Harm OCD - A Terrible Mysterious Secret

Mom's Thoughts:

There is nothing more horrible and heart-wrenching than seeing your own child in pain - real, agonizing pain - and not being able to do anything about it.  And not being able to understand it.  I'm sure people whose children have cancer or some other horrible disease know how this feels.  You suddenly become obsessed with finding out everything you can about the disease and how to treat it or cure it if you can.  The fact-finding is a bit of a salve - it makes you feel better to know more about what you are dealing with - but is a bit like putting a band-aid on a severed limb when you are in the throes of dealing with your child's pain. 

Elizabeth has several types of OCD - kind of a cruel trick of OCD's, really, that you can have more than one kind, and the way they manifest can change suddenly.  And I can't say that one kind is more painful or cruel than another.  Is a handwashing compulsion "better" than a checking or cleaning compulsion?  They are equally painful.  But a lesser-known type, Harm OCD, is harder for me to wrap my head around, and just seems particularly cruel punishment for its victim.  That's just my opinion, but I really think that.  It's a particularly terrible secret that a person with OCD thinks she has to keep, and it's so mysterious and hard to understand that it seems incomprehensible.

You never hear about people suffering from this, and it's easy to understand why:  these poor men, women and children think they are crazy, dangerous, and oh boy, you better not tell anyone what you are thinking!  I've found a new blog from the OCD Center of Los Angeles that has helped me understand this a bit better, and I am dying to share it, even before I've really even finished the entire thing.  Here's an excerpt from that website describing Harm OCD - the link to the entire article is at the bottom of this page:

Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.... (underscore is my addition)

What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt.

I feel a sense of relief when I read this, because I know so purely and completely that there are few people in the world as kind-hearted as my Elizabeth.  She loves children and animals and is amazing to watch when she interacts with them.  She is a hard-working, conscientious person who always tries her hardest to do what is right.  She volunteers her time, helps others without a second thought, and is so averse to mean-spiritedness that she has never been able even to watch America's Funniest Home Videos, saying it's just too mean.  She hates seeing others take pleasure in someone else's misfortune or pain, and has even served on the Anti-Bullying Committee at her school as a peer leader and attending workshops on how to help others if you observe bullying going on.  

So how in the world is SHE the one struck with this type of OCD?  I can imagine some strange, depressed, goth kind of person being prone to this type of violent thought, right?  Isn't that how it works?  No, apparently not.  In fact, Harm OCD typically afflicts people who are so horrified and guilt-ridden about their thoughts that they are highly distressed.  Many people have strange thoughts of doing something to hurt another person - things they would never, ever do - but are able to shake them out of their minds and move on with their day.  People with Harm OCD can't shake them out of their minds; they review them over and over, analyzing their responses, feeling crushing guilt and fear that they would actually do the things they have envisioned.  However, people with this kind of OCD are no more a danger to others or themselves than any "normal" person.  They are just afraid they are.  In Elizabeth's case, they generate panic attacks, making it even more difficult for her to calm down.

Harm OCD can manifest through fears of hurting others, or of hurting yourself.  Or both.  Elizabeth recently has been obsessing about hurting herself, which is very distressing to her father and me, as well as to her.  When she is suffering through an "attack," she thinks she "wants" to hurt herself - more to stop herself from "being crazy" than anything.  She wants to stop the pain in her head by causing pain to herself - you know, the old "if you want to stop thinking about the pain in your toe, hit yourself over the head with a hammer" mentality.  But she really doesn't want to hurt herself... this is the child that was so afraid of getting hurt that it took her forever to learn how to ride a bike.  But it's a testament to how much pain she's in mentally.  This is what makes me want to get rid of OCD more than anything!!  

It is fairly easy to see what the obsession is, but what about the compulsion?  According to the OCD Center of Los Angeles, Harm OCD is sometimes called "Pure O" - as if there is no compulsion associated with it, just obsessions.  This is not true.  People with Harm OCD have many kinds of compulsions, and I see some of them in Elizabeth.  Some of the compulsions are, checking (to be sure you haven't actually hurt someone or yourself,) avoidance (avoiding places, being alone with people, knives, etc.,) reassurance seeking (asking others for reassurance that you are not a bad person, haven't done anything bad, etc.,) and mental rituals (compulsive praying, mental checking or reviewing thoughts or memories to be sure you haven't done anything, thought neutralization, etc.)  You can learn more about this on the blog I linked below.)

IF YOU SUFFER FROM HARM OCD, YOU ARE NOT CRAZY!!  It IS treatable with Cognitive Behavior Therapy!  Be sure to find a specialist in CBT for people with OCD.  Do not seek help from someone who does not do a form of CBT!!

Treatment of Harm OCD

As with other forms of OCD, it is important that the sufferer seek treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) specifically for the treatment of OCD. The primary CBT technique used in treating Harm OCD is the same as that used in treating other types of OCD, and is called Exposure and Response Prevention (ERP). Unfortunately, many individuals with harming obsessions seek out traditional talk therapy or psychodynamic therapy, both of which can swiftly worsen a Harm OCD sufferer’s condition by encouraging them to further examine these meaningless thoughts, which only serves to unnecessarily inflate their importance.

OK, that is all for today.  If you'd like to learn more, please visit the blog website of the OCD Center of Los Angeles:

http://www.ocdla.com/blog/harm-ocd-1-1488

Who is King Kong?

Mom's Thoughts:

There is an explanation as to the name of this blog - King Kong's Bitches.  It sounds harsh, but it is a way for us to get through CBT:

According to Dr. John March's very helpful book, Talking Back to OCD, it helps a child to better understand that OCD is something outside of his or herself if the child can give OCD a funny name.  Then she can use the name when talking about how she feels, "Oh, (silly name) is bothering me again today."  Dr. March says sometimes teenagers don't feel comfortable using a funny name and just prefer to call it "OCD."  I wasn't sure how Elizabeth would react to this suggestion when I told her about it early on.  

However, when I mentioned giving OCD a silly name, she immediately said, "King Kong."  No hesitation on her part.  I was not too excited about it.  I had already come up with a bunch of other ideas, and (of course) felt pretty sure I was more on the right track.   "Are you sure?  Dr. March said to be careful not to choose a name that makes it seem scary or anything."  "Yep, King Kong," she replied.  "OK... King Kong it is." 

At first, it was very strange referring to OCD as King Kong all the time - I felt downright stupid at times.  But that really is the point, I think.  After all, the idea is not only to depersonalize OCD, it's also to reduce its power.  I thought calling it King Kong would make it seem too big, unbeatable - but it really had the opposite effect, I think.  Probably because we felt silly saying it.  "Is King Kong bothering you?" is kind of a weird thing to say.

The next steps from Dr. March's book after naming King Kong involved "mapping" her OCD symptoms - identifying exactly what her obsessive thoughts were and the compulsions that those thoughts caused her to do.  One easy example - Obsession:  My hands are dirty after I touch my belt/use the bathroom/use a keyboard because those surfaces have germs.  Compulsion:  Wash hands 3 times in a row.  More often if at school where soap is suspect. There are several other symptoms that fit in different categories.  Elizabeth sort of enjoyed listing them, but it was also a little stressful thinking of them all.  She got through it well. 

She then assigned each of the symptoms with a number from 1-10... a "fear thermometer."  1-2 is something that isn't as much of a big deal for her, and 8-10 are things that are very hard - very hard to resist doing the compulsion, or cause her a great deal of anxiety.  For a couple of weeks, she tried to resist the ones with very low fear temperatures to see how she did, and she did pretty well.  Some days were harder than others, and she tried too hard to resist things that had a 5-10 fear temperature, which didn't work very well and sometimes put her into a panic attack.  In order to be successful, according to Dr. March, she must work only on things with a fear temperature of 3 or lower.  Once she's got that down and she's stronger and motivated by her successes, other obsessive symptoms will get easier to tackle.  It's not a good idea to go too fast through the steps, because she will get too discouraged and may be so anxious she can't work on anything.  This has happened to her because she thinks she should be able to do it really fast, in a sort of "I should be able to make an A+ at this if I just put my mind to it" kind of way.  Hmm... I can understand that thinking, but it's a trap!

Finally, she needed to come up with a visual - a tangible way to see what her "map" was, and how much progress she makes once she began EX/RP in earnest - that is "Exposure/Response Prevention."  Her homework each day is to allow herself to be exposed to something uncomfortable related to an obsession (like touching a "dirty" object,) and resisting the compulsion (like only washing her hands one time instead of 3.)  Sometimes she has to break these things down into even smaller components of the OCD issue.  For example, it's too hard for her to only wash her hands once at school since she doesn't think the soap is good, so she tries to only wash 2 times (in a row.)  But she's pretty good at washing only once at home after going to the bathroom, which is still pretty hard but not undo-able. 

We went to Joanne's to get some supplies to make a board - kind of like a game board - where she could map her progress.  She picked out a white board/corkboard combo and some magnets to move her pieces around.  Then, she saw stickers - princess stickers.  Lots of them in a big package, on sale!  "Mom, do you think I could make OCD things princesses?  And they could be trying to get to the castle?  What do you think?"  I think it sounds awesome.

When we got home, we realized that the princesses actually corresponded very nicely with her various OCD issues - Cinderella is "cleaning," Ariel is "washing," Snow White is "violent images," Belle is "organizing school stuff/checking," and so on.  It worked out perfectly!  Once she got her path to the castle set up and the princess stickers on the magnets, the princesses were ready to go!  Any princess not ready to move toward the castle (because the fear thermometer is too high,) stays behind the line like a game board piece that hasn't gone across the starting line yet. 

"Interesting," Elizabeth said, "it's like the princesses are sort of parts of King Kong, like they work for him or something." 

"They are just King Kong's bitches," I said.  And we laughed and laughed.  It is working... now they are truly outside her, and even sillier than before.  Any given day, we can laugh at them, get excited at their progress... or just reduce them to the stupid mean girls who are just trying to take Elizabeth down and make her sad so we can fight them. 

Dr. John March's book, Talking Back to OCD, available online:  

 

Do I have OCD, or do I just like to clean? What is OCD?

Mom's Thoughts:

Like a lot of people, I've used the acronym OCD flippantly to describe myself before, "Oh, I'm a little OCD about this," even though I do not have OCD.  I have misused other such references, "Oh, I'm so ADD today, I can't keep my mind on what I'm doing!" when I don't have ADHD at all, I'm just being a flake or am overextended.

I guess we all have some obsessive or compulsive tendencies - maybe we call them "pet peeves." One of my pet peeves is dirty baseboards - something I attribute to my dad.  He always had us kids cleaning the baseboards, something I thought of as a huge waste of time when I was young, but now do it almost every time I am talking on the phone because it's an easy, mindless task and makes me feel productive.  Some may call that compulsive; I just like my baseboards clean.

But to say, "Oh, I'm a little OCD too - I keep my house (office, car, etc.) very clean and organized.  It's not that big of a deal,"  shows a great ignorance of the disorder and the amount of pain and suffering it causes its victims.  Yes, my hand is up too; until a couple of months ago I didn't know anything about it really either.  I just saw a video of Howie Mandel (love that guy!) in an interview with Larry King (not so much love for that guy!) that illustrates perfectly to me the pervasive ignorance in society about OCD and mental illness in general.  If you don't already know, Howie Mandel is a very open sufferer of OCD, and that was the topic of this portion of his interview with Larry:

So that begs the question, "What is OCD?"  Is it, as Larry King suggests, simply liking a certain amount of order in your medicine cabinet or in your home?  A disclaimer:  I am not a doctor or a psychologist!  I haven't even stayed in a Holiday Inn Express!  (OK, corny commercial reference.) But I have done a lot of research lately and have compiled a quick (i.e. not complete) answer that hopefully gives a pretty good summary.  The following paragraph is quoted from a very helpful website called HelpGuide.org:

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free.
Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular thought or urge. For example, you may check the stove twenty times to make sure it’s really turned off, wash your hands until they’re scrubbed raw, or drive around for hours to make sure that the bump you heard while driving wasn’t a person you ran over. 

OCD signs and symptoms: Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

• Fear of being contaminated by germs or dirt or contaminating others.
• Fear of causing harm to yourself or others.
• Intrusive sexually explicit or violent thoughts and images.
• Excessive focus on religious or moral ideas.
• Fear of losing or not having things you might need.
• Order and symmetry: the idea that everything must line up “just right.”
• Superstitions; excessive attention to something considered lucky or unlucky.

OCD signs and symptoms: Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

• Excessive double-checking of things, such as locks, appliances, and switches.
• Repeatedly checking in on loved ones to make sure they’re safe.
• Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
• Spending a lot of time washing or cleaning.
• Ordering or arranging things “just so.”
• Praying excessively or engaging in rituals triggered by religious fear.
• Accumulating “junk” such as old newspapers or empty food containers.  

Me again:
So you can see, OCD isn't simply about being super clean (a common misconception) or being a "washer/cleaner" (the most well-known type of OCD.)  Many of those who suffer from OCD have more than one "type" - they may be a washer and a checker, for example.  A much lesser-known type of OCD that Elizabeth also suffers from (in addition to being a washer/cleaner & a checker,) she also has harm/aggressive obsessions, where distressing, violent images intrude upon her mind suddenly and repetitively at random times.  At times, they are so vivid and convincing to her, they seem like memories - like what she's "seeing" has actually happened.  (Imagine you think your car has just been hit by a semi and your sisters are dead next to you.  Sound distressing to you?  Yep, does to me too.)  They are so disturbing to her, they can set off a panic attack very quickly.  She's never experienced anything traumatic in her life - at least, nothing more traumatic than not getting picked for the team or making a bad grade on a test or running out of Fruit Roll Ups or whatever.  So where do these thoughts/images come from?  No one knows. 

These thoughts and compulsions can begin to intrude so much on your life that you can't function normally - you can't concentrate enough to work or study because of intrusive thoughts; you are constantly late because you have to complete your compulsions before you can leave the house, and it can take longer and longer to do that as your OCD worsens; you have chronic skin problems and/or are embarrassed in public situations due to your excessive hand-washing or checking rituals; you have difficulty sleeping or relaxing because of OCD.  OCD is a serious mental illness that arises out of anxiety, and can actually worsen anxiety issues. 

If you or someone you love suffers from OCD, you know that it is not a fun thing to have.  It often accompanies other problems as well, such as generalized anxiety disorder, panic disorder, social anxiety, and depression.  Diagnosing what you have and getting proper treatment can be tricky.   BUT from everything I've read, OCD is treatable!  Many people find relief with the proper medication.  Medicating oneself (and especially one's child!) is controversial, and I don't want to start a debate - everyone has to decide what is best for him- or herself.  For Elizabeth, medication to reduce her anxiety has been critical although not a complete fix.  We tried modifying her diet, relaxation and visualization techniques, yoga and exercise, but in the end she needed medication to find any relief whatsoever.  But there is no "magic pill" (darn it!!)  Research shows that cognitive behavior therapy (CBT) works very well to reduce and possibly eliminate symptoms.  I will post more about that and what Elizabeth has been doing in a later blog.  In the meantime, read up on what you can do to help yourself or your loved one, and find a good psychologist that specializes in anxiety and OCD if you don't already have one.

And if you have anything that has worked for you, please share it!  I am just beginning to learn about these things.  I want to open up discussion for everyone suffering - evil things whither in the light!  Let's bring it out in the open, into the light, and begin healing!

The Handwashing Curse

Elizabeth's Thoughts:

I like feeling clean. Like really clean. The feeling of a thick layer of soap on my hands, sprouting little clear bubbles is the best feeling in the world. ...But I know it shouldn't be. But it is and I want to change that.

In the last week I have decided I will only wash my hands once whenever I choose to wash them. Normal people are perfectly happy and healthy even though they only lather once, so I'm not going to blow up if I don't. So after much talking to myself on the topic I washed my hands once and turned off the water! It was terrible. I felt itchy and tingly - Bleh!!! I was dying to fling the handle of the sink up and scrub my hands a second or third time, but I thought about it and sat on my hands. "No! I am not going to submit! Even if it will kill me! I shall explode!!" And 30 minutes went by and I didn't explode. I didn't even start coughing blood or laying on the floor slowly dying. I was fine! :) YAY!!!

Skip ahead three days and I'm still not deathly ill, although King Kong tries to tell me so. I have only washed once (per time I want or need to wash) every time! (Ok, not entirely true. I have washed my hands twice about once a day... but hey, I'm not perfect.)

As I am doing a victory dance about my house tonight singing that I am punching King Kong in the face, I am silently worrying inside. "How much longer can I keep this up?" "It's been a long weekend and you've been home where there is good soap. What will happen when you go back to school? They have crappy soap! I always wash three more times than usual at school!" These thoughts make me want to burst out crying. I feel so helpless and dumb at the same time. This is so hard and nobody understands. They think that girl that's always in the bathroom after third and fifth period is a freak that always washes five times. What loser! Why would somebody be so stupid to do that??? I don't know what I should do...

Tomorrow will be the ultimate test of strength, will-power and endurance. So I will prepare myself to face it! I will just imagine an entire army of people behind me cheering me on not to do what King Kong screams at me to do.

So, yeah. If anybody else has this "handwashing curse" I totally get you. Right now I am looking at my bright red, cracked and bleeding hands. It really hurts to move them, but I'm used to it. Lotion doesn't work and I don't like to put it on because it makes me feel like I am some how weaker than other people. I know that is totally not true, but I can't get it out of my head. I've never told my mom this, but after a week of using a lotion I would just wash my hands after she checked to make sure I had it on. I was at rock bottom. I feel alone and weird. That's why I always wear long-sleeved shirts! I am so embarrassed, but I want to be better and be done with this crap. For good.

 

Let the Bird Fly Over Your Head...

Mom's Thoughts:

 We went to see Elizabeth's medical doctor (Dr. G) yesterday at a follow-up visit after he increased her dosage of Paxil to the max - 60mg.  During our visit, I told him that the psychologist had not started CBT (Cognitive Behavior Therapy) and had actually sort of pushed the notion aside when I mentioned it to her.  She also told me to ask Dr. G about prescribing Xanax or something like it to help her through the anxious days.  I was uncomfortable about it, particularly after reading more about Xanax on the web.  But I will admit, it is tempting on the days when she is suffering so much with her OCD and anxiety - a mom just wants to make it all better, right now!

Much to my relief, Dr. G told Elizabeth, "You would like Xanax, really like it.  You'd like it too much.  It is highly addictive and would start you on a slippery slope.  I don't think it's a good idea to start you on a benzodiazepine (Xanax, Valium are some.)  They are a quick fix, but we are looking for a long-term fix."

Dr. G and I agreed that perhaps her psychologist was not the right person for the job.  He gave me a referral to a psychiatrist that he sends his son to for ADHD.  He said, "We need to get someone to pick you apart and find out what all is in there and how to treat you best."  There are also psychotherapists in that practice, so we can get her a team that can really get to the bottom of things.  I hope and pray!!  It's time for someone other than me to help her with CBT.  We have been working on it together with the help of Dr. John March's book, Talking Back to OCD.  (Here's a link to the book on Amazon:  http://www.amazon.com/Talking-Back-OCD-Program-Parents/dp/1593853556)  It has been great, but I think we need reinforcements. 

Two websites I've found helpful:

1.  Steve Seay's blog:  http://www.steveseay.com/

 Dr. Seay is a psychologist in Palm Beach who has some great information about all kinds of OCD on his blog where you can post questions that he and others will answer.  He talks about things in a very easy-to-understand way. 

Among other things, I found some very helpful information on Dr. Seay's blog about Aggressive OCD - a fear of hurting or killing someone, something Elizabeth suffers from among other types.  It was such a relief to see that not only is it common, those who have it are typically very kind, caring, super moral people, which Elizabeth is.  She would never hurt a fly!  So she is sooo distressed about those thoughts and images, they kick her into a full-on panic attack.  Now that we know they are put into her head by OCD, it has helped some, but not much.  We need more help for her to be able to get those thoughts out of her head. 

2.  Shannon Shy's Facebook page - Shannon is an ex-Marine who also suffers from OCD:

http://www.facebook.com/pages/Shannon-Shy-OCD-Can-Be-Defeated-Im-Living-Proof/

He posts motivational comments and quotes each day and gives others with OCD a place to learn, comment, etc.  He and a reader had a conversation about how to beat OCD by not feeding it - ignoring it...  Shannon says, "allow the thought; don't resist it.  I didn't care whether I had the thought or not."  His reader's reply was something that really stuck with me... "Let the bird fly over your head..."

I love that... Let the bird fly over your head.  We can beat this!!  Don't feed King Kong! 

Things that get me through the day...

Elizabeth's Thoughts:

Most days OCD catches me at school. I'm completely ready for it, but still it successfully sneaks up on me day after day. This pattern started just two or three months ago; I had been fine at school before...

What's happening to me?

I ask myself this everyday, but it does more harm than good. So, since the past few weeks have been awful "King Kong-wise". ← I call OCD King Kong. I thought this was a dumb idea at first, but giving OCD a silly name really helped me. (WAY more than I thought it would) It makes me feel like it's something unrelated to me. Even though I know it's a disease, I always felt like it was me or my fault. That is not good to think at all because I can't blame myself for it, that's like a person with cancer  just saying "Oh well, I just suck so bad I gave myself cancer." Totally untrue. Now King Kong is just some big, dumb monkey that I can yell at for making me feel like I'm going mental.

Anyway, so in really hard days or times when I'm with friends I love, but suddenly feel the shiver down my back that alerts me King Kong is trying to make me freak out in front of everyone, I read these phrases and say them three times.

* Impossible just tells you I'm possible.

Seriously. *Smack* Take that King Kong!

If OCD is stupid enough to try and keep me anxious, I think:

* Everyday may not be good, but there is something good in everyday. :)

Although they're cheesy Instagram-type phrases, it does pretty good at making me believe in my ability to push OCD out of the way. (Now it does always work, but it's worth a shot!) I write lots of sayings like this in my school agenda, on my phone, and on stickie notes I put on the walls in my closet (which is where I go to cry when I freak out). They give me confidence and a glimmer of hope in the darkness of my mind right now.

As I still struggle day to day with King Kong, I'm trying to stay happy. I try to remember that worrying all day about anything is stupid, I have lots of friends that care about me and a family that will do anything for me. Every night I count my blessings (roof? - check! food? - check! bed? - check! sister? - check!) and pray to God, it helps organize the positive things in my life rather than the negatives. I love it! :)

So no matter what I just have to remember that I will win. Sooner or later. No question! Until then I have to keep smiling and acting like he's going away until he does.

Every day is a challenge...

Mom's Thoughts:

The last few days have been rough for my poor child, so it's been tough for me to find time to blog.  Today seems to be better - she didn't come off the bus and dissolve into a panic attack, and said the day was pretty good.  Still not great, but pretty good.  So I'm happy.  Last night she was able to get through her tennis lesson, get her shower and finish all her homework; I'm hoping for the same tonight. 

This week, I'm not sure how much of it is OCD that bothers her or how much is symptoms of general anxiety and panic disorder.  We have yet to have a "real" diagnosis to hold on to.  This is something I'm going to address with her therapist next week. Last week, I asked about CBT and she her answer was "Well, when you've been thinking a certain way your entire life, it can be really hard to just change it."  What the heck does that mean?  From everything I've read, isn't that what we need to start working on?  Isn't that how you combat anxiety and OCD?  I've got to press her on that issue next week.

After just 3 sessions, I'm not 100% sure the therapist is the right person for the job.  We'll see.  We are going to the GP tomorrow to discuss medications again.  She's been taking 60mg of Paxil for almost 2 weeks now, and has been on Paxil for 2 months.  So far it seems to take the edge off sometimes, but doesn't work as well as it needs to.  This is a bit exhausting, all this back and forth between doctors and medications, with seemingly little progress.  I've got an appointment with a psychologist for her, but the earliest we could get in is April - almost 3 months away.  Sigh.