Why Y-BOCS?

The spectrum of severity and the need to test treatments for OCD underlines the importance of reliable and valid scales when it comes to rating the symptoms. It needs to be sensitive to the slight changes in severity and frequence of both obsessions and compulsions, and currently only one scale seems to encompass this definition - the Yale Brown Obsessive Compulsive Scale, or Y-BOCS.

There are two other rating scales used in the diagnosis and treatment of OCD - the Maudsley and the Leyton Obsessive Compulsive Inventories, but these depend on self rating and confound measurement of trait with other variables. The Y-BOCS is not influenced by the number or type of obsessions and compulsions, and rather than cataloguing the symtoms experienced, it analyses the impact on the sufferer's life and the resulting anxiety.

The intended use of the Y-BOCS is the quantification of symptom severity in patients diagnosed with OCD and their response to treatment - it is not designed as a diagnostic test. Symptoms are assessed with regard to the amount of time spent daily on obsessions and compulsions, the interference that this provokes, the subjective distress that is caused and the resistance that the sufferer is able to show when faced with both are measured on the scale.

At the end of the day, no scale is perfect, but I think that the Y-BOCS is an efficient tool for the monitoring of progress - by applying the scale every now and then, it is possible to see even the smallest of steps, and I think that's important.

Obsessively compulsively yours,

Bellsie

Stigma

Last week my grandmother phoned to tell me that she was taking me on holiday for two weeks in February, and yet rather than the unadulterated pleasure that this should have caused me, instead I was filled with fear. She doesn’t know that I have OCD.

The stigma attached to mental illness includes the attitudes, feelings and behaviours that occur when a label is placed on an individual or a group, when they possess an undesirable characteristic, when they are seen as crazy, mad or just different. It is debilitating and upsetting, and in some cases, worse than the illness itself. It means that many sufferers fail to seek help, or are reluctant to share their experiences with others, and worst of all, it means that we feel ashamed.

I’ve been lucky – the majority of my friends have been very supportive, but stigma doesn’t necessarily translate itself into pure hostility. For how long will I be thought of us weak – one friend asked me if I thought that I would be able to go back to Medicine – for how long will I be thought of as the girl with OCD, for how long will my illness overshadow my achievements and opinions, how long will I be stuck with this label on my forehead?

How can stigma be addressed? By providing public education for sure, by assuring a fair portrayal in the media and working on awareness, but shouldn’t we start a little closer to home? Should we not take a stand at the root of the problem, by ‘coming out’ as mentally ill, by being brave and not caring about the consequences?

I am, I have to admit, a hypocrite. A few weeks ago I was interviewed for a podcast for OCD sufferers, but am I going to post my episode on Facebook, or email it to my friends? No, because I’m too ashamed, too scared of their reactions, so once again I will hide this huge part of me, stand in front of it and pretend that it isn’t there.

And that’s sad, I think.

Obsessively compulsively yours,

Bellsie

Keeping it in the Family

Last night I made a huge advance in my exposure therapy. I only kissed my youngest brother once before bed, rather than the usual requisite of twice. I cried, I screamed and I shouted, but I did not give in. The thing is, I would be prouder of myself, I would think more of this achievement if it were not for the fact that I did all of this in front of my family.

I think that it’s pretty well accepted that mental illness does not pick and choose – anyone from David Beckham (yes, another OCD sufferer) to the girl down the road can be struck down by an invisible illness. The thing that has got me thinking is the affect that this has on the family, on those that care for and love the crazy people of this world.

Whether it’s the endless reassurance that I demand in order to satiate the dragging doubt or the complicity in my rituals that I require, they certainly don’t get an easy ride. I will never have enough words to tell them, but I appreciate the fact that my mother will reply to the endless questions that I ask, repeating again and again that yes, it is off, I am thankful that my father will push me into doing the exposure therapy, that he will challenge me and yet give me a great big hug when I do make it. I will never be able to thank my youngest brother enough – at the age of ten and without any understanding of the condition he is my greatest cheerleader.

They live with this illness just as much as I do; they sit through the anxiety with me and celebrate when it falls, they calm me when I cannot breathe, so tight is the worry that squeezes me, they laugh with me when I need cheering up, they give me a kick when I don’t want to face my fears. And for that I am truly grateful. And truly sorry.

Obsessively compulsively yours,

Bellsie

Acceptance

God grant me the serenity to
accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference.
- The Serenity Prayer, AA

I have OCD. It isn't fair, and yet it is not unfair - tiny flaws in the biochemistry of my brain means that I live with a chronic and debiliating condition.

Change cannot happen without acceptance - I cannot recover without first accepting that I was ill in the first place. Perhaps I am not a sick, homicidal maniac just about to break free of my inhibitions and kill everyone in sight, perhaps I am poorly. Perhaps I am not responsible for everything that surrounds me, blessed with a God like power, perhaps I just have a disorder that means that sometimes I have a hard time working out that my presence and actions have a limited effect.

I suppose that at the end of the day this elusive acceptance means coming to terms with the fact that this world is not perfect and nor am I, that I must live in the present rather than ruminating over the past and worrying about the future. Instead of using all my physical and mental energy to control the uncontrollable it is time for me to make some goals, to start the hard and long journey to the new, OCD free me.

It is not that I am not up for a challenge and my competitive spirit is itching to get out, to attack the progress charts that are lurking inside my computer, it is just that there is this tricky acceptance thing in the way.

Obsessively compulsively yours,

Bellsie

In Five Years Time

Where will I be in five years time? Perhaps I’ll be studying to become a doctor, working long hours and socialising hard, doing the job that I dreamt about for so many years. Perhaps I’ll have decided that Medicine is not the future that it promised to be and have transferred to a different course. Maybe I’ll be studying for my masters, or teaching or nursing or any multitude of possibilities.

Perhaps I’ll be better.

Perhaps I won't.

Keep On Taking Those Crazy Pills (appt n°2)

(Just found this on my Blogger dashboard - I forgot to post it last Friday. It was written when I was still quite low and is therefore a little slow and clumsy, but I'd rather leave it that way)

It is once again Friday and therefore once again time for me to step into Dr T's immaculately furnished room.

"So, today I want to know a little more about Bellsie!" She exclaims perkily, causing me to shrink into my chair with more than a little doubt clawing at my mind. Please don't tell me that she's going to go into the pyschoanalytical area that I was dreading. I'm afraid that I don't believe that the reason that I have OCD is because my father looks a little too like my goldfish - I am strongly on the neurological side of the fence.

As it turns out she only wants me to describe myself so I try to drag myself from the lethargy and despair that has been consuming me (yes, I know that it's my fault for not telling her last time that I was on medication and that it was not working) and manage an adjective. Serious. She smiles and writes it down. Not stupid, I add, but not clever either. She nods again. I stop - that's about it really.

This obviously is not enough. She continues to poke various adjectives at me, offering each one to me with an inquisitive frown. Spontaneous? I shake my head vigorously. Loyal? I nod. And so it goes on.

Why do I feel that my OCD has taken the form that it has? I proffer my own favoured explanation - the reason that my main fear is of accidents and catastrophes, the reason why my head is filled with images of my family dying in horrendous circumstances, the reason that I fear hurting someone so very much - my eldest brother had an accident about five years ago. She asks a little more about this event and I dutifully talk her through the whole ribbon of head injuries and helicopters, of bikes and brains until she seems satisfied.

The question of medication is finally raised. Would I consider taking something? I feel that it is time to come clean and therefore admit that I am taking an SSRI (a type of antidepressant). She explains that the reason that it is not working is that I am on too low a dose - with OCD you have to go for the higher end of the spectrum. She decides to add another medication to the cocktail, another form of crazy pills. I leave happily, prescription in hand.

I like her, I really do. I'm just not feeling like liking anybody at the moment.

Obsessively compulsively yours,

Bellsie

Who is this for?

I want to write about the Y-BOCS (the scale that is used for evaluating OCD), I want to write about the biology of OCD, about the medication that is used to treat it, about how I’m doing with my CBT. However, I am more and more drawn to the idea of using the blog as a confessional, to share with you all (well, the one or two that will read this) how I really feel and not just the “I’m fine” that I casually throw to my parents or my psychiatrist.

There is a problem. I have reached a point where I have to consider my audience – who is reading this? When I started writing this blog I sent the address to a few carefully selected individuals who were aware that I had a problem – friends and family members, but it’s not really meant for them. What was originally going to be a tool with which to better explain what OCD actually is and how it affects my life is in danger of becoming a soup of introspection and self pitying posts, but do I really want a friend to know that I have obsessions about killing them? It is likely that they will not understand that this obsession is as unfounded as the rest of the bunch that I keep tied up in my muddled brain and could perhaps (and not entirely without reason) be more than a little startled.

Ah, the refreshing debates sparked by modern technology!

Obsessively compulsively yours,

Bellsie