Question: Dr. Steven, my name is Alejandra and I haven currently started seeing a therapist for obsessive thoughts, anxiety and rumination. I have been told by the therapist that I show ocd tendencies. I believe I have Pure-O ocd because all of my obsession are mental. They range from obsessing over an underlying illness that I may have, to doubting my love for my partner, to questioning my sexuality-regardless of a completely heterosexual past/present, to the latest thing that has crossed my mind, fear of attraction to my own brother. It is horrible and these feelings make me feel extremely upset with myself and I believe along with the ocd/anxiety, there is mild depression. Yesterday, I had a good day, but today has been a setback. I am emailing you because ultimately, one of the most important things to me is my relationship with my boyfriend. He is so wonderful and when I am not doubting everything, I come to acknowledge how deep my love and affection for him is. My biggest fear I guess, is losing him to the ocd/anxiety. I lack hope and faith lately, which may be because of the depression. I know I am seeking reassurance, and I know that reassurance backfires... But I need some hope. Some motivation/advice/anything. I want to feel good, how I felt yesterday. And I want to feel secure with what I know I want and who I know that I am, without doubting every single thing. Help me keep my relationship/my sense if self. My boyfriend has always been there for me, and he brings out the best in me. I no longer want to be plagued with questions and "what if's."

Dr. Steven Brodsky Says...:

Dear Alejandro:

I'm sorry to hear of your plight.  This advice does not constitute

treatment and I wouldn't want to diagnose someone by email. However,

the symptoms you describe (reassurance seeking, repeating, testing, checking, endless internet research, etc.) are typical among the OCD sufferers I treat

in my practice. OCD can take literally thousands of different forms as

unique as the individual, not just the ones you read about. OCD is an

anxiety condition in which the sufferer has unwanted thoughts or

worries and feels compelled to get rid of the thought by either an

action, avoiding certain situations, or by mentally reassuring

themselves (or asking others to reassure them) that their worry is

irrational. None of these measures works and, in fact, only make the

worry worse in the long run. OCD does not mean you are going crazy, it

is simply an anxiety condition and nothing more. About 6 million people

suffer from OCD in the U.S. alone.

The good news is that OCD is very treatable, and medication might not

be needed indefinitely, if at all. Hundreds of studies support that the

most effective treatment for OCD is "exposure response prevention"

(ERP), which is a special type of behavior therapy designed

specifically for OCD. ERP is the only treatment endorsed by the

Obsessive Compulsive Foundation. ERP enables sufferers to very

gradually overcome their fears and let go of their compulsions at a

pace with which they feel comfortable, so they are never overwhelmed.

Results are achieved in a matter of months not years. ERP is more

effective than medication, therapy and medication combined, or any

other kind of therapy. Medication provides only temporary or partial

relief and has side effects; symptoms just come back when you end the

medication. ERP provides permanent relief, essentially eliminating OCD

forever.

Most of my clients benefit from ERP alone with no medication. If

someone is on medication already, however, I recommend staying on it

until therapy is complete and then gradually reduce and eliminate

medication while continuing the therapy for another several weeks or

months to assure that symptoms don't return.

There are about a dozen medications used for OCD. The most popular are Luvox, Zoloft, Lexepro,

Celexa, Prozac, Zoloft, Effexor, and Anafranil, which is an older

medication, and many other medications.

One very helpful book on OCD is written by my former client, Linda

Maran, and is called "Confronting the Bully Of OCD," which describes

her therapy with me. It's a wonderful success story written from the

perspective of a former OCD sufferer who overcame it. Two helpful books

written by professionals are "Stop Obsessing" by Edna Foa and "When

Once Is Not Enough" by Gail Steketee. The movie "As Good As It Gets"

with Jack Nicholson is a depiction of an OCD sufferer, although aspects

of it are inaccurate.

I don’t know where you live. I practice in mid-town Manhattan (34th St.

5th Ave.), northern New Jersey (near the GWB), and Rockland (near the

Tappan Zee), and would be happy to arrange an appointment

at 212-726-2390. If you live outside of the New York metropolitan area,

you can find a local therapist by contacting the Obsessive Compulsive

Foundation (www.ocfoundation.org) or the Association For Behavior and

Cognitive Therapies (www.abct.org), or the NJ OC Foundation

(www.njocf.org) or Central (Upstate) NY OC Foundation at

(http://www.cnyocf.org/Providers_List.htm). Check them for an OCD

specialist in your area. Please note, by "local" and "your area" I mean

within a 2 hour trip, so be flexible about how far you'll look; trust

me it's worth the trip. If they don't have someone in your area, ask

them if they know of a similar organization in your region that could

make a referral to you. Such organizations would have words such as

"OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. For

those with limited funds, the most affordable option is some large

prestigious hospitals associated with a medical schools have clinics

with low fees that accept insurance and Medicaid/Medicare with words

such as "Anxiety," "Depression," "Fear and Phobia," or the above terms

in it's title. Usually the therapists in these hospital clinics are

junior therapists-in-training--such as psychology graduate students or

medical students--but they are supervised by very experienced licensed

professionals. Once you get names of therapists, you have to call and

interview the therapists by phone.

If you are considering another therapist, there are TWO "TEST

QUESTIONS" you must ask them before you make an appointment: (1) Is ERP

the main technique they use? If they don't, forget about using them.

And (2) How many people have they SUCCESSFULLY treated FOR OCD? They

should have treated at least a dozen people (a few dozen in

metropolitan areas), the people should not longer have obsessions or

compulsions or should not be taking medication any more. They should

NOT say they just helped people "live with" their OCD better.

Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVER

BEFORE due to a new law, called Timothy's law, that went into effect in

2007. Although I am out of network, as are all private specialists

competent to treat OCD, the new law mandates all insurance companies to

cover treatment for OCD (which they term a "biological condition") at a

higher rate (as much as 70%) and usually for more or unlimited

sessions. So whether or not the therapist is in-network doesn't make as

big a difference as it used to. In fact, even with HMOs, if you can't

find and ERP specialist within network they are required to cover them

out of network.

If you can't find anyone in your area, I offer phone

sessions for those outside of the New York Metropolitan area. It's not

ideal, but it's a lot better than going to someone who is not an expert

on OCD. I can be reached at 212-726-2390.

By the way, would you mind emailing me back to tell me how you found my

website? Was it through a link off another website or through a keyword

search, and, if so, which keywords and on which search engine? Your

feedback will help me make this information more accessible to other

people. If you found this information helpful and would like others to

benefit from it, please consider providing a very brief rating of my

services at Health Grades (about 10 seconds)

at http://tinyurl.com/GradeDr-Brodsky. Or consider providing a brief

review to Angie’s List at http://tinyurl.com/RateDrBrodsky or call in a

review at 888-888-5478 (one word is sufficient).

I hope this information has been helpful. I only want to ensure you get

the right kind of treatment, regardless of whether that is from me or

someone else.  May I only hear good news from you in the future!

Sincerely,

Dr. Brodsky

Question: I have panic attacks and bad social phobia and I am addicted to valium and marijuana and I just found I am pregnant. I am probably about 7 weeks pregnant and I have been using my normal 60mgs a day the whole time and also smoking 5 or 6 joints every day. This pregnancy is accidental but abortion is not an option I would EVER consider. I know I need to tell a doctor about this but I am so scared at the thought of giving up the valium. I have tried before and it is HELL on EARTH when I try to stop. I do not have a doctor right now. I just took the pregnancy test this evening and I am still in shock. Have I done any damage to my baby yet from the marijuana and valium and will I have to stop valium all of a sudden or will I have to taper down? If I have to taper do you know how quickly I will have to do this. I am very scared at the idea of withdrawals because when I stopped completely a year ago I felt like I was going to die but I want to do the right thing.

Dr. Steven Brodsky Says...:

I think I can help  you, but I need more information in order to advise you best.  Please answer each of the following questions one at a time:

1.  Can you  please tell me when and in which situations you feel anxiety (or avoid or overcompensate) the MOST and in which situations you feel anxious the LEAST.

2.  Please revisit my websites at www.ocdhotline.com  and www.anxietyhotline.com and check the  symptom lists and self-tests and tell me whether the problem you are seeking  help with is OCD, social anxiety, agoraphobia/panic, or  PTSD. 

3.  Do you experience  anxiety or avoid traveling alone to faraway or new places, enclosed spaces that  you can't exit (subways, elevators, planes, bridges, expressways, etc.), being  in the middle of a crowd or a full theater, or big deserted spaces (empty malls,  deserted park), or being alone in your home?

4.  Do you frequently look for exits or  escape routes from situations, or do you ever depend upon a "safe" person(s) to  accompany your.

5.  Do you have bothersome thoughts or worries that you can't stop and feel a need to keep checking, getting reassurance, or avoiding situations.

6.  Do you experience discomfort in or avoid certain social situations or presentations, or do you work very hard to  overcompensate in social situations?

7.  Do you have flashbacks, as if you're  really living in a past traumatic situation, have a "startle response" to sudden  noises, or feel as if people are trying to harm you.

I look forward to  hearing back from you.  Please also tell me where you live or work.

Thank  you.

Sincerely,

Dr.  Brodsky

Question: I have OCD. A friend told me to check out something called the Mary Reed protocol. Basically she believes that OCD is caused by thin myelin covering nerve endings. According to this protocol, a specific program of foods and supplements are used to repair the myelin and to detox and improve liver and intestinal functioning and from what I have read it really seems to be helping a lot of people. I would like to get an expert’s perspective on this protocol. Is this something that makes any sense to a professional? Would you recommend its use?

Dr. Steven Brodsky Says...:

I'm sorry to hear of your plight. This advice does not constitute treatment and I wouldn't want to diagnose someone by email. However, the symptoms you describe are typical among the OCD sufferers I treat in my practice. OCD can take literally thousands of different forms as unique as the individual, not just the ones you read about. OCD is an anxiety condition in which the sufferer has unwanted thoughts or worries and feels compelled to get rid of the thought by either an action, avoiding certain situations, or by mentally reassuring themselves (or asking others to reassure them) that their worry is irrational. None of these measures works and, in fact, only make the worry worse in the long run. OCD does not mean you are going crazy, it is simply an anxiety condition and nothing more. About 6 million people suffer from OCD in the U.S. alone.

The good news is that OCD is very treatable, and medication might not be needed indefinitely, if at all. Hundreds of studies support that the most effective treatment for OCD is "exposure response prevention" (ERP), which is a special type of behavior therapy designed specifically for OCD. ERP is the only treatment endorsed by the Obsessive Compulsive Foundation. ERP enables sufferers to very gradually overcome their fears and let go of their compulsions at a pace with which they feel comfortable, so they are never overwhelmed. Results are achieved in a matter of months not years. ERP is more effective than medication, therapy and medication combined, or any other kind of therapy. Medication provides only temporary or partial relief and has side effects; symptoms just come back when you end the medication. ERP provides permanent relief, essentially eliminating OCD forever.

Most of my clients benefit from ERP alone with no medication. If someone is on medication already, however, I recommend staying on it until therapy is complete and then gradually reduce and eliminate medication while continuing the therapy for another several weeks or months to assure that symptoms don't return.

There are about a dozen medications used for OCD. The most popular are Luvox, Zoloft, Lexepro, Celexa, Prozac, Zoloft, Effexor, and Anafranil, which is an older medication, and many other medications.

One very helpful book on OCD is written by my former client, Linda Maran, and is called "Confronting the Bully Of OCD," which describes her therapy with me. It's a wonderful success story written from the perspective of a former OCD sufferer who overcame it. Two helpful books written by professionals are "Stop Obsessing" by Edna Foa and "When Once Is Not Enough" by Gail Steketee. The movie "As Good As It Gets" with Jack Nicholson is a depiction of an OCD sufferer, although aspects of it are inaccurate.

I don’t know where you live. I practice in mid-town Manhattan (34th St. & 5th Ave.), northern New Jersey (near the GWB), and Rockland (near the Tappan Zee), and would be happy to arrange an appointment at 212-726-2390. If you live outside of the New York metropolitan area, you can find a local therapist by contacting the Obsessive Compulsive Foundation (www.ocfoundation.org) or the Association For Behavior and Cognitive Therapies (www.abct.org), or the NJ OC Foundation (www.njocf.org) or Central (Upstate) NY OC Foundation at (http://www.cnyocf.org/Providers_List.htm). Check them for an OCD specialist in your area. Please note, by "local" and "your area" I mean within a 2 hour trip, so be flexible about how far you'll look; trust me it's worth the trip. If they don't have someone in your area, ask them if they know of a similar organization in your region that could make a referral to you. Such organizations would have words such as "OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. For those with limited funds, the most affordable option is some large prestigious hospitals associated with a medical schools have clinics with low fees that accept insurance and Medicaid/Medicare with words such as "Anxiety," "Depression," "Fear and Phobia," or the above terms in it's title. Usually the therapists in these hospital clinics are junior therapists-in-training--such as psychology graduate students or medical students--but they are supervised by very experienced licensed professionals. Once you get names of therapists, you have to call and interview the therapists by phone.

If you are considering another therapist, there are TWO "TEST QUESTIONS" you must ask them before you make an appointment: (1) Is ERP the main technique they use? If they don't, forget about using them. And (2) How many people have they SUCCESSFULLY treated FOR OCD? They should have treated at least a dozen people (a few dozen in metropolitan areas), the people should not longer have obsessions or compulsions or should not be taking medication any more. They should NOT say they just helped people "live with" their OCD better.

Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVER BEFORE due to a new law, called Timothy's law, that went into effect in 2007. Although I am out of network, as are all private specialists competent to treat OCD, the new law mandates all insurance companies to cover treatment for OCD (which they term a "biological condition") at a higher rate (as much as 70%) and usually for more or unlimited sessions. So whether or not the therapist is in-network doesn't make as big a difference as it used to. In fact, even with HMOs, if you can't find and ERP specialist within network they are required to cover them out of network.

If you can't find anyone in your area, I offer phone sessions for those outside of the New York Metropolitan area. It's not ideal, but it's a lot better than going to someone who is not an expert on OCD. I can be reached at 212-726-2390.

By the way, would you mind emailing me back to tell me how you found my website? Was it through a link off another website or through a keyword search, and, if so, which keywords and on which search engine? Your feedback will help me make this information more accessible to other people. If you found this information helpful and would like others to benefit from it, please consider providing a very brief rating of my services at Health Grades (about 10 seconds) at http://tinyurl.com/GradeDr-Brodsky. Or consider providing a brief review to Angie’s List at http://tinyurl.com/RateDrBrodsky or call in a review at 888-888-5478 (one word is sufficient).

I hope this information has been helpful. Good luck and tell me how it works out. I only want to ensure you get the right kind of treatment, regardless of whether that is from me or someone else.

Sincerely,

Dr. Brodsky

Question: I’ve always been a bit of a double checker of things, but it’s gotten to the point now that I have a lot of trouble leaving the house. I have these crazy worries that I left the stove on or the iron is plugged in or the electrical wire is dangling out of the socket. Before I leave the house and before I got to bed I have to check and recheck everything like 5 times – and I’ll usually end up getting out of bed or unlocking the door after leaving to go back and check things a few more times before I can reluctantly leave it alone. I used to really like to smoke marijuana but I had to give it up because it just drove my anxieties about this kind of stuff into super overdrive and I’d literally stay up for hours into night just so I could monitor the house so it wouldn’t burn down. If I use the stove at any point near when I have to go I have to check that it’s off and cooled down an insane number of times. I’ve told a few friends about what I go through and they laugh it off and say they do the same thing…but I don’t think they could to the same level, because I really have a hard time even leaving the house anymore. Oddly enough, if I am with someone else and they do the checking, I don’t worry at all and can leave without distress. I also brought it up with my doctor at a recent check-up but he said that people with OCD are much more affected and that my behavior remains within the normal range. He recommended relaxation exercises as a way to overcome compulsive feelings. Based on what I have described, do you think I have OCD? If so, will medication help me?

Dr. Steven Brodsky Says...:

This advice does not constitute treatment and I wouldn't want to diagnose someone by email. However, the symptoms you describe(checking, difficulty leaving, etc.) are typical among the OCD sufferers I treat in my practice. OCD can take literally thousands of different forms as unique as the individual, not just the ones you read about. OCD is an anxiety condition in which the sufferer has unwanted thoughts or worries and feels compelled to get rid of the thought by either an action, avoiding certain situations, or by mentally reassuring themselves (or asking others to reassure them) that their worry is irrational. None of these measures works and, in fact, only make the worry worse in the long run. OCD does not mean you are going crazy, it is simply an anxiety condition and nothing more. About 6 million people suffer from OCD in the U.S. alone.

The good news is that OCD is very treatable, and medication might not be needed indefinitely, if at all. Hundreds of studies support that the most effective treatment for OCD is "exposure response prevention" (ERP), which is a special type of behavior therapy designed specifically for OCD. ERP is the only treatment endorsed by the Obsessive Compulsive Foundation. ERP enables sufferers to very gradually overcome their fears and let go of their compulsions at a pace with which they feel comfortable, so they are never overwhelmed. Results are achieved in a matter of months not years. ERP is more effective than medication, therapy and medication combined, or any other kind of therapy. Medication provides only temporary or partial relief and has side effects; symptoms just come back when you end the medication. ERP provides permanent relief, essentially eliminating OCD forever.

Most of my clients benefit from ERP alone with no medication. If someone is on medication already, however, I recommend staying on it until therapy is complete and then gradually reduce and eliminate medication while continuing the therapy for another several weeks or months to assure that symptoms don't return.

There are about a dozen medications used for OCD. The most popular are Luvox, Zoloft, Lexepro, Celexa, Prozac, Zoloft, Effexor, and Anafranil, which is an older medication, and many other medications.

One very helpful book on OCD is written by my former client, Linda Maran, and is called "Confronting the Bully Of OCD," which describes her therapy with me. It's a wonderful success story written from the perspective of a former OCD sufferer who overcame it. Two helpful books written by professionals are "Stop Obsessing" by Edna Foa and "When Once Is Not Enough" by Gail Steketee. The movie "As Good As It Gets" with Jack Nicholson is a depiction of an OCD sufferer, although aspects of it are inaccurate.

I don’t know where you live. I practice in mid-town Manhattan (34th St. trust me it's worth the trip. If they don't have someone in your area, ask them if they know of a similar organization in your region that could make a referral to you. Such organizations would have words such as "OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. For those with limited funds, the most affordable option is some large prestigious hospitals associated with a medical schools have clinics with low fees that accept insurance and Medicaid/Medicare with words such as "Anxiety," "Depression," "Fear and Phobia," or the above terms in it's title. Usually the therapists in these hospital clinics are junior therapists-in-training--such as psychology graduate students or medical students--but they are supervised by very experienced licensed professionals. Once you get names of therapists, you have to call and interview the therapists by phone.

If you are considering another therapist, there are TWO "TEST QUESTIONS" you must ask them before you make an appointment: (1) Is ERP the main technique they use? If they don't, forget about using them. And (2) How many people have they SUCCESSFULLY treated FOR OCD? They should have treated at least a dozen people (a few dozen in metropolitan areas), the people should not longer have obsessions or compulsions or should not be taking medication any more. They should NOT say they just helped people "live with" their OCD better.

Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVER BEFORE due to a new law, called Timothy's law, that went into effect in 2007. Although I am out of network, as are all private specialists competent to treat OCD, the new law mandates all insurance companies to cover treatment for OCD (which they term a "biological condition") at a higher rate and, sometimes, for more or unlimited sessions. So whether or not the therapist is in-network doesn't make as big a difference as it used to. In fact, even with HMOs, if you can't find and ERP specialist within network they are required to cover them out of network.

If you can't find anyone in your area, I offer phone sessions for those outside of the New York Metropolitan area. It's not ideal, but it's a lot better than going to someone who is not an expert on OCD. I can be reached at 212-726-2390.

By the way, would you mind emailing me back to tell me how you found my website? Was it through a link off another website or through a keyword search, and, if so, which keywords and on which search engine? Your feedback will help me make this information more accessible to other people. If you found this information helpful and would like others to benefit from it, please consider providing a very brief rating of my services at Health Grades (about 10 seconds) at HealthGrades.com. Or consider providing a brief review to AngiesList.com or call in a review at 888-888-5478 (one word is sufficient).

I hope this information has been helpful. Good luck and tell me how it works out. I only want to ensure you get the right kind of treatment, regardless of whether that is from me or someone else.

Sincerely,

Dr. Brodsky

Question: I lost most of my belongings and when my apartment burned down in a fire started by the guy next to me who got a little bit exuberant with his deep frying and ignited the curtains when his French fry oil went up in flames. I had no renter’s insurance so I lost all my stuff and I have no money for a deposit on a new place so I have been living in a weekly rate motel while I try to save up to rebuild my life. The motel is a scary place. I am pretty sure the guy next to me deals drugs because he has a non-stop stream of visitors all night long. I cannot wait to get out of here but it will be at least another month before I can. I am generally a pretty high strung person but since the fire my stress levels have been through the roof and I have even had a few stress attacks that have left my gasping for breath. The weird thing now is that I also don’t feel like I am living inside my own body anymore. It is like things are happening to me but that it’s almost like they are happening to someone else and I am kind of just observing what’s going on. It’s like I am living in jello and it’s not real or something. It doesn’t sound that bad but it actually really sucks. Is this happening because of the stress I am under/ What can I do to not feel like this anymore?

Dr. Steven Brodsky Says...:

I think I can help  you, but I need more information in order to advise you best.  Can you  please tell me when and in which situations you feel anxiety (or avoid) the MOST  and in which situations you feel anxious the LEAST.  Please revisit my  websites at www.ocdhotline.com  andwww.anxietyhotline.com and check the  symptom lists and self-tests and tell me whether the problem you are seeking  help with is OCD, social anxiety, agoraphobia/panic, or  PTSD. Do you experience  anxiety or avoid traveling alone to faraway or new places, enclosed spaces that  you can't exit (subways, elevators, planes, bridges, expressways, etc.), being  in the middle of a crowd or a full theater, or big deserted spaces (empty malls,  deserted park), or being alone in your home?  Do you frequently look for exits or  escape routes from situations, or do you ever depend upon a "safe" person(s) to  accompany your.  Do you have bothersome thoughts or worries that you can't stop and feel a need to keep checking, getting reassurance, or avoiding situations.  Do you experience discomfort in or avoid certain social situations or presentations, or do you work very hard to  overcompensate in social situations?  Do you have flashbacks, as if you're  really living in a past traumatic situation, have a "startle response" to sudden  noises, or feel as if people are trying to harm you.

I look forward to  hearing back from you.  Please also tell me where you live or work.

Thank  you.

Sincerely,

Dr.Brodsky