A Guide to Obsessive Compulsive Disorder Written by a Doctor and Patient

Shiro Kamei is a Japanese psychiatrist.
But after he develops obsessive-compulsive disorder, his life falls into the abyss.
It was a disease I thought I knew well, but I was helpless in the grip of a terrible obsession.
After years of what he describes as "hell on earth," he was driven to the brink of giving up on life, but after meeting Japan's top obsessive-compulsive disorder specialist, he overcame numerous difficulties and finally broke free from his obsessive-compulsive disorder.
This book is a friendly guide and vivid account of the author's struggle with obsessive-compulsive disorder, written by a psychiatrist and former patient, for people and their families who are struggling with the same problem.


This book is different!

There are many books about obsessive-compulsive disorder.
However, it is true that it feels distant from us because it is overly theory-centered and mainly explains using American examples.
Of course, I sympathize with the patient's situation, but my sympathy is purely from the objective perspective of a therapist.
This book is different.
All the suffering, fear, and worry experienced at the moment when obsession 'comes upon' are vividly described from the person's perspective.
At the same time, as a doctor, he carefully explains the causes and coping methods for each process that occurs in the mind.
It is also important to note that his own struggles with illness and the patient cases he experienced as a doctor are all set in Japan, a country with similar culture and way of thinking, making it feel much more relatable.
While no mental illness is without its distressing symptoms, few plague people as persistently as obsessive-compulsive disorder.
Through this book, readers will discover empathy and courage rarely found anywhere else, and will gain practical strategies and countless tips for overcoming obsessive-compulsive disorder.

Have you ever had this experience?
① ‘Did you lock the door?’, ‘Did you turn off the gas?’ I suddenly became anxious and went back home to check.
② I have avoided the numbers 4 and 9 because I felt an inexplicable sense of unluckiness.
③ I washed my hands thoroughly because I thought they were contaminated with bacteria.
④ I was concerned that the books on the bookshelf were not the right height, so I rearranged them.
⑤ I didn't like the shape of the letters I wrote in my note, so I erased them and wrote them again.
These are all normal psychological states.
Many people have probably had similar experiences.
You might agree and say, “That’s right, that’s right.”
It doesn't matter if this happens a few times.
But in this psychology, the seed of obsession is hidden.
As with anything, if it goes too far, it becomes a problem.
--- p.21

Once you feel anxious, you have to choose between two paths: take action to resolve it or endure it without doing anything.
If your anxiety is intense, it's a thorny path no matter which way you choose.
But you can run away before anxiety sets in.
Since most of the conditions that make you anxious are set in stone and you are fully aware of them, I think you won't feel anxious if you avoid the places that cause it.
This is evasion.
For example, I avoid places with lots of children because I'm worried that I might bump into them and get hurt.
Avoid areas around elementary schools during school commute times.
Also avoid department stores and stores with lots of families.
You should also avoid subway stations at certain times as they are crowded with children.
There are fewer and fewer places you can go this way.
But the flames of anxiety still burn.
No, on the contrary, the more you avoid it, the more your fear grows and it can easily lead to anxiety.
No matter where you run, you will eventually find the object of your anxiety.
How many places can a child never appear? The pursuit of absolute safety narrows the scope of their activities.
Some people experience it much more frequently, but in any case, they experience a life quite different from that of ordinary people.
--- p.72

This quantifies the various intensities of anxiety.
As long as it's easy to understand, it doesn't matter how you do it, but usually I make a table that lists the numbers in order from 0 to 100.
For reference, here's my anxiety hierarchy chart at the time (I've changed it a bit to make it easier to understand).
It's okay to be rough around the edges at first.
It doesn't matter if you change the order in the middle.
It's important to try making it first.
It makes sense to just visualize the overall picture of your symptoms in a table format.
CBT tasks are determined through consultation with a therapist using the anxiety hierarchy as a reference.
We need to start by addressing the weak anxiety at the bottom of the table.
If we use a mountaineering analogy, it's like climbing properly from the first ridge.
If you keep winning, you will gain confidence.
You have to get into the habit of winning.
As your winning streak continues, you can overcome cognitive distortions.
--- p.104

In the beginning, it was difficult to strictly adhere to the principle of 'not being dragged in'.
Unable to bear his anxiety, he often asked his wife for reassurance.
“Isn’t the outlet on fire?”, “I didn’t drop anyone on the platform, did I?” Before CBT, this kind of dragging was commonplace, so it was difficult to eliminate it all at once.
At this time, my wife's cooperation, who had learned how to respond from her doctor, was of great help.
He saw through my questions and responded calmly every time, knowing that they were pathological demands for guarantees.
They only provide a certain amount of reassurance, such as, “It’s okay! It’s over now!” and never respond beyond that.
Since I also knew that fact, I didn't ask for any more guarantees.
My wife's response was effective and the attraction gradually decreased.
--- p.169

The characteristics of this type are ① the involvement of obsessive thoughts is not noticeable, ② the genetic component is relatively strong, ③ the onset tends to occur at a young age, and 4) it is likely to appear together with tics.
Distinguishing obsessive-compulsive disorder from other types is therapeutically significant.
Because it is helpful in choosing a drug.
In general, it is effective to administer antipsychotic medication in addition to antidepressant medication.
So it's important to know if you have tics.
Neatness obsessions are more ego-friendly than other types.
As the name suggests, ego-compatibility means that symptoms are friendly to the ego.
In other words, they do not feel that the compulsive behavior itself is irrational, but rather accept it as something they do because they want to do it.
This is also due to the fact that obsession with organizing often appears as an extension of a perfectionistic personality.
So, wouldn't the compulsive behavior itself be so difficult? It isn't.
In the end, you will face great difficulties.
--- p.202

Families of people with OCD are exhausted.
Because the consumption caused by attraction is truly enormous.
The behaviors or rules that patients force upon us are often absurd and ridiculous.
When you are swayed by words you don't understand without even knowing the reason, you get angry.
I want to understand because we are family, but I get angry at myself for not being able to understand.
The patient's position is similar.
There is a growing sense of dissatisfaction, thinking, 'Why don't you understand me?'
For example, behind the compulsive behavior of 'I have to clean the refrigerator thoroughly to kill germs when putting items I bought at the store in it', there is a strong will to 'protect not only myself but also my family from infection'.
You may think that you are protecting your family through bone-cutting efforts.
I feel tremendous stress and sadness because my desperate feelings are not conveyed at all and my family does not appreciate me.
This difference in perspective causes strain in family relationships.
In the minds of patients who are exhausted beyond repair, misconceptions such as, "I am not loved," or "I cannot receive help because my family is like this," arise, and a desperate situation may arise for both the patient and the family.
--- p.253

A good primary care physician or clinical psychologist, medication, more promising medications, and strong family support are all important.
But in the end, it is you who succeeds in treating your OCD and freeing yourself from your compulsions.
The most important thing is to understand your illness, face it head on, and take the right action.
It can be a lonely and harsh fight.
Sometimes you may feel overwhelmed by anxiety and fail to respond to treatment.
Some people may have almost given up.
But I still hope that it will rise again.
People with obsessive-compulsive disorder tend to judge every situation in binary terms, either 0 or 100.
If you fail once, you tend to get disappointed and think, 'I'm starting from zero again' or 'I'm wrong now'.
Overcoming such crises is growth.
In the process, you will gain flexibility and resilience.
Let's analyze your symptoms again and develop a treatment strategy with the help of a professional.
There will certainly be a way forward that leads to healing.
This book consistently provides knowledge on how to overcome obsessive-compulsive disorder.
Knowledge is a weapon.
Weapons exist to fight.
I sincerely hope that this weapon will help you in your fight to overcome your compulsion and achieve freedom, and that you and your family will regain true health and a happy life.

--- p.283