I have recently become obsessed with what category my OCD falls under (i.e. mild-moderate-severe-extreme). I gave a copy to my psychiatrist who said he would fill it out, but I am impatient and was wondering if you could all help me figure out my obsessional score (or at least make an educated guess)..I pretty much figured out the compulsive part so no need for that.
Well, I pretty much obsess the whole day except for maybe some gaps when my attention is sufficiently distracted but I am 100% sure it takes up more than 8 hours (1/2 waking hours)
PART 2) Distress from Obsessions
2-moderate but manageable
This is tricky. My distress throughout the day comes in "spikes" and "throughs" varying between "moderate" to "severe". When I mean "severe" it implies that the obsessions don't necessarily disable me, but rather I feel intense stress levels that sap me of my energy, frustrate the hell out of me, and leave me exasperated. It feels like someone working a high stress job (stockbroker.....) but add 15-20% additional stress to that. It's TOLERABLE but not MANAGEABLE...difference being one is testing the limits of my frustration, while the other is easily dealt with, though somewhat disturbing. I took an anxiety screening test and sure enough, during the "stress periods" I scored in the "marked" anxiety range, while during calmer periods I fell into the "moderate" range. Since the "severe" spikes amounted to 1.5-3.5 hours/day usually (depending on stress), most of the day was "moderately" stressful. I don't know if the question implies what's the "worst" distress you experience, or the "averege" amount of distress experienced through the day. I chose 2-moderate since I really didn't experience 8+ hours of severe distress but I really don't know what they imply by the question. One thing for sure, the 2 hours or so of intense stress was enough to cause plenty of physical pain "stomach cramps/spasms, twitching, migranes, severe muscle tension followed by achy muscles, weight loss (up to 10% before OCD diagnosis), dull brooding worry amount to a sense of dread rather than necessarily acute panic, insomnia lasting nearly 2 hours, chest tightness etc...."
I chose 3-substantial because my psychiatrist filled out a form and most of it was filled with checks in the "substantial impairment". OCD hit me hard socially; I have only 1 friend (the averege is 6 for US) and it is strained and full of hardship; I have only dated once, and that lasted 1.5 months (the averege is at least 4 months for short term); I could only hold on to a "regular" job for 4 months max. before getting fired, the averege for my age is about 8 so 50% impairment; additionally, because obessions zapped strength from me I could only effectively work 3-4 hours/day (50% reduction from norm), tutoring which I excell at thanks to my OCD perfectionism which helps me figure out every possible thing that a person could not understand and simply put it on paper...still, that's not acceptable amount of time....there's more, but I'm pretty much 50-60% functional (too much impaired to function normally but not really housebound or disabled either)
The next two parts I really am confused with....Resistance/Control
1) much resistance
2) moderate resistance
3) often yields/minimal resistance
4) completely yields.
Well, here's the deal. I really don't make an active effort in trying to control and suppress my obsessions unless on medications. Out of the hundreds to thousands of repetitive thoughts experienced daily I cringe and yell stop to about 4-8 of them (really embarrassing one's that I don't want to think about). For example, my mind gets stuck on an image of a person/ and a piece of music which much like a CD skipping plays stops and replays on a 7 second cycle to the clock for 80 minutes at times. In the mean time, some other random intrusive thoughts sneak into the mix and about 3 of them in the 80 minutes are immediately suppressed. Considering I am flooded with 650-700 thoughts during that time which are not in anyway resisted those 3 amount to 0.4%....I don't even know if that's worth considering. Furthermore, I often go out of my way to PROVOKE obsessions. For example, if I feel my OCD getting milder, I feel guilty that I don't have OCD and immediately look up something distressing on the computer which will automatically increase my OC symptoms. Or, when I have a song jammed in my head producing high anxiety just from the hundreds of replays which don't stop, I try to preserve it in my head. That is, if I am in a store and hear another song which kicks the one in my head out, I'll literally leave the store to have it continue. I don't understand why I want obsessions to remain in my head, but meds. make me want to put up an active resistance to them. How would you rate my "resistance" under normal cirumstances?
I don't know what's the standard length of obsession free interval for the OCD sufferer, but I have tried several times to "thought stop"....i.e. make my mind go blank and time how long it would take for the obsession to return. On 3 seperate occaisions I timed 6 seconds. That's it....no matter how much effort, 6 seconds is as long as my mind stays obsession free when I am by myself. When talking to someone, my obsessions temporarily go blank, regroup and "accomodate" the new situation....I may get instrusive aggressive thoughts against the person, or may automatically start insulting them mean-spiritedly in my mind. These thoughts are generally weaker and have more time spaced between, but the point is, that there's really never a period where I can really take my mind off obsessive thinking. One obsession may stop completely, but is quickly replaced by a new one. However, it's not like I have 0 control, otherwise it would be extremely distracted having a conversation, and would really be noticeable to the other person.
Well, I appreciate if you can help me score this esp. the resistance and control grades. On medication, I put up a good fight (in my opinion) and am better able to control my thoughts....I can make my mind blank for 11 seconds, and when I block the thoughts they dissapate quickly (eventhough they return) whereas, stopping obsessions normally doesn't weaken their strength one bit
Well, I'm not an expert on the YBOC's, but I will tell you this- we have about the exact same OCD. When I was 12, and my OCD was at its worst, I obsessed eight hours a day, from the moment I got home from school to the moment I went to bed, and I had a constant "spinning" in my head from the obsessions, and I couldn't clear my mind for five seconds, either. That was horrible, so I know what you're going through, but at least you know that it's OCD. I had no idea what was wrong... I will tell you this: resistance refers to compulsions, not obsessions. It's not possible to resist an obsession- that's one of the defining characteristics of one. They simply pop up out-of-nowhere. Some people (I'm one of them when I'm really bad) can feel one coming on, a sense of inevitable foreboding, and you may try to direct your attention elsewhere, but they mean if you resist doing a compulsion after you have the obsession, or do you simply just give in and do the compulsion? If I were to guess, I'd say you're a pure obsessional, like me, and only have mental compulsions. This question doesn't really apply much to pure obsessionals. That's where the control really comes in. Many OCD-ers do have some control, but pure obsessionals almost always score a "four," or no control whatsoever. I understand that you're being obsessive-compulsive about the YBOC's, but believe me, you have a severe case. I have moderate-severe myself, depending because I'm the classic "waxer-waner." I, too, worry when I'm not as bad because then I feel like I'm faking it, or am just using the diagnosis falsely, but this is what I always say: only a true obsessive-compulsive would wonder if they were really obsessive-compulsive... Good luck, God bless, and if you have any questions, feel free to ask!
"Not everything that steps out of line, and thus 'abnormal,' must necessarily be 'inferior.'"
Last edited by GatsbyLuvr1920; 07-12-2006 at 09:22 AM.
How are you. Thank you for responding to my response, I really appreciate it. Well, I had a good day, my medication began kicking in the late afternoon and it literally felt like most of my nervous energy was being channeled out...felt like getting sleepy in a very enjoyable relaxing way. Well, I scored my YBOCS and I can't believe the score I came up with. For obsessions, I figured most of my day was filled with intrusive thoughts (so probably more than 8 hours) score 4 (which is half-the-day 8/16 hours awake=0.5). I know from my psychiatrist+personal research that I am substantially impaired, but not disabled, score 3. Anxiety related, psychiatrist and pre-CB therapist reported pretty "high" anxiety levels. I assume high=severe, because high is higher than moderate. I filled out hamilton HAS rating scale, one that had explicit guidelines and scored 35, 35, 34 took it 3 times to make sure score was consistent (bit compulsive checking I guess) 25-30 is "moderate-severe", 30+ is "severe" so that would put me in the severe range, though a "low" severe. 35/56 is about 6.25/10. I took a seperate test and score 27/44 which is "marked" anxiety, the level above "moderate" and below "very severe". The moderate/marked cutoff was 23/44 and 27/44=6.1/10......Either way, through tests and doctors opinions I have high anxiety levels considered "severe" but not-so-severe I am guessing that "incapacitating" score 4 would be a panic or near panic state. Over the day, my anxiety fluctuated and there were periods when my anxiety dropped into the "moderate-severe" range, but I would say at least 4 hours were "severe" score 3. Alot of the anxiety feels more like intense stress. I feel exasperated, exhausted, worn out, angry+annoyed, and extreme frustration. This is reflected on my face, and is the only way for people to "see" my OCD symptoms...a worn out angry-from constant frustration face. Many people have asked why I look so upset and have told me to smile or "chill out". I feel frequently "crazy" am hyped-up with nervous energy, walk, speek, write more quickly than usual, my muscles are sore and ache, I am tense and stiff as a board literally, I "limp" or walk awkwardly often bumping into people or just acting very uncomfortable...which made several people laugh at me, one person giggled "You're nervous..hehehe", other people found my behavior hysterical in a nice way...compliments "you crack me up", "you're hilarious" were given because of my obvious and visible nervousness. Either in the mean or nice way, I don't really get what the hell is so funny about it, but whatever. Point is, my facial expression and posture/motor movements were so out of the norm to be easibly visible to other. I have NOT seen ONE person as nervous/tense/hyped as myself and I have gazed OBSESSIVELY to try to find someone without luck. I've seen it in some movies, but not in real life....I imagine, people who have higher anxiety are housebound or something...I don't know really. My ex-girlfriend of 1.5 months (substantial reduction from the norm of 4 months for short term relationship) yelled out "SO.......NERVOUS" when she initiated foreplay. On last thing, people have either complained/complemented me on my eyes. Suppose I give off an "intense" gaze which is either regarded as intimidating or attractive/striking depending on the person. That "look" disapears when I am Lexapro. The "intense" stare I think is a window into my obsessiveness....good example, watch the AVIATOR in the scene before "Hell's Angels" is premiered. Look at DICAPRIO's look....I think THAT's the exact stare I am giving people. My ex- COMPLAINED about my eyes, that she interpreted as not being as interested in her....Heard another remark, about behavior disturbingling different on LEX using eyes as example...CAN YOU believe that!! There's nothing wrong with me, I am close to NORMAL on the drug (no complaints from my dad/doctor about "crazed" behavior, just much calmer, relaxed). People are noticing a change in behavior makes me think that I am getting a good reduction in symptoms which probably confuses them. Well, resistance I put at a 3 little resistance (when I am getting therapeutic effects) I resist actively otherwise, I'm not consciously resisting the obsessions. If anything I am fueling them or purposely making them worse to rid doubts which is very disturbing. The scary thing also, is I feel like I WANT to have OCD and enjoy its presence even though it's screwing up my life. I did however did tell myself occaisonally this is really ridiculous behavior...stop doing w/o trying to supress them, so I didn't completely lay down and let them run over. About 4-7 times a day I get a single thought that I yell out stop and "cringe" because it's so embarassing...but it's a reflex, not really a concious will to control it...like sneezing....that would be "suppression" but not really "active" and besides this was so minimal. Control wise I could rid my mind at most 4 seconds with OCD in full force...with med. about 8-12 seconds...I found 6 seconds last time, but I think the med. was not completely worn off. Anyways, I marked 3 little control. Summing it up gives 16/20...compulsion wise 11/20....Sum equal 27/40....CAN IT BE THAT HIGH?? I re-evaluated the time component to 3 (3-8 hours) during which I experience "severe" distress for most of the period. SO I get 15/20 for obsessions 11/20 compulsions. A 26/40. I don't know if it's that BAD...maybe I'm overexaggerating a bit. The medication provided great change in symptoms and I felt "normal" and was visibly acting/thinking differently to others. I came out with a score of 17/40 about 35% reduction from 26/40....is it possible to get that much from medication???? Right now, I am close to normal but not quite cause the med has worn off not completely. But judging by the length of the mail, I'd say I'm getting pretty obsessive again. Your thoughts???? By the way for the 17/40 the obsessions dropped to 10/40 and 7/40 compulsions. Aside from that, I'm interested about your OCD...How bad it is? You mentioned having onset around age 13, which is amzing, because I had onset around age 13 too!!!!! The reason I know this is because, I was in seventh grade when I started flicking light switches on/off. It started a little earlier than the premier "As good as it gets" which came out in 1997. I'm 22, so in 1997 I was 13 I have a Jan. birthday so I know I was 13. That's when I noticed something really wrong with my behavior and remarked in my head during the movie "Oh he does that too??!". Wow we have a lot in common. You're 19 from what you said, so we're about the same age. Are you in college? What state or country do you live in. It's a pleasure taking to you, since we have a common OCD experience based on reading your reply. Take care and please write back!
Believe me, you don't have to tell me to watch The Aviator! lol! It's one of my three favorite movies (the others are Chicago and A Beautiful Mind) and one of my main obsessive fixations from my Asperger's, but you could probably already tell that by my signature. I think it's such a shame that DiCaprio didn't win the Oscar for that. He did a fantastic job, but I think the main reason is that most people pass over the OCD aspect of the movie because they've never experienced the symptoms, and they don't appreciate how excellent he mimicked the symptoms and portrayed it. I can't tell you how many people on here have compared their OCD to something in that movie... You say you're on Lexapro? I'm very glad it's helping you- it only made my OCD worse. I've been on Zoloft, Lexapro, Zoloft again, and Prozac, in that order. I'm not on an SSRI right now because I don't feel as if they were really helping much, and they made me sooo freakin' tired! I had full-blown OCD at 11 1/2; it was the worst at 12. However, I showed obsessive-compulsive symptoms since age four on-and-off. I don't like As Good as it Gets- it was touted as "the OCD movie," which is wrong because it's a very stereotypical viewpoint. I'm a pure obsessional, so I don't do anything Udall does. I only have one compulsion, too, and it's a praying/neutralizing one. I'd say Udall doesn't even really have OCD- it's more like OCPD, Obsessive-Compulsive Personality Disorder. Everything must be his way, or the highway. OCD-ers aren't outwardly mean like that. They're mostly afraid to hurt peoples' feelings. The only time they're hard to get along with is if they're interrupted during a compulsion, or are prevented from doing a compulsion. Since I'm a pure obsessional, I have blasphemous, violent, and sexual obsessions. As I said, I do a praying/crossing/mental phrase compulsion. It used to be a tapping compulsion made from "knocking on wood," but I tired of tapping and switched to my current compulsion. I was in CBT, but it didn't really work for two reasons: pure obsessionals tend to not fare well in CBT, and I was diagnosed with Asperger's by my CBT therapist, and she said that the Asperger's was interfering because it wasn't know what was anxiety related to the Asperger's, and what was anxiety related to the OCD; I was pegged as a "moving target," regarding my fears. I'm an American, and yes, I'm in college. I'll be a sophomore this fall. I, too, have been told that my anxiety levels are very high, probably because of my panic attacks (I don't have panic disorder). My CBT therapist said that my OCD was "intense," which to me means that it must be pretty bad because she sees people every day... I wouldn't judge your obsessiveness on the length of your posts. I'm very verbose, if you haven't already noticed from my other posts, and it's just because this is my interest. It probably is obsessive for me, but that's my Asperger's. I don't think that you simply talking about it makes you more obsessive. I'd say that, in your case like many others, you talk a lot because you're so relieved to finally find someone else who is going through the same thing that you are. To put it mildly, this website is a Godsend for thousands of people... Is there anything else you'd like to know?
"Not everything that steps out of line, and thus 'abnormal,' must necessarily be 'inferior.'"
Last edited by GatsbyLuvr1920; 07-15-2006 at 10:22 PM.
Don't mean to be annoying, but I have really been obsessed with this whole score issue. Can you give me your appraisal (even though you're not an expert). I spend pretty much all day obsessing, I don't think I have moments where I'm not...when I talk to someone, the frequency and intensity is reduced but intrusive thought pop in, or I obsess w/out realizing it. I guess that's a 4) 8+ hours (more than 1/2 day)
Anxiety fluctuates during the day....It goes from 'high' moderate levels to moderately severe levels. Like I said, I have "high anxiety" visibly obvious to tohers and tons of stress+frustration which I can tolerate and bear but is not MANAGEABLE. I lost 15 pounds first starting college over a period of 2-3 months...and that's alot (didn't go "underweight" but people said in a concerned tone "you've lost alot of weight). I get strong distress usually late afternoon, followed by a drop, and peaks about 11-3AM...I usually get a good 1.5 hours of insomnia, and even with anti-anxiety or sleeping pills it takes about an hour to put me to rest...ambien knocks out most people in 30 minutes...so the stress is pretty powerful. Even on some isolated instances, I have remained awake w/ them....sleepless night. I'd say I averege 4-6 hours/day where I'm agitated, the rest is calmer though I'm still restless/wired/prone to fatigue/fast thoughts (look up generalized anxiety disorder symptoms and amplify them to a high degree and that's me "normal". My anxiety through the early evening is moderate-to-severe I'd say going from 29 on the HAS (highest moderate score) to 31 one point above severe cutoff. I really don't know if that's "severe" for YBOC, but in my opinion "disabling distress" would be more like a panic attack...or near-panic...you can't really do anything in that state. In my normal state, I can still do things just it causes alot of impairment (concentration down to 30% of capacity....can't still through lecture....getting fired after 4 months because of anxiety interfering with doing task at hand...that's an awful lot of "problems" to be manageable. In my opinion severe anxiety is high anxiety which doesn't restrict/prevent the person necessarily, but really causes them to perform poorly or mediocrely the task at hand. I chose 2/3, don't know which one, because I don't have really severe distress all day long only 4-6 hours..so I could use advice. Impairment is substantial...no question. I'm not disabled/housebound but seriously limited in what I can do (example I can only handle 2 classes/semester instead of 4...I can only work 3-4 hours a day instead of 8 etc...) That's a 3) As far as resistance is concerned, I read actually that yelling stop outloud to an intrusive thought is not resistance but merely thought neutralizing "compulsion" So I didn't really resist any of my thoughts, as in trying to block them (ex. trying to make mind blank), but I sometimes told myself "these thoughts are recking your life" which is not totally giving in to them. But many thoughts were actively indulged...my CBT told me one time "I go out of my way to keep them there" So either 3 or 4 for that question. Control, I can rid my mind for about 4-6 seconds before the "flood" comes back. Also, in talking to CBT he told me it took 20 minutes (of a 40 minute session) for me to switch topics. He often had to stop me (at least 2-3 times) because I was obsessing. So even with concentration focused talking to someone, I still obsessed but I felt it a bit weaker than when alone. I'd say little control score 3). As far as my OCD overall, my therapist said "it's pretty bad" and I was the WORST case he has treated. He doesn't treat many I think 7-10 or something like that, but he told me that there are people worse but who can't continue treatment. My psychiatrist has told me he's seen worse, but then again he's a psychiatrist so he's dealt with people hospitalized w/ the disorder. he explained that one person took 8 hours to tie his/her shoes....OK I'm NOT that bad, but I still think I have a strong case of it. He told me moderate-to-severe but when he filled out forms he marked "severe" OCD. Interestingly, Paxil conducted trials on people with "moderate-to-severe" OCD who had scores between 23 and 26. Prozac took scores of 22 to 26 as "moderate-to severe", and Zoloft took scores 23-25. I'm somewhere in that range, I'd imagine. The total for obsessions was either 4+2+3+3+3=15 or 4+3+3+4+3=17 or 4+3+3+3+3=16. If I take time spent on obsessions causing "severe" distress 3-6 hours then I get 3+3+3+3+3=15 or 3+3+3+4+3=16. Compulsion score is 10 or 11, I think it's more about 10. So possible scores are 10+15=25 10+16=26 10+17=27
If I use 11, I get 11+15=26 11+16=27 11+17=28. I'm more interested in obsessional score do you think it's 15-16-17. They all sound awfully high. I could use your advice. I'm truly sorry about bugging you about this, but it's annoying (I spent 1/2 hour trying to figure it out....checking compulsion). Thanks again
I'd say that, if you truly are having obsessions that "pop" into your head all day long with little to no relief, and you have little to no control over stopping the obsessions, then your obsessional score would be quite high. It does indeed sound as if you're a pure obsessional, and they are the ones that usually have scores of "severe." Again, like you said, I'm not an expert on the YBOCS, but I understand your worry on a different level. I think, if I'm not mistaken, that you're worrying primarily if you actually do have OCD or not, or just how severely you have it? I went through that same doubt, too. If I were you, I'd judge your severity on how often the obsessions come, which for you, seems to be almost constantly, rather than the interference with your job/work/school. Pure obsessionals are surprisingly good at hiding their symptoms, even though they are silently suffering on the inside. I know that, despite me obsessing eight hours a day at home in seventh grade, I still got all of my homework done and made straight "A's," so I wasn't prevented from working to my best ability, despite being tormented by obsessions all day long. I'd say that, if your doctor said you were one of the worst cases he had seen, then that probably means you fall into the severe range. I was also told by my CBT therapist that I had the worst and most anxiety he had ever seen, and I'd say that my OCD falls into the moderate-severe range, but whenever I'm really bad, I'm always severe. I don't know if this helped much, and I'm probably just rambling because I have trouble writing when there's not a clear-cut question posed (this is probably my Asperger's), but if you ever want to talk some more, I'll be happy to oblige...
"Not everything that steps out of line, and thus 'abnormal,' must necessarily be 'inferior.'"