Hush Little Girl by Lisa Regan (first e reader .txt) 📗

behaviors, and it tries to help you change them. It proposes strategies and coping mechanisms to meet those behaviors exactly as they are in your life.”

“Was Lorelei good at it?”

“I don’t know,” Paige answered. “We lost touch after the PhD program. I had been splitting my time between Philadelphia and here while I completed the program. Lana and my husband were here in Denton—this is where we lived—so once I got my PhD, I came back permanently. Lorelei stayed in Philadelphia. I’m surprised to learn she’s even here. I thought she’d be working for a large hospital by now, maybe teaching, speaking at conferences. She was very ambitious.”

“Her license was revoked twenty years ago,” Josie said.

“Oh my. Do you know what for?”

“I haven’t found out yet. What can you tell me about Emily?”

Paige glanced down at her notes. “It sounds like she has obsessive-compulsive disorder. I’m no expert, but the counting, the hoarding, the meltdown—those are pretty classic signs.”

“What do you mean?”

Paige closed her laptop. “People think of OCD as this disorder in which the person who has it is simply excessively clean, or that they insist on symmetry, right? Someone will say, ‘oh, I have to straighten that painting out because it’s bothering my OCD,’ or ‘I keep my house so clean because I have OCD.’”

“I’ve heard people say things like that, yes,” Josie agreed.

“OCD has nothing whatsoever to do with cleanliness.”

“Really?”

“Really. It’s about certainty. A person with OCD usually has some form of intrusive thoughts or obsessions. Typically, they don’t make sense. For example, if I don’t step on my bathroom floor tiles in a certain order every time I’m in there, my friend might die. Or if I don’t repeat the same phrase fifty-two times in my head, then my house might burn down. OCD is illogical that way, but the main thing to understand is that the obsessive thought will cause the person anxiety. In terms of the examples I just talked about, you would not want your friend to die or your house to burn down, right?”

“Right.”

“So you have to do something to relieve that anxiety you’re feeling. That’s where the compulsion comes in.”

Josie said, “The compulsion is stepping on the tiles in a certain order or repeating the phrase.”

“Yes! Exactly. If you believe that stepping on your bathroom tiles in a certain order is going to prevent your friend’s death, then doing that is going to relieve the anxiety you have which comes from worrying about your friend dying. The problem is that even if you step on those tiles in the perfect order, there’s always this little voice in your head that is nagging and asking, ‘Are you sure you stepped on those tiles in the right order?’”

“It makes you go back and do it again and again,” Josie said. “Because the more your mind asks the question, the more uncertain you become.”

“Precisely. So you keep carrying out the compulsion. It’s all very ritualistic, and it takes so many different forms. It sounds like Emily has some intrusive thoughts and compulsions surrounding counting and hoarding. The problem is that no matter how many times a person with OCD carries out their compulsion, that anxiety is never going to go away because it’s based on distorted thinking. That’s why trying to reason with them or talk them out of their thoughts or compulsions won’t work. Their brain is misfiring. Telling someone with OCD not to think obsessive thoughts or engage in the compulsive behaviors would be like telling a diabetic patient to produce more insulin.”

“You said hoarding,” Josie noted. “But she had five very random little objects. That hardly seems like hoarding.”

“Hoarding doesn’t always mean collecting hundreds or thousands of objects. What Emily was doing is a form of hoarding. Those objects are meaningless, aren’t they?” Paige argued. “Most people would think they were trash. In fact, obviously housekeeping thought they belonged in the garbage. Yet she was hoarding them—keeping them—because to get rid of them would cause too much anxiety and stress. This is the distorted thinking. The brain is misfiring. Those items took on some significance to Emily, making it very difficult for her to part with them. The voice in her head was likely saying something like, ‘if you throw that away, something bad will happen.’ It’s very nonsensical. That’s why cognitive behavioral therapy works so well to change the behaviors and thinking.”

“What about the meltdown?” Josie asked.

“OCD provokes a fight or flight response. While you or I might only have a fight or flight response to something like being assaulted, someone with OCD will have that response to something that seems very minor—like these objects being thrown away. Again, it’s the brain misfiring, telling her that losing those objects is a life-or-death situation when it’s not. Believe me, she can’t control it. Stress and trauma, like the kind she experienced in the last twenty-four hours, will always make the obsessive thoughts and compulsions worse. OCD can be difficult to manage in the best of circumstances, let alone after a traumatic event. To be honest, she was lucky that Lorelei was her mom. She would probably be much worse without Lorelei to—”

Paige broke off and looked at the floor. Lines creased her face. Neither of them needed to say it. Emily was now a lot worse off without Lorelei. Clearing her throat, Paige changed direction. “The trick with cognitive behavioral therapy and OCD is exactly what Emily told you: if you can tolerate those feelings, eventually they decrease and even go away. For example, if she was afraid to touch a railing, you’d make her touch it over and over again and just sit with the feelings until her brain righted itself and realized that touching that railing isn’t going to make something bad happen. The worst thing you can do is give in to the compulsions.”

“So I shouldn’t be digging through the dumpsters out back for a stone, sequin, feather, birthday candle and milk bottle cap?”

Paige smiled. “No, I would