I Once Broke Up With a Therapist Because She Would Not Assess Me for Psychosis: My OCD Story
It was 2020. I was in my last year of grad school. In the midst of a global pandemic marked by worldwide isolation and anxiety, I was in classes like “existential therapy” and “dual diagnosis” being encouraged to analyze systems and symptoms and how and why people struggle and what it looks like when they do.
It started with underlying anxiety. The intensity and stress of graduate school combined with the uncertainty of the time period, the not knowing what it would mean... for me, my job, but also.. humanity?
It compounded with an intrusive thought one day:
“what if none of this matters?”
Which quickly spiraled into, “wait… is any of this real?”
I had enjoyed taking philosophy classes in undergraduate school, and was not a stranger to deep conversations around dinner tables and campfires with friends about the meaning of life and perceptions of reality. But this felt different.
There was terror. There was dread. There was the spiral of obsessive thoughts that followed:
“is anybody else thinking about this?
what if I just discovered something no one else knows?
how do I know if any of this is real?
am I real?”
“wait... am I having a psychotic break?”
I didn’t know it yet but quickly my days were consumed by obsessions and compulsions.
I was constantly mentally checking if my brain felt “regular” which only made things worse, because, surprise surprise, when you are obsessing and compulsing your brain certainly does not feel “regular”! I watched other people closely, trying to “figure out” if they also had these thoughts. I took online tests to see if I had schizophrenia. I read countless reddit posts, meticulously comparing my experience to the poster’s.
I arduously tumbled around these questions in my brain in some kind of futile attempt to prepare myself for what it would mean if these thoughts were true:
I wouldn’t be able to be a therapist anymore that’s for sure. I probably would never have a family. What if snapped and did something really bad? Then I could never live with myself.
I was spending hours worried about these questions.
And that’s when it got confusing. Something had to be wrong with my brain, because “normal” people definitely did not have these kind of thoughts. A sort-of self-fulfilling prophecy that OCD creates.
At first I kept all of this to myself. I didn’t want anyone else to know yet this secret I had discovered about myself that I might be psychotic. I was so afraid of it being or becoming true that even saying it out loud felt risky.
But the weight of it became all too much.
I started disclosing pieces to close friends. And quickly developed a new compulsion: reassurance seeking.
It became like a job I clocked in for. First the panic would set in, and then I would go down my list. First call would be to my childhood best friend. I’d share with her some weird thoughts and feelings I’d been having, she’d reassure me in several different ways: “Oh yeah, I’ve thought about that before. I know, it’s scary.” or “Oh my gosh, you’re fine! I’ve known you since you were 10.” I’d feel a little better, but it wouldn’t be quite enough.
So I’d continue down the list. Second call would always be to my sister. I’d tell her, “I’m having the thoughts again” sometimes in tears. She’d talk me down, I’d feel a little better, and then I’d move on to my 3rd call.
This would usually be my close grad-school friend. She’d use clinical language to help me feel better about my obsessions: “you’re experiencing derealization, it’s a symptom of anxiety, we know this. you’re okay.” On more than one occasion, she indulged my request for her to go through the DSM-5 diagnostic criteria for schizophrenia and assess me. This was really reassuring. It became a test, and when I “passed,” it felt like I had just dodged a bullet. “Phew, we better keep checking” my brain would say. Meanwhile, she’d joke “yup, no schizophrenia, and listen, who cares?! if you have schizophrenia then we’ll just move to a culture where people with schizophrenia are honored as super-beings and you’ll be a shamanic healer. I’ll go with you.” I did consider this a good back- up plan, actually. That’s how deep in my OCD I was.
Then one day, my usual reassurance seeking routines were not enough. And in a panic, I called my parents. Hysterical, I told my mom I thought I was having a psychotic break. To my surprise, she didn’t freak out and say we should go to the hospital or call the police. She just responded in kind of a confused and matter-of-fact way, “what? honey, people who are psychotic don’t think they are psychotic….” This was helpful. She was right. I felt immediate relief. But then the intrusive thought just shapeshifted:
What if I’m on the BRINK of a psychotic break?
It was a question that no amount of figuring out or reassurance seeking could answer. Spoiler alert: there’s no way to really prove that you won’t have a psychotic break. You can compulse your heart out and do all sorts of checking and assessing, you can make your life as rigid and controlled as possible, but there’s no proof that your mind is safe. And the more you compulse, the more unsafe you’ll feel. And this was one of many hard truths of life that I had to learn to embrace.
—————
Now of course all these people encouraged me to seek some support. So I contacted a therapist that I had seen in college. But pretty quickly our therapy sessions would fall into this familiar cycle. I’d loop and spiral, and she’d tell me I was experiencing anxiety and provide anxiety psychoed and walk me through deep breathing and guided visualization exercises that just made me feel worse. Finally, one day I demanded she assess me for psychosis, but she just kept insisting, “this is anxiety. you’re not psychotic.”
Here’s the thing: she wasn’t wrong. But she missed something big.
That anxiety was OCD. And I was in a debilitating cycle of obsessions and compulsions that was in fact making me feel like I was losing my frickin’ mind and only confirming my deepest fear: that I’d lose control.
I share this story because OCD is one of the most misunderstood and misdiagnosed mental health condition. Almost every person who struggles with OCD does not realize that what they are struggling with is OCD. And even therapists can miss it.
I was a new therapist myself, in a class learning about diagnostic criteria for OCD, and I could not identify that what I was struggling with was OCD. I thought I was just losing my mind, which only made it worse.
What I was struggling with was actually a very common OCD subtype called psychosis OCD or existential OCD- OCD that concerns itself with questions of reality.
Other subtypes of OCD are:
contamination OCD (the most stereotypical subtype)- intrusive thoughts and compulsions associated with germs
harm OCD- unwanted thoughts about harming yourself or others
relationship OCD- intrusive thoughts, worries, and compulsions concerning close relationships
sexuality OCD- intrusive thoughts and doubts about sexuality
responsibility OCD- obsessions and compulsions related to one’s morals
sensorimotor OCD- worries or fears about bodily sensations or processes
perfectionism or just right OCD- obsessive concerns and fears about things being wrong, off, not right, or imperfect
and many others
It does not matter what subtype of OCD you struggle with, at the root of all OCD is some version of 1 of 3 fears:
fear of losing control (which would mean……)
being alone (ostracized, rejected, abandoned, isolated, etc)
being bad (wrong, broken, evil, immoral, incompetent, etc)
or death
As for me, I did end up connecting with an OCD specialist and doing ERP therapy. It changed my life and is what led me to ultimately train in ERP therapy and do this work with my clients.
I’m so passionate now about OCD work, not only because of my own story, but because at our core, even if we don’t struggle with OCD, we all fear these three things to some capacity. There is so much power in facing our fears and loosening the grip of control.
