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Jacob Cohen Asks ...
Dear Dr. Brodsky,
For the past few moments I have been plagued by uncomfortable feelings and thoughts. It started out with me fearing that I was gonna run people over with my car. I knew I wouldnt, but I would always fear that I would lost control over myself. While driving down residential streets, I sometimes drive on the wrong side of the road, if I see someone walking on the side of the street. This feeling has subsided to some extent, but it still exists. After that, I had this fear that I was gonna hurt others. That I would punch someone in the face, particularly someone smaller, and more defenseless then myself. These thoughts for the most part have left me, and I dont have to think about controlling myself or being aware of every single moment. Then I had the thought, that I might get brain damage, I read articles about brain damage which triggered this fear of getting hit in the head, I became even more cautious whenever I washed my head, I was constantly aware of how rigorously I was doing it. For one day, I had to worry about walking throught doors, making sure nothing touched my head. For a second there, I even became self aware whenever putting my headphones on, making sure my hands did not brush my temple instead of my ears. I dont feel that self aware of these actions anymore, I cant wear my headphones with easy.
Then these thoughts (while still there to some extent), they started to get sexual. I got nervous when I saw some other guys at the gym. In a later incident, I started sweating profusely at the gym, and felt like I got really warm all of a sudden, and I could not concentrate on what I was doing, I was just going through the motions. At home, I guess you can say, I started to "test myself". Looked at pictures of the same sex, to see if they brought up any feelings. Even affected me when I started watching pornography, my concentration went away from the girl a lot. I guess its safe to say I am a porn addict. I watch too much, and I dont know maybe I am desensitized. I dont know if desensitization is something that leads to same sex fantasies, I am sure plenty of people watch too much pornography but it never leads them to even think about same sex fantasies. I thought that was me until a while ago. I felt like I started to get a strange feeling in my testicular region. But sometimes it was there in the presence of these fantasies. Sometimes it wasnt. Sometimes I got it when I was thinking of straight sex, and straight porn. Sometimes I even feel like I enjoy the same sex fantasies more.
For 23 years of my life, I hadnt even thought about it, and now it brings up questions. Was I in denial the whole time. Did I subconsciously prevent myself from thinking these thoughts all these years. Throughout my time growing up and college, all I thought about in terms of romantic relationships and sex, was women. Now I feel like I am lost. Even when I look at a woman now, I think to myself, Am I attracted to her, or am I convincing myself that I am, just to make myself feel better. Maybe its both, I just dont know. These thoughts have made me avoid the gym sometimes, or I try to go at earlier or different times. The thoughts plague me everyday, I will even think of events in the past, that may somehow be an indicator, and then I realize it wasnt, and then I am relieved for a couple hours, until another thought pops up in my head. On some days I think there is just no way, I love women too much. But then other times I feel like I need to be honest with myself, and that maybe I am just not being honest. It even affects me when I jog around the park, I start to get these thoughts, and then I just lose the motivation to continue. I get filled with dread, shame, disgust. I feel unworthy and undeserving of anything. The only time the feeling subsides greatly is when I am in the presence of friends or close family, thats when I feel like myself. Every other time, its just me with my thoughts, trying to fight them off.
I am emailing you today, because I read about you on Psychology Today. I thought maybe you would have some insight on this matter. Its all very stressful, as I am preparing for the most important exam of my life (the LSAT for law school). I wanted to put off any form of therapy until after I was done taking my exam, and was satisfied with my score, but now I dont know if I should hold off. I dont know if my sexual thoughts have any correlation to other thoughts or if thats just a personal matter of someone with an identity crisis or who has just not been honest with myself. Maybe you can help me figure out what are the potential possibilities for these thoughts. I understand expecting a consultation via email is not ideal, I am saving up money for actually therapy. I just need to express my thoughts, and get some opinion from someone who could potentially point me in the right direction. I greatly appreciate your time, and I apologize in the event that I completely wasted your time.
Sincerely,
Jacob
email: [email protected] -
Dr. Steven Brodsky Says ...
I'm sorry to hear of your plight. This advice does not constitutetreatment 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 asunique as the individual, not just the ones you read about. OCD is ananxiety condition in which the sufferer has unwanted thoughts orworries and feels compelled to get rid of the thought by either anaction, avoiding certain situations, or by mentally reassuringthemselves (or asking others to reassure them) that their worry isirrational. None of these measures works and, in fact, only make theworry worse in the long run. OCD does not mean you are going crazy, itis simply an anxiety condition and nothing more. About 6 million peoplesuffer from OCD in the U.S. alone.The good news is that OCD is very treatable, and medication might notbe needed indefinitely, if at all. Hundreds of studies support that themost effective treatment for OCD is "exposure response prevention"(ERP), which is a special type of behavior therapy designedspecifically for OCD. ERP is the only treatment endorsed by theObsessive Compulsive Foundation. ERP enables sufferers to verygradually overcome their fears and let go of their compulsions at apace with which they feel comfortable, so they are never overwhelmed.Results are achieved in a matter of months not years. ERP is moreeffective than medication, therapy and medication combined, or anyother kind of therapy. Medication provides only temporary or partialrelief and has side effects; symptoms just come back when you end themedication. ERP provides permanent relief, essentially eliminating OCDforever.Most of my clients benefit from ERP alone with no medication. Ifsomeone is on medication already, however, I recommend staying on ituntil therapy is complete and then gradually reduce and eliminatemedication while continuing the therapy for another several weeks ormonths 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 oldermedication, and many other medications.One very helpful book on OCD is written by my former client, LindaMaran, and is called "Confronting the Bully Of OCD," which describesher therapy with me. It's a wonderful success story written from theperspective of a former OCD sufferer who overcame it. Two helpful bookswritten by professionals are "Stop Obsessing" by Edna Foa and "WhenOnce Is Not Enough" by Gail Steketee. The movie "As Good As It Gets"with Jack Nicholson is a depiction of an OCD sufferer, although aspectsof it are inaccurate.I don’t know where you live. I practice in mid-town Manhattan (34th St. 5th Ave.) and northern New Jersey (near the GWB) and would be happy to arrange an appointmentat 212-726-2390. If you live outside of the New York metropolitan area,you can find a local therapist by contacting the Obsessive CompulsiveFoundation (www.ocfoundation.org) or the Association For Behavior andCognitive 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 OCDspecialist in your area. Please note, by "local" and "your area" I meanwithin a 2 hour trip, so be flexible about how far you'll look; trustme it's worth the trip. If they don't have someone in your area, askthem if they know of a similar organization in your region that couldmake a referral to you. Such organizations would have words such as"OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. Forthose with limited funds, the most affordable option is some largeprestigious hospitals associated with a medical schools have clinicswith low fees that accept insurance and Medicaid/Medicare with wordssuch as "Anxiety," "Depression," "Fear and Phobia," or the above termsin it's title. Usually the therapists in these hospital clinics arejunior therapists-in-training--such as psychology graduate students ormedical students--but they are supervised by very experienced licensedprofessionals.
Finally, in the New York/New Jersey Metro area, for those with no insurance or very limited resources, I highly recommend one of the specialized treatment centers on my web site (www.ocdhotline.com/id10.html) that use the very same techniques I do, but at a fraction of the cost. I have hand picked these centers; if you were a member of my family, I wouldn't hesitate to recommend going to them.If you are considering another therapist, there are TWO "TESTQUESTIONS" you must ask them before you make an appointment: (1) Is ERPthe main technique they use? If they don't, forget about using them.And (2) How many people have they SUCCESSFULLY treated FOR OCD? Theyshould have treated at least a dozen people (a few dozen inmetropolitan areas), the people should not longer have obsessions orcompulsions or should not be taking medication any more. They shouldNOT say they just helped people "live with" their OCD better.Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVERBEFORE due to a new law, called Timothy's law, that went into effect in2007. Although I am out of network, as are all private specialistscompetent to treat OCD, the new law mandates all insurance companies tocover treatment for OCD (which they term a "biological condition") at ahigher rate (as much as 70%) and usually for more or unlimitedsessions. So whether or not the therapist is in-network doesn't make asbig a difference as it used to. In fact, even with HMOs, if you can'tfind and ERP specialist within network they are required to cover themout of network. For more information about insurance, fees, and financing therapy please see my web site at www.ocdhotline.com/id10.html.
If you can't find anyone in your area, I offer phonesessions for those outside of the New York Metropolitan area. It's notideal, but it's a lot better than going to someone who is not an experton OCD. I can be reached at 212-726-2390.By the way, would you mind emailing me back to tell me how you found mywebsite? Was it through a link off another website or through a keywordsearch, and, if so, which keywords and on which search engine? Yourfeedback will help me make this information more accessible to otherpeople. If you found this information helpful and would like others tobenefit from it, please consider providing a very brief rating of myservices at Health Grades (about 10 seconds)at http://tinyurl.com/GradeDr-Brodsky. Or consider providing a briefreview to Angie’s List at http://tinyurl.com/RateDrBrodsky or call in areview at 888-888-5478 (one word is sufficient).I hope this information has been helpful. I only want to ensure you getthe right kind of treatment, regardless of whether that is from me orsomeone else. May I only hear good news from you in the future!Sincerely,Dr. Brodsky
