Why "71º & Sunny?"

I consider 71º to be the perfect temperature. Not too cold and not too hot. I also love perfect sunny days. The vast majority of days are not 71º & Sunny and yet, all days were created by God's hand and they are still gifts, even if they don't fit my ridiculous definition of perfection. My struggle with OCD has at times imprisoned me in an impossible attempt to achieve perfection. I'm now learning to love all kinds of days that don't even come close to 71º & Sunny.

Please leave me a comment below. I really want to know what you are thinking!

Wednesday, August 12, 2015

Worry vs. GAD vs. OCD

Another wonderful session that I attended at the IOCDF Annual Conference was led by Martin N. Seif, Ph.D., who is the co-founder of the Anxiety and Depression Association of America. Dr. Seif was a great speaker and he kept us entertained with his witty commentary while sharing some really good material. I thoroughly enjoyed his very informative presentation. Specifically, it was titled, "Worry and Subtle Forms of OCD: When Rational Refutation, Problem Solving, Stress Management, and Coping Skills are Counterproductive."

Dr. Seif's talk gave me a lot to think about, both in regard to OCD, but also in regard to my struggles with Generalized Anxiety Disorder (GAD). Though, to the best of my knowledge, I have never been officially diagnosed with GAD, I'm 1000% positive that I have it. As Dr. Seif put it, there is a continuum of GAD to OCD, where GAD worries are ordinary in content (but overblown), and OCD worries are irrational and can even become quite bizarre. I've often wondered if everyone with OCD might also have GAD. If you tend to worry about bizarre, irrational things, doesn't it follow suit that you would also be worried about normal, every day kinds of things too? If I understood this talk correctly, I think worry looks like the continuum below:


<____________________________________________________________>
  Regular worry (ordinary content)   GAD (ordinary content)            OCD (irrational/bizarre content)
   Husband's serious illness              Husband's serious illness                                   hit a person
   Ability to pay bills                        Abilty to pay bills                                         I will be arrested
   My child's future/safety                My child's future/safety            My germs will make others sick
                                                           
My worries toward the left and center of the continuum are ordinary type worries, which most people have. And notice that the worry contents are the same for regular worry and GAD. However, they turn into GAD for me, because my mind tends to blow them up and I do obsess about them. (And I found out, I tend to perform compulsions too.)

Something important to note is that not all worry is neurotic. According to Dr. Seif, (roughly quoting) "if a plan is created and the 'what if' thought is put to rest, then that is productive worry." (That is the worry at the far left of the continuum.) Unhealthy worry is worry that is toxic, and it keeps repeating itself and does not go away. So if I am worried about something of normal content, but after I've done some decent research and put a plan together, but I keep thinking, "Well, what if this happens or what if that happens?" and I can't let the subject drop, I have probably entered the territory of toxic worry. Hmmm . . . almost sounds like OCD. Also, like OCD, the content of the worry (if it is the toxic type) does not matter. Apparently, it is almost never helpful to spend time analyzing the content of toxic worries. Again, that sounds remarkably like OCD.

Ironically, like OCD, GAD and unhealthy worry can have compulsive-like behavior that accompanies it. Believe it or not, even some standard coping skills like "thinking positive thoughts" can become compulsive if they are repeatedly used over and over again in order to lower anxiety. The key here is repetition. Avoidance could certainly be a compulsion here as well. I suspect that rumination and reassurance seeking (in all its forms - whether it is asking others, or over-researching a subject, etc.) may be compulsions, again, if done repetitively.  I suppose making elaborate plans over and over in your mind (like I often do!) in order to deal with or prevent a feared worry from coming true might also be compulsive. Of course, if it is compulsive, any relief would be short lived and would not stop the anxiety. That "what if" would still be present. That is probably the key to identifying unhealthy worry or anxiety.

So how to deal with worry? First I think we need to recognize it. Apparently, worry is thinking, not feeling. I sure often mistake it for feeling. I know I really need to recognize that. Dr. Seif said that we shouldn't engage with the content. The thought will be there, but we don't need to respond to it. In fact, he likened the worry thoughts to having a rude comment yelled at us by a stranger while we are walking down the street. What's the best way to handle that? Well, you hear the comment and of course, you internally acknowledge it and it might be initially upsetting, but it's probably best to not dignify the comment with any type of response, and to just keep on walking. Just like OCD, we need to learn to sit with and tolerate the unpleasant thoughts/feelings.

Interestingly, the treatment sounds awfully similar to the treatment for OCD. It seems to me that the biggest differences between these illnesses are the content of the anxiety producing thoughts, and perhaps the difference in the types of compulsions? From what I can tell, people with GAD (who do not have co-morbid OCD) don't seem to have irrational compulsions like people with OCD do, such as excessive hand washing, or counting, or re-checking things over and over. I don't know, maybe they do? I'm speculating here, but it's almost as if the more irrational the thoughts, the more irrational the compulsions. Just thinking out loud . . .

This workshop was very eye opening to me, as it answered questions that I had had for years. I knew that GAD was similar in a way, but I did not understand just how similar. Ultimately the goal is the same in either disorder - I need to learn to tolerate uncertainty.

11 comments:

  1. Hi Monique! I also have OCD and GAD. I love the analogy Dr. Seif used about someone yelling a rude comment to you. You hear it, it's there, but you just keep going. I feel that way about my worry and OCD at this time in my life. I have gotten a lot of help, but when I have a worry (most of the time), I acknowledge it came into my mind. I also think that is so important because than you can decided how to deal with it. I have gotten good at recognizing it and then telling it to buzz off (in my mind of course), just like I would that rude person and then keep on keeping on. Thanks for sharing! Love your post!

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    1. Hey Holly! Oh I'm so glad you liked the post! I loved that analogy too and thought it was quite helpful. I was taking notes like crazy in that session because so much of what he shared was really great. Wish they had the OCD Conference like once a month!

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  2. To me (or maybe I should say, for me), the GAD compulsion is the rumination, the over and over and over again with the what ifs. Definitely overlaps with OCD, but many times the GAD can be even worse for me.

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    1. GAD is no joke. And I definitely have times when it is worse too. Though so many of my symptoms overlap between GAD and OCD it can be hard to tell the difference. Although, I have to learn to tolerate uncertainty in either case anyway. Rumination is a big one for me too. Dr. Seif didn't list out GAD compulsions, so a lot of that is sort of supposition on my part.

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  3. Um, i think i do treat my anxiety issues like i would the comment of a rude stranger; i go over it and over it and try to understand it and figure out if i should have done something different and what i should do next time... Although i know that's not what he meant. :) In the thick of ocd, though, it seems quite rational. And how many signs out there tell us to wash our hands so we won't spread germs? Granted, washing hands to offset a "dirty" thought is less logical... My counselor tells me i have GAD, but my psychiatrist has not specifically told me i had GAD, though perhaps has referred to other, non-OCD anxieties that i have. Also, anxiety still feels like a feeling or physical response, because if i had no feeling or reaction to a thought, it wouldn't be anxiety... So I'm confused there... Wish i had been to the conference. Thanks for sharing part of it with us.

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    1. Ha ha ha yes, Abigail I do the EXACT same thing! Oh and I absolutely hate those stupid hand washing signs too. Ughhhhhh. But there is a percentage of the population that does not wash their hands after using the restroom (eeew) and I have seen this with my own horrified eyes, and I suspect that those signs are directed more to people who don't wash their hands as a regular practice.

      Good point/question about the "worry as thought" thing. I *think* what Dr. Seif means is that worry as a function of us purposefully ruminating over the situation again and again is us *thinking* vs. us just feeling the anxiety over the situation and learning to just sit with and tolerate the uncomfortable feelings. If I recall correctly, he did say something about worrying causing anxiety. And if I understood that correctly, then it is just like any other compulsion that adds to our overall anxiety in that, rather than minimizing anxiety, like we hope it will, it only increases it. I'll admit that I'm a wee bit confused on that myself. But he absolutely did say that "worry is thinking and not feeling" because I took direct notes. Still trying to work though that one too. Thanks for your comments. Very thought provoking.

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  4. Hi Monique,
    A couple months ago, I got really scared that maybe I had a GAD too and just everything else also. So, one day while my coach and me were driving to an exposure sight, I flat out asked him if I had it and he said no, explaining to me that GAD is more on the spectrum of obsessive worry where people can become paralyzed by not being able to function over things like what to wear in the morning or what to eat...so to me, it sounded like normal worries and other things that become magnified. I asked because I worry constantly about my future being in my twenties, but I think that is actually normal.
    To me, it doesn't seem like compulsive thoughts are always a bad thing....I mean, for social anxiety people have phrases that they say, even people with OCD have compulsions (phrases) to get them through situations, or at least I have. So positive affirmation/reassurance for someone using compulsions such as those to reframe their mindset doesn't seem like a bad thing. Just thinking from a different angle here.
    This sounds like an interesting seminar, though! Hope you enjoy the last week of summer, Monique.
    Xoxo

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    1. Hey there C! I'm sure that was a big relief to you to find out that you did not have GAD. You've certainly come a long way in your treatment and I know you have worked really hard. Yeah, the whole conference was really interesting and I'm glad I got an opportunity to go once again. So so happy for you and all your progress!!!

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    2. Oh and ughhhhhhhh. I posted a decent sized comment on your blog after your last post and when I hit publish, poof, it just disappeared!!! I need to go back and repost. : )

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  5. Interesting read. I was actually discussing this yesterday with my therapist, I was telling him I can't tease apart my GAD and OCD and he said it's because my scrupulosity gets in the way HAHA. He told me that GAD is rumination with no compulsions and OCS is the obsessions with compulsions. It's confusing but ruminating is just going over and over the worst case scenario (which I do).

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    1. Ah yes, the ruminating. I do plenty of that too, unfortunately. And yes, I also struggle with figuring out what is OCD and what is GAD. But, in either case, I feel like the the big thing is to learn to live with and tolerate risk and uncertainty. (Um, still working on that!!!) Always really good to hear from you Elizabeth, and I hope you are doing well.

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