Tag Archives: ocd

Stolen Therapy

Someone stole my therapy appointment today. I saw it happen.

I’ve been out of therapy since the beginning of August. I’ve been trying to get back in it since the beginning of September when I had my little freak out.

I had finally had an appointment scheduled for this morning. I dressed in a cute outfit, which is very much in contrast to my routine ‘stay inside doing homework outfit’ that is typical of my Thursdays.

I wasn’t at all familiar with the neighborhood his office is in (despite the location being close to my home) so I left early. And by early I mean I allowed an hour an a half for what turned out to be a 20 minute trip.

I have a thing about not entering therapist offices more than ten minutes early (earlier feels invasive on my part), so I walked in circles around the area and killed a lot of time in a coffee shop.

Finally, 10 minutes till the appointment I went into the waiting room and I sat down.
A few minutes later a man, probably late twenties early thirties, enters the waiting room.
‘Do we just wait here, or..?”, He asks

I shrugged and said ‘I assume so, it’s my first time here’
It was clearly his first time as well.

Then commenced the awkward situation of being in a small waiting room and attempting to avoid all conversation and eye contact. I stared intently at the generic waiting room art.

At Noon, my time for the appointment. A guy walks out of an office. ‘Is one of you here for Dr. X?’
The waitingroom man says, “Yes” and follows the guy into an office.

I have a auditory processing disorder. One of the things that means is that I have a lag time for understanding auditory info. So basically I didn’t understand the sound part of what happened until after both people were gone.

Dr. X was the doctor I was there to meet with.

I sat there for 10 minutes trying to figure out what happened. “Maybe they’re only meeting for a couple of minutes”, “Maybe he accidentally double booked”, “Maybe I was supposed to show up last week”, “Maybe my appointment is later today”, “Maybe I showed up at the wrong address and it happens to be the office of another psychiatrist who happens to have the same name in the same general area”

I felt  uncomfortable,like I shouldn’t be there, even though I knew my appointment time was correct. I’m very careful about these things. I check and recheck when writing it down. I read it back after writing it down as well. The probability of me writing the wrong time down is very small.
Ten minutes of this and I went into the hall and called my parents. I watched the door to see if this man would leave making my appointment available again. Twenty minutes past, against my parents advice that I should either phone the therapist or knock on his door, I left to go home.

I’m so busy. I’m juggling full time school, an internship, leadership roles in extra curricular activities and maintaining my ridiculous GPA standards. I hardly had time for this appointment. I especially I don’t have time to sit in an waiting room for an hour to wait for an appointment that isn’t happening.

I forced in into my schedule. Because I need it badly. My word repeating is at an all time worst. I’m terrified my neighbors can hear, because the volume is much too loud. Every night I pick apart my day and beat myself over every awkward imperfect interaction. There are a lot of them. One thing I am good at is creating awkward moments.
I don’t have time to sit in an waiting room for an hour to wait for an appointment that isn’t happening.

I cried my way home. Wow that’s a cliche sounding line. Sorry about that.

I didn’t feel comfortable calling the therapist. I considered not doing anything, just forgetting about this therapist so I could avoid the awkward interaction that would result from confronting him about this issue.

I whined to my Dad a lot on the phone and finally I agreed to let him call the therapist. I gave him permission just to gather facts, not to make a new appointment.

Here’s what happened:

-That man didn’t have an appointment at all. He’d just shown up. He wasn’t even already patient. He was just a person who showed up.

-The therapist hadn’t checked to see who his next appointment was with before going to fetch someone from the waiting room.

-When that man was able to react faster than me, he stole my appointment (Who does that!? Did he think therapy was just some sort of drop in thing?) and it took the therapist a significant part of the appointment to realize what had happened.

-Then the therapist went into the waiting room to look for me, but I was long gone.

I made an appointment for next week. I’m willing to give this guy another shot, though I’m not pleased about the whole situation. It threw off my homework schedule badly, because I was too upset to get work done. The only work I got done today was the work I did before I left to go to therapy.

In all my hypothetical situations I wondered about in that waiting room, the idea of someone stealing my therapy appointment wasn’t one that would have ever occurred to me.

Trichotillomania

Trichotillomania. I can’t spell the words “schedule“, “definitely” or “regularly” without the help of spellcheck, but I can spell “trichotillomania“. It’s a good thing, because wordpress’s spellcheck doesn’t recognize trichotillomania as a word.

Trichotillomania (compulsive hair pulling) is the one diagnosis I have that all mental health professionals I’ve met with are in agreement about. I, however, feel very out of place in internet communities for those who share my diagnosis. I don’t pull from my scalp, so my problem is more easily hidden. As a result, I don’t suffer from the social consequences that many people have to deal with.

My favorite hairs to pull are ingrown ones. They don’t belong. They’re already defective, they are guilt free pulling.

First I notice the irritation of the skin. Sometimes I can see the hair sometimes I can’t. When the area is more inflamed I poke it with a pin to release the fluid. Digging with tweezers, pins and fingernails I search for the hidden hair. Sometimes blood obstructs my work. I have to allow a day of rest before resuming.

I question the existence of the hair. Maybe I already pulled this one out and forgot? Maybe the skin was irritated from something other than a hair? Was that a shadow or a hair?

After some healing, I recommence my hair retrieval mission. When finally I free the hair from my , then mutilated, skin, I feel immense satisfaction. The greater the length of the hair the greater the satisfaction. The visual is very important to me. I study it wondering how long it had been hiding in my body. Sometimes dead skin is firmly attached to the strand. I slide it off carefully, examine both hair and skin individually and dispose of them.

I replay the scene over and over in my head, eagerly awaiting my next opportunity to repeat it.

Nose hairs are my second most favorite type of hair to pull. They are also the most uncomfortable to discuss. There’s such social stigma about putting fingers up a nose, pulling out a hair there is even worse. I can comfortably tell therapists I pull pubic hair, but often omit the nose hair.

Using tweezers makes me sneeze, so fingers are the way to go. I wonder about the risks of pulling a hair with such an obvious purpose (filtration of the air). I justify it by pointing out to myself, ‘I can’t reach all of them to pull. The ones farther up are still in place functioning.’ I don’t seem to get sick more than average so I suppose it’s fine.

Eyebrows and eyelashes are the source of the most post-pulling-guilt. I start with light tugs. The hairs coming out in my hands are ones that were about to fall out anyway, right? If I’m not careful this quickly escalates into harder tugs. Now it’s uneven. I have to keep pulling to even things out, right? I have to finish the job. It’s all or nothing. Fortunately, I’ve had this more under control in recent years. I started wearing makeup more often. Mascara makes it easier to accidentally pull more hairs in one tug, but seeing the mascara on my hands helps to remind me to stop. Seeing eyeshadow on my hands when pulling eyebrows helps the same way. Wouldn’t want smudgy makeup, would I?

I also pull arm, leg and underarm hair. These are the socially accepted places for hair removal, but I take it to an extreme. Shaving feels like cheating. The hair is still there. I want it gone. I am in a constant struggle to remove it all. There is always that one hair I missed. I remove that and then there’s another.

I use an epilator (basically electronic tweezers) to remove it. I advocate epilators as aggressively as some women advocate diva cups (diva cups freak me out by the way. I bought one and it sits in my desk unused). Epilating is a very soothing experience for me. Unfortunately is as a noisy device. I try to minimize the time I use it when others are home. I don’t want people realizing how much time I spend removing hair.

At times when I don’t have access to an epilator I will eventually begin pulling out the hairs individually. I can tolerate a certain amount of hair, but I have a limit. That limit is lower when stressed. At my first hospitalization I reach that limit. The staff didn’t understand my situation and wouldn’t let me use my epilator because it had a cord (no wires allowed. I could strangle myself -_-). They also misunderstood my trichotillomania as a type of self-injury. I was individually pulling out my hairs, gripping them with my finger nails. I reached the point where I was wiling to compromise with shaving. I couldn’t have a razor to shave either, because I cut. My roommate, who was allowed to shave, took pity on me and allowed me to use her razor on the condition that she supervised to see I didn’t cut. It was very much appreciated. I was eventually allowed access to the epilator under supervision from staff.

Let me elaborate on that point I just made. Trichotillomania is not self-injury. Some people might pull their hair as self-injury, but that is not trichotillomania.

When I self-injure I want to see destruction. When I pull I aim for perfection.

I self-injure as a direct response to stress. I know I will release that stress by self-injuring.

I often start pulling without even noticing. While stress may play a role, it is not the entire explanation. I pull at times I am bored or have inactive hands as well as in reaction to stress.

What they do have in common for me is the importance of visuals. I have to see the hair I pull out, just like I need to see the damage from my self-injury.

I tend to pull more with my right hand than left, which is interesting as it is my non-dominant hand. Pulling with my left hand feels strange.

I have some ideas regarding environmental root * causes for my hair pulling, but I’ll save that for another post.

*ahah poor word choice

Talking to myself

I involuntarily repeat words and phrases. They forcefully crawl their way out of my throat. I hear my voice talking, but I didn’t chose for it to talk.

I don’t mean the things I say. They just pop out.

I’ll try to keep my jaw clenched tight to prevent them, but I can’t hold my mouth like that all day.

Lately the most common word is “Dead“. Others include “I’m gonna kill myself” and “Fucking hate you“. Sensing a pattern? There’re many more than just those few. A lot are minor variations on the same phrases.

Often they come out in the third person. In the phrase “I’m gonna kill you” the “you” refers to me. This is a little confusing, because I don’t mean these words when I say them. Why would I be able to explain the intended meaning of the words? I can’t explain why, but I with 100% certainty know that the “you” is me. In a way it makes some sense for them to come out in the 3rd person. While my mouth is involved in the process of producing the sounds my consciousness is not involved in the decision to make them.

When I was in a french immersion program they switched into french “Je veux me tuer“. If only they could have stayed in french after the program ended. That would have been nice.

I do have some levels of control over the words. Not to much with the decision to make them, but more with minimizing the way they come out.  For example: I can reduce a phrase to a shorter nonsense sound. Suppose “I’m gonna kill you” starts to come out. I can compress it into “mmmgn“.  It takes a level of concentration, but is worth it since a nonsense sound is much less socially damaging than what would otherwise happen. Unfortunately for me psychologically I know what was supposed to come out.

I also have some control over volume. Well, not consiously. The volume when I am alone at home is a normal speaking level. In public it is generally only whisper.  It happens all the time to me in public, but it’s quiet enough that no one has ever commented on it. I’m just the crazy person walking down the street muttering to herself. Problems can occur when I forget I am not alone and the words come out too loudly. Then I feel anxious worrying that I might have been heard.

It’s pretty impressive how little I have been overheard. Or at least how few times I’ve been called out on it. My brother hears me all the time, I don’t hold it back as much around him. He thinks I just get really angry at my computer and talk to it.

Being overheard is a major worry. There are times I’ll be walking somewhere with my headphones on and be struck with panic. I’ll be convinced that it might happen and I wouldn’t know it had because of the headphones blocking the sound. This has not to my knowledge ever happened. I’ll keep my jaw clenched shut preventing sounds from escaping until the fear passes.

So what triggers it? It only happens when I’m being spacey. It would never happen while in conversation with someone or while in deep focus. My mind will be off doing something and then suddenly I hear words coming out of my mouth pulling me back down to earth. If immediately after it happens I scan my brain for what I was thinking about I can locate a specific thought that triggered it. If I don’t do that the thought is gone. The thought is always something anxiety provoking. Saying the words serves the function of forcing an unpleasant thought out of my mind.

I imagine it works by taking advantage of the limited capacity of working memory. By throwing a distraction at me older items get pushed out of working memory and forgotten.

The thoughts are always more minor anxieties. It doesn’t happen for bigger stressors.

Around a month ago I decided to keep count how often it happened. Therapists kept asking the number and I had difficulty answering. Unfortunately the act of counting manipulated how it presented. Knowing I was counting made it happen less so I didn’t get an accurate number. I became better able to stop it while I was keeping count. I noticed my body often tenses in specific ways right before it happens. With that warning I could hold my jaw shut to stop the words.

My body is tricky and wouldn’t accept that. The ways my muscles tensed before the words broke free from the speech. They started happening independent of words and became more exaggerated.

One day I noticed that everything was uncomfortably quiet. And realized it was because I wasn’t talking to myself as much. I realized that the words also served an additional function. I spend most of my time alone and they break up the quietness.

I decided to stop counting and things went mostly back to normal. The muscles tensing are still happening independent of the words sometimes, but I guess this isn’t so bad. Less crazy looking than talking to myself.

Whether this is OCD or a Tic disorder all depends on who the therapist I’m talking to is. Tic disorders run in my family. Some think OCD because I can, with effort, identify a specific trigger. The words are “undoing” the thought. I don’t know. It doesn’t matter too much to me though it would be nice if for a change I could have a diagnosis that could be agreed upon. Both are obsessive compulsive spectrum disorders so combined with my trichotillomania someone should invent the diagnosis “Obsessive Compulsive Spectrum Disorder NOS” for me. It’s probably already been invented I bet. Nope. I just googled it no one has. DSM-V committee members, get on that, will you?

I wonder about the relationship this has with my ADHD. It happens at times when I’m spacey. Tic disorders have high co-morbidity with ADHD. Do other people with similar problems find attention is a factor?

If anyone can recommend a good memoir about tic disorders I’d be interested in reading it. I want to read about subjective experience. I’ve read about the outward presentation in technical literature, but I’ve been unable to find much on the experience.