I'm drained. My anxiety is at an all-time high. I've only been getting about 4 hours of sleep each night. I feel awful. I practice therapy, but I'm not getting better. The results aren't happening.

:( I remember your OCD is a little more complicated and meta than is typical, do you think it's possible your therapist might not be understanding well enough to give you the best exposures? I know you've asked here for instructions about what the proper ERP to do is, so I hadn't realised you were in therapy, I actually think seeing a specialist could really help you. It's normal for therapy to increase anxiety and triggers but not really normal to have no improvement after years, let alone it getting worse. That really makes me think the methods you're using might not be suitable somehow. OCD is treated the same ways for all of us so you should take comfort that you're not a uniquely unsolvable case or unresponsive brain, there definitely is a way through it, you just have to figure out what that is. And I really think that's best done with a specialist OCD therapist and being open to their suggestions, even if it hasn't seemed to work before. If you can help them to understand the layers, I would think they can come up with something effective for your treatment plan. Honestly the best rule I can think of to work through treating it layer by layer is to do always just the opposite of what your OCD suggests you ought to do, and avoiding compulsions. So with that one where you get the thought that you should leave detergent on your clothes in order to do ERP, you should not leave the detergent on your clothes and not do checking compulsions about whether you did it or not, even though it worries you that maybe you should have done it. That worrying and ruminating is a big mental compulsion which needs to be addressed too and actually I suspect there is more of that mental element at the core. A lot of time we can think we are treating our OCD but we have still been doing the thoughts, or imagining doing the compulsions (and imagining doing the compulsion is almost as bad as doing the compulsion). It seems like it's key that you're doing ERP when you aren't feeling a desperation that you need to. It's very meta but I would guess that the need to do ERP inappropriately because you feel like it might help you and is the right thing to do is rooted in moral scrupulosity or health OCD, so it might be worth checking out some resources on those. I'm actually curious about what initial OCD(s) you started with or which kicked this off. Do you have other existing OCDs which aren't related to the urges to do ERP? For example POCD, HOCD, ROCD or harm or contamination OCD or over-responsibility etc? As hopefully you should also be able to treat those by doing regular ERP for them. If you have the same obsessive urges to treat those as you get to treat the inappropriate things, perhaps you can decide to only do ERP for those on a fixed daily schedule, so that whether you do it or not isn't dictated by whether you have an urge to do it.

The OCD is just spiraling into layers on top of layers. It's become meta and I feel like I've lost my mind.

Hi, I know it's hard and I'm sorry this is happening to you. When my OCD get worse I repeat to myself that it's all in my head and I try to do other things, for example I feel very useful talking to my friends or to my parents. Remember that you're strong and therapy will be successful.

I really want to show your message to my therapist. It's odd that sufferers get it more than therapists seem to get it. Or actually, it's not that odd. Makes more sense considering we live with the disorder. But yeah, you hit the nail on the head with what I'm struggling with. In this past I've struggled with various themes, perfectionism, checking, skin picking, violent obsessions, etc. Usually, my OCD stays mainly focused on one or two issues at a time. It has shifted a lot in the past. However, this current theme around therapy has been going on for years. I know the content doesn't matter & at the same time my brain feels on fire with this theme. I'd say it's the worst bit of OCD I've been through. Something about the risk of not recovering correctly has OCD on a rampage. I have a map of how the layers are presenting themselves & would share with you, but I don't think we can do attachments on here. Anyway, thanks for getting it. I'm going to keep trying to explain to my therapist about what's happening and hope they get it. I'm just ready to get some relief from this.