I Think It Moved(cont)
Is my pain a result of having OCD or discovering I'm gay?
Ultimately, in the course of treatment, the most threatening question a person with OCD has to deal with is, "Do I indeed have OCD or is the distress and panic I am experiencing a manifestation of what one would naturally go through when one is ‘coming out’ as a homosexual?" In the hierarchy this ultimately becomes the last barrier to clinical success. There is no way to give a definite answer to the question as to the potential of the validity of this question. Ultimately, one faces the opportunity to choose whether they are willing to engage in the therapeutic process and accept the risk that they may be missing out on what might actually be going on in their sex life. Since OCD's main motivator is anxiety-based, there is generally very little confusion on the part of the experienced clinician as to whether the presenting problem is just another spike or a coming out crisis. The terror experienced at having to get the answer to the overriding question "Am I gay?" is a clear signal that homosexuality is not in the offering.
The old backdoor spike
A common phenomena associated with therapeutic success is an experience I refer to as the "backdoor spike." A backdoor spike is the threat which emanates out of no longer experiencing anxiety in association with the ambiguous question. For most OCD sufferers, getting anxious is a bit of a reassurance that something is amiss. "How do I know that I have OCD and I'm not really gay? Because the mere question makes me so anxious." Therefore, when someone reaches their therapeutic goals and no longer experiences anxiety in association with the spike, the threat that the question might be real, without producing anxiety, becomes a whole new spike. In other words, patients then become anxious because they are no longer anxious. "I saw my roommate in his/her underwear the other day… Oh My God… since I didn't experience any anxiety does that mean I looked because I was really interested?!?"
Close, but no cigar
There are at least two spike themes which closely approximate the sexual orientation question. One is the rare spike that "my partner may be gay, and I just need to know". Although rare, I have worked with a very few individuals who have spent many a sleepless night pondering the endless data available which might shed light on answering, with certainty, their partner's sexual orientation. I am sure that a recent book just on this topic about a woman whose husband left her and the kids will make this spike theme more predominant. The other more common concern is that "I may be a child molester or sexual deviant since when I see little kids or they play on my lap, I feel a definite tingling sensation from my groin." The existence of this actual physical sensation in the groin region (groinal response) spawns a dogged belief that the proof of the perversion exists in the definite experience located "down there."
How do I know this is the one for me?
Or Is this Mr. Right or Mr. Right-now?!"
An associated feature, but entirely different spike, for those with OCD in committed relationships, is the inability to clearly discern the emotional rationale for remaining in a relationship, despite the absence of a clear justification. A large number of persons who spike about their sexual orientation and who are also in a long-term intimate relationship will often attempt to prove whether their level of attachment to their partner is sufficient. For gay-spikers, it is not uncommon that the relationship-justification spike exists within the diversity of their spike menu. Persons whose spike theme entails substantiating their relationship, often rely on measurements of their emotional intensity as a justification for whether or not they should actually be in the relationship. Persons with this spike theme will also endlessly analyze what they or society believe to be the "correct" qualities which make up a meaningful relationship. The majority of persons with this spike theme focus on justifying their emotional intensity for a romantic interest. In addition, the adequacy of one's feelings for children, parents, and even God, can fall under the emotional microscope within this form of OCD.
Reading One's Own Emotional Scale
When a person with this spike theme makes an effort to use emotional reactivity, to justify his or her own level of commitment, the most common outcome is to feel either nothing or just anxiety. During intimate moments where the OCD sufferer finds that he or she happens to be experiencing fulfillment with his or her partner, a spike often accompanies this realization and the experience of stimulation evaporates. Attempting to critically analyze one's level of arousal has the predictable and paradoxical effect of removing the original experience. Sexually speaking, erections are lost and lubrication evaporates when focus is placed on the need to maintain arousal to prove that one's physical signals clearly signify that one is with the "right" person. Ultimately, there is no proof or test as to one's justification for being in a relationship. The infinite variables which persons justify remaining in a relationship are too complex to develop a model, which can be used to reliably guide ourselves or others. Consequently, we are left with the notion of the "unjustified choice" to either remain in, or to terminate the relationship. This phrase implies that one chooses to be determined and committed to another person. One can not conceptualize through endless ruminations the reasons for ending a relationship or justify remaining in one. Hence the phrase "There are no answers, only choices!"
Finding My One and Only
All OCD sufferers possess a driving force to prove that their own particular risk is not justified. Most persons with OCD will readily admit that they are painfully aware that the nature of what they spike about is irrational. Amongst persons with relationship justification spikes, there tends to be much less clarity about the irrational nature of their particular concern. This is in large part due to western society's romantic notions about what being in a relationship entails. Our fairy tales and popular media present all-loving relationships as being endlessly earth moving, firework events. There is very little mention that being with the same person over a long period of time tends to create a habituated effect, such that we actually get our appetite back and do find that there may be at least one other person on this planet whom we also find attractive.
Persons with relationship spikes in general, seem substantially more perfectionistic in their actual life philosophy then the general OCD population at large. This perfectionistic tendency leads to the belief that the answers to some basic questions will ultimately prove whether one is with the correct person. Examples of questions include: "Do I love him?," "Is she right for me," "Isn't it reasonable to assume that I could find someone just as good, but who doesn’t leave the toilet seat up?" If perfectionism seems to be a life theme, then one might consider reading the article "The Right Stuff" from the web site, (WWW.OCDOnline.com).
The mind of the OCD sufferer is so desperate for a conclusion that one cannot casually gaze at one's partner for affirmation of one's feelings. In the overall attempt to find the rational for remaining in the relationship, the mind acts like a high powered microscope and general experiences of satisfaction are replaced by a focus on minute details. Persons with this spike theme will often intently focus on minutia defects within their partner, such as the thickness of one’s partners eyebrows or the excessive dryness of their partners skin. Questions might even arise regarding one’s own laugh intensity in attempting to ascertain whether a response to the joke was a sufficient reply to their partner's humor. "Oh, my god! If I don't think he's funny enough what am I doing with him?!" Feelings of satisfaction and happiness occur naturally in the course of the relationship as long as one does not actively seek them out in an effort to get a definite answer. As a result, a relationship spiker's emotional connectedness can only be experienced in his or her psychological periphery.
Absence makes the heart grow fonder
The aftermath of this desperate need to measure the emotional intensity of a person’s commitment can greatly disturb a person’s choice to remain in the relationship. Relationships can be like a revolving door when persons end their commitments in an effort to turn off the endless cycle of mental anguish. A constant temptation for the relationship spiker is to see what peace they would experience if they would just break up with their partner. Generally, persons with this spike theme believe that their ruminations indicate that a fundamental defect exists within the relationship. On the contrary, the vast majority of these relationships function in an exceptionally healthy way. This tendency explains why many significant others remain devoted despite their partner's constant doubts. The choice to get married despite ones mental anguish is occasionally made to put an end to the uncertainty. The rational being that since I have taken the plunge, the nagging question is brought to a close. Unfortunately, neither marriage or separation really brings an end to the toil. This explains why a number of patients have initiated therapy up to five years after they have ended the relationship and are still trying to bring a close to justifying that the final choice was the correct one.
The saying "absence makes the heart grow fonder" is apropos. Usually, when one follows through with the urge to break away, the realization of what has been lost comes back with a vengeance. Persons with this form of OCD who have ended relationships often incessantly ruminate about whether the choice was justified. After the relationship has ended, the mind becomes very selectively focused on only the positive memories and tends to disqualify the negative times. The natural discord associated with getting "the answer" in regard to whether to be in the relationship is tremendous. When OCD is involved, the magnitude of this discord is amplified to the point of torment. Persons who, in their reasonable mind, are aware that the relationship is truly over, can still spend hours pondering whether or not it might still be worthwhile making one more attempt to salvage it. When this element of obsession is present the natural healing effects of time tend to be eliminated.
There Must Be Fifty Reasons to Leave Your Lover
The most common justification for persons considering the termination of basically good relationships is the absence of the anticipated emotional longing and desire when they are both with and without their partner. In the absence of these feelings, individuals interpret their experience (i.e. anxiety, depersonalization, derealization, etc.) as uncomfortable emptiness. The disorder offers a compelling promise of relief, if one were to merely end the relationship. A common position taken amongst persons with this spike theme is that "It seems only reasonable that since everyone else gets to 'feel' love for a partner, I should be able to do the same." Persons often contemplate and occasionally dabble in the effort to establish whether they would feel different if they were with someone else.
There are a number of other common rationales that persons focus on which keep the endless desperate cycle spinning. The belief in a "singular soul mate" can promote an intense scrutiny of having to feel that the person they are with is compatible with them in every way. Minor differences, which in any other relationship would easily be absorbed into the natural diversity of relationships in general, become extreme points of contention. For example, "If I don't fully appreciate my partners sense of humor, then wouldn't I be better off finding someone who was just like my partner, but whose sense of humor I could appreciate more?" Another common misconception is that, "If I can find someone else attractive, that might mean that my partner and I were not 'meant to be' or I'm not sufficiently attracted to her." Being aware that one can still find others attractive at any point in a healthy relationship is an important basis to operate from. Believing that one's soul mate should be perfectly compatible in every way, and/or uniquely and completely attractive, results in endless doubts and insecurities about the person being your "true" soul mate.
One possible reason for the prevalence of this spike theme is the common notion in society that one should "feel" in love with their partner. Being guided by one's "true feelings" is a popular romantic notion which plays itself out in a variety of media venues. The author M. Scott Peck wrote in the book The Road Less Traveled that a committed love is one based on the conscious effort to prioritize one’s partner and make CHOICES which demonstrate one’s level of commitment. He emphasized that romantic love, in contrast, is an attachment based on an intensity of an overwhelming experience. Many persons in long-term relationships will end the relationship due to no longer feeling prior levels of emotional intensity. Often the statement "I love you, but I'm not IN LOVE with you," becomes a justification for the end of the relationship.
Living In the Choice
The treatment strategies with this form of OCD shares many similarities to the treatment previously outlined regarding the sexual orientation spike. A gradual acceptance of living with uncertainty, and choosing to be willing to be resilient to the pain of not having a definitive answer, are paramount features of these treatments. A frequently expressed phrase which captures the essence of the therapeutic goal is expressed in the question: "Are you living in the choice or the experience?" Living in the experience implies using one’s feeling to gain insight into the justification of continuing. For persons with this type of OCD, living in the experience perpetuates the endless cycle of seeking emotional justification to derive a conclusion about the worthwhileness of continuing in the relationship. Living in the "choice" captures the essence of accepting that, with this spike, I can ultimately make an unjustified choice about living with this person and accepting the uncertainty regarding the relationship being "real." I often request that patients inquire within themselves whether they would be willing to remain within their relationships, through merely making a choice to continue their commitment, rather then needing the prerequisite feelings to justify their choice. Aggressively bringing on and facing the spike, rather then passively awaiting its intrusion, are strongly encouraged. A common therapeutic home-based challenge might entail carrying in one's pocket a stack of ten index cards. Each index card lists a separate rationale for ending one’s relationship. While reviewing each card ten times a day the patient rates the level of intensity that each spike presents. Second, the person then marks down, next to the first number, a number which represents the level of resistance that they are choosing to offer the spike theme. This second number is extremely important and generally represents the foundation of this entire therapy. Basically, the less resistance one has to any spike theme, the greater the chance of, habituation (i.e. getting used to the spike and not being emotionally responsive to it). Through the daily repetitiousness of choosing to expose one's self to these ideas, habituation can set in and the unsettling reminders become neutralized. Being willing to let go of all the sound justifications, which society strongly promotes in regard to "going with your true feelings," is of paramount importance.
The traditional behavioral treatment would proceed as follows: First a hierarchy is established related to a stepwise list of threatening ideas associated with remaining with one’s partner. This list might include items which represent flaws or potential shortcomings within one's partner which might justify not being in the relationship. Perhaps carrying around a picture of ones partner which portrays the person in a unflattering light would help expose the OCD sufferer to the question of not feeling enough love to remain in the relationship. Making the choice to do such a counter-intuitive act also help might instill the principle of being proactive, rather then a victim of these thoughts.
With this spike theme, engaging in sexual relations often plays a large role in the creation of spikes and self-consciousness. It is therefore encouraged that persons with this spike theme focus entirely on providing one's partner with pleasure and do not attempt to ascertain whether their body is reacting in a reassuring way. With many secure relationships, a heirchacy can be established involving a progression of behaviorally intimate acts which purposely expose the OCD sufferer to increasing questions pertaining to ones expected level of arousal. Using a lightness and humor in starting with a gentle kiss and having the non-OCD partner ask "So babe, how was that for you? Did you feel the earth move?" might be an effective beginning item to utilize. The heirchacy might progress up to greater levels of sexual activity, whereby the affected partner purposely tries to not respond in a sexually aroused way. "I'd rather have a dead fish on my neck then your lips". Well… you get the picture…
I often inform persons who contact me, that the gay spike is my favorite. The reason for this is that you can be creative and adventurous in working up the treatment hierarchy. The therapeutic success rate with this spike is also very high. I hope this exceedingly long article has shed a significant amount of light on the unique nature of these two spike themes. Specifically, and in conclusion, these spike themes are easily mistaken for "real life" issues, and the answers to these spike questions in society are thought to be obtained, mistakenly, through one's experience. However, let it be known that a reliable and effective treatment is available to treat these issues.