could do exposure therapy, we moved into getting at my core obsession. My exposure therapy became reading factual information about suicide, and then eventually reading accounts of actual suicides. 23At one point, when my knife fear started rearing up again, I particularly focused on reading about seppuku, i.e. hara-kari — ritual disembowelment. Unlike fondling a knife I feared I might gut myself with, the reading didn’t involve any risk of physical danger, 24I should say “perceived risk of physical danger.” There was never really any risk that I would stab myself. but yet it scared me much, much more. In fact, within seconds of just telling me what my assignment would be, my doctor saw me become physically anxious. At that point I was scared that reading about suicide would mean I’d discover that I was suicidal. Or worse, I thought it might compel me to kill myself.

But I wanted to get better, so I developed a routine of sitting at the computer in the bedroom, gathering up articles on the web and reading about suicide for thirty, then sixty, then ninety minutes a day. At first, the sessions caused me real terror. Mental and physical anxiety. Hyperventilating, sweating, nausea, all of it. I would stare at the clock in the corner of the screen begging for the time to run out much the way an Olympic weightlifter stares at the timer while holding a 500-pound barbell over his head. But just like with the knives, it became less and less frightening, and I progressed up through the subject matter, starting over from almost zero again when I switched to focusing on reading about actual suicides and suicide attempts. But the anxiety faded ever quicker until, after several weeks, the whole thing became a chore. The thought that I might kill myself — or want to kill myself, or want to want to kill myself — didn’t scare me anymore. And that, 12 weeks after I first started treatment, was when I was done.

The last thing I’ll say about exposure therapy is a tip for anyone who might have it prescribed. As scary as it seems at first, it gets easier. And the more you do it, the easier it gets and the faster it gets easier. That doesn’t seem like much of a tip, until you’ve actually done exposure therapy. But trust me — remember it. Say you’re training to become a lifeguard. The coach tells you to swim a lap of the pool underwater. 25What’s with all the swimming pool metaphors? Your first thought might be, “This is going to be hard. I don’t really want to do this.” And at first it’s really really hard, and you can’t do it. But then it quickly becomes easier, and you’re able to swim the lap. Then it rapidly becomes less and less challenging, and you do it regularly until finally you think, “Why the hell is he still making me do this over and over?”

Great. Duh. That’s obvious, and that’s why it’s not what I’m talking about. What I’m talking about comes after that, when the coach tells you to swim two laps underwater. Your initial thought is different, because now you know that you’ll eventually be able to do it. You think, “Ugh, this is going to be a total pain in the ass, but I have to do it, so I might as well get it over with.” That is what happens with exposure therapy. Once you start, it eventually stops being scary and starts being just a pain in the ass that you know you have to get through to get what you want. Exposure therapy by its nature always gets easier. And it works.

I was going to talk about one more aspect of my CBT, the most significant one. But it’s become such an important part of my everyday life that I’m going to save it for tomorrow and the conclusion of this story, when I talk about just that — my everyday life, before and after treatment.

Robert Smithson's "Spiral Jetty" photographed by George SteinmetzThe night of November 20, 1983, my fourth-grade teacher watched the TV movie The Day After, about life in a small town during and after a nuclear war. The next morning in class, for reasons I’ve never understood, he ranted in horrifying detail about what it would be like living through a hydrogen bomb blast and on the scorched earth that followed. I was nine years old. For the next several years — well into adolescence — I was consumed with anxiety about impending nuclear armageddon.

Thoughts of it filled my mind whenever it wasn’t otherwise occupied. Even sometimes when it was. I remember standing out on a baseball field during pee-wee practice and staring at the next hill over, imagining burnt sienna mushroom clouds exploding up from behind them. I once saw a construction crane in the distance and thought it was a missile, raised to the launch position. TV news special reports panicked me — eventually one of them was certain to report that the rockets were in the air, on their way, good night. 26That particular fear wasn’t helped any by the 1985 episode of The New Twilight Zone, “A Little Peace and Quiet,” which climaxes with precisely that kind of special report. While looking up the name of that episode just now, I discovered it was directed by legendary horror master Wes Craven. Asshole.

I’m not sure my parents even know about this. Like everyone with OCD, I became excellent at hiding my anxiety. I never talked about it to anyone that I remember. Much of the time while I was sitting quietly I was stewing over the likelihood of the world’s blowtorching or wondering how everyone managed to just go around living normally with a giant fissionable gun pointed at their heads. I covered up my anxiety so thoroughly and constantly that eventually it became second nature, and I wasn’t even aware that I was doing it. I was such an expert that my stepmother once told me that she’d “never seen me nervous.”

As I grew up and lived through the years of kindly Gorby and drunky Yeltsin, the threat of atomic destruction diminished, and that particular anxiety faded. In my later teen years and into college, I became a more well-rounded adult with actual friends and even a girlfriend. My life was changing enough to push my obsessions further into the background. But fears of war, natural disaster, and other apocalyptic events never went away completely — not even close — and in my twenties they got worse again. On a road trip with a friend, I made sure we zipped through Los Angeles as quickly as possible, so that we didn’t get nailed by an earthquake. After seeing Saving Private Ryan, I became obsessed first with the idea of having to live through a war, and then with being drafted and sent away to fight one. That obsession traded off with, and was eventually replaced by, one about impending terrorist attacks. That lasted almost as long as my nuclear fetish.

This was years before 9/11. It started somewhere around 1996 or 1997, I think, and I don’t know what triggered it. I was living in New York City at the time, and just like when I was a kid, my idle brain was flooded with the certainty of impending destruction. At times in a busy public place — or a quiet public place, or a busy private place, or any place that met my constantly shifting mental criteria — I’d be overcome with the anxiety that I had to leave, because the place was too easy of a target. Something terrible was about to happen. I asked Sophie to marry me just before Christmas in 1998. The next day we left for different airports to go visit our separate families. I sat on the bus to Newark, waiting for Al Qaeda’s hidden atomic bomb to destroy the city. The only question in my head was whether she and I would both be able to take off in time to escape the blast and see each other again.

Of course, almost no one knew about my obsessions. In fact, I was afraid of people finding out. 27This is the first time I’ve described those anxieties on paper, and even I can’t believe how obsessed I was. What now seems totally bats seemed so rational at the time. It wasn’t until after September 11 that I started to open up a little, and then just to Sophie. We were still in New York and both experienced the attacks directly in ways that I’m not going to bother to go into right now. Surprisingly, during the strikes and their immediate aftermath, I didn’t lose my shit as completely as you might expect. The fantasies that up until then had been locked inside my head suddenly turned into reality, but reality is usually way less scary than anything an obsessive-compulsive can imagine. So while while all those terrible things were happening (and after I knew Sophie was safe) I felt like, “Hey, this isn’t nearly as bad as I thought.”

That calmness was gone by the next day, replaced by an obsession of what was coming next. There were days when I couldn’t bring myself to go down into the subway, or to get on the bus, or to leave the apartment, or to do whatever my brain said was unquestionably dangerous activity. As time went on, I developed a kind of checking compulsion around my obsession with the next attack. Whenever I heard something disquieting on the news — or heard a strange noise, or overheard something in a cell phone conversation (every one of which I’d come to assume involved someone calling to tell someone else about something terrible happening somewhere) — I’d start clicking through news on the Internet to see if I could figure out what was going on. I’d get caught in a loop for hours, jumping from one site to another and then back to one I’d checked several times already, in case it’d been updated.

Sophie and I moved out of New York in December of 2001. We’d been wanting to do it for years, to escape from a whirlpool of debt and general stress, so we weren’t just running scared. At least Sophie wasn’t. But the sudden decision to move, the quick choice of Pittsburgh as a destination, and the nearly immediate move were all, for me, a direct result of my obsession. I was scared, and I thought living somewhere other than New York would make us safer.

I concealed those facts just as well as I’d been concealing anxiety my whole life. But when that anxiety got mixed together with a dash of PTSD, eventually it got bad enough that Sophie knew something was wrong with me. And I had in my favor (or disfavor) the fact that at the time it was okay to be scared. Everyone in the country was scared, at least a little. Fuck, if you weren’t scared, you weren’t patriotic. So I eventually was able to bring myself to tell Sophie about my fears and let her know whenever I was feeling particularly anxious. We weren’t really doing the right things to treat it, because neither of us knew what was going on. But our life together was so good that I was able to be happy and trundle on. We even eventually moved back to New York. On rare especially good days I’d have no severe anxiety. On others anxiety would just take hold for a few minutes several times a day. But often it would consume me for hours. Days of anxiety with short breaks of relaxation. Anxiety was a permanent part of my life — one I took for granted as a typical inconvenience, like plaque buildup.

It should be obvious that everything I just described to you was my OCD before I knew that I had OCD. 28If you’re wondering, I’ve since realized that I had plenty of other, more minor behavior of the type typically associated with OCD, including some compulsions. Plenty of straightening and fastidiousness, sure. And I went through a phase as a kid in which whenever I read a word on a sign I needed to say it backwards in my head. Also for a while I used to say “snitch” whenever I saw a Volkswagen Beetle. When it became too weird for me to say it aloud, I’d just think it. Even if I was in the middle of talking, if I saw a VW, I’d shut up for a second to think “snitch.” But I want to make clear two very important things about it. The first is how completely my obsessions had taken over my life without my knowing it. They had a hand in almost everything I did, from something as large as the city I lived in to something as small as rushing through a dog walk because I saw a plane overhead and needed to get home to check to see if it had crashed into anything. My career path veered off down the path of least resistance, largely due to decisions I made because of my anxieties. I’m only now, at the age of 37, switching it permanently over to the track that it should’ve been on all along.

The second fact I want to clarify is that I didn’t think anything was wrong with me. I’ve made this point before about people with OCD, but I’m making it again, because it’s critical. I knew everybody had anxiety. I just figured mine was a little worse. Some people ate too much; I worried too much. So what if I thought that that tornado in Kansas was a sign that the Yakuza were probably going to use their weather-control technology to detonate the supervolcano under Yellowstone? I just knew more about those things than other people, and I needed to worry about them because they weren’t. I thought the way my life worked was just the way life is.

I WAS WRONG. I put those three words in underlined, bold, italic all caps because they are the most important truth you need to understand if you suffer from severe, life-affecting anxiety. It is not normal. There is no need for you to be overwhelmed by fear. It is not something that everyone experiences. It is not a necessary part of life. Everyone who suffers from an anxiety disorder 29And there are plenty of anxiety disorders other than OCD. thinks they don’t. I told you about OCD being called the Doubting Disease, but doubt and denial come along with all irrational anxiety. And the key to freeing yourself from that anxiety is being aware that it exists.

That brings me to the crucial part of my own cognitive behavioral therapy, and the only aspect of it that I still do regularly. It’s mindful awareness — identifying when my obsessions are just obsessions, when my anxieties are irrational, when whatever’s worrying me is just effluent from my brain. The ability to recognize those things takes such huge gaping bites out of anxiety that I find it tremendously perplexing, and even a little unfair, that I didn’t know about it my whole life.

A couple of days ago I mentioned Jeffrey Schwartz’s Brain Lock. The meat of that book is a self-directed CBT for OCD based around mindful awareness. It’s a bit more complex than that and involves several specific — and sometimes difficult — steps, but Dr. Schwartz 30Of the UCLA School of Medicine, by the way. At first I avoided the book, wrongly thinking that it’s a self-help shit bubble, but it’s actually well supported science. describes how simply being mindfully aware that your obsession is nothing but an obsession can not only make it disappear, but also can make you progressively less obsessive.

I worked through Schwartz’s CBT technique in conjunction with my other therapy, and I witnessed it pay off. I was finally able to teach myself the things I’d never been able to learn: I recognized that my anxiety has no bearing on reality, that obsessions are nothing but a self-created internal universe which is the be-all and end-all of itself and which has no reason to exist other than what you imbue it with. Best of all, I learned to identify obsessions, distinguish them from real thoughts, and throw them away.

I’m lucky enough now that on most days I don’t have any obsessive thoughts. When I do, I stop them from spiraling out of control by being mindfully aware of them and ripping off the masks disguising them as reality. I have a lot of techniques to do that, and I’m constantly inventing new ones. A few months ago, I was cleaning up for a housewarming party and trying to hide the mess of AV cables around my TV cabinet. I fiddled with them over and over and couldn’t get them right. I was sure that if the guests saw any visible wiring they’d be horrified and wouldn’t want to be my friend any more. Eventually, Sophie came to check on me because I was yelling, “Oh Jesus Christ, enough already!” I wasn’t frustrated with the cables. I’d suddenly realized I was obsessing, so I was yelling at my brain, berating it for pumping out bullshit. I made myself aware of what was happening, and I stopped worrying about the TV cabinet. 31And if anyone reading this did happen to stop being my friend because of my HDMI hook-ups, fuck off.

If you follow me on Twitter, sometimes you’ll see me tweeting things like “Bad OCD! Go lie down! Get in your crate!” That’s because I’m having a bad patch of obsession and anxiety, and I need to make myself aware of what’s going on and who’s in charge. Sometimes I’ll just tweet a description of the actual anxiety so that I can get it out of my head, look at it, and recognize it for what it is. That has the side effect of convincing people that they should by no means ever let me buy them lunch, but oh well. Lately when an obsession pops up I find myself laughing at it. Literally laughing out loud and thinking, “Ha! You expect me to believe that?

Like I said, no one with OCD thinks they have a problem. That’s why mindful awareness is critical. So critical that right now while I’m talking about it is the only point in the many pages of this story that I’m going to ask you to do something for me. If you have a surfeit of anxiety or obsession of any type, just play along with me for a second.

Okay, first, just try to make yourself aware that the anxiety exists. Don’t worry about whether it’s irrational or legitimate or hormonal or anything else. Just be aware that you’re anxious. Simple. Now, make yourself aware that you don’t like being anxious. And face it, you don’t. Even if you feel like you need to be anxious — for yourself or on other people’s behalf — you can’t really say that you like it, can you?

All right, those two steps should’ve been easy. Now you’re aware that you have a lot of anxiety and that you don’t like it. But there’s one more thing to make yourself aware of, and this one might be harder. You might not even believe it, so just treat it like a fact that you read in a textbook: be aware that you can live your life without that anxiety.

If you need proof of that, I’m it. Until I got a hold of my OCD — OCD that I didn’t even know I had for almost thirty years — I didn’t know what life is supposed to be like. Not only didn’t I know it, I didn’t even know that I didn’t know it. Now I do. And my life is so much better, immeasurably so.

Yes, I still feel anxiety sometimes, and I still deal with obsession. OCD, like other mental illnesses, never goes away. It flares up regularly, like arthritis. But whenever it does, I’m aware of it, and I can get it back under control. Sometimes it takes days or weeks for me to gain that awareness, but I’m always able to do it. As a result — and with the help of medication — I live most days without anxiety. A lead blanket that had weighed down my life and blotted out the sun has been yanked away. I still get depressed, nervous, embarrassed, scared, but now it’s for the reasons that everyone does, and everyone should. But my life is so much better now. That’s the second time I’ve said that, and I’m going to say it once more to make sure you get it: my life is so much better now. A couple of times while writing this story I’ve teared up, and it’s happening again right now, because I remember how awful things were before. I can’t believe how bad I let them get. I never knew how wonderfully, purely good life is supposed to be.

So there you go. Three simple things. You’re aware of them now. And now that you’re aware of them, you’re ready to get help. Real life is waiting.

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1. Store #1345 (Village Square) for enthusiasts.
2. If you’re interested, you can read a little about that here.
3. I hope it will become clear as this essay goes on how hard it was for me to type that last sentence.
4. This isn’t an exaggeration. Unchecked OCD intensifies in an unending feedback loop. It’s part of the nature of the disease.
5. The Imp of the Mind by Lee Baer. Honestly, I never brought myself to read the whole thing out of anxiety that it would tell me the doctor was wrong and that I would kill myself. It says a lot about OCD that even now, knowing the truth, I feel such a strong sense of anxiety about that book that my reading it would take a strong act of will.
6. An anti-anxiety drug.
7. For a more complete — and exceptionally clear and fascinating — explanation of OCD, read Jeffrey M. Schwartz’s excellent book Brain Lock. I’d recommend it to anyone interested in the bizarre workings of the brain, but it’s intended for OCD sufferers, for whom it’s a must read. Reading Brain Lock pushed me past a major sticking point of my treatment and made me 100% accept that I had OCD, which finally allowed me to take control. I can’t stress enough how important that book was to me.
8. Note that the person doesn’t want to think those thoughts repeatedly. It’s purely a result of screwed up brain chemistry. It’s not unlike the brain of a Parkinson’s patient repeatedly telling a muscle to twitch.
9. And once those anxieties become obsessions, they cause more anxiety. Which causes more obsession. Repeat. In that way, untreated OCD snowballs to severity that can be mistaken for psychosis.
10. How out of control can it get? Think of Howard Hughes, who’s become an archetypal “crazy guy,” peeing into jars and demanding constant blood transfusions. He had OCD that spiraled out of control. That’s all.
11. Here’s a tidbit that will either make this clearer or more confusing: later my anxiety evolved from fear that I would kill myself to fear that I wanted to kill myself.
12. My psychiatrist once told an OCD patient who was terrified she might act on a violent obsessive thought, “If you do it, we’ll write it up as a case study of the first known occurrence.”
13. The Imp of the Mind by Lee Baer
14. And at that stage I would’ve found something, because I would’ve adapted any fact to fit my anxiety.
15. That kind of mutating anxiety is standard operating procedure, and it’s worse in creative people. Creativity becomes something of a curse, because you’re able to fashion all sorts of complex new anxieties without realizing that you’re creating them out of nothing. Once I described a particular new fear to my psychiatrist, and he laughed at me and said that he was endlessly impressed at the anxieties I was able to invent for myself.
16. Fun side note: The bathroom had so many mirrors on the walls that you could sit on the toilet and see the back of your head.
17. Which by the way I’ve been lucky enough to have few. The most interesting are the effects on my dreams. Klonopin tends to suppress dreams, while Paxil tends to make them extremely vivid. That amalgamates into enjoyable weirdness. Remind me to write about it sometime.
18. I used to have a job!
19. You might have noticed by this point that today’s part of this essay is already twice as long as the previous three. Sorry. I’ve decided that I’m just going to go ahead and post it all today, because there’s still one more section to come.
20. For the sake of length, I’m skipping over the week I spent rationalizing not doing the therapy.
21. I want to point out that part of the reason I was successful with exposure therapy is that, as bad as my OCD seemed, it’s relatively minor. The level of fear I felt during exposure therapy, while certainly not pleasant, was nowhere near as hysterically severe as in people with the worst cases.
22. Actually, after a few days I had progressed to upping my anxiety level by sitting alone in the living room with a large knife in my hand. It was especially fun when Sophie would walk into the room and find me silently contemplating a santoku.
23. At one point, when my knife fear started rearing up again, I particularly focused on reading about seppuku, i.e. hara-kari — ritual disembowelment.
24. I should say “perceived risk of physical danger.” There was never really any risk that I would stab myself.
25. What’s with all the swimming pool metaphors?
26. That particular fear wasn’t helped any by the 1985 episode of The New Twilight Zone, “A Little Peace and Quiet,” which climaxes with precisely that kind of special report. While looking up the name of that episode just now, I discovered it was directed by legendary horror master Wes Craven. Asshole.
27. This is the first time I’ve described those anxieties on paper, and even I can’t believe how obsessed I was. What now seems totally bats seemed so rational at the time.
28. If you’re wondering, I’ve since realized that I had plenty of other, more minor behavior of the type typically associated with OCD, including some compulsions. Plenty of straightening and fastidiousness, sure. And I went through a phase as a kid in which whenever I read a word on a sign I needed to say it backwards in my head. Also for a while I used to say “snitch” whenever I saw a Volkswagen Beetle. When it became too weird for me to say it aloud, I’d just think it. Even if I was in the middle of talking, if I saw a VW, I’d shut up for a second to think “snitch.”
29. And there are plenty of anxiety disorders other than OCD.
30. Of the UCLA School of Medicine, by the way. At first I avoided the book, wrongly thinking that it’s a self-help shit bubble, but it’s actually well supported science.
31. And if anyone reading this did happen to stop being my friend because of my HDMI hook-ups, fuck off.

Kindly Provide Mr. Madej With Your Viewpoint


Thank you for sharing this story, it was amazing at times how I felt like I had written it myself. Here’s to our continued success at battling our OCD bullies!

my gf is experiencing this atm. im going to try to get her help. its a little different for sure, but its ocd and anxiety issues. its amazing how similar you and her are. thank you for writing this. dont stop trying to help people.

Not once in 29 years of my life did I have any symptoms or non that I realized would become a battle. It’s been a little over a year and I’m still learning how to live and cope. Thank you for the in detail write up as it’s nice to hear from another person because when you are going through the thoughts it’s very hard to think anyone else has ever gone through the same thing. Thank you :-)

This was an extremely inspirational read for me. I am around your age and have just discovered in the past 6 weeks that I have a moderate case of purely obsessional OCD. There were so many things I could relate to while reading your article sometimes it seemed to be written about me. Especially the part where your OCD tries to come up with new and creative ways to provide you with fresh doses of anxiety. This can waste a lot of your time very quickly and like you said, the more creative you are the more unsettling the results can be!

There is an interesting video presentation online given by a Dr. Steven Phillipson who describes his research and treatment plan for “pure-o” OCD. He is apparently considered one of the top experts for this purely obsessional type of OCD. I also agree that Brain Lock is probably the most helpful book on the subject as far as learning how to get control over this disorder.

I am working on the ERP therapy now in conjunction the Dr. Schwartz’s book. I will give it about 2 months to see if there is any progress. If not or if it is going too slowly I will consider adding medication to the treatment plan.

The medication option is something that I am very curious about (I have found my obsessive nature focusing on it like a laser beam lately). I know the results are completely different for everyone and that a lot of trial and error is required usually. The cost/benefit analysis when considering meds is something I keep mulling over. Are the side effects worse than dealing with the condition or vice versa. I would be curious to hear your take on that point.

Thanks Simon, I’m glad I could help. Be heartened that a lot of readers contact me to say that what I wrote describe their experiences too. That means that what we’re dealing with is common and treatable.

As for medication: it’s been part of my treatment from the beginning. All the psychiatrists I’ve seen have told me that the research shows that most patients have better results if they’re treated with both medication and behavioral therapy than if they’re treated with one or the other alone.

I’m not sure if by cost/benefit analysis you’re referring to the financial cost but, assuming you are, that of course varies based on which medications you take and if you have insurance. I take generic meds covered by my plan, so my costs are less than $20 per month.

When it comes to side effects, they’re never the same from patient to patient. I’ve been lucky that I’ve had few side effects since finding the right drug combination. I take Klonopin and Paxil; the Klonopin has had no significant side effects that I’ve noticed. I have some moderate sexual side effects from the Paxil, and also a period of weight gain may have been in part due to it. I judge my minor side effects to be well worth the benefits.

(I’ve also experienced some side effects from both drugs related to dreaming. They’re neither good nor bad, so I won’t go into detail about them here except to say that they’re really interesting.)

Talk to your doctor about medication to see if he/she thinks it would benefit you. I’ll also mention that many OCD patients, myself included, become anxious and obsessed about medication when they’re considering taking it or first start taking it. That often leads to them letting their anxiety dictate they’re treatment, which is obviously the wrong way to go. But you’re clearly learning the techniques to help prevent that.

And thanks for the tip about Dr. Phillipson. I’ll look into that.

Best of luck!

Thank you for the reply! This is all very helpful information.

I keep hearing that an older Tricyclic antidepressant called Anafranil is used often to treat Pure-O OCD but the downside of that one seems to be the strong side effects due to the fact that it was developed before the newer SSRI’s.

Again thank you for all the support you are providing those suffering with this ailment!

This is easily one of the best essays I’ve ever read. Easily. It took guts to share your deepest fears. By contemplating your own wound, you spark the healing process for countless others.

I’ve struggled with OCD my entire life — a deep, prolonged dark night of the soul — but after reading your essay, I’m inspired to finally confront my problem.

Thanks and take care, man.

Seth, this was INCREDIBLY helpful. Even though I was diagnosed last year finally after several years of anxiety and several months of “holy crap, what the hell was that thought?! where did that come from!”, every once in awhile my OCD throws me for a new loop. My themes jump around from harm OCD (of others and of self) to relationship OCD to health OCD, and to a lesser extent things like hit-and-run OCD, the need to check that appliances are off repeatedly, etc. I had been doing better for awhile but due to some heavy life stressors, it’s been back with a vengeance lately and I started having panic attacks again for the first time in a few years. that has now led to fear of panic attacks, and feeling down about myself as a result. I finally decided I was tired of feeling sucky and maybe I need an SSRI to help take the edge off while I get back into CBT, ERP, and mindfulness more seriously than last time. A logical decision, but the OCD started attacking that!! “I know people on SSRIs who tried to kill themselves. If I need an SSRI, my depression and OCD have gotten the best of me. I don’t feel like myself. What if I can never come off the meds? what if the meds make me suicidal?” and so now I am stuck back on the “what if I want to hurt myself” thoughts that you described. No fun

Anyway, this was a long-winded way of saying that I admire your courage for putting your story out there, and that I feel relief (reassurance, whoops!) reading a story that sounds so much like mine!

Thanks. By the way, almost every OCD patient I’ve talked to (myself included) has had very similar anxieties and obsessions regarding starting on medication. See my reply to simon, two above this one. You’re not alone. Good luck!

This is seriously the BEST article about CBT I have found!! I’ve googled CBT, tried watching YouTube videos about CBT, but NO ONE explained it as simply and perfectly as you have!! I’m seeing a psychologist but she doesn’t really say anything, just lets me talk, doesn’t have any notes on me or offers any advice other than to read her books she’s written..I have PURE O IS hell, I was on Paxil for 12 years, then it crapped out on me and thought I was crazy because the OCD?Panic Attacks were out of control 24/7 and ended up being Baker Acted because I couldn’t eat, or sleep, or even move off the couch, just frozen with fear. It was AWFUL.

I also have PTSD from being raped TWICE and so I wanted to own a gun for protection, but I too have these intrusive, “what if I’m there at this gun class and I just shoot someone? What if I shoot my boyfriend in my sleep who I love more than life itself? What if I shoot the instructor at the gun class or if I point the gun at my head just to see if I would pull the trigger?” Its terrible, and makes me feel like a psycho.

I broke down crying reading this, realizing this “psychologist” of mine has no idea what CBT or exposure therapy is and I’ve had OCD since I was 7!! I am now on Zoloft and Klonopin, which has helped some, I don’t have the extreme panic attacks just some anxiety…daily..and I hate being alone. I really want to face this stupid fear and be a normal person that can own a gun to protect myself so I never have to go through what I went through before. I’m just so scared to go to a gun class, I’ve never even held a gun! lol. Thank you so much, I can’t believe out of all my searching I didn’t come across this site before, but it is so encouraging and if a gun class is my exposure therapy then so be it. I know I need to face these stupid fears, because that’s what these thoughts are, our fears. It’s really terrible and telling someone without OCD these thoughts is sooo hard because you just KNOW they are going to think you’re crazy, its very isolating. Thank you so much for this post. Bless you!!

Thank you for the kind words, Kylene, and I’m really glad I could help. I should caution you though that you should never attempt any exposure therapy without a doctor’s guidance. That’s especially important when dealing with anything weapon-related. I strongly encourage you to find another doctor before you attempt any CBT.

Hi seth,

Thank I for ur essay! I have been dealing with this obsession for the past 3 years on and off. It’s truly terrifying.

I have stated exposure with instruction from my therapist the last few weeks. This week it’s the reading and researching suicide on the Internet. The same as u mention, my fear is that it may compel me to do it by desensitising me to the idea of it. I am realy struggling with this exposure exercise.

I am trying to just believe it will get easier as time goes on but right now I feel like my obsession is becoming worse although I feel less afraid of it, which then scares me more. Lol.

That new anxiety your feeling as part of your exposure therapy is typical, and I experienced the same thing. Because your original obsession about suicide causes less anxiety, your brain finds a new way of framing it that DOES make you anxious. For me, that kind of thing kept happening until eventually the anxiety went away.

Remember, exposure therapy is SUPPOSED to cause you anxiety. That’s why it works. As long as you keep at it, it WILL work. Don’t give up, no matter how hard it seems.

Thanks for ur response! I felt like I needed a little encouragement!

I found myself on the Internet for like 2 hours last night reading stuff because I was waiting for the anxiety and fear to die down but it didn’t. I’ll stick at it though as I know it should work.

It’s the whole idea of the more I read the more obsessed I will become with it and it will fill my brain even more and I will think it’s normal and ok to commit suicide coz so many people do it! Blah blah blah.

Fun fun fun.

Not supposed to be easy though as you say.

I can’t explain how much peace of mind this has given me. Thank you so much for sharing this. I actually genuinely laughed whilst reading this (not because OCD or anxiety is In any way shape or form funny) but because I never thought anyone could be going through exactly what I am. 6 days ago I was getting so down and so fed up with my obsession that if I went out ANYWHERE I would be sure to have diarrhoea. So going for dinner was a write off! I couldn’t go anywhere long distance in a car, and my boyfriend could absolute forget it if he thought he was driving. I would go no where unless I was driving! So anyway, 6 days ago I was fed up with living my day to day life so restricted with this obsession that I had a fleeting thought that “if I died then I wouldn’t have this obsession”. Low and behold this how now become major obsession. “Oh my god what if I go completely out of control and do end up killing myself” what if my boyfriend or friends think I’m mental and get me sectioned for having suicidal thoughts!!! I do not want to die, never ever have I had a thought of self harm or suicide., I have absolutely no desire to leave this earth through myself. But the thought that other people would think I was mad is the worst. And the fact that this one thought makes me feel utterly out of control freaks me out no end!!! So for now I take peace in knowing that other people suffer this all the time and I am not alone, and that I can get a normal life back again!! Yay!! Here’s to a beautiful future!! (And hard work with the CBT). Thank you so much again for posting, it takes people like you that change futures for other sufferers because anxiety and OCD can be the most lonely mind set ever. People don’t want to admit they have this, let alone share their experience about it! Let’s all help each other, this is what it’s all about.

Great article! This really gave me hope that I could do ERP therapy and get my life back! My only worry that I can’t get over is that maybe my Harm OCD isn’t actually Harm OCD. I know that is a feature of OCD in and of itself, but where I go wrong is that I think my thoughts might be different. Usually, if I just see a knife, I start to worry that I’ll lose control and act on it, which is pretty typical HOCD. However, sometimes I feel like I get these impulses to do it (even though I don’t). The impulses feel so real, and that freaks me out. Then it confuses me, and makes me think that maybe I do actually want to hurt myself, since it’s not just a thought, but some type of impulse. Does this sound familiar to anyone? I am going to see a therapist in a few weeks, so we shall see.

Also, I was wondering how many people have told you that they have gotten better? I can’t wait to be one of those people. The constant worry and fear sucks! Oy!

The “different” thoughts you describe are exactly the same as what I experienced and are EXTREMELY typical for OCD sufferers. That said, it’s important that you not try to diagnose yourself and instead see a doctor. Best of luck!

Ok, great. I will obviously check with a mental health professional (I talked with one before, but was too afraid to tell him about those “different” thoughts, since I was worried I’d get locked up). Thanks for at least making me feel a little more normal in the meantime!

Seth. Firstly, thank you so much for writing this article. Finally realising that I’m not the only sufferer out there already makes me feel as though the biggest weight has been lifted. Secondly, I’m saying thank you because I can imagine how hard it must have been to recount your story to the public. For the last 4 years, I have been silently suffering from pure O; too afraid and too ashamed to ever even mention my thoughts to anyone. What started off as an obsession of constantly monitoring my heart beat, fearing that at any moment it would stop (an aftermath of finally having a heart operation to treat a lifetime irregularity in my heart), turned into constant obsessions over whether I worry too much, whether I stress too much, what if I’m depressed, what if I’ll never be happy, what if these thoughts are with me forever and I’ll never be able to relax or escape my mind, etc etc. Anyway, after 4 long painful years, in what was supposed to be the ‘best time of my life’ (late teens), I’ve finally realised that everything I’ve been going through has a label. Not only that, but there are others just like me, and perhaps most importantly, it is treatable. I was always the happiest and most out-going kid growing up, so you can imagine the complete confusion and shock my parents and long-term girlfriend experienced when I finally broke down and told them everything. It has only been a few days since, but I already feel ten times better knowing that they’re still sticking with me and ready to support me through this. They have already arranged I get the proper treatment and help from a true professional, and I cant wait to start beating this now that I realise it’s possible. I’m going for my first appointment in two days, and although these thoughts are still plaguing me even as I’m writing this, I cant help but to feel optimistic. My feelings of optimism were only increased after reading your story; especially the part where you mentioned your life being defined in two parts, before and after help. My only fear I guess is that situation is a little different from most of the accounts I’ve read in the sense that my constant obsessions aren’t over a specific event or fear but rather a constant thought of worrying that I’ll never be happy and I’ll be plagued by the fog in my head forever. I know it’s irrational because if the thoughts of being an unhappy person disappeared then I would be happy, haha. But I guess that’s the thing with pure O is that the harder I try block this thought out, the easier it is for the thought to repeat itself. Anyway, I think I’m a little concerned that exposure therapy wont work for me as I’m unsure what it is I should be exposed to. I’m scared as well that the medication wont work because I will be constantly trying to monitor whether the treatment is working and whether I’m happy or not now and this will only continue my obsessive pattern. Sorry to ask but I’m curious what your point of view on my situation is? These are obviously all worries I’ll discuss with the psychologist in a couple days, but having recently reached out for help, I feel as though I might benefit from getting an opinion from a fellow sufferer. Thanks again for your article; it has left me feeling reassured and inspired. Ray.

Ray, thank you for sharing your story and congratulations on starting treatment! I’m glad I could help a little bit.

In answer to your questions, I can tell you from my own experience and from talking to many others with OCD that there are two typical anxieties that plague sufferers when they first realize they have OCD: 1) anxiety that their personal version of the illness is somehow “different” and can’t be treated, and 2) anxiety about having anxiety, i.e. worrying about worrying.

So the concerns you describe fit the EXTREMELY TYPICAL pattern of the illness. I suspect that your doctor will tell you the same thing. I’m also confident that your doctor will be able to find a treatment that will help you, whether or not it’s exposure therapy.

Your optimism is appropriate. Be determined and strong, and you’ll see a change for the better. Best of luck.

Seth, I have had the same suicidal obsessions as you for the past year. You mentioned in one of your footnotes that you had an obsession about literally :being suicidal about being suicidal”. Do you have any advice on how to overcome that fear?

Thanks for reading, Brandon. I can tell you that that type of obsession is typical with people who have OCD-related intrusive thoughts about self harm. That said, I always refrain from giving specific advice for these type of situations, because I don’t have the knowledge to do so responsibly. I recommend you find a doctor or therapist with experience treating anxiety disorders. Good luck!

Seth – thank you for writing about your story. As someone who does not have OCD but who uses exposure and response prevention to help people deal with their OCD, I can corroborate it is a challenge to design exposures that are manageable and challenging as well. OCD is a horrible problem to have yet it is a real privilege to work with people daily and see the willingness of people to confront their fears.

Seth…thank you so much. You have written so well what I have been going through. I appreciate you sharing your personal journey to help the rest of us.

Hey this article was fantastic. I have not been diagnosed, but believe that I have OCD of the same form and have yet to tell anyone. It’s extremely embarrassing and getting harder every day. I’m a young woman, I don’t WANT to harm myself, but the obsessive thoughts are literally causing my body pain without me even harming myself. I think it’s time to seek help and I want you to know this article helped me to come to this point. You are a talented writer and an inspiring person, thank you for your blog

I have read a lot of articles about OCD, and I mean A LOT (goes with the territory, obession), and this is the best. It felt like I was reading a slightly different story about my life…I kept saying to myself throughout this blog, yes I had that happen, yes I had/have those fears, yes I thought I was alone, yes to pretty much everything. Thank you man, I recently went through an experience this past Summer where my OCD finally flared like a wild fire (age 23) and it brought me to tears reading that there really is hope. I’m still recovering, and I know there is no magic pill, but it can be treated and you can live your life. And you helped validate that point even more…can’t say it enough….Thank you! -Erik S.

You have helped more people than you will ever know. As many of your readers have noted, your article describes me perfectly. My OCD concerned fears of nuclear war and terrorism. It started on the first day of news coverage of the first Gulf War, with videos of scud missiles hitting Tel Aviv. I was convinced that the war would lead to complete nuclear war. I was incapacitated by fear for months. Fortunately, I found a great psychiatrist who prescribed medication that I’m still on more than 20 years later. Also like you, I lived through the 9/11 terror attacks and was surprised that I didn’t freak out. I was at my office in downtown Washington, DC, located between the State Department and the White House. My house was 3 miles from the Pentagon. Walking home, I could see the smoke billowing up from the burning Pentagon, but found it all more surreal than frightening. Even through the Anthrax attacks, I weathered it all surprisingly well.

Until I read your story, I thought I was the only one with a nuclear war fear obsession. Thank you so much for sharing, and good luck to you.

Kevin, you’re the first person to tell me they shared that nuclear war fear. It must have been so common, though. I’m sure there are lots of us out there. I’m glad to hear you’ve had your OCD so well under control for so long.

I just had to tell you what a tremendously helpful resource this article is. I found it during one of my many reassurance-seeking Google sessions. It was almost like you were describing ME.

I’ve struggled with OCD, and anxiety, for probably most of my life, but until recently I had no idea that’s what it was–I had only ever heard about the stereotypical symptoms, and as those didn’t apply, OCD never really crossed my mind. For whatever reason, last month I reached my breaking point when my husband was on a business trip. It wasn’t just Suicide OCD, but also a fear that I would snap and hurt my two boys (Harm OCD). I was suddenly incapable of being alone without having a panic attack, and like you said, every intrusive thought seemed absolutely terrifyingly real. Every little thing was a trigger. My butt was sore from clinging to the couch.

Long story short, I ended up scaring my primary care doctor who had no knowledge of Harm OCD, and he ordered me to a psychiatric emergency room. That was a frightening experience, especially since the nurse sent me to the secure waiting room as a precaution, but the hours I waited were well worth it when an understanding psychiatrist finally gave me my formal diagnosis, and told me that if he could, he would give me a big gold plaque to put on my wall stating “YOU WILL NEVER HARM YOURSELF OR ANYONE ELSE.” He didn’t commit me for the rest of my life, he sent me home. He also prescribed Zoloft and Xanax. I had been adamantly against medicine because it scared me, but at that point I would try whatever it took. Five weeks later, I am functioning again, and doing better than ever. The worst of the Zoloft side effects lasted 6 days. I haven’t needed a Xanax in over two weeks, but it helped greatly during the early days.

Before I started medicine, I had been reading self-help books, and my husband and mom were helping the best way they knew how. We were all trying to challenge me to get past the anxiety and do the things I needed to do, but I just couldn’t get anywhere. My husband would leave for work, and I was back to square one. I felt like a failure because this was all in my head, yet I just couldn’t be by myself. I was able to give this blog post to my husband and say “THIS is what I am going through right now.” He was able to see how bad it really was, better than I myself could describe to him, and he made arrangements to work from home while my medicine kicked in. I am also doing therapy with an OCD expert, but that’s just started.

I am happy to say that my husband went to work 30 miles away every day last week, and will from now on. I’ve been caring for my boys on my own, making dinner, running errands, etc. When I was at rock bottom I didn’t think I would ever get to this point again. Seriously.

I kind of laugh at myself now because I feel like I’ve survived a battle for my very life, when in reality I was one of the least likely people in the world ever to carry out the scary things I thought about. I mean, I can’t even stomp on an ant on purpose. I like to joke that I would be the most remarkable/notorious person ever to have lived if even a handful of the things I obsess about actually happened to me.

Thank you so much for sharing your experience–you helped me get the help and understanding I so desperately needed.

Jennifer, I was so pleased to read your comment and admittedly teared up a little bit. I admire your courage and determination to take what must have been a terrifying experience and using it as a catalyst to turn your life around. Not everyone has that kind of strength. Thank you for your kind words and especially for telling me your story. Remember that just by sharing it you help other people.

Thank you so much for writing this! This has helped me so much. I have dealt with this since I was very little with the same fear. I always felt alone and scared. I would get images same as you and cry in bed wishing they would go away. I would miss school cause I was to scared to leave my bed. Thankfully I finally talked to my mother and I got help. I got put on Prozac and I didn’t have any of these irrational scary thoughts for 2 years. Sadly this week they came back and have felt more real then ever. I try to reassure myself that these are just anxiety thoughts and that I don’t want to do such thing. I would feel better for a few minutes then it would start up again. It got so bad that I finally told my boyfriend of 3 years about them and I was scared as you were to tell Sophie. I thought he would think I was crazy or someone who actually wanted to kill myself. He listened to me and understood. And he actually wanted to help me. I always get these thoughts and I always get the “what if I do it” or the images. I would cry and ask why I can’t be just someone normal or have these thoughts disappear. I would stay up on the computer for hours just trying to find out the difference between Harm OCD and people who actually want to hurt them self. After realizing that I do have Harm OCD I then would have the “what if it’s not that”. What you wrote has showed me that I have OCD and that its normal. I think it will help me a lot to see someone and talk to them about this. I just need to believe in myself and have strength. Thanks again for writing this(:

Seth, this is the best article I’ve ever read on this subject. I probably think that because it’s the closest to my own experience that I have ever come across. Only I am going through it right now and totally in hell… but it’s so well observed and written. I hope I can back to some sense of normality like you did.
Love to you.

Thank you, Guy. I’m sorry you’re having such a hard time, but be strong and don’t give up and you’ll not only get through it but come out better than before.

Hey there Seth,

Thanks for this wonderful article. It really helps me feel a bit better. At the moment I’m having a bit of a relapse with my OCD. For some reason, whenever another schoolyear starts, the scary intrusive thoughts seem to creep back in. I’m scared for a few weeks and then the feelings and scary thoughts seem to disappear, not showing up for months and months.

But now that I look back at it, in my mind I would still have these rituals to keep my anxiety at bay. Last summer, I found a tiny bite mark on my hand and I was convinced I was bitten by a bat, they fly around the house where I live in, and was infected with rabies. I wasn’t ofcourse, but the OCD had me believe I was.

I actually managed to get rid of my OCD for quite some time by using reversal psychology. Instead of doing the rituals to prevent something from happening, I made myself believe that if I did the compulsions, something bad would happen. It actually helped me get rid of most of my compulsions.

However, at the moment I’m struggling with the Pure-O form. It happened last week. I was watching a walkthrough of a scary video game when an intrusive thought popped randomly into my head. I was thinking: ‘what if my obsessions tell me that to get rid of my fears, or if I ever wanted to find peace again, I had to harm/kill someone? It’s really difficult, writing that last sentence down.

My anxiety shot through the roof and I felt so scared. To help calm my nerves I prayed, I made myself a new ritual. That praying before I went to sleep would neutralize the thoughts and that it would mean that I would not act on impulses. It helped a little bit and I managed to get a good nights rest. But now I’m constantly thinking ‘what if, what if, what if this thought never leaves my head? What if I never get rid of this feeling?’

At the moment I feel a bit calmer since I managed to distract myself by watching funny movies. But the last couple of days I hate going to bed since I can’t really distract myself there and it takes a while for me to fall asleep. Although I am glad that I do manage to get a good few hours of sleep.

So far I managed to beat my relapses every time, although it took a few weeks. I never used medication before and I really don’t want to, but I am thinking of finally facing my problem with some therapy, because the rational part of me knows I’m wasting my time with these intrusive thoughts. My thoughts also seem to adapt to what I fear at the moment, first it was health and now it’s fear of harming someone.

I have succeeded in getting rid of thoughts I thought I would never get rid of. But when in relapse it seems so different and difficult. I’m positive I will feel better soon, but I am contemplating on getting some help with it this time after having read your article.

Thanks for writing it!


Thank you for sharing your experience, Céline. I strongly encourage you to find help from a doctor. Even if you don’t take any medication, understanding your illness and talking about it with a professional will help you immensely. A good place to start looking for professional help is

Thank you Seth, I’m not American though. I did see a doctor and now I’ve signed up for therapy in combination with medication. I’m curious and a bit nervous, because I’m tired of OCD ruling my life. Did read a couple of selfhelp books. I know how the disorder works, but my brain is being stubborn at the moment. I hope I don’t have to wait for too long for therapy to start.

This is great! I’ve had each of the obsessions you mentioned above. I was able to show my mom and girlfriend and they got it. It’s a very difficult thing to explain and you did it wonderfully. I finally starting ERP (It was suprisingly hard to find someone who could do it, I ended up finding someone via Skype). Had my first experience with it this morning… nothing like waking up and pointing a knife at yourself! The hardest part is dealing with the doubt that this is OCD. Pretty damn scary…. Anywho, what sort of ERP did you do with the original core obsession with the gun? Part of my first assignment is to look at pictures of guns 10 times a day. Easier said than done! Again, thank you for writing this. It’s a particularly horrid version of OCD.

Thanks Paul. I didn’t do any ERP related to guns because by the time I’d started treatment my obsessions had morphed to more general self-harm stuff. Though I can imagine that looking at pictures of guns must be very effective for you.

Stick with the ERP no matter how hard it seems. It’ll get easier quickly and is invaluable. Good luck!

Thanks Seth, at this point im struggling to give up on some of my compulsions. Did you develop any compulsions? Any advice on how to cut them off?

I’m not the best person to give advice on that, because compulsions have always been the lesser part of my OCD. But I found the four steps in Jeffrey Schwartz’s Brain Lock to be invaluable in overcoming my obsessions, and they’re geared to compulsions too. If you haven’t read that book, I really recommend it.

Cool, thanks. One last question… I’m finally getting ERP and getting on the right track and now im getting hit with doubt that I want to get better. Do you know if this is a common thing on the road to recovery?

I don’t have any information about how common that feeling is. But I can tell you that searching for evidence and reassurance that one’s anxieties are just OCD is VERY common. And it’s not productive to recovery. The best way to overcome any doubts is to do the work to get better.

Seth, I have this morning had a minor revelation about the whole ‘you are not your thoughts’ thing, and it broadly feels good. There is something that troubles me slightly though, and I wanted to bounce it off you for your response, if you will permit me. It’s to do with the ‘Imp of The Mind’ book. Which maybe you haven’t read all of, as you said the book actually causes you anxiety… but it is described often as a helpful text, but I have a bit of a problem with a specific part of it….
It says in the section ‘What causes bad thoughts’
“It is especially important to make a clear distinction between the bad thoughts that are the subject of this book, and the suicidal thoughts that are common in depression. If you have frequent and strong thoughts like:
Fantasizing about how you would kill yourself
Images of yourself lying in a coffin
Strong impulses to shoot yourself with a gun
Strong impulses to hang yourself
(etc etc the list continues)
Then you should take these thoughts or impulses seriously and talk to a mental health professional about them as soon as possible. These thoughts can be dangerous and are different from the type of harmless sexual , aggressive and religious bad thoughts that are the subject of this book.”

Now, I have some of the above thoughts, and I am fairly sure from your article, you did too. Or is it just the semantics of the language? ‘What is a strong urge?’ etc
I just wonder how you react to this paragraph of the book, how seriously should I take it, as I think this has currently negated the usefulness of this book to me, because I feel like it’s telling me ‘YOU DON’T HAVE OCD/ANXIETY, YOU HAVE SUICIDAL URGES THAT YOU NEED TO TAKE SERIOUSLY’.
Let me know what you think, please.

Guy, I can’t interpret that paragraph as it applies to you in particular. All I can tell you is that, if you have any concerning thoughts about self harm, you should seek help from a doctor. If you have OCD, it will be your first step to getting a handle on it. Please let me know if I can help you find one.

Well I have seen a lot of doctors and do have a professional psychotherapist, but I still have intrusive thoughts about various subjects, mostly that relate to suicide – knives, crashing my car, jumping in front of a bus etc. I know that these urges don’t make ‘sense’ to me and I’m very scared of them. I feel like I need more drastic help, but it doesn’t seem like I can convince anyone of that…

I can’t give you (or anyone) an opinion on a diagnosis. All I can suggest is that you talk to your psychotherapist again about your intrusive thoughts and how much they’re concerning you.

If, after that, your doctor is still convinced that your thoughts are OCD, I’d remind you that OCD is called “the doubting disease” for a reason. OCD sufferers, myself included, always doubt that our obsessions are just symptoms of our disease. We all have periods of fear that something else is wrong with us, that our intrusive thoughts represent reality. It can be terrifying–I know from experience–and the hardest part of the disease to overcome.

If you describe your thoughts and your feelings about them throughly to your therapist and s/he believes you have OCD, then it’s time for you to trust your doctor’s diagnosis–just as you would a doctor diagnosing your physical health–and then take the steps necessary to start getting better.

Best of luck.

I just wanted to say thank you so much for posting this. I have had a lot of different Intrusive thoughts. My first OCD attack was with suicidal thoughts which then turned into new intrusive thoughts about going crazy or having Schitzaphrenia and currently it’s about harming others. I’ve been diagnosed with an anxiety disorder. I have asked my doctor and therapist about this being OCD and they all said its my anxiety. I plan on seeing someone that knows more about OCD and who does CBT. OCD is definitely hell, and something i would never wish to anyone to have. Something that my doctor said that has helped me and may help others is “we have these intrusive thoughts that scare us and don’t fit with our morals or personality at all, but at least we are AWARE of these thoughts”, people that want to harm others, or who are crazy, or who wants to hurt themselves DONT CARE about there thoughts, they think there normal thoughts and most of the time arnt AWARE of these thoughts. We are all here for a reason to try to get answers about this horrible doubting disease and to get help because we all are AWARE of these thoughts. Trust me it took me such a long time to actually feel better with this OCD and these thoughts. My thoughts of harming others have almost been gone, and I have no more doubt. It takes time and strength. I promise there is a light at the end of the tunnel (: we are all so strong and I promise it will get better. I’m here if anyone wants to talk. Take care

Wonderful article! I am actually curious what was going through your mind when you were doing the ERP (reading articles online)? I saw somewhere that OCD almost always has a compulsion. Physical or mental and the compulsion should be avoided during ERP.

Thanks Jes. The question of whether OCD always has a compulsion seems to be somewhat controversial lately. I see more and more people referring to OCD such as mine as “pure O” OCD, meaning obsession-only. I personally think that’s a misnomer.

I definitely had compulsions, but they weren’t of a typical hand-washing, door-locking type. I sometimes call them “avoidance compulsions” — things like compulsively avoiding entering a kitchen because I was afraid I’d stab myself with a knife, or compulsively sitting on my hands in the car because I thought I was preventing myself from opening the door and jumping out.

That said, ERP doesn’t have to be related to compulsions. The point of the therapy is to cause anxiety. A person with a compulsion avoids acting on it during ERP, thereby causing anxiety. But for me, holding a knife or reading articles about suicide easily got my anxiety-producing thoughts rolling and as such were very effective therapy. Similarly, a person treating a fear of flying might be made to watch footage of airplane accidents.

I haven’t read Imp of the Mind, but that’s because I’m not particularly interested in it. Honestly, I’ve mostly forgotten about it.

Going off of SSRI isn’t a goal of mine. The medication offers a huge positive benefit with few side effects, so I have no plans to try to stop taking them. I’ve had to change my particular medication and dosage a few times, but I’m very happy with where I am right now.


You are the man! What a great entry. Did you have any clue that something you wrote years ago would still help people? I bet that feels great.

I stumbled on this post randomly, after reading about BMX legend Dave Mirra committing suicide. Just reading about it spiked my anxiety about suicide. Something I have been especially afraid of. I’m in the recovery phase of having anxiety about having anxiety. But I had NEVER had professional help mention anything about OCD. Your post rang true to how it all works for me. I was relating to most of your types of OCD you experienced and was basically just amazed I hadn’t considered OCD, or heard OCD mentioned to me with how i analyze things. Too damn funny.

So THANK YOU. For helping bring awareness. For being truthful and open. For making the world a better place. Random internet guy, you rock.

Thanks man.

After reading your post, I just kind of laugh at how anxious i was getting about suicide, much like how you use to. Just dust in the wind.

I too have suicidal OCD and harm OCD. I have had this for about 35 years now. I’ve actually had periods of years straight without any symptoms at all. But the last 2 years have been horrible. It just goes on and on. First it started again with the Boston Marathon Bombing as harm OCD. I felt like I was right back where I was 30 years ago. I started to feel better. Then came the suicide of Robin Williams. That hugely impacted me and made my suicidal OCD spike like never before. And we have had people in our community that have committed suicide over the past year and my exposure to that makes it all come back with a vengence. I can’t separate why they would do this and I wouldn’t. Unfortunately my doctor isn’t back for a month so I will have to wait until then. I have been seeing him for over 20 years and I feel like I have so much trust in what he tells me. The one thing he has never mentioned is exposure therapy. I don’t even know if I could do this as just the word suicide (which is even hard for me to type at this moment) causes so much anxiety.

Your article is great by the way. I don’t usually look things up online about OCD as it usually causes more anxiety. Like having OCD about OCD if you know what I mean.

Any thoughts on how to handle these intrusive thoughts until my doctor returns??

Thank you

Kelly, I’m sorry to hear that you’re having such a hard time. I know how difficult it can be. I’d suggest reading Brain Lock and learning the techniques it describes. It’s very quick to read, and the CBT is easy to understand. I found it immeasurably helpful.

If you talk to your doctor about exposure therapy and he decides it’s right for you, I’d strongly encourage you to try it despite your fears. It’s very, very hard at first, but the results if you stick to it are far worth the effort.

Best of luck.

I was so relieved when I ran into your article, 3 years after it first came out, because it meant I wasn’t alone! While anxiety runs in my family, it hadn’t affected me until I ran into some health problems. Then the anxiety came with a vengeance. This past year has been so hard for me, largely because I seem to obsessively return again and again to the same set of fears, including, but not exclusive to self harm (an idea which popped up on me completely out of the blue, but likely was rooted in my mind because it was something a close friend went through). It’s hard for me even admitting having such thoughts and fears because it would be so nice to pretend I didn’t , but reading this article was exactly what I needed because I hadn’t even thought of OCD as something affecting me. Having read your article, and relating so much, I’m now convinced that it is. Like many others have commented, I often return to the thought “if it has happened to others, why wouldn’t it happen to me?” and struggle to rationalize the difference. I am now actively seeking the help of a therapist/psychiatrist but I just wanted to reiterate that I was so relived to see your writing and sharing your experience, and appreciate the courage it took for you to publish this. I hope to be at that point someday! Is there any advice that you have with starting and effectively using CBT? It’s something I’d really like to try out.
Thank you, and all the best!

Best of luck with your treatment, Teresa. If your doctor or therapist decides that CBT is right for you, the only advice I can give is to stick with it no matter how difficult it can be. The CBT I’ve done is very hard at first, and the instinct is to quit. You have to persevere and remember that it’s supposed to be hard — that’s why it works. Best of luck.

Easily the best thing I’ve read about Harm OCD anywhere, and I’ve read a ton. I’ve had mine since I was about 14 (I’m now 42) and I can go for years and years with mild or no symptoms. The past few months I’ve had a bad flare up and am in therapy and will start CBT/ERP soon, too. I’m also switching medications, although now that I’m older I want to rely less on meds and more on techniques. Anyways, I identify very much with your story Seth and with many posters here. The doubts, the fears, the anxiety, the constant mental questions, the ruminations, the constant “what ifs” .. I’ve been through them all. One thing I’ll add is that for me life’s uncertainties and/or huge life changes are always at the root of these flare-ups. I had one around college graduation, one when I was about 30, and now this time I’m 42 with a new kid and a new job. Not a coincidence. This knowledge doesn’t always make it easier but knowing there are other people out there with this does help, as does knowing that people are able to live great lives despite having OCD. What’s tricky about OCD is it tries to make you think you’re beyond help, which would almost be laughably funny if it weren’t so damn terrible. Anyways, point being, don’t give up. Ever. Peace everyone.

Omg I want to cry reading this, I know this is an old article , but It describes exactly how I feel , I never knew I had OCD, but now that I realize it I did have it since I was a child. I would get depressed just thinking about death and I would start getting panic attacks it started out of no where I did not enjoy the things I would normally with my family because in my head I was like ” what is the point we are all going to die” “Why am I at work working my butt off if I am just living to die” etc… I spend almost 2 week in my room crying , didn’t want anyone to leave me alone because I was scared I was going to harm myself, but deep down inside I didn’t want to it. I would say to myself ” I will call 911 and have them send me to a crazy home before I do something” I just started taking Zoloft almost 3 weeks ago and it has helped me a little, but I don’t want to depend on the medication so I am looking articles online to help with strategies to defeating this evil :) Thank you for your story! I know it will take time but day by day I will get better , at least it helps me knowing I am not insane lol ( well not that much :) )