Thursday, December 17, 2009

15 Bans.

Here's a more technical look into what my treatment consists of....

The majority of my day is spent doing Cognitive Behavioral Therapy (CBT), which is the core of my treatment. CBT consists of Exposure and Response Prevention. I've talked about exposures before (facing our fears), and Response Prevention is where my "bans" come in. I carry around a tiny little pocket book with "bans" listed on the top of each page specific to my form of OCD. There is a column for "submit" and one for "resist." There are a couple purposes behind the ban book, but the main idea is to stop the automatic response that I have to my anxiety. In other words, I record every time I either submit or resist a compulsion. Exposures and Response Prevention work as a my BT puts it, it's like a 1-2 punch. The response prevention MUST follow the exposure; otherwise, I'm spinning my wheels. For example, I started a new exposure today which is placing both hands on a "low-traffic" area of the floor. I keep my hands on the floor until my anxiety subsides to at least half of where it peaks. But when I lift my hands from the floor, the response prevention is often just as hard if not harder than the exposure itself. So for my floor exposure, the response prevention is not washing my hands, not isolating my hands, doing "normal" things with my hands such as brush hair out of my face, touch my clothes, touch things in my room, etc......essentially continuing to move and use my hands so that I retrain my brain that I won't freeze or go into a catatonic state if I get "dirty." I guess it's not so much retraining my brain, as it is proving to myself that my fear is only an irrational thought and not at all likely to happen.

It would be near impossible....or at least extremely try to create a ban for every single compulsion, so my BT came up with 15 bans that encompass the majority of compulsions I struggle with. My 15 bans are:

1. Hand washing - Who's surprised? Really, lets be honest, anybody who's hung out with me in the last few years will agree that Kristen and hand washing is a 1-2 punch. :) Not only do I wash my hands more than what is probably necessary, a typical hand wash is 4-5 minutes. When I get "stuck" that time can increase to closer to 10 minutes. I have to use lots of hand lotion to keep my knuckles from cracking and bleeding. The skin on my hands completely peels every 1-2 months.

2. Barriers - This is probably where I was the "sneakiest" as far as using a tissue or napkin to touch many, many handles (doors, refrigerator, sinks, etc...) I was so "good" at doing this, that unless you were consciously watching, you probably would have never noticed. Other examples of how I use barriers is when I know I have to sit on furniture that I consider contaminated, I will often deliberately put on a hooded shirt so that I can pull the hood up around my neck so as not to be "weird and obvious" but enough to cover my neck and hair that I feel "safe."

3. Cleaning and Sanitizing - This pertains to a lot. If I drop a clean item of clothing on the ground when taking laundry out of the dryer, I rewash the item. I sanitize door knobs quite often...for no particular reason, other than that they are door knobs and seem dirty. I sanitize anywhere hands touch in my car if someone else drives my car and I didn't see them wash their hands prior. I would rarely be caught without sanitizing gels or sani wipes in my purse or car, because if I drop anything on the ground, I will use a sani wipe to clean it before using it again (pens, earrings, water bottles, cell phone.)

4. Inspecting - I look things over before sitting, touching, eating, wearing, etc.... For example, before putting food on my plate, I want to carefully inspect to make sure there is nothing on the plate making it dirty. If I see a spot, I try to determine what it is, because if I can make some sort of sense out of it....a water spot? ok, somewhat safe. .....tiny little left over mark from food even though it's been in the dishwasher.....not safe at all.

5. Repeating - Mainly pertains to hand washing. I will use 7-8 pumps of soap, scrub my hands, rinse, 5-6 pumps of soap, scrub, rinse, 1-2 pumps of soap just to be safe on my "dirty fingers." I have "dirty fingers" and "clean fingers."

6. Just Right - Just right has to do with how things feel. I struggle with "just right" when touching things like my alarm clock or light switches. When washing my hands, I will also swish water back and forth between my hands until it feels "just right." There is no rhyme or reason to's just until it feels right.

7. Left Foot - This is what I can remember as one of my most consistent compulsions for the most amount of consecutive years, besides my hand washing. I am more concerned with the bottom of my left foot getting dirty than I am with my right foot. When standing, I often roll my left foot onto the side, sometimes slightly and sometimes very drastically. I have a very hard time standing flat-footed on bathroom mats/rugs. When wearing enclosed shoes, I use my right foot to adjust or tap the back of my left shoe more as a "just right" thing. Over the years, this compulsion has caused a lot of pain in my left ankle.

8. Avoidance - Pretty self explanatory. I pretend to shuffle through my purse for something during the meet and greet time at church so as to avoid hand shakes. I stand till my legs or back are bothering me before sitting on public furniture. Even though it makes no sense whatsoever, I will turn a straw over in my drink because I get a feeling that the side I was drinking out of got dirty somehow. I know....doesn't make sense, because I put the "dirty" side into my drink.....but for some reason it makes me feel better.

9. Rubbing / Wiping Off - I rub my feet together before getting into bed. I will often rub my arms because I feel that awful creepy-crawler sensation. I rub and wipe things off quite often in an attempt to wipe off germs and dirt.

10. Ordering and Arranging - I have quite a keen sense for knowing if something has been moved from how I had it. I am not always a neat freak as you might assume, but my things are all placed very strategically because of a specific thought process.

11. Rewriting - Basically retracing letters or making marks until it feels or looks right.

12. Reassurance Seeking - This is very interesting. Many of you have been enabling my OCD by reassuring me in different ways. For example....when someone comes out of the bathroom, with very little regard for who it is, I will often ask, "Did you wash your hands?" Everybody usually answers, "yes." I am stressed about the possibility that the person didn't wash their hands. By answering me, my anxiety sharply subsides, but my fear is reinforced that "dirty bathroom hands" are dangerous and could cause my fear to become a reality.

13. Warning Others - This is the most nagging compulsion. "Oh my gosh, don't touch's dirty!" "Wash your hands." "You should clean that before using it." "Don't put your shoes there." get the point. I hate it. I hate doing it. I hate how I feel. I don't want to care what you this sense at least. :)

14. Evening Out - This usually has to do with how my clothes feel and whether or not things are happening simultaneously. Observing me, you might think I'm twitching a little, or just restless. I adjust my shoulders or sleeves or the waistband of my pants until it feels even. I'm pretty sure my sister's favorite compulsion of mine :) is how I sometime get hung up on feeling like my eyelids don't close at the same time. So, I will deliberately wink one eye at a time at different "pressure" levels until it feels "even," as if my eyes are an etch-a-sketch and I'm erasing the unevenness so I can try all over again to close both eyes at the same time. This only happens at night when I'm going to sleep.

15. Smelling - I tend to smell things a lot, and based on how I think something smells will determine its level of contamination and/or presumed danger. It's a form of inspecting that I struggle with a lot after exposures, because I want to smell my hands to determine how contaminated I got. My BT has been challenging my "smell theories" a lot lately. He says I must come from a lineage of blood-hounds because apparently I smell things that no one else does, which he says is my anxiety. I argue that smell is smell and that there is no way it is affected by anxiety.....but that's a whole other blog.

Hopefully, my vulnerability in this blog gives you a deeper understanding of why I struggle, why I'm fighting, and how exhausting this process is. I'm sure just reading about my compulsions (now bans) is completely exhausting. Now imagine each of those 15 compulsions happening over and over and over again throughout my day, coupled with crazy, intrusive thoughts.....

I'm fighting for my free spirit.


  1. I'm sure other people have said this, but when all is said and done, you need to write a book (or at least compile this blog into something). Cause this is the clearest explanation I've ever heard for what it really means in a concrete way to be doing "exposures" and "response prevention." You are such a good writer!

  2. Fight on, Kristin.

  3. Thank you. This was a fantastic explanation- I share 8 of your 15 bans and have countless others. Scrupulosity being a big one. I just found out about your blog and have been reading it, it is great! You are helping others by sharing your struggles!