Substance Abuse and Other Harmful Behaviors

Other OC behaviors can also damage your health, sometimes in subtle ways.

As we discussed when we talked about the dangers of “self-medicating,” many people who have OCD and other anxiety disorders end up using alcohol or other illegal drugs, perhaps in greater numbers than the general population. You probably already know that this is a bad idea. Self-medicating may seem to alleviate some of your anxieties in the short term, but it will not prove useful beyond that. In addition to preventing or hindering you from getting the right treatment, it can also cause untold other problems, from dependency to dangerous behaviors to potentially serious health damage. If you find that you have difficulty stopping your alcohol or drug use, seek out an organization such as Alcoholics Anonymous (AA), Cocaine Anonymous, or other appropriate group, or look for a qualified therapist immediately. Or do both.

Getting the Right Health Care

It may be important for your primary care physician to know about your OCD. There are several good reasons for this: It could be affecting your health, as in any of the situations described earlier in this chapter. Or, it may cause you to seek more than a “normal” amount of reassurance from your doctor. Telling him now that you have an anxiety disorder may save you from having him conclude later than you've singled out his office or his habits as unclean. (On the other hand, it may be possible that your doctor will become dismissive of any concern you bring to his attention once he knows you have OCD. This is not necessarily likely, but, if it should happen, it might be wise to change physicians. You deserve to be taken seriously, OCD or no.)

Question

Has a link been established between OCD and physical illness?

As far as we know, such a correlation has not been proved. However, many experts believe that stress and physical illness go hand in hand, and OCD definitely involves a lot of stress!

If you express a greater-than-average amount of concern about your doctor's hand washing or office cleanliness, or if you're bothered by things in her examining room, such as the garbage pail, the biohazards container, or needles, it might be wise to let her know not to take your anxiety personally. (Again, if she should decide not to wash her hands because it's only obsessive-compulsive you making the suggestion, you might want to consider changing doctors.)

If you need any special accommodations, it will probably be a good idea for you to mention this early in the relationship.

The Right Doctor for You

Some doctors just naturally have a more sympathetic manner than others. This probably cannot be taught in medical school, or anywhere else. If you do not have a doctor you like or feel comfortable with, ask friends for recommendations. You may be limited by your health plan, as many of us are. Still, you can “audition” different doctors on the plan until you find one who exudes the tranquility, cleanliness, sympathy, or other factors you seek. (Please note, however, that some medical offices charge more for a “meet and greet” than for a regular visit; you may need to make an appointment for a checkup to avoid paying the higher cost.)

A Note about Health Care Providers

Often, doctors are extremely pressed for time and stressed by the demands of their profession. Long hours, emergency calls, and a health care system that often demands they see patients for only short amounts of time may conspire to make the doctor the less patient-friendly choice. Whom, then, should you see?

Essential

If you already like the doctor you have, but feel uncomfortable about her sanitation or other practices, it should be perfectly fine to tell her so. (Once per visit ought to be sufficient, however.) It is, in fact, essential for doctors to wash their hands before and after examining each patient. There's nothing wrong with reminding your physician about this (again, once per visit).

One choice is a nurse practitioner. Nurse practitioners, in general, know a great deal about health and medicine, and often are able to spend much more time with patients. They can also prescribe some medications. For these and other reasons, it is not unusual for a patient to find the nurse practitioner a more sympathetic presence than a doctor. (This is not to say, of course, that you won't feel differently about your doctor.) In any case, you might want to “try out” a number of doctors and nurse practitioners before deciding on the right care for you.

Other Things to Keep in Mind

You will also want to factor into your choice such things as how far your health care provider's practice is from your home or work or whether his office is located in a hospital, office park, or other structure. If you have anxieties about parking, for instance, you will want to find out what the parking situation is there. Another thing that may be helpful to keep in mind: Some doctors practice out of more than one office. One office may be located in a huge urban hospital with a multi-tiered garage, for instance, while the same doctor's other office is in a low-rise suburban building with a large lot just outside. If you like the doctor but not the office, ask whether he works out of another office as well.

Fact

Fear of doctors is called latrophobia and is surprisingly common. There even are commercial programs available, using CBT-type techniques or hypnosis, that promise to cure it. Some people fear needles or germs in general, making them fearful of doctor's offices specifically.

It also may be important to you to know a little bit about the doctor's professional philosophy. If you are afraid of medication, for example, how does your new or prospective doctor feel about Eastern medical practices or other alternative or integrative medical options?

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