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Sunday, April 25, 2010

Addictions and Compulsions

Question: For about the past fifteen years (I am 30 now) I have been involved in what I consider to be compulsions. I compulsively pick at scalp and skin trying to erase the imperfections (bald patches on head, scars on body, but i do have psoriasis and acne), that will last for months, then it will stop for a few months to a few years, and then I pick it right back up and spend hours a day doing it not even fully aware I am doing it. If I'm picking at my scalp I become agitated if I have to stop and say use that arm. What concerns me greater than that are the compulsions I have to enter this sort of fantasy world. I spend hours a day doing this, and if prevented from doing so I can get extremely angry and feel this just imbalance inside, that is MUST be done. I can't simply just stop doing it, at good times though I may go a few days without doing it but those are rare and only happen every few years (and the thought of it never leaves my mind). During my trance like state reality becomes clouded, what feels like minutes is actually hours passing, and outside sounds become distorted, I can't make out what I am hearing in this state. My vision blurs, and I focus on lists of purchases I'd like to make/need to make, people that don't exist that I have created in my mind and often I replay the same images over and over again for hours of say what I have to buy at bed bath and beyond or what I wished I looked like, or who I wished I was. during this I have a ritual. I hold an object in each hand, always the same object and if i lose one of the objects great distress blankets over me. With an object in each hand I flutter my wrists back and forth and eventually my vision blurs, and I am only slightly aware of my surroundings. Sometimes during this state I am suddenly snapped out of it by an audible sound that I make that seems to me to come from nowhere, almost like I was holding my breath and I wasn't even aware. Sometimes pacing is involved and during that the objects in hands can become lose from the fluttering and have snapped me out of trance like state by smacking me in the face. I feel like i can somewhat control the level of the trance, I get pleasure from my activities on one hand (no pun intended) because they soothe me and seem more natural to me than not doing them, but on the other it is time consuming, embarrassing, and I spend a great deal of my life trying to hide that I do this which causes strain on my relationships with other people, especially my husband. There's such a guilt involved that this doesn't seem like a mental disorder I can pinpoint, and therefore part of me agrees with my family that I should just be able to stop. I have never had counseling for this, even as a teen I was ashamed of it and when my parents sought out treatment i would deny it in therapy. sometimes when I am not in trance like state I will still flutter my wrists with objects, like I am doing now as I type this, I also do it while I read books. It feels like I can almost heighten my imagination if I am doing this. as much as the clouded kind of consciousness, the fluttering is another compulsion I just have to do related, and unrelated. I read one time a question on an ask a therapist site that sounded like me, and the writer was told that he was just lacking stimulation, but I disagree in my case if we truly are similar. If I go out to say Disneyland or Busch gardens today and have a great day completely over stimulated, I'll want my alone time so i can do my rituals. It's much more than just a bored habit to me. I think I do have low self esteem, as indicated by a lot of the fantasies in my world are a more grandiose me (sometimes so far removed from myself that I have another name but I am still me, or rather maybe I become them for a time). In my aware self I am always certain of who I am, I do not suffer from any sort of split personality. I have used marijuana from time to time in the past, but the problem started before that and continues without it. All the marijuana did was make me a little more focused on my fantasy world, and perhaps a little more agitated if I was being prevented from it. I do have unstable emotions at times that fluctuate, and I feel like sometimes my emotions are out of my hands, but through practice I am learning to control myself better. I just can't control my compulsions,I think that if I didn't spend hours a day doing these activities I could actually do some of the things I fantasize about, like landing that dream job or what have you. I am fully aware that what I do is not considered "normal". I am aware enough to the point of hiding it from loved ones. any sort of insight on any of this would help. thanks. PS: my family background was a very unstable home, being bounced around, I didn't know my father much and my mom died several years after I started doing this.

Click on comments to see Laura's advice.


Eleventh Hour LLC said...

Dear Bethany,
Although at first glance, your question may appear complicated, when we break it down, you will be able to clearly explore what is going on for you. First, let's start with some definitions. A compulsion is an irresistible impulse to act, regardless of rationale. It is an overwhelming urge to perform an irrational act or ritual. An addiction is a recurring compulsion to engage in pleasure-seeking activity, a persistent behavioral pattern that causes significant disruption and negatively impacts quality of life. And a habit is a recurrent pattern of behavior acquired through frequent repetition. So is your behavior a compulsion, an addiction, or a habit? Well let's take a closer look. You say it is somewhat pleasurable for you to engage in this ritual. You say you go into a "trance." So that part sounds like an addiction. But you also say you don't feel you can stop doing it. And that part sounds like a compulsion because you have insight to know that the ritual is odd and not necessary but you are compelled to engage in the activity. And you also indicate that you have been doing this ritual for many many years. So that part makes it a habit. Because this has been a part of your life for so long, it is truly a compulsion, an addiction, and a habit. A compulsion involves the experience of having no choice and addictions, by their very nature, cause a moment of a heightened state of consciousness, the "trance." And, compulsions and addictions both involve a perceived lack of control and both disrupt a person's ability to function. So now what? If you can accept that it is a habit, a compulsion, and an addiction, then we can explore its origin. You spoke of your childhood as being somewhat stressful and difficult. And perhaps, how you coped with the internal anxiety when you were young, was to enter into this trance, and was to pick at yourself as a way to self-sooth, and that reduced your anxiety. My opinion is that you may benefit from an anti-anxiety medication in combination with an antidepressant. I would start both medications at the same time and I would have you keep a daily journal of behaviors and mood in relation to the medication dosing schedule. Of course this is just one opinion based on your question. I would encourage you to have a full evaluation to determine a definitive diagnosis. I do believe you would benefit from both medication groups I mentioned earlier. Medication in combination with some therapy would be the best plan. Being able to further explore your coping style will help you to adjust and implement a healthier way to cope with anxiety in your life. And, I believe it is partly a neurobiological issue, and that is where the medication will help you. We can never dismiss the impact of our genes and our environment. Both have equally contributed to your current state of being. I also recommend a full physical exam with lab work. Vitamin deficiencies, thyroid disorders, and other medical conditions may be a factor as well. Good luck and let us know how it goes.

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