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Summary
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A 25-year-old person says treatment has improved their Obsessive-compulsive disorder (OCD) but they still feel emotionally detached and unable to experience pleasure or affection naturally. They wonder whether this is related to OCD or medication.
The answer distinguishes difficulty identifying feelings from loss of pleasure and suggests that depression or anhedonia may be contributing, without establishing a diagnosis.
It recommends adding cognitive behavioral therapy with a skilled therapist to the existing treatment, rather than attempting to force emotional responses.
Question
Reader · Identity withheldDr. Schwartz, I’m 25 and found out two years ago that I’ve been OCD (to my knowledge) since my late teens. I have a lot of obsessions, almost no compulsions to balance, and for the longest time I shut myself away from everything.
\nFlash forward. I’m on Lexapro, it works well, and I’ve managed to get most everything I had back. Except my ability to feel. I used to think it was a separate issue, but recently read somewhere that lack of emotion is a symptom of OCD as well.
\nIt’s strange. I rarely smile or cry, and when I do, it’s not for genuine reasons. I try to make myself love, but it’s not the same when you do it because you think you should. I don’t remember what it feels like (except in dreams) but I remember enough to know it felt good and something good is missing. Just your opinion… OCD related or not?
\nMy doctor has said that it’s also a side effect of medication, but the disattachment is there regardless of if I’m on something or not. Are there recommended actions for this type of thing? I already know that trying to force it doesn’t work.
\nThanks.
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Answer
Allan Schwartz, Ph.D.I \"hear what you are saying.\" There are two important words that come to mind as I read your question. One of them is alexithymia and the other is anhedonia. Alexithymia refers to the inability to be aware of or able to describe one’s feelings. Anhedonia is the loss of feeling of pleasure and the withdrawal from pleasurable activities. I believe that you are experiencing anhedonia and here is why.
\nYou are already diagnosed with OCD. While OCD is an anxiety disorder it is also associated with feelings of depression. In other words I believe that you are depressed and have been for a long time, even before the OCD was diagnosed.
\nWhile it is true that Lexapro will help you with both depression and anxiety it is not enough. Your medication treatment should supplemented with psychotherapy, particularly Cognitive Behavioral Therapy. CBT is especially effective with OCD because it is used to block those thoughts. For those who also have compulsions, the behavioral part of therapy blocks the repetitive actions.
\nOne of the important features of depression and anxiety are the types of thoughts we give ourselves. Those thought are unrealistic, at least to a large degree. CBT helps people learn new, healthier and more realistic ways of thinking and, thus, do not lead down the road to anxiety and depression.
\nI want to urge you to see a therapist who is trained and skillful in the use of CBT in addition to continuing your Lexapro medication. In these ways you should be able to recapture your feelings again.
\nBest of Luck
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