Finding Sanctuary from OCD

For Charlene, the first symptoms began in her early 20’s after she’d graduated from college and started a job. “I was commuting into New York every day, and some out of the ordinary things started happening,” says the Jersey City, NJ, resident who is now 40. “I started feeling dirty most of the time—uneasy and anxious. It felt like everything I touched was dirty.”

In the months to come these symptoms intensified to the point of disrupting her daily routines. Charlene would wash her hands up to 100 times each day, take showers that lasted more than an hour, and spend up to three hours after work disinfecting her purse, jacket, and other belongings she feared had been contaminated by the outside world. Concerned about her increasing difficulties, Charlene’s mother took her to a psychiatrist, who diagnosed her with obsessive-compulsive disorder (OCD), a condition characterized by repetitive, intrusive thoughts and urges to perform ritualized behaviors. Charlene was started on a regimen of medication and talk therapy, but she continued to struggle and embarked on a period of seeing multiple therapists while her runaway symptoms persisted. “I didn’t have much of a life,” she says of that period. “My days were pretty much just disinfecting, ritualizing, and obsessing—it became a way of life for me.”

A few years after moving to California in 1997, Charlene found relief when she started intensive outpatient treatment with a therapist who was able to bring her symptoms under control. For a time, Charlene was effectively managing her fears and leading what she considered a “normal life.” But that progress was soon to suffer a setback.

A Startling Relapse

After moving back to New Jersey in 2002, a string of stressful events triggered Charlene’s old symptoms to resurface and new ones to awaken. After dealing with the loss of a job and the passing of her father, Charlene entered a painfully dark period plagued not only by OCD but also depression.

“There were times when I was in such despair,” Charlene remembers, adding that her symptoms made it impossible to maintain any semblance of a normal schedule. Now when she came home her routine of decontaminating her jacket, purse, and all items she’d touched while outside ballooned to an eight-hour process, ending with an hour-long shower. “I wouldn’t be done until about 4:00 in the morning—it was exhausting,” she remembers. “After awhile I didn’t want to go out because I didn’t want to come home and deal with all that. Every waking moment was cleaning and wiping, cleaning and wiping.”

But Charlene says such germ-based fears only accounted for 75 percent of her OCD symptoms; the other 25 percent dealt with the need to compulsively check things: checking door knobs to make sure they were locked, checking the oven to make sure it was off, and checking faucets to make sure they wouldn’t cause a flood. “OCD distorts your thinking in so many ways,” Charlene says. “It was filling my head with all these doubts and distortions—plus I had the complication of depression mixed in as well.”

Recognizing the severity of Charlene’s situation, her family started researching treatments on the internet, where the International OCD Foundation website led them to the Mount Sinai Obsessive-Compulsive and Related Disorders Program. Charlene’s first appointment at Mount Sinai was in June 2012, and she immediately felt she was in good hands with Ariz Rojas, PhD, who handled her psychotherapy, and Matthew Hopperstad, MD, who handled her medications. “They became partners in my treatment, and I love them both.”

In the care of the Mount Sinai team, Charlene underwent regular exposure therapy sessions in which she was asked to perform tasks she feared in order to lessen her anxiety response. But one-hour sessions each week were proving insufficient treatment for the severity of Charlene’s symptoms. Although she was making some progress, approximately two months after the start of treatment, Dr. Rojas suggested referring Charlene for intensive, inpatient therapy. So Charlene went to the OCD Institute at McLean Hospital near Boston, where she underwent four hours of OCD exposure therapy each day—and where she responded so well after two months she was released back into the care of Mount Sinai.

On the Right Path

Since her discharge in February 2013, Charlene has continued outpatient treatment with Drs. Rojas and Hopperstad, which includes a combination of exposure therapy, cognitive behavioral therapy, and medication management, as well as the involvement of her family. And Charlene is thrilled to have her life back.

“I’m doing so much better now—I don’t even carry hand sanitizer anymore,” she reports, adding that she’s improved to the point at which she’s starting to look for a job. But Charlene recognizes that she has to keep working to get the full benefit of treatment. In one recent exposure therapy session, for example, Dr. Rojas took Charlene to Central Park and challenged her to walk on the lawn with her eyes closed as well as lie down in an area of high pet traffic—anxiety-provoking exercises for someone fearful of the germs that could be lurking in the grass.

“It was really hard, but I’m willing to do the hard work because I want to stay well,” Charlene says, adding her appreciation for the Mount Sinai team that’s working with her. “They’re so supportive and they’re really helping me rebuild my life,” she says. “Now I look forward to coming here; I feel like this is my sanctuary. It’s saved me in a lot of ways.”