Dr. Schubiner's Blog The relationship between OCD and MBS: Jacob's story

Originally written by Dr. Schubiner on August 28, 2009

I have learned so many things about the mind and the body over the past 5 years of working with patients with Mind Body syndrome.One of the most interesting things is that disorders that we considered psychological, such as anxiety, depression, PTSD (post-traumatic stress disorder), and OCD (obsessive-compulsive disorder) actually are similar to (dare I say identical to?) Mind Body syndrome.In other words, these disorders are caused by patterns of neurological response to stress and emotional reactions to stressful situations.This leads to two conclusions: 1) that psychological disorders such as these occur as part of MBS and typically are exchanged (substituted) with pain and other typical MBS symptoms and 2) we can treat these disorders effectively using the same methods as we use for MBS.

Read the story of Jacob, who had OCD, which morphed into chronic pain.He learned that he had to deal with the OCD and the pain, but that they were connected by being components of Mind Body syndrome.

“About 10 years ago I had back pain for 2-3 years and read Dr Sarno’s book and also had a MRI which showed no problems and my back pain went away. A couple years ago when having my second child I started getting high anxiety and really bad obsessive-compulsive disorder (OCD) about things like locking doors, chemicals around house and just about anything else. Then about a year ago, I had surgery, and the pain after surgery started going away but lingered and then after taking numerous tests and seeing specialists and searching the internet about why the pain was not going away it started getting worse and worse. Soon I was taking Vicodin for pain and searching for any cure I could find. I even tried a pain clinic and had a nerve block which did not work and even made my back hurt for a few weeks (the doctor warned me that it was a possible side effect). I was getting pretty desperate and depressed. The pain was nearly unbearable. I was taking sleeping pills at night to sleep and pain killers during the day.

I saw Dr Schubiner during the middle of this and he tried to help me realize that the pain was caused by MBS and there was no physical problem. However, I don’t think I really believed what he was saying.I called him many many times desperately in pain. One thing was weird and amazing:when I was in really bad pain my OCD would subside, and then when the pain was a little better, the OCD would ramp back up. I tried reading Dr. Sarno’s books and writing 1-2 hours every day. Some days it seemed to work, other days it didn’t.

I knew in the back of my mind that the pain was mostly mental, but it as so severe that it controlled me and my thoughts. One day I was in my garage and I came to the realization that the pain had to be mental and I suddenly felt really confident.The next day I woke up feeling a lot better. But a couple of days later, the pain was back with a vengeance.However, whenever I was able to be confident that I knew what was causing my pain (MBS), it would subside.This happened a number of times, but I would always seem to slip back into pain.

Once when researching pain online (I do this much more often than I should), I stumbled across information about movements that can cause a hernia, which can cause pain in the lower abdominal area (my area of pain). One of the things mentioned was lifting a heavy weight. Well, that has become a big stumbling block in my recovery, as I would feel a little better and then I would lift something and sure enough I would start feeling more pain. The pain wouldn’t necessarily occur right away, but it would start in a day or two, as I obsessed about it and got mad at myself for lifting whatever it was.

I do feel better now. I have a much better understanding of how my mind creates pain and how my obsessive thoughts are a big part of this problem.I still have some pain every day. It’s usually minor compared to what it was, but there is still some pain. Every couple weeks it will get worse, usually after I obsess about lifting something. But it gets better after a couple days. Generally what’s worse than the ongoing pain is the fear in lifting anything over 15-20 pounds. I know deep down that it is silly but the bombardment of thoughts about it is not worth putting my self through it. Fortunately for me, my job does not require any lifting and I have become a pro at leaving the room to go to the bathroom when something heavy needs picked up. I am definitely not cured but am holding on to the progress I have made.

There are two things that I think are definitely true. The pain definitely takes my mind off of the obsessive thoughts/fears.The second thing is that no one can help you but yourself. It has to come from you. I kept trying to look to somebody for an answer. I think I started feeling better when I forced myself thru the agony to make it thru a day without taking any pain pills. I always worried what if I would take the maximum amount of pain pills and still couldn’t make it through the day.And I also worried that I would never start feeling better.I do believe that when I was able to stop fearing the pain even a little (I still fear it to some degree as I was hesitant to even write this), that helped me feel better. Now I just take a pain pill when it is really bad, but I know it will feel better in a couple days.

I am trying to take it day by day and not worry about tomorrow. If I have some pain, I try not to worry about “what if it doesn’t go away.” It is tough, but today I’m definitely better than I was a year ago. The pain is sometimes better and sometimes worse, but it’s not near as bad as it was. It’s the same with the OCD, sometimes better and sometimes worse, but again, it’s definitely not as bad as it was. Unfortunately, I’m still terrified of lifting anything that might cause a hernia, but usually those thoughts go away after awhile.But I can live with that.”

I am very impressed with Jacob’s story as it shows how difficult it can be to conquer MBS, especially when it is complicated by severe anxiety, in this case in the form of obsessive-compulsive disorder.Jacob taught me that physical symptoms (typically pain) and psychological symptoms (typically anxiety or depression) are frequently exchanged for each other.I have seen innumerable examples of symptom substitution over the years; pain moves from place to place, ringing in the ears replaces pain, pain replaces anxiety, insomnia replaces pain, diarrhea or constipation replaces OCD, depression replaces pain, fatigue replaces urinary symptoms.Jacob had to cope with both pain and OCD; and as one improved the other one worsened.It took great courage for him to face both of these symptoms at the same time in order to begin his recovery.His story also teaches us that recovery isn’t always quick and immediate; it is often a prolonged and rocky journey.Jacob isn’t totally free of pain or of OCD, but he understands himself better and has made tremendous strides in alleviating both of his MBS symptoms.And, while he continues to work towards freedom, he can enjoy his life.


To your health,

Howard Schubiner, MD